Equitable Health Care Services Research Articles

Status and effects of health workforce related factors on implementation of universal health care in Nakuru West Sub County, Nakuru, Kenya

Background: Globally, due to low health care coverage, there have been continued efforts to ensure that there is increased accessibility to quality, affordable and equitable universal health care (UHC) services in most parts of developing countries, such as within Nakuru county in Kenya.Methods: The study focused on determining health workforce gaps in health care facilities that affect the implementation of UHC in Nakuru West Sub County. Cross-sectional study design was applied, data was collected using structured questionnaires, analyzed using statistical package for social sciences 23rd version and presented in charts for ease comparison.Results: The findings of this study indicated that there was shortage of HWCs. This implies that the staffing in the facilities located in Nakuru West Sub-County is inadequate for the implementation of the Kenyan government UHC and it was evident that the mostly affected sections were the nursing, public health officer (PHO), pharmacy, clinical officers and laboratory in that order. Most alarmingly, majority of the HCWs (58.2%) were not being appreciated for good work, despite the fact that they play a key role in the implementation of UHC.Conclusions: It is therefore imperative for the county government which is the arm of the Kenyan government to ensure that they recruit adequate health care workers in all cadres to serve the continuously rising population and HCWs should have adequate level of education, acceptable training skills and be well- motivated.

Patient-Reported Experiences in Accessing Primary Healthcare among Immigrant Population in Canada: A Rapid Literature Review.

(1) Background: Immigrants represent around 21.9% of the total population in Canada and encounter multifaceted obstacles in accessing and receiving primary healthcare. This literature review explores patient experiences in primary care from the perspective of immigrants and identifies areas for further research and improvement. (2) Methods: A comprehensive search was performed on PubMed, MEDLINE, Embase, SCOPUS, and Google scholar to identify studies published from 2010 to July 2020. Relevant articles were peer-reviewed, in English language, and reported patient experiences in primary healthcare in Canada. (3) Results: Of the 1566 searched articles, 19 articles were included in this review. Overall, the finding from articles were summarized into four major themes: cultural and linguistic differences; socioeconomic challenges; health system factors; patient–provider relationship. (4) Conclusion: Understanding the gaps to accessing and receiving appropriate healthcare is important to shape policies, enhance the quality of services, and deliver more equitable healthcare services. It is therefore pertinent that primary healthcare providers play an active role in bridging these gaps with strong support from policymakers. Understanding and respecting diversity in culture, language, experiences, and systems is crucial in reducing health inequalities and improving access to quality care in a respectful and responsive manner.

Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

BackgroundTwo of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks. This paper seeks to examine whether the type of health insurance enrollment affects the utilization of health services, choice of provider and financial protection of households in Togo.MethodsData were obtained from a cross-sectional, representative household survey involving 1180 insured households that had reported either illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. A nested logit model was used to account for the utilization of health services and provider choice, and methods of assessing catastrophic health care expenditures were used to analyze the level of household financial protection.ResultsPolicyholders of private health insurance use private health care facilities more than policyholders of public health insurance. The main reasons for not using health centers among households with public insurance were out-of-pocket payments (49.19%), waiting time (36.80%), and distance to the nearest health center (36.76%). Furthermore, on average, households with public insurance spent a higher proportion of their total monthly nonfood expenditures on health care than those with private insurance. We find that the type of insurance, share of expenditures allocated to food, distance to the nearest health center, and waiting time significantly impact the choice of provider. Regardless of the type of health insurance, elderly individuals avoid using private health centers and referral hospitals due to the high cost.ConclusionWe found that a multiple health insurance system results in a multilevel health system that is not equitable for everyone. The capacity of the health insurance system to provide equitable health care services and protect its members from catastrophic health care expenditures should be at the core of health care reform. This study recommends raising awareness of the criteria for the reimbursement of medical procedures within the framework of public insurance and promoting specific health insurance mechanisms for elderly individuals. Careful attention should be paid to ensuring universal education and literacy as a means of improving access to and the use of health care.

How to adapt sexual and reproductive health services to the needs and circumstances of trans people\u2014 a qualitative study in Colombia

BackgroundPeople living a trans-life require access to equitable healthcare services, policies and research that address their needs. However, trans people have experienced different forms of violence, discrimination, stigma, and unfair access barriers when dealing with healthcare providers. Therefore, adapting sexual and reproductive health services with the purpose of providing more equitable, inclusive and discrimination-free healthcare services is an urgent need. The article presents an example of how operative research can be used in order to adjust sexual and reproductive healthcare services to trans people’s needs, identities and circumstances.MethodsThis is a qualitative study written from a constructivist perspective, and it is based on the voices and experiences of trans people in four major cities in Colombia. The research used a combination of focus groups of discussion (n = 6) and in-depth interviews with trans people (n = 13) in Barranquilla, Bogota, Cali and Medellin. This research had two specific objectives: i) identifying the main sexual and reproductive health needs of people living a trans-life; and ii) generating new evidence in order to guide the adaptation of sexual and reproductive health services centered to trans people’s needs, identities, and circumstances. Qualitative data codification and analysis was using NVivo.ResultsOnce access barriers to sexual and reproductive health services, unmet sexual and reproductive health needs were identified, the research helped define strategies to adapt sexual and reproductive health services to the needs, identities, and circumstances of people living a trans-life in Colombia. Amongst the main barriers found were healthcare costs, lack of insurance, stigmatization, discrimination and abuse by health care providers. Perhaps among the most notable sexual and reproductive health needs presented were trans-specific services such as sensitive assistance for the transition process, endocrinology appointments, and sex reaffirmation surgeries.ConclusionsThe evidence obtained from this research allowed Profamilia, a Colombian healthcare provider, to adapt the sexual and reproductive health services it provides to people living a trans-life in Colombia. Furthermore, it was possible for Profamilia to design and implement an inclusive sexual and reproductive health program that specifically addresses trans people’s needs, identities, and circumstances.

Out of pocket expenditure for availing maternal health care services in Northern India

Abstract Introduction Maternal and child health comprise one of the most important parameters of the health situation in a country at any given time. Maternal and new born child's health are inter-related to a great extent and while improving one, we might greatly affect the other; hence, joint efforts are required to cope with the rising demands of better healthcare for both. Out-of-pocket expenditure act as a major deterrent, especially to underprivileged communities, in accessibility to maternal health care services and knowledge of the determinants of maternity related expenses helps in outlining policies. Material and Methods This is a community based cross sectional study conducted in state of Uttar Pradesh between July 2019 to December 2019 among 848 women who delivered in past six months at a public health facility. A pretested, semi structured questionnaire was used to collect data. The data thus collected was entered into Microsoft Excel spreadsheet and was analysed using Statistical Package for Social Sciences (SPSS) version 24.0, IBM Inc. Chicago, USA software. Results The analysis showed that the median OOPE was INR 1000 (US$ 13.89) which varied between INR 950 (US$ 13.19) for normal delivery and INR 4900 (US$ 68) for caesarean section. OOPE for availing diagnostic facilities especially ultrasound with a median value of INR 500 (US$ 6.94) contributed to the major share. Women from households with income more than INR 7500 (US$ 104.17) per month, education higher than high school, primi-gravida, occupation of mother and type of delivery were significant predictors for high OOPE. Awareness level about various free entitlements in public health facility was significantly associated with overall out of pocket expenditure. Conclusions Although services at the public health facility in India are supposedly provided free of cost, considerable out of pocket expenditure is still incurred on beneficiaries while availing maternity services. Key messages Out of pocket expenditure is a major deterrent in availing institutional deliveries in public health facilities. Zero-cost, equitable and accessible maternal health care services through timely access to health care facilities is of paramount importance for reducing MMR and IMR in every country.

The Importance of Competent and Equitable Healthcare Services and Data Collection Methods for SGM Communities

The Importance of Competent and Equitable Healthcare Services and Data Collection Methods for SGM Communities

Prison Health as Public Health in Ontario Corrections

The majority of incarcerated individuals in Canada, and especially in Ontario provincial correctional institutions, are released into the community after a short duration in custody. Adult correctional populations have generally poor health, including a heightened prevalence of mental health and substance use disorders. There are legal and ethical obligations to address health care needs of incarcerated individuals, and also public health benefits from ensuring adequate, appropriate, and accessible health services to individuals in custody. The Independent Review of Ontario Corrections recommended the transformation of health care in Ontario provincial corrections in 2017, including transferring health service responsibilities to the Ministry of Health and Long-Term Care. The Correctional Services and Reintegration Act, 2018, would affirm the provincial government’s obligation to provide patient-centred, equitable health care services for individuals in custody. We encourage the Government of Ontario to proclaim the Act and continue the momentum of recent reform efforts in Ontario.

The Role of Collaborative Healthcare in Improving Social Sustainability: A Conceptual Framework

Healthcare systems around the world face both increasing demands and inequality in service distribution. The current trend is for collaboration among healthcare actors, named as collaborative healthcare, in order to address challenges such as these to improve the social sustainability of the system. That is to provide accessible and equitable healthcare services to meet people’s health and well-being needs. Based on an integrative literature review, this study aims at crafting a conceptual framework to explore how collaborative healthcare networks contribute to social sustainability and the specific actors involved in these collaborations. It identifies relationships between different collaborative healthcare networks and social sustainability. Interprofessional networks have been the most studied in relation to social sustainability. Communication and sharing information or knowledge have been identified as used collaborative healthcare practices. This study contributes theoretically by considering a new model of the healthcare organization in which collaborative networks play a central role in improving social sustainability. In terms of practical implications, the study provides managers and policy makers with investment insights on a range of collaborative networks and practices.

Information Assurance and Security Issues in Telemedicine — Future Directions

One of the challenges in healthcare is to provide equitable access to services, given that the provider and the patient are traditionally expected to be physically present in the same place [1], [2], [3]. Technological advancements have been made to overcome obstacles to equitable healthcare services and enable convenient access to quality healthcare for consumers throughout the world. The field of digital healthcare, which is known as telemedicine [2], [3], [4], [5], is rapidly making its way globally across the healthcare services domain. It allows the transfer of images and video through telecommunication technology, giving physicians the ability to evaluate, diagnose, and in certain cases, treat patients remotely [6]. Patients can visit providers over live video without travelling for immediate care and for follow up treatment. Not only does it give patients the ability to schedule appointments with local physicians via live video communication without having to leave home, but it also allows them to consult with distant healthcare professionals and avail their services remotely.

An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design

BackgroundUganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated.MethodsThe overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation – acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability.DiscussionThe study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context.This project is registered at the ISRCTN Registry with number ISRCTN15848572.The trial was first registered on 03/01/2019.

An Intersectionality Approach to the Process of Cultural Competemility – Part II

Significant literature exists that focuses on cultural competence at the individual level, while cultural competence at the organizational level is rarely addressed. In addition, there is extensive literature separating and distinguishing cultural competence from cultural humility. The lack of intersectionality between individuals and organizations and the perceived division between cultural competence and cultural humility impedes the delivery of quality and equitable services. Part II of this two-part series on cultural competemility applies an intersectionality approach to the process of cultural competemility and offer strategies for nurses to actively challenge and address inequalities in their journey towards cultural competemility. In Part II the authors discuss the problem of silo thinking, after which they present an intersectionality perspective of cultural competemility, offer practice, educational, and administrative, and research applications, and conclude that a lens of intersectionality allows healthcare providers to consider new ways to overcome the division between individuals and organizations so as to promote delivery of quality and equitable healthcare services.

Identifying Health Literacy in Kansas Using the Behavioral Risk Factor Surveillance System.

Health literacy continues to be an important research topic as part of population-based assessments for overall health issues. The objective of this continuation study was to examine the health literacy rates and health outcomes as measured by the Kansas Behavioral Risk Factor Surveillance System (BRFSS) survey. A cross-sectional research design was used. Health literacy data were extracted from the state-specific module of the BRFSS telephone survey. Demographic and health status variables were extracted from the core BRFSS dataset. The association between demographic and health status characteristics with health literacy was obtained using weighted samples in multivariable logistic regression models. As in the previous study, most respondents had moderate health literacy (61.1%), followed by high health literacy (31.4%) and low health literacy (7.5%). The demographic variables of interest included race, marital status, home ownership, insurance status, metropolitan status code, survey language, veteran status, education, employment, income, sex, and age. The health status variables included general health rating, presence of chronic conditions, and length of time since last check-up. Findings include individuals with low levels of health literacy were nearly 7 times as likely to be unsure of at least one health condition than those with high health literacy and demonstrate a broad gap in people's ability to communicate accurate information to health-care providers. Results can inform future efforts to build programs that address health disparities issues including low health literacy to provide equitable health-care services. There is a continued need for support for the creation of health literate programs.

Patients\u2019 perspectives regarding hospital visits in the universal health coverage system of Thailand: a qualitative study

BackgroundA universal health coverage policy was implemented in Thailand in 2002 and led to an increase in accessibility to, and equity of, healthcare services. The Thai government and academics have focused on the large-scale aspects, including effectiveness and impacts, of universal health coverage over one decade. Here, we aimed to identify patients’ perspectives on hospital visits under universal health coverage.MethodsA qualitative study was carried out in four public hospitals in rural Thailand. We collected data through focus group discussions (FGDs) and in-depth interviews (IDIs). The semi-structured interview guide was designed to elicit perspectives on hospital visits among participants covered by the Universal Coverage Scheme, Social Security Scheme or Civil Servant Medical Benefit Scheme. Data were transcribed and analysed using a thematic approach.ResultsTwenty-nine participants (mean age, 56.76 ± 16.65 years) participated in five FGDs and one IDI. The emerging themes and sub-themes were identified. Factors influencing decisions to visit hospitals were free healthcare services, perception of serious illness, the need for special tests, and continuity of care. Long waiting times were barriers to hospital visits. Employees, who could not leave their work during office hours, could not access some services such as health check-ups. From the viewpoint of participants, public hospitals provided quality and equitable healthcare services. Nevertheless, shared decision making for treatment plans was not common.ConclusionsThe factors and barriers to utilisation of healthcare services provide exploratory data to understand the healthcare-seeking behaviours of patients. Perceptions towards free services under universal health coverage are positive, but participation in decision making is rare. Future studies should focus on finding ways to balance the needs and barriers to hospital visits and to introduce the concept of shared decision making to both doctors and patients.

Health care curricula in multicultural societies.

Globalisation has led to increasing diversity worldwide. The rapid rise in the number of international migrants over the last 15 years has been unprecedented and currently accounts for more than 10% of the European and 16% of the Norwegian populations. Most countries in Europe attempt to provide equitable health care services to their citizens regardless of their ethnicity, religion, country of origin and other characteristics.1 Still, a large body of literature describes challenges in providing healthcare for multicultural populations for doctors and other health care professionals.2,3 Furthermore, European health professionals are not at ease providing adequate health care in multicultural societies and in many countries they are still to receive systematic training to tackle this new and complex situation.4 Intercultural challenges are often attributed to the immigrant patients alone. However, the responsibility of health professionals in initiating, maintaining or inadequately tackling these challenges cannot be ignored. Although international recommendations to improve cross-cultural care exist,5 health professionals still perform differently in diagnostic procedures undertaken,6,7 number of consultations needed for referral to secondary care,8,9 specificity of diagnoses provided or treatments given10,11 for immigrant patients compared to non-immigrants. Furthermore, immigrants from low and middle-income countries in Europe seem to be less satisfied with health care services than the majority population.12,13 The so-called refuge-crises in 2015 actualised the necessity of dealing with intercultural consultations as a part of everyday work for healthcare professionals. Not surprisingly the authors have frequently been contacted to lecture about migration and health for different audiences. This demand responds to self-perception of lack of knowledge, skills or competencies necessary to give equitable health care to a growing number of immigrant patients.14,15 This paper aims to present and argue the need for a profound change in the healthcare curricula by describing our observations and experiences within medical education. Teaching undergraduate students We will first describe the situation of undergraduate medical students at the end of their education. At the beginning of our lessons, we often explore their experiences and knowledge to ensure that our teaching builds from their current state. Typical questions are: · What health care entitlements can immigrants and refugees receive at the different stages of their life in Norway? · Are there specific risk factors or diseases to be kept in mind, in consultations with patients of migrant origin? · Do we talk about culture with patients? Should we talk about culture at all? How to have effective consultations with translators? · Should we culturally adapt healthcare interventions for specific groups or choose a diversity-sensitive approach that accommodates migrants? As per our observations, few students can answer these or similar questions despite their clinical encounters with patients with immigrant background through their clinical rotations during several semesters. Furthermore, they can seldom refer to senior clinicians who have been good role models for cross-cultural consultations. Moreover, the simple exercise of describing one’s own ethnic and cultural background is often an eye-opener for many students and practitioners. It makes them realise that it is far too easy to describe another persons’ background by the different colour of their skin, their different clothes or because they speak with an accent. It is relatively easy for immigrant students or for Norwegians, who are proud of their regions and local dialects, to describe themselves if they have moved within the country, but the task is far more challenging for those who have never moved out of these local communities.

Brazil's Family Health Strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012).

Universal Health Coverage (UHC) is one of the United Nations Sustainable Development Goals (SDGs). Achieving UHC will require strong health systems to promote and deliver equitable and integrated healthcare services through primary healthcare (PHC). In Brazil, the Family Health Strategy (FHS) delivers PHC through the public health system. Created in 1994, the FHS covered almost 123 million individuals (63% of the Brazilian population) by 2015. The FHS has been associated with many health improvements, but gaps in coverage still remain. This article examines factors associated with the implementation and expansion of the FHS across 5419 Brazilian municipalities from 1998 to 2012. The proportion of the municipal population covered by the FHS over time was assessed using a longitudinal multilevel model for change that accounted for variables covering eight domains: economic development, healthcare supply, healthcare needs/access, availability of other sources of healthcare, political context, geographical isolation, regional characteristics and population size. Data were obtained from multiple publicly available sources. During the 15-year study period, national coverage of the FHS increased from 4.4% to 54%, with 58% of the municipalities having population coverage of 95% or more, and municipalities that had not adopted the programme decreased from 86.4% to 4.9%. The increase in FHS uptake and coverage was not homogenous across municipalities, and was positively associated with small population size, low population density, low coverage of private health insurance, low level of economic development, alignment of the political party of the Mayor and the state Governor, and availability of healthcare supply. Efforts to expand the FHS coverage will need to focus on increasing the availability of health personnel, devising financial incentives for municipalities to uptake/expand the FHS and devising new policies that encompass both private and public sectors.

Determinants Leading to Change in Career Preferences among Medical Students

Background: Information regarding career choices of medical students is important to plan human resources for health, design need-based educational programs and ensure equitable and quality health care services in a country. Objectives: To determine the change in career preferences with successive years among final year medical students and to determine those factors which affect change in career choices among final year medical students. Study design: Cross sectional study. Settling: Allama Iqbal Medical College, Lahore. Data Collection and analysis: Total 230 final year medical students irrespective of their ethnicity or religion fulfilling the inclusion criteria were asked to fill out self-structured questionnaire, which consisted demographic details and their views regarding career choice and various factors influencing on their choices. Finally, data was analyzed by using SPSS version 21. Frequency and percentage were calculated. Results: Out of 230 final year M.B;B.S students, 177 (76.96%) changed their career preference during their medical education. The most important factor influencing change in career preference was the awareness over the passage of time about their future married life, followed by having children, early settlement, high wages, better working conditions and influence of role model. Conclusion: Re-orientation of health care and medical education should be done along with policy settings to attract doctors to the scarcity and high-priority disciplines so that imbalances encountered would be minimal in future.

From Paternalistic to Patronizing: How Cultural Competence Can Be Ethically Problematic.

Cultural competence literature and training aim to equip healthcare workers to better understand patients of different cultures and value systems, in an effort to ensure effective and equitable healthcare services for diverse patient populations. However, without nuanced awareness and contextual knowledge, the values embedded within cultural competence practice may cripple rather than empower the very people they mean to respect. A narrow cultural view can lessen cultural understanding rather than grow it. In its first part, this paper argues that a hasty, unrestrained, and uneducated willingness to accept something as a cultural good, despite being well intentioned, can still cause significant harms-particularly when based on false, misinformed, and stereotypical conceptions-including the minimization of issues, the reinforcement of stereotypes, and the impediment of cultural change. The second part of this paper examines medical autonomy within the context of Saudi Arabian women. It pushes back on the common perception that Saudi women, by virtue of culture and religion, view dependency on and deference to male relatives as a cultural good. Through a historical examination and a presentation of the current women's movement in Saudi Arabia, it is argued that the continued assumption that personal agency is a value external to Saudi women is false, misguided, and ethically problematic. Lastly, this paper considers some approaches to help providers navigate the narrow grounds between paternalism and patronization when caring for patients.

Data visualisation to support decision making and equitable healthcare service provision.

ABSTRACTObjectivesThe aim of this research is to explore current advances in data visualisation technology to improve the analysis of health service utilisation data to support decision making and equitable health care service provision.ApproachMulti-dimensional mapping allows for informative presentation of many types of spatial and geographical data. It allows for the visualisation, question, analysis, and interpretation of data to identify relationships, patterns, and trends. Such techniques can be used to identify patterns in healthcare utilisation relative to a point in time. This can be calendar time, where the event may be a change in services (such as the building of a new hospital) or a change in policy or practice across the system. Or it may be relative time, where the event is a transition in a patient’s health or a new diagnosis.Patterns recognised through such data visualisations may be the result of apophenia, i.e. where patterns are observed in what is essentially random information. Thus, data visualisations such as these are a method to help generate hypotheses which can then be rigorously testing using statistical methods.The entire linked Western Australian Data Collections from 2002-2015 (including population-wide hospital admissions, emergency department presentations, cancer registry records, mental health care, maternity records, and mortality records) were examined. Both changes in the source (patient residential location) and target (location of service used) were visualised. Hypotheses generated were then statistically examined.ResultsThree analyses will be presented. Mean emergency department (ED) presentations follow a specific pattern of rising and falling in the years around a diagnosis of heart failure. The geospatial utilisation of ED over time will be visualised and areas of high and low use of ED will be identified. Mental healthcare involves both ED presentations and inpatient services. The geospatial pattern of ED and inpatient service use by mental health patients over time will be visualised and implications for provision of healthcare services discussed. Finally, in a specific current example, the closure of a metropolitan ED and the subsequent opening of a nearby ED has changed the local population’s pattern of ED use. These changes will be visualised.ConclusionAdvanced methods of data visualisation improve the analysis of large population based datasets to support decision making and equitable health care service provision.

Research for Health Priorities in the Northern Cape Province: Fostering Research Capacity to Translate the Identified Research Needs into Action

Background: Over the past decades active community engagement in health research has gained significant attention in people-centered health systems throughout the world. Yet there is little evidence about how best to enhance active community engagement in setting priorities for health research, particularly from low-and middle-income countries (LMICs). This study presents the approaches employed to identify health research priorities and the lesson learnt from the Northern Cape Province in South Africa. Methods: A combination of approaches involving the Essential National Health Research (ENHR), and the World Cafe consultation processes with the support of experts’ ideas used to enhance key stakeholders (n=41) participation towards the identification of health research priorities for the province. A document on the burden of diseases, health systems challenges and population health status indicators was presented and critically reviewed at the workshop. Results: The top ten health research prority areas for the province identified with active community engagement. More than 90% of the prioritised research areas are operational research which are linked to health services delivery challenges including health systems issues, burden of diseases, health program effectiveness, and the social determinants of health. Conclusion: Active community engagement in setting research priorities for health is a necessary first step to improve the delivery of good quality, equitable and accessible healthcare services for all citizens. However, the current limited resource capacities both in terms of funding and human resources for health research is a concern; and may hamper the effective translation of research priorities to actual action.

Validity and reliability of a thoracic kyphotic assessment tool measuring distance of the seventh cervical vertebra from the wall.

Background:In primary healthcare (PHC) service, community residents, village health volunteers (VHVs), and healthcare professionals need to work in partnership to facilitate universal and equitable healthcare services. However, these partnerships may need an appropriate tool helping them to execute an effective health-related activity.Objectives:To investigate the reliability and validity of a simple kyphosis measure using a perpendicular distance from the seventh cervical vertebra (C7) to the wall (C7WD).Methods:Elderly people with different degrees of kyphosis (n = 179) were cross-sectionally investigated for the intra- and interrater reliability of the measurement by a physical therapist (PT), VHV, and caregiver. The validity was assessed in terms of concurrent validity as compared with the Flexicurve, and discriminative validity for functional deterioration in participants with mild, moderate, and severe kyphosis.Results:The method showed excellent reliability among PT, VHV, and caregivers (ICC > 0.90, p < 0.001), and excellent correlation to the data from the Flexicurve. Results of the assessment were greater than a level of minimal detectable change and could clearly discriminate functional deterioration in participants with different severity of kyphosis (p < 0.001).Conclusion:C7WD is valid and reliable, thus it can be used to promote the standardisation of kyphosis measures among PHC members.