Knowledge Of Health Providers Research Articles

Water and Sanitation Access for Children in Alabama.

Safe drinking water and closed sanitation are fundamental to health and are assumed in the United States, however, gaps remain, disproportionately affecting marginalized communities. We sought to describe household sanitation access for children in rural Alabama and local health provider knowledge of sanitation related health concerns. Data were collected from self-administered surveys obtained from children enrolled in a larger cross-sectional study to determine soil transmitted helminthiasis prevalence in Alabama, from a survey of health providers from local federally qualified health centers and from a baseline knowledge check of Alabama health providers enrolled in an online sanitation health course. Surveys completed on 771 children (approximately 10% of county pediatric population) revealed less than half lived in homes connected to centralized sewers; 12% reported "straight-pipes," a method of discharging untreated sewage to the ground outside the home, and 8% reported sewage contamination of their home property in the past year. Additionally, 15% of respondents were likely to use well water. The local health providers surveyed did not include routine screening for water and sanitation failures or associated infections. Regional healthcare providers have limited knowledge of soil transmitted helminthiasis. A significant number of children from rural counties of Alabama with high rates of poverty reside in homes with water and sanitation challenges that predominantly affect African American families. This is an under-recognized health risk by local health providers, and its contribution to well-documented health disparities in this region is poorly understood.

Training in preconception care focused on primary health care providers: Effects on preconception care knowledge and provision

ObjectiveTo assess the effect of a rapid training intervention on the knowledge of health providers and the provision of preconception care in primary health care services. MethodsRandomized community trial in eight primary health care facilities (four were randomly allocated to the intervention group and four to the control group) in 2020 in Brazil. The intervention consisted of rapid training in preconception health for all health providers in the intervention group. Health providers who had medicine and nursing backgrounds answered structured questionnaires about their knowledge and practices of preconception health-related topics, and reproductive-age women attending the services completed a questionnaire about their experience with preconception care in pre- and postintervention (three months after the intervention) periods. FindingsThe level of knowledge among health providers increased after the intervention, but providing information about preconception care and prescribing folic acid showed no significant change, with the exception of screening for future pregnancy intention. Key conclusions and implications for practiceAlthough the knowledge of health providers on preconception care is a fundamental requirement for its provision in primary health care settings, rapid training focused on preconception health topics was not sufficient to change their practices, with the exception of pregnancy intention screening, which experienced a slight increase after the training. It appears that additional elements, such as the reorganization of primary health care services to prioritize non-pregnant women, the development and implementation of specific guidelines, along with strategies for the dissemination of preconception care awareness, may also play crucial roles for full preconception care implementation in addition to health providers’ knowledge of such issues.

Colonial drivers and cultural protectors of brain health among Indigenous peoples internationally.

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health.

Living with and managing type 1 diabetes in humanitarian settings: A qualitative synthesis of lived experience and stakeholder tacit knowledge.

Humanitarian health actors are beginning to better consider and manage non-communicable diseases, such as diabetes, in emergency and protracted crisis settings. However, a focus on the more globally prevalent type 2 diabetes (T2D) dominates. Blind spots prevail in the unmet needs for type 1 diabetes (T1D), a chronic autoimmune condition where individuals are unable to produce insulin, thereby dependent on lifelong insulin therapy and blood glucose management. Although some T1D management requirements overlap with those of T2D, the immediate risk of fatal complications following insulin therapy disruption, the earlier age of onset during childhood, adolescence or young adulthood, and its lower prevalence compared to T2D within communities and local health systems mean that T1D requires nuanced consideration and targeted interventions. Intending to inform program and policy design for people with T1D (PWT1D), we synthesized themes of lived experience from PLWT1D and their caregivers, and the tacit working knowledge of health providers and policymakers in the context of local humanitarian operations. Through a strategic search of health databases (up to July 2023), we identified 11 articles that include interview excerpts from PWT1D, caregivers, healthcare providers and policymakers about T1D management in humanitarian settings. We used reflexive thematic analysis to guide data extraction, coding, and synthesis, resulting in the identification of four overarching themes: food and insulin security, family relations, knowledge translation, and response to diagnosis. The narratives highlight harsh trade-offs made by PWT1D and their families in the face of insulin and food insecurity, as well as the damaging impact of low T1D education in families, communities and health systems. Targeted family and community-based solutions are urgently required, alongside systemic reforms and international collaboration to enable better T1D coping and management in humanitarian settings.

"It was a very awkward consultation because I didn't know"-general practice staff experiences and challenges in providing healthcare to gender and sexual minority youth in Aotearoa New Zealand.

Rainbow young people (RYP; people of diverse genders, sexualities, and variations in sex characteristics) face barriers accessing primary care, often report negative experiences and the need to educate clinicians on rainbow-specific issues. This study explores general practice staff views and experiences of providing care to RYP. Three focus groups were held with staff from 5 general practices in an urban area of Aotearoa New Zealand (25 participants in total). Practices were purposively selected to include some known to be more "rainbow-friendly" seeing larger numbers of RYP and some with no particular focus on RYP. All members of each practice were invited to participate, including administration and reception staff. Focus groups were audio-recorded, transcribed, and analysed in NVivo using inductive thematic analysis. Four main themes were identified: (i) Practice experience, (ii) Feeling awkward, (iii) Knowledge and training, and (iv) Structural barriers. Differences were apparent in health provider knowledge, comfort, and experience in providing care to RYP. Participants identified a lack of knowledge and training and wanted more resources and education. Systems limitations were common (e.g. with IT systems for recording gender) and often contributed to awkward clinical encounters. Participants recognized shortcomings in their training, knowledge, and level of confidence providing care to RYP and expressed a desire to improve their competency. Further work is needed to identify and trial practical strategies that help improve communication skills, knowledge, and the delivery of more equitable healthcare to RYP.

The first thousand days of mother and child: a lifelong investment in oral health!

Obstetricians, gynaecologists, paediatricians, pharmacists, paediatric dentists and hygienists are all health professionals that women encounter during the perinatal period. Today we know that during pregnancy and even earlier-at a pregnancy planning phase-the factors that will influence the future of the child's oral health are established. These are the 1,000 days stretching from conception to the child's second year of life, a time that will influence the health of oral cavity for life, and the foundations for the overall health are laid. In fact, oral health is the result of the ongoing prevention carried out by all the above-mentioned health professionals and operators. Often, dental diseases result from misinformation, mistakes and carelessness that begin in pregnancy and continue for the first few years of life. During pregnancy there is an increased risk for and/or worsening of periodontal diseases and a higher incidence of dental erosion and caries for the mother-to -be. In turn, this can even lead to an increase in pregnancy-related diseases such as premature births and miscarriages. Maternal nutrition, oral hygiene and lifestyle choices are the main elements influencing the health of both the mother and the child. Adequate nutrient levels during crucial periods of fetal development can lead to optimal fetal tissue programming and confer the child a greater protection against chronic diseases later in life. It is therefore imperative to promote information campaigns on these topics to prepare caregivers and women for the perinatal period. A survey carried out in Italy on a sample of women of childbearing age shows widespread misinformation about the oral health of mothers and children. The knowledge of health providers is also unsatisfactory: while most respondents recognise the importance of care during pregnancy, they do not advise patients to have dental check-ups or ask them if they have underwent dental care in the previous 12 months. We are carrying out a similar project with the University of Barcelona and it would be interesting to have data from other countries: we will consider them for immediate publication in our journal. Only by improving our knowledge of different realities we will achieve an effective dissemination of information and reduce the incidence of both pregnancy-related pathologies and those affecting childhood. We are looking forward to your contributions!

Preferences of parents for mental health services to suit children with chronic medical conditions.

Objectives To identify features of mental health services that affect the uptake of services among parents of children with chronic medical conditions, to inform the design of pathways into mental health care. Methods A discrete choice experiment in which participants made choices between hypothetical mental health services described in terms of service features: cost, wait time, provider knowledge of chronic medical conditions, recommendations, opening hours, and travel time. Participants were parents of children attending The Royal Children's Hospital outpatient clinics for the management of a chronic medical condition who completed the online survey between August 2020 and January 2021. The uptake of mental health services with differing features was predicted based on regression models examining the relationship between choice and service features, and accounting for participant characteristics and unobserved heterogeneity. Results The sample comprised 112 parents, of whom 52% reported unmet needs. The most influential service features were wait times, cost, recommendation from medical specialists, and mental health provider knowledge of chronic medical conditions. Predicted uptake of a realistic service showed inequalities across income, parental education, and single parent status. A service comprising preferred features was predicted to eliminate these inequalities. Conclusions Reducing cost and wait time for mental health services could reduce unmet need among children with chronic medical conditions. Specific approaches to tackle the high levels of unmet needs in this group include equipping medical specialists to recommend mental health providers and training mental health providers on the impacts of chronic medical conditions on children. Offering preferred services could increase uptake and reduce inequalities in mental health care.

Mental health Project ECHO Autism: Increasing access to community mental health services for autistic individuals.

Despite the high prevalence of co-occurring autism spectrum disorders and mental health condition(s), there exist substantial barriers to mental health treatment for autistic individuals. These barriers are exacerbated by a lack of mental health provider training and self-efficacy in providing adapted services to autistic individuals. One method which has been effective in mitigating similar service gaps is the Extension for Community Healthcare Outcomes (Project ECHO) Autism model, a tele-mentoring platform that connects primary care physicians to autism spectrum disorder experts to improve physicians’ knowledge, self-efficacy, and practice. This study developed and implemented a pilot mental health version of Project ECHO Autism designed to increase mental health provider knowledge, self-efficacy, and problem-solving. Community mental health providers (N = 51) participated in the 6-month Project ECHO Autism including mental health–focused didactics and provider case presentations. Analysis of pre- and post-measures revealed improvements in all domains, including significant increases in provider knowledge of autism spectrum disorders, self-efficacy, and problem-solving. Participants additionally reported high satisfaction with their experience. Taken together, preliminary results indicate that Project ECHO Autism may be a feasible, accessible, and effective method for increasing mental health provider competence and ultimately increasing access to services for autistic individuals who have co-occurring mental health diagnoses.Lay abstractAlthough many autistic individuals have additional mental health conditions, most have a hard time getting services from mental health providers. One reason why these services can be hard to access is that many mental health providers do not feel confident in their ability to provide services to autistic individuals. To share autism expertise with local community providers and boost their confidence in working with autistic individuals, we created a mental health version of the Extension for Community Healthcare Outcomes (Project ECHO) Autism virtual teleconsultation program. In this pilot study, we recruited 51 community mental health providers to participate in Project ECHO Autism. During each biweekly session, providers received information from autism experts about how to tailor mental health interventions (e.g. attention-deficit hyperactivity disorder or anxiety interventions) for use with autistic individuals. They also had the opportunity to ask questions and get advice on their current cases. At the end of the 6-month study, mental health providers showed improvements in their confidence, in their knowledge of autism, and in their problem-solving skills. Nearly half (45%) of these providers participated from rural counties, suggesting that the Project ECHO Autism teleconsultation model was able to reach mental health providers who might not have been able to get training otherwise. This study supports the feasibility of using Project ECHO Autism to share autism knowledge with mental health providers, consequently expanding mental health service options for autistic individuals with co-occurring mental health conditions.

Podoconiosis in Rwanda: Knowledge, attitudes and practices among health professionals and environmental officers.

BackgroundPodoconiosis is a neglected tropical disease commonly found in volcanic regions, where soil is rich in silica. It usually manifests as bilateral lower limb edema. The majority of people affected by podoconiosis are farmers who do not wear shoes. The condition was recently documented in all 30 districts in Rwanda but knowledge, attitudes and practices (KAP) of Rwandan health professionals and environmental officers towards podoconiosis are unknown.Methodology/FindingsThe objective of this study was to assess the knowledge, attitudes and practices (KAP) of Rwandan health providers and environmental officers towards podoconiosis in order to improve patient healthcare experiences and health outcomes, and to reduce stigma against affected individuals. To achieve this goal, we administered a KAP assessment to physicians (N = 13), nurses/midwives (N = 59), community health workers (N = 226), and environmental officers (N = 38) in the third highest podoconiosis prevalence district in Rwanda (Musanze).All 336 respondents had heard of podoconiosis, but 147 (44%) respondents correctly identified soil as the only direct cause of podoconiosis. The awareness of signs and symptoms and risk groups was lower than any other category (31.5% and 47.5%, respectively). The overall attitude toward podoconiosis was positive (86.1%), with CHWs least likely to harbor negative beliefs against podoconiosis patients. One particular area where most respondents (76%) expressed negative attitude was that they saw people with podoconiosis as a threat to their own health and their family’s health. Prescription of antibiotics and use of ointments/soap to manage wounds was low (5% and 32.2%, respectively), in part due to supply shortages at health facilities.ConclusionsThis study identified clear gaps in health provider knowledge and practices that affect patient care for those with podoconiosis. Improved access to essential medicines at health facilities and podoconiosis-focused training sessions for practicing health providers are necessary to minimize the burden and stigma of affected individuals.

The patient\u2013physician relationship: an account of the physician\u2019s perspective

BackgroundThe issue of patient–physician relationships in general, and particularly the trust of patients in their primary care physician has gained much interest in academia and with practitioners in recent years. Most research on this important topic, however, focused on how patients view the relationship and not how the physicians see it. This research strives to bridge this gap, with the resolution of leading to an improved appreciation of this multifaceted relationship.MethodsA survey of 328 actively practicing physicians from all four health maintenance organizations (HMOs) in Israel resulted in a hierarchical formation of components, indicating both the relative as well as absolute importance of each component in the formation of the patient–physician relationship. The sample conducted was a convenience one. Methodologically, we used two different complementary methods of analysis, with the primary emphasis on the Analytic Hierarchical Processing (AHP), a unique and advanced statistical method.ResultsThe results provide a detailed picture of physicians’ attitudes toward the patient–physician relationship. Research indicates that physicians tend to consider the relationship with the patient in a rather pragmatic manner. To date, this attitude was mostly referred to intuitively, without the required rigorous investigation provided by this paper. Specifically, the results indicate that physicians tend to consider the relationship with the patient in a rather pragmatic manner. Namely, while fairness, reliability, devotion, and serviceability received high scores from physicians, social interaction, friendship, familial, as well as appreciation received the lowest scores, indicating low priority for warmth and sociability in the trust relationship from the physician’s perspective. The results showed good consistency between the AHP results and the ANOVA comparable analyses.ConclusionsIn contrast to patients who traditionally stress the importance of interpersonal skills, physicians stress the significance of the technical expertise and knowledge of health providers, emphasizing the role of competence and performance. Physicians evaluate the relationship on the basis of their ability to solve problems through devotion, serviceability, reliability, and trustworthiness and disregard the “softer” interpersonal aspects such as caring, appreciation, and empathy that have been found to be important to their patients. This illustrates a mismatch in the important components of relationship building that can lead to a loss of trust, satisfaction, and repeat purchase.Policy implicationsWe study the impact physicians’ incentives have on the tangible relationship and discuss the significance of physician-patient relationship on satisfaction with the health service given. As a result policies leading to a more dynamic role must be given to the patient, who being well informed by the physician, can help in the decision making process. Policy schemes need to be implemented as a way of changing physicians’ behavior, forcing them to better construct and utilize this dyadic relationship.

Knowledge of Preconception Care and Associated Factors among Healthcare Providers Working in Public Health Institutions in Awi Zone, North West Ethiopia, 2019: Institutional-Based Cross-Sectional Study

Background. Preconception care is a set of interventional care for the better maternal and childbirth outcome. Nevertheless, this area still faces implementation problems in most of the developing countries including Ethiopia. Objective. To assess the knowledge of preconception care and associated factors among healthcare providers working in public health institutions in Awi zone, North West Ethiopia. Method. An institutional-based cross-sectional study was conducted among 660 healthcare providers working in public health institutions in Awi zone, North West Ethiopia. A pretested structured self-administered questionnaire was used to collect the data from individual healthcare providers who were selected randomly using a multistage sampling technique. The data entry and analysis were conducted using SPSS version 25 software. Frequency, proportions, means, and standard deviations were used to describe the data. Candidate variables at bivariate logistic regression with a p value > 0.2 were moved to multivariable logistic regression models, and statistical significance was declared at p value < 0.05 with 95% confidence interval. Result. Among the total of 660 healthcare providers, 344 (52%) had good knowledge of preconception care. The odds ratio of having good knowledge of preconception care was high among healthcare providers working at hospitals [AOR=2.316, 95% CI: 1.900-5.528], using smartphones [AOR=3.177, 95% CI: 1.945-5.167], presence of preconception care guidelines at health institutions [AOR=3.166, 95% CI: 1.872-5.299], taking training on preconception care education and counseling [AOR=3.812, 95% CI: 2.241-6.581], taking training about human immune virus [AOR=4.911, 95% CI: 3.008-8.123], and attending training on increasing public awareness of preconception health and care [AOR=2.345, 95% CI: 3.922-5.488] which were independent predictors associated with knowledge of preconception care among healthcare providers. Conclusion. Healthcare providers’ knowledge of preconception care was low. Study participants working at hospitals, using smartphones, presence of preconception guidelines at health institutions, taking training on preconception education and counseling, taking training about human immune virus testing and management, and increasing public awareness of preconception care affect knowledge of health providers positively. The provision of updated training on preconception and linkage of internet service with health service should be enhanced among healthcare providers.

Assessing Health Provider Perspectives Regarding Barriers American Indian/Alaska Native Transgender and Two-Spirit Youth Face Accessing Healthcare.

American Indian/Alaska Native (AI/AN) youth disproportionately face barriers accessing healthcare compared with non-AI/AN youth. AI/AN youth who also identify as transgender or Two-Spirit (2S) face higher rates of mental health issues and suicidality, along with increased rates of disease, due to health inequity and historical trauma. This project evaluated health provider knowledge of context surrounding gender and sexuality in AI/AN communities. It assessed provider perspectives of provider-side and patient-side barriers accessing care to develop suggestions for improvement. Semi-structured interviews (SSI) and focus group discussions (FGD) were held among healthcare providers across four sites in the Pacific Northwest. Questions were developed using a community-based participatory research conceptual model, considering the impacts of context, partnerships, and community knowledge. A grounded theory approach was used to analyze transcripts. This project received exemption from the University of Washington IRB and approval from each tribal ethical/research committee. Twenty healthcare providers from varied geographic settings, provider types, and ethnic backgrounds participated in this study. Knowledge regarding contexts surrounding gender in AI/AN communities varied. Long-standing effects of settler colonialism, trauma, and systemic issues presented as overarching concepts. Participants also shared a number of patient and provider-side barriers impacting care and suggested solutions to reduce these barriers. Patient and provider-side barriers inhibit AI/AN transgender and 2S youth access to healthcare. Historical trauma and community resilience play a role in health for these youth. Understanding history, the intersection of identities, and community strengths can help with the development of solutions to provide high quality care to AI/AN transgender or 2S youth.

Technology-Based Newborn Health Learning Initiatives for Facility-Based Nurses and Midwives in Low- and Middle-Income Countries: A Scoping Review

PURPOSEGiven high neonatal mortality in many low- and middle-income countries, addressing missed opportunities by enhancing the quality of newborn care provided by facility-based nurses and midwives is critical. This scoping review synthesizes and critiques the literature on technology-based newborn health learning initiatives. Kirkpatrick's model is used for training program evaluation.METHODSA literature review was conducted from multiple databases. Articles selected for analysis consisted of original research studies published in peer-reviewed journals from 2012 to 2017.RESULTSTwelve studies fell into two categories: (a) Simulation training in routine neonatal care and newborn resuscitation (n = 9) and (b) eLearning initiatives (n = 3). Most studies evaluated health provider's knowledge and skills before and/or after training (n = 9); fewer evaluated the effect on change in provider practice (n = 3) and/or patient health outcomes (n = 5) (Kirkpatrick levels 3–4). Few studies utilized robust study designs and validated measurement instruments.CONCLUSIONLearning approaches emphasizing simulation training and eLearning initiatives for facility-based health workers hold promise. However, existing simulation literature demonstrates that translation of knowledge gained during simulation into improved clinical outcomes in real births is variable. Additionally, the volume of peer-reviewed evidence demonstrating the potential benefit of eLearning strategies, especially in the neonatal period, is limited.

Nurses' Knowledge, Attitude, and Confidence in Delivering Palliative Care for Hospitalized Patients with Heart Failure: An Integrative Review (S707)

•Define the current heart failure clinical practice guidelines regarding the nurses’ role in communicating palliative care options to patients.•Identify the nurses’ perceived communication barriers to delivering information to individuals in the palliative phase of heart failure.•Discuss opportunities and strategies to remove palliative care communication barriers in the acute care setting. Heart failure is a nonmalignant, chronic, complex, syndrome that is common and burdensome. International heart failure clinical practice guidelines recommend that healthcare providers communicate palliative care options with patients. The aim was to conduct an integrative review to review how nurses perceived communication barriers to delivering information to individuals in the palliative phase of heart failure. CINAHL, Embase, PubMed, Scopus, and the gray literature were searched from January 1987 to February 2017. Articles were considered if participants involved nurses caring for adult heart failure in the acute care setting and the nurses identified communication barriers that inhibited palliative care discussions. Articles were excluded if the nurse was not in direct care or primarily an outpatient setting. Studies were graded for strength and quality using a reliable critical appraisal tool. Articles were formatted into a summary tool and key themes were extracted and synthesized. Sixteen articles met the full inclusion criteria. Most studies were qualitative or non-experimental studies of good quality. Several studies found that nurses lacked basic knowledge about palliative care or did not possess sufficient knowledge to effectively provide care. Poor knowledge of health providers of palliative care created a barrier between the provider and the patient. Inadequate education or inexperience in palliative care led to the resistance of health providers to implementing a palliative approach. The results of this review emphasize a lack of knowledge as a barrier to delivering palliative care. Nurses caring for individuals with heart failure need palliative care knowledge, skills and competencies to ensure that this vulnerable population receives patient centered care. To bring about practice change, education will need to be incorporated into all levels of nursing, including students and practicing nurses.

The Benefits and Risks of Energy Drinks in Young Adults and Military Service Members.

Energy drinks (EDs) have become an integral part of the young adult, athletic, and military culture. Many athletes are convinced that EDs enhance performance, and service members as well as college students frequently use EDs as stimulants to counter sleep deprivation, or to improve academic performance. However, concerns have been raised by some military leaders about potential adverse effects of EDs. A needs assessment survey of a convenience sample of military health care providers was conducted and identified EDs as a top knowledge need for those providers working in the area of traumatic brain injury (TBI). The instrument demonstrated high interitem consistency (Cronbach's α > .80). To further explore the state of knowledge on EDs, and to prompt further discussion of ED use and how it may related to military treatment protocols and supporting educational products, we conducted a literature review of English language publications listed in the National Library of Medicine using the search term "energy drinks" and published during the last 5 years to determine what is known about EDs in terms of their potential benefits and health risks. The active ingredients in most EDs are caffeine, and to a lesser extent taurine and sugars. Several reports suggest that the combination of these ingredients is more active than the caffeine alone. Despite the positive attributes of EDs, there are increasing reports of serious and potentially life-threatening side effects. Most recently there also has been a dramatic increase in the use of ED/alcohol combination drinks, and there are preliminary studies that suggest important adverse effects with this combination. A 2013 National Institutes of Health expert workshop concluded that more clinical studies are needed to clearly define the health risks associated with ED use. The needs assessment points to a desire for more ED knowledge of health providers working with TBI patients. A few key themes emerged from the exploratory literature review that can be taken into consideration when educating health providers and delivering knowledge-based resources. Adverse effects of EDs are most closely associated with the dose of caffeine consumed. In general, the combination of ED with alcohol should be avoided because the ED can mask the level of intoxication, and the combination may be associated with increased risk-taking behavior. Overall, the risks and benefits of EDs remain controversial and good-quality long-term clinical trials are needed to inform policymaking, regulation, and the development of prevention and treatment resources.

The impact of the Helping Babies Survive program on neonatal outcomes and health provider skills: a systematic review protocol.

The objective of this review is to evaluate the impact of the Helping Babies Survive program on neonatal outcomes and healthcare provider knowledge and skills. This quantitative review will aim to answer the following question: What is the impact of the Helping Babies Survive modules (Helping Babies Breathe, Essential Care for Every Baby and Essential Care for Small Babies) on neonatal outcomes and health provider knowledge and skills?

Program Impact Pathway Analysis of a Social Franchise Model Shows Potential to Improve Infant and Young Child Feeding Practices in Vietnam

By mapping the mechanisms through which interventions are expected to achieve impact, program impact pathway (PIP) analysis lays out the theoretical causal links between program activities, outcomes, and impacts. This study examines the pathways through which the Alive & Thrive (A&T) social franchise model is intended to improve infant and young child feeding (IYCF) practices in Vietnam. Mixed methods were used, including qualitative interviews with franchise management board members (n = 12), surveys with health providers (n = 120), counseling observations (n = 160), and household surveys (n = 2045). Six PIP components were assessed: 1) franchise management, 2) training and IYCF knowledge of health providers, 3) service delivery, 4) program exposure and utilization, 5) maternal behavioral determinants (knowledge, beliefs, and intentions) toward optimal IYCF practices, and 6) IYCF practices. Data were collected from A&T-intensive areas (A&T-I; mass media + social franchise) and A&T-nonintensive areas (A&T-NI; mass media only) by using a cluster-randomized controlled trial design. Data from 2013 were compared with baseline where similar measures were available. Results indicate that mechanisms are in place for effective management of the franchise system, despite challenges to routine monitoring. A&T training was associated with increased capacity of providers, resulting in higher-quality IYCF counseling (greater technical knowledge and communication skills during counseling) in A&T-I areas. Franchise utilization increased from 10% in 2012 to 45% in 2013 but fell below the expected frequency of 9–15 contacts per mother-child dyad. Improvements in breastfeeding knowledge, beliefs, intentions, and practices were greater among mothers in A&T-I areas than among those in A&T-NI areas. In conclusion, there are many positive changes along the impact pathway of the franchise services, but challenges in utilization and demand creation should be addressed to achieve the full intended impact.

Gender, sexuality and the discursive representation of access and equity in health services literature: implications for LGBT communities.

BackgroundThis article considers how health services access and equity documents represent the problem of access to health services and what the effects of that representation might be for lesbian, gay, bisexual and transgender (LGBT) communities. We conducted a critical discourse analysis on selected access and equity documents using a gender-based diversity framework as determined by two objectives: 1) to identify dominant and counter discourses in health services access and equity literature; and 2) to develop understanding of how particular discourses impact the inclusion, or not, of LGBT communities in health services access and equity frameworks.The analysis was conducted in response to public health and clinical research that has documented barriers to health services access for LGBT communities including institutionalized heterosexism, biphobia, and transphobia, invisibility and lack of health provider knowledge and comfort. The analysis was also conducted as the first step of exploring LGBT access issues in home care services for LGBT populations in Ontario, Canada.MethodsA critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives.ResultsA continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1) multicultural discourse, and 2) diversity discourse; and three counter discourses: 3) social determinants of health (SDOH) discourse; 4) anti-oppression (AOP) discourse; and 5) citizen/social rights discourse.ConclusionsThe analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress organizational assumptions about, and ideological commitments to, sexual and gender diversity and health services access and equity. Thus, the continuum of discourses may serve as an important element of a health care organization's access and equity framework for the evaluation of access to good quality care for diverse LGBT populations. More specfically, the analysis offers four important points of consideration in relation to the development of a health services access and equity framework.

Strategies that promote high quality care in Indonesia

To investigate factors predicting the quality of care received using a nationally representative dataset from Indonesia. The study combines two surveys in 13 provinces: a household survey of 2451 women who delivered a live birth in 1992-1998, and a facility survey that measured quality available from outpatient providers. Multivariate regressions are used to explain the quality of care received. Explanatory variables are high facility quality, maternal education, household wealth, ethnicity, and insurance. Quality available is measured by provider adherence to prenatal protocols using a clinical case scenario. Quality received is measured by maternal reports about routine prenatal services received. High facility quality predicts an increase in quality received. Although poor households have access to the same or higher quality care compared with the least poor, the poor receive lower levels of quality. In remote regions, quality received rises with increasing levels of maternal education and household wealth. Improving health provider knowledge, and increasing household financial resources and information could redress inequalities in quality received among the poor and least educated.