Skilled Delivery Research Articles

Factors Influencing Women’s Choice of Place of Delivery in Ngenge Sub-county, Kween District-Uganda

<i>Background</i>: Maternal and neonatal morbidity and mortality are major public health concerns in most developing countries and in under resourced settings. Increasing the proportion of babies that are delivered in health facilities is an important factor in reducing the health risks to both the mother and the baby. In Uganda’s skilled birth attendance is 58% of antenatal care mothers. <i>Objective</i>: The study assessed factors influencing the choice of place of delivery among women of reproductive age in Ngenge Sub County, Kween District- Sebei Sub region, Eastern Uganda. <i>Methodology</i>: The study design was cross-sectional in which data were collected using an interviewer administered structured questionnaire and analyzed using Epi info version 7.2. <i>Results</i>: A total of 350 mothers were interviewed of which 82% were married. Delivery under skilled attendance was 46%. Chances of delivering at the health facility decreased with increase in age (p=0.001), with increased parity (p=0.002), and increased with higher household income (p=0.011), and among mothers and their partners who had higher level of education (p=0.031, 0.024 respectively). The factors which influenced delivery in the health facility included: short waiting time at the health facility before receiving health care services, good attitude of the health care workers, and adequate birth preparedness during ANC. The factors which influenced delivery elsewhere included; the far distances to the nearest health facility, low education of mothers and their partners, increased maternal age, low household income, high parity, poor decision making and high perception of the mothers about the care provided by TBAs. <i>Conclusion</i>: The study concludes that skilled delivery was low at 46% way-below the national target of 95%. The factors statistically associated with choice of place of delivery included: waiting time at the health facility, attitude of the health care workers, birth preparedness during ANC, distance to the nearest health facility, level of education of mothers and their partners, maternal age, household income, parity of mothers, decision making, and perception of the mothers about the care provided by TBAs.

Role and effectiveness of AYUSH doctors in providing maternal health services under National Health Mission in rural India

With the inception of National Health Mission (NHM)/National Rural Health Mission (NRHM), Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) doctors were colocated in public health institutions and were made a part of the mainstream healthcare system. The study was conducted with an objective to understand the role and effectiveness of AYUSH doctors in providing maternal health services in public health institutions in rural India. This brief review was carried out by selecting articles through cross-references and hand search. Research on AYUSH principles/therapeutics in maternal health is found in good quantity; however, the role of AYUSH doctors in providing maternal health services is very limited. These studies assessed the theoretical knowledge regarding essential and emergency obstetric care, identifying and managing pregnancy related complications and the usage of partograph. Skills related to antenatal checkups, counseling skill on danger signs of pregnancy, vaginal delivery, neonatal resuscitation, and postnatal care were also evaluated by some studies. Studies observed variation in knowledge and skills among AYUSH doctors in different states, which reflects the support of the government and the training ambience that these doctors are exposed to at their undergraduate level and on-the-job training. The presence of AYUSH doctors in rural areas is, indeed, a great help for the community; however, they need regular training and orientation to upgrade their knowledge and skills for effective service delivery.

The effect of direct observation of procedural skills method on learning clinical skills of midwifery students of medical sciences.

INTRODUCTION:Clinical education is one of the most important parts of medical students' education, and it is a major part of the education of qualified and professional people. Therefore, this study was conducted to determine the effect of applying Direct Observation of Procedural Skills (DOPS) on midwifery students' clinical skills.MATERIALS AND METHODS:This is a quasi-experimental, two-group study conducted as a pre- and post-study on midwifery students in 2017–2018. Cluster and randomized sampling method was used. The processors involved in this study were three main skills of vaginal examination, pelvic examination, and vaginal delivery. The DOPS method was used to assess the practical skills in the interventional group during three times the process at day, 1 day, and at least 1 week later; the usual logbook method was used in the control group. Two groups were evaluated at the end of the midwifery course by Comprehensive Final Midwifery checklist. The tools were checked for validity and reliability, and data were analyzed using descriptive and analytical statistics.RESULTS:There was no statistically significant difference between the two groups in terms of important demographic variables such as age, grade, marital status, and initial assessment score (P > 0.05). The mean of final scores in the normal delivery, vaginal examination, and pelvimetry was statistically significantly higher in the interventional group (P < 0.001). On the other hand, the functional field of the students in the interventional group was statistically significantly improved in normal delivery and pelvimetry (P < 0.05), and this difference was not significant in the vaginal examination. In addition, the mean scores of students before and after the DOPS method were statistically significantly different in every skill in Comprehensive Final Midwifery checklist (P < 0/05).CONCLUSIONS:The DOPS assessment methodology is not only a useful tool of clinical evaluation, but also an effective tool for clinical learning of students. For this purpose, it is suggested that educational members of midwifery take enough time to design DOPS method in the same process.

Capacity & capability building for applied dementia research in low- & middle-income countries: Two exemplars from South Asia.

Background & objectives:Cognitive and other neurodegenerative conditions related to ageing have become public health priorities in low- and middle-income countries. However, contextually based, applied research to support the development of awareness, diagnosis and care pathways for people with dementia in South Asia is still largely undeveloped. This study was aimed to use applied research studies for dementia in South Asia as exemplars of how individual-level capacity and capability building for dementia research can be achieved.Methods:Using Theory of Change as a framework, we embedded capacity and capability building into the studies through six domains: people (human resources), research integrity and governance, study delivery skills, international collaborative working, patient and public involvement (PPI) (awareness raising, stigma and health literacy) and development of ‘pathways’. For each aspect, development goals were defined and how they would be achieved.Results:New principal investigators, research assistants (including outcome raters), study coordinators and intervention practitioners were trained across eight study sites in India, Pakistan, and Bangladesh, for dementia research. Training was delivered at study start, and through booster sessions, using workshops, face-to-face sessions, online training and video-link sessions. International collaborations were fostered, leading to a proposal for international funding. Each study site co-created PPI events to raise awareness and to inform the research. The recruitment pathways and study logistics fostered the development dementia diagnosis and care pathways.Interpretation & conclusions:Embedding capacity and capability building in applied dementia research in South Asia fosters the sustainability of dementia research, which is essential in developing diagnostic and care pathways.

Antenatal care and skilled delivery service utilisation in Somali pastoral communities of Eastern Ethiopia.

ObjectiveTo assess maternal health care service utilisation and associated factors in Somali pastoral communities of eastern Ethiopia.MethodsCommunity‐based cross‐sectional study complemented by qualitative assessments in Adadle district, Somali region, eastern Ethiopia, among 450 women in six kebeles from August to September 2016. Logistic regression was used to assess factors associated with antenatal care use and skilled delivery care use, controlling for confounders.ResultsAbout 27% [95%CI 22.8–31.2%] of women used antenatal care, and 22.6% [95%CI 18.7–26.5%] received skilled delivery service. None of the respondents reported post‐natal care. About 43% reported that they had no knowledge of antenatal care, and 46% did not perceive delivery at a health facility as important. Pastoral lifestyle, husband’s educational status, women’s attitude towards health care service and financial support from the husband were significantly associated with antenatal care utilisation. Health professionals’ attitudes, perceptions of institutional delivery, antenatal care utilisation and information about exemptions from maternal health care fees were associated with skilled delivery service utilisation.ConclusionImproving community awareness of antenatal care, employing female health professionals and culturally adapted guidelines could improve skilled delivery utilisation. In a patriarchal society, involving male partners in all maternal health issues is essential to increase use of maternal health services and to decrease maternal mortality.

Uterine Perforation after Manual Vacuum Aspiration

Surgical modality of abortion should be backed up by adequate skill and facility in service delivery as well as in detecting and managing complications.&#x0D; Keywords: abortion, hemoperitoneum, manual vacuum aspiration

Use of Self-Assessment of Video Recording to Raise Students’ Awareness of Development of Their Oral Presentation Skills

This paper aims to examine if using video recordings help students raise their awareness of the development of their oral presentation skills by reviewing video recordings of their presentations. For this study, all students who took a Financial Accounting class in the academic year 2018&amp;ndash;2019 at Lincoln University (LU) were video-recorded when presenting. Participants were asked to review their video recordings, assess their performance, and record their reflections by using a Self-Assessment Questionnaire (SAQ). The results indicated that the students&amp;rsquo; attitude toward recording the presentations was highly positive. The predominant response was that this new learning activity increased students&amp;rsquo; awareness of the importance of presentation skills without provoking their anxiety. Participants were able to observe that certain delivery skills such as good preparation, self-confidence, eye contact, and voice quality needed improvement. For managerial implications, LU, through its Writing and Speaking Center (WSC), offered thirty-minute sessions with a presentation coach to improve students&amp;rsquo; communication skills and prepare them to give a more polished presentation in class. In comparing the practice presentation at the WSC with the final in-class presentation, students were observed to be more confident, better prepared, and less nervous during the final presentation. However, we observed that the practice presentation did not carry the same weight as the final presentation as the practice presentation was neither graded nor delivered in front of an instructor or a wider audience.

Online Peer Motivational Feedback in a Public Speaking Course

Providing peer feedback is commonly practiced in teaching and learning of public speaking courses. However, there is limited research examining peer motivational feedback in an online setting. This study adopted a qualitative, descriptive approach using document analysis to investigate the frequencies of peer motivational feedback which students’ use in a public speaking course within an e-learning system of a local university. In addition, the specific public speaking skills and the nature of the feedback offered by students were also examined. Twenty-three final year undergraduate students video recorded their speeches, uploaded their videos, offered and received online peer feedback in the e-learning platform. All of the recorded online peer feedback went through a thorough classification process to identify, arrange, and systemize into the specified types of feedback. The data was examined at three levels of analysis to ensure concrete conclusions were drawn. Frequencies and examples of online peer motivational feedback were also presented. The results indicated that students provide relatively more motivational feedback on delivery and voice control skills, while paying less attention to language and proficiency skills. The process of giving and receiving feedback has acted as individualized feedback in which peers helped clarify the goal, criteria and expected standards of good performance. Thus, this study suggests that online peer motivational feedback could be used as a form of practice in the teaching of online public speaking courses due to its ability to motivate and sustain students’ interest in learning public speaking while creating a student-centered learning environment.

Predisposing, enabling and need factors associated with skilled delivery care utilization among reproductive-aged women in Kersa district, eastern Ethiopia

BackgroundSkilled delivery care utilization in Ethiopia is still very low compared with the goal set by the global community for countries with the highest maternal mortality. As a result, the country is overburdened with high maternal morbidity and mortality. We aimed to explore the predisposing, enabling, and need factors associated with skilled delivery care utilization among reproductive-aged women in Kersa district, eastern Ethiopia.MethodsA community-based cross-sectional study was conducted with a total of 1294 women. The participants were selected using systematic sampling techniques. An interviewer-administered structured questionnaire aided by an electronic survey tool was used to collect data. Univariate analyses were conducted to describe the study sample. Bivariate and multivariate logistic regression analyses were carried out to elicit the association of predisposing, enabling, and need factors associated with skilled delivery care utilization. Separate multivariate models were fitted for primiparous and multiparous women categories. Odds ratios with 95% confidence intervals were used to assess statistical significance.ResultsMore than a quarter (30.8%) of the women surveyed used skilled delivery care for their most recent birth. Significant predisposing factors were as follows: presence of educated family member; receiving education on maternal health; previous use of skilled delivery care; and best friend’s use of maternal care. Place of residence was the enabling factor that predicted skilled delivery care use. Antenatal care attendance and pregnancy intention were significant need factors associated with skilled delivery care utilization.ConclusionThe findings of the study highlight the need for a concerted effort to establish community-based peer education programs; improve access to family planning services (to reduce unintended pregnancies); increase antenatal care uptake; and facilitate access to skilled delivery care in rural areas.

Rethinking solutions for re-balancing the education–job mismatch

Purpose In the international graduate job market, education–job mismatches are affecting recruitment, and consequently efficiency. The purpose of this paper is to identify a widening gap in “global operating skills”, then put forward a structure for addressing the education–job mismatch, based on data gathered from higher education teachers and graduate recruiters. Framed as a case examining the contemporary context in Russia, the objective is to identify a cross-cultural management (CCM) skills set for graduates who are pursuing a career in an international environment. The study therefore has implications for managers and educators who work in this sector. Design/methodology/approach The study identifies a number of factors that need to be taken into account for developing CCM competence among graduate job seekers. Set in the specific case of a Russian higher education institutions and one of its international partners, stakeholder theory is used for theoretical underpinning and data collection. A qualitative-oriented mixed-methods approach was designed to: explore the education–job mismatch by using documentary sources and direct observations; collect data in a three-step sequence (focus groups, interviews and interactive seminar). Findings The key findings revealed the extent of the education–job mismatch. Specifically: a lack of transferable CCM skills, mismatch between the provision of CCM skills development in higher education and the needs of recruiters, and curriculum shortfall in terms of CCM skills. Furthermore, areas such as cross-cultural communication and cross-cultural awareness require urgent attention; new approaches are needed to enhance the knowledge transfer of CCM skills to students, in order to better equip them to work in an increasingly international workplace. Research limitations/implications The enquiry provides a snapshot of knowledge transfer regarding CCM skills based on a particular case, from the perspective of teachers and recruiters. While care was taken to respect the language and cultural norms, the interview guide captured only a narrow dimension of the subject area. The modest size of the sample does not allow any generalisations when interpreting the data. The findings should not be applied to other national contexts, disciplines or sectors. Practical implications The authors put forward actions for enhancing the implementation of an international education programme (IEP), emphasising the importance of co-creating with stakeholders. The distinguishing features of an IEP are identified and a framework for explaining the opportunities generated by such a programme is developed. Failing to address the “skills gap” may trigger long-term ramifications for both business and society. Social implications Academics and students claim to be dissatisfied with the current delivery of CCM skills. The identification of an education–job mismatch implies that CCM skills are not being effectively transmitted within higher education. This study sets out to identify and explain the current situation of CCM skills development in contemporary society. The genesis of this study stems from the topical debate surrounding reconceptualising higher education to reflect a more international-oriented approach. Originality/value Research into CCM is frequently undertaken from an Anglo-centric perspective, or sets out to compare an “Anglo” environment with a non-Anglo setting. Few CCM studies are set in the context of a contemporary Post-Soviet society.

Predicting skilled delivery service use in Ethiopia: dual application of logistic regression and machine learning algorithms

BackgroundSkilled assistance during childbirth is essential to reduce maternal deaths. However, in Ethiopia, which is among the six countries contributing to more than half of the global maternal deaths, the coverage of births attended by skilled health personnel remains very low. The aim of this study was to identify determinants and develop a predictive model for skilled delivery service use in Ethiopia by applying logistic regression and machine-learning techniques.MethodsData from the 2016 Ethiopian Demographic and Health Survey (EDHS) was used for this study. Statistical Package for Social Sciences (SPSS) and Waikato Environment for Knowledge Analysis (WEKA) tools were used for logistic regression and model building respectively. Classification algorithms namely J48, Naïve Bayes, Support Vector Machine (SVM), and Artificial Neural Network (ANN) were used for model development. The validation of the predictive models was assessed using accuracy, sensitivity, specificity, and area under Receiver Operating Characteristics (ROC) curve.ResultsOnly 27.7% women received skilled delivery assistance in Ethiopia. First antenatal care (ANC) [AOR = 1.83, 95% CI (1.24–2.69)], birth order [AOR = 0.22, 95% CI (0.11–0.46)], television ownership [AOR = 6.83, 95% CI (2.52–18.52)], contraceptive use [AOR = 1.92, 95% CI (1.26–2.97)], cost needed for healthcare [AOR = 2.17, 95% CI (1.47–3.21)], age at first birth [AOR = 1.96, 95% CI (1.31–2.94)], and age at first sex [AOR = 2.72, 95% CI (1.55–4.76)] were determinants for utilizing skilled delivery services during the childbirth. Predictive models were developed and the J48 model had superior predictive accuracy (98%), sensitivity (96%), specificity (99%) and, the area under ROC (98%).ConclusionsFirst ANC and contraceptive uses were among the determinants of utilization of skilled delivery services. A predictive model was developed to forecast the likelihood of a pregnant woman seeking skilled delivery assistance; therefore, the predictive model can help to decide targeted interventions for a pregnant woman to ensure skilled assistance at childbirth. The model developed through the J48 algorithm has better predictive accuracy. Web-based application can be build based on results of this study.

PNS91 ACCESS AND UTILIZATION OF MATERNAL HEALTHCARE IN A RURAL DISTRICT IN THE FOREST BELT OF GHANA

The objective of this study was to investigate the access and utilization of maternal healthcare in Amansie-West district in the Ashanti Region of Ghana. Methods: An analytical cross-sectional study, involving 720 pregnant women systematically sampled from antenatal clinics in five sub-districts was conducted from February to May 2015 in the Amansie-West district. Data on participants’ socio-economic characteristics, knowledge level and access and utilization of maternal health care services were collected with a structured questionnaire. Odds ratios were estimated to describe the association between explanatory variables and maternal healthcare using generalized estimating equations (GEE). 68.5, 83.6 and 33.6% of the women had >3 antenatal care visits, utilized skilled delivery and postnatal care services respectively. The mothers’ knowledge level of pregnancy emergencies and newborn danger signs was low. Socio-economic characteristics and healthcare access influenced the utilization of maternal healthcare. Compared to the lowest wealth quintile, being in the highest wealth quintile was associated with higher odds of receiving postnatal care (adjusted odds ratio [aOR]; 95%CI: 2.84; 1.63, 4.94). Use of health facility as a main source of healthcare was also associated with higher odds of antenatal care and skilled delivery. This study demonstrates suboptimal access and utilization of maternal healthcare in rural districts of Ghana, which are influenced by socio-economic characteristics of pregnant mothers. This suggests the need for tailored intervention to improve maternal healthcare utilization for mothers in this and other similar settings. Keywords: Maternal healthcare, Antenatal care, Postnatal care, Skilled delivery, Limited-resource setting, Rural Ghana, Amansie west district

Safety, feasibility, acceptability and effects of a behaviour-change intervention to change physical activity behaviour among people with multiple sclerosis: Results from the iStep-MS randomised controlled trial

Background: There is limited information regarding the safety, feasibility and acceptability of behaviour-change interventions to increase physical activity (PA) and reduce sedentary behaviour among people with multiple sclerosis (MS). Prior to evaluating efficacy, it is important to identify problems with feasibility and acceptability, which may undermine effectiveness. Objective: To examine the safety, feasibility and acceptability of a behaviour-change intervention to increase PA and reduce sedentary behaviour among people with MS. Methods: Sixty people received a 3-month intervention or usual care. Fatigue, pain and adverse events (AEs) were assessed. Feasibility and acceptability were explored through focus groups with physiotherapists and interviews with participants. Fidelity to intervention content, delivery skills, programme receipt and programme task were assessed. Results: There was no difference in AE rate between groups (p = 0.965). Fatigue and pain were not higher in the intervention group at 3 or 9 months. Therapists reported the intervention was feasible to deliver and fidelity was acceptable. Twenty-nine participants (97%) attended at least 75% of sessions. Participants found the intervention acceptable but suggested some amendments were required to intervention components. Conclusions: The intervention was safe, feasible and acceptable. Although modifications are required to intervention components, the intervention warrants further evaluation in a future trial.

The impact of a depression self-management intervention on seizure activity

PurposeSeizures have a variety of significant physical, cognitive, and social effects upon the individual. Depression has been linked to an increase in seizure activity, and Project Using Practice and Learning to Increase Favorable Thoughts (UPLIFT) was shown to reduce depressive symptoms. Project UPLIFT, based upon mindfulness-based cognitive therapy (MBCT), provides distance delivery of depression management skills to groups of people with epilepsy. Because Project UPLIFT reduces depression and depression is linked to seizure activity, the current analysis was designed to determine the impact of Project UPLIFT upon seizure frequency and severity. MethodParticipants (n = 107) were adults ages 21–70 with epilepsy and mild-to-moderate depressive symptoms from the states of Georgia, Michigan, Texas, and Washington. The eight-session Project UPLIFT intervention was group-delivered weekly via the web or telephone. Participants were randomly assigned to condition (i.e., Project UPLIFT or a treatment-as-usual [TAU] waitlist) and assessed at baseline, and after intervening in the Project UPLIFT group (~10 weeks). Assessments included valid self-report measures of seizure frequency and severity and depression. ResultsMediation analysis found that there was a significant negative direct relationship between condition and number of seizures at posttest; the mean number of seizures decreased by 3.2 in the Project UPLIFT group, but increased by 2.3 in the TAU group. The indirect path from condition to number of seizures through change in depression was not significant. Conversely, there was no significant negative direct relationship between condition and seizure severity at posttest, although the seizure severity decreased by 2.2 points in the UPLIFT group and increased by 2.7 points in the TAU group. The indirect path from condition to seizure severity through depression was significant, however, demonstrating that change in depression mediated the effect of Project UPLIFT on seizure severity. ConclusionsThis study found that participating in Project UPLIFT directly reduced the number of seizures experienced by participants with epilepsy. This was not mediated by the change in depression. Participation in Project UPLIFT also reduced their perceived seizure severity indirectly, through reducing their depressive symptoms. This suggests Project UPLIFT may have the potential to impact the health, healthcare costs, and well-being of people with epilepsy.

Factors Influencing Home Births in the Krachi Nchumuru District in the Oti Region, Ghana: a Qualitative Study

The rate of home births compared with health facility deliveries has severe implications for maternal and child health outcomes. In this paper, we explored the factors that influence home births in rural communities in the Krachi Nchumuru District of the Oti Region, Ghana. The paper used qualitative research methods involving in-depth interviews with fifteen women who gave birth at home and traditional birth attendants (TBA). Data were manually analysed using a thematic approach and the results presented in quotes. The findings show that costs associated with health facility delivery, sudden onset of labour period, the absence of health facility and personnel, unavailability of transportation, support and care services of the TBA and the opportunity for spiritual assistance and intervention were the key drivers of home delivery among women in the district. The study also shows home births have some negative effects on maternal and child health during and after labour such as malaria, fever, bleeding after circumcision and a rise in body temperature. Several contextual factors encourage home births among women in the Krachi Nchumuru District, Ghana. There is, therefore, the need to increase health facilities and personnel to provide skilled delivery care and improve the transportation infrastructure in the district.

Evaluation of an interprofessional naloxone didactic and skills session with medical residents and physician assistant learners.

Background:The CDC has reported 399,230 opioid-related deaths from 1999-2017. In 2018, the US surgeon general issued a public health advisory, advising all Americans to carry naloxone. Studies show that enhanced naloxone access directly reduces death from opioid overdose. Despite this, health care professional learners report low knowledge and confidence surrounding naloxone. Therefore, it becomes critical that medical education programs incorporate didactic and experiential sessions improving knowledge, skills and attitudes regarding harm reduction through naloxone.Objectives:1. Describe the components and evaluation of a replicable and adaptable naloxone didactic and skills session model for medical providers; 2. Report the results of the evaluation from a pilot session with family medicine residents and physician assistant students; and 3. Share the session toolkit, including evaluation surveys and list of materials used.Methods:In July 2017, a literature search was completed for naloxone skill training examining best practices on instruction and evaluation. A training session for family medicine residents and physician assistant learners was designed and led by University of Cincinnati College of Medicine and College of Pharmacy faculty. The same faculty designed a pre and post session evaluation form through internal review on elements targeting naloxone knowledge, attitude, and self-efficacy.Results:The training session included one hour for a didactic and one hour for small group live skills demonstration in four methods of naloxone administration (syringe and ampule, nasal atomizer, branded nasal spray and auto injector). Forty-eight participants showed statistically significant (p<0.05) improvement in knowledge (67.5% to 95.9%), attitudes (71.2% to 91.2%), and self-efficacy (62.1% to 97.8%) from pre to post assessment. Forty-four of 48 participants agreed that the pace of the training was appropriate and that the information will be of use in their respective primary care practices. Supply costs for the session were USD 1,200, with the majority being reusable on subsequent trainings.Conclusions:Our study of a naloxone didactic and skills session for primary care trainees demonstrated significant improvements in knowledge, self-efficacy, and attitudes. It provides an adaptable and efficient model for delivery of knowledge and skills in naloxone administration training. The pilot data suggest that the training was efficacious.

A Qualitative Exploration of Division I Tennis Players Completing the Mindfulness Meditation Training for Sport 2.0 Program

The present study examined college tennis players’ experience of the 6-hr sport-tailored mindfulness- and self-compassion-based intervention Mindfulness Meditation Training for Sport 2.0 (MMTS 2.0). Nine college athletes participated in individual semistructured interviews. Interview results revealed that the athletes perceived the mindfulness and self-compassions skills as valuable tools to respond optimally to adversity through observing, accepting, and offering self-compassion toward negative internal states on and off the court. The mindfulness and self-compassion skills were described as creating enhanced ability to overcome challenges and improve focus on the court and an enhanced quality of life off the court, including self-reported well-being markers. The participants also noted several challenges in completing the program (i.e., discomfort meditating, lack of independent practice, and hectic schedule as a student-athlete). These findings provide insight into how the delivery of mindfulness and self-compassion skills in a time-limited environment helps male and female athletes combat competition distress.

Increasing Community Knowledge Through the Literacy Movement

Literacy is an important human skill that depends on the ability and awareness to continue learning. Literacy is very closely related to reading activities and information is interpreted as information or news about something. Information literacy in principle aims to develop skills in understanding the information needed or information literacy both through print media and online media. Community service activities will be carried out activities to increase community knowledge through literacy culture. The main problem experienced by the community in general is the low ability of people to read and get good and correct sources of information and avoid hoax information. The steps for the implementation of community service activities carried out in this community service are training activities, provision of useful books for the community, and assistance. The material presented in the training includes (a) the delivery of basic literacy skills in improving reading, writing, numeracy, science, communication information technology (ICT), financial, and cultural &amp; citizenship skills; (b) information literacy through the introduction of electronic sources (technology), critical thinking, problem solving, communication and synthesis; (c) strategies for selecting correct information and stating the source accurately and avoiding hoax information or false information that contains defamation and blasphemy; and (d) motivation for students to have a sense of caring for the surrounding environment. The results of community service can be concluded that the increase in community knowledge through literacy culture is done through the delivery of training materials, the provision of books that are beneficial to the community, and mentoring activities. As a recommendations for further community service activities is focused on fostering students dropping out of school, dropping out of elementary school, dropping out of middle school, and dropping out of high school through literacy culture based on the identification of problems previously carried out.

EFFECT OF THE DISTANCES OF PUBLIC HEALTH FACILITIES FROM THE NEAREST MAJOR ROADS ON SKILLED DELIVERIES CONDUCTED IN KISUMU COUNTY, KENYA

Abstract. The project sought to describe health facility accessibility and its effect on skilled delivery in Kisumu in line with the pillars of UHC. Proportion of skilled deliveries for 156 public health facilities conducted in 2016 was mined from DHIS2. Healthcare physical services accessibility was represented using a 5km radius fixed distance buffering around health facilities and the health facilities’ distances to the nearest major roads. Simple linear regression was then done between distances of the health facilities to their nearest major roads and skilled deliveries conducted in the health facilities. The mean skilled delivery was 42.5% (Median = 45.8%, Range 0 to 358% and IQR = 48.6%). There exist 4 pockets of underserved areas in Nyando, Nyakach and Muhoroni sub counties measuring 21 km2, 52 km2, 60 km2, 65 km2 and 94 km2 respectively. Distance from the nearest road to skilled deliveries conducted, showed the R2 value was 0.02. The study found out that underserved areas are located away from major roads. The mean skilled delivery was lower than the national of 65%. However some facilities exceeded 100%. This can be explained by in referrals that cause such facilities to exceed their projected workloads. The distance of a health facility to the nearest major road is inversely proportional to the skilled deliveries conducted meaning that the further a heath facility is from a major road, lesser the skilled deliveries conducted in that facility and vice versa. However, this model is weak in establishing such an effect because of the low R2 value. In conclusion, there are pockets of underserved areas in Kisumu and distance of health facilities from the nearest major road does not significantly affect the conduct of skilled deliveries in Kisumu County.

Verbs, visuals, and vignettes: Incorporating images into the impromptu speaking exercise

This activity extends the rich pedagogical scholarship on impromptu speaking by integrating visual imagery into the impromptu speaking exercise. The goal of this semester-long series of exercises is to provide students with the opportunity to apply effective delivery skills across general purposes of speaking, receive feedback, and thus develop the ability to self-correct behaviors and strengthen core public speaking competencies over the course of a semester. The integration of visual imagery offers an engaging medium through which these quick-thinking skills are developed and refined for both the speaker and the audience.CoursesIntroductory Public Speaking, Advanced Public Speaking, Business and Professional Speaking, Interview Communication, Mass Communication, Public Relations.ObjectivesAfter repeated participation in impromptu speech exercises for varying general purposes, students should be able to (a) demonstrate an increased awareness of nonverbal behaviors, (b) apply practices of effective delivery across general purposes of speaking, and (c) demonstrate increased ability to speak extemporaneously.