Experiences Of Health Workers Research Articles

Factors influencing neonatal male circumcision uptake among expecting couples in Zambia: formative findings

ABSTRACT Male circumcision is a protective HIV prevention strategy. However, uncircumcised Zambian men are reluctant to undergo voluntary medical male circumcision (VMMC). Tailored interventions are necessary to stimulate the uptake of early infant male circumcision (EIMC) and VMMC in Zambia. This feasibility study presents the formative process of utilising the PRECEDE framework in the development of a family-centred EIMC/VMMC intervention, Like Father Like Son, and its application in an existing VMMC intervention, Spear & Shield. We found that fear of the pain associated with EIMC procedures, foreskin disposal, beliefs in children’s autonomy and rights, and men’s dominance in health decision-making were factors affecting EIMC uptake. Perceived benefits for infants included improved hygiene, protection from HIV infection, and faster recovery. Reinforcing factors included female partners and fathers’ MC status. The availability and access to EIMC services and information, skill and experience of health workers, and engagement and belief in traditional circumcision practices were factors enabling EIMC uptake. These individual, interpersonal, and structural factors positively and negatively influencing EIMC uptake in the Zambian clinic context were integrated into the intervention for expecting parents. Feedback from community advisory boards suggested the process was effective in developing a culturally tailored and acceptable EIMC/VMMC promotion intervention.

'Kontra-partido': untangling oppositional local politics andhealthcare devolution inthe Philippines.

A long-recognized problem of healthcare devolution in many developing countries is its inextricability from the influences of local politics. This has been particularly self-evident in the Philippines, where, since the adoption of the Local Government Code of 1991, the devolution of health governance, planning, administration and service delivery has placed the health system largely under the control of individual provinces, cities, municipalities and villages or barangays. In this article, we utilize the notion of 'kontra-partido' (the Filipino term connoting 'oppositional politics') to concretize local, oppositional politics as a lived experience of health workers, government officials and ordinary citizens in the country. Through multi-sited qualitative fieldwork, we demonstrate how 'kontra-partido' politics ultimately worsens health outcomes in any locality. We show how such politics figures in the relational dynamics of health governance, often resulting in petty infighting and strained relationships among local health authorities; how it leads to the politicization of appointments and prevents the local workforce, especially those at the grassroots, from doing their jobs efficiently amid environments rife with hostile patronage; and how it impedes service delivery as politicians prioritize 'visible' projects (over sustainable ones) and selectively deliver health care to their known supporters. In turn, health workers and ordinary citizens alike have been actively negotiating their roles within this political milieu, either by joining the so-called political frontlines or by engaging in the transactional relationships that develop between politicians and their constituents during perennial election seasons. We conclude with a reflection on the vulnerability of health to politicization and the visceral consequences of 'kontra-partido' politics to health workers, as well as an identification of possible areas of intervention for future policy reform, given the deepening political polarization in the country and the upcoming implementation of the recently passed Universal Health Care Law.

Understanding Reproductive Health among Survivors of Paediatric and Young adults (URHSPY) cancers in Uganda: A mixed method study protocol.

Although reproductive failure after cancer treatment in children and young adults has been extensively described in high-income countries, there is a paucity of data in low-income settings. In addition, patient, parent, or health worker experiences, perspectives, and attitudes toward the risk of reproductive failure among young cancer patients in these settings are unknown. This study will describe the extent of reproductive morbidity associated with cancer treatment among childhood and young adult cancer survivors in Uganda. In addition, we aim to explore the contextual enablers and barriers to addressing cancer treatment-related reproductive morbidity in Uganda. This is an explanatory sequential mixed-method study. The quantitative phase will be a survey among childhood and young adult cancer survivors recruited from the Kampala Cancer Registry (KCR). The survey will utilize a Computer Assisted Telephone Interview (CATI) platform on a minimum of 362 survivors. The survey will obtain information on self-reported reproductive morbidity and access to oncofertility care. The qualitative phase will use grounded theory to explore contextual barriers and enablers to addressing reproductive morbidity associated with cancer treatment. The quantitative and qualitative phases will be integrated at the intermediate and results stage. Results from this study will inform the development of policy, guidelines, and programs supporting reproductive health among childhood and young adult cancer survivors.

The experiences of health workers using telehealth services for diabetes-related foot complications: a qualitative exploration

BackgroundDiabetes-related foot disease (DFD) accounts for up to 75% of lower-extremity amputations globally. Rural and remote communities are disproportionately affected by DFD. Telehealth has been advocated as a strategy to improve equity of access to health care in rural and remote communities. Current literature suggests that successful implementation of telehealth requires access to adequate reliable equipment, staff training, and support. A real-time video-based telehealth foot service (TFS) for delivering DFD management has recently been established in a Vascular Surgery and Podiatry clinic within a large South Australian metropolitan hospital. The purpose of this study was to gain insights into the experiences of rural and remote health professionals utilising the TFS, as this could be invaluable in optimising the uptake of telehealth use in DFD.MethodsThis exploratory, descriptive qualitative study employed one-on-one, semi-structured interviews with health professionals who utilised the service. Thematic analysis using an essentialist inductive approach was employed.ResultsParticipants included 14 rural and remote health professionals; 2 general practitioners, 2 nurses, 1 Aboriginal Health Practitioner, and 9 podiatrists. In addition, 2 metropolitan-based TFS staff were interviewed. Five key themes were identified. ‘Patients have reduced travel burden’ included that telehealth enabled Indigenous patients to stay on country. ‘Patients had increased psychosocial support’ covered the benefits of having health professionals who knew the patient present in consults. ‘Improved access’ incorporated how telehealth improved interprofessional relationship building and communication.‘Technological and equipment challenges’ highlighted that poor network connectivity and poor access to equipment to conduct telehealth consults in rural areas were barriers. The last theme,’Lack of service communication to rural health professionals’, highlighted the need for communication around service details.ConclusionTelehealth is a valuable tool that can improve access to treatment for rural and remote Indigenous DFD patients. While this has the potential to improve DFD outcomes, empirical data is required to confirm outcomes. Considering the advantages of telehealth and rural staff shortages, there is an urgent need for investment in improved equipment and processes and an understanding of the training needs of the health care workforce to support the use of telehealth in DFD management.

Human preparedness: Relational infrastructures and medical countermeasures in Sierra Leone

ABSTRACT This paper examines health worker experiences in two areas of post-epidemic preparedness in Sierra Leone – vaccine trials and laboratory strengthening – to reflect on the place of people in current models of epidemic response. Drawing on ethnographic research and interviews with health workers in the aftermath of Ebola, it explores the hopes and expectations that interventions foster for frontline workers in under-resourced health systems, and describes the unseen work involved in sustaining robust response infrastructures. Our analysis focuses on what it means for the people who sustain health systems in an emergency to be ‘prepared’ for an epidemic. Human preparedness entails more than the presence of a labour force; it involves building and maintaining ‘relational infrastructures’, often fragile social and moral relationships between health workers, publics, governments, and international organisations. The COVID-19 pandemic has underscored the value of rethinking human resources from an anthropological perspective, and investing in the safety and support of people at the forefront of response. In describing the labour, personal losses, and social risks undertaken by frontline workers for protocols and practicality to meet in an emergency context, we describe the social process of preparedness; that is, the contextual engineering and investment that make response systems work.

Bachelor of Science in Nursing students' perceptions of being a nurse: A scoping review.

High attrition rates in new graduate nurses maybe attributed to unrealistic perceptions of being a nurse. It is therefore important to identify nursing students' perceptions and the factors that influence them. The present study was conducted to identify and describe the literature relating to nursing students' perceptions of being a nurse. Research questions guiding the review were: (1) What are nursing students' perceptions of nursing? (2) What factors influence nursing students' perceptions of nursing? A scoping literature review was conducted between the years 2008 and March 2022 to capture nursing student perceptions from multiple countries, and year levels of study to note the changes in perceptions overtime. The data sources consisted of five electronic data bases; CINAHL, Medline, PsychINFO, Scopus, and Web of Science and search engine Google Scholar revealed 39 relevant sources. A scoping review methodology informed by the Joanna Briggs Institute and a published Scoping Review Checklist guided this review. An inductive thematic analysis identified five key themes. Key themes: Attributes and characteristics of nurses; Nursing as a profession; Skills required for nursing; Gender perceptions; and Influence of time and previous health work experience. Findings provide insight for future research to ensure the adequacy of curricula experiences in preparing new graduates for having realistic perceptions for practice. For nursing students to be prepared for the role of a nurse they must have realistic perceptions of what it means to be a nurse. Whilst it is evident that perceptions can be influenced by a variety of sources, this review highlights a lack of research pertaining to perceptions related to the physical, emotional, and social effects on an individual from being a nurse.

Reward Management as A Precursor of Employee Retention in Christian Faith-Based Health Institutions in Kenya: Moderating Role Transformation Leadership

Employee retention is one of the most critical issues facing health institution managers today. In Kenya, Health Sectors have experienced health workers' strikes and high employee turnover. Retaining staff in Christian Faith-Based Health institutions is a dilemma that many health institutions have to grapple with. This motivates the undertaking of the current study to assess reward management as a precursor of employee retention in Christian faith-based health institutions in Kenya. A descriptive research design was used. The target population was 10,124 staff from CHAK Organization. The sample size was 385. The study used primary data collected using a questionnaire. Findings indicated that reward management was a significant precursor for employee retention in Christian Faith-Based health institutions in Kenya (B= 0.754, P = .003). An increase in reward management would impact positively on employee retention. The study concluded that reward management is a significant precursor for employee retention in Christian Faith-Based health institutions. The study also concluded that transformational leadership has a significant moderating effect on the relationship between reward management and employee retention. The study recommends that management in Christian Faith-Based health institutions should seek to measures manage rewards effectively.

The Use of Video in Delivering Maternal Health Education in Mountainous Areas: A Qualitative Exploration of the Experience of Health Workers.

Health education via DVD/video has been demonstrated as a novel method to encourage a positive change and improvement in patients' health behaviors. A community health project was implemented in Cao Bang, a mountainous area of Vietnam, for health workers to use tablets, portable projectors, and television to disseminate health education messages via designed video clips. A qualitative study using semi-structured individual and group interviews was conducted with 25 health workers in Trung Khanh district to explore their experience of using video in providing health education. The video was confirmed to be an accessible, interactive, and flexible tool supporting health education activities in this mountainous area. However, some health workers in the mountainous area struggled due to a lack of technological skills and responsibility for their work. More training on using technology for health professionals and incorporating video-based health education activities into labor contract-based responsibilities can alleviate present obstacles.

Implementation and evaluation of obstetric early warning systems in tertiary care hospitals in Nigeria.

Obstetric Early Warning Systems (EWS) use combined clinical observations to predict increased risk of deterioration and alert health workers to institute actions likely to improve outcomes. The objective of this study was to explore the experience of health workers about the implementation of an obstetric EWS and assess its effectiveness as an alternative clinical monitoring method compared to standard practice. This mixed-method study included obstetric admissions (n = 2400) to inpatient wards between 01/08/2018 and 31/03/2019 at three Nigerian tertiary hospitals (1 intervention and two control). Outcomes assessed were the efficiency of monitoring and recording vital signs using the patient monitoring index and speed of post-EWS trigger specialist review. These were evaluated through a review of case notes before and four months after EWS was introduced. Qualitative data was collected to explore healthcare workers' views on EWS' acceptability and usability. EWS was correctly used in 51% (n = 307) of the women in the intervention site. Of these women, 58.6% (n = 180) were predicted to have an increased risk of deterioration, and 38.9% (n = 70) were reviewed within 1 hour. There was a significant improvement in the frequency of vital signs recording in the intervention site: observed/expected frequency improved to 0.91 from 0.57, p<0.005, but not in the control sites. Health workers reported that the EWS helped them cope with work demands while making it easier to detect and manage deteriorating patients. Nurses and doctors reported that the EWS was easy to use and that scores consistently correlated with the clinical picture of patients. Identified challenges included rotation of clinical staff, low staffing numbers and reduced availability of monitoring equipment. The implementation of EWS improved the frequency of patient monitoring, but a larger study will be required to explore the effect on health outcomes. The EWS is a feasible and acceptable tool in low-resource settings with implementation modifications. Trial registration: ISRCTN, ISRCTN15568048. Registration date; 9/09/2020- Retrospectively registered, http://www.isrctn.com/ISRCTN15568048.

Health worker experiences of implementing TB infection prevention and control: A qualitative evidence synthesis to inform implementation recommendations.

Implementation of TB infection prevention and control (IPC) measures in health facilities is frequently inadequate, despite nosocomial TB transmission to patients and health workers causing harm. We aimed to review qualitative evidence of the complexity associated with implementing TB IPC, to help guide the development of TB IPC implementation plans. We undertook a qualitative evidence synthesis of studies that used qualitative methods to explore the experiences of health workers implementing TB IPC in health facilities. We searched eight databases in November 2021, complemented by citation tracking. Two reviewers screened titles and abstracts and reviewed full texts of potentially eligible papers. We used the Critical Appraisals Skills Programme checklist for quality appraisal, thematic synthesis to identify key findings and the GRADE-CERQual method to appraise the certainty of review findings. The review protocol was pre-registered on PROSPERO, ID CRD42020165314. We screened 1062 titles and abstracts and reviewed 102 full texts, with 37 studies included in the synthesis. We developed 10 key findings, five of which we had high confidence in. We describe several components of TB IPC as a complex intervention. Health workers were influenced by their personal occupational TB risk perceptions when deciding whether to implement TB IPC and neglected the contribution of TB IPC to patient safety. Health workers and researchers expressed multiple uncertainties (for example the duration of infectiousness of people with TB), assumptions and misconceptions about what constitutes effective TB IPC, including focussing TB IPC on patients known with TB on treatment who pose a small risk of transmission. Instead, TB IPC resources should target high risk areas for transmission (crowded, poorly ventilated spaces). Furthermore, TB IPC implementation plans should support health workers to translate TB IPC guidelines to local contexts, including how to navigate unintended stigma caused by IPC, and using limited IPC resources effectively.

Challenges to paediatric tuberculosis care as perceived by health workers in Kano, North-western Nigeria

Tuberculosis (TB) remains the world’s deadliest infectious disease that affects a third of the world’s population and newly infected an estimated 10 million people in 2018. The number of TB infected Nigerians ranks sixth in the world and first in Africa. Kano State has the highest Nigerian TB prevalence. I aimed to identify Paediatric TB care challenges as perceived by Kano Medical and DOT health care providers. The study design was prospective, descriptive and cross sectional involving structured questionnaire interviews of 43 healthcare providers, during TB supervision visits of 10 Health facilities in Kano. Generated data was entered, validated and analysed using the STATA 13 statistical software package. The sample size was convenient, since it is the number of all the health providers working in the facilities assigned to the author for supervision under a supervision contract with KNCV in 2017. Of the 43 respondents, there were 26 males, with a M: F ratio of 1.5: 1. Those health workers aged from 30 and 40 years constituted 58% of respondents. The staff cadre of respondents comprised of Community Health Extension Workers [CHEW] (40%), doctors (30%) and nurses (3%). Up to 51% of respondents had over 10 years health worker experience and greater than 36 months Child TB DOT care provision. The most commonly identified challenges to paediatric TB care included poor health knowledge (97.7%), poor health seeking behaviour (95.4%), poverty (95.4%), the inability of children to cough up sputum 95.4%, late presentation (90.7%), contact tracing logistics (90.7 %), patient and community factors of stigma and discrimination (86%) and poor health worker paediatric TB knowledge (70%). Perceived health worker challenges to effective Paediatric TB care were the adult orientation of the TB programme and its contact tracing logistic challenges, inadequate health worker Paediatric TB knowledge, children’s inability to cough up sputum, poverty, poor patient TB health knowledge, community stigma and discrimination, poor health seeking behaviour and late presentation.

Apparently We Cannot Live, We are like Infectious Zombies: A Qualitative Research on Personal and Familial Experiences of Health Workers in the Filiation Teams in Turkey during the COVID-19 Pandemic

ABSTRACT This study aims to examine the experiences of health workers in filiation teams in Turkey. The qualitative research model has been used. 375 health workers have participated using a non-probability sampling method. The data were collected over the internet using the questionnaire. The data have been analyzed with the MAXQDA and various code-sub codes-segment maps and code matrices have been used. The results expressed in two dimensions: instrumental and emotional areas. It has been observed that issues such as burnout, loss of motivation, and future anxiety have often been coded due to poor working conditions of the filiation teams, lack of rewards, and other factors. They have been determined as experiencing social stigma along with fear of infecting their families, and therefore have problems with child care, visiting adult family members in the risk group. It is recommended to develop psychosocial support services and improve organizational conditions.

Feasibility, acceptability, and appropriateness of a mobile health stroke intervention among Ghanaian health workers

BackgroundmHealth interventions can improve care delivery in settings with limited resources. The Phone-based Interventions under Nurse Guidance after Stroke (PINGS) is a nurse-led, mHealth-centered approach to blood pressure (BP) control among recent stroke survivors with hypertension in Ghana. It has 4 key components: (1) home blood pressure monitoring, (2) nurse-coordinated mhealth consults, (3) phone alerts as medication reminders, and (4) patient motivational messages delivered as interactive voice recordings. ObjectiveTo assess the feasibility, acceptability, and appropriateness for scale up of the PINGS intervention in Ghana, from the perspective of health workers. MethodsBetween July and August 2021, we deployed an online questionnaire describing the components of PINGS to a cross-section of health workers in Ghana. The questionnaire used an adaptation of psychometrically validated Likert scale measures to elicit agreement or disagreement with attributes of the intervention. The questionnaire was distributed online to approximately 4000 healthcare workers via email and social media platforms. A summary of descriptive statistics was obtained; summed composite scores were then calculated, dichotomized, and binary logistic regression performed using R programming software. ResultsOf 653 health workers who completed the survey, 57.2% were male; 73.2% clinicians; median age was 33 years (IQR 29, 37). Respondents' primary workplaces were public (64.4%), quasi-government (9.4%), and private, including mission-based (26.2%) facilities. PINGS was deemed feasible, acceptable, and appropriate by 93.9%, 94.8%, and 95.1% of respondents respectively. Clinical staff had higher odds of finding PINGS feasible (OR 4.10; C.I. 2.15, 8.0; p < 0.001), acceptable (OR 3.76, C.I. 1.87, 7.69; p < 0.001), or appropriate (OR 2.91, C.I. 1.41, 5.95; p = 0.004) compared to non-clinical staff. There was no statistically significant difference in the rating of each measure when analyzed by age, sex, years of health work experience, geographic location, type, or level of health facility. ConclusionAn overwhelming majority of health workers (particularly clinical staff) considered PINGS to be a feasible, acceptable, and appropriate for BP control among stroke survivors in Ghana.

’[We] learned how to speak with love’: a qualitative exploration of accredited social health activist (ASHA) community health worker experiences of the Mobile Academy refresher training in Rajasthan, India

IntroductionMobile Academy is a mobile-based training course for India’s accredited social health activist (ASHA) community health workers (CHW). The course, which ASHAs access by dialling a number from their phones,...

Healthcare Frontliners Experiences during COVID-19 Pandemic: A Phenomenological Study

Healthcare personnel are working in the higher-risk department as they are in primary contact with Covid-19 patients. In the Philippines, 2,315 Filipino healthcare workers have been infected by the corona virus as of May 2020, with death toll at 35 (DOH, 2020). A qualitative study using empirical phenomenological approach was used to examine the lived experiences of healthcare frontliners. Participants are healthcare frontliners, specifically nurses who are providing direct care and treatment for patients with Covid-19. Participants were recruited through purposive and snowballing sampling. Data was saturated on the 15th informants. Result showed that Healthcare frontliners face a challenging situation in this time of pandemic. Challenges of the healthcare frontliners includes physical challenges, emotional challenges, psychological challenges, financial challenges and organizational challenges. Despite the overwhelming challenges they are facing, still they have ways to cope up with these challenges. Their coping strategies includes strengthening mental health, strong spiritual health, support system and strengthening physical health. The importance of recognizing the experiences of health workers and understanding them is deemed significantly necessary as these accounts will help influence the policy making of future governmental programs for health workers.

Risk, Causality and Management of Severe Allergic Reactions of RNA Messenger SARS-CoV-2 Vaccine: A Mini Review

SARS-CoV-2 infection has become a health problem throughout the world, including Indonesia with high rates of morbidity (more than 3 million confirmed case) and mortality (more than 80 thousand) due to COVID-19 since it was announced as pandemic in March 2020. Vaccination is one of the efforts to eliminate the pandemic, and just recently Food and Drug Monitoring Agency (BPOM) and Indonesian Government have granted approval for emergency use of messenger RNA (mRNA)-based vaccines. Allergic reactions after vaccination are rare adverse events, including severe allergic reactions and anaphylaxis. Polyethylene glycol (PEG) in mRNA vaccines is thought to be a hidden allergen that trigger allergies. Screening of individuals with a previous history of allergies is necessary to prevent reaction. Experienced health workers are also needed to provide adequate management in the event of a severe allergic reaction or anaphylaxis after COVID-19 vaccination. Aim of this review is to look at the risk of allergy of mRNA vaccine SARS CoV-2; possible causes of allergies and management of individuals with severe allergies/anaphylaxis.

Assessment of Staffing Needs for Frontline Health Workers in Selected Maternal and Child Health Services in 3 Countries of Sub-Saharan West Africa: Cote d'Ivoire, Burkina Faso, and Niger.

Sub-Saharan African countries health systems are generally faced with shortages and inequitable distribution of qualified health workers. The application of provider-population ratio or fixed staff establishments, not considering variation in workload, given contextual variations in service utilization rates, cannot adequately match the human resource needs of different health facilities. The Workload Indicators of Staffing Need (WISN) method uses workload to determine staffing needs in a given facility. The aim of this study was to assess the current workload and staffing needs of maternal and child health services in 12 primary healthcare facilities from Burkina Faso, Niger, and Cote d'Ivoire. We employed the WISN methodology, using document reviews, in-depth interviews with health providers, and observations, to obtain the data needed for estimating the required number of staff in a given facility. Then, we calculated both the WISN difference (current-required staff), and the WISN ratio (current staff/required staff). Using the WISN ratio, we assessed the work pressure that health workers experience. The results showed a shortage of health workers in most services in Cote d'Ivoire and Niger (WISN ratio <1), in contrast to Burkina Faso where services were either adequately staffed or overstaffed (WISN ratio ⩾1). The workload pressure was generally high or very high in Cote d'Ivoire, while in Niger, it was very high in maternity services but rather low in dispensary ones. There was also a geographic discrepancy in health workers staffing, rural areas services being more understaffed, with a higher workload pressure as compared to urban areas ones. This study results strengthens the body of knowledge on the shortage of health workforce in sub-Saharan Africa French speaking countries. Policies and strategies to increase students training capacities and the application of regular WISN studies for a better staff distribution are necessary to address the human resource needs of health facilities in these countries.

Training as a Tool for Service Delivery: A Case Study of Health Care Workers in Gwanda, Zimbabwe

The healthcare sector across most global south countries is challenged by various issues and this includes poor service delivery. The delivery of quality service within healthcare institutions is complicated by unprecedented emigration of healthcare workers to the global north. The other challenges include, poor funding and infrastructure, limited medical resources, equipment, and shortage of health care experts. As such this study examines how on and off the job training of healthcare workers impact service delivery. Adopting a quantitative paradigm, the paper identifies the training provided to healthcare workers and examines the effectiveness of the training for effective service delivery. A closed-ended structured questionnaire was used to elicit responses from 80 healthcare workers at Manama Mission Hospital in Gwanda, Zimbabwe. Findings revealed that practical hands-on experience (on-the-job training) supported with effective supervision and guidance from more experienced health workers aids effective service delivery. Training targeted at effective service delivery, constant assessment, and provision of constructive feedback from senior staff members are crucial measures for an effective healthcare system. Beyond constant training, measures must be put in place to ensure the retainment of healthcare experts within the country as an overstretched healthcare system will continue to battle with ineffective service delivery. This study adds to the body of knowledge related to employee training of healthcare workers within Zimbabwe.

KESIAPSIAGAAN PETUGAS KESEHATAN PUSKESMAS DALAM MANAJEMEN BENCANA DI WILAYAH KERJAPUSKESMAS SILIH NARA KABUPATEN ACEH TENGAH

  Disaster management is a very important factor to reduce the impact of disaster events. This study aims to determine the preparedness of health workers in disaster management based on the characteristics, knowledge, attitudes and practices/previous experiences of health workers in disaster management. This type of research is a quantitative research with a cross sectional approach. The study was conducted in the Working Area of the Silih Nara Health Center, Central Aceh Regency in August 2021 with a population of 85 health workers and all of them were used as samples (total sampling). Data analysis used univariate, bivariate and multivariate analysis. The results of data analysis show that there is a relationship between age and knowledge and attitudes, while based on previous practice/experience there is no relationship; there is no relationship between gender and previous knowledge, attitude and practice/experience; there is a relationship between education and previous knowledge, attitudes and practices/experience; there is a long-standing relationship with knowledge but no long-standing relationship with previous attitudes and practices/experiences; there is a relationship between involvement in disaster response with previous knowledge, attitudes and practices/experiences; there is a relationship between disaster management training and previous attitudes and practices/experience, while disaster management training has no relationship with knowledge; There is a relationship between being included in the Rapid Action Team (TGC) with previous knowledge, attitudes and practices/experiences based on the preparedness of health workers in disaster management in the Work Area of the Silih Nara Health Center, Central Aceh Regency. The variable of disaster management training is the most dominant variable in the preparedness of health workers in disaster management in the Work Area of the Silih Nara Health Center, Central Aceh Regency.

Optimising recruitment to a late-phase tuberculosis clinical trial: a qualitative study exploring patient and practitioner experiences in Uzbekistan

BackgroundAddressing the global burden of multidrug-resistant tuberculosis (MDR-TB) requires identification of shorter, less toxic treatment regimens. Médecins Sans Frontières (MSF) is currently conducting a phase II/III randomised controlled clinical trial, to find more effective, shorter and tolerable treatments for people with MDR-TB. Recruitment to the trial in Uzbekistan has been slower than expected; we aimed to study patient and health worker experiences of the trial, examining potential factors perceived to impede and facilitate trial recruitment, as well as general perceptions of clinical research in this context.MethodsWe conducted a qualitative study using maximum variation, purposive sampling of participants. We carried out in-depth interviews (IDIs) and focus group discussions (FGDs) guided by semi-structured topic guides. In December 2019 and January 2020, 26 interviews were conducted with patients, Ministry of Health (MoH) and MSF staff and trial health workers, to explore challenges and barriers to patient recruitment as well as perceptions of the trial and research in general. Preliminary findings from the interviews informed three subsequent focus group discussions held with patients, nurses and counsellors. Focus groups adopted a person-centred design, brainstorming potential solutions to problems and barriers. Interviews and FGDs were audio recorded, translated and transcribed verbatim. Thematic analysis, drawing on constant comparison, was used to analyse the data.ResultsHealth system contexts may compete with new approaches especially when legislative health regulations or policy around treatment is ingrained in staff beliefs, perceptions and practice, which can undermine clinical trial recruitment. Trust plays a significant role in how patients engage with the trial. Decision-making processes are dynamic and associated with relationship to diagnosis, assimilation of information, previous knowledge or experience and influence of peers and close relations.ConclusionsThis qualitative analysis highlights ways in which insights developed together with patients and healthcare workers might inform approaches towards improved recruitment into trials, with the overall objective of delivering evidence for better treatments.