Implementation Of Health Services Research Articles

Development of Protocol for the Indian Council of Medical Research (ICMR) task force study to strengthen the implementation of National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) in tribal population

ABSTRACT Understanding the health culture of tribal community is important as health problems among tribal communities and their care is influenced by sociocultural factors, which will help in the implementation of health services. The conventional way of improving the access for the general populations may not suit the tribal populations owing to their distinct culture and owing to health systems factors as well. A stepwise process was followed for the development of a protocol to study to strengthen the implementation of National Programme for Prevention and Control of Non-Communicable Diseases. The study was planned to be carried out across six tribal districts of India. A detailed protocol was built around Implementation Research Logic Model, primarily as a method for planning, executing, reporting, and synthesizing the implementation.

A qualitative study identifying implementation strategies using the i-PARIHS framework to increase access to pre-exposure prophylaxis at federally qualified health centers in Mississippi

BackgroundMississippi (MS) experiences disproportionally high rates of new HIV infections and limited availability of pre-exposure prophylaxis (PrEP). Federally Qualified Health Centers (FQHCs) are poised to increase access to PrEP. However, little is known about the implementation strategies needed to successfully integrate PrEP services into FQHCs in MS.PurposeThe study had two objectives: identify barriers and facilitators to PrEP use and to develop tailored implementation strategies for FQHCs.MethodsSemi-structured interviews were conducted with 19 staff and 17 PrEP-eligible patients in MS FQHCs between April 2021 and March 2022. The interview was guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework which covered PrEP facilitators and barriers. Interviews were coded according to the i-PARIHS domains of context, innovation, and recipients, followed by thematic analysis of these codes. Identified implementation strategies were presented to 9 FQHC staff for feedback.ResultsData suggested that PrEP use at FQHCs is influenced by patient and clinic staff knowledge with higher levels of knowledge reflecting more PrEP use. Perceived side effects are the most significant barrier to PrEP use for patients, but participants also identified several other barriers including low HIV risk perception and untrained providers. Despite these barriers, patients also expressed a strong motivation to protect themselves, their partners, and their communities from HIV. Implementation strategies included education and provider training which were perceived as acceptable and appropriate.ConclusionsThough patients are motivated to increase protection against HIV, multiple barriers threaten uptake of PrEP within FQHCs in MS. Educating patients and providers, as well as training providers, are promising implementation strategies to overcome these barriers.

Implementation of a population mental health and wellness text-message service: a mixed-methods study

BackgroundDespite the growing adoption of digital health tools as a means to support mental health, many individuals remain unaware of the variety of mental health resources available to them through this format. To address this knowledge gap, this study advanced the design, development, and implementation of a text-based service called SaskWell to raise awareness of evidence based mental health resources and create more immediate connections to these tools. The two primary objectives of the study were to assess and evaluate the adoption of SaskWell by focusing on user acceptance, satisfaction, and perceived benefit, and to identify factors which contributed to user engagement with the SaskWell text-based service. Both quantitative and qualitative data contributed to the final study results.ResultsThis study utilized a co-designed text-messaging service to provide residents of Saskatchewan an important connection to digital mental health and wellness resources during the height of the COVID-19 pandemic. Using the RE-AIM framework as an implementation guide, four distinct cycles of SaskWell were delivered with modifications to the service in each subsequent cycle based on user engagement, feedback, and the direction of a community advisory group. Quantitative data was collected through user engagement text message response data, along with enrollment and exit surveys, while semi-structured interviews served as the primary means of qualitative data collection. In addition to the quantitative user data, these user interviews resulted in themes exploring motivation to sign-up for the service, perceptions of texting as a mechanism to deliver mental health resources, the impact of SaskWell on mental health and well-being, and beliefs on the future potential of text-based mental health supports.ConclusionsBoth the user engagement survey and the qualitative data supported the worth of ongoing efforts to refine and extend the use of text messaging as a means to engage citizens around the awareness and use of digital mental health and wellness resources. As the pandemic has receded into the background in many peoples’ daily lives, for healthcare providers, and others who continue to be impacted more heavily by the persistent challenges of this global event, this type of service may continue to be timely.

Applying the extension for community healthcare outcomes (ECHO) model to promote collaborative and effective school mental health services.

School staff increasingly seek to implement evidence-based school mental health services to promote student mental health. However, barriers to accessing programming and support mean that implementing these programs is difficult. Popular strategies to address these challenges, like one time professional development, often fail to be effective or sustainable. This study used mixed methods to evaluate how a set of training activities-sequential online learning modules combined with interprofessional telementoring, following the extension for community healthcare outcomes (ECHO) model-influenced provision of school mental health services. School counselors, nurses, psychologists, and social workers (n = 46) participated in training activities, which included nine, cohort-based ECHO sessions and 12 modules. We used a concurrent mixed methods design in which quantitative (implementation data and pre-post surveys) and qualitative (posttraining focus groups with a subset of participants, n = 11) data were used to evaluate training. Quantitative results indicated statistically significant pre-post improvements in participants' clinical self-efficacy (d = .83) and knowledge of evidence-based practices (d = .37). Qualitative data corroborated quantitative results. Post training, focus groups described positive reactions, learning, and behavior change, particularly with respect to equitable service provision and interprofessional teaming. ECHO appeared to facilitate the application of evidence-based strategies to real-life practice and improved participants' understanding of effective coordination of services. Taken together, findings suggest that group-based telementoring may be a high-impact strategy for supporting the implementation of effective, culturally specific, and collaborative school mental health services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effectiveness of Indigenously Developed Clinical Supervision in Therapeutic Setting

Clinical supervision is a process in which a supervisor assists the supervisee in reflecting their own clinical work in a therapeutic setting. In this regard, cultural competency is important in clinical supervision and religion plays a substantial role in culture. Therefore, the American Psychological Association has focused on religion in psychology. However, despite acceptance of the importance of religious integration into clinical practice, very few psychologists receive training, which is important for addressing the integration of religious values in therapeutic settings. Therefore, the current study was designed to assess the effectiveness of indigenously developed clinical supervision, based on the general guidelines of the development model of supervision. It was designed for an inclusive environment that respects diverse spiritual and religious perspectives. The study included 15 supervisees who received clinical supervision from trained clinical supervisors who were trained on an indigenously developed clinical supervision model. Supervisors provided regular supervision to the supervisee over a period of six months. The effectiveness of the protocol was measured by using the Clinical Skills Assessment Rating Form (CSA-RF). The CSA-RF is 32 items scale, facilitating in the measurement of the effectiveness of the protocol in the five domains of demonstrating professional therapeutic engagement, creating a secure base, formulation, facilitating mutual understanding and session structure. The results showed that the supervisee who received supervision through the indigenous clinical supervision protocol brought significant changes in their therapeutic skills (p=.001). These findings have significant implications in the development and implementation of mental health services, particularly in therapeutic settings.

The implementation study of nurses’ work related low back pain prevention and care guideline: A quasi-experimental study

AimTo understand the implementation process and outcomes of nurses' work related low back pain (WLBP) prevention and care guideline. BackgroundWLBP is a common occupational injury for clinical nurses. We developed the first evidence-based guideline of nurses' WLBP prevention and care of its kind both at home and abroad, and it is necessary for us to explore its feasibility, appropriateness and effectiveness in practice. MethodsBased on the model of the integrated Promoting Action on Research Implementation in Health Services, we performed a four-phase implementation study in a tertiary hospital. The study was a non-randomized concurrent controlled trial design，and multilevel measures were examined including implementation outcomes and clinical outcomes. ResultsFor the implementation outcomes, the tailored recommendations of the guideline were found to be acceptable, appropriate, feasible, and well adopted both at the unit level and the hospital level. The clinical outcomes indicated that, compared with the control unit, nurses of the treatment unit performed better in awareness, knowledge, practice of WLBP prevention and care. ConclusionsThe implementation study supports the successful application of the guideline, which can serve as a valuable evidence-based document to improve back health of nursing personnel.

Goal-oriented temperature management in severely traumatized children in the emergency department: an evidence-based practice project.

Hypothermia commonly occurs in trauma patients. Evidence-based practices for hypothermia prevention are not strictly followed by all medical staff in the emergency department. This study aimed to assess compliance with evidence-based practices regarding goal-oriented temperature management for severely traumatized children in a Chinese hospital. This project used the JBI Evidence Implementation Framework to translate evidence into practice. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used to identify barriers to compliance with best practices. A goal-oriented temperature management strategy for trauma patients was developed based on the identified barriers, along with a simulation training module, and the supply of warming materials. Field observation, review of medical records, and interviews with medical staff and patients were used to assess baseline and follow-up audit compliance with best practices. Twelve criteria were audited in the baseline and follow-up audits, with 11 and 37 trauma patients, respectively. In the follow-up audit, compliance with all criteria increased, with a reduction in shivering and cold discomfort scores. Except for two patients who died, hypothermia did not occur in any of the patients. The JBI Evidence Implementation Framework was used to successfully improve compliance with best practices. Future audits should be conducted to sustain the evidence-based behavior of all medical staff. http://links.lww.com/IJEBH/A234.

Avoidable Mortality in Korea 1997-2001: Temporal Trend and its Contribution to All-cause Mortality.

This study analyzed the mortality trends from avoidable causes in Korea from 1997 to 2021, to estimate its contribution to the overall mortality in different subgroups, including. Gender, age, and cause of disease. The all-cause and avoidable mortality were presented as a time series plot and average annual percent change. Trend of avoidable mortality was also analyzed by subgroups, disease causes and the percentage attributed to each causes. The decline in avoidable mortality accounted for 82.6% of all-cause mortality reduction. Preventable mortality showed a more pronounced decline than treatable mortality, explaining 72.3% of the avoidable mortality reduction. In 1997-2001, avoidable death occurred in 72.2% (537,024 cases) of all-cause deaths, which declined to 60.0% (342,979 cases) in 2017-2021. The contribution of avoidable mortality in the decline of all-cause morality was greater in males (83.6%) than in females (79.3%). The decline in avoidable mortality and its contribution to the all-cause mortality reduction implies general improvement of the population health in Korea. Nevertheless, the heterogenous trend within different subgroups warrants more equitable design and implementation of health services and policies.

SNAP: Supportive non-invasive ventilation for acute chest syndrome prevention for hospitalized children with sickle cell disease: Perspectives of patients, parents, and the healthcare team.

Acute chest syndrome (ACS) often develops during hospitalizations for sickle cell disease (SCD) vaso-occlusive episodes and may be triggered by a combination of chest wall splinting, opioid use, hypoventilation, and atelectasis. In 2017, Boston Medical Center's general pediatric inpatient unit instituted the novel use of bi-level positive airway pressure (BiPAP) as "supportive non-invasive ventilation for ACS prevention" (SNAP) to prevent ACS and respiratory decompensation. The goals of this qualitative study were to identify perceived benefits, harms, facilitators, and barriers to use of SNAP. We conducted semi-structured key informant interviews at three sites with different levels of SNAP implementation (Site 1: extensive implementation; Site 2: limited implementation; Site 3: not yet implemented) regarding experiences with and/or perceptions of SNAP. Interviews and coding were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. Thirty-four participants (physicians, nurses, respiratory therapists, child life specialists, psychologists, youth with SCD, and parents) completed interviews. Major themes included: (i) participants perceive BiPAP as effective at preventing ACS, and for those with medically stable ACS, for preventing respiratory decompensation. (ii) BiPAP use is appropriate on the general pediatric inpatient unit for medically stable patients with SCD. (iii) Improving the patient experience is the most important factor to optimize acceptance of BiPAP by patients and families. SNAP is perceived as effective and appropriate for hospitalized pediatric patients with SCD. Improving the patient experience is the biggest challenge. These data will inform a future protocol for a multicenter hybrid effectiveness/implementation trial of SNAP.

Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada.

In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies. This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban-rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018-2020) received from the 27 PHUs. Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs' activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban-rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities. Findings suggest broad implementation of health equity approaches in public health independent of PHUs' geographic size and population dispersion, though strategies and key challenges differ across units.

Türk Yetişkinler İçin Öznel Yaşam Kalitesi Ölçeği Geçerlik ve Güvenirlik Çalışması

As defined by the World Health Organization, quality of life is a concept that is associated with the individual's personal perception in the context of the culture, value systems, and life experiences in which they live. Therefore, quality of life measurement requires a multifaceted process consisting of both objective and subjective dimensions. However, the fact that quality of life is based on subjective perceptions leads to the lack of a standardized measurement tool and a lack of consensus in the measurement of quality of life. This research is based on the assumption that subjective perceptions are the main determinant in the evaluation of quality of life. In this context, the aim of the study is to develop a valid and reliable measurement tool that can measure non-economic quality of life elements based on people's subjective perceptions. The study group consisted of 742 adults aged 18 and over, including Kırıkkale High Specialization Hospital staff and Ankara Yenimahalle Municipality employees. As a result of the analyses, a structure consisting of five sub-dimensions and 17 items that can be considered a valid and reliable measurement tool for measuring subjective quality of life was obtained. This study emphasizes the subjective dimension of the concept of quality of life and focuses on individuals' evaluation of quality of life based on their own experiences and perceptions. The obtained measurement tool can be used in further research in the field of quality of life and can contribute to the literature in this field. It can also be an important source of information for the planning and implementation of health policies and services. Keywords: World Health Organization, subjective quality of life, Kırıkkale Yüksek İhtisas Hospital, Ankara Yenimahalle Municipality

Implementation of guidelines on Family Involvement for persons with Psychotic disorders: a pragmatic cluster randomized trial. Effect on relatives’ outcomes and family interventions received

BackgroundFamily interventions (FI) are recommended as part of the treatment for psychotic disorders, but the implementation in mental health services is generally poor. Recently, The Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, demonstrated significant improvements in implementation outcomes at cluster-level. This sub-study aims to examine the effectiveness of the IFIP intervention on relatives’ outcomes and received FI.MethodsA cluster randomized controlled trial, was conducted in 15 Norwegian Community Mental Health Center (CMHC) units that were randomized to either the IFIP intervention, including implementation interventions and clinical interventions, or treatment as usual (TAU). The clinical interventions consisted of FI: basic family involvement and support (BFIS) to all patients and family psychoeducation (FPE) to as many as possible. Patients with psychotic disorders and their closest relative were invited to fill in questionnaires at inclusion and 6 months and 12 months follow-up. Received FI was reported by both relatives and clinicians. The relatives’ primary outcome was satisfaction with health service support, measured by the Carer well-being and support questionnaire part B (CWS-B). The relatives’ secondary outcomes were caregiver experiences, expressed emotions and quality of life. Patients’ outcomes will be reported elsewhere.ResultsIn total 231 patient/relative pairs from the CMHC units were included (135 intervention; 96 control).The relatives in the intervention arm received an increased level of BFIS (p=.007) and FPE (p < 0.05) compared to the relatives in the control arm, including involvement in crisis planning. The primary outcome for relatives’ satisfaction with health service support, showed a non-significant improvement (Cohen’s d = 0.22, p = 0.08). Relatives experienced a significant reduced level of patient dependency (Cohen’s d = -0.23, p = 0.03).ConclusionThe increased support from clinicians throughout FI reduced the relatives’ perceived level of patient dependency, and may have relieved the experience of responsibility and caregiver burden. The COVID-19 pandemic and the complex and pioneering study design have weakened the effectiveness of the IFIP intervention, underscoring possible potentials for further improvement in relatives’ outcomes.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT03869177.

The transition towards community-based mental health care in the European Union: Current realities and prospects

The shift of mental health care from mental institutions to community-based services has been implemented differentially throughout the EU. However, because a comprehensive overview of the current mental health provision in member states is lacking, it is challenging to compare services across nations. This study investigates the extent of implementation of community-based mental health services within the EU using data collected from the WHO Mental Health Atlas. Results show that, although great cross-country variation exists in the implementation of community-based services, mental hospitals remain the prominent model of care in most countries. A few countries endorsed a balanced care model, with the co-occurrence of community services and mental hospitals. However, missing data, low quality of data and different service definitions hamper the possibility of a thorough analysis of the status on deinstitutionalization. Although policies on the closing and downsizing of mental institutions have been endorsed by the EU, the strong presence of mental hospitals slows down the shift towards community-based mental health care. This study highlights the need for an international consensus on definitions and a harmonization of indicators on mental health services. Together with the commitment of member states to improve the quality of data reporting, leadership must emerge to ensure quality monitoring of mental health-related data, which will help advance research, policies and practices.

A protocol of a pilot randomised trial (Action-RESPOND) to support rural and regional communities with implementing community-based systems thinking obesity prevention initiatives.

Over a quarter of children aged 2-17 years living in Australia are overweight or obese, with a higher prevalence reported in regional and remote communities. Systems thinking approaches that seek to support communities to generate and implement locally appropriate solutions targeting intertwined environmental, political, sociocultural, and individual determinants of obesity have the potential to ameliorate this. There have however been reported challenges with implementation of such initiatives, which may be strengthened by incorporating implementation science methods. This pilot randomised controlled trial protocol outlines the development and proposed evaluation of a multicomponent implementation strategy (Action-RESPOND). to increase the implementation of community-based systems thinking child obesity prevention initiatives The target of this intervention is ten rural and regional communities (or local government areas as the unit of allocation) within Northeast Victoria who were participants in a whole-of-systems intervention (RESPOND). Action-RESPOND builds on this intervention by assessing the impact of offering additional implementation strategies to five communities relative to usual care. The development of the multicomponent implementation strategy was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and consists of seven implementation strategies primarily delivered via 'facilitation' methods. Implementation strategies aimed to ensure initiatives implemented are i) evidence-based, ii) address community's specific needs and iii) are suitable for local context. Strategies also aimed to increase the community's capacity to implement, through iv) improving the health promotion team's implementation knowledge and skills, fostering v) leadership, vi) physical resources and vii) community culture to drive implementation. The feasibility, acceptability, potential impact, and cost of the strategy will be assessed at baseline and follow up using surveys administered to key representatives within the community and internal records maintained by the research team. By leveraging an existing community-based whole-of-systems intervention, Action-RESPOND offers a unique opportunity to collect pilot feasibility and early empirical data on how to apply implementation and systems science approaches to support obesity prevention in rural and regional communities in Victoria.

Using the i-PARIHS theoretical framework to develop evidence implementation strategies for central venous catheter maintenance: a multi-site quality improvement project.

Evidence-based nursing practice can reduce complications associated with central venous catheters (CVCs). In this project, the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was considered an ideal theoretical instrument to identify facilitators and barriers to implementing evidence-based practice. The project was conducted in pediatric intensive care units in six Chinese tertiary children's hospitals. Twenty-two audit criteria were obtained from best practice recommendations, and a baseline audit was conducted to assess current practice against best practice. Next, the i-PARIHS framework was used to identify facilitators and barriers to best practice and develop improvement strategies. A follow-up audit was then conducted to measure changes in compliance with best practices. Facilitators and barriers were identified at the innovation, recipient, and context levels. A comprehensive CVC maintenance strategy was then developed to apply the best evidence to nurses' clinical work. Of the 22 audit criteria, 17 showed significant improvement compared with the baseline audit. The i-PARIHS framework is an effective tool for developing targeted, evidence-based improvement strategies and applying these to the clinical setting. The quality of the nurses' clinical practice improved during CVC maintenance. However, there is no certainty that these positive results can be maintained, and long-term data are needed to verify this. http://links.lww.com/IJEBH/A185.

The Effect Of Operational Audit and Good Clinical Governance On The Effectiveness Of Health Services At Hikmah Hospital Makassar City

Hospitals have a very important role in the implementation of health services in the community, this study aims to examine the Effect of Operational Audit and Good Clinical Governance on the Effectiveness of Health Services at Hikmah Hospital Makassar City. The variables in this study are the influence of operational audits and good clinical governance as independent variables, and the effectiveness of health services in hospitals as dependent variables. This study used a quantitative approach, using primary data through the distribution of questionnaires. The respondents in this study were employees from Hikmah Hospital Makassar City which amounted to 118 people. Data collection used by researchers in conducting this study, namely with primary data sources. Data collection method in research using questionnaires. The analysis requirements are tested in the form of normality tests, multicollinearity tests, and heteroscedasticity tests. The data analysis technique used in this study is the regression analysis technique of two predictors or multiple analysis. Data analysis techniques are carried out with descriptive statistical analysis and using SPSS 27.00. The results showed that it shows that operational audit and internal control variables have a positive and significant effect on the effectiveness of health services. The results showed that operational audit variables and good clinical govenance simultaneously (together) had a positive and significant effect on the effectiveness of health services.

Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study.

The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients.

Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990–2017

BackgroundThe United Nations (UN) Sustainable Development Goal − 3.2 aims to eliminate all preventable under-five mortality rate (U5MR). In China, government have made efforts to provide maternal health services and reduce U5MR. Hence, we aimed to explore maternal health service utilization in relation to U5MR in China and its provinces in 1990–2017.MethodsWe obtained data from Global Burden of Disease 2017, China Health Statistics Yearbook, China Statistical Yearbook, and Human Development Report China Special Edition. The trend of U5MR in each province of China from 1990 to 2017 was analyzed using Joinpoint Regression model. We measured the inequities in maternal health services using HEAT Plus, a health inequity measurement tool developed by the UN. The generalized estimating equation model was used to explore the association between maternal health service utilization (including prenatal screening, hospital delivery and postpartum visits) and U5MR.ResultsFirst, in China, the U5MR per 1000 live births decreased from 50 in 1990 to 12 in 2017 and the average annual percentage change (AAPC) was − 5.2 (p < 0.05). Secondly, China had a high maternal health service utilization in 2017, with 96.5% for prenatal visits, 99.9% for hospital delivery, and 94% for postnatal visits. Inequity in maternal health services between provinces is declining, with hospital delivery rate showing the greatest decrease (SII, 14.01 to 1.87, 2010 to 2017). Third, an increase in the rate of hospital delivery rate can significantly reduce U5MR (OR 0.991, 95%CI 0.987 to 0.995). Postpartum visits rate with a one-year lag can reduce U5MR (OR 0.993, 95%CI 0.987 to 0.999). However, prenatal screening rate did not have a significant effect on U5MR.ConclusionThe decline in U5MR in China was associated with hospital delivery and postpartum visits. The design and implementation of maternal health services may provide references to other low-income and middle-income countries.

A prospective assessment of readiness to implement an early detection of cerebral palsy pathway in a neonatal intensive care setting using the PARIHS framework

BackgroundEarly detection of cerebral palsy (CP) is possible through targeted use of assessment tools. Changes in practice are needed to facilitate this shift towards earlier diagnosis of CP in New Zealand. The aim of this study was to prospectively evaluate readiness to implement an early detection of CP pathway within a level 3 neonatal intensive care unit (NICU) setting prior to any implementation taking place. The PARIHS (Promoting Action on Research Implementation in Health Services) framework was engaged to assess readiness by highlighting determinants that influence implementation outcomes as either barriers or enablers.MethodsA mixed methods approach was used. Firstly, an online staff survey assessed PARIHS sub-elements using Likert scores and free text with the intent to develop a baseline understanding of staff views. Secondly, focus groups were conducted to gain deeper understanding of barriers and enablers to implementation. Participants included health professionals involved in the first 6 months of life. Data were analysed to outline the barriers and enablers of implementation under the Evidence and Context constructs of the PARIHS framework.ResultsTwenty-seven participants completed the survey, and 20 participants participated in eight focus groups and two individual interviews. Quantitative (survey) findings found 65% agreement around the usefulness of research evidence on early CP detection; however, ≤ 45% felt current resources (i.e. human, financial and IT) were sufficient for implementation. Qualitative findings (survey and focus groups) highlighted key staff concerns around resources, family impact (creating unnecessary stress), and equity (barriers to participation). Staff wanted information regarding how international evidence translates to the local context and availability of timely follow-up services. Sub-elements within the Evidence and Context constructs were rated as either mixed or low (except for Evidence - Research, rated as high), overall indicating that Auckland NICU is at the early stages of readiness to implement the early CP detection pathway.ConclusionThis work may resonate with other neonatal services preparing to implement CP early detection pathways. Resourcing has a major role in facilitating implementation of pathways and uncertainty about resources is a barrier to implementation. Ongoing focus on building consensus and funding is required to ensure optimal uptake.

Acceptability of virtual psychiatric consultations for routine follow-ups post COVID-19 pandemic for people with intellectual disabilities: cross-sectional study.

After the rapid implementation of digital health services during the COVID-19 pandemic, a paucity of research exists about the suitability of remote consulting in people with intellectual disabilities and their carers, particularly for neuropsychiatric reviews. This study examines when remote neuropsychiatric routine consulting is suitable for this population. A survey was conducted of people with intellectual disabilities and their carers, examining their preference between face-to-face and video consultations for ongoing neuropsychiatric reviews within a rural countywide intellectual disability service in Cornwall, England (population: 538 000). The survey was sent to all adults with intellectual disabilities open to the service on 30 July 2022, closing on 30 September 2022. Participants were asked to provide responses on 11 items predesigned and co-produced between clinicians and experts by experience. The entire service caseload of people had White ethnicity, reflecting the ethnic demographics of Cornwall. Responses received without consent were excluded from the study dataset. Of 271 eligible participants, 119 responses were received, 104 of whom consented to having their anonymised data used for research analysis. There were no significant differences between preferences and age and gender variables. There was no statistically significant difference regarding preference for the reintroduction of face-to-face appointments (52.0%) compared with video consultations (48.0%). Travel distance (>10 miles) to the clinical setting was important but did not outweigh benefits for those preferring a face-to-face appointment. This study offers insights into the factors that influence preferences about what type of neuropsychiatric appointment is most suitable for people with intellectual disabilities.