Experiences Of Service Providers Research Articles

The Administration of Youth Justice Through the Lens of Community-Based Service Providers: Risk Factors and Programming Challenges

Since the Youth Criminal Justice Act of 2003 in Canada, the juvenile justice system has prioritized diverting youth away from in-custody sentences (incarceration in jail, prison, or other facilities) and towards a community-based system of justice. Despite this shift, there is limited research directly examining the experience of community-based service providers that were responsible for this shift in adjudicating youth. To understand the experience of working with youth involved in the system, we conducted semi-structured interviews with youth justice workers from one of the largest community-based organizations in a western Canadian province that offer alternatives to custody for at-risk youth. Findings provide a complex depiction of youth risk factors and illustrate the successes and challenges of administering youth justice in a community context.

Barriers to Care After Intimate Partner Violence Acquired Brain Injury: Current Systems Silence Survivors and Providers.

A qualitative meta-synthesis was conducted to answer the following question-What barriers are experienced by survivors of intimate partner violence and service providers when seeking or providing resources or care after experiencing brain injury (BI)? This approach was completed through 2 main phases-a systematic search and literature appraisal and reciprocal translation with interpretive triangulation of the extracted data. The databases searched were PubMed, CINAHL, and PsycInfo. The initial search yielded 559 articles. The final synthesis included 16 articles for the qualitative meta-synthesis. After data extraction, a qualitative exploratory design evaluated the experiences of survivors and service providers when connecting with resources. The findings highlight larger systemic barriers preventing smooth relationships between survivors and providers. Survivor barriers include risk-driven safety mechanisms and a lack of awareness and understanding of BI. Provider barriers are a lack of clarity within providers' scope and training limitations, diagnosis complexity, first responder's initial response to survivors, lack of open discussion, screening limitations, financial barriers, infrastructure barriers, and lack of resources. Systemic barriers include stigmatization, BI symptoms mistaken as other diagnoses like mental health, access and awareness of resources, and navigation of complex systems. This qualitative meta-synthesis demonstrates that survivors and providers face multiple individual and systemic barriers when seeking and providing resources after BI. Future research is needed to understand survivors' help-seeking behaviors and assistance needs and providers' education about BI and organizational relationships and networks. Recommendations are made for future research to understand how to reduce barriers for providers working with survivors, from trauma-informed education and communication to connecting with resources, where to concentrate, and initiatives for collaboration to increase the network of resources yet improve its accessibility.

Developing community-based physical activity interventions and recreational programming for children in rural and smaller urban centres: a qualitative exploration of service provider and parent experiences

BackgroundChildren’s physical inactivity is a persisting international public health concern. While there is a large body of literature examining physical activity interventions for children, the unique physical activity context of low-density communities in rural areas and smaller urban centres remains largely underexplored. With an influx of families migrating to rural communities and small towns, evaluations of health promotion efforts that support physical activity are needed to ensure they are meeting the needs of the growing populations in these settings. The aim of this community-based research was to explore service providers’ and parents’ perspectives on physical activity opportunities available in their community and recommendations toward the development and implementation of efficacious physical activity programming for children in rural communities and smaller urban centres.MethodsThree in-person community forums with recreation service providers (n = 37 participants) and 1 online community forum with the parents of school-aged children (n = 9 participants) were hosted. An online survey and Mentimeter activity were conducted prior to the community forums to gather participants’ views on the barriers and facilitators to physical activities and suggestions for activity-promoting programs. The service provider and parent discussions were audio-recorded, transcribed verbatim, and analyzed following a deductive approach guided by Hseih and Shannon’s (2005) procedure for direct content analysis. A code list developed from the responses to the pre-forum survey and Mentimeter activity was used to guide the analysis and category development.ResultsSeven distinct categories related to the existing physical activity opportunities and recommendations for programs in rural communities and smaller urban centres were identified during the analysis: (1) Recovery from Pandemic-Related Measures, (2) Knowledge and Access to Programs, (3) Availability, (4) Personnel Support, (5) Quality of Programs and Facilities, (6) Expenses and Subsidies, and (7) Inclusivity and Preferences.ConclusionTo improve the health and well-being of children who reside in low-density areas, the results of this study highlight service provider and parent recommendations when developing and implementing community-based physical activity programs and interventions in rural and smaller urban settings, including skill development programs, non-competitive activity options, maximizing existing spaces for activities, and financial support.

Delivery of Enhanced Asthma Care in Pharmacies: Perceptions and Experiences of Australian Service Providers

BackgroundEvidence-based asthma management services have been tested in Australian community pharmacies for over two decades and have been well received by patients but are not retained in practice. The positive clinical outcomes of these tested services suggest the potential for wider implementation, for which the providers’ perspective is critical. ObjectiveThis investigation evaluates the implementability of the Pharmacy Asthma Service (PAS) through the experiences and perceptions of the community pharmacists delivering the service. MethodsForty-eight pharmacists took part in a post-trial semi-structured qualitative telephone interview, representing 42 of 51 (82%) eligible PAS intervention arm pharmacies. Qualitative data were deductively analysed in accordance with the Implementation Outcomes Framework. ResultsPharmacists recognised the positive impact of the service on patients’ health outcomes, the pharmacist’s practice and in fostering stronger and more beneficial pharmacist-patient relationships. However, whilst acknowledging the importance of such a service, the pharmacists faced challenges in recruitment and patient follow-up. Pharmacists stated that further work is required to address pharmacist and patient time constraints, patient health beliefs and to increase the acceptance of pharmaceutical care provision in community pharmacy practice by patients and other health care professionals ConclusionPharmacists can deliver enhanced clinical care for asthma patients with positive perceived professional and patient outcomes. However, it remains evident that time, remuneration and recognition of the pharmacist’s role in chronic care management form barriers to the implementation of asthma services in community pharmacies. Broader policy and systemic changes are required to successfully balance medication supply and quality patient management roles at the same time as a required shift in research processes.

Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach in multicultural context: a qualitative study in identifying the barriers and enablers to Watch Me Grow-Electronic (WMG-E) program with a culturally diverse community

BackgroundChildren and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program.MethodsSemi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study is an implementation evaluation which formed as part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach, using inductive coding, was adopted to analyse the data.ResultsParticipants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink.ConclusionsFamilies and service providers in this qualitative study found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child’s development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and increases knowledge around navigating the health and social care services. Notwithstanding the issues that were raised by families and service providers, which include accessibility challenges for CALD communities, absence of clinical oversight during screening, and narrow scope of engagement with available services being offered, it is worth noting that improvements regarding these implementation factors must be considered and addressed in order to have longevity and sustainability of the program.Trial registration.The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

Working With Youth Who Have Experienced Commercial Sexual Exploitation: Voices From the Field.

Little is known about the experiences of service providers working with youth who have experienced commercial sexual exploitation (CSE). In this qualitative study, 12 service providers shared their experiences working with youth who have experienced CSE. Thematic analysis was used to develop key themes that included the challenges posed by working with this population, including the breadth of necessary services and the type of support that is needed for this work. Participants shared the importance of being prepared to work with this population and learn from those with lived experience. The complexity of cases and the difficulty engaging youth who had experienced CSE were also themes. These results can inform service providers who work with youth about the common challenges in working with this population and prepare the next generation of service providers for this difficult work. Training service providers, managing their expectations, and getting them ready for their role will be critical for successful intervention with youth who have experienced CSE.

Review of Therapeutic Care for Survivors of Online Sexual Exploitation in the Philippines

ABSTRACT Background In studies and reports conducted on online sexual exploitation and abuse of children (OSAEC), identified gaps include understanding programmes and services for victim-survivors. In the Philippines, care services consist of a blend of programmes specifically tailored for OSAEC and more generalised therapies for trauma. However, there is a lack of documentation regarding the variety of programmes available and the experiences of service providers during implementation. This qualitative study aims to provide a comprehensive description and critical analysis of these existing programmes and services. Methods Twenty-two in-depth interviews were conducted with key informants from selected government agencies and non-government organisations involved in providing services for the case management of victim-survivors of OSAEC in identified hotspots. Results A thematic analysis of the interviews revealed that a range of programmes and services are offered to address the needs of the survivors in various aspects of their lives, encompassing psychological, medical, educational, spiritual, and even the recreation of home life. A trauma-informed approach was commonly employed, with care often tailored based on age and gender. Challenges and facilitating factors in providing care were also identified, including limited evaluation of existing programmes and services. The findings carry implications for the ongoing implementation of these programmes, the development of new services and programmes, and the formulation of further policies and laws addressing OSAEC and broader issues concerning child protection and wellbeing.

Urban children at risk of violence: A qualitative study of experiences of parents, teachers, and service providers of collaborative support.

Children who are at risk of involvement in violence need assistance from multisector agencies such as social services, law enforcement, health, and education. The aim of this study was to understand the perceptions and experiences of parents, teachers, and service providers (i.e., counselors, psychologists, paralegals, and social workers) on collaborative support for children at risk of violence in Banda Aceh, Indonesia. Twenty-four structured interviews were conducted with ten parents whose children were victims of sexual or physical abuse or were involved in substance abuse and theft and have received support from the Integrated Service Center for the Empowerment of Women and Children in Banda Aceh, Indonesia; ten service providers; and four teachers who either worked with the concerned children or knew them. Using a thematic analysis approach, the data was systematically coded and analyzed to identify important themes. Most parents who sought help or support from governmental agencies were referred by other service providers or recommended by relatives or friends. Parents hesitated to discuss their children's problems with the teachers, worrying about stigma, particularly for sexual abuse victims. The school's lack of collaboration with external agencies was consistent with the teacher's claim that they seldom work with other agencies outside of school, resulting in a siloed system of care. It can be concluded that the biggest barrier to communication and coordination among parents, teachers, and service providers is the parents' and service providers' lack of willingness and confidence to work with teachers. Clear policies are needed to establish a cross-institutional linkage structure that promotes shared responsibilities.

“We have to fight for our existence in the system”: exploring service providers’ experiences with male victims and female perpetrators of intimate partner violence

Purpose This study aims to investigate the experiences of service providers supporting male victims and female perpetrators of intimate partner violence (IPV). The study explored the drivers, methods and treatments of female-perpetrated IPV, the nature and impact of abuse towards male victims, the barriers and facilitators to service provision and the impact on the practitioners themselves. Design/methodology/approach The study used a qualitative approach, using reflexive thematic analysis to analyse semi-structured interviews with 13 experienced service providers. Findings Two overarching themes were identified: systemic issues in service provision, including challenges with multi-agency approaches, funding and availability of services and the impact on practitioners; and gender stereotypes, which created barriers to male victims' help-seeking and influenced the treatment of female perpetrators. Practical implications The findings suggest the need for a multi-level approach, addressing gendered inequalities in IPV policy and funding, implementing gender-inclusive, evidence-based and trauma-informed practices, and raising public and professional awareness to challenge the dominant “domestic violence stereotype”. Originality/value This study provides a detailed, in-depth exploration of the experiences of service providers supporting “non-typical” populations in IPV, revealing the complex, multi-faceted challenges they face within a system that is inherently designed to support female victims of male perpetrators.

Communicate, support and integrate: strategies to improve engagement with cardiac rehabilitation

Abstract Background Factors beyond Cardiac Rehabilitation (CR) service continue to negatively impact CR attendance and programme completion. Intrapersonal, socioeconomic, health perception/co-morbidity and logistical factors can have a significant impact on CR uptake. During the COVID-19 pandemic many services reconsidered their approach and utilised novel but more flexible delivery solutions (1). As clinical services remodel post-COVID we sought to incorporate the patient perspective. Purpose To identify and co-design strategies to improve engagement with CR. Methods Experience Based Co-Design (EBCD) is a Codesign methodology that incorporates the experiences of patients, caregivers and service providers (2). The project involved staff, patients and caregivers linked to CR across the region. In an iterative process, a literature review followed by focus groups and co-design workshops were conducted by the research team during 2019-2021. Results The co-design workshops identified numerous multifaceted issues in relation to engagement with CR. These can be described in three distinct themes. Communicate Misunderstandings about CR content and efficacy persist amongst patients and the public. Health Care Professionals must streamline, and focus information provided to patients in order to highlight the multifaceted benefits of CR, a patient-led information video for patients and public was produced and shared through CR networks. Support Patients require additional emotional and social support following a cardiac event. Significant concerns described by patients relate to family, work, socialising and future health. A supportive, facilitated discussion was warranted and a brief cardiac intervention (CABIN) was developed and will be tested in a feasibility trial. Integrate Following COVID-19 patients are more receptive to hybrid approaches to delivering CR. Diverse options for delivery of CR should be integrated into standard practice. Patient suggestions included online learning modules, social exercise, video libraries, online support meetings, text chat facilities, and regionally specific webpages. The study resulted in three key outputs; a short regional information video, a regional webpage and the brief supportive intervention, CABIN. Conclusion Co-designing with staff and patients provides relevant and important information about highlighting the importance of and accessing and delivering a service which can be incorporated into future service changes.

Closing doors, opening windows – Adaptations and opportunities for harm reduction services during the COVID-19 pandemic in Europe

Background Across Europe, harm reduction services experienced significant disruptions during the COVID-19 pandemic. This study analyses the experiences of harm reduction service providers during the pandemic in 34 European cities, focusing on their main challenges, adaptations, and opportunities for change. A closer examination of Athens and Dublin offers an in-depth look into these experiences. Methods A mixed-methods approach is used, integrating qualitative and quantitative data. Two surveys conducted in 2020 and 2021 involved 34 European cities. In-depth and informal interviews with four local experts from Athens and Dublin complemented the analysis. Results Despite significant disruptions, many harm reduction services scaled up their operations and achieved favorable policy reforms that were met with resistance before the pandemic. In Athens, major gains were opening the first housing program, the first drug consumption room, and the liberalization of naloxone. In Dublin, new housing, lowered thresholds for methadone provision, benzodiazepine provision, and improved naloxone availability were key gains. Conclusion The pandemic triggered opportunities for policymakers to reframe matters of social equity in the field of drug policies, opening policy windows to further advance harm reduction. Based on these lessons, recommendations to improve social justice and equity for people who use drugs are provided.

Searching for choice and control: Western Australian service provider experiences of health, housing and migration.

This research aimed to inform approaches to increase access to secure housing and improve mental health outcomes for migrants from culturally and linguistically diverse backgrounds (hereafter migrants) who are generally invisible in health and social policy and service provision in Western Australia. We used semi-structured, in-depth interviews (n = 11) and interpretative phenomenological analysis to explore service provider experiences and perspectives of issues impacting service provision and the needs of migrants in this context. Five superordinate themes reveal complex experiences for both service providers and the migrants with whom they work. Findings reflect tensions between contemporary notions of choice and control and a social service system that is difficult to navigate, reflects systemic racism and appears to rely heavily on the non-government sector. Insights have important and practical implications for health promotion policy, practice and research. Recommendations include improvements to housing access, provision, funding and policies; addressing service barriers via staff training and more accessible community resources; and co-design and community outreach approaches.

Disclosure and Reporting of Abuse Against Older Adults: Perspectives of Older Adults with Abuse Histories and Service Providers in Alberta, Canada

ABSTRACT This exploratory qualitative study seeks to understand the barriers and facilitators of disclosure and reporting of abuse against older adults by conducting interviews with older adults with lived experience of abuse and service providers working directly with this population in Alberta, Canada. Thematic analysis revealed three key themes: (1) Barriers to disclosure and reporting of abuse; (2) Facilitators to disclosure and reporting; and (3) Key tensions between service providers’ and older adults’ perceptions of the disclosure and reporting process. Based on these findings, we offer recommendations to increase awareness, promote disclosure, and improve services for older adults experiencing abuse.

Implementing good life with osteoArthritis from Denmark (GLA:D®) in Australian public hospitals. Part 2: Service providers’ perceptions

BackgroundPrevious literature has reported the successful implementation of the Good Life with osteoArthritis in Denmark (GLA:D®) program into predominantly private practice settings. There may be unique challenges present within the public hospital setting that influence GLA:D® implementation in public health. ObjectiveExplore the attitudes and experiences of service providers directly involved in implementing GLA:D® in Australian public tertiary hospitals. DesignQualitative descriptive study design. MethodService providers (n = 14) from three participating hospitals took part in semi-structured focus groups at the completion of the 6-month implementation period. Inductive thematic analysis was employed to identify primary domains across all facilities. ResultsFour broad domains were identified. Factors that influenced uptake included GLA:D® being a recognisable, evidence-based product requiring minimal development or adaptation. The fidelity of the GLA:D® Australia program was challenged by referral of patients with multiple/complex medical comorbidities, and patient preference to complete registry data via paper rather than online. Several operational considerations are required when delivering GLA:D® in a public hospital setting, including adequate numbers of GLA:D®-trained staff, additional screening requirements, obtaining appropriate clinical space, and persisting patient barriers to attending the service. GLA:D® provided benefits beyond improvement in pain and function, including social interactivity, high attendance and promotion of long-term self-management, while also maximising service efficiencies. ConclusionsImplementing GLA:D® in Australian public hospitals was supported by service providers. Specific operational and administrative factors, including staff training, patient complexity, and registry requirements should be considered when attempting to embed and sustain GLA:D® in large Australian public tertiary hospitals.

Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework.

People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing.

Effectiveness of Interventions for Meaningful Activity Participation in Homelessness: A Systematic Review.

Background. Meaningful activity participation has been identified as a key outcome of services designed to support individuals during and following homelessness. Little is known about the effectiveness of interventions for promoting this outcome. Purpose. To identify the range and effectiveness of interventions on promoting meaningful activity participation among persons with experiences of homelessness. Method. We conducted a systematic review using the Joanna Briggs Institute methodology following PRISMA guidelines including a critical appraisal and narrative synthesis. Findings. Of 12,343 titles and abstracts screened, we included 12 studies. The authors of the included studies primarily used standardized measures of meaningful activity engagement. Critical appraisal scores ranged from 50.0 to 77.8. The most common interventions evaluated in the included studies were psychosocial interventions (n = 6; 50.0%), followed by case management and housing support interventions (n = 4; 33.3%) and Housing First (n = 2; 16.7%). While several interventions demonstrated effectiveness in promoting meaningful activity participation including psychosocial and case management interventions, Housing First, Critical Time Intervention, and a peer support intervention were found to be ineffective for promoting engagement in meaningful activity. Conclusion. Few intervention studies have been conducted that demonstrate effectiveness for promoting participation in meaningful activity for individuals during and following homelessness. Occupational therapy researchers and practitioners can build on existing evidence by developing and evaluating novel approaches by co-designing interventions in collaboration with persons with experiences of homelessness and service providers.

Colonial necropolitics in responding to gender‐based violence amidst cascading disasters in Puerto Rico

AbstractThis article analyzes how the practice of cascading disaster responses and the relative erasure of increasing cases of gender‐based violence (GBV), including feminicidio, or feminicide, by the government in Puerto Rico evidence the structural and regularly reproduced vulnerability of marginalized populations. Drawn from fieldwork in southwestern Puerto Rico between 2019 and 2020, this essay juxtaposes the lived experience of frontline GBV service providers with the relative absence of GBV from the public record until 2022. For activists and scholars, the prevalence of GBV and its relative exclusion from state discourse and records is rooted in ideological, cultural, and operational concerns: operationally, GBV is too often excluded from planned disaster response. Culturally, state‐supplied statistics on GBV minimized and otherwise naturalized GBV into a cultural norm or reality‐to‐be‐expected. Ideologically, the exclusion of GBV is also tied to the colonial relationship between Puerto Rico and the United States. We argue that GBV and its relative exclusion from the public record sustains high levels of violence that have already fueled notable public protest and the constrained working conditions of GBV frontline service providers. The article's focus on frontline worker experiences highlights their important role at the forefront of decision‐making on how to mitigate GBV during and in the wake of cascading disasters.

Facilitating virtual social connections for youth with disabilities: lessons for post-COVID-19 programming

Purpose Social connections are essential for the development of life skills for youth. Youth with disabilities have long faced barriers to meaningful social connections. The onset of COVID-19 increased barriers to social connections for all youth, and also led to enhanced use of virtual platforms in paediatric rehabilitation programming. Harnessing this opportunity, service providers created a suite of online programs to foster social connections and friendships. The current study explores participant and service provider experiences of such programs. Methods This qualitative descriptive study used interviews and focus groups to explore how youth with disabilities (n = 8), their parents (n = 7), and service providers (n = 13) involved in program development and delivery experienced the programs, the accessibility of the virtual platforms, and their social connections in relation to program participation. Results Participants were satisfied with the programs’ content, accessibility and ability to meet their social needs. Qualitative themes included facilitating social connections, accessibility of virtual spaces, and recommendations for future virtual programming. Discussion For youth with disabilities who have been historically marginalized in social spheres, the newly ubiquitous infrastructure regarding virtual programming must be supported and enhanced. A hybrid approach involving virtual/in-person options in future programming is recommended.

The quest for continuous quality improvement in Australian long day care services: getting the most out of the Assessment and Rating process

The National Quality Framework (NQF) was intended to drive continuous improvement in education and care services in Australia. Ten years into implementation, the effectiveness of the NQF is demonstrated by steady improvements in quality as measured against the National Quality Standard (NQS). The process of assessing and rating services is a key element in the NQF, drawing together regulatory compliance and quality assurance. This paper draws on findings from a national Quality Improvement Research Project investigating the characteristics, processes, challenges and enablers of quality improvement in long day care services, concentrating on Quality Area 1 Educational program and practice and Quality Area 7 Governance and leadership. This was a mixed-method study focusing on long day care services that had improved their rating from Working toward NQS to Meeting NQS or to Exceeding NQS. The study comprised three phases, and in this paper, we draw on Phase 3 to understand the contribution of the NQS Assessment and Rating (A&R) process to continuous quality improvement from the standpoint of providers and professionals delivering these services. Phase 3 involved qualitative case studies of 15 long day care services to investigate factors that enabled and challenged quality improvement. Data was collected during two-day site visits, using professional conversations and field notes to elicit the views and experiences of service providers, leaders and educators. In this paper, we look at how the A&R process is experienced by those involved in service provision, with a focus on the factors that enabled and challenged quality improvement. Recognizing the interchangeability of enablers and challenges, three broad themes emerged: (i) curriculum knowledge, pedagogical skills and agency; (ii) collaborative leadership and teamwork; and (iii) meaningful engagement in the A&R process. The study found that meaningful engagement in the A&R process informed priorities for ongoing learning and acted as a catalyst for continuous quality improvement. Apprised by stakeholder views and experiences of A&R, we offer a model to foster stakeholder participation in quality assurance matters through affordances of meaningful engagement.

Evaluation of a comprehensive health check offered to frontline health workers in Zimbabwe.

Health workers are essential for a functioning healthcare system, and their own health is often not addressed. During the COVID-19 pandemic health workers were at high risk of SARS-CoV-2 infection whilst coping with increased healthcare demand. Here we report the development, implementation, and uptake of an integrated health check combining SARS-CoV-2 testing with screening for other communicable and non-communicable diseases for health workers in Zimbabwe during the COVID-19 pandemic. Health checks were offered to health workers in public and private health facilities from July 2020 to June 2022. Data on the number of health workers accessing the service and yield of screening was collected. Workshops and in-depth interviews were conducted to explore the perceptions and experiences of clients and service providers. 6598 health workers across 48 health facilities accessed the service. Among those reached, 5215 (79%) were women, the median age was 37 (IQR: 29-44) years and the largest proportion were nurses (n = 2092, 32%). 149 (2.3%) healthcare workers tested positive for SARS-CoV-2. Uptake of screening services was almost 100% for all screened conditions except HIV. The most common conditions detected through screening were elevated blood pressure (n = 1249; 19%), elevated HbA1c (n = 428; 7.7%) and common mental disorder (n = 645; 9.8%). Process evaluation showed high acceptability of the service. Key enablers for health workers accessing the service included free and comprehensive service provision, and availability of reliable point-of-care screening methods. Implementation of a comprehensive health check for health workers was feasible, acceptable, and effective, even during a pandemic. Conventional occupational health programmes focus on infectious diseases. In a society where even health workers cannot afford health care, free comprehensive occupational health services may address unmet needs in prevention, diagnosis, and treatment for chronic non-communicable conditions.