Program Delivery Research Articles

A pre and post evaluation of the communication and interaction training programme for professionals in dementia care.

NICE guidelines advocate that healthcare professionals should aim to use non-pharmacological and person-centred approaches as primary strategies to reduce or prevent distress in people living with dementia who reside within care settings. However, despite these recommendations, recent studies have illustrated that there is still a requirement for healthcare professionals to have adequate opportunities to access training programmes and guidance on how to effectively use non-pharmacological approaches in dementia care settings. Communication and Interaction Training (CAIT) was developed to train healthcare professionals in dementia care on how to apply person-centred principles to effectively reduce or negate distress in people living with dementia in a non-invasive manner. This paper provides an overview of current debates regarding the use of non-pharmacological approaches in dementia care, as initial care strategies, to reduce the primary use of pharmacological interventions that may have deleterious side effects for people living with dementia. Furthermore, this paper provides a summary of an evaluation that assessed the extent to which a 2-day CAIT programme could enhance healthcare professionals in their perceived ability to communicate therapeutically with and provide care for people living with dementia. In this evaluation, 35 healthcare professionals in dementia care engaged with the 2-day CAIT programme. The Confidence in Dementia Scale, Knowledge in Dementia Scale and Compassionate Competence Scale were administered for participants to complete pre and post training. A series of parametric paired samples t-tests were completed, and the results indicated that the 2-day CAIT course was effective in enhancing healthcare professionals' perceived confidence, communication skills, sensitivity, and ability to meet the care needs of people living with dementia. However, staff' knowledge of dementia did not significantly increase following the CAIT course, which could be due to participants already having high levels of knowledge on dementia prior to training. These results indicated that engaging in CAIT could be beneficial in enhancing healthcare professionals' perceived ability to use therapeutic communication strategies in their interactions with people living with dementia. Discussion is provided on how the delivery of training programmes, such as CAIT, may assist in re-enforcing guidelines that advocate for the use of non-pharmacological and non-invasive approaches in dementia care.

Exploring the impact of professional development about family-centred service for health professionals working in paediatric disability: a scoping review.

To explore the impact of family-centred service education on the knowledge, attitudes, self-efficacy, and practice of service providers working in paediatric disability. The review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The search strategy was completed in seven electronic databases. Screening and data extraction was undertaken by two reviewers. Data extraction included content, delivery methods and impact of professional development programs. A narrative synthesis was conducted. Twenty-two studies reported on twenty programs. Participants were from multiple disciplines in 13 programs and families were involved in development, delivery, or as participants, in nine. Program content typically related to participatory caregiving. Synthesis of findings suggested the 'active ingredients' were dynamic interactions among the participants and facilitators, and the program content and delivery methods, that promoted reflection and shifting perspectives among participants. Studies reported positive impacts on service provider attributes, but few studies evaluated behaviours in practice and broader influences on family-centred services. While all programs involved active participation and relevant content, programs promoting reflection, sharing perspectives as part of a diverse group, and lived experience through family involvement, supported learning about family-centred services as both a philosophy and a process.

Factors associated with parental intentions to vaccinate 0-4-year-old children against COVID-19 in Canada: a cross-sectional study using the Childhood COVID-19 Immunization Coverage Survey (CCICS)

BackgroundThe objective of this study was to determine the factors associated with low or no parental intention to vaccinate children of 0-4-years in Canada with a COVID-19 vaccine through the 2022 Childhood COVID-19 Immunization Coverage Survey (CCICS). The CCICS was conducted prior to the introduction of a COVID-19 vaccine and a vaccine recommendation for this age group.MethodsSimple and multiple logistic regression models were used to determine associations between sociodemographic factors as well as knowledge, attitudes and beliefs and low/no intentions to vaccinate against COVID-19 among parents of children 0–4 years.ResultsFactors associated with low intentions to vaccinate children against COVID-19 included being male (aOR: 2.0; 95% CI: 2.0‒2.1) compared to female; being 30–39 (aOR 1.1; 95% CI: 1.1‒1.2) compared to 40+; being Black (aOR: 2.3, 95% CI: 2.2‒2.5), East/Southeast Asian (aOR: 3.6, 95% CI: 3.3‒3.8), or having multiple ethnicities (aOR: 1.3, 95% CI: 1.1‒1.6) compared to White European ethnicity; living in a rural (aOR: 2.0, 95% CI: 1.9‒2.1) compared to urban community; having a total 2021 household income of $60,000‒$79,999 CAD (aOR: 1.4, 95% CI: 1.3‒1.5) compared to $150,000 CAD and above; and trusting government bodies (aOR: 2.4; 95% CI: 1.1‒1.2), international bodies (aOR: 2.4; 95% CI: 2.2‒2.5), or media (aOR: 2.0, 95% CI: 1.9‒2.2) for information about COVID-19 vaccines compared to health care providers.ConclusionsThe findings of this study demonstrate that several sociodemographic factors and parental beliefs impact the decision to vaccinate children 0–4 years of age against COVID-19. Future research should focus on sociodemographic barriers to vaccination and how to most appropriately tailor the delivery of vaccination programs to specific groups, in an effort to narrow the gap between intentions and uptake of COVID-19 vaccination in younger children. As well, messaging should specifically be targeted to parents who have lower confidence in the COVID-19 vaccine and the government to provide correct information and build trust.

Will they come back? Evaluation of health student placements in remote and very remote regions of Australia

BackgroundDespite the benefits of rural placements in attracting healthcare professionals to rural areas, there remains a gap in understanding the specific impact of placements in remote and very remote areas of Australia, particularly within the unique context of the Kimberley region. There is a need to elucidate differences across geographical areas and contribute to the knowledge about the specifics of where and how student placement programs work. This research explored the impact of a remote placement program at Majarlin Kimberley Centre for Remote Health (‘Majarlin’) on educational outcomes and workforce intentions of participating students.MethodsThis research evaluated student placement data and post-placement surveys of allied health, dentistry, midwifery and nursing students who had completed remote placements in the Kimberley region between 2018 and 2024. Placement numbers and demographic data from 2018 to 2023 were descriptively analysed, while post-placement surveys collected between January 2023 and June 2024 were used to examine educational outcomes, placement satisfaction, and rural practice intention.ResultsBetween 2018 and 2023, Majarlin hosted 1111 students from 20 universities in remote and very remote regions, completing a total of 6068 weeks from 2018 to 2023. Post-placement surveys showed high levels of student satisfaction, with 96.2% also reporting improved clinical knowledge. Many students participated in voluntary positions in the community while completing their clinical placements, with 97.1% feeling that they had a positive impact on the community. All students reported that their cultural awareness and ability to engage with Aboriginal and Torres Strait Islander Peoples improved. Notably, intention to work in remote areas significantly increased post-placement (p < .001).ConclusionsThe results of this study demonstrated that the remote student placement program improved students’ self-rated clinical knowledge, cultural awareness, and community engagement skills. The program significantly influenced students’ intention to work in remote areas after graduation. These results can be used to inform the design and delivery of similar remote student placement programs which aim to improve the rural health workforce pipeline, paving the way for a more equitable and effective healthcare system across Australia.

Development and delivery of enhanced implementation support to disseminate a national caregiver skills training program

Abstract Background and Objectives As the population ages there is increasing need for caregiver training programs, but little is known about how to deliver implementation support for diverse sites in large-scale implementation efforts. External group-based implementation facilitation may be one promising approach. This study’s objective is to detail the development and delivery of a pragmatic implementation facilitation approach to support the national rollout of a caregiver training, Caregivers FIRST, at over 140 Veterans Health Administration (VHA) sites. Research Design and Methods Using administrative, survey and project data, we describe the process of developing and delivering enhanced support to 13 VHA sites unable to meet adoption benchmarks as part of a national mandate. Enhanced support consisted of 4 group-based calls delivered within a 12-week period that used tailored external facilitation to address barriers, facilitators, and strategies for program implementation. We present key implementation barriers, implementation strategies, and sites’ perceptions of highly valued elements of enhanced support. Results Enhanced support calls focused on 3 implementation barriers commonly identified by implementing staff (n=25) in a site-level needs assessment survey: recruiting and retaining caregivers (83%), balancing program delivery alongside competing demands (57%), and support from other departments in program delivery (44%). Sites attended a median of 3 out of 4 enhanced support calls. In post-implementation quantitative surveys, the average response of perceived helpfulness of enhanced support (ranging from 1 to 5) was 3.4 at 6 months, increasing to 4.2 at 12 months. Respondents valued collaborative problem-solving and the ability to learn best practices from other implementing sites during enhanced support calls. Discussion and Implications Describing the process of developing and delivering enhanced support via group-based external facilitation for Caregivers FIRST in VHA may provide useful information to guide similar efforts in other healthcare systems as they broadly disseminate interventions to support caregivers across diverse sites.

Mapping agents: A spatial economic analysis of agent location in the Federal Crop Insurance Program

AbstractCrop insurance is delivered to farmers and ranchers through a partnership among the Federal Crop Insurance Corporation (FCIC), part of the United States Department of Agriculture, and the crop insurance industry. The FCIC offers financial incentives, through reinsurance and subsidies, to private insurance companies for insurance contracts sold in accordance with the Standard Reinsurance Agreement (SRA). Crop insurance agents play an important role in the delivery of the federal crop insurance program, acting as intermediaries between farmers and crop insurance companies. Little is understood about the supply of crop insurance agents and the role of government policy in the provision of agent services, particularly after the 2010 SRA. We model the equilibrium supply of crop insurance agents to derive testable hypotheses about the factors that influence agent concentration across space. We evaluate our model using spatial econometric techniques and a novel dataset of crop insurance agent locations by county. Generally, forces that raise agent compensation, including the degree of competition among insurance companies, are shown to increase the local supply of agents. Results vary by government‐defined reinsurance regions. Notably, historical average premium rates, which both reflect actuarial risk and influence farmer insurance demand, are negatively related to agent competition in the low‐risk Group 1 states, which contributes over 40% of insured liabilities. These factors produce spatial spillovers, suggesting the presence of agglomeration effects in the market for agent services. Proposed changes to the SRA should consider impacts on the regional distribution and local supply of agents.

Cognitive outcomes of the at-home brain balance program

Accessibility to developmental interventions for children and adolescents could be increased through virtual, at-home delivery of training programs. Virtual childhood training programs and their effects on cognitive outcomes have not been well studied. To that end, this study examined the effects of the at-home Brain Balance® (BB) program on the cognitive task performance of children and adolescents with baseline developmental and attentional difficulties. The study included students with reported diagnosis of ADHD, autism, anxiety, sensory processing disorder, or dyslexia, and students with no reported diagnosis (aged 4–17 years). The at-home BB program is delivered through (1) a computer-based format utilizing multimodal program activities previously studied in-center (multisensory stimulation, gross motor, coordination, balance, and nutritional recommendations); and (2) the BB app (visual motor, auditory and visual processing, and rhythm and timing training) — creating a comprehensive program experience delivered remotely. Cognitive performance was measured by six cognitive tasks from Creyos Health before and after 3 months of participation in the at-home BB program (N = 316) or in-center BB program (N = 4,232), compared to controls. Results showed that overall cognitive assessment scores (including attention, response inhibition, and working memory) improved after participation in either the at-home or the in-center program, compared to controls. Importantly, significant improvements over the controls were observed for two tasks involving attention and inhibitory control, in both programs. Further, two analyses support that the effects on cognitive performance from either delivery format, in-center or at home, are comparable in magnitude. This research: (1) presents new findings demonstrating improved cognitive performance after completing the at-home BB program; (2) replicates previous findings of cognitive improvements after completing the BB program; and (3) suggests that the cognitive effects of virtual at-home BB training are similar to those observed for in-center BB training. Overall, the results demonstrate the effectiveness of the at-home BB program in improving cognitive functioning in pediatric populations with preexisting developmental and attentional difficulties. Virtual delivery and ease of use, provide at-home programs the potential to reduce barriers of access to much-needed developmental and cognitive support, for individuals who may otherwise lack access to high-quality, evidence-based developmental programs.

Ballet after breast cancer: A qualitative evaluation of a novel 16-week ballet intervention for women after breast cancer

ObjectivesOur evaluation of the pilot study- “Ballet after breast cancer”, demonstrated that a classical ballet program delivered online and/or face-to-face is feasible and acceptable, with promise for improving health and wellbeing following breast cancer. The present study aimed to explore participant experiences of the 16-week ballet intervention, and their perceptions of the future potential of ballet in the context of breast cancer. DesignQualitative analysis of focus group discussions. MethodsIntervention participants were invited to take part in online focus groups to discuss: Perceived changes resulting from ballet participation, content of the ballet classes, delivery of the ballet program, suitability of ballet for future implementation during/after active cancer treatment. Themes were generated using an inductive approach, and feedback/recommendations for future implementation of “Ballet after breast cancer” were summarised. ResultsSeventeen women previously treated for breast cancer (54.4 ​± ​11.9 years; 54.2 ​± ​43.5 months post-diagnosis) took part in one of three focus groups. Themes generated through discussion included: Embracing normal; Connection to others; Acceptance without judgement; Engagement; Learning and progress. Participants described perceived improvements in physical, psychosocial, and cognitive wellbeing, and identified some limitations of online attendance compared to face-to-face. The personal attributes and experience of the ballet instructor were identifed as key determinants of program engagement and enjoyment. Participants reported a preference for classes specifically for people with lived experience of breast cancer. Recommendations to improve future ballet programs during/after breast cancer treatment included: Hybrid delivery model; Opportunities to socialise with classmates; Access to additional learning resources. ConclusionsParticipants offered novel and valuable insight into their experiences of the “Ballet after breast cancer” program, providing guidance for future delivery of ballet across the cancer continuum.

Medical students’ perceptions of a community-engaged learning approach to community health in Ghana: the Students’ Community Engagement Programme (SCEP)

BackgroundRevitalizing primary health care requires that the health workforce, especially doctors, must appreciate the significance of the socio-cultural environment in health. To achieve this objective, training of medical students must emphasize greater understanding of the community and its role in health through community engagement using community-engaged learning. However, research on this learning method applied in a purely community engagement context is lacking. A medical school in Ghana adapted its fourth-year junior clerkship curriculum in Community Health to include a community-engagement programme. This study reports students’ perceptions of the said programme as a way of evaluating it and helping to improve upon its implementation.MethodsA cross-sectional survey using a Google form-based questionnaire with open- and closed-ended questions was conducted from May 2022 to December 2023 among 303 current and past medical students of the University of Health and Allied Sciences, Ghana who had experienced the said programme. Based on the first three levels of the Kirkpatrick’s four-level model of training evaluation, data was collected on participants’ socio-demographics, their assessment of the programme content and delivery, subsequent attitudinal changes and their application to practice. Descriptive statistics were performed on quantitative data and thematic content analysis done for responses to the open-ended questions.ResultsMore than half of participants were males (188/303). The mean (SD) participant age was 23.9 years (2.4). Over 90% indicated the programme was valuable to their training (277/297) and were satisfied with the facilitators (283/297) despite some anxieties expressed at the start of their clerkship. Participants noted that they acquired other skills including teamwork and leadership aside the reinforced academic content. At least 99% of participants noted they could conduct the processes of community entry and engagement with or without assistance.ConclusionAlthough there is room for improvement, the students’ community engagement programme may have some utility in the training of medical students to enable them better appreciate community interactions that influence health. Further research incorporating objective assessments of learning and behaviour change is needed to comprehensively assess the programme.

Exploring Information Needs and Educational Preferences of Individuals Referred to Cardiac Rehabilitation Before Program Start.

To explore information needs and educational preferences of individuals referred to cardiac rehabilitation (CR) before program start. This cross-sectional study was conducted from June 2023 to February 2024. Referred patients were contacted via email, which included a link to a website providing information about the CR program, and instructional videos. Data were collected through surveys that assessed health literacy levels, information needs (using the short version of the Information Needs in CR), frequently asked questions, delivery preferences, and engagement/satisfaction with educational resources. Throughout the study period, the CR center received 2571 referrals, of which 881 individuals were eligible for the study, and 467 (mean age 66.4±12.2years; 36% women) consented and completed questionnaires. Information needs were highest for CR and diagnosis/treatment and lowest for nutrition and risk factors. The study revealed significant differences in the perceived importance of information needs across various sociodemographic and clinical characteristics, including age (P =.01), educational level (P =.009), work status (P =.04), main reason for CR referral (P <.001), and health literacy (P =.02). Moreover, participants identified key areas of interest and concern related to their CR journey. These included inquiries about safe exercise initiation, pre-stress test instructions, and personalized exercise plans, among others. It was also observed that the majority of participants engaged with the educational materials provided and indicated high levels of satisfaction. This study revealed patient preferences regarding educational content, delivery format, and areas of interest/concern related to CR prior to program start, providing valuable insights for improving the delivery and effectiveness of such programs.

COVID-19 and social care screening for older adults in social housing: a CP@clinic adaptation

BackgroundCOVID-19 has changed healthcare access and delivery, especially impacting older adults. The Community Paramedicine at Clinic (CP@clinic) program is a chronic disease prevention, management, and health promotion program for community-dwelling low-income older adults. We investigated a telephone-based CP@clinic program adaptation during the pandemic.MethodsCommunity paramedics delivered CP@clinic via telephone to residents of 36 social housing buildings. They conducted screening for COVID-19, emergency preparedness, and social health factors. Community paramedics provided education on staying safe, self-isolating, self-monitoring, and preparing for pandemics using governmental infographics. Descriptive analysis was conducted on assessments completed between March and June 2020. Paramedic documentation was thematically analyzed to identify common themes.ResultsAll 191 participants had ≥ 1 telephone visit and 34.6% had ≥ 2 telephone visits, 82.8% were aged 65 years and older, 30.9% had internet access, and 57.9% had cable TV (limiting exposure to COVID-19 information). The CP@clinic program infrastructure provided a platform for paramedics to swiftly contact many vulnerable older adults to screen for COVID-19, educate on safe practices, and facilitate healthcare access. One-quarter of participants screened positive for social isolation. Thematic analysis described participants’ experiences adapting to daily life in the pandemic, emotional experience during the pandemic, and paramedics supporting participants during the pandemic.ConclusionsPublic health interventions are needed for low-income or hard-to-reach older adults, especially during pandemics. Community paramedics were able to support vulnerable older adults living in social housing through the unique CP@clinic adaptation. This innovative program delivery increased vulnerable populations’ access to public health services and information at a time of great health need.

Tilde, an interdisciplinary data access solution serving GeoNet’s volcano and other hazard data

Tilde is a new in-house developed solution that the GNS Science’s GeoNet program has recently developed to provide storage and access to low sample rate datasets used to monitor tsunami, landslides, and volcanoes in Aotearoa New Zealand. It includes datasets covering sample rates of 15 s or longer. Time series data are stored and disseminated in JSON and CSV formats, and users can access these through an application programming interface (API) and through graphical user interfaces (GUIs). Tilde’s GUIs were created to allow technical and non-technical users easy access to the available data. The introduction of the Tilde system as one of the GeoNet program delivery channels has represented a big step forward for GeoNet’s volcano data holdings by providing a single point to access all low to medium-sample rate volcano-specific monitoring data. We designed the system and developed a domain model, an API, a graphical data discovery interface, and associated data tutorials. This work leverages the open-by-default data policy for data generated through the GeoNet program. This paper is intended to highlight how we made many of the key decisions that shaped the Tilde system, how they were impacted by our multi-hazard monitoring requirements, and how they have improved access to volcano monitoring data. We conclude with some open questions about the need to develop common standards to share analysis-ready time series data within different disciplines in volcanology and geophysics.

Finding Solutions to Scaling Parenting Programs That Work: a Systems-Contextual Approach.

Prevention science has now encompassed decades of research exploring risk and protective factors and effective programs for the prevention and treatment of childhood behavioral, emotional, and developmental concerns. This paper shares our experience over the last 40years as program developers and researchers in responding to contemporary needs and finding solutions to barriers preventing access to evidence-based parenting support. We propose a systems-contextual approach to designing and implementing programs that meet families' needs and preferences and promote self-regulatory capacity across the lifespan. Key areas discussed are innovations to improve the reach of evidence-based parenting support (e.g., online program delivery, cultural adaptation, and tailored programs to engage vulnerable children and families), innovations to improve professional training outcomes (e.g., competency-based training, peer supervision and support, implementation support, and workforce development), and innovations to meet future needs (e.g., embracing new technology, standing by science, and considering global issues). It is incumbent on program developers, researchers, and clinicians to continue to evolve our practices and service systems in response to new evidence, societal changes, and technical advances to remain relevant and impactful in shifting prevalence rates of conduct problems and promoting child, family, and community well-being.

Indigenous Parents' Perspectives of Factors That Facilitate or Impede Engagement in Internet-Based Parenting Support Programs: Interpretive Description Study.

Parenting support programs enhance parents' health and their child's development. The COVID-19 pandemic necessitated the delivery of these programs over the internet. After the pandemic, internet-based programs are still preferred by some. We aimed to understand Indigenous parents' experiences engaging in internet-based parenting support programs; thus, an interpretive description study was conducted. A total of 20 Indigenous (female, male, and Two-Spirit) parents of children aged <5 years participated in semistructured interviews; data underwent collaborative thematic analysis with Indigenous community partners informed by the Two-Eyed Seeing framework and ethical space. Parents' experiences were classified into five themes: (1) Purpose: Program Delivery and Content, (2) Belonging: Building Relationships and Connections, (3) Hope: Cultural Connection, (4) Meaning: New or Improved Parenting Skills and Mental Wellness, and (5) Recommendations for Organizations. The study findings can inform internet-based parenting program delivery to enhance engagement for Indigenous families.

Workforce development in the trucking industry: A comprehensive analysis of truck driver training entities

The transformation of transportation technologies, economic structures, and social lifestyles is changing the truck-driving workforce. Recognizing the trends and challenges of the job is essential for proactive planning to address potential disruptions in the trucking industry and the broader economy. Despite the importance of truck drivers, the research community has little information about the entities involved in training truck drivers. These entities are critical in creating a pipeline of drivers to address the driver shortage issue and respond to the changing requirements of drivers. To address this knowledge gap, we utilize institutional theory as a framework to disentangle the factors that affect entities' considerations behind the design and delivery of driver training programs. Using explanatory sequential mixed methods, we collect and analyze multiple sources of data about driver training, including information about the entities providing training, as well as information about funding and federal regulations. In-depth interviews with these entities provide additional insights into the process of training drivers and how it varies between different types of training entities. Analytical results indicate that regulatory changes have impacted the number and types of entities providing driver training. A qualitative analysis of the interviews reveals different business models for training drivers, as well as the advantages and disadvantages of these models in terms of cost to the trainee, time to completion, and coordination costs. Finally, we discuss the implications of our findings for policymaking, including workforce development, transportation safety, and preparation for technological change.

Mental health professionals’ insights on developing and implementing a Mental Health Awareness and Destigmatisation program (MHAD) for adolescents

ABSTRACT This study examined mental health professionals’ insights on developing and implementing a Mental Health Awareness and Destigmatisation (MHAD) program for adolescents aged 14–18 years in Bangalore. Qualitative Interviews with 17 professionals revealed three main themes: 1. Awareness and Destigmatisation Programs: A Boon 2. Key Ingredients: Program Content and Delivery Style 3. Shaping Program Success: Key Drivers and Challenges. Professionals recommend interactive programs that promote open discussions and educate them on symptom recognition, online behavior, and healthy relationships. They identified key enablers and challenges, emphasizing the programs’ ability to empower adolescents, parents, and educators to create a supportive, stigma-free environment.

‘George’s Gymnastics Program’, a Community Gymnastic Program for Children with a Disability: Perceptions of Participant Stakeholders

Background: The aim of this study is to understand what children with a disability like and dislike about participating in a gymnastics program, and to understand the views of the adults supporting the program. Methods: Children with a mild intellectual disability (aged 5–12) from a primary school providing special education participated in one of four gymnastics programs (1 h/week for 5 weeks) at a gymnastics centre. The program included ~25–50 children per group, with ~20 adults providing support, including gymnastics coaches, teachers, and adult students on placement. To evaluate the program, children (11–12-year-olds; n = 51) were invited to complete a written two-page reflection, and the adults were invited to participate in one of three focus groups. Results: 150 children attended one of four programs. Twenty-six 11–12-year-olds participated in the evaluation (n = 26/51, 51%), and, from the written responses, the themes of ‘individual preference’ and ‘resilience’ emerged. It was found that 96% (n = 25/26) reported they would like to do more gymnastics, 88% (n = 23/26) reported positive feelings during gymnastics, and 65% (n = 17/26) expressed concerns such as feeling tired or hot. Twenty-three adults participated in a focus group. Key themes included the positive impact the program delivery had on the children’s participation; and the positive impact on coaches, students, and teacher’s disability attitudes and knowledge. Conclusions: This gymnastics program was well-liked by children with a disability. To optimise participation, promoting individual choice and control may be of benefit.

Key influencers of mass drug administration implementation and scale-up: a social network analysis of soil-transmitted helminth intervention platforms in Benin, India, and Malawi

IntroductionLarge community-based public health programs, like mass drug administration (MDA), require coordination across many stakeholders. We used social network analysis (SNA) to systematically identify the network of stakeholders who influence delivery of school-based and community-wide MDA for soil-transmitted helminths (STH) in Benin, India, and Malawi and determine how network dynamics may impact implementation and scale-up across these delivery platforms.MethodsThis study was embedded within the implementation science research of the DeWorm3 Project, a hybrid clinical trial in Benin, India, &amp;amp; Malawi testing the feasibility of STH transmission interruption via community-wide MDA. Sites developed lists of stakeholders engaged in both MDA programs and indicated stakeholders’ attitudes towards the intervention and influence over intervention delivery. We developed digital sociograms for both MDA networks by site, comparing baseline vs. endline. We descriptively compared changes over time in stakeholder attitudes and influence and key SNA measures, including centrality, centralization, and density.ResultsAcross sites, we identified an expansive network of stakeholders involved in delivery of school-based (N= 139, 63, 58 vs. N=139, 162, 63) and community-wide MDA programs (N=52, 137, 54 vs. N=54, 136, 60) at baseline vs. endline in Benin, India, and Malawi, respectively. At both timepoints, a majority (&amp;gt;70%) of stakeholders held positive attitudes towards both programs. For both programs, stakeholders with the highest degree centrality scores (i.e., the most connected individuals) were those responsible for implementation such as community drug distributors or school teachers, while those with the highest betweenness centrality scores (i.e. those who controlled resource or information flow across networks) were responsible for policy-making &amp;amp; program leadership (e.g., NTD Program Managers). Low density scores indicated networks had poor overall connectedness due to minimal connectivity across administrative levels, while low centralization scores reflected stable networks where no single individual exhibited high control over resource flow.ConclusionDuring stages of innovation, redesign, or scale-up, analyzing the network of policymakers and implementers provides an opportunity to optimize effectiveness and efficiency of public health programs. Study findings provide useful insight for NTD policymakers and implementers in STH-endemic countries aiming to successfully interrupt STH transmission by transitioning from school-based to community-wide MDA.

Audience Perceptions on Online Radio Platforms: A Case of University Students in Nyanza Region, Kenya

The purpose of this study was to examine audience perceptions of online radio platforms among university students in the Nyanza region. The study’s objectives included assessing audience perception of the programming of online radio platforms among university students in the Nyanza region, evaluating audience perception of signal reception of online radio platforms among university students in the Nyanza region, investigating audience perception of programs aired on online radio platforms among university students in the Nyanza region, and analyzing audience perception of program presentation of online radio platforms among university students in the Nyanza region. This study was underpinned by the framing theory and the agenda-setting theory. The research employed a descriptive research design. The target population was 872 media studies undergraduate students in six universities in the Nyanza region. Stratified random sampling was utilized to select 274 students in each of the universities. Data were collected through semi-structured questionnaires, and a pilot study was conducted at Rongo University. The study used questionnaires for accuracy and consistency, and data were cleaned and analyzed using the Statistical Package for Social Sciences software. Descriptive statistics were employed to examine audience perception of online radio platforms. A thematic analysis approach was used to identify recurring themes and to explore participants' perspectives. Data were presented using graphs, pie charts, and tables. Findings revealed that online radio provided higher quality programming compared to traditional radio. Results indicated that signal reception on online radio platforms was consistently reliable. According to the findings, programs aired on online radio platforms were engaging and interesting. Results indicated that the presentation style of programs on online radio platforms was professional. The study concludes that diverse and high-quality content on online radio platforms caters to varied interests, offering clear audio and stable listening experiences. Engaging and well-structured programs meet entertainment needs, recommending the development of new genres, topics, and formats to stay relevant. Quality programming, optimized scheduling, and innovative content delivery methods are essential for maintaining listener satisfaction and competitiveness in the media industry.

Neurological Surgery Manpower Training and Density in Islamic Republic of Iran: A Population Study

BACKGROUND AND OBJECTIVES: Significant disparities in worldwide neurosurgical training and workforce distribution are prominent primarily in low-income and middle-income countries. Although Iran is considered a lower middle–income country, neurosurgical density and distribution in Iran has surpassed the recommended ratio of 1 neurosurgeon for every 100 000 population. The objective was to determine neurological surgery density and distribution in Iran and the factors significant in the relative success in training and allocation of neurosurgeons in Iran. METHODS: Review of PubMed and administration of site surveys of multiple data sources including Neurosurgical Society of Iran, Iranian Board of Neurological Surgery, Medical Council of Islamic Republic of Iran, Universities of Medical Sciences in Iran, and Ministry of Health and Higher Education of Iran. RESULTS: Over the 72-year period from 1952 to 2024, 1200 neurosurgeons have been trained and distributed in 31 provinces in Iran, attaining a ratio of 1.4/100 000 population. All but 40 neurosurgeons were trained after 1981, which coincided with the Iran-Iraq War. Decentralization of medical and neurosurgical residency training programs, resolving the immediate need for neurosurgeons managing penetrating traumatic brain and spinal cord injuries during the 1980 to 1988 Iran-Iraq War, and active participation of legislative and executive branches of government in solving health care disparities were major factors in meeting the needs of the country. At the present time, more than 555 neurosurgeons are practicing in Tehran Province, a proportion of 3.8 neurosurgeons for every 100 000 population, which indicates an element of disparity in density distribution across Iranian land. CONCLUSION: Legislative initiatives and government support of public health care delivery and decentralization of medical and residency training programs after the Iran-Iraq War and introduction of the Ministry of Health and Medical Education are considered the main reasons for the relative success in meeting the neurosurgical demand and manpower density. Still, further adjustment of distribution of manpower is needed.