Engagement Of Key Stakeholders Research Articles

My husband will love me more if I give birth to more children: Rural women’s perceptions and beliefs on family planning services utilization in a low resource setting

IntroductionResponsibility for family planning in low resource settings is almost solely delegated to women, with very low male involvement. This study investigated rural Tanzanian women’s perceptions and cultural beliefs of the barriers to family planning services utilization. MethodsThis study used a qualitative descriptive approach drawing on four group discussions with 20 purposively selected married women with two or more children. The study followed COREQ guidelines for reporting qualitative studies. Data were collected from participants at four health facilities in Bagamoyo and Kisarawe districts in Pwani, Tanzania. ResultsParticipants’ occupations included housewives, small-scale farmers, and entrepreneurs. Most women were Muslim and had a primary school education.Five main themes were identified: use of modern and traditional family planning methods; my husband will love me more if I give birth to more children; men’s expected roles in family planning; provide education to dispel myths; and religious barriers. Associated sub-themes covered use of strings, snares and pigis; calendars; breastfeeding linked to family planning; men as heroes for having many children; men not having time to attend clinic; and conflicting sources of health information. ConclusionLack of adequate family planning information; beliefs on and use of traditional/unconventional methods; gender roles expectations that influence decision making and limit women’s choices of family planning methods and; socio-cultural and religious beliefs were main perceived barriers for family planning utilization in this study. Mitigation of these barriers depends on the sustained engagement of key stakeholders including religious and community leaders. Health education must be designed to adapt socio-cultural and religious doctrines with benefits of family planning and health outcomes. Health delivery services must also address women’s’ prevailing perceptions and beliefs with emphasize on the partner communication and their encouragement of men’s’ involvement in reproductive health services utilization.

Faculty Members’ Perceptions of Quality Assurance and Accreditation in Afghanistan

Abstract
 This study investigated faculty members’ perceptions of quality assurance and accreditation (QAA) in Afghanistan. The study aimed to examine how familiar faculty members were with QAA policy, quality concepts, QAA processes, and whether QAA process has improved the status quo. Through a sequential exploratory mixed methods design, the investigators interviewed seven faculty members at four universities, and subsequently conducted a self-administered survey questionnaire at six universities (two public and four private). A response rate of 54 percent (N = 42) was obtained from the survey. The study findings suggest that faculty members had mixed impressions about QAA implementation. For instance, an overall sum of mean scores shows that faculty members have a positive view about QAA processes M = 3.5 (SD = .75), however, interview participants were less satisfied with QAA outcome. Lastly, implications are made that a successful implementation of QAA processes in Afghanistan is contingent on: 1) establishment of a quality culture wherein universities own the processes and outcomes, and 2) engagement of key stakeholders including faculty, staff, and administrators to internalize QAA processes to improve the status quo.
 Keywords: higher education quality; quality assurance; accreditation; higher education in Afghanistan

National survey: Developing a common approach to grading of practice in pre-registration midwifery.

This paper presents the final phase of a national project exploring grading of practice in programmes leading to registration as a midwife in the United Kingdom. The aim was to develop a generic framework for grading practice, enhancing standardisation while enabling flexibility in application of current and new educational standards. A mixed method on-line survey considered existing practice assessment tools, factors contributing to robust and reliable assessment and perceptions of two assessment tools developed by the research team: a 'Lexicon Framework' and 'Rubric', which were tested through scenarios. Participants included 170 midwifery and nursing academics, clinicians and students, representing 20 universities in the UK. Seven key themes emerged, from which an 'Evidence Based Model for Professional Practice Assessment' was developed. The proposed tools were overall positively evaluated and demonstrated a good level of reliability. A national tool to standardise midwifery practice assessment is recommended, and scope for transferability of our tools to all midwifery programmes and to nursing was identified. Other recommendations include engagement of key stakeholders in development of practice assessment documentation, and maintaining the professional purpose of grading practice as central to the process. A set of key principles for assessing practice is presented.

US e-learning course adaptation to the Ukrainian context: lessons learned and way forward

BackgroundAccess to continuing education opportunities is limited for Ukrainian healthcare workers, and the need is acute in order to support healthcare reform efforts currently underway in Ukraine. Online learning is a cost-effective mechanism for continuing education since healthcare workers can remain on the job during training. It also provides a means of keeping health professionals up to date on their knowledge and skills in rapidly changing and increasingly complex healthcare environments.MethodsThis paper describes the process of adapting an existing e-learning course from a US institution to the Ukrainian setting. Course participants’ feedback was used to evaluate the effectiveness of the adapted version that was piloted twice in 2016–2017 with 53 participants in total, 46 of whom completed the course and contributed to the evaluation.ResultsThis was the first fully online course on Leadership and Management in Health (LMiH) to be offered in Ukraine. Several lessons were learned during course adaptation when multiple aspects of the Ukrainian environment were taken into account including 1) linguistic accessibility, 2) access to the Internet, 3) computer literacy, and 4) novelty of online learning. Based on these findings, course material was first adapted by translating it from English to Ukrainian with the emphasis on cultural adjustment of idioms and real life examples. Then, using the first pilot results and participants suggestions, videotaped interviews with local healthcare management experts were added in order to further enhance cultural suitability as well as relevance and applicability of the course concepts. The last but not least lesson learned consisted in the fact that enhancing, transitioning, and sustaining online learning to new contexts required engagement of key stakeholders, national level support, and technical assistance through implementation and beyond yet turned out to be both cost-effective and sustainable investment of limited resources. Formative evaluation confirmed that the adaptation efforts resulted in a course relevant and acceptable to healthcare professionals in Ukraine.ConclusionTransition of the course to local ownership was accomplished in partnership with the Ukrainian Family Medicine Training Center in the Bogomolets National Medical University in Kyiv: LMiH is now certified for continuing medical education credit and offered twice a year by this institution. Lessons learned from this experience provide a roadmap for rapidly increasing access to new knowledge and skills for healthcare workers by adapting existing online resources to local needs; they are used to facilitate rapid expansion of other continuing education offerings in Ukraine: additional online courses from the University of Washington (UW) are planned for adaptation.

A feasibility study of a mental health mobile app in the Dominican Republic: The untold story

Mobile health (mHealth) interventions include mental health apps (MHapps). There are hundreds of MHapps, which have been touted as a means of revolutionizing mental health care delivery. In spite of the rosy outlook and promise of MHapps, there are challenges to implementation in Low and Middle Income Countries (LMICs). We report on several domains of implementation: acceptance, appropriateness, engagement, and work processes assessed in two samples of clinicians and patients designed to develop and test the feasibility of a Spanish language Cognitive Behavioral VoiceThread® app for Dominican primary care patients with depression. Results indicated that feasibility of our eMH intervention was compromised by appropriateness of the target audience and the eligibility criteria used, including language, age, access to phones, and access to the internet. Both participants and clinical providers had varying degrees of engagement in the MHapp. Clinical providers had a desire for increased knowledge and capacity building, but also unspoken expectations and misaligned incentives. For participants, there were logistical and emotional barriers to use, some of which could not be fully determined in this study due to a lack of feasibility in terms of a low retention rate. Corresponding to these issues, we identified four potential solutions: 1) understanding of characteristics of end-users; 2) engagement of key stakeholders; 3) working within the existing infrastructure; and 4) addressing the social determinants of health. Unforeseen strengths also emerged as a result of our investigations. The challenges encountered in this pilot study can be viewed as evidence of failure or part of the incremental steps necessary to build future success.

Integrating Breast Cancer Early Detection Services Into the Rwandan Health Care System

Background and context: Promoting earlier detection of breast cancer is critical in low-income countries like Rwanda where symptomatic women face long diagnostic delays and most patients present with advanced disease. In these settings, promoting earlier clinical diagnosis should be the initial priority before screening of asymptomatic women. However, there are few data to guide such early detection policies. Aim: Develop a pilot breast cancer early detection program in a rural Rwandan district to evaluate its clinical and health system impact, identify the most effective and feasible roles for staff from each health care system level, and inform national policy. Strategy/Tactics: From 2015-2017 we implemented a training program for 12 randomly selected health centers (HCs) in Burera District, where Butaro Cancer Center of Excellence is located. We trained 1076 community health workers in breast awareness and 127 HC nurses in clinical breast exam (CBE) and management of breast concerns. We trained 9 hospital-level nurses and doctors in diagnostic breast ultrasound to facilitate evaluation of palpable masses. We used pre- and posttests, focus groups, patient surveys, HC registries, and hospital medical records to determine the impact of the training on trainees' knowledge and skills, the volume of patients presenting to health facilities and services provided, cancer detection rate, and clinical stage at diagnosis. Program/Policy process: We met regularly with cancer policy leaders in the Ministry of Health (MOH) and Rwanda Biomedical Centre (RBC) to share findings, identify successes and challenges and build support. Clinicians trained through the project have been invited to serve as national trainers in CBE and contribute to national cancer strategy discussions. Outcomes: Trainings significantly improved knowledge and skills among trainees and increased the number of patients with breast concerns at HCs and the hospital. There was an increase in the proportion of patients with benign disease and the number of needed ultrasounds and biopsies. HCs and the hospital were able to accommodate the increased volume without compromising other services. We had limited power to assess the impact on cancer stage, but noted a nonsignificant increase in incidence of early stage disease among patients referred by intervention HCs. We are now working with MOH/RBC in planning scale-up of the program to other districts and identify a strategy of diagnostic breast ultrasound at the DH level to facilitate evaluation of patients referred from HCs. What was learned: A strategy to promote earlier detection of symptomatic breast cancer was feasible in a rural Rwandan district, effectively strengthened health system capacity to care for patients with breast concerns, and suggests promising impact on patient outcomes. Engagement of key stakeholders in implementation science can help foster evidence-based national cancer control policy.

Results from a mobile outreach influenza vaccination program for vulnerable and high‐risk populations in a high‐income setting: lessons learned

ObjectiveThe aim of this pilot project was to assess the feasibility of an outreach mobile influenza vaccination program led by a large hospital network targeting high‐risk and vulnerable populations in a high‐income setting. MethodsKey populations were identified and stakeholders with established access to these populations were engaged. A mobile, nurse‐led immunisation service attended sites where these populations attend and offered influenza vaccine. Data was collected on risk factors for severe disease and past vaccination history. Vaccine type and date of administration were entered onto the Australian Immunisation Registry. ResultsSixteen sites were visited, and 520 influenza vaccines were administered. Of those receiving the vaccine, 61% had received it previously, but only 39% in the past 12 months. A total of 232/520 participants (45%) self‐reported a risk factor for severe disease. ConclusionsAppropriate identification of vulnerable populations, with good engagement of key stakeholders, can successfully deliver vaccines to sections of the population who may struggle to engage with healthcare services even when they are freely available. Implications for public healthTaking vaccines to vulnerable populations is well received and remains an important strategy to maximise uptake, even within high‐income settings with universal access to healthcare.

Standing frames for children with cerebral palsy: a mixed-methods feasibility study.

Standing frames are recommended as part of postural management for young people with cerebral palsy (CP) Gross Motor Function Classification System (GMFCS) level IV or V. They may have a variety of benefits, including improving bone mineral density, gastrointestinal function and social participation. The NHS needs to know if these benefits are real, given the cost implications of use and the reported negative effects (e.g. pain). The lack of evidence for the clinical effectiveness of standing frames demonstrates the need for evaluative research. The aim of the study was to explore the acceptability of a future trial to determine the clinical effectiveness of standing frames. A sequential mixed-methods design was used. The findings of each stage informed the next stage. We conducted surveys, focus groups and in-depth interviews. Professionals who work with young people who use standing frames and parents who have a child who uses a standing frame took part in a survey of current standing frame practice (n = 551), a series of focus groups (seven focus groups, 49 participants in total) and a survey of research trial acceptability and feasibility (n = 585). Twelve young people who use a standing frame were interviewed. Standing frames were widely used as part of postural management for young people with CP both in school and at home but more frequently in school, and particularly by young people in primary school. Achieving the prescribed use was not always possible owing to resources, environment and family factors. Participation and activity engagement were important to young people. The majority of participants believed that standing frames research is necessary. Some reported concern that stopping standing frame use for a trial would cause irreversible damage. The maximum amount of time most health professionals and parents would agree to suspend standing frame use would be 12 weeks. Owing to the nature of recruitment, we could not calculate response rates or determine non-response bias. Therefore, participants may not be representative of all standing frame users. Although parents and professionals who engaged in the qualitative aspect of this research and stakeholders who took part in the design workshops appreciated the lack of clinical evidence, our surveys, qualitative information and PPI demonstrated that most people had strong beliefs regarding the clinical effectiveness of standing frames. However, with key stakeholder engagement and careful planning, a trial would be acceptable. We recommend a carefully planned trial that includes a pilot phase. The trial should evaluate the following question: 'does using a standing frame in school improve patient-reported outcomes of participation (primary outcome), quality of life, subjective well-being, body function and body structure (secondary outcomes) in young children (aged 4-11 years) with CP GMFCS III-V?'. The National Institute for Health Research Health Technology Assessment programme.

Towards a feasible and representative pan-African research infrastructure network for GHG observations

There is currently a lack of representative, systematic and harmonised greenhouse gas (GHG) observations covering the variety of natural and human-altered biomes that occur in Africa. This impedes the long-term assessment of the drivers of climate change, in addition to their impacts and feedback loops at the continental scale, but also limits our understanding of the contribution of the African continent to the global carbon (C) cycle. Given the current and projected transformation of socio-economic conditions in Africa (i.e. the increasing trend of urbanisation and population growth) and the adverse impacts of climate change, the development of a GHG research infrastructure (RI) is needed to support the design of suitable mitigation and adaptation strategies required to assure food, fuel, nutrition and economic security for the African population. This paper presents the initial results of the EU-African SEACRIFOG project, which aims to design a GHG observation RI for Africa. The first stages of this project included the identification and engagement of key stakeholders, the definition of the conceptual monitoring framework and an assessment of existing infrastructural capacity. Feedback from stakeholder sectors was obtained through three Stakeholder Consultation Workshops held in Kenya, Ghana and Zambia. Main concerns identified were data quality and accessibility, the need for capacity building and networking among the scientific community, and adaptation to climate change, which was confirmed to be a priority for Africa. This feedback in addition to input from experts in the atmospheric, terrestrial and oceanic thematic areas, facilitated the selection of a set of ‘essential variables’ that need to be measured in the future environmental RI. An inventory of 47 existing and planned networks across the continent allowed for an assessment of the current RIs needs and gaps in Africa. Overall, the development of a harmonised and standardised pan-African RI will serve to address the continent’s primary societal and scientific challenges through a potential cross-domain synergy among existing and planned networks at regional, continental and global scales.

Emergency inserted peripheral intravenous catheters: a quality improvement project.

Vascular access devices are common and necessary in healthcare provision but their use poses a significant risk of acquiring an infection. Ambulance/emergency inserted peripheral intravenous catheters (PIVCs) potentially have higher risks of catheter-related bloodstream infection (CRBSI) because of the inability to maintain asepsis during the insertion procedure. Local guidelines (Queensland, Australia) recommend the removal or replacement of PIVCs inserted in these situations within 24 hours. Routine clinical audits performed within the authors' health service demonstrated a delay in removing ambulance/emergency inserted PIVCs beyond acceptable dwell times. Ambulance/emergency inserted PIVCs were not being recognised as requiring removal by ward staff. A quality improvement project involving key stakeholder engagement, the roll out of a sticker to readily identify ambulance/emergency inserted PIVCs and education of ward staff was introduced to enable identification of this high-risk group. Post-implementation audits demonstrated a significant reduction in numbers of ambulance/emergency PIVCs remaining in situ for longer than 24 hours.

Stakeholder engagement in the development of international air services: A case study on Adelaide Airport

This paper examines the air route development process, including key stakeholder engagement, to identify essential factors in the successful establishment of new international air services at regional airports. Data from semi-structured interviews with airports, airlines and destination marketing organisations were analysed to provide perspective regarding Adelaide, an Australian regional international airport. The research proposes a model that maps out the relationships and processes of primary and secondary stakeholders for air route development and finds route profitability and stakeholder relationships as critical factors for air route development. The airport emerges as a leading actor in driving route development. Efficiencies and broader regional objectives are realised when the airport collaboratively engages with wide-ranging stakeholders. The paper provides future research direction to address identified limitations and provides recommendations to guide other regional airports and airlines in establishing new international air services.

Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care.

Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba, derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. To explore the use of gemba boards and gemba huddles to facilitate practice change. Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted.

Assessing fatigue in adults with axial spondyloarthritis: a systematic review of the quality and acceptability of patient-reported outcome measures.

ObjectiveThe aim was to evaluate the quality and acceptability of patient-reported outcome measures used to assess fatigue in patients with axial spondyloarthritis.MethodsA two-stage systematic review of major electronic databases (1980–2017) was carried out to: (i) identify measures; and (ii) identify evaluative studies. Study and measurement quality were evaluated following international standards. Measurement content was appraised against a conceptual model of RA-fatigue.ResultsFrom 387 reviewed abstracts, 23 articles provided evidence for nine fatigue-specific measures: 6 multi-item and 3 single-item. No axial spondyloarthritis-fatigue-specific measure was identified. Evidence of reliability was limited, but acceptable for the Multi-dimensional Fatigue Inventory (internal consistency, test–retest) and Short Form 36-item Health Survey Vitality subscale (SF-36 VT; internal consistency). Evidence of construct validity was moderate for the Functional Assessment of Chronic Illness Therapy-Fatigue and 10 cm visual analog scale, limited for the SF-36 VT and not available for the remaining measures. Responsiveness was rarely evaluated. Evidence of measurement error, content validity or structural validity was not identified. Most measures provide a limited reflection of fatigue; the most comprehensive were the Multi-dimensional Assessment of Fatigue, Multi-dimensional Fatigue Inventory-20, Functional Assessment of Chronic Illness Therapy-fatigue and Fatigue Severity Scale.ConclusionThe limited content and often poor quality of the reviewed measures limit any clear recommendation for fatigue assessment in this population; assessments should be applied with caution until further robust evidence is established. Well-developed, patient-derived measures can provide essential evidence of the patient’s perspective to inform clinical research and drive tailored health care. The collaborative engagement of key stakeholders must seek to ensure that future fatigue assessment is relevant, acceptable and of high quality.

Progress in designing and delivering effective fishing industry–science data collection in the UK

AbstractThis study was undertaken to address the increasing need for a strategic approach to industry–science data collections in the face of reducing resources and growing need for evidence in fisheries management. The aim was to evaluate progress in the development of plans and procedures that can be employed to collect, record and use fishing industry knowledge and data in the evidence base for managing fisheries. This was achieved by reviewing industry‐led data initiatives already undertaken or ongoing within the United Kingdom to document how these projects have/are incorporating fishing industry data into the process of management decision‐making; canvassing stakeholder opinion on data gaps and whether these could be filled by data gathered by commercial fishing vessels; establishing what issues might prevent or stimulate commercial fishing vessels in collecting data when they have the opportunity; and describing guidance on a step‐by‐step process for gathering scientific information such that fishers are empowered to collect the right data, at the right times and in the right format for their fishery. Given recent advances in the collection, interpretation and application of fisheries‐dependent data, we compare progress made in the UK to other areas of the world. We conclude that there is considerable evidence of a paradigm shift from the conventional practice of scientists asking fishers to provide data for scientific analyses towards full engagement of key stakeholders in data collection.

An Evidence-Based, Community-Engaged Approach to Develop an Interactive Deliberation Tool for Pediatric Neuromuscular Trials.

Duchenne/Becker muscular dystrophy (DBMD) and spinal muscular atrophy (SMA) are rare neuromuscular disorders that present challenges to therapeutic and clinical trial decision making. We developed an interactive, evidence-based online tool designed to encourage thoughtful deliberation of the pros and cons of trial participation and to inform meaningful discussions with healthcare providers. Prior research demonstrates the importance of tool availability at the time each family is considering trial participation, which may be prior to the informed consent process. The tool is intended to be easily modified to other pediatric disease communities. Tool development was informed by prior qualitative research, literature reviews, and stakeholder input. Specific items were derived based on an online exploratory questionnaire of parents whose children participated in a trial for DBMD or SMA to understand motivations for participation. Parent participants in the exploratory survey reported strong impact of altruistic and individual benefit motivations and placed much greater emphasis on anticipated trial benefits than on harms when making participation decisions. We used this data to develop the evidence-based deliberation tool using a community-engaged approach. We initially targeted the tool for DBMD while using SMA survey data to evaluate ease of transition to that population. We conducted two iterative sets of activities to inform development and refinement of the tool: (1) community engagement of key stakeholders and (2) user experience testing. These activities suggest that the tool may increase deliberation and the weighing of benefits and harms. Ongoing evaluation will determine the acceptability and efficacy of this online intervention.

School as setting to create a healthy teaching and learning environment

PurposeThe purpose of this paper is to analyze how professional cultures in schools and school systems could improve the well-being of students, with a particular emphasis on teacher-health partnerships, which would not naturally occur without a specific intentional intervention. Implemented with a whole-school approach, the Health Promoting School (HPS) is one of the most effective intentional interventions to achieve improvements in both the health and educational outcomes of students through the engagement of key stakeholders in education and health to create a healthy physical/psycho-social environment. This paper emphasizes collaboration and the building of professional cultures in schools that share collective responsibility for the whole student.Design/methodology/approachStudent outcomes in schools should include both academic and health and well-being outcomes that promote positive pathways throughout adulthood. This paper connects HPS research with policy analysis drawing on Hong Kong’s unique context as being at the top of the PISA rankings and striving toward a positive health culture and well-being in its schools.FindingsEvidence has been gathered extensively about what schools actually do in health promotion using the HPS framework. The HPS framework has served to assist schools and authorities to concentrate on the gaps and affirm best practices. This paper also reports how teachers have created a professional and collegial community with health partners to address outbreaks of infectious diseases in schools and obesity in students.Practical implicationsThe concept of HPS can serve as an ecological model to promote the positive health and well-being of students, fostering their personal growth and development, and as an alternate model for school improvement.Social implicationsThis paper has highlighted that structured school health programs such as HPS could have positive effects on educational outcomes, while also changing professional cultures and communities in schools with an emphasis on students’ physical health, emotional health, social health, or spiritual health. The Assessment Program for Affective and Social Outcomes is used as a tool by schools in Hong Kong, reflecting the affective and social developments of the students in the school under review as a whole, and how they relate to the school. It resembles the core areas of action competencies, and school social environment; the two key areas of HPS.Originality/valueHong Kong is often analyzed from an educational rankings perspective. However, it offers broader lessons on educational change, as it has in recent years emphasized dual goals in student outcomes and professional communities – the importance of whole student health and well-being as a both a precursor and key component to the educational outcomes schools seek. Globally, very few schools are able to implement HPS in its entirety. Continuing development of HPS in Hong Kong would add value to international literature in terms of which types of data would influence adoption of HPS in which types of school and policy contexts.

Enhanced Cleaning and Education to Prevent Transmission of Clostridium difficile in Pediatrics

BackgroundTransmission of healthcare-associated Clostridium difficile infection (HA-CDI) has been shown to occur directly or indirectly through a contaminated environment. At a tertiary-care cancer center, HA-CDI rates were higher for pediatric units than for other general oncology units. To address the problem, a multidisciplinary team, including Infection Control, Nursing, and Environmental Services (EVS), was convened and identified refusals and room clutter as barriers to proper cleaning of rooms on the unit.Aim: The aim of this study seeks to reduce HA-CDI in the inpatient pediatrics setting through environmental and educational interventions.MethodsIn the first phase of the study from February to April 2016, a baseline assessment of prevalent environmental disinfection practices was made among Nursing, EVS, Physicians, and Patient Representatives. Based on this feedback, the following were implemented during Phase 2, from June through October 2016: 1) Unit-wide disinfection with bleach twice a day including common and high traffic areas; 2) Initiation of a “preferred time for cleaning” program to engage families; 3) Enhanced visitor and family education on PPE use; 4) Creation of a communication plan in case of refusal to clean rooms; and 5) Dedicated use of diaper scales.ResultsDuring the first phase of the study, the following barriers to cleaning were identified: 1) High refusal rate as cleaning was perceived as inconvenient by families due to timing; 2) Common perception among EVS staff that multiple requests for cleaning the room may appear intrusive to the families; 3) Excessive clutter in the room; 4) Lack of education regarding PPE use; and 5) Shared equipment for diapers. To overcome these barriers, several interventions as outlined in methods were implemented. In Phase 2, there were 0 cases of HA-CDI identified in pediatric patients starting in July through October, 2016.ConclusionControl of CDI on pediatric units poses unique challenges. Engagement of key stakeholders is essential to identify and meet these challenges and to devise effective strategies that will ultimately lead to reduced hospital-based transmission of CDI.Disclosures All authors: No reported disclosures.

Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health.

BackgroundIn a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial.MethodsIn 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis.ResultsTo achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital–prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking.ConclusionsThe current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond the project lifetime, and engagement of key stakeholders, in order to promote and sustain knowledge implementation.

Investigating the job satisfaction of healthcare providers atprimary healthcare centres in Lebanon: A national cross-sectional study.

Low job satisfaction is linked to higher staff turnover and intensified shortages in healthcare providers (HCP). This study investigates the level of, and factors associated with, HCP job satisfaction in the national primary healthcare (PHC) network in Lebanon. The study adopts a cross-sectional design to survey HCP at 99 PHC centres distributed across the country between October 2013 and May 2014. The study questionnaire consisted of four sections: socio-demographics/professional background, employment characteristics, level of job satisfaction (Measure of Job Satisfaction scale) and level of professional burnout (Maslach Burnout Inventory-HSS scale). A total of 1,000 providers completed the questionnaire (75.8% response rate). Bivariate and multivariate regression analyses were used to identify factors significantly associated with job satisfaction. Findings of the study highlight an overall mean job satisfaction score of 3.59 (SD 0.54) indicating that HCP are partially satisfied. Upon further examination, HCP were least satisfied with pay, training and job prospects. Gender, age, career plans, salary, exposure to violence, and level of burnout were significantly associated with the overall level of job satisfaction which was also associated with increased likelihood to quit. Overall, the study highlights how compensation, development and protection of PHC HCP can influence their job satisfaction. Recommendations include the necessity of developing a nationally representative committee, led by the Ministry of Public Health, to examine the policies and remuneration scales within the PHC sector and suggest mechanisms to bridge the pay differential with other sectors. The effective engagement of key stakeholders with the development, organisation and evaluation of professional development programmes offered to HCP in the PHC sector remains crucial. Concerned stakeholders should assess and formulate initiatives and programmes that enrich the physical, psychological and professional well-being of their HCP. The aforementioned suggestions are necessary to strengthen and sustain PHC HCP and support the provision of universal health coverage to the Lebanese population.

Meeting community needs through collaborative partnerships: A case study of a novel awareness program for learning disability using creative art forms

ABSTRACTLearning disability (LD) is a prevalent problem among Indian children. Due to poor awareness among teachers and parents, children with LD face many challenges in school that adversely affect their self-confidence and career prospects. The present case study describes a novel community-based awareness program for LD. Occupational therapy students performed street plays, a culturally relevant art form in public places and schools, depicting the symptoms of LD, effect on the child and family and management. The program also involved a pilot workshop for 20 primary school teachers emphasizing on early signs and symptoms, their critical role in early identification during the formative years of a child, behavioral issues and management strategies. The program required engagement of key stakeholders, namely the university, healthcare team, district education department, schools, civic authorities and philanthropists in the community. It demonstrates how occupational therapists could liaison and develop creative partnerships to serve community needs.