Frontline Workers Research Articles

Work First or Education First? Frontline Service Challenges of Providing Enabling Activation

Activation policies, especially formal upskilling, can strengthen social inequality among long-term unemployed people. Also, receiving skill-enhancing activities may be at odds with the ‘work first’ principle. Drawing on interviews with frontline workers in the Norwegian employment and welfare service (NAV), this article analyses how frontline workers handle the challenging aspects arising from activation policies in providing enabling activities to claimants who need comprehensive support. The findings suggest that frontline workers face claimants who expect to embark on an education, and on the contrary, claimants who lack motivation or capability to do so. In both cases, frontline workers are challenged in terms of experiencing contradictory expectations from policies and users and in assessing future outcomes and suitability of the services. Education activities provided by the public employment agency (PES) involves multiple policy fields and require specific competency on the part of frontline workers.

How to not revert to type: learnings from the pandemic response for universal health system reform

Abstract Background Understanding of the opportunities and learnings for health system change that have arisen during the pandemic is still emerging. Situated in the Irish health reform context of Sláintecare, the programme which aims to deliver universal, integrated healthcare, this study set out to generate evidence on the processes that impacted access to universal, integrated care during COVID-19, with a view to informing universal health system reform and implementation. Methods The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with 16 health system professionals (including managers and frontline workers) from a range of responses to explore their experiences during the pandemic. Following thematic analysis, a complexity-informed approach guided the interpretation of the findings. Results A range of factors facilitated better access to integrated care during the crisis, falling under three key themes (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a human-centred health system. Conclusions Alongside establishing health system structures, we must also incorporate alternative approaches to reform that recognise the value of shared sense-making in an interdependent system, while also allowing for innovation, exploration and learning; and acknowledging the role of social dynamics in driving change.

Interconnected mental health symptoms: network analysis of depression, anxiety, stress, and burnout among psychiatric nurses in the context of the COVID-19 pandemic

BackgroundMental health symptoms such as anxiety, depression, stress, and burnout are common among healthcare workers. However, the interconnections among them remain under-explored. This study aimed to address the interrelationships among these symptoms in psychiatric nurses.MethodsWe conducted a nationwide survey in the early stage of the COVID-19 pandemic (January to March 2021) to investigate the interconnectedness of depression, anxiety, stress, and burnout among psychiatric nurses. Using network analysis, we identified central symptoms, important bridge symptoms, and the correlations among these central symptoms.ResultsOf the 9,224 psychiatric nurses (79.2% female) included in the statistical analyses, 27.6% reported clinically significant depression, 31.2% anxiety, 14.5% stress, and 23.8% burnout. Network analysis revealed that stress had the highest expected influence (EI) value (0.920) and the highest strength among all nodes. The node for depression scored the highest in both closeness and betweenness. Emotional exhaustion (EE) had the highest bridge expected influence (BEI) of 0.340, with the strongest intergroup association between EE and depression. No significant differences were found in gender or frontline work experience (all p > 0.05).ConclusionsBurnout, depression, anxiety, and stress are relatively common among psychiatric nurses in the context of the COVID-19 pandemic. While anxiety was the most prevalent, stress emerged as the core symptom, and depression as an important bridging node. Interventions targeting the core symptoms and bridging nodes may improve the mental health of psychiatric nurses.

Healthcare Internet of Things system implementations for COVID-19 prevention

BackgroundIn response to the widespread transmission of COVID-19 in Australia, healthcare facilities implemented stringent infection control measures, and mandatory and manual screening procedures were introduced to ensure the safety of patients and healthcare staff. However, these necessary measures resulted in imbalances within the healthcare system, a shortage of front-line workers and impacts on patient experience and wait times. The prioritization of infection control measures shifted resources away from routine care, causing delays in accessing necessary healthcare services.Methods and FindingsTo address these challenges, we developed and implemented an Internet of Things (IoT) Smart Screening eGate solution in partnership with a large metropolitan children’s hospital in Australia. This solution integrated a contactless health self-service web app, thermal camera, and physical barrier to automate the COVID-19 health screening and data recording process. During the 3-month pilot period, we deployed the eGate at multiple entrances to the hospital, and monitored the number of users of the system in different periods. We also used a framework of formative evaluation to classify user design challenges within limited resources and improved the design of the eGate to enhance its effectiveness. Our findings show that the IoT eGate solution improved the efficiency of the screening process and reduced the workload and exposure risks of front-line staff and anyone who required access to the hospital. By automating the screening process, we reduced the need for manual screening and minimized contact between individuals, thus reducing the risk of potentially infected.ConclusionIn conclusion, our pilot study demonstrated the potential of IoT technologies in improving the efficiency and safety of medical facilities during pandemics and provided a series of recommendations for the translation of IoT technologies for medical facilities, including the importance of co-design and collaboration with stakeholders, user-centered design, and ongoing monitoring and evaluation.

Assessment of the Knowledge Level of COVID-19 Vaccines and Vaccine Hesitancy amongst Final-Year Medical Students in Southeast Nigeria

Background: Despite how ravaging and deadly COVID-19 infection is, vaccine hesitancy is high among the uneducated, medical students, and health workers, who as frontline workers, should lead by example and drive COVID-19 vaccination efforts. Objectives: This research aims to assess the knowledge level of COVID-19 vaccines among final-year medical students in Southeast-Nigeria universities and determine the factors responsible for the hesitancy of this vaccine among them. Methodology: A cross-sectional study of final-year medical students in six medical schools in Southeast Nigeria using an electronically distributed structured, validated online Google form amongst final-year medical students from which 125 of them responded. Results: Out of a sample of 125 final-year medical students, 123 (98.4%) are aware of COVID-19 vaccines while 2 (1.6%) lack knowledge of COVID-19 vaccines. The demographics of the final year medical students comprised 68 (58%) males and 57 (45.6%) females, 74.4% (93/125) of the respondents do not have a preference for any vaccine while 25.6% (33/125), shows a preference for various vaccine types. 95 (76%) final year medical students have not been vaccinated as against 30 (24%) who have received the vaccine for the Covid-19 virus, this large gap in the vaccination ratio accounted for many factors ranging from safety, availability, side effects, etc. Conclusion: The level of awareness of COVID-19 vaccines is very high among final-year medical students but it is not equivalent to the level of uptake of the vaccines. Despite being future healthcare professionals, medical students' vaccination rates remain suboptimal, highlighting a significant vaccine hesitancy and a large gap between knowledge and practice. Understanding and addressing these underlying factors is crucial to improving vaccine uptake and ensuring that medical students, as future healthcare leaders, are equipped to promote evidence-based public health practice.

An Exploration of the Knowledge and Current Practices of Frontline Workers Regarding Elder Abuse.

Annually, approximately 16% of adults aged 60 and older are victims of abuse in community settings. A critical first step toward effectively intervening and reducing the prevalence of elder abuse is to better understand the current state of knowledge, beliefs, and practices. This qualitative descriptive study explored the perceptions of US frontline community workers regarding elder abuse through focus groups and interviews conducted in the spring and summer of 2021. Participants represented various aging and victim services (n = 9), healthcare (n = 7), and law enforcement (n = 8). Thematic data analysis led to the emergence of three major themes in our data: societal influence, individual circumstances, and nature of abuse. Our findings point out several directions in which researchers and policymakers can begin moving the field forward. These include the need to focus on prevention strategies as well as the need to reduce ageist beliefs and attitudes.

COVID-19 Vaccine-induced antibody response to BNT162b2 mRNA in frontline healthcare workers

The emergence of SARS-CoV-2, the virus causing COVID-19, has resulted in a pandemic that has disrupted all sectors of society. Less than a year after the sequencing of the virus’s genome, emergency use authorization for the BNT162b2 vaccine was requested. The aim of this study was to evaluate the response to the BNT162b2-mRNA COVID-19 vaccine in frontline workers from two hospitals in Colombia. Nasopharyngeal swabs were collected for the molecular detection of SARS-CoV-2 using real-time PCR, and blood samples were taken to assess seroconversion using qualitative and quantitative IgA, IgG, and IgM test kits. The study was conducted at a high-complexity healthcare institution in Bucaramanga, Colombia. 245 people were included in the first round and 129 in the second. SARS-CoV-2 molecular tests were conducted by RT-qPCR, and peripheral blood samples were collected to measure IgG, IgM, and IgA. The main outcome was to establish natural infection and the antibody response induced by the vaccine. The entire population was tested at two fixed times with RT-PCR tests and antibody level measurements approximately 4 and 8 months after receiving the second vaccine dose. 62 (25.3%) and 35 (14.3%) participants had a history of positive PCR in the first and second rounds, respectively. All positive cases showed elevated levels of all immunoglobulins, especially IgG. The average concentrations of IgA, IgM, and IgG at 90 days were 1149.5 U/mL (95% CI 828.2-1470.9); 320.3 U/mL (95% CI 218.4-422.3); and 9277.3 U/mL (95% CI 8989.2-9565.3). Frontline healthcare workers showed an adequate response to the BNT162b2 mRNA vaccine.

The role of discretion and street‐level deliberative practices in the COVID‐19 crisis response: Lessons from the Philippines

AbstractThis study investigates the role of frontline workers, such as the Barangay Health Emergency Response Teams (BHERTs) in the Philippines, as street‐level bureaucrats (SLBs) in implementing COVID‐19 community quarantine policies. Drawing from SLB theory and deliberative policy analysis (DPA), I explore how SLBs adapted to rapidly changing conditions by exercising discretion in interpreting and adapting the implementation of nationally formulated pandemic management policies to meet local realities. I argue that SLBs functioned as deliberative practitioners, mediating between national policies and local realities while engaging in deliberative practices with their clients. Using the experience of BHERTs in Palompon, Leyte in the Philippines as an illustrative case, I identified the policy mandates (policy‐as‐written) of the BHERTs; the challenges and constraints they faced in implementing community quarantine policies; and the discretion they exercised in implementing community quarantine policies (policy‐as‐practiced). The findings reveal that, to meet their policy mandates and address the challenges they faced, they engaged in deliberative practices and collaborated with citizens in implementing context‐specific and creative strategies. Insights from this study highlight the adaptive and deliberative potential of SLBs in crisis situations and the value of a DPA in understanding SLB theory and research. By examining SLBs’ experiences during the pandemic, this study contributes to the SLB literature and offers practical lessons to policy practitioners in facilitating deliberation and developing context‐specific solutions in times of crisis.Points for practitioners The COVID‐19 pandemic and the subsequent government response in the Philippines have increased the challenges faced by street‐level bureaucrats (SLBs), including resource scarcity, organisational and political pressure, public resistance, and the risk of exposure to the virus. SLBs have shown their capacity to apply discretion and collaborate with their clients to resolve their own and the client's challenges and limitations through negotiation, mediation, conflict management, and active listening. This cooperative approach empowers them to resolve common issues and together formulate effective strategies that are beneficial to all parties involved. Relationships outside of SLBs’ duties as state agents (i.e. socio‐cultural relationships) can be a viable pathway for SLBs to implement alternative policy strategies to meet their policy mandates and address the challenges they face as they implement their mandates. Competing value systems, knowledge claims, and emotional narratives, compounded by a governance crisis, define the complex and informal nature of the policy process in the context of a crisis like the pandemic. Although SLBs demonstrate their capacity to creatively solve the challenges they encounter through deliberative practices, this should not serve as a justification for the government's lack of action in prioritising, safeguarding, and preserving their welfare.

Excellence in Homelessness Services: Evidence-Based Frontline Practices

Optimizing the performance of frontline workers in homelessness services (FWHSs) is vital for delivering effective support to individuals experiencing homelessness while prioritizing worker wellness. This paper builds on a previous study applying Orlick's "Wheel of Excellence" mental success elements, originally based on research with Olympic athletes, to social services. It assessed how high-performing FWHSs used these elements, providing practical insights for tailored mental-readiness training in social service facilities. The success elements—commitment, self-belief, positive imagery, mental preparation, full focus, distraction control, and constructive evaluation—were evident in FWHSs when successfully navigating challenging situations. This study provides further analysis of the elements contributing to FWHS’s mental readiness, including quotations from “excellent” FWHSs to highlight their common best practices. It defines excellence in frontline homelessness services, illustrates the use of the seven success elements, and identifies performance blocks and coping strategies from a frontline perspective. Performance blocks include general stressors and mistakes by trainees. The accompanying motivational quotes from high performers are akin to storytelling, elevating understanding and facilitating learning. Recommendations advocate tailoring existing tools, creating online learning opportunities, and implementing an Indigenous-inspired Sharing Circle for evidence-based practice discussions in homelessness services.

Dealing with Mental Health Problems and Work Performance Among Frontline Healthcare Workers Through the Influence of Digital Platform in Malaysian Private Hospitals: A conceptual analysis

The purpose of this study to examine mental health problems of frontline healthcare workers and their impact on work performance through exploring the influence of digital platforms in Malaysian private hospitals. This research is essential in addressing previous knowledge and theoretical gaps on the antecedents that denote to mental health problems and how digital platforms are used to improve mental health wellbeing. Basically, this study discusses the impact of four independent variables which are categorized as depression, anxiety, insomnia and distress factors whereas dependent variable is work performance. This study also will discuss problems concerning work performance of frontline healthcare workers (doctors, nurses, medical assistance, pharmacists and HR Management), specifically on poor service quality, turnover intention, work-related burnout, and exhaustion in Malaysian private hospitals. Hence, this study explores new solutions on the employees’ work performance related issues to create awareness for the Malaysian private hospitals in improving mental health issues among front-line healthcare workers to enhance their work performance through the influence of digital platforms. Private hospitals in Malaysia are experiencing critical situations related to poor employees’ performance which indirectly influence the overall productivity. Thus, private hospitals need to provide serious attention towards these related issues. A conceptual framework was formulated based on identified research gaps through the literature review. It is expected that this study will enhance the awareness for the management in Malaysian private hospitals on dealing with mental health problems which impacts work performance by exploring digital platforms as a solution.

Modeling the operational and labor costs of autonomous robotaxi services

Autonomous vehicle (AV) companies are rolling out driverless taxi-type services in cities around the world, promising to enhance road safety, promote equity, and foster environmental sustainability while simultaneously threatening the jobs of current taxi and ride-hailing drivers. The potential impacts of these “robotaxi” services hinge upon not only whether AV technology becomes sufficiently performant, but also whether AV services become economically competitive. In this study, we develop ground-up cost models for a traditional taxi and a robotaxi service to compare their relative competitiveness. We draw on direct observations of commercially available robotaxi services, semi-structured interviews with AV operational and regulatory experts (N = 27), and archival documents to include the most detailed accounting of frontline robotaxi labor roles to date. We find that labor remains a significant cost for existing robotaxi services but that robotaxi operating costs are still lower than those of traditional taxi services. Ultimately, utilization rates and annual mileage will serve as the most influential factors for robotaxi competitiveness. Finally, if jobs shift from traditional taxi to robotaxi services, the total number of frontline jobs could decrease by between 57% and 76%, but the distribution of worker wages would shift higher. Transportation planners, researchers, and policymakers should continue accounting for labor costs in an AV future, as these costs will influence where AV deployment and job losses are (and are not) likely to occur, and should proactively investigate alternative career paths for potentially displaced frontline workers. Robotaxi costs are highly sensitive to lower labor ratios (i.e., fewer vehicles per worker), but firms reach economies of scale relatively quickly. Robotaxi firms should weigh marginal labor cost reductions against impacts to passengers and workers.

Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment.

Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that "there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level," seconded by the Botswana National eLearning strategy (2020), which states that "there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating." The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. DERR1-10.2196/52411.

A process evaluation of a home garden intervention

BackgroundMost reviews of nutrition-sensitive programs assess the evidence base for nutrition outcomes without considering how programs were delivered. Process evaluations can fill this void by exploring how or why impacts were or were not achieved. This mid-term process evaluation examines a home garden intervention implemented in a large-scale, livelihoods improvement program in Odisha, India. The objectives are to understand whether the intervention was operating as planned (fidelity), investigate potential pathways to achieve greater impact, and provide insights to help design future home garden programs.MethodologyData collection and analysis for this theory-driven process evaluation are based on a program impact pathway that shows the flow of inputs, processes, outputs, outcomes, and impacts. Quantitative and qualitative data from focus group discussions, semi-structured interviews, and a Process Net-Mapping exercise with beneficiaries, frontline workers, and program management staff.ResultsDespite a mismatch between the design and implementation (low fidelity), the process evaluation identified positive outputs, outcomes, and impacts on home garden production, consumption, income, health and nutritional outcomes, and women’s empowerment. Flexibility led to greater positive outcomes on nutrition, the adoption of sustainable agricultural practices and easy-to-understand nutrition models, and the likelihood of the intervention being sustained after the program ends.ConclusionsTo help food systems in rural settings reduce food insecurity by utilizing more sustainable agricultural practices, we recommend that home garden interventions include instruction on easy-to-understand nutrition models and on how to make natural fertilizer. Finding local solutions like home gardens to help address critical supply issues and food insecurity is paramount.

Frontline Worker Discretion in the For‐Profit Banking Industry: Lessons From Early Pandemic Relief Programming

ABSTRACTIn April and May 2020, the United States banking industry approved over $650 billion in federal relief funds as part of the Paycheck Protection Program (PPP). Since then, extensive evidence of discriminatory lending has been revealed by investigative journalism and academic studies. Our study is based on 41 interviews with frontline banking professionals conducted during the days and weeks of the PPP rollout. We find that under the crisis conditions of the pandemic, capped funds in the PPP and built‐in incentives that encouraged certain types of loans, banking employees relied upon the professional norms and logic of the for‐profit sector. We argue that these norms and logics threatened the integrity of the PPP as a public relief programme by applying profit‐oriented priorities to resources marked for universal and fair distribution. Our findings offer new directions for theorising sector‐level differences in street‐level bureaucratic discretion in the context of mixed‐sector collaboration on public service delivery, particularly under conditions of crisis and urgency.

Staff Safety Alert Banner Program Against Workplace Violence at an Urban American Hospital.

Workplace violence (WPV) in healthcare has become an issue worldwide, with increasing prevalence after the COVID-19 pandemic. Notably, WPV in any setting has individual and systemic repercussions. However, despite extensive literature reporting the prevalence of WPV in healthcare worldwide, effective, standardized prevention policies have not been established. We developed and piloted a WPV initiative at an urban hospital in the state of Maryland. Here, we aim to describe our program development methods and implementation. The 6-month program utilized a reporting tool developed within patients' electronic medical records (EMRs) to request the display of a Staff Safety Alert (SSA) banner to alert healthcare professionals of patients who engaged in violent behavior and are at increased risk of subsequent behavior. This tool was piloted on 21 patient care units. A review committee either approved or denied case requests filed by frontline workers, with holistic consideration involving patient status, potential biases, and communication flaws. Twenty-one banner requests were filed during the course of the pilot. Of which, eight were approved, and 13 were denied. The multi-trauma intermediate care floor filed the most case requests for a safety banner. Our pilot program offers a patient-centered intervention program where extensive personnel training and patient-focused considerations were applied prior to the approval or denial of a banner display. The SSA program was the initial step in institutionally combatting WPV in healthcare as staff are encouraged to officially document unsafe events followed by careful action in response.

Leveraging a Global Partnership to Address COVID-19-Related Mental Health Challenges.

The COVID-19 pandemic profoundly affected nurses globally. As frontline workers, nurses faced increased responsibilities amid challenges such as isolation, infection risks, family obligations and disrupted social support systems. Coping with these challenges was associated with adverse mental health outcomes. This perspective paper examines a collaboration between two schools of nursing in the United States and India to address these mental health challenges. Faculty from both institutions identified key mental health topics, leading to five webinars that delved into topics such as acute and long-term impacts of COVID-19 on nurse mental health, coping mechanisms, caregiving responsibilities and children's needs during the pandemic. Impressively, over 11,000 nurses from 60 countries engaged, fostering a global platform for sharing evidence-based knowledge, experiences and strategies. This partnership exemplifies the value of international collaboration. By pooling resources and expertise across cultural contexts, the initiative not only disseminated crucial knowledge but also cultivated a sense of global community among nurses. The success of this collaboration underscores the potential of such global partnerships for healthcare institutions worldwide, offering avenues to share best practices and enhance support systems for nurses confronting similar crises globally.

Academic hospitalist perspectives on the benefits and challenges of secure messaging: A mixed methods analysis.

Hospitals and patients rely on effective clinician communication. Asynchronous electronic secure messaging (SM) systems are a common way for hospitalists to communicate, but few studies have evaluated how hospitalists are navigating the adoption of SM and the benefits and challenges they are encountering. The objective of this study is to assess academic hospitalist perspectives on SM to guide future research and quality improvement initiatives. This was a mixed methods study utilizing an embedded REDCap survey and six virtual semistructured focus groups. It took place during a Hospital Medicine ReEngineering Network Zoom meeting on October 13, 2023. Rapid qualitative methods were used to define major themes. There were 28 hospitalists and one patient representative across 24 separate academic institutions. There was a 71% survey completion rate (N = 20). SM was felt to be an effective and efficient communication modality but was associated with a large amount of multitasking and interruptions. Perspectives around SM clustered around three main themes: SM has been widely but variably adopted; there is a lack of institutional guidance about how to best engage with SM; and SM is changing the landscape of hospitalist work by increasing ease but decreasing depth of communication, increasing cognitive load, and changing interpersonal relationships. Recommendations for SM improvements included the need for institutions to work with frontline workers to develop and implement clear usage guidelines. SM is likely contributing to both positive and negative effects for clinicians and patients. Understanding hospitalist perspectives on SM will help guide future research and quality improvement initiatives.

Housing infrastructure and women in care: COVID-19 experiences from urban informal settlements of Khulna, Bangladesh

Urban informal settlements in the Global South, home to over a billion people, face significant challenges due to limited space and inadequate Water, Sanitation, and Hygiene (WASH) and Solid Waste Management (SWM) infrastructure. These deficiencies significantly impact women's ‘triple care role’—reproductive, productive, and community caregiving responsibilities—within their families, society, and the economy, exacerbated by the COVID-19 pandemic. This study aimed to explore how inadequate infrastructure in three informal settlements in Khulna, Bangladesh, influenced women's caregiving roles during the pandemic and their responses. Through semi-structured interviews with 24 women community leaders, who served as front-line workers during COVID-19, and supporting fieldwork, we discovered that women adapted by modifying their habits and the spatial layouts of their homes for isolation. Although some improvements were noted in WASH and SWM conditions, significant challenges remained, particularly in temporary housing, household adaptability, and reproductive responsibilities Despite facing informal employment, financial constraints, and food insecurity, women showed resilience through leadership, socio-political networking, and community initiatives. This study underscores the urgent need for adaptive infrastructure planning to improve living conditions in informal settlements, with a focus on proactive management of both spatial and non-spatial resources to enhance adaptation in resource-scarce contexts.

Becoming Hand Hygiene Heroes: implementation of an infection prevention and control campaign for patient and family hospital safety

BackgroundThe COVID-19 pandemic highlighted that hand hygiene is key in preventing healthcare-associated infections. Patients and families are understudied targets for infection prevention and control practices. Previous campaigns to change hand hygiene behavior have been effective, but often face systemic challenges with implementation. MethodsThe “Hand Hygiene Heroes” educational campaign was developed to improve patient and family hand hygiene at two tertiary care pediatric and obstetrics hospitals. Its multiple phases included visual materials, tailored activities for nine hospital units, and long-term evaluation during a two-year period. Hand hygiene rates among patients/families and healthcare workers were measured at baseline and throughout the campaign via direct observation. ResultsOverall, hand hygiene significantly increased for both patients/families (OR 1.82, p 0.041) and healthcare workers (OR 2.15, p <0.001) after campaign initiation. However, individual units had varying degrees of sustainment on follow-up evaluations. DiscussionDuration of intervention, activity simplicity, active participation, and resource availability may affect success of campaign initiatives. Positive prognostic factors included mixed leadership support from administration and front-line workers, pre-determined sustainability plans, and tailored activities by target audience. ConclusionsImplementation of hospital educational campaigns can be resource-intensive but can positively impact patient and family hand hygiene.

Service delivery in postpandemic period for routine childhood immunization in Assam following capacity building with BRIDGE IPC Skill tool

ABSTRACT Background: For COVID-19 pandemic and associated factors, around 25 million children missed routine immunization in 2021. NFHS-5 for Assam reported 67% coverage with routine immunization in 2019–21 which is below national average (77%) and lowest among Indian States/UTs. Lack of knowledge and skill among provider can reduce coverage. To address vaccine hesitancy and demand generation for routine immunization, BRIDGE IPC Skills (Boosting Routine Immunization Demand Generation) training in routine immunization for frontline workers considered an effective tool. Objectives: To estimate the service delivery in postpandemic period for routine childhood immunization in Assam following capacity building with a BRIDGE IPC Skill tool. Materials and Methods: This cross-sectional comparative study was conducted among immunization service providers from April 2022 to March 2023, where training coverage of service providers on BRIDGE IPC Skill was assessed. Comparison was made between functionalities of trained services by service providers with untrained ones. Results: A total of 2312 session sites were visited, of which 67.7% of frontline workers were trained, while 32.3% were not trained. Alternate vaccine delivery was present in 58.5%. Updated due list was present in 64.1% vs 29.8% in trained and untrained sites. Significant association was found between delivery of key message and status of frontline worker on BRIDGE IPC Skill training. Conclusion: Capacity building of frontline workers on BRIDGE IPC Skill can boost efficiency of frontline workers and may facilitate in addressing gaps that EXIST between health care system and community.