Implementation Of Health Services Research Articles

Examining the managerial and cost control for an optimal healthcare education

In recent decades, both economic development and technological advances in medicine have contributed to an increase in health demand and costs, mainly derived from the growing implementation of innovative health services. In this context, it is necessary to note that welfare economics involves the rationalization of limited economic resources. Likewise, the concern about the increase in health spending that is occurring in developed countries has meant that hospitals have flexible management accounting that helps to maximize the efficiency of internal management and obtain the maximum performance of the allocated financial resources. This will have a favourable impact on indicators such as minimal infant mortality, increased life expectancy at birth, or the rate and effectiveness of transplants. Hence, organizations choose to improve their management systems to carry out a more efficient health care education, in such a way that these try to optimize the available resources to offer a quality product or service with the minimum possible costs. Bibliometric techniques have been applied to a sample of 2003 articles to establish the relationships between the main dynamic agents of this research topic, in addition to identifying the main current and future lines of research. Providing a benchmark for future research on management control for health care education, this study reveals the emerging intellectual structure of this interdisciplinary field.

THE INFLUENCE OF NURSING HOME CONTEXT ON IMPLEMENTATION: EARLY FINDINGS

Abstract Evidence suggests that organizational context, including context of care in nursing homes (NHs) is associated with implementation and improvement success and that optimized context contributes to improved resident and staff outcomes. However, evidence on mechanisms of these influences is scarce. The longitudinal Translating Research in Elder Care program (2007 to present) is our data source. This symposium reports findings of a secondary analysis of longitudinal organizational structural and contextual, staff worklife, and resident care quality data collected in nursing homes from 2007-2021, in a cohort of 94 Canadian nursing homes. Our data include continuously collected administrative data (RAI-MDS 2.0), 5 waves of primary surveys from multiple care providers in NHs (15,000 cases to date), extensive qualitative case study data, and data from two large scale pragmatic trials. The TREC program was framed originally and continues to be, using the Promoting Action on Research Implementation in Health Services (PARiHS) framework. Each of our 5 papers will report on a critical aspect of the findings. The symposium will conclude with a discussion of implications of these findings of phase one and a description of phase two and how it is shaped by our interactions with expert panels (context and implementation experts, policymakers, NH managers, paid care providers, and residents and families). Early implications of this work for future research in nursing homes and for practice and policy will be mentioned.

DEVELOPMENTAL ADVANCES OF THE PARIHS FRAMEWORK OVER THE LAST DECADE: A CRITICAL INTERPRETIVE SYNTHESIS

Abstract The original Promoting Action on Research Implementation in Health Services (PARiHS) and i-PARiHS frameworks contend that the successful implementation of evidence-based practices is a function of the core elements evidence, context, facilitation, and the capacity of intended recipients to apply research to practice. While applied widely, a number of theoretical and practical challenges associated with the framework’s application have been identified. Our critical interpretive synthesis examines how the last decade of research has advanced understanding of the conceptualizations of, relationships between, and dynamics amongst, PARiHS core elements. We find that work over the past decade affords more nuanced conceptualizations of context and facilitation; reveals myriad conceptualizations of implementation success, suggesting the need for a typology; demonstrates contradictory effects of context on facilitation that warrants more study; leads us to question the contextual primacy of leadership; and generally under-examines the interactions and dynamics amongst PARiHS core elements and their sub-elements.

Comparison of in-person vs. telebehavioral health outcomes from rural populations across America.

This study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementation program, the aims of this study were to evaluate outcomes in patient symptoms of depression and anxiety across the programs' 17 grantees and 95 associated sites, with each grantee having data from telehealth patients and from an in-person comparison group. The research design is a prospective multi-site observational study. Each grantee provided data on a nonrandomized convenience sample of telehealth patients and an in-person comparison group from sites with similar rural characteristics and during the same time period. Patient characteristics were collected at treatment initiation, and clinical outcome measures were collected at baseline and monthly. The validated clinical outcome measure instruments included the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety-related symptoms. Linear mixed models, with grantee as the random effect, were used to determine the association of behavioral health delivery (telehealth versus in-person) on the one-month change in PHQ-9 and GAD-7 while adjusting for covariates. Across a total of 1,514 patients, one-month change scores were improved indicating that PHQ-9 and GAD-7 scores decreased from baseline to the one-month follow-up at similar rates in both the in-person and telehealth groups. Reduction in scores averaged 2.8 for the telehealth treatment group and 2.9 for the in-person treatment group in the PHQ-9 subsample and 2.0 for the telehealth treatment group and 2.4 for the in-person treatment group in the GAD-7 subsample. There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 or GAD-7. Individuals with higher baseline scores demonstrated the greatest decrease in scores for both measures. Upon adjusting for baseline scores and grantee program, patient demographics were not found to be significantly associated with change in anxiety or depression symptoms. In our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.

How Can We Use the Promoting Action on Research in Health Services (PARIHS) Framework to Move from What We Know to What We Should Do for the Rehabilitation of a Painful Hemiplegic Shoulder (PHS)?

Several theoretical frameworks currently promote the evidence-based clinical practice. One of these is Promoting Action on Research Implementation in Health Services (PARIHS) framework. However, The PARIHS framework emphasizes the use and implementation of pre-existing knowledge. This study aims to integrate of PARIHS conceptual framework to categorize evidence, context, and facilitation elements for the successful implementation of evidence-based painful hemiplegic shoulder (PHS) rehabilitation. Stroke therapists (n=21) were interviewed to elicit important PHS rehabilitation concepts. Following that, a consensus approach was undertaken to tailor PHS recommendations to the local context. All consensus recommendations have been included in the PARIHS framework. The consensus level was set at 75% or more. The interviews revealed four broad themes of PHS rehabilitation, each further subdivided. Based on the themes and subthemes, 74 recommendations were deemed pertinent to PSH rehabilitation from a reliable source. Out of 74 recommendations, 63 recommendations reach the consensus level for PHS practice. Secondary prevention of PHS (n=10), assessment (n=14), PHS care management (n=19), and service delivery (n=20). A consensus was not reached for the remaining 11 recommendations. Each recommended guideline was integrated into the appropriate element of the PARIHS framework as follows: evidence (28), context (18), and facilitation (17). The findings showed how the PARIHS framework has been configured to empirically support the implementation of robust stroke rehabilitation recommendations in the field of rehabilitation. Using an implementation intervention theory (for example, PARIHS) as a guide, provide a thorough picture of the many levels that may affect implementation requirements. Many prior studies on evidence-based stroke rehabilitation in physical therapy practice lacked knowledge of translation theories. This result illustrates how to use an intervention implementation (such as PARIHS) to enhance evidence-based practice implementation in routine stroke rehabilitation. Further study is required for the clinical use of the PARIHS framework.

Mobile Health and Nutrition Team Service Implementation in Somali and Afar Regions of Ethiopia: A Qualitative Implementation Science Study.

Ethiopia has been implementing Mobile Health and Nutrition Teams (MHNTs) to improve the accessibility of essential healthcare services for unreached populations with poor infrastructure to ensure health for all target by Universal health coverage (UHC). However, the current implementation status of this MNHT is not assessed. This study aimed to capture the current implementation status of the MHNT from the program managers, supporting partners and decision makers at each level of the health system structure in Afar and Somali regions. We conducted qualitative study with phenomenological study design. The data was collected from RHB MHNT coordinator, woreda health office MHNT coordinator, MHNT leader and representatives from implementing partners. The interview guides were developed using the CFIR framework. Out of the 17 respondents, 13 responded all the standard service packages a MHNT is expected to deliver (76.5%). Overall, the KIIs mentioned that the MHNTs are effective in ensuring access and quality of health services. MHNT strategy has high demand and acceptability by the community and the service providers. The main barrier to program implementation is the gap in service integration within and across sectors. Inadequate staffing of the MHNT, gaps in ensuring proper professional mix, frequent turnover of contract health workers, and skill gaps hamper effective and sustainable implementation of the program. MHNT establishment, effectiveness, acceptability and sustainably in the implementing woredas of Afar and Somali Regions is very promising. The culture of MHNT documentation and reporting needs some improvement. Besides, community engagement and government ownership are good drivers for sustainability of MHNT. Standardizing and adding additional professionals with capacity building is crucial to ensuring service quality. Furthermore, community mobilization and woreda leadership commitment boosting will be needed for granting sustainability. Finally, national scale up of this alternative strategy is recommended through standardized implementation modality.

Long-term use of an ankle-foot orthosis intervention in patients with peripheral artery disease using the integrated promoting action on research implementation in health services (i-PARIHS) framework

BackgroundPeripheral artery disease (PAD) is a cardiovascular disease that limits patients' walking ability. Persistent ankle-foot orthosis (AFO) use may increase the distance patients can walk as well as physical activity. PurposeThe purpose of the study was to determine the implementation and patients' perspectives related to the use or disuse of the AFO intervention six months post-intervention. This study was guided by a semi-structured interview and survey based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs. DesignA convergent mixed methods design was used to evaluate participants' perceptions six months following a three-month AFO intervention. A survey and semi-structured questionnaire based on the i-PARIHS constructs were administered and analyzed. SettingVascular surgery clinic and biomechanics research laboratory. ParticipantsPatients (N = 7; male, 100%; age, 71.9 ± 0.6.7y; body mass index, 29.0 ± 0.5.5; ankle brachial index 0.50 ± 0.17) with claudication completed the study. InterventionsA certified orthotist fit participants with an AFO that was worn for 3 months. Main outcome measuresQualitative analysis of semi-structured interviews and quantitative analysis of the survey. ResultsThe highest positive ratings were seen in the dimensions of usability and cost-effectiveness. The patients found the AFO device and instructions to wear, easy when starting the intervention and there were no out-of-pocket costs. The lower scores and challenges faced with observability and relative advantage domains indicated issues related to motivation for sustained use of the AFO. ConclusionsBarriers associated with AFO function that prevent common activities and poor health seem to be the biggest issue for not wanting to wear the AFO after the 3-month intervention. Addressing patients' perceptions and challenges to wearing the AFO is essential to increasing compliance and physical activity. Future research should concentrate on understanding the compatibility of orthotic device interventions with the subject's lifestyle.Clinical Trial Registration No.: NCT02902211.

Interprofessional intensive care unit (ICU) team perspectives on physical restraint practices and minimization strategies in an adult ICU: A qualitative study of contextual influences.

Guidelines advocate for minimization of physical restraint (PR) use in intensive care units (ICU). Interprofessional team perspectives on PR practices can inform the design and implementation of successful PR minimization interventions. To identify ICU staff perspectives of contextual influences on PR practices and minimization strategies. A qualitative descriptive study in a single ICU in Toronto, Canada. One-on-one semi-structured interviews were conducted with 14 ICU staff. A deductive content analysis of interviews was undertaken using the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Five themes were developed: risk-averse culture, leadership, practice monitoring and feedback processes, environmental factors, and facilitation. Participants described a risk-averse culture where prophylactic application of PR for intubated patients was used to prevent unplanned extubation thereby avoiding blame from colleagues. Perceived absence of leadership and interprofessional team involvement situated nurses as the primary decision-maker for restraint application and removal. Insufficient monitoring of restraint practices, lack of access to restraint alternatives, and inability to control environmental contributors to delirium and agitation further increased PR use. Recommendations as to how to minimize restraint use included a nurse facilitator to advance leadership-team collaboration, availability of restraints alternatives, and guidance on situations for applying and removing restraints. This analysis of contextual influences on PR practices and minimization using the i-PARIHS framework revealed potentially modifiable barriers to successful PR minimization, including a lack of leadership involvement, gaps in practice monitoring, and collaborative decision-making processes. A team approach to changing behaviour and culture should be considered for successful implementation and sustainability of PR minimization. The establishment of an interprofessional facilitation team that addresses risk-averse culture and promotes collaboration among ICU stakeholders will be crucial to the success of any approach to restraint minimization.

Exploring interprofessional collaboration during the implementation of a parent-infant mental health service: A qualitative study

ABSTRACT We examined interprofessional working in a newly implemented parent-infant mental health service team supporting families experiencing bonding and attachment difficulties. The aim was to identify forms of interprofessional work undertaken, barriers and facilitators of this work, and families’ and healthcare professionals’ perceptions of it. Semi-structured interviews were carried out with 21 stakeholders (5 parents, 4 team clinicians, 9 service referrers, 3 service commissioners) and were analyzed thematically. Interprofessional activities identified included building the service team’s cohesion and shared practice, building partner networks, interagency communication, coordination of roles, and raising awareness of infant mental health and parent-infant relationship needs. Enablers and barriers to interprofessional working were broadly consistent with findings from previous studies of related services, but with additional emphasis on consultative work as an enabler. Healthcare professionals reported benefiting from the case consultations and training on infant mental health provided by the service team. Parents reported that good interprofessional working enhanced satisfaction and engagement with the service. Findings indicate the centrality of interprofessional working for parent-infant mental health teams, with implications for future service implementation, service development, and understanding of mechanisms by which such services may influence family outcomes.

Precision medicine in Australia: now is the time to get it right.

Precision medicine in Australia: now is the time to get it right.

Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review

BackgroundEmpirical evidence suggests data and insights from the clinical practice guidelines and clinical quality registries are not being fully utilised, leaving health service managers, clinicians and providers without clear guidance on how best to improve healthcare delivery. This lack of uptake of existing research knowledge represents low value to the healthcare system and needs to change.MethodsFive electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews) were systematically searched. Included studies were published between 2000 and 2020 reporting on the attributes, evidence usage and impact of clinical practice guidelines and clinical quality registries on health service delivery.ResultsTwenty-six articles including one randomised controlled trial, eight before-and-after studies, eight case studies/reviews, five surveys and four interview studies, covering a wide range of medical conditions and conducted in the USA, Australia and Europe, were identified. Five complementary strategies were derived to maximise the likelihood of best practice health service delivery: (1) feedback and transparency, (2) intervention sustainability, (3) clinical practice guideline adherence, (4) productive partnerships and (5) whole-of-team approach.ConclusionThese five strategies, used in context-relevant combinations, are most likely to support the application of existing high-quality data, adding value to health service delivery. The review highlighted the limitations of study design in opportunistic registry studies that do not produce clear, usable evidence to guide changes to health service implementation practices. Recommendations include exploration of innovative methodologies, improved coordination of national registries and the use of incentives to encourage guideline adherence and wider dissemination of strategies used by successful registries.

Analisis Kualitas Pengelolaan Mutu Pelayanan Pendaftaran Pasien di Instalasi Rawat Inap Rumah Sakit Santa Elisabeth Medan

Inpatient services are non-structural service units that provide facilities and organize individual health service activities which include observation, diagnosis, treatment, nursing and medical rehabilitation. Inpatient registration (TPPRI) is the responsible part of the data and information of patients to be hospitalized. Hospitalization is the maintenance of hospital health where the patient stays for at least one day based on referrals from the implementation of other health services. This study aims to find out how the flow of processing the quality of patient registration services at the Inpatient Installation at Santa Elisabeth Hospital Medan. This study aims to find out how the flow of processing the quality of patient registration services at the Inpatient Installation at Santa Elisabeth Hospital Medan. This study is a qualitative descriptive study using purposive sampling, and collected 17 informants, namely 10 inpatients, 3 medical record services, 4 inpatient registration officer service staff at Santa Elisabeth Hospital Medan. Inpatient installation is one of the clinical services that serves patients who have to be treated for one day or more. The assessment of the success rate of services in health services is usually seen from various aspects, namely the level of utilization of facilities, quality and level of service efficiency. Some standard indicators related to health services that are monitored include bed utilization (Bed Occupancy Rate / BOR), average length of stay (LOS), average bed turn over (BTO), and percentage of discharged patients who died ≥ 48 hours of treatment (Net Death Rate/ NDR).

Relationship Physical Aspect and Policy Nerve Inpatient Service with Patient Satisfaction at Cut Nyak Dhien Regional General Hospital Aceh Barat Regency

Patient satisfaction is one of the first indicators of hospital’s standards, and a measure of service quality. The quality of health services is health services that can lead to patient satisfaction in every patient, where the procedures for implementation are in accordance with established standards and codes of ethics. The purpose of this research problem is to determine the relationship between physical and policy aspects with patient satisfaction at the Cut Nyak Dien Hospital in West Aceh.This research uses descriptive quantitative with cross sectional design. The population in this study were 855 patients or their guardians, the sampling technique used the type of accidental sampling using the Slovin formula to produce 90 respondents who had been hospitalized for 1x24 hours in June- August 2021. To analyze the data, the researcher used univariate and bivariate tests using Chi-square test, obtained p-value: 0,855 (p-value > α = 0,05) for the physical aspect and p-value = 0,049 (p-value < α = 0,05) for the policy. So, it can be concluded that there is no significant relationship between physical aspect with patient satisfaction, there is a significant relationship between policy and patient satisfaction, follow-up by providing intervention to socialize the implementation of health services according to standard operating procedures

Making the case for the governance of (digital public) health futures

Abstract Digital and data tools are fundamentally changing approaches to health and the design of health systems, but governance models have neither followed nor kept up with the pace of innovation. In response to this challenge, The Lancet & Financial Times Commission on Governing health futures 2030: Growing up in a digital world explores the convergence of digital health, artificial intelligence, and other frontier technologies with universal health coverage to support attaining the SDG 3. Children and young people are crucial groups requiring particular attention to ensure that no one is left behind in achieving universal health coverage and SDG 3 amidst the digital transformation in health. Today, there are 1.8 billion people between the ages of 10 and 24 - the largest youth population in history - 90 percent of whom live in developing countries. This cohort represents an unprecedented powerhouse of human potential and digital engagement that could transform health to reach sustainable development goals. This presentation introduces several key findings from the Commission's report which pertain to the governance of (digital public) health futures amidst digital transformations in health. It will highlight how human-centred approaches to health are vital to navigating the digital transformations and maximising their benefits for population health and well-being. Further, it will provide an action plan for meaningful youth engagement in the design, development, implementation, and evaluation of digital public health policies, programmes, and services.

Barriers and Facilitators to Intradialytic Parenteral Nutrition Implementation Targeting Protein Energy Wasting in Malaysian Hemodialysis Patients.

The capacity to deliver intradialytic parenteral nutrition (IDPN) for patients on hemodialysis (HD) diagnosed with protein energy wasting (PEW) in low resource settings is unknown. This study aimed to examine the extent of IDPN practice in HD units in Malaysia, and its implementation to treat PEW. We surveyed pharmacists (n = 56), who are central to parenteral nutrition delivery in Malaysia including IDPN. Seventeen healthcare stakeholders engaging with the Promoting Action on Research Implementation in Health Services (PARIHS) framework used the Likert scale to rate survey outcomes on IDPN implementation to treat PEW, according to the Evidence, Context, and Facilitation elements. IDPN for HD patients was available in 28 of 56 hospitals providing parenteral nutrition services, with only 13 hospitals (23.2%) providing IDPN to outpatients. Outpatient treatment was concentrated to urban locations (12/13) and significantly associated (p < 0.001) with resident nephrologists. The Evidence domain was rated poorly (2.18 ± 0.15) pertaining to IDPN indication when the oral spontaneous intake was ≤20 kcal/kg/day. The Context domain indicated good adherence to international best practice relating to IDPN administration (4.59 ± 0.15) and infusion time (4.59 ± 0.12). Poor adherence was observed in the Facilitation domain on ’Access to pharmacist and dietitian at HD units’ (2.65 ± 0.21) and ’Access to continuous medical education on managing PEW patients on HD’ (2.53 ± 0.15). The IDPN outpatient service was concentrated to urban hospitals with greater manpower resources. The PARIHS evaluation on IDPN implementation to treat PEW revealed facilitators in good practice adherence for prescribing and administration of IDPN but highlighted major barriers relating to IDPN indication and nutrient calculation.

Development of a community-based COVID-19 intervention in rural Ghana: a document analysis

BackgroundThe COVID-19 pandemic has caused the loss of millions of lives and economic breakdowns in many countries across the globe. Despite the limited availability of vaccines and the challenges of poor health infrastructure, few interventions have been developed and implemented for those who live in rural areas, particularly in sub-Saharan Africa. In response, Cocoa360, a global health nonprofit in rural Ghana designed an intervention called Cocoa360’s COVID-19 Preparedness and Outbreak Prevention Plan (CoCoPOPP). This paper aimed to examine the extent to which CoCoPOPP’s design aligned with the Promoting Action on Research Implementation in Health Services (PARIHS) framework.MethodsWe reviewed documents influencing CoCoPOPP’s design between March and June 2021. A total of 11 documents were identified for analysis. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework as a guide, thematic analysis was done to analyze the extracted data.ResultsOverall, CoCoPOPP’s design aligned with the evidence, context, and facilitation domains of the PARIHS framework. It positioned CoCoPOPP as an intervention that considered the unique context of a rural Ghanaian setting. It was guided by robust and high-quality published and non-published evidence and engaged external and internal stakeholders during its implementation. CoCoPOPP’s context-dependent nature positions it for potential replication in sub-Saharan Africa’s rural communities with similar farming contexts. Specific areas that were less well and/or not addressed were the unintended negative consequences of community engagement, the absence of primary data in the guiding evidence, and the lack of a facilitation continuum coupled with the role of power during the facilitation process.ConclusionCoCoPOPP, Cocoa360’s response to the COVID-19 pandemic in rural Ghana, is an evidence-driven, context-dependent public health intervention that has been designed to reduce COVID-19 infections and prevent potential deaths. This study underscores the importance of considering the unique community and cultural contexts, employing evidence, and engaging local and external actors as facilitators when designing interventions to respond to global health pandemics.

Health workers’ experiences of implementation of Helping Mothers Survive Bleeding after Birth training in Tanzania: a process evaluation using the i-PARIHS framework

BackgroundIn-service training, including the competency-based Helping Mothers Survive Bleeding After Birth (HMS BAB) is widely implemented to improve the quality of maternal health services. To better understand how this specific training responds to the needs of providers and fits into the existing health systems, we explored health workers’ experiences of the HMS BAB training.MethodsOur qualitative process evaluation was done as part of an effectiveness trial and included eight focus group discussions with 51 healthcare workers in the four districts which were part of the HMS BAB trial. We employed deductive content analysis informed by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) construct of context, recipients, innovation and facilitation.ResultsOverall, health workers reported positive experiences with the training content and how it was delivered. They are perceived to have improved competencies leading to improved health outcomes. Interviews proposed that peer practice coordinators require more support to sustain the weekly practices. Competing tasks within the facility in the context of limited time and human resources hindered the sustainability of weekly practices. Most health facilities had outlined the procedure for routine learning environments; however, these were not well operational.ConclusionThe HMS BAB training has great potential to improve health workers’ competencies around the time of childbirth and maternal outcomes. Challenges to successful implementation include balancing the intervention within the routine facility setting, staff motivation and workplace cultures.

EVALUASI KEBIJAKAN STANDAR PELAYANAN MINIMAL DI PUSKESMAS NAGRAK KABUPATEN SUKABUMI

ABSTRACT Minimum service standards (SPM) are provisions for public services to meet all citizens’ basic needs. Based on observations and interviews conducted with several informants in this study, it was stated that the implementation of health services at the Nagrak Health Center, Sukabumi Regency, had not achieved the fulfilment of targets by the provisions of the SPM, meaning that the Nagrak Health Center had not met the standards in its services. This study intends to evaluate the Minimum Service Standards policy at the Nagrak Health Center, Sukabumi Regency. The research method used by the researcher is qualitative. In the setting of the informants, the researcher used purposive sampling, which consisted of 9 informants. Data collection techniques in this study used observation, interviews, and documentation. Data analysis techniques that will be used in this research are data reduction, data presentation, conclusion drawing and verification. The results showed that the MSS policy was very appropriate by providing a good impact on the Nagrak Health Center, the community, and the relevant Government.

KNOWLEDGE OF OVULATORY CYCLE AND ASSOCIATED FACTORS AMONG REPRODUCTIVE AGE WOMEN IN NIGERIA

Relevance. The break-up and exit of the dominant follicle into the fallopian tube from the ovary is a physiological event known as ovulation. To determine fertility chances, it is essential to understand the physiology of the ovulatory cycle.&#x0D; Objective. This study assesses the knowledge of the ovulatory cycle (KOC) and associated factors among reproductive-age women in Nigeria.&#x0D; Materials and methods. The research was based on 2018 NDHS data (which was the most current at the time of this study). 90,290 women of reproductive age were taken into account for this investigation. The methods of analysis used are percentage, frequency, chi-square test and Binary Logistic Regression Analysis. p&lt;0.05 was considered to be statistically significant.&#x0D; Results. Only 25% of the 90,290 reproductive women included in the investigation were found to be knowledgeable of the ovulatory cycle. The study revealed that age, region, place of residence (urban), religion, marital status (living with a partner), maternal education (primary and higher education), husband's educational level and women's media exposure had a significant effect on knowledge of the ovulatory cycle.&#x0D; Conclusion. KOC, however, was low (25%), necessitating the development and implementation of reproductive health services through community media campaigns and health promotion. The authors of this study urge the Nigerian Ministry of Health to prioritize improving the reproductive health of women by prioritizing adolescents and those with less education. Additionally, media initiatives might be strengthened to improve women's KOC, which is essential for preventing unwanted pregnancy.

Identification of Factors Determining the Success of Health Care at Correctional Institutions in Indonesia

ABSTRACT This study aims to extract the factors that have an impact on the success of health services in correctional institutions in Indonesia. This is an exploratory study that was conducted in 18 correctional institutions spread across 4 islands in Indonesia through virtual interviews and triangulation of sources and experts. This study uses health service standards of correctional institutions from WHO and Mandela Rules covering medical care, health protection, health promotion, and health resilience. The results of this study provide an overview of the success factors of health services in correctional institutions in Indonesia. The implementation of health services is following the standard although the management is adjusted to the resources and environment.