Perspectives Of Healthcare Workers Research Articles

"PrEP Gives the Woman the Control": Healthcare Worker Perspectives on Using pre-Exposure Prophylaxis (PrEP) During Pregnancy and Postpartum in Kenya.

Background: Pregnant and postpartum women in high HIV prevalent regions are at increased HIV risk. Oral pre-exposure prophylaxis (PrEP) can decrease HIV incidence reducing infant HIV infections. Understanding healthcare worker (HCW) beliefs about PrEP prior to national roll-out is critical to supporting PrEP scale-up. Methods: We conducted 45 semi-structured interviews among a range of HCW cadres with and without PrEP provision experience purposively recruited from four clinics in Kenya to compare their views on prescribing PrEP during pregnancy and postpartum. Interviews were analysed using a conventional content analysis approach to identify key influences on PrEP acceptability and feasibility. Results: All HCWs perceived PrEP as an acceptable and feasible HIV prevention strategy for pregnant and postpartum women. They believed PrEP meets women’s needs as an on-demand, female-controlled prevention strategy that empowers women to take control of their HIV risk. HCWs highlighted their role in PrEP delivery success while acknowledging how their knowledge gaps, concerns and perceived PrEP implementation challenges may hinder optimal PrEP delivery. Conclusion: HCWs supported PrEP provision to pregnant and postpartum women. However, counseling tools to address risk perceptions in this population and strategies to reduce HCW knowledge gaps, concerns and perceived implementation barriers are required.

Primary health care workers perspective towards cancer in Fiji: a qualitative study.

By 2040, the predicted global cancer burden is expected to be more than 27 million new cancer cases per year. Understanding primary health care workers' (HCWs) perception on cancer can highlight new ways in which cancer advocacy can be increased. This study aimed to explore the perceptions of primary HCWs in Lautoka, Fiji, towards common cancers with focus on knowledge, risk perceptions, barriers and preventive approaches. The study used a qualitative method approach. The study was conducted among primary HCWs at four purposively selected health centres in Lautoka Subdivision, Fiji, from 1 March 2021 to 1 April 2021. Focus group discussions (FGDs) were conducted with primary HCWs. A semi-structured open-ended questionnaire was used to collect data, and the FGDs were audio-recorded. These audio recordings were transcribed and analysed using thematic analysis. The responses from the four FGDs with six primary HCWs in each group emerged four major themes. These themes were cancer knowledge, health professional training, barriers and challenges and awareness strategies. Primary HCWs were not fully aware about common cancers and were not confident to discuss about cancer with their patients which is an important role of primary HCWs in cancer management. This lack of knowledge was attributed to less training received in primary care setting. Barriers to accessing cancer screening included misconceptions about cancer, negative attitudes from patients, stigmatization, lack of resources at health facility and less informed health staff. Community outreach programmes, opportunistic screening, community HCWs and the concept of a cancer hub centre were awareness strategies highlighted by primary HCWs. Lack of knowledge about common cancers among primary HCWs is a concern that is depicted well in this study. This low knowledge was attributed to lack of training on cancers received by primary HCWs. Guidelines on cancer screening and diagnosis can be developed by the health ministry to assist primary HCWs in detecting patients at pre-cancerous stage.

Effects of COVID-19 pandemic on ART Service delivery: perspectives of healthcare workers in a Teaching Hospital in Ghana

BackgroundGhana has a generalized HIV epidemic and efforts have been made to curb the spread and reverse its effects on the general population. In the wake of COVID-19 pandemic, the health system was unsettled and antiretroviral therapy (ART) care has been impacted in diverse ways. The study sought to explore the effects of COVID-19 on ART service provision in Ghana from the perspectives of the healthcare workers.MethodsAn exploratory-descriptive qualitative approach was employed in this study. Using maximum variation sampling method, fifteen healthcare workers; nurses, data managers and pharmacists were recruited from an ART clinic in a Teaching Hospital in Ghana. In-depth interviews were conducted and analysed using Braun and Clarke thematic approach.ResultsThree themes emerged from the data; “… And the pandemic struck”, “Impact of the pandemic on ART service delivery”; “Effecting the needed change”. The healthcare workers’ initial reactions to the pandemic and their show of commitment in ensuring continued ART service was evident. COVID-19 impacted service delivery in three main ways; (1) clients’ clinic attendance was erratic at various stages of the pandemic, (2) irregular resource availability as shortage was reported due to affected last mile delivery as a result of the lockdown in Accra, and (3) the health worker-patient interaction became less engaging because of established COVID-19 protocols. The healthcare workers however instituted strategies such as adjusting the patient appointment schedule, health professionals’ work schedule, establishing several work stations, task-shifting, and ensuring the implementation of all the COVID-19 protocols within the ART unit to ensure consistent service delivery as well as patient and staff safety. The study also found a decline in the implementation of several strategies established in the ART clinic during the initial phases of the pandemic such as a decline in the supply of Personal Protective Equipment (PPEs) by hospital management.ConclusionsAlthough several strategies were implemented to manage the effects of the pandemic on ART care, there is a need to establish pathways of support for healthcare workers within the ART clinic and to consolidate as well as institutionalise the changes that ensured continuous but safe service delivery.

Defining clinical empathy: a grounded theory approach from the perspective of healthcare workers and patients in a multicultural setting

ObjectiveTo define clinical empathy from the perspective of healthcare workers and patients from a multicultural setting.DesignGrounded theory approach using focus group discussions.SettingA health cluster in Singapore consisting of an acute...

Researching, co-creating and testing innovations in paper-based health information systems (PHISICC) to support health workers\u2019 decision-making: protocol of a multi-country, transdisciplinary, mixed-methods research programme in three sub-Saharan countries

BackgroundHealth information systems are crucial to provide data for decision-making and demand for data is constantly growing. However, the link between data and decisions is not always rational or linear and the management of data ends up overloading frontline health workers, which may compromise quality of healthcare delivery. Despite limited evidence, there is an increasing push for the digitalization of health information systems, which poses enormous challenges, particularly in remote, rural settings in low- and middle-income countries. Paper-based tools will continue to be used in combination with digital solutions and this calls for efforts to make them more responsive to local needs. Paper-based Health Information Systems in Comprehensive Care (PHISICC) is a transdisciplinary, multi-country research initiative to create and test innovative paper-based health information systems in three sub-Saharan African countries.Methods/DesignThe PHISICC initiative is being carried out in remote, rural settings in Côte d’Ivoire, Mozambique and Nigeria through partnership with ministries of health and research institutions. We began with research syntheses to acquire the most up-to-date knowledge on health information systems. These were coupled with fieldwork in the three countries to understand the current design, patterns and contexts of use, and healthcare worker perspectives. Frontline health workers, with designers and researchers, used co-creation methods to produce the new PHISICC tools. This suite of tools is being tested in the three countries in three cluster-randomized controlled trials. Throughout the project, we have engaged with a wide range of stakeholders and have maintained the highest scientific standards to ensure that results are relevant to the realities in the three countries.DiscussionWe have deployed a comprehensive research approach to ensure the robustness and future policy uptake of findings. Besides the innovative PHISICC paper-based tools, our process is in itself innovative. Rather than emphasizing the technical dimensions of data management, we focused instead on frontline health workers’ data use and decision-making. By tackling the whole scope of primary healthcare areas rather than a subset of them, we have developed an entirely new design and visual language for a suite of tools across healthcare areas. The initiative is being tested in remote, rural areas where the most vulnerable live.

Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda.

In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.

An integrated literature review on cultural management systems and patient safety

The incidence of adverse events in healthcare is a global problem with negative consequences for all stakeholders including patients, their family members, health professionals and the government. Patient safety and patient safety culture lie at the heart of all adverse events within healthcare settings. The culture of an organization determines its approach to problem solving and determines how individuals within that setting work; this is also true for patient safety culture and the reduction of adverse events within healthcare organizations. The aim of this study was to assess, identify and have a better understanding of the importance of patient safety culture within the healthcare organization and to create insights on the impact of cultural management systems regarding patient safety. The research method of this study is an integrated literature of the patient safety culture and perspectives of healthcare workers, assessed using the Modified Stanford Instrument (MSI) and Manchester Patient Safety Framework (MaPSaF). Analysis of the data revealed that health professionals working in the same organizations have differing opinions on the same topic; therefore, there is need for open communication and a systematic approach to establishing the right safety culture within healthcare organizations. In conclusion, establishing the right culture and having systematic ways of measurement enable improvements and the ability of organizations to learn from their mistakes. There is paucity of data with respect to the use of these tools in the respective countries (Canada and United Kingdom) even though the tools are the national tools established through rigorous research. Therefore, a study of MaPSaF in New Zealand was also analyzed. There is need for further research and publications to enable learning on patient safety, which will reduce the incidence of adverse events and associated consequences in healthcare organizations.

HEALTH PROMOTION BEHAVIOUR FOR NON-COMMUNICABLE DISEASES AMONG HEALTHCARE WORKERS IN KAKAMEGA COUNTY, KENYA

Introduction: The rising burden of non-communicable diseases poses a great health system challenge in Kenya. Healthcare workers have a critical role to play in health promotion, in addressing patients’ lifestyle risk factors. However, their own lifestyle habits can influence their attitude and practices towards patient care. Opportunistic counselling of patients by health professionals signifies one of the most cost-effective medical interventions in combatting non-communicable diseases. Objective: To determine the attitudes and practice of health promotion for the prevention and management of non-communicable diseases among healthcare workers In Kakamega county. Methods: A cross-sectional mixed method study was carried out from June to July 2018 at Kakamega county referral hospital. For the quantitative method, one hundred and eighty-five doctors and nurses were recruited through stratified sampling. Data on healthcare workers; socio-demographic characteristics, lifestyle practice, attitude, and practice of health promotion was collected through self- administered questionnaires. Frequency and percentage distributions tables were used to initially describe the study population while, Chi- square test of significance was used to evaluate the association between healthcare workers attitudes and practice of health promotion and their socio-demographic features. Secondly, a total of 12 doctors and nurses were purposively selected based on age, gender and profession of participants for the qualitative method. Data on healthcare workers perspective on health promotion and organizational support factors were collected through in-depth interviews. The recorded interviews were transcribed and data analysis was done using content analysis of thematic areas. A verbatim approach was used to describe study findings. Results: 69.2% of the respondents were females, mean age was 36 years and the median years in profession was 12 years. The respondents exhibited good lifestyle practices with alcohol and tobacco prevalence at 30.8 %and 3.8% respectively. 72% of the respondents demonstrated a positive attitude towards health promotion while, 31% showed good health promotion practices. Less than half of the respondents inquired about a patient’s lifestyle practices during routine visit. The study found that healthcare workers with a positive attitude were four times more likely to have good health promotion practices (OR = 3.54, p<0.001). Lastly findings from the in-depth interviews revealed that staff had no written guidelines on health promotion and that the hospital management had abolished the health promotion unit. Conclusion: The results indicated that a positive health professional attitude is a precursor to good health promotive practices. Recommendation: Efforts to build capacity and support for health promotion in health services should be encouraged. Additionally, health Promotion programs for non- communicable disease should not only target the health of general population but also the health of health care workers.
 
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‘Code‐95’ rapid response calls for patients under airborne precautions in the COVID‐19‐era: a cross‐sectional survey of healthcare worker perceptions

BackgroundTo allow better allocation of staff and resources, rapid response teams attending to acutely deteriorating or aggressive patients with suspected or confirmed COVID‐19 infection were pre‐warned with the announcement of 'Code‐95' with calls.AimTo assess healthcare worker (HCW) perspectives on pre‐warning rapid response calls (RRC) with ‘Code‐95’ in announcements when attending to deteriorating or aggressive patients with suspected/confirmed COVID‐19 infection.MethodsDesign: prospective cross‐sectional single‐centre survey of HCW over a 3‐week period. Setting: tertiary public hospital. Participants: HCW caring for deteriorating or aggressive patients. Main outcome measures: the primary outcome was to assess HCW perspectives in attending Code‐95 calls. Secondary outcomes were to identify any differences related to craft group, age, experience or presence of comorbidities.ResultsA total of 297 responses was analysed; 86.7% of HCW (n = 257) attending Code‐95 calls reported anxiety. Medical staff reported greater anxiety in comparison to nursing staff (93.8% vs 78.5%; P = 0.002). Efferent team reported higher anxiety in contrast to afferent team (92.6% vs 58.8%; P = 0.021). There was no significant difference in perceived anxiety based on age (≤40 vs >40 years of age), years of experience (≤5 vs >5 years), comorbidities or mental illness; 54% reported concerns about adequacy of infection‐control policies and personal protective equipment; 45% were worried about inadequate training for responding to Code‐95 calls.ConclusionsMost surveyed HCW supported Code‐95 announcements pre‐warning them of potential COVID‐19 exposure when attending a RRC. However, the majority of HCW reported anxiety when attending these calls. Medical and efferent team HCW perceived greater anxiety compared to nursing and afferent team HCW. The Code‐95 system to pre‐warn rapid response teams may be a useful addition to protecting HCW from infectious diseases, although broader implementation will require greater resourcing, training and support.

COVID-19 – A perspective of health care workers at Tertiary Care Hospital in Karachi – A Clinical Survey.

Objective: To assess the knowledge of healthcare officials about COVID-19 disease and its effects on the mental health of healthcare workers (HCWs). Study Design: Cross-sectional Survey. Setting: Tertiary Care Hospital in Karachi. Period: 1st February to 30th June 2020. Material & Methods: After approval of the hospital’s ethical committee, 70 HCWs, filled the pre-formed questionnaire including their demographic features, specialty and questions related to fear, stressful factors and strategies to mitigate this stress. Results: A total of 120 questionnaires were distributed to healthcare workers at a peripheral hospital with a return of 58.3%. Majority were females, 59(84.3%). The mean age was 30.32 years ±8.17 SD. All of our participants perceived it their professional and ethical responsibility to perform duties during COVID-19 pandemic. 97.1% felt proud to be serving humanity. 57.1% of HCWs were anxious. 52.9% were satisfied with hospital policies and felt appreciated. Triggering factors for the mental stress included: psychological conflict between profession and personal safety 71.4%, 87.1% feared intubation of colleagues, lack of family support among 38.6%, 92.9% were afraid of transmitting the infection to their families while 88.6% had anxiety due to uncertainty regarding when the pandemic will end. Various techniques employed by HCWs to cope with this stress included prayers, sports and exercise (95.7%), self-motivation (88.6%)and psychologist’s help (41.4%). Conclusion: The COVID-19 pandemic has led to mental stress to HCWs from multiple factors and special attention to strategies to alleviate this stress is strongly recommended.

Perspective of healthcare workers regarding self-protection during COVID-19 pandemic: A cross-sectional study from Saudi Arabia

The aim of this study was to assess the perception of healthcare workers regarding self-protection during the COVID-19 pandemic in Saudi Arabia. The novel COVID-19 pandemic has completely changed the dynamic of governments, social lives, global economy, and health care systems priorities. Healthcare workers (HCWs) are one of the most group of people at risk of acquiring the infection, especially those who are taking care of COVID-19 patients. This cross-sectional survey-based study was conducted among HCWs during the period between May to July 2020 in Saudi Arabia. More than 70% of participating HCWs were able to access the personal safety policies and procedures in the workplace and COVID-19 treatment algorithm. In addition, the presence of an infection control team was also present in most of the institutes. The most common accessible personal protective equipment was hand gel sanitizer (89.9%), followed by disposable gloves (82.5%) and disposable masks (78.9%). More than 75% of participants reported that their institute has a special infection control team during the COVID-19 pandemic. Most of the respondents (~75%) believe that their institute would take all necessary measurements to protect their personal integrity at work. Several precautionary measures were undertaken appropriately by the Saudi Government to overcome the COVID-19 immediate and futuristic consequences. Personal protective equipment and protective measures would be crucial for public health if implemented appropriately during highly spreading infections (e.g., COVID-19) to minimize the transmission and preserve health

Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses

Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mistakes, mutual understanding, and debriefings of conflict situations are reported to improve collaboration. Additionally, emergency trainings, trainings in precise communication, and handovers are proposed to reduce risks for pAEs. Furthermore, the participants reported time-constraints and understaffing as a huge burden that hinders safe communication. Concluding, safety culture and organizational management are closely entwined and strategies should address various levels of which communication trainings are promising.

Challenges of effective management of medical waste in low-resource settings: perception of healthcare workers in Vhembe district healthcare facilities, South Africa

Many developing countries face various challenges in managing medical waste properly, and most of these challenges lie within the healthcare facilities. This study was conducted to investigate the challenges of effective management of medical waste in Vhembe District from the perspective of healthcare workers. The convergent parallel approach of mixed-method design was adopted. In-depth interviews were conducted with managers, infection prevention and control coordinators and environmental health practitioners of 15 public healthcare facilities in the district to gain insight into the challenges they identify in their respective healthcare facilities. A self-administered questionnaire was employed to obtain data from medical waste generators and handlers. Qualitative data were thematically analysed, and the Statistical Package for the Social Sciences version 25 was used to analyse the quantitative data. The challenges identified by healthcare workers include poor understanding of medical waste management guidelines and poor compliance; lack of regular training; poor attitudes of medical waste generators; insufficiency of waste management equipment and sub-standard central storage rooms. Most of the challenges were found to be linked to inadequate training of healthcare workers. For effective management of medical waste, efforts should be intensified towards adequate training of healthcare workers and provision of necessary equipment.

A study to evaluate behavior of society with Covid-19 Frontline health workers

Background: Health care workers caring for Covid-19 patients go through mental stress, physical exertion, stigma from society and the fear of losing patients’ and colleagues.
 Aims and Objective: To evaluate frontline health care workers perspective about the society’s behavior towards them.
 Materials and Methods: This questionnaire-based study included a total of 648 participants and included 20 questions about demography, Covid duty, health related issues and behavioral aspect of society during Covid duty. Behavioral related responses were scaled on the basis of response score.
 Results: Suggested that the overall population behavior was satisfactory but behavioral biases were existent. Major health issue of concern that surfaced during duties was stress.
 Conclusion: Behavioral prejudices are existent due to the stigma attached to this pandemic and hence needs to be addressed with great concern. Health related issues should be dealt promptly and psychological counseling should be made mandatory.

Healthcare worker's perspectives on use of memes as an implementation strategy in infection prevention: An exploratory descriptive analysis

New implementation strategies, such as social media platforms, are being used to help disseminate and implement evidence-based practices. This project reports on an Infection Prevention Week Meme Contest and describes healthcare worker's perspectives on using memes as an implementation strategy to improve knowledge and compliance with evidence-based infection prevention practices.

Patient and health-care worker perspectives on the short-course regimen for treatment of drug-resistant tuberculosis in Karakalpakstan, Uzbekistan.

Standard multidrug-resistant tuberculosis (MDR-TB) treatment is lengthy, toxic, and insufficiently effective. New drugs and a shorter treatment regimen (SCR) are now recommended. However, patient and health-care worker (HCW) perspectives regarding the SCR are unknown. We aimed to determine the views and experiences of patients with MDR-TB and HCW regarding the SCR in Karakalpakstan, Uzbekistan. In a qualitative study, we conducted 48 in-depth interviews with 24 people with MDR-TB and 20 HCW, purposively recruited to include those with a range of treatment-taking experiences and employment positions. Data were analysed thematically using Nvivo 12, to identify emergent patterns, concepts, and categories. Principles of grounded theory were drawn upon to generate findings inductively from participants' accounts. All patients viewed the SCR favourably. The SCR was seen as enabling an expedited return to work, studies, and "normality". This reduced the burden of treatment and difficulties with treatment fatigue. The SCR appeared to improve mental health, ease difficulties with TB-related stigma, and foster improved adherence. While patients wanted shorter treatment, it was also important that treatment be tolerable and effective. However, HCW doubted the appropriateness and effectiveness of the SCR, which influenced their confidence in prescribing the regimen. The SCR was said to benefit treatment completion and patients' lives. HCW concerns about SCR appropriateness and effectiveness may influence who receives the regimen. These are important considerations for SCR implementation and MDR-TB treatment developments, and dissonance between patient and HCW perspectives must be addressed for successful implementation of shorter regimens in the future.

Health Care Workers' Perspectives of the Influences of Disrespectful Maternity Care in Rural Kenya.

While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low-resource countries. In Kenya, a large body of research studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HCWs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identified four areas connected to the delivery of disrespectful care, including poor infrastructure, understaffing, service users’ sociocultural beliefs, and health care workers’ attitudes toward marginalized women. Investments are needed to address health system influences on DMC, including poor health infrastructure and understaffing. Additionally, it is important to reduce cultural barriers through training on HCWs’ interpersonal communication skills. Further, strategies are needed to affect positive behavior changes among HCWs directed at addressing the stigma and discrimination of pregnant women due to socioeconomic standing. To develop evidence-informed strategies to address DMC, a holistic understanding of the factors associated with pregnant women’s poor experiences of facility-based maternity care is needed. This may best be achieved through an intersectional approach to address DMC by identifying systemic, cultural, and socioeconomic inequities, as well as the structural and policy features that contribute and determine peoples’ behaviors and choices.

Perspectives of health care workers and village health volunteers on community-based Integrated Management of Childhood Illness in Madagascar

The Ministry of Health and Family Planning of Madagascar introduced Integrated Management of Childhood Illness (IMCI) strategy in 2006, and community-based IMCI (c-IMCI), in Mahajanga II District in 2007. Following the 2009 political crisis, foreign organisations' suspension of development aid until 2012 significantly affected the implementation of c-IMCI. This study aimed to elucidate the perspectives of village health volunteers (VHVs) and public health officers (PHO) on c-IMCI. Semi-structured in-depth interviews with all VHVs working in three communes and PHOs working at central, district, and health centre levels were conducted in 2013. Textual data, created from transcripts, were translated into English and French. Data management involved analysis of sections of translated transcripts, which were marked, coded, and linked with similar experiences, challenges, and opinions; these were categorised into words and phrases to discover meaningful relationships between emerging themes. From all interviews of 30 VHV in three Mahajanga II communes and 4 PHOs, 3 themes emerged: 1) benefits of c-IMCI to the community and for VHVs, 2) challenges to continue c-IMCI, and 3) motivation to continue c-IMCI. Although all respondents considered c-IMCI as beneficial, they stated it was difficult to continue. The health system and implementation of c-IMCI should be strengthened to enable programme survival beyond the initial phase, especially during times of political instability.

Barriers and facilitators of tuberculosis infection prevention and control in low- and middle-income countries from the perspective of healthcare workers: A systematic review.

Tuberculosis remains a leading cause of death worldwide. Transmission is the dominant mechanism sustaining the multidrug-resistant tuberculosis epidemic. Tuberculosis infection prevention and control (TBIPC) guidelines for healthcare facilities are poorly implemented. This systematic review aimed to explore the barriers and facilitators of implementation of TBIPC guidelines in low- and middle-income countries from the perspective of healthcare workers. Two separate reviewers carried out an electronic database search to select qualitative and quantitative studies exploring healthcare workers attitudes towards TBIPC. Eligible studies underwent thematic synthesis. Derived themes were further organised into a macro-, meso- and micro-level framework, which allows us to analyse barriers at different levels of the healthcare system. We found that most studies focused on assessing implementation within facilities in accordance with the hierarchy of TBIPC measures—administrative, environmental and respiratory protection controls. TBIPC implementation was over-estimated by self-report compared with what researchers observed within facilities, indicating a knowledge-action gap. Macro-level barriers included the lack of coordination of integrated HIV/tuberculosis care, in the context of an expanding antiretroviral therapy programme and hence increasing opportunity for nosocomial acquisition of tuberculosis; a lack of funding; and ineffective occupational health policies, such as poor systems for screening for tuberculosis amongst healthcare workers. Meso-level barriers included little staff training to implement programmes, and managers not understanding policy sufficiently to translate it into an IPC programme. Most studies reported micro-level barriers including the impact of stigma, work culture, lack of perception of risk, poor supply and use of respirators and difficulty sensitising patients to the need for IPC. Existing literature on healthcare workers’ attitudes to TBIPC focusses on collecting data about poor implementation at facility level. In order to bridge the knowledge-action gap, we need to understand how best to implement policy, taking account of the context.

Perspectives of healthcare workers on factors influencing diabetes management and diabetic foot problems in Zimbabwe

Background: Poor management of diabetes mellitus gives rise to complications such as diabetic foot (DF), which pose a host of medical and socioeconomic problems, especially in low-income countries ...