Public Health Service Delivery Research Articles

Association between obtaining injury prevention information and maternal and child health services during COVID-19

BackgroundCoronavirus disease 2019 disrupted the delivery of public maternal and child health services to caregivers of preschool children, leading to decreased opportunities for injury prevention education. We aim to 1) explore the timing, content, and methods of providing injury prevention information desired by pregnant women and mothers and 2) identify mothers who experienced difficulty in obtaining injury prevention information owing to reduced maternal and child health services.MethodsFrom March 24 to 29, 2022, we conducted a population-based cross-sectional study and web-based survey. Of the registered monitors of the internet research company Rakuten Insight, 675 mothers raising their first child aged 0–2 during the COVID-19 period (February 2020 to March 2022) were included in the analysis.ResultsOver half of the mothers wanted injury prevention information throughout their pregnancy. They preferred receiving information through traditional face-to-face services provided by local governments, such as antenatal classes or checkups. However, 34.1% of mothers said they did not obtain the information they needed; this was particularly true of unemployed mothers, had children aged 0–1, and had children with illnesses requiring hospital visits.ConclusionsMothers who could not obtain injury prevention information were originally disadvantaged mothers concerning access to information. The decrease in maternal and child health services may have widened this information gap. These findings can inform recommendations for caregivers, particularly those susceptible to information gaps during emergencies, and offer insights into future injury prevention education strategies.

Evidence-based management and the nurse's decision-making process

The managerial decision-making process is a competence of nurses in the hospital and primary care context, which makes them a highly requested professional for solving problems involving the unit and the care provided to the user. Such a process must be informed by evidence, with a view to achieving the best results. To discuss the use of scientific evidence by nurses in the health management process. An integrative literature review, carried out in the PubMed/MEDLINE, LILACS, BDENF, and SciELO databases, through the DeCS/MESH "Evidence-Based Nursing" AND "Health Management" OR "Evidence-Informed Policy", 694 studies were identified and 07 were included. Evidence-based decision-making is important for the delivery of effective and cost-effective public health services, this decision-making process consists of the integration of the best available research evidence, along with consideration of local context, community and policy preferences, professional experience, and resources in public health decision-making. It is, therefore, crucial to improve the quality of management decisions, consequently improving service delivery, and increasing effectiveness and efficiency, in addition to contributing to patient safety. It is concluded that evidence-based management is essential to improve the quality of management decisions and, therefore, to improve the optimization and allocation of resources in the health system.

An innovative Indigenous-led model for integrated COVID-19 case management in Auckland, New Zealand: lessons from implementation.

In Aotearoa/New Zealand (NZ), the Indigenous Māori population have been more severely impacted than non-Māori throughout the COVID-19 pandemic, and less well served by NZ's COVID-19 response. This case-study describes an innovative Indigenous-led service delivery model, which was designed and implemented to improve the case and contact management of Māori with COVID-19 in Auckland. We outline the context in which the conventional public health case and contact management was failing Māori and the factors which enabled Indigenous innovation and leadership. We describe the details of the model and how the approach fundamentally differed to the conventional approach to care. Qualitative and quantitative data on impact of the model are shared, along with the key barriers and enablers in the implementation of the model. The Māori Regional Coordination Hub (MRCH) model offers a valuable alternative to the conventional public health case and contact management approach, and this case study highlights lessons which may be applicable to improving the design and delivery of public health services to other Indigenous and marginalized groups.

A qualitative evaluation of a co-design process involving young people at risk of suicide.

Co-design is becoming common practice in the development of mental health services, however, little is known about the experience of such practices, particularly when young people are involved. The aim of this study was to conduct a process evaluation of the co-design which was undertaken for the development of an intervention for youth and adolescents at risk of suicide. This paper briefly outlines the co-design process undertaken during a COVID-19 lockdown and then focuses on a qualitative evaluation of the experience of taking part in a co-design process. The evaluation involved young consumers of a public youth mental health service, their carers/parents and service delivery staff who had taken part in the co-design process. This study used follow-up semistructured interviews with the co-design participants to explore their experience of the co-design process. Inductive thematic analysis was used to draw out common themes from the qualitative data. It was found that despite the practical efforts of the project team to minimise known issues in co-design, challenges centred around perceptions regarding power imbalance, the need for extensive consultation and time constraints still arose. Despite these challenges, the study found that the co-design provided a human-centred, accessible and rewarding process for young people, parents and staff members, leaving them with the feeling that they had made a worthwhile contribution to the design of the new service, as well as contributing to changing practice in service design. With sensitivity and adaptation to usual practice, it is possible to include young people with suicidal ideation, their parents/carers and professional staff in a safe and effective co-design process. The authors would like to thank and acknowledge the young people with a lived experience and their carers who participated in the co-design process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in this research.

Uncertainty and instability in social and health services impact well‐being of mothers with lived and living history of substance use

AbstractMothers who use substances often experience gender‐based and structural inequities that can jeopardize maternal and family wellness. Instability in the availability of services, particularly during public health crises (e.g., COVID‐19 pandemic), often results in changes in population health needs/funding/services, which may magnify experiences of disadvantage. Limited research has focused on times of change/crisis and its impact on maternal and family wellness. We examined the experiences of structural disadvantage, service access, and well‐being among mothers who use or formerly used substances during the first year of the COVID‐19 pandemic. Semi‐structured interviews were conducted with 26 mothers with current or past engagement in outpatient substance use treatment programs for pregnant and parenting women in Ontario, Canada. Transcripts were analysed using reflexive thematic analysis, revealing that instability of services and decreased access to/quality of informal and formal relationships often magnified the mental and affective toll of stressors, both pre‐existing and new. The impact on well‐being appeared to be greater for families who were actively engaged with child protective services. Findings are discussed in relation to literature examining systemic and societal factors that perpetuate gender‐based and structural inequities experienced by mothers with lived and living histories of substance use. The potential impact of changes in public health service delivery requires thoughtful and proactive attention for and by all stakeholders, including integrated attention across systems (e.g., health, social, education) that provide services to support maternal and family well‐being.

A New Statistical Method to Detect Disease Outbreaks from Hospital Emergency Department Data.

Early detection and prediction of disease outbreaks are crucial for public health service delivery, containment response, saving patient lives, and reducing costs. We propose a new data-driven statistical methodology for outbreak detection and prediction based on routinely collected hospital Emergency Department data. The time between consecutive ED presentations matching a diagnosis of interest forms the basis of a novel index measure to signal that an outbreak has occurred. We validate the method using historical presentations of influenza-like illness made to a large sample of public hospital EDs in 2020 and compare outbreaks identified by the method with the start of the first wave of COVID-19. The method shows promise within the field of disease outbreak detection.

An Empirical Investigation on Healthcare Professionals' Work Ethic and Ethical Attitudes: The Impact of Leadership Qualities on Ethics Construct and Professional Behaviors

The ability to act ethically is essential for providing high-quality treatment, yet there is a dearth of qualitative research on healthcare practitioners' perceptions of ethical competence. In this study, the ethical competence of healthcare practitioners was examined in the context of student healthcare. The way healthcare is delivered is changing, calling for adjustments to descriptions of and frameworks for ethical leadership. The purpose of this study was to evaluate the relationships between various leadership styles and healthcare professionals' conceptions of and attitudes toward work ethics. Participants in a cross-sectional study that employed the snowball sampling technique were healthcare professionals. The survey used in this study was divided into two sections: the first section collected data on the sociodemographic characteristics of the participants, and the second section contained three validated assessment scales, including inquiries about work ethics, ethical attitudes for public health professionals, and leadership abilities. Higher work ethics and a higher intrinsic work motivation subscale were significantly correlated with high leadership administrative skills (Beta = 6.04, p = 0.019 and Beta = 2.55, p 0.001, respectively). However, a lower intrinsic work motivation subscale was associated with higher leadership conceptual skills (Beta = 1.07, p = 0.027). Stronger leadership and administrative skills were found to be significantly correlated with higher ethical attitudes scores (Beta = 28.39, p 0.001). The work ethic in the delivery of various public health services is significantly improved by higher administrative leadership. Leadership abilities can considerably predict an individual's ethical attitude and professional behavior and are not restricted to a particular profession, experience, or stage of a person's career in the healthcare industry

Achieving COVID-19 and Routine Immunization Data Systems Integration on the Electronic Management of Immunization Data System in Nigeria.

In 2021, Nigeria developed a novel Electronic Management of Immunization Data (EMID) system to address COVID-19 data management challenges and ensure the successful implementation of its COVID-19 vaccine deployment plan. The EMID system was envisioned to be interoperable with the DHIS2 national data management system and serve as a gateway into the integration of other primary health care (PHC) service data management. However, the EMID system faced challenges, including inability to filter reports, missing or loss of data, and difficulties with data synchronization, which curtailed its potential to meet the country's needs for COVID-19 data management and negatively impacted system scalability to enable integration with other PHC data systems. Multilayered stakeholder interviews were conducted to determine the optimal functionality requirements for the EMID system. Based on these findings, an optimization plan was designed and implemented to address identified gaps and create a more stable and scalable system to enable further system integrations. Following optimization, a routine immunization module was developed and integrated with the EMID system as a first step to achieving an integrated data management system for PHC services in Nigeria. The integrated system currently provides an opportunity to address data fragmentation and strengthen PHC service delivery in Nigeria. By allowing 1 health care worker to deliver both vaccinations, there is also potential for reduction in cost and redundancies, informing redistribution of the health workforce and overall system strengthening. The journey from the initial challenges faced by the EMID system to the development of an integrated system for PHC services in Nigeria has been a transformative one. Through a thorough optimization process, training and capacity-building, stakeholder-driven improvements, and an elicitation exercise, the EMID system has evolved into a powerful tool for addressing data fragmentation and enhancing public health service delivery in the country.

Stewards of Society: Preparedness and Perceptions Among the Unsung Heroes of Public Health Service Delivery

Front-line public health workers are essential to protecting the health of the public, particularly during widespread public health emergencies. Local public health workers were instrumental in mitigating the spread of the coronavirus pandemic through their efforts to contract trace, disseminate tests and vaccines, and educate the public about the dynamic state of the crisis. Yet, reports indicate that the public health workforce has been shrinking for some time. Recent studies indicate more than one-quarter of those serving in public health roles hope to leave the profession within one year because of factors such as stress and burnout. Few studies examine the perceptions of local health workers or the impacts that multi-level governmental responses have on their ability to do their jobs. Having a strong public health workforce is essential for a thriving society, so addressing this gap and identifying solutions are important steps towards identifying solutions for slowing the exodus of public health workers from the field. Through analysis of original survey data of front-line workers mid-pandemic in two western states, this project examines perceptions regarding factors which contribute to added stress and burnout. Findings indicate that workers felt relatively prepared to address a public health crisis, but institutional factors, such as changing job responsibilities, competing governmental directives, and limited resources, may contribute to ongoing feelings of burnout. To address these concerns, decision makers need to provide more resources and have a clear strategy of communication to mitigate conflicting governmental directives.

Association between the COVID-19 pandemic, caregiving burden, and quality of life of caregivers of people with dementia: A cross-sectional study.

This study aimed to examine the association of COVID-19-related stress, anxiety, access to public healthcare services, and the presence of secondary caregivers (CGs) on the burden of caregiving and health-related quality of life (HRQoL) for CGs of people with dementia (PwD). A cross-sectional survey with 218 family CGs for PwD was completed in various settings between August and September 2021. The CGs had moderate and severe stress (42.7%) and reported having difficulty accessing public healthcare services (51.8%) and receiving help from secondary CGs (42.7%). In the multivariable linear regression, the stress and anxiety levels related to COVID-19 had a positive association with caregiver burden (β = 4.25, p < 0.001, and β = 5.73, p = 0.032, respectively), with no statistically significant association to HRQoL. Unexpectedly, accessing public healthcare services and supporting the secondary CGs were unrelated to the caregiving burden and HRQoL. Therefore, interventions aiming to alleviate family CGs' stress and anxiety levels should be provided to ensure PwD live in their homes in terms of continuity of public health service delivery.

Multiobjective Optimization of Public Health Service Delivery Networks

Providing an effective health service as a state is equivalent to giving life. Health services, whose pillar is to optimize the supply chain with public policies based on equity, are equal to providing life. Identifying all the variables and characteristics of the services allows the development of a multiobjective model to represent a public health services network. A case of the National Public Network of Colombia has been analyzed, minimizing costs and contributing to the decision making process. In this paper, a multiobjective approach to optimize the National Public Network in Colombia has been proposed. The proposed scheme combines mathematical techniques with managerial aspects related to public network health. Thus, we identify the distribution of services by the municipality to minimize the total cost and maximize coverage. The opening of services is suggested according to the demanding complexity and transport of patients between institutions. The results contrast with the current hospital services of Valle del Cauca in Colombia. The proposed scheme results show a reduction in the transfer of patients with a minimum increase in the costs of hospital services. The service proposal is based on improving access and quality in the provision of services, avoiding du- plication of supply, and generating an impact on the sustainability of the network of Valle del Cauca.

Measuring disparities in access to district and referral hospitals in the city of Kigali, Rwanda

The study focused on the identification of theoretical and methodological constructs that can be used to analyse and improve the spatial performance of public health service delivery systems and the development of a corresponding spatial-analysis and GIS-based planning approach using the city of Kigali as a case study. Access to health care as a multi-tiered system was measured by using five dimensions of access, namely geographic accessibility, availability, affordability, acceptability and accommodation. Geo-statistical analysis was performed to measure and evaluate access to the district and referral health care. For geographic access, the travel time for every trip is approximated for the two main modes of transport (walking and public transport). To realistically represent the friction of distance, the street network was categorised into several road classes for which different travel speeds are estimated for each transport mode on the basis of local knowledge. A factor analysis model was used for availability, affordability, acceptability, and accommodation dimensions. Different indicators were evaluated in various units and scales and standardized to see how satisfaction levels varied with each dimension. Based on the type of indicator, for the cost or benefit, the score was zero (0) or one (1). One (1) was considered a positive impact, while zero (0) was considered a negative impact. Summary scores were developed for all indicators by combining more than one indicator into a single value. The created summary score also ranges from 0 to 1, and the higher the score, the better the access attainment. To find areas that need intervention, the comparison of all five indicators and the scores of access for each indicator was made. The dimensions of geographic accessibility and availability appeared to be the most problematic. The district health care dimensions have revealed a low performance level in geographic accessibility (0.64) and a high-performance level in affordability (0.94). The referral health care dimensions have revealed a low performance level of geographic accessibility (0.17) and a high-performance level of acceptability (0.92). Health planners and policy makers will commonly require such a planning method, particularly in the developing world where spatial contexts are highly dynamic as a result of rapid urbanisation.

The Role of Anthropology in India's Public Health

Abstract Conducting research on healthcare systems, policy implementation and the impact of health programmes can systematically identify the gaps and challenges in public health service delivery in India. Anthropology is particularly useful for so doing, but the role of anthropologists in health policy and planning needs recognition in India, as they can evaluate the effectiveness of interventions through a cultural lens, informing the development of evidence-based policies. The USA and Europe are more advanced in the use of anthropology in public health, due to their established academic programmes, robust research funding and infrastructure, and effective integration into public health institutions. Anthropological analysis and intervention has the capacity to improve Indian public health practice, particularly in terms of inclusivity and diversity issues.

Cognitive Dissonance Induction to Decrease Vaccine Hesitancy Among Syrian Refugees in Lebanon: A Cognitive Approach Towards the Promotion of Health Seeking Behaviors

Background: The rollout of the COVID-19 vaccine represented more than logistical challenges. Lebanon, despite benefitting from the COVAX initiative that made vaccines more accessible to everyone residing in the country, faced considerable challenges encouraging the Syrian refugee population to register for a vaccine. The reasons behind refugees’ reluctance to get vaccinated were mainly behavioral in nature: fear of side effects, doubts about the vaccine’s effectiveness, and even the belief that the vaccine was unnecessary. Methods: An RCT was conducted in order to test the impact of dissonance induction on the level of willingness of Syrian refugee survey respondents who had not been vaccinated (n=1,569). The survey also collected data on refugees’ knowledge, attitudes, and practices regarding the vaccine. Results: Results revealed that dissonance induction significantly reduced vaccine hesitancy, with more pronounced effects detected among women, middle aged adults. Conclusion: These findings have important implications on rethinking the behavioral aspect of the delivery of public health services to the refugee population in Lebanon and vulnerable populations elsewhere.

Influence of Human Resource Capacity on Public Health Service Delivery in the Western Kenya Region

This study investigated about the influence of human resource capacity on public health service delivery in the Western Kenyan Region. The study employed the descriptive correlational research design. A closed ended questionnaire was used as a source of data from 264 staff and 69 patients from selected health facilities. Data was processed through regression analysis to establish the relationship between the independent and the dependent variables. The study concludes that enhancing the human resources capacity through collaborative decision making and training leads to improved public health service delivery. The study, therefore, recommends that the Ministry of Health in the County Governments should enhance the human resources capacity through collaborative decision making in that opinions of workers are taken into consideration in daily operations. Furthermore, different forms of training like in-service training, mentorship, coaching, workshops and seminars should be considered so as to effectively enhance the public health service delivery.

Influence of Human Resource Capacity on Public Health Service Delivery in County Governments in Western Kenya Region

Poor health service delivery has been linked to the devolution of health services, with some health workers walking off the job due to inadequate pay and unsafe working conditions. This research aimed at determining the influence of human resource capacity on public health service delivery by county governments in the Western Kenya region. The study was anchored on human capital theory. Descriptive survey and causal-comparative research designs were adopted with a target population of 966 personnel consisting of the CECMs, Chief Officers, Directors and County Nursing Officer for Health, Medical Superintendents, Hospital Administrator, Human Resource Officer, Head of Pharmacy, Head of Nursing, Health Records Information Officer, Head of Laboratory, Head of Clinical Services and number of patients admitted, treated and discharged drawn from four Counties of Bungoma, Busia, Kakamega and Vihiga. Primary data was collected using structured questionnaires and interview schedules. Content analysis was used for qualitative data while quantitative data was analysed using both descriptive and inferential statistics. The SPSS Software version 26 was used for statistical analysis. The hypothesis tested for significance of the study at 5% significance level. From the results the beta value for human resource capacity from the regression model was 0.690 at p&lt; 0.05. Human resource capacity explains 47.6% (R2 =0.476) of variance in public health service delivery, thus hypothesis was rejected. Consultation is a necessary part of the decision making process. In this regard, as many of the perspectives of workers who are directly affected by the decision as feasible should be considered.

Influence of Participative Leadership Style on Public Health Service Delivery in County Governments in the Western Kenya Region

Poor health service delivery has been linked to the devolution of health services, with some health workers walking off the job due to inadequate pay and unsafe working conditions. This research aimed at establishing the influence of participative leadership style on public health service delivery by county governments in the Western Kenya region. Taking a positivist approach, the study was anchored on participative leadership theory. Descriptive survey and causal-comparative research designs were adopted with a target population of 966 personnel consisting of the CECMs, Chief Officers, Directors, and County Nursing Officer for Health, Medical Superintendents, Hospital Administrator, Human Resource Officer, Head of Pharmacy, Head of Nursing, Health Records Information Officer, Head of Laboratory, Head of Clinical Services and number of patients admitted, treated and discharged drawn from all four counties of Bungoma, Busia, Kakamega, and Vihiga. Primary data was collected using both structured questionnaires and interview schedules. Qualitative data was analysed by content analysis while quantitative data was analysed using both descriptive and inferential statistics. The SPSS Software version 26 was used for statistical analysis which was both descriptive whereby frequencies, percentages, means, and standard deviation were clearly shown in the form of both tables, models and charts. The hypothesis tested for significance of the study at 5% significance level. From the results, the beta value for participative leadership from the regression model was 0.777 at p&lt;0.05. Participative leadership explains 60.4% (R2 =0.604) of the variance in public health service delivery. Therefore, the hypothesis was rejected. The study recommends establishing transparent and straightforward policies and procedures for managing human resources, which are essential for promoting productivity, equity, and workplace peace. In order to improve service delivery, the report suggests that county governments implement methods to promote collaborative decision-making. Consultation is a necessary part of the decision making process. In this regard, as many of the perspectives of workers who are directly affected by the decision as are feasible should be considered.

Appraising two decades of public sector health financing and service delivery reforms in Ghana between 2000-2020: a scoping review protocol (Preprint)

Appraising two decades of public sector health financing and service delivery reforms in Ghana between 2000-2020: a scoping review protocol (Preprint)

Improving safe post-abortion care practices: A study on interventions implemented by Ipas Pakistan.

An estimated 50 million induced abortions occur in developing countries annually, and an estimated 7 million women are treated for complications associated with unsafe abortions. According to a 2012 estimate, 15 per 1,000 women aged 15-49 years seek treatment for abortion-related health complications in both private and public sectors. A high unmet need for family planning in Pakistan and a low percentage of women adopting a contraceptive method in the post-partum period led to unwanted pregnancy becoming one of the reasons for unsafe abortion. Post-abortion care (PAC) is an integrated service delivery model that includes both maternal health and family planning interventions. The study aims to examine improvement in abortion-related practices through the implementation of the PAC model at all tiers of public health service delivery systems in the two most populous provinces-Punjab, Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory (ICT) region-of Pakistan. The improvement model comprises clinical training of healthcare providers, community engagement, and counseling of community women on safe post-abortion practices. It was a descriptive study utilizing data of 27,616 PAC clients recorded and reported by the service providers on the logbooks from 104 selected public health facilities from March 2018 to December 2021 in ICT, Punjab, Sindh, and Khyber Pakhtunkhwa provinces of Pakistan. Women who received PAC services were older than 25 years, 22,652 (82%), with a mean age of 29 years. Most of these women were in their first trimester, 26,110 (95%), and the majority diagnosed with PAC (incomplete, missed, or threatened abortion), 26,838 (97%). The majority of women, 25,324 (92%), received safe methods for post-abortion care that included the use of misoprostol, 15,804 (58%), and manual vacuum aspiration, 8,898 (32%). In total, 17,105 (72%) of women opted for a contraceptive method that included long-acting reversible contraceptives, 2,313 (10%); short-term excluding condoms, 3,436 (27%); and condoms, 8,113 (34%). The key predictors identified for uptake of the post-abortion family planning method indicated that women more than 25 years of age, in the early second trimester, and who were counseled on post-abortion family planning were more likely to adopt the contraceptive method than others. Increased access to post-abortion care and family planning could potentially reduce the incidence of unsafe abortion, unintended pregnancies, and associated maternal mortality. The experience of Pakistan suggests that the integrated post-abortion care service delivery model can be effectively implemented across the public health systems.

Effectiveness of Operation K9 Assistance Dogs on Suicidality in Australian Veterans with PTSD: A 12-Month Mixed-Methods Follow-Up Study

Post-traumatic stress disorder (PTSD) is a pervasive disorder among both current and ex-serving Australian Defence Force (ADF) members. Studies have shown current psychological and pharmacological treatments for PTSD are suboptimal in veterans, with high dropout rates and poor adherence to treatment protocols. Therefore, evaluating complementary interventions, such as assistance dogs, is needed for veterans who may not receive the ultimate benefit from traditional therapies. The present longitudinal mixed-method study examined the effectiveness of Operation K9 assistance dogs among sixteen veterans with PTSD, specifically, their effects on suicidality, PTSD, depression, and anxiety from baseline to 12 months post-matching. Self-reported measures were completed prior to receiving their dog (baseline) and at three time points (3, 6, and 12 months) following matching. The Clinician-Administered PTSD Scale for DSM-5 was used to assess the severity of every PTSD case. Veterans participated in a semi-structured interview 3 months post-matching. Whilst there was a reduction in the proportion of veterans reporting any suicidality, there was no significant change in the probability of veterans reporting suicidality between time points. There was a significant effect of time on PTSD, depression, and anxiety symptoms. Three major themes emerged from qualitative data analysis: life changer, constant companion, and social engagement. Qualitative data suggest assistance dogs can have a positive impact on important areas of daily life and support veterans in achieving some of the prerequisites for health, including access to services, transport, education, employment, and development of new and diverse social and community connections. Connections were key in improving health and wellbeing. This study exemplifies the power of human-animal relationships and adds emphasis to the need to take these seriously and create supportive healthy environments for veterans with PTSD. Our findings could be used to inform public health policy and service delivery, in line with the Ottawa Charter action areas and indicate that for veterans with PTSD, assistance dogs may be a feasible adjunct intervention.