Training Primary Health Care Research Articles

Mobbing in the case of primary health care providers, Antalya Turkey

Objective: Primary healthcare workers are the main drivers of the population-oriented health education programs. In this work, we aim to offer an account of the conditions that lead to mobbing in Primary Health Care Employees, and of the ways to address this problem and its consequences. Methods: This study has been conducted on the medical staff in primary health care units in the province of Antalya, with the permission of the Provincial Health Directorate and the approval of the ethics board of the Antalya Education and Research Hospital. It was planned as a cross-sectional study; survey forms were filled out by 752 employees during an internal training for primary health care in 2017. After informing the subjects regarding the aims of the study, we gave them a survey of 21 questions. The average time for the individuals to answer the questions was 30 minutes. The survey was designed to ask the individuals their age, gender, educational background and occupation, whether they know of any case of mobbing, whether they were subjected to mobbing themselves and for how long, the position and the gender of the perpetrator, and whether and how they addressed the issue. The answers of the participants were analyzed with descriptive statistical analysis, the frequencies were determined and chi-square test was used. Results: 72.2% (543) of the participants declare that they heard the words ‘mobbing’ or ‘psychological harassment’ before. In our study, the rate of exposure to mobbing was found to be 30.4% among primary care providers. We have found that mobbing exposure was significantly higher among females and midwives and nurses. Our study reveals that in every occupational group perpetrators are mostly in management positions, that 36-45 age group was the most victimized group by both genders, that the most common method in order to handle mobbing is the loss of commu-nication between the perpetrator and the victim and that the most common response to mobbing is to share it with friends, and our study finds that the period of mobbing in the midwife-nurse group is mostly 19 months and more, while this period takes to 9-12 months in the case of doctors. Discussion: One of the most important steps in preventing mobbing is to take timely measures in organizations and to prevent the problem from harming the organization and employees. Educating employees about emotional assault within their working environment is proposed as an important solution for them to protect themselves when they are subjected to harassment.

Prevention of breast cancer through primary health care training

Prevention of breast cancer through primary health care training

Training in Family Health and its association with work processes of Primary Care Dentistry Teams

The National Oral Health Policy emphasizes the importance of training in Primary Health Care and adapting the work processes to the new health care model. This study seeks to investigate the association between the training of Dental-Surgeons in Family Health and the work process. It involved a cross-sectional and multicentric study, with 18,114 Oral Health Teams that participated on the National Program to Enhance Access and Quality of Primary Health Care. Data were collected through interviews, using a structured questionnaire. Professionals with post-graduate education in Family Health share their schedule with other Primary Care professionals more frequently (PR: 1.04; CI 95%: 1.03 - 1.06), organize their schedule to offer educational activities in Oral Health more frequently (PR:1.03; CI 95%: 1.02 - 1.04), ensure completion of the treatment of patients more frequently (OR: 1.68; CI 95%: 1.19 - 2.38), conduct more home visits (PR: 1.08; CI 95%: 1.07 - 1.09) and use more protocols for prioritizing actions more frequently (PR: 1.06; CI 95%:1.04 - 1.07). Investment in training in Family Health may be important for better performance in Primary Care Dentistry, thereby leading to changes in the model of Comprehensive Oral Health care.

Community-Based Primary Healthcare Training for Physiotherapy Undergraduates: Perceptions of Physiotherapy Academics

Community-based primary healthcare training for health science students is based on the tenets of primary healthcare. The approach seeks to provide clinical education and training for health science students in previously disenfranchised communities. Some South African universities train their physiotherapy students through a community-based primary healthcare approach to undergraduate training. However, there is currently a lack of an integrated model guiding clinical education for physiotherapy clinical education in the country. The aim of this paper was to explore the perceptions of physiotherapy academics about a novel, community-based primary healthcare approach to clinical education for students at a university in South Africa. This study sought to inform the roll-out of an evidence-based model for physiotherapy education. A qualitative explorative approach, using semi-structured interviews with physiotherapy academics at the institution, was used to explore their perceptions of the community-based primary healthcare training platform. Data was analysed using conventional content analysis and was classified into themes and sub-themes. Four overarching themes emerged, namely: curriculum review, constraints to decentralised learning, benefits of community-based clinical education and recommendations for the learning platform. Participating academics believed that community-based primary healthcare training is an approach that influences students to be socially responsive, while providing access to healthcare services, such as rehabilitation, in resource-poor communities in South Africa.

Childhood Cancer Early Detection Training Program for Primary Healthcare Providers

Background and context: Over 250,000 new pediatric cancer cases are diagnosed yearly worldwide. Health care providers (mainly nurses) at health centers (HC) level are the children´s first opportunity for correctly recognizing and responding to early signs and symptoms of childhood cancers by appropriately referring them to district hospitals but studies show that 83% of nurses did not receive training on pediatric cancers. Insufficient knowledge about the warning signs and symptoms of pediatric cancer usually leads to improper diagnosis or delay to diagnosis and hence loss of many lives of these children. After realizing that majority in our community lack information on childhood cancers, our efforts since 2017 has been concentrated on training primary healthcare providers to recognize early signs and symptoms of childhood cancers. Aim: Improve survival of children with cancer by early detection of symptoms and signs and prompt referral by nurses at health centers. Strategy/Tactics: The program is consisted of trainings in selected regions of Rwanda. The first step is a “train the trainer workshop” where volunteering medical students and doctors are trained to train the nurses and community health workers. A two days workshop is organized subsequently in each province bringing together at least with one nurse from each selected health center. These trained nurses go back with materials to train their colleagues. They are followed up every three months with a survey to assess how much they retain the learned knowledge and the impact made. Prior to trainings, RCCR and pediatric oncologists develop training materials that include training curriculum for both the trainers and for the trainees (nurses), educational and awareness material (posters, fliers, brochures). Trained nurses are kept in RCCR database for their follow-up and track any case of a childhood cancer at their health facilities. Program/Policy process: The program is run in 4 phases, Phase 1: Develop training materials materials Phase 2: Recruitment and train the trainer phase Phase 3: Selection of health center and recruitment of healthcare providers Phase 4: The execution phase. Trainings are carried out in selected health centers. Phase 5: Post training follow-up. Outcomes: In 2017, the program was conducted in 4 health centers and around 90 health care providers were trained with more than 800 posters, 950 brochures and 300 flyers distributed. According to reports, after the training, the number of referrals from health centers increased and the posttraining showed how accurate nurses were in stating their differential diagnoses. What was learned: Childhood cancers are curable when detected and treated early, there is a need to build strong partnerships with private and public sectors to address the challenge of early detection and late presentation at the hospital because the program of training primary healthcare providers showed a good impact.

Long term effect of primary health care training on HIV testing: A quasi-experimental evaluation of the Sexual Health in Practice (SHIP) intervention.

BackgroundTo examine the effect of Sexual Health in Practice (SHIP) training for general practitioners (GPs) on HIV testing rates in Haringey, a deprived area of London, UK, with a population of over 250,000 and HIV prevalence of 0.7% (in 2014). SHIP is an educational intervention delivering peer-developed and peer-led face-to-face training to improve quality of sexual and reproductive health (SRH) care.MethodsWe carried out a quasi-experimental study of intervention effects across 52 GP practices (2008–2016). We used time variation in SHIP intervention exposure for effect estimation, controlling for practice and calendar month fixed effects in panel analysis. From 2008–2010, baseline data were collected, and in the subsequent six-year period, 78 GPs in Haringey (approximately 40% of all GPs) were SHIP trained. 46 Haringey practices (of 52) had at least one trained doctor. Outcome measures were monthly HIV tests and results by practice (obtained from the hospital laboratories).ResultsSHIP significantly increased HIV testing; for every GP trained, practice HIV testing rates increased by 16% (testing rate ratio (TRR) 1.16, 95% confidence interval (CI) 1.05–1.28, p value 0.004). This significant effect was demonstrated using an 8-year observation period, and was sustained over the post-intervention period. An average of 1.42% of HIV tests were positive.ConclusionSHIP training produces a significant and sustained increase in HIV testing for each GP trained. Compared with general population screening, HIV tests used in routine clinical care have a high probability of detecting a positive person. Unlike an RCT, this evaluation is a ‘real life’ measure of the effect that commissioners of SHIP could expect in comparable areas of the UK. The effectiveness of the SHIP training may be related to the programme components not included in interventions that did not demonstrate an effect, such as peer-led teaching, and use of approaches to communication and rapid risk assessment tailored to the setting.

Bridging the gap in health systems through task-sharing: A model of PHC workers’ competency for cervical screening

BackgroundSeveral developing countries have begun implementing the recently proven ‘Screen and treat’ approach using visual inspection methods and cryotherapy. Nonetheless, a dire lack of established screening programs in Nigeria necessitates proffering effective task sharing to improve the availability of screening at the primary care level thereby making it more accessible to women. MethodsThis study employed a cross-sectional, analytic design with competency-based training of health workers to underscore the competence of primary healthcare (PHC) workers to perform cervical screening. The degree of agreement for the visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI) results between the PHC workers and O & G doctors was determined using Kappa statistics, and indices of validity were used to express the accuracy of results. Results Following training, the PHC workers demonstrated a fair to excellent proficiency at the procedures for VIA and VILI, although the phase of VIA/VILI proper was the best performed. The degree of agreement (kappa) between workers for VILI (k - 0.442) and VIA (k - 0.374) was statistically significant (p < 0.001). The sensitivity of VILI among PHC workers (42.9%) was lower than O & G doctors (78.6%), however, PHC had a higher specificity (45.5% vs. 22.7%). The positive predictive values of VILI and VIA were similarly low for both groups (PHC workers vs. O & G doctors - 33.3% vs. 39.3%; 28.6% vs. 27.3%); whereas the negative predictive values for VILI and VIA were moderately better for PHC workers (PHC workers vs. O & G doctors - 62.5% vs. 55.6%; 58.6% vs. 56.0% respectively). The diagnostic accuracy for VILI was the same for both groups of healthcare workers, however VIA accuracy was slightly higher among PHC workers. The sensitivity of VIA was lower among the PHC workers (PHC workers vs. O & G doctors −14.3% vs. 21.4%), who also had a higher specificity (PHC workers vs. O & G doctors - 77.3% vs. 63.6%). ConclusionThe findings of this study suggest that VIA and VILI as done by trained PHC workers is comparable to those performed by registrars of obstetrics and gynecology, which is in keeping with reports from several other studies. This study thus highlights the value of competency-based training for primary healthcare workers in order to accomplish task sharing for cervical screening using visual inspection methods.

Integrating Mental Health into Primary Care Using a Population Based Approach: Six Years Outcome of Aro Primary Care Mental Health Programme for Ogun State, Nigeria

Introduction: Integration of mental health services into Primary Health Care (PHC) is a proven way of reducing the treatment gap in developing countries. A major constraint to scaling up mental health services in developing countries is scarcity of mental health professionals. A practical solution is to adopt task shifting and task sharing strategies involving Primary Health Care Workers (PHW). One of the major challenges of such integrative services is their long term outcomes and sustainability. The Neuropsychiatric Hospital Aro, Abeokuta, Nigeria embarked on mental health services provision across primary health care facilities in Ogun state six (6) years ago. Objective: This report describes the development, challenges of the programme and presents a post-implementation evaluation after 6 years of its commencement. Methods: Applying a population based expansion of pilot- tested integration model of Aro Primary Care Mental Health Programme (APCMHP) for Ogun State, 80 PHC workers were trained using an adapted mental health Gap Action Programme (mhGAP) intervention guide to assess and treat/refer 5 priority conditions: Psychosis, Depression, Epilepsy, Alcohol and Substance abuse and Other Significant Emotional Complaints (OSEC).There was mental health service provision in 40 designated PHC centers across Ogun state. There was support and supervision of the trained health workers by field supervisors, supplementary training and re-training for skill sustenance, periodic stakeholders meeting with Local Government Service Commission, zonal consultants’ review, financial and other resources commitment by the hospital, monthly programme evaluation and monitoring by the faculty members. We reviewed caseload of patients managed by trained PHC Workers since commencement of the programme in November 2011 till October 2017 (6 years period) using descriptive statistics. Appropriate ethical approval was obtained. Results: During the six-year period (November 2011-October 2017), 2194 cases (average of 366 new cases yearly) were identified and treated by Trained Health Workers (THWs). About 90% of cases were Psychosis and Epilepsy. There was a steady attrition of THWs and at the end of the sixth year only 29% of the THWs remained within the programme. Treatment outcomes were fair as over 50% of patients had ≥ 3 follow-up visits, symptom remission of ≥ 30% and a subjective improvement in Global Ratings. Conclusion: Our project has demonstrated that it is feasible, practicable and cost effective with community acceptance to scale up mental health services at primary care setting in Nigeria using adapted mhGAP-IG document. The need to understand the dynamics and econometrics of sustainable primary mental health services is indicated.

Implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care.

BackgroundThe DE-PLAN-CAT project (Diabetes in Europe–Prevention using lifestyle, physical activity and nutritional intervention–Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention–Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible.MethodsA multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45–75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation.ResultsThe programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively).ConclusionsA large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.

Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal

BackgroundNon-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, REducing Stigma among HealthcAre Providers to ImprovE mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare.MethodsThis protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit, k = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities (n = 150); indirect beneficiaries are their patients (n = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors, ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes including stigma-related barriers to care, daily functioning, and symptoms.DiscussionThe pilot and feasibility study will contribute to refining recommendations for implementation of mhGAP and other mental health services in primary healthcare settings in low-resource health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE to advance the evidence-base for optimal approaches to training and supervision for non-specialist providers.Trial registrationClinicalTrials.gov identifier, NCT02793271

Multiple Regressions of a Malcolm Baldrige's Patient Safety Models

This research proposed to develop patient safety models in primary health care and provide a possible model to implementated. Primary health care in Indonesia battling in assessment of risk reduction strategy because difficulty in identifying adverse event and there are no model or guidance for patient safety in primary health care yet. The patient safety model can be framed with Baldrige Health Care Criteria for performance excellence. Basic Emergency Obstetric Care was an critical health care in Indonesia for reduce maternal death by early detection of maternal complication. So, this study focus to develop patient safety model in basic emergency obstetric care bases on Baldrige criteria. We conducted a cross sectional study, data collected through a likert scale questionnaire from 194 respondent, there were doctors, nurses, midwifes, pharmacist, and medical report officer from six basic emergency obstetric care. Data analysis by linear regression and multiple regression to determined the most suitable variable to the models. The result shows that incident detection, mitigation, health workers workload and commitment, internal audit are variables for a patient safety model development. It is recommended to futher researcher to developed module for patient safety training in primary health care.

Patients satisfaction with consultation at primary health care centers in Abha City, Saudi Arabia.

Aim of Study:This study aims to assess patients satisfaction regarding consultations at the General Clinics of primary health-care (PHC) centers, in Abha City.Patients and Methods:This cross-sectional study design was conduct among adult patients attending training PHC centers in Abha City, Saudi Arabia during September 2016. The researcher designed a data collection sheet that comprised patients’ personal characteristics and the consultation satisfaction questionnaire, which contained 18 questions within four dimensions, i.e., general satisfaction; professional care; depth of relationship; and length of consultation.Results:The total number of the patient included in this study was 400, more than half of them were male (54%). Most of them were Saudi (90%), married (79%), and educated (93%). More than half 53% were dissatisfied, 20% were satisfied with consultation while 27% were natural. The most important factor affecting satisfaction with consultation was age, education level and income.Conclusions:Patients satisfaction toward their consultation experience at general clinics of training PHC centers in Abha City was suboptimal. Total consultation scores differ significantly according to their age groups, education level, and monthly income.Recommendations:PHC physicians should be more concerned with improving medical consultations provided to their patients. Continuing medical education and training of PHC physicians about provision of medical consultation.

Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial

BackgroundExclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya.MethodsWe conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant’s first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis.ResultsA total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4–59.9) in the intervention group and 54.6% (95% CI 50.0–59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0–2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0–4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0–6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718).ConclusionsEBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.Trial registrationISRCTN ISRCTN83692672. Registered 11 November 2012. Retrospectively registered.

Impact of practice, provider and patient characteristics on delivering screening and brief advice for heavy drinking in primary healthcare: Secondary analyses of data from the ODHIN five-country cluster randomized factorial trial

Background: The implementation of primary healthcare-based screening and advice that is effective in reducing heavy drinking can be enhanced with training.Objectives: Undertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and the extent to which training mitigates any differences due to such characteristics found at baseline.Methods: A cluster randomized factorial trial involving 120 practices, 746 providers and 46 546 screened patients from Catalonia, England, the Netherlands, Poland, and Sweden. Practices were randomized to receive training or not to receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen-positive patients advised.Results: Nurses tended to screen more patients than doctors (OR = 3.1; 95%CI: 1.9, 4.9). Screen-positive patients were more likely to be advised by doctors than by nurses (OR = 2.3; 95%CI: 1.4, 4.1), and more liable to be advised the higher their risk status (OR = 1.9; 95%CI: 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high-risk status.Conclusions: Training primary healthcare providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised.Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552

Cases of acute pesticide poisoning in Colonia Puerto Pirapó, Itapúa, Paraguay, February, 2014

In Paraguay, pesticides are the causative agent in 13.7% of poisonings, especially organophosphorus compounds. Such poisoning produces the inhibition of acetylcholinesterase generating three possible clinical conditions: acute poisoning, intermediate syndrome or late neurotoxicity. We present 15 cases of acute poisoning, ten women and five men from a rural community between 5 and 67 years of age, whose symptoms began after using water contaminated by pesticides from the community network. The most common symptoms were nausea and vomiting, followed by abdominal pain, headache, fever, itching, red eyes and sweating. Five patients underwent blood tests for blood count, renal and liver function and serum cholinesterase, with results within the reference values; just one patient had high liver enzymes.In two samples from the community water supply network the active compound detected was profenophos. It is essential to train primary health care personnel to identify cases of acute pesticide poisoning in a timely manner to provide appropriate treatment, especially in rural areas. Additionally, it is necessary that responsible institutions monitor compliance with environmental regulations in these areas to avoid such incidents.

Rural Paramedic Practitioner – A future model of care

This commentary looks at the introduction of a rural paramedic practitioner (RPP). A RPP is a rural paramedic that has completed advanced medical training in primary health care and is able to provide prehospital, hospital and primary health care.

The Influence of Primary Health Care Training on Health Workers and the Community: A Case Study of Esan West Local Government Area, Edo State

The rate of poor health care delivery services in Nigeria has been a major problem in the Nigerian Health Sector consuming so much thoughts and rigorous policies that have been set in place to curb its trending limitations. The sermons of development have become so ear irritating as so much has been said, discussed on the news, platforms, name it, but yet the problems are still persistent and on daily basis land mosquito-like bites on the minds of those who struggle daily to cope and still hope for development somewhere, somehow. This was a study intervention to determine the awareness level of Primary Health Care (PHC) training in Esan west L.G.A of Edo state, Nigeria. This study also investigated the influence of these training both previous and present on the quality of health care services provided in the health care centres also assessing the problems and providing possible tackling mechanisms to curbing these problems in the Esan West Local Government Area. This study involved the use of questionnaires to assess the individual perception of the PHC training. 300 questionnaires were randomly handed out to the respondents present at the PHC training and analysed afterwards. This study however highlighted some of the distinctive problems tail dragging the delivery services in the primary health care centres in Esan West Local Government area of Edo state, Nigeria. Evaluating from majority opinion carried out in this study, the primary health care trainings had not been really conducted/ felt in the community, as commencement of these health care programs will bring about an improvement in the health care delivery services as well as improve the rate of tackling diseases conditions in the community.

The situation of nursing education in Latin America and the Caribbean towards universal health.

Objective:to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health.Method:quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results:a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion:there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.

Experience of Trained Primary Health Care Workers in Mental Health Service Delivery across Ogun State Nigeria

Background: In developing countries with shortage of mental health professionals, paramedics are trained in the delivery of mental health services. Knowledge of the experience of the trained health workers is useful in evaluating output of service and restructuring training package. This study was undertaken to determine the experience of trained primary health care (PHC) workers in mental health service delivery across Ogun State South west Nigeria. Methods: Aro Primary Care Mental Health Program (APCMHP) was developed for the training of 80 PHC workers across the state using adapted mhGAP intervention guide to assess and treat/ refer five priority conditions: Psychosis, Depression, Epilepsy, Alcohol & Substance Abuse and Other Significant Emotional Complaint (OSEC). Data was collected on their experience 12 months after commencement of service delivery. Descriptive statistics were used and appropriate ethical approval was obtained. Results: Out of the 80 PHC workers, attrition of 25 (31.3%) was recorded in 12 months period. 54 valid questionnaires were analyzed. There were 52 (96.3%) females and 90.7% were nurses. The mean (SD) age was 42.4 (16.3) years. A total of 473 patients were seen with diagnostic breakdown as follows: Psychosis (45.9%), Epilepsy (38.3%), Depression (10.1%), OSEC (3.2%) and Alcohol & Substance Abuse (2.5%). Diagnostic and treatment difficulty was reported for the following: Psychosis (23.1%), Depression (22.0%), Epilepsy (3.7%), OSEC (52.2 %) and Alcohol & Substance Abuse (57.1%). Personal fulfillment in mental service delivery was reported by 88.5%, while 94.3% reported that the program was helpful to the community. Good attitude of clients and relatives towards the program was identified by 86.8% of the PHC workers. Conclusion: Our study revealed a high personal fulfillment of the trained PHC workers in mental health service delivery. There is need for re-training of the PHC workers towards effective service delivery.

Environmental Scan of Weight Bias Exposure in Primary Health Care Training Programs

Negative attitudes and beliefs about individuals with obesity (also known as weight bias) have negative consequences for physical and mental health for individuals with obesity and impact the quality of care provided by health professionals. A preliminary environmental scan of college and university training programs was conducted consisting of 67 degree and diploma granting programs from 22 institutions in Alberta, targeting programs training future health professionals. Publicly available online course descriptions were examined for weight-related keywords. Keyword frequency was used to determine the extent that coursework addressed weight-related issues. The results suggested that courses are structured to include learning about general health promotion as well as lifestyle factors that may contribute to obesity but may not systematically include learning about weight bias or its potential impact. Our findings highlight the need for further in-depth investigations as well as the need to enhance current curricula in higher education by including information related to weight, obesity and weight bias. Les attitudes et les croyances négatives concernant les personnes obèses (également connues comme partialité contre les obèses) ont des conséquences négatives sur la santé physique et mentale des personnes obèses et affectent la qualité des soins qui leur sont prodigués par les professionnels de la santé. Nous avons mené une étude environnementale préliminaire des programmes de formation universitaires et collégiaux qui a porté sur 67 programmes menant à un certificat ou à un diplôme dans 22 établissements d’Alberta, et nous avons principalement visé les programmes de formation de futurs professionnels de la santé. Les descriptions de cours en ligne accessibles au grand public ont été examinées et les mots clés faisant référence aux problèmes de poids ont été identifiés. Les résultats suggèrent que les cours sont structurés de manière à inclure l’apprentissage de la promotion de la santé en général ainsi que les facteurs relatifs au style de vie qui peuvent contribuer à l’obésité mais ils n’incluent pas l’apprentissage systématique de la partialité contre les obèses ou ses effets potentiels. Nos résultats illustrent le besoin de mener des enquêtes approfondies ainsi que celui de renforcer les programmes de cours actuels en enseignement supérieur pour y inclure des informations relatives au poids, à l’obésité et à la partialité contre les obèses.