In-depth Interview Guides Research Articles

Challenges in Maintaining Quality Assessments in Higher Learning Institutions: Experiences from Selected Tanzanian Universities

This study was conducted to assess the extent to which universities in Tanzania ensure quality in assessments and identify challenges facing the whole assessment process. Literature showed a poor linkage between university graduates and industry whereby some graduates were reported to be lacking essential skills expected of them beside of having good results. This situation motivated the researcher to conduct this study being guided by TQM theory. The study adopted a convergent parallel design which allowed a collection of both qualitative and quantitative at a go. The study targeted lecturers, examination officers, heads of departments and quality assurance directors from universities offering teacher education in Tanzania. Stratified convenience and purposeful sampling techniques were used to select 48 lecturers, 4 examination officers, 4 heads of departments and 4 quality assurance directors from four universities. Questionnaires and in-depth interview guides were used to collect data. Quantitative data were analyzed in frequencies and percentages while the analysis of qualitative data was done in themes and its presentation was done narratively being supported by direct quotations. The study found out universities to be striving to improve quality in final examinations but doing less in formative assessments. Large classes and workloads on the other side were found to be the challenges facing the assessment process. The study recommended for universities to extend the moderation process to the continuous assessments and develop policies that will make lecturers maintain quality in the assessment process.

Immunosuppressive medication adherence and affecting factors in solid organ transplantation patients: a mixed-methods study

Objectives: Transplantation is a form of treatment that requires long-term pharmacotherapy. After transplantation, patients may have difficulty adapting to medication use for various reasons, and this may result in rejection. The aim of this study is to determine participants’ medication compliance and the factors affecting it. Methods: The research was conducted with a sequential explanatory mixed method. In the study, quantitative data were collected using the Turkish Immunosuppressive Medication Adherence Scale, and qualitative data were collected using the In-Depth Individual Interview Guide. Quantitative data were analyzed using statistical methods, and qualitative data were examined according to Braun and Clarke's thematic analysis framework. Results: In this study, 62.3% of the participants were male, 37.0% were 50 years old and over, 71.3% lived with their spouse, 54.0% had primary and secondary school education, and 42.0% could not work due to their current health condition. From a clinical perspective, it was determined that 78% of the transplants were kidney transplants, and 41.3% were more than 4 years after transplantation. 74.3% of the transplants were from living donors. The mean score of the immunosuppressive medication compliance scale was determined to be 40.91±4.09. In the qualitative data analysis of the study, factors affecting medication adherence were examined and the themes of "individual factors", "complexity of the regimen" and "social support resources" were obtained. The sub-themes of the individual factors theme are reluctance, hopelessness and addiction; Sub-themes of the complexity of the regimen theme are drug side effects and polypharmacy; The sub-themes of the social support resources theme are loneliness and family pressure. Conclusions: The factors influencing medication adherence among organ transplant recipients have been investigated, revealing that adherence levels vary significantly depending on various factors. These findings underscore the importance of tailored care strategies and individualized support approaches.

Spiritual Emotional Freedom Technique (SEFT) Analysis of the Anxiety Levels of Primigravida Pregnant Women in the Third Trimester

Background:When facing childbirth, anxiety about giving birth often occurs. Anxiety that is not resolved properly causes changes in the function of the autonomic nervous system/ANS, worsens cardiovascular adaptation and risks complications in pregnant women.Purpose:This research aims to identifySpiritual Emotional Freedom Technique(SEFT) Regarding the Anxiety Level of Primigravid Pregnant Women in the Third Trimester.Methods:Qualitative study with a case study approach. The informants in this study consisted of 10 primigravida pregnant women who were recruited through purposive sampling. Data collection through in-depth interviews using data collection instruments, in-depth interview guides, field notes, audio recorder. By analyzing data using Collezi thematic analysis.Results:The results of the qualitative analysis showed that two major themes were studiedSpiritual Emotional Freedom Technique(SEFT) Regarding the Anxiety Level of Primigravida Pregnant Women in the Third Trimester, namely; 1) Spiritual Emotional Freedom Technique (SEFT) process, 2) Spiritual Emotional Freedom Technique (SEFT) results.Conclusion:Spiritual Emotional Freedom Technique(SEFT) is good for women who are undergoing pregnancy to reduce feelings of anxiety and worry, especially the worries experienced by pregnant women in the third trimester, the feelings of anxiety and worry are increasing. Pregnant women feel the benefits of SEFT. They feel the effectiveness of SEFT and can continue to practice SEFT in a sustainable manner.

“When selling anything to an audience, visible publicity is key:” experiences, barriers, and enablers to participate in a COVID-19 study in Malawi

BackgroundMany studies in infectious diseases struggle to recruit participants. The SARS-CoV-2 infection, transmission dynamics, and household impact in Malawi (SCATHIM) study reported a refusal rate of 57.2%. Adequate publicity can lead to more people participating in studies. This study explored the reasons for participating in the SCATHIM study.MethodsA descriptive qualitative study informed by the theory of reasoned action was conducted in Blantyre between January 2022 and March 2022 to assess factors that influence participation in a COVID-19 study among 10 index cases, 10 caregivers, 10 study decliners, and 5 research staff. The data were collected via in-depth interview guides, audio recorded, transcribed, managed via NVIVO and analysed via a thematic approach.ResultsThe factors that motivated participation in the study included one’s knowledge of COVID-19; potential access to medical services, including free COVID-19 tests for members of the household; financial reimbursements; and the ability to contribute scientific knowledge. The barriers to participation included minimal publicity of the study amidst a novel condition, perceived stigma and discrimination, perceived invasion of privacy, discomfort with the testing procedures, and suboptimal financial reimbursements.ConclusionEffective publicity and outreach strategies have the potential to decrease refusal rates in study participation, especially if a condition is novel. Studies on infectious diseases should address stigma and discrimination to promote participation and ensure participant safety.

The Extent to Which Teachers Perceive Open Performance Appraisal System in Enhancing Work Commitment in Public Secondary Schools in Moshi District, Tanzania

The study investigated the extent to which teachers perceive OPRAS in enhancing their work commitment in public secondary schools in Moshi District, Tanzania. The study was guided by one research question for which the researcher searched for a response. The study was guided by the Management by Objectives theory (MBO), which was propounded by Peter Drucker in 1954. Convergent Research Design under Mixed Research Methods was adopted. The target population was 1239 teachers, 10 heads of schools, one DSEO and one TCS secretary. The study used total population and stratified random sampling techniques to determine the study sample, which consisted of 136 respondents. Instruments for data collection were questionnaires and In-depth interview guides. Face and content validity was ensured by three MWECAU research experts. Pilot testing was done in two public secondary schools. The reliability was aided by the Likert-items type, which was estimated using Cronbach's Alpha, whereby the results obtained from the teachers' questionnaire were 0.74. Triangulation and peer debriefing were used to ensure the reliability of the interview guide. Descriptive statistics were used to analyze quantitative data in frequencies, means and percentages and presented in tables with the aid of SPSS version 22. Qualitative data were transcribed and analyzed thematically. The study found that teachers in public secondary schools perceive negatively that OPRAS enhance work commitment in public secondary schools. Some teachers do not believe that OPRAS effectively enhances their overall job dedication and engagement. This negative perception highlights a gap between teachers who had expectations and those who perceived the effectiveness of the OPRAS system. The study recommends that the government should come up with practical mechanisms to ensure that all teachers work effectively and efficiently in order to improve general organizational performance.

Analysis of Public and Private Treatment Services for Substance Use Disorders in Kaduna State, Nigeria

Inappropriate use of substances, also known as substance abuse, especially among youths constitutes a problem globally. The trajectory of substance abuse exposes individuals to various health problems and disorders. To this end, the provision of treatment services is considered an important measure towards addressing the side effects of the inappropriate use of substances. Focusing on Kaduna State, Nigeria, this study analyzes public and private facilities available for individuals facing substance use disorders. The study employed quantitative and qualitative data collection methods, with the administration of questionnaires and in-depth interview guides to respondents and research participants in selected treatment facilities. Copies of questionnaires were administered to eighty-six staff while in-depth interviews were conducted on eight (8) staff of the selected treatment facilities. The study leverages Talcott Parson’s social system theory to explain the subject matter. Findings from the study revealed that the selected facilities provided evidence-based psychosocial treatment services to the victims of substance abuse. In addition to other medical services provided by public and private treatment facilities, findings revealed that public facilities provided HIV/AIDs services than private facilities. Unlike private treatment facilities, the study discovered that wraparound services (such as vocational training) are minimally provided by public facilities. Despite the importance of supportive services towards optimal rehabilitation of victims of substance abuse, the study revealed that both public and private facilities neglect such services. The study therefore recommends strong collaboration among the existing treatment facilities towards the provision of optimal skills and rehabilitation of victims of substance abuse and its associated disorders.

Clinical Legal Education and Social Justice: Assessing the Impact on Law Students in a Law Clinic in Nigeria

One of the core missions of clinical legal education is to expose students to the legal needs of society while enhancing access to justice for indigent members of the community. This, the University of Ibadan Women’s Law Clinic (UI-WLC) does by offering pro bono legal aid to indigent women in the community who lack access to justice. In the process, law students are engaged in clinic experiences involving interaction with real clients and conduct of outreach programs for different target audiences within the community. Through these experiences, it is expected that professionalism, empathy, equality and and a sense of fairness is inculcated in the students. Students trained with these values ideally have a strong sense of what is just and fair, and are able to choose careers and lifestyles that support their immediate communities. Since its establishment, the UI-WLC has groomed over 960 law students; and currently has about 120 students spread over third, fourth and fifth year students, however, an assessment of the impact of social justice values which the clinic seeks to impart to the students through the training they receive at the clinic has not been carried out. This research seeks to achieve this aim through a mixed methods approach. Using a quota sampling method, 90 law graduates were identified and interviewed through self- administered pre-tested questionnaires and in-depth interview guides. Two sessions of focus group discussions were also conducted. Findings in this study revealed how participation in the UI-WLC through various activities and programs has had both positive and negative outcomes for the students. It also showed an aspect of group dynamics which has to be improved upon at the UI-WLC to better equip students to impact the society.

Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya.

Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the country. The study utilized a Convergent-Parallel-Mixed-Methods design, incorporating both quantitative and qualitative approaches. The study sampled diverse population groups and randomly selected health facilities. Four UHC pilot counties are paired with two non-UHC pilot counties, one neighboring county and the second county with a geographically distant and does not share a border with any UHC pilot counties. Stratification based on ownership and level was performed, and the required number of facilities per stratum was determined using the square root allocation method. Data on the availability of human resources for health was collected using a customized Kenya Service Availability and Readiness Assessment Mapping (SARAM) tool facilitated by KoBo ToolKitTM open-source software. Data quality checks and validation were conducted, and the HRH general service availability index was measured on availability of Nurses, Clinician, Nutritionist, Laboratory technologist and Pharmacist which is a minimum requirement across all levels of health facilities. Statistical analyses were performed using IBM SPSS version 27 and comparisons between UHC pilot counties and non-UHC counties where significance threshold was established at p < 0.05. Qualitative data collected using focus group discussions and in-depth interview guides. Ethical approval and research permits were obtained, and written informed consent was obtained from all participants. The study assessed 746 health facilities with a response rate of 94.3%. Public health facilities accounted for 75% of the sample. The overall healthcare professional availability index score was 17.2%. There was no significant difference in health workers' availability between UHC pilot counties and non-UHC pilot counties at P = 0.834. Public health facilities had a lower index score of 14.7% compared to non-public facilities at 27.0%. Rural areas had the highest staffing shortages, with only 11.1% meeting staffing norms, compared to 31.8% in urban areas and 30.4% in peri-urban areas. Availability of health workers increased with the advancement of The Kenya Essential Package for Health (KEPH Level), with all Level 2 facilities across counties failing to meet MOH staffing norms (0.0%) except Taita Taveta at 8.3%. Among specific cadres, nursing had the highest availability index at 93.2%, followed by clinical officers at 52.3% and laboratory professionals at 55.2%. The least available professions were nutritionists at 21.6% and pharmacist personnel at 33.0%. This result is corroborated by qualitative verbatim. The study findings highlight crucial challenges in healthcare professional availability and distribution in Kenya. The UHC pilot program has not effectively enhanced healthcare facilities to meet the standards for staffing, calling for additional interventions. Rural areas face a pronounced shortage of healthcare workers, necessitating efforts to attract and retain professionals in these regions. Public facilities have lower availability compared to private facilities, raising concerns about accessibility and quality of care provided. Primary healthcare facilities have lower availability than secondary facilities, emphasizing the need to address shortages at the community level. Disparities in the availability of different healthcare cadres must be addressed to meet diverse healthcare needs. Overall, comprehensive interventions are urgently needed to improve access to quality healthcare services and address workforce challenges.

An introduction to qualitative research for resident doctors

Qualitative research involves systematically collecting, organising, and interpreting textual or other non-numeric data to better understand experiences and context, convey different perspectives on a complex issue, explore new concepts, and understand attitudes and perceptions of phenomena of interest. Qualitative research is also used to identify ‘intangible’ factors, such as social norms, gender roles, ethnicity, religion, and religiosity/spirituality. Unlike quantitative methods that ask the questions ‘how many’ or ‘how much’, qualitative methods focus on the ‘what’, ‘how’ or ‘why’ of a phenomenon. Resident doctors across disciplines can use qualitative research methods but often lack the skills and training to use these methods in their research work. Qualitative and quantitative methods can complement each other through mixed methods approaches. This mixed methods approach to research may be useful across medical and surgical disciplines when one data source is insufficient, thus a second data source can enhance or complement the first. Combining multiple data sources allows researchers to triangulate the information they obtain. Qualitative research most often entails conducting interviews (in-depth interviews, key informant interviews), focus group discussions or observations (participant, non-participant). Tools used to obtain qualitative data include in-depth interview or focus group discussion guides; case studies and vignettes may be introduced into such data collection endeavours. Qualitative data in the form of transcripts and field notes is obtained by using these tools. Observation checklists and diaries (e.g. time use, food diaries) may also be used to collect qualitative data. Qualitative data analysis is often thematic, done either manually or using Computer Assisted Qualitative Data Analysis Software. In reporting the findings of qualitative research, illustrative quotes are usually employed. Qualitative research can be subjective and full of nuance, thus the need to assess its quality using criteria such as credibility, member checking and reflexivity. Ethical considerations, especially confidentiality is primarily important because of the relatively small sample sizes and the need to ensure participants’ responses are not traceable to them.

Maintenance Culture of Road Infrastructure and Socio Economic Development in Uyo Local Government Area Akwa Ibom State Nigeria

The focus of this study was on the maintenance culture of road infrastructure and the socioeconomic development in Uyo Local Government Area, Akwa Ibom State, Nigeria. The study was guided by the assumptions of Talcott Parsons' Structural Functionalism Theory. The study adopted a descriptive survey design. The population of this study consisted of critical stakeholders which included eleven (11) Councilors, Chairman, Vice Chairman, Secretary and technocrats – Head of Local Government Service, Director of Finance, Director of Works, and Director of Environmental Health as key informants; and key workforce in AKROIMA and FERMA were part of the participants. The sample size for the study was 40 participants who were selected using purposive and snowballing non-probability sampling techniques. The study adopted observation, key informant interview (KII) and in-depth interview guide (IIG) as major instruments. The findings showed, among others, that maintenance culture is minimally felt in Uyo Local Government Area as a result of the slow response of the maintenance agencies to the deplorable roads in the area. Equally, prompt release of funds distorted by bureaucratic processes constituted a major hindrance to quick response which has affected the access to vital socio-economic institutions and marred the pace of socio-economic development in the study area. The study recommended stakeholders' concerted efforts through advocacy, support, and concern geared toward road maintenance for the development of social life and economic well-being.

Barriers to the use of mental health services amongst men in Nigeria and the potential of digital mental health support

ABSTRACT Objective Mental health problems are increasing. Nonetheless, the uptake of professional mental health support remains very low in Nigeria and other African countries, especially among men. This study explored the potential of digital mental health support in eliminating barriers to professional mental health services amongst men in Nigeria. Method Qualitative data were collected between July-August 2022 using an In-depth Interview (IDI) Guide with 24 men aged 18–38. NVivo 12 was employed to assist with the analysis. Results Digital mental health support has the potential to improve acceptance and uptake of professional mental health support services, reduce deterrent factors such as stigma, issues with confidentiality and trust, cost and availability. The use of digital support may also mitigate the nature of masculinity which deters some men from asking for help. Regulations around providing mental health support may improve men’s confidence in seeking professional mental health support. Conclusion Findings highlight the acceptability of digital mental health support for men, and the need for clinical practice regulations.

Factors Associated with Chronic Kidney Disease in Jigawa State, Nigeria: A Mixed Methods Study

Abstract Background: Chronic kidney disease (CKD) is becoming an increasing public health problem. A study that reviewed patients receiving treatment in hemodialysis centers reported 79.2% of patients from Jigawa State to be managed for CKD. This study aimed to find the factors associated with CKD among adults from high-burden kidney disease areas of Jigawa State. Materials and Methods: A cross-sectional descriptive study design that utilized mixed methods (quantitative and qualitative) of data collection (sequential explanatory) was used to study eligible respondents from the four local government areas (LGAs) reported to have a high burden of kidney disease. The modified WHO STEPS questionnaire, key informant interview, and in-depth interview guides were employed to collect information from the eligible selected community members. Multistage and purposive sampling techniques were used, and data were analyzed using IBM SPSS version 22.0 with a statistical significance set at P ≤ 0.05. Thematic analysis was used to analyze the qualitative interviews. Results: The age of the respondents ranged from 18 to 102 years, with a median of 45 (interquartile range = 30–80) years. The period prevalence over the past five years (2018–2023) of having kidney disease in the family was 67 (18.6%), while the point prevalence (currently having a patient with kidney disease) was 51 (14.1%). In terms of the distribution of cases by LGAs, Jahun reported more cases, 33.3% in the family within the last five years, followed by Hadejia 18.7%. In the same vein, respondents from Jahun 28.9% and Hadejia 16.5% reported more current cases of kidney disease in the family. The prevalence of ever had patient with chronic kidney disease in the family was significantly higher among those with systolic hypertension (BP) ≥140 mmHg (29.3%, P &lt; 0.001). Elevated systolic BP was significantly associated with currently having a kidney disease patient (23.3%, P = 0.001). The interviews revealed late presentation and noncompliance to medications among those with risk factors as the perceived facilitators of kidney disease. Conclusions: The prevalence of kidney disease was alarming in the high-burden kidney disease areas. The government should develop a sustainable model for mass community screening of risk factors and community-based health insurance to effectively manage all identified cases.

Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews.

In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding.

Formal support services and (dis)empowerment of domestic violence victims: perspectives from women survivors in Ghana

BackgroundAs part of efforts to prevent violence against women, several countries have institutionalized formal support services including legislations to prevent, protect victims, and deter perpetrators of domestic violence (DV). Prior research on formal support service utilization shows that DV survivors do not get the necessary services they deserve. However, much remains to be known about the experiences of women survivors of DV who accessed a range of formal support services and how their experiences (dis)empowered them. Here, we assessed the experiences of Ghanaian women survivors of DV with formal support services vis-à-vis the provisions of the Ghana DV Act and insights of subject experts.MethodsFrom May to August 2018, we recruited a total of 28 participants: 21 women survivors of DV in Weija-Gbawe Municipality of Ghana, and 7 experts from the police, human rights, and health professions. We used two sets of in-depth interview guides: one to collect data on survivors’ experiences, and the second for the insights of experts. We performed summary descriptive statistics on survivors’ sociodemographic characteristics and used thematic analysis to assess their experiences of DV; and access to, patronage, and response of formal support services.ResultsOf 21 DV survivors, 19 (90.1%) were aware of the existence of the DV law, however none was well informed of their entitlements. DV survivors have low formal education and are not economically empowered. Some DV survivors are revictimized in the process of accessing formal services. DV survivors expect the government to provide them with shelter, upkeep, medical, and legal aid. All the 21 survivors had at least one contact with a women’s rights organization and were knowledgeable of their supporting services namely legal services, temporary shelter, and psychosocial support.ConclusionsThe experiences of DV survivors do not reflect the legal provisions of Ghana’s DV Act. Government under funding of formal services and negative gender norms are disempowering to survivors. NGOs are popular among women survivors of DV in Ghana for the education, legal, and material support they provide. A close collaboration between the government and NGOs could better mitigate DV in Ghana.

Mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district, Uganda- a qualitative study.

In Uganda 27% of deliveries take place outside a health facility. The existing gaps in quality of maternal and newborn health care must be addressed for Uganda to attain its health targets and consequently its economic targets. Some of the gaps include but are not limited to; ill-equipped healthcare facilities in rural settings, inadequate client/customer care skills by healthcare providers, and health worker absenteeism especially in the night hours. In Kaberamaido District, only 38.3% of the deliveries in Alwa sub county took place at a health facility. Despite the district local government and stakeholder efforts to promote health facility-based deliveries, sadly, a very low proportion of women use the health facilities for delivery. We sought to explore mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district. The study adopted a cross-sectional descriptive qualitative design. We purposively included 115 mothers who delivered outside the health facility and consented to participate and those who lost their babies within the last 24 months preceding the study. Other participants included in the study were village health team (VHT), traditional birth attendants (TBA) and older women. The main instruments used to collect data were focus group discussion (FGD) and in-depth interview (IDI) guides. All voice recordings from FGDs and interviews were transcribed and translated from the local language (Kumam) into English. Thematic content analysis was used to synthesize data by applying codes to segments of the transcripts upon which major domains were derived. Key findings were synthesized and quotes were carefully selected based on their relevance and representativeness to the analysis and study objective. Our findings indicated general satisfaction with the care provided during and after home delivery by TBAs as expressed by mothers. Motivation to seek services from TBAs was attributable to their vast experience spanning decades with history of safe delivery. Few mothers expressed discontent with TBA services citing abuse and rudeness. Our study underscored the common view that TBAs effectively managed home deliveries, providing satisfactory care to mothers. However, concerns emerged on TBAs' capacity to manage complications, emphasizing a need for their reintegration into formal healthcare systems, alongside further training, and standardization in maternal care practices.

Feasibility and acceptability of the paediatric pulse oximeter in integrated management of neonatal and childhood illnesses (IMNCI) services by public health facilities: A qualitative study in rural Western India.

Pneumonia contributes to about 15% of child deaths globally, with 20% of the overall deaths occurring in India. Although WHO recommends the use of pulse oximeters (PO) in first-level facilities for early detection of child pneumonia in low- and middle-income countries (LMICs), this has not yet been implemented in India. We aimed to assess the feasibility and acceptability of introducing PO in integrated management of neonatal and childhood illnesses (IMNCI) services at primary health centres (PHC) in the rural Pune district. We identified medical officers (MO) and auxiliary nurse midwives (ANM) from six PHCs as study participants due to their involvement in the treatment of children. We developed in-depth interview (IDI) guides for both groups to explore their IMNCI knowledge and attitude towards the program through a qualitative study. We conducted interviews with MOs (n = 6) and ANMs (n = 6) from each PHC. The PO module was added to explore perceptions about its usefulness in diagnosing pneumonia. After baseline assessment, we conducted training sessions on adapted IMNCI services (including PO use) for MOs and ANMs. PO devices were provided at the study PHCs. At baseline, no PO devices were being used at study PHCs; PHC staff demonstrated satisfactory knowledge about paediatric pneumonia management and demanded refresher IMNCI training. They also felt the need to reiterate the PO use for early diagnosis of pneumonia in children and highlighted the challenges encountered in managing pneumonia at PHCs, such as health system-related challenges and parents' attitudes towards care seeking. There was positive acceptance of training and PO started to be used immediately in PHCs. There was increased confidence in using PO at endline. PO use in examining symptomatic children increased from 26 to 85%. Paediatric PO implementation could be integrated successfully at PHC levels; we found pre-implementation training and provision of PO to PHCs to be helpful in achieving this goal. This intervention demonstrated that an algorithm to diagnose pneumonia in children that included PO could improve case management.

Are physicians ready for precision antibiotic prescribing? A qualitative analysis of the acceptance of artificial intelligence-enabled clinical decision support systems in India and Singapore

Artificial intelligence (AI)-driven clinical decision support systems (CDSSs) can augment antibiotic decision-making capabilities, but physicians' hesitancy in adopting them may undermine their utility. We conducted a cross-country comparison of physician perceptions on the barriers and facilitators in accepting an AI-enabled CDSS for antibiotic prescribing. We conducted in-depth interviews with physicians from the National Centre for Infectious Diseases (NCID), Singapore, and Christian Medical College Vellore (CMCV), India, between April and December 2022. Our semi-structured in-depth interview guides were anchored on Venkatesh's UTAUT model. We used clinical vignettes to illustrate the application of AI in clinical decision support for antibiotic prescribing and explore medico-legal concerns. Most NCID physicians felt that an AI-enabled CDSS could facilitate antibiotic prescribing, while most CMCV physicians were sceptical about the tool's utility. The hesitancy in adopting an AI-enabled CDSS stems from concerns about the lack of validated and successful examples, fear of losing autonomy and clinical skills, difficulty of use, and impediment in work efficiency. Physicians from both sites felt that a user-friendly interface, integration with workflow, transparency of output, a guiding medico-legal framework, and training and technical support would improve the uptake of an AI-enabled CDSS. In conclusion, the acceptance of AI-enabled CDSSs depends on the physician's confidence with the tool's recommendations, perceived ease of use, familiarity with AI, the organisation's digital culture and support, and the presence of medico-legal governance of AI. Progressive implementation and continuous feedback are essential to allay scepticism around the utility of AI-enabled CDSSs.

Supporting Adolescents With HIV in South Africa Through an Adherence-Supporting App: Mixed Methods Beta-Testing Study.

Novel smartphone app-delivered interventions have the potential to improve HIV treatment adherence among adolescents with HIV, although such interventions are limited. Our team has developed Masakhane Siphucule Impilo Yethu (MASI; Xhosa for "Let's empower each other and improve our health"), a smartphone app-delivered intervention to improve treatment adherence among adolescents with HIV in South Africa. MASI was adapted to the South African cultural context using the HealthMpowerment platform, an evidence-based digital health intervention developed for and with youth in the United States. We conducted this beta-testing study to (1) explore the initial usability of MASI, (2) examine engagement and experiences using MASI features, and (3) inform refinements to the app and intervention implementation plan prior to a subsequent pilot randomized controlled trial (RCT). This study was conducted from August 2021 to December 2021 in Cape Town, South Africa. Beta-testing participants received access to MASI for 3 weeks. A mixed methods approach was used, with brief questionnaires and semistructured in-depth interviews conducted prior to app installation and after 1 week to 2 weeks of app testing. Engagement with MASI was measured through analysis of back-end app paradata, and follow-up in-depth interview guides were tailored to each participant based on their app use. Participants in the beta-testing study (6 male participants, 6 female participants; ages 16-19 years) collectively spent 4.3 hours in MASI, averaging 21.4 minutes per participant over the 3-week period (range 1-51.8 minutes). Participants logged into MASI an average of 24.1 (range 10-75) times during the study period. The mean System Usability Scale score was 69.5 (SD 18), which is considered slightly above average for digital health apps. Thematic analysis of qualitative results revealed generally positive experiences across MASI features, although opportunities to refine the app and intervention delivery were identified. Initial usability of MASI was high, and participants described having a generally positive experience across MASI features. Systematically analyzing paradata and using the interview findings to explore participant experiences allowed us to gain richer insights into patterns of participant engagement, enabling our team to further enhance MASI.The results from this study led to a few technological refinements to improve the user experience. Enhancements were also made to the intervention implementation plan in preparation for a pilot RCT. Lessons learned from the conduct of this beta-testing study may inform the development, implementation, and evaluation of similar app-delivered interventions in the future.

Perceptions and Rumors About the Ebola Virus Disease Vaccine in the Ituri and Kivu Provinces of the Democratic Republic of Congo.

Perceptions and rumors about vaccinations can contribute to vaccine hesitancy. This study aimed to examine perceptions and rumors about the Ebola vaccine during the 10th Ebola Virus Disease outbreak in the Ituri and North Kivu provinces of the Democratic Republic of Congo. Eight hundred randomly selected respondents were surveyed with a uniform structured questionnaire. Further, we collected qualitative data through focus group discussions and using in-depth interview guides. Results revealed several misperceptions and rumors about the vaccine, which led to some level of vaccine hesitancy and refusal among the people. The acceptance rate of the vaccine was 67.3% (below the 80% threshold needed to create herd immunity in the population). More of the urban population (31.3%) than the rural population (10.4%) accepted the vaccine. Refusals were largely due to fear that the vaccine could activate other diseases in the body and could even kill. Some feared that it was a conspiracy of the government to reduce the population in the study area through forced fertility control and death, among other such concerns. In conclusion, these rumors increased mistrust, which challenged the efforts of the government and its partners to safeguard the health of the people.

Management of chronic non-communicable diseases in Ghana: a qualitative study of patients’ coping strategies and the role of caregivers

BackgroundChronic Non-Communicable Diseases (CNCDs) has become a major cause of mortality and disability globally. We explored the coping strategies adopted by CNCD patients and the roles of caregivers in the management of CNCDs in Ghana.MethodsThis was a qualitative study that adopted an exploratory design. The study was carried out at the Volta Regional Hospital. Purposive convenience sampling procedures were used to sample patients and caregivers. Data for the study were collected using in-depth interview guides. Data were collected among 25 CNCDs patients and 8 caregivers and analysed thematically using ATLAS.ti.ResultsPatients adopted a variety of strategies to cope with their condition. These strategies were emotion-oriented coping, task-oriented coping, and avoidance-oriented coping. Family members were the main caregivers, who provided social and financial support for patients. Financial challenges, inadequate family support, poor attitudes of health workers, delays at the health facility, unavailability of drugs at the facility, and patients’ non-adherence to the medical advice were major challenges that militated against caregivers’ efforts in supporting patients in the management of their CNCDs.ConclusionWe found that patients adopted various strategies to cope with their conditions. The roles of the caregivers in supporting patients in the management practices were identified as very important as they contribute immensely to the financial and social support for the patients in their management of CNCDs. It is crucial that health professionals actively involve caregivers in every aspect of the day-to-day management of CNCDs as these caregivers spend more time with these patients and understand them better.