Indian Providers Research Articles

Healthcare worker resilience during the COVID-19 pandemic: A qualitative study of primary care providers in India.

Since 2020, the world saw a myriad of creative health‐care policy responses to the COVID‐19 pandemic. This article studied the experience of rural primary care providers (PCPs) in India deputized for COVID‐19 care in urban areas. In‐depth interviews were conducted with PCPs (n = 19), who served at COVID‐19 facilities. Lack of epidemic management and intensive tertiary care experience, limited and inadequate training, and fear of infection emerged as the primary sources of distress, in addition to absent systemic mental health support and formalized recognition. Even so, resilience among the respondents emerged as a result of encouragement from their families, peers, and mentors through various means including social media, and from individual recognition from communities and local governments. Rural PCPs expressed an eagerness to serve at the frontlines of COVID‐19 and demonstrated indomitable spirit in the face of an acutely understaffed health system, growing uncertainty, and concerns about personal and family health. It is imperative to reconfigure health‐care education and continuing professional development, and equip all health‐care professionals with mental health support and the ability to deal with public health emergencies and build a more resilient health workforce.

Prevalence and severity of secondary traumatic stress and optimism in Indian health care professionals during COVID-19 lockdown.

The COVID-19 pandemic has brought to light the lacunae in the preparedness of healthcare systems across the globe. This preparedness also includes the safety of healthcare providers (HCPs) at various levels. Sudden spread of COVID-19 infection has created threatening and vulnerable conditions for the HCPs. The current pandemic situation has not only affected physical health of HCPs but also their mental health. This study aims to understand the prevalence and severity of secondary traumatic stress, optimism parameters, along with states of mood experienced by the HCPs, viz., doctors, nurses and allied healthcare professionals (including Physiotherapist, Lab technicians, Phlebotomist, dieticians, administrative staff and clinical pharmacist), during the COVID-19 lockdown in India. The assessment of level of secondary traumatic stress (STS), optimism/pessimism (via Life Orientation Test-Revised) and current mood states experienced by Indian HCPs in the present COVID-19 pandemic situation was done using a primary data of 2,008 HCPs from India during the first lockdown during April-May 2020. Data was collected through snow-ball sampling technique, reaching out to various medical health care professionals through social media platforms. Amongst the study sample 88.2% of doctors, 79.2 of nurses and 58.6% of allied HCPs were found to have STS in varying severity. There was a female preponderance in the category of Severe STS. Higher optimism on the LOTR scale was observed among doctors at 39.3% followed by nurses at 26.7% and allied health care professionals 22.8%. The mood visual analogue scale which measures the "mood" during the survey indicated moderate mood states without any gender bias in the study sample. The current investigation sheds light on the magnitude of the STSS experienced by the HCPs in the Indian Subcontinent during the pandemic. This hitherto undiagnosed and unaddressed issue, calls for a dire need of creating better and accessible mental health programmes and facilities for the health care providers in India.

What Can Be Done Differently to Enable The Social Participation Of Individuals With Deafblindness or Dual Sensory Impairment?

<h3>Research Objectives</h3> To identify ways to enhance the social participation of individuals with deafblindness or dual sensory impairment. <h3>Design</h3> The exploratory study involved a scoping study followed by two qualitative research studies. Data were collected through qualitative interviews with 16 adults with deafblindness, as well as through two focus group discussions with their 16 rehabilitation service providers in India. Various accessible modes of communication were used to conduct qualitative interviews with individuals with deafblindness. Directed content analysis approach and the International Classification of Functioning, Disability and Health (ICF) as a framework were used to analyze the qualitative data. <h3>Setting</h3> Community and social participation settings. <h3>Participants</h3> Sixteen community-dwelling adults (18-45 years of age) with deafblindness as well as their sixteen rehabilitation service providers in India. <h3>Interventions</h3> Not applicable. It was an exploratory study. <h3>Main Outcome Measures</h3> Social participation of individuals with deafblindness <h3>Results</h3> Participants with deafblindness or dual sensory impairment identified access to information, communication, mobility, relationships, education and productivity, and recreation and leisure as important domains of life for their participation. The rehabilitation service providers suggested developing deafblind-specific rehabilitation services and assistive technology (e.g., hearing aids, cochlear implants, refreshable braille displays, magnifiers) to improve access to information, communication and social interactions, and thus to enable the social participation of individuals with deafblindness or dual sensory impairment. <h3>Conclusions</h3> Our findings suggest that the interventions should focus on enabling access to information for these individuals as it is available for their non-disabled counterparts. It is imperative for clinicians to design rehabilitation services to remove participation barriers located in the environment and focus on life domains that they value to enable the societal participation of those with deafblindness or dual sensory impairment. <h3>Author(s) Disclosures</h3> No conflict of interest to declare.

Legal Abortion Limit Raised up to 24 Weeks of Gestation for Substantial Foetal Anomalies or for Rape Victims: a Welcome Step for Women and Health Providers in India.

Legal Abortion Limit Raised up to 24 Weeks of Gestation for Substantial Foetal Anomalies or for Rape Victims: a Welcome Step for Women and Health Providers in India.

Providers' Knowledge of Diagnosis and Treatment Best Practices for Acute Myocardial Infarction (AMI): Evidence from India Using Clinical Vignettes

Research ObjectiveCardiovascular diseases (CVDs) are a leading cause of death worldwide, and 80% of CVD deaths occur in low‐ and middle‐income countries (LMICs). The Global Burden of Disease Study estimates that CVDs contribute 28·1% of total deaths in India. Acute Myocardial Infarctions (AMI) make up a large share of these deaths. Early diagnosis and correct treatment of AMI is critical to preventing CVD‐related deaths. This study aims to assess the competence of primary care providers in India to diagnose and treat AMI and examine differences between public and private sector providers.Study DesignWe conducted a cross‐sectional study of healthcare providers' knowledge of diagnosis and treatment for AMI. Data collection took place in Odisha, one of the poorest states in India, from August 2019 to March 2020. Using data from vignette‐based interviews with primary care providers in the public and private sectors, we assessed providers' knowledge of best practices in clinical care. The public sector providers within this study included physicians at government‐run primary health centers, and the private sector providers were engaged in solo‐practice, irrespective of medical qualifications. The vignette‐responses were evaluated against standard treatment guidelines (STGs) for AMI at the primary care level.Population Studied110 primary care providers working in Odisha, India a state with ~47 million people, of which 32.5% earn &lt; $1.90/day and ~ 60% belong to indigenous or vulnerable social groups.Principal FindingsOverall, providers demonstrated low levels of knowledge: only 67.27% diagnosed AMI correctly, and 0% recommended the correct treatment as per STGs. Providers seldom asked key diagnostic questions such as family and medical history (6.36% of cases) and the nature of the chest pain (10.91%) or results from diagnostic tests like ECG and EKG (30%), lipid profile (1.82%), or angiograms (3.64%). Private sector providers showed higher competence in making a correct diagnosis than public providers (difference of 32.73 percentage points). In line with STGs, 82.43% of providers referred AMI cases to hospitals, with more private than public providers making these referrals. 55.41% of providers prescribed at least one correct drug (in combination with unnecessary drugs). More private providers prescribed at least one correct drug than public sector providers. 44.74% of public providers prescribed only unnecessary drugs, without a single medicine recommended for angina.ConclusionsHealthcare providers in Odisha, India, have low levels of knowledge regarding AMI diagnosis and treatment, with public providers showing lower competence than private providers.Implications for Policy or PracticeOur findings indicate strikingly poor quality of care for AMI at the primary care level. The widespread misdiagnosis of AMI, the prescription of unnecessary drugs, and a lack of appropriate referral raise concerns for India's efforts to address rising rates of CVD. Our findings suggest addressing CVD in LMIC contexts is complex and requires improving the baseline knowledge of providers in both public and private sectors; which may be particularly relevant in contexts with little de facto regulation.Primary Funding SourceBill and Melinda Gates Foundation.

Comparing the average cost of outpatient care of public and for-profit private providers in India

IntroductionUnderstanding the cost of care associated with different kinds of healthcare providers is necessary for informing the policy debates in mixed health-systems like India’s. Existing studies reporting Out of Pocket Expenditure (OOPE) per episode of outpatient care in public and private providers in India do not provide a fair comparison because they have not taken into account the government subsidies received by public facilities. Public and private health insurance in India do not cover outpatient care and for-profit providers have to meet all their costs out of the payments they take from patients.MethodsThe average direct cost per acute episode of outpatient care was compared for public providers, for-profit formal providers and informal private providers in Chhattisgarh state of India. For public facilities, government subsidies for various inputs were taken into account. Resources used were apportioned using Activity Based Costing. Land provided free to public facilities was counted at market prices. The study used two datasets: a) household survey on outpatient utilisation and OOPE b) facility survey of public providers to find the input costs borne by government per outpatient-episode.ResultsThe average cost per episode of outpatient care was Indian Rupees (INR) 400 for public providers, INR 586 for informal private providers and INR 2643 for formal for-profit providers and they managed 39.3, 37.9 and 22.9% of episodes respectively. The average cost for government and households put together was greater for using formal for-profit providers than the public providers. The disease profile of care handled by different types of providers was similar. Volume of patients and human-resources were key cost drivers in public facilities. Close to community providers involved less cost than others.Conclusions and recommendationsThe findings have implications for the desired mix of public and private providers in India’s health-system. Poor regulation of for-profit providers was an important structural cost driver. Purchasing outpatient care from private providers may not reduce average cost. Policies to strengthen public provisioning of curative primary care close to communities can help in reducing cost.

Byju’s Learning App in the COVID-19 Outbreak to Analyze Online Education-A Case Study

Background/Purpose: Byju’s e-learning App is one of the most used online learning mobile applications in India. Byju’s app operations began in 2011. It is launched by two business entrepreneurs Byju Raveendran and Divya Gokulnath. The Company's head office is in Bengaluru, India. The app slogan is "Fall in love with learning.” Byju's app brings new and innovative trends in education, specifically in online education. In the beginning, the Byju e-Learning app consists of all kinds of students, all state boards in India, especially from grades first to 12th. Furthermore, the app provides unique services to graduates attempting to pass competitive tests like GATE, JEE, NEET, UPSC, and Bank Exams. The application's main segment is to provide an electronic learning platform with numerous examples to improve students' concentration. It is Indian's fastest electronics app, focused only on learning the concept by various methods and through various animated videos, more straightforward and effective, where to get the best outcome in learning mathematics and science subjects. Objective: In this paper, we analyze Byju's app's influence on students during the COVID-19 pandemic, and to know whether its subscription increased or not in the Covid 19 outbreak. This paper also analyzes how e-learning apps can focus on enhancing the experience of students and helping to improve customer focusing and subscription rate. Design/Methodology/Approach: A survey is conducted in a semi-urban area to analyze different aspects related to online education through Byju’s app during COVID 19 pandemic. In addition, analyze the information collected from the survey and from various scholarly articles and by using the SWOT analysis framework. Findings/Results: During the COVID-19 pandemic, for online education, Byju's app stands as a leading online education brand, with 85% of parents subscribed to this mobile application for their child's education. So, coronavirus crisis helped Byju’s app to become a leader in online education providers in India. Conclusion: From the conducted survey-increased subscription rate of the app was seen and noticed that customers are loyal to Byju’s App. Also, it is found that most of the students in the semi-urban area use Byju's app for their studies during the Covid 19 pandemic. By SWOT analysis, we have given some suggestions that can be added to Byju's Learning App as a business strategy. Paper Type: Case study-based Research Analysis

Decimating an Oligopoly: Study of how Jio Telecoms conquered the Indian Network Industry

One of the most debatable and informational business contemplates is that of how Reliance Jio took over a commercial center control by BSNL, the latter who is uncertain of staying alive these days. Among a concise range, viable ways were utilized by Jio and the awkward obstacles looked at by BSNL lead to the creation of one the biggest network providers in India and furthermore made an exceptionally beneficial organization go to obligation. The paper expects to reveal the components and factors for BSNLs ruin and the manner in which it influenced the insights of telephone clients inside the nation. This paper furthermore reveals insight into Jio selling its SIM card without charge and the undeniable reality that not charging any money for a long time since its release changed the total telephone-charge structure in the nation. It’s a comprehensive report on the monetary, political, and psychological ways utilized by a shiny new organization known as Jio and its uncommon impacts until now, where Jio holds over half piece of the pie. The discoveries of this examination are masterminded get into terms of the effect on the all-out scope of endorsers in accordance with the Telecom Statistics India Reports from 2019.T

Age and Reasons for First Dental Visit in a Tertiary Care Hospital in South India

Abstract Background: Early visit to the dentist with an aim of prevention has been advocated universally, but the timing for seeking dental treatment differs among different countries. Aim: This study aimed to determine the timing and reasons for the first dental visit among children attending the dental clinic in a tertiary care hospital in Tamil Nadu, South India. Methods: This hospital-based study reviewed the dental records of children who had visited the dental clinic from January 1, 2019 to December 31, 2019. All those between 0 and 10 years of age and visiting a dentist for the first time were included in the study. The continuous variables were analyzed using mean and standard deviation. The categorical variables were calculated using Chi-square, Fisher's exact test, and two-proportion test. Results: We reviewed the dental records of 1005 children (60% boys and 40% girls). The most frequent age for the first dental visit was between 5 and 6 years. The most common reasons for visits to the dental clinic were pain (23.8%) and dental caries (16.6%). Only 3.8% of children had their first dental visit by 1 year of age and primarily for therapeutic purposes. Dental caries and traumatic injuries were more frequent in children below the age of 3 years. Conclusion: The present study found pain as the most frequent reason for the visit, but there was a delay in first dental visits among children. This study suggests effective oral health policies for children and a need to change the perception and practices among the dental professionals in the region. Timing of the first dental visit of a child can help us to determine the quality of dental care a child receives. Delayed dental visit among children in this study indicates the ineffective oral health policies and the gap that exists between the pediatric health-care providers in India.

Exploring quality of life among head-and-neck cancer patients in Western India using European organization for research and treatment of cancer questionnaires.

Head-and-neck cancers (HNCs) are one of the major public health problems for both patients and the health-care providers in India. The clinical manifestations of HNC and its treatment can lead to negative effects on the quality of life (QoL) of the patient. The study is aimed to explore the QoL using the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires among HNC patients in Western part of India. A cross-sectional prospective study was conducted among 400 HNC patients attending the tertiary cancer center. The QoL was assessed by using the EORTC core questionnaire (EORTC QLQ-C30) and EORTC head- and neck-specific questionnaire (EORTC QLQ-H and N35). The data were explored using means, standard deviation, medians, ranges, and proportions. All the 400 patients had completed the questionnaire having a compliance rate of 100%. There was no missing data at the item level for the EORTC QLQ-C30 questionnaire. While the missing items for EORTC QLQ-H and N35 were: problems while swallowing food, problems with teeth, and sexuality. The mean functional score ranged from 74.22 to 93.49 for EORTC QLQ-C30. The mean symptoms score was found in the range from 3.25 to 81.50 for EORTC QLQ-H and N35. Both questionnaires were comprehensive and well accepted by the patients. These questionnaires provided the information-related disease-specific QoL data, which otherwise is often missed. Health-care providers should not only focus on the clinical effects of treatment but also on QoL issues because it will improve overall patient care and survival.

Why do some health care providers disrespect and abuse women during childbirth in India?

BackgroundDisrespect and abuse during childbirth can result in fear of childbirth. Consequently, women may be discouraged to seek care, increasing the likelihood for women to choose elective cesarean section in order to avoid humiliation, postnatal depression and even maternal mortality. This study investigates the causes underlying mistreatment of women during childbirth by health care providers in India, where evidence of disrespect and abuse has been reported. MethodsQualitative research was undertaken involving 34 in-depth interviews with midwifery and nursing leaders from India who represent administration, advocacy, education, regulation, research and service provision at state and national levels. Data are analysed thematically with NVivo12. The analysis added value by bringing an international perspective from interviews with midwifery leaders from Switzerland and the United Kingdom. FindingsThe factors leading to disrespect and abuse of women relate to characteristics of both women and their midwives. Relevant woman-related attributes include her age, gender, physical appearance and education, extending to the social environment including her social status, family support, culture of abuse, myths around childbirth and sex-based discrimination. Midwife-related factors include gender, workload, medical hierarchy, bullying and powerlessness. DiscussionThe intersectionality of factors associated with mistreatment during childbirth operate at individual, infrastructural, social and policy levels for both the women and nurse-midwives, and these factors could exacerbate existing gender-based inequalities. Maternal health policies should address the complex interplay of these factors to ensure a positive birthing experience for women in India. ConclusionMaternal health interventions could improve by integrating women-centred protocols and monitoring measures to ensure respectful and dignified care during childbirth.

Peripartum Safety: Time to Act

Peripartum safety refers to the safe care of women throughout the antenatal, intranatal, and postnatal periods.Approximately 15% of all childbearing women are likely to develop life-threatening complications. Indiaand Nigeria accounted for one-third of global maternal deaths at the country level. Recognizing the need,the United States has initiated a Maternal safety Bundle. On a par with, The Government of India introducedvarious programs to reduce maternal deaths. Though the country made most of its progress, MMR stateperformances are varied in their extremes and failed to achieve the targeted goal. High maternal mortalityis associated with medical, socio-economic, and health care system problems are evidenced. The shortfallof skilled health care providers in India hampers progress towards achieving universal health coverage. Thecurrent situation calls for more sensitization and sustainable efforts for integration and institutionalizationof health system monitoring to achieve the target of Sustainable Developmental Goals. Studies need togerminate to tackle the health care insufficiencies of pregnant women and enhance the quality of care.

CHALLENGES AND SCOPE IN LOGISTICS SERVICES – A COMPREHENSIVE STUDY IN INDIAN CONTEXT

The logistics sector in India contributes to 14% in GDP and recently has added a lot of consideration from both business industries as well as policy makers. Fluctuating government policies on tax system and guidelines of service providers are going to play an important role in logistics industry. Coordination among many government agencies needs agreement from various ministries and is a barrier for multi modal transportation in India. Growing demands from e-commerce industry and Government initiatives like MAKE IN INDIA, will absolutely bring considerable development for logistics service providers in India. The LSPs need to restructure their strategies with the purpose of gaining all approaching opportunities. LSP’s in India are facing many challenges with the intention to deliver shipments on assured time and in proper condition. In this study, it has been attempted to highlight the challenges faced by LSP’s and what measures can be taken to mitigate the challenges. Based on the opinions of experts and literature reviews from few journals, the challenges and solutions has been identified. This study explains how globalization plays an important role in driving the Indian logistics industry and detailed information about each challenge.&#x0D;

An Assessment of Awareness, Preparedness and Availability of Personal Protective Equipment among Frontline Healthcare Providers in India during the COVID-19 Pandemic

Background Across the world as millions of people stayed at home to reduce the transmission of severe acute respiratory syndrome coronavirus 2 COVID-19 health-care providers braved all odds and did the exact opposite. Though health workers are expected to save the lives of people however concerns related to the awareness preparedness of hospital settings and availability or shortage of PPE kits surfaced and probably put healthcare workers at risk while carrying out their duties. An unforeseen shortage of PPE was evidenced across India during the peak of the pandemic in mid 2020. The media reported that many healthcare providers including nurses became infected and some of them even lost their lives. Hence the safety and protection of healthcare providers while at work assumes great significance.Objectives The study aimed to evaluate the awareness and preparedness regarding PPE and protocols for the same among frontline healthcare providers in India during theCOVID-19 pandemic and also explore the need and availability status of PPE kits for frontline health workers across India.Methodology This cross-sectional study included a total of 65 healthcare providers who were actively treating COVID-19 patients across hospitals in India during the middle of 2020. After obtaining informed consent respondents were invited to answer an online questionnaire-based survey on the awareness knowledge and availability of PPE and recommended PPE practices related to COVID-19 infection in healthcare settings. Out of the 87 providers reached out to only 65 of them answered the questionnaire in its entirety reflecting a response rate of 74.71. A purposive convenient sampling method was used for data collection. Statistical analysis was performed and descriptive statistics are presented.Results The overall awareness among all categories of frontline healthcare workers was found to be adequate. Approximately 49 of the respondents had never used PPE during their clinical duties and as high as 60 of the respondents reported that they were not being provided appropriate PPE routinely. However most of the respondents were aware that PPE can help protect them from COVID-19 infection. Nearly 51 of the respondents used the N95 respirator mask during clinical duties following by 44.62 using triple layered medical mask and 4.62 of them using cloth masks. Interestingly only 47.69 of the respondents were confident about having been demonstrated the appropriate method to wear the PPE and the precautions to be followed therein. As high as 95 of the respondents were interested to receive guidelines andor trainings to help understand the right method to use and dispose the PPE. Concerningly only 24.62 of the respondents confirmed positively that they had been provided with appropriate PPE kits during their clinical duties 23.08 of them said they probably received the PPE while 20 of them were unsure of either.Conclusion The findings lead us to believe that there have been some gaps and potential risk for frontline healthcare workers. In terms of awareness availability and training received regarding the use of PPE by frontline health workers much more needs to be done and there is a need to constantly monitor the implementation of PPE regimen in all healthcare facilities. Healthcare professionals in lower and middle income countries such as India may face more difficulties than those from other countries with a high proportion of respondents reporting that they did not have the necessary resources to care for patients with COVID-19. It is very important that technical and logistical difficulties should be addressed in the event of a future outbreak as they have a negative impact on healthcare workers. Most of the respondents as high as 85 have the willingness and interest to receive training to understand the proper method to use and dispose PPE. It is important for authorities to provide an efficient supply chain up-to-date protocols and pertinent lucid information. This study has highlighted some areas that need to be improved for dealing with future waves of the COVID-19 pandemic and other potential future pandemics and epidemics especially in a low resource developing country context

Replacement Blood Donation Denials in Children: A Cross-sectional Study

Introduction: Developing countries like India still depend on Replacement Donors (RD) for their blood requirements. Healthcare providers in India often face Replacement Blood Donation (RBD) denials in children especially in rural areas. Aim: To find reasons for RBD denials in children. Materials and Methods: A cross-sectional study was done over six months at a tertiary care centre located in rural part of Northern India. Children requiring Blood Transfusion (BT) whose parents refused RBD were included in the study. Children were divided into three groups based on their age and data on various parameters were collected. Observation parameters included sex, birth order, number of siblings, disease for which admitted, duration between admission and need for transfusion, indication for transfusion, decision maker in the family, resistance to decision of denial by any other member of family, parental education, socio-economic status and reasons for denial. Data were analysed using SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc, Chicago, Ill, USA). The p-values were computed for categorical variables using Chi-square (χ2) test. A p-value of less than 0.05 was considered statistically significant. Results: Out of 356 children requiring BT, parents and relatives of 130 children (36.51%) refused RBD. Of these 130 children, 84 were females and 46 were males with male-female ratio of 1:1.8. Females were more likely to be denied RBD (p-value=0.001). Of these 130 children, only 77 could be included in the study because of various reasons. Age of the study group ranged between 2 days to 15 years. Denials were significantly higher (p-value=0.0032) in children with 3rd or higher birth order. Little benefit in terms of life expectancy was the commonest reason for denials in neonates and was found statistically significant (p-value=0.00368). Fear of donation was the most common reason for denial in all the groups combined (38.9%). Considering themselves ineligible and religious beliefs were the other reasons for denials. Conclusion: RBD denial in children is common in India. Misconceptions, Illiteracy, poverty, sex discrimination and false beliefs are major contributory factors for denial.

An NLP-SEM approach to examine the gratifications affecting user’s choice of different e-learning providers from user tweets

ABSTRACT In this digital era, it is important for service providers to gain insights from the customer-generated data and act accordingly for gaining a competitive advantage over competitors. However, there are few studies that have attempted at utilising the online user-reviews in structural-models for examining the factors affecting user-behaviour. Additionally, there is a paucity of studies that have utilised the sentiment and emotional aspects to understand the motives affecting usage intentions. This study attempts to address this gap by exploring various uses and gratifications valued by users for different e-learning providers in India, namely, Coursera, Lynda, Udemy, Udacity and Byjus, by analysing the tweets posted by users using various official handles. Utilising a Natural-Language-Processing (NLP)-based approach (sentiment and opinion-mining) and 5868 tweets, the customer motives were analysed and mapped to the various gratifications. Results of the natural language processing-based structural-equation-modelling (NLP-SEM) technique show that consumers of different companies value gratifications differently.

Evaluating the Efficacy and Social Validity of a Culturally Adapted Training Program for Parents and Service Providers in India.

In regions such as India, where one-to-one behavior-analytic intervention is not easily accessible, parents and service providers may advocate for children with disabilities better if they have foundational training in behavioral approaches to problem behavior. The purpose of this study was to evaluate a culturally adapted training delivered in an underresourced region of India. Ten parents and professionals from Chennai completed the training, and the researchers evaluated its effects using a multiple-baseline design. Participants showed improvements in correct responses on a structured form designed to capture skills involved in function-based assessment and intervention, as well as the fidelity of implementation of extinction and functional communication training. Moreover, participants rated the acceptability of training highly on measures of social validity. Guidelines for the education of parents and service providers in underresourced areas outside of the United States are discussed.

Continuing Education for Prehospital Healthcare Providers in India - A Novel Course and Concept.

BackgroundEmergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public–private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India.MethodsFrom 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide).Lessons LearnedDuring the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials.ConclusionThese key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.

Factors that influence the participation of individuals with deafblindness: A qualitative study with rehabilitation service providers in India

Evidence to inform rehabilitation service delivery for individuals with deafblindness, especially in the Indian context, is inadequate. Rehabilitation professionals often find it challenging to design rehabilitation interventions that promote participation for those with deafblindness. Therefore, our purpose was to understand the contextual factors that influence the participation of individuals with deafblindness in India from the perspectives of those who are involved in providing rehabilitation services to them. Using the International Classification of Functioning, Disability, and Health (ICF) as a framework, we conducted two focus group discussions with 16 rehabilitation service providers in India. We used a content analysis approach to examine the data. Rehabilitation service providers perceived participation barriers to be linked primarily to the social environment. Specifically, participants identified four major factors acting as barriers, including (a) lack of awareness about deafblindness; (b) negative attitudes and stigma associated with disability; (c) lack of access to resources such as assistive technology and interpreter support; and (d) communication challenges associated with severe impairments. Facilitators include accessibility of the built environment for multisensory impairments, affordable technology, provision of an interpreter and personal support worker, and training on deafblindness for professionals. The participation of individuals with deafblindness could be enhanced by identifying and removing environmental barriers and improving knowledge about deafblindness among rehabilitation professionals for proper identification, assessment, and access to rehabilitation services.

Mission hospital responses to challenges and implications for their future role in India’s health system

Background: India’s health system is currently experiencing rapid change. Achieving India’s aspirations for improved population health and universal health coverage will require the contribution of all health providers; public, private-for-profit, not-for-profit, and charitable providers. Among the largest charitable providers in India are Christian mission hospitals, who have played a historic role in healthcare delivery to the poor and underserved. This study explored the main internal and external challenges facing mission hospitals, their response to those challenges, and the role they might play in the broader health system going forward. Methods: The study employed interdisciplinary methodology to assess the top challenges and responses between 2010-2017. The theory of everyday resilience was used to categorize challenges as chronic stresses or acute shocks and to explore features of resilience in responses to challenges, along with the underlying capabilities that enable resilience responses. Results and Discussion: Mission hospitals were impacted by social, political, and health system challenges. Most operated as “stressors,” for example, strained governance structures and human resource shortages. “Shocks” included major changes in health policy and increasing competition from for-profit providers. In response, some mission hospitals exhibited features of everyday resilience, traversing between absorptive, adaptive, and transformative strategies. Among mission hospitals that appeared to be successfully navigating challenges, three core capacities were present: 1) cognitive capacity, understanding the challenge and developing appropriate response strategies; 2) behavioral capacity, having agency to deploy context-specific responses; and 3) contextual capacity, having adequate resources, including hardware (e.g., money, people, infrastructure) and software (e.g., values, relationships, networks), to exercise the first two capacities. Building on their history and current examples of everyday resilience, mission hospitals can contribute to the larger health system by attending to health and well-being at the margins of society, encouraging innovation, developing human resources, and engaging in policy and advocacy. Conclusion: While mission hospitals face pressing internal and external challenges, many exhibit features of everyday resilience and retain strong commitment to population health and service to the poor. These features make them potentially strong actors in their local contexts as well as potential partners in the realization of improved population health across India.