Community Health Providers Research Articles

Mobile Phone Based Strategies for Preconception Education in Rural Africa.

Background:Prepregnancy health care is vital to alleviate and prevent maternal and neonatal disability and death.Objectives:The purpose of the study was to measure the levels of knowledge and attitude on preconception care and their determinants among women who delivered at government hospitals in a rural setting in southern Ethiopia.Methods:A facility-based cross sectional study was done from January 01 to February 30, 2017 on a sample of 370 women who delivered at government hospitals in Wolayita zone. The mothers were selected using systematic random sampling technique. The data were collected using structured and pretested interviewer administered questionnaires at the postnatal ward of each hospital. Data were analyzed using bivariate and multivariable techniques.Results:The result showed that 53% (95% confidence interval [CI]: 47.8%, 58.1%) of mothers who delivered at public hospitals had adequate level of knowledge on preconception care, whereas 54.3% (95% CI: 49.2%, 59.5%) possessed positive attitude to preconception care. Mothers who have radio, planned pregnancy and have participated in community meetings related to preconception care had a meaningfully higher odds of good level of knowledge to preconception care. Ordinal regression showed that women who own mobile phone had at least three times significantly higher odds of positive attitude to preconception care, whereas women who have participated community meetings had lower odds of positive attitude on preconception care.Conclusions:The results revealed that the levels of mothers’ knowledge and positive attitude on preconception care are low relative to other studies. Using transistor radio and mobile phone have significant effect in improving the knowledge and attitude of reproductive age women on preconception care. Hence, providing community health education based on radio and/or mobile phone messaging could be useful in positively influencing the knowledge and attitude of women on preconception care.

Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have...

Analysis of written resources for parents of children discharged from a paediatric emergency department.

The aim of this study was to profile the information and readability of parent-focused resources to support care at home following a child's discharge from a paediatric emergency department (ED). Analysis included recording the scope, source, readability scores and benchmarking the contents against previous recommendations for discharge information. Information from 46 resources (on 41 conditions) from three separate sources was analysed. Overall, a wide range of resources was available. Inconsistency was evident in the framework and design of resources available. Approximately two-thirds of resources provided information about referral to community resources, and most had links to community health providers. Assessment of readability levels showed a predominant pitch towards a relatively high level of schooling. Existing written resources available for parents to use in caring for their child following discharge from an ED could improve with more streamlined designs as well as consistent references to community resources and additional health providers. Parents with low reading capacity may not be able to make the most of existing resources to care for their child at home following ED discharge. This framework was developed for reviewing the resources that could be useful for quality assessment of other parent-focused discharge information.

Working together in cancer care: An academic community partnership for a diverse patient population.

10525 Background: The Massachusetts General Hospital Cancer Care Equity Program conducted a qualitative survey health assessment in the inner-city communities of Boston to study Black Bostonian patients’ perceptions of the barriers to cancer care. Findings revealed a level of mistrust toward large cancer centers and a request for more interactions with their trusted community health providers. At a subsequent community forum geared toward soliciting solutions to improve relationships with academic medical centers, community members recommended that academic oncologists increase engagement with their community health center (CHC) clinicians with a cancer lecture series. Methods: Academic oncologists from Massachusetts General Hospital and Boston Medical Center met with the leadership at two CHCs prior to the creation of the cancer lecture series. Feedback on how to best support CHC providers was established and a cancer care lecture series was created with continuing medical education (CME) credit provided. Five in-person lectures were given at each CHC. Topics included: Consultative Hematology, Breast Cancer, Prostate Cancer, Thyroid Cancer, Colon Cancer and Adrenal Masses. Survey evaluations (summative and formative) were distributed to all participants. An online portal was established to provide ongoing CME to providers. Results: Six academic physicians specializing in cancer care provided lectures at two CHCs. Currently, we have 176 surveys completed from both CHCs. Thus far, 98.3% surveys have indicated that the lectures have been “Excellent” or “Above Average,” and all participants have responded that the objectives of each presentation have been met. We have developed a website to provide ongoing CME for the lectures that were given: http://bucme.org/cancercare . Conclusions: This project aims to improve cancer care education and communication between providers from academic cancer centers and primary care providers at CHCs that care for a diverse and vulnerable patient population.

Effectiveness of School-Based Education Programs on Health Risk Behaviors in Adolescents: South-East of Iran

Background: Improving and providing community health is one of the main pillars of community development. Objectives: The present study aimed at investigating the effect of school-based interventions on health-risk behaviors among adolescents in the South-East of Iran. Methods: This interventional quasi-experimental study recruited a total of 420 adolescent females in the 10th grade of public schools, selected by the census in Zahedan, Iran. The study tool was a questionnaire of high-risk health behaviors with a Content Validity Ratio (CVR) of 0.80, a Content Validity Index (CVI) of 0.88, and reliability (α) of 0.70. After the pre-test, multidimensional interventions (individual education, group education, individual counseling, modern education, and parents’ educational packages) were provided for the intervention group from October 2015 to June 2016. After a three-month interval, the post-test was conducted during October 2016. Results: The mean score changes in interventional and control group were -0.7 (2.3) and 0.1 (2.7) for high-risk behaviors; 0.8 (5.5) and -0.4 (5.2) for healthy nutritional behaviors, and physical activity behaviors with 1.4 (4.5) and 0.3 (5.1). Also, there was a positive significant relationship between score changes of high-risk behaviors (P < 0.001), healthy nutritional behaviors, and physical activity (P < 0.05) of students with study group (interventional and control) in univariate linear regression, yet in the multivariate linear model, only high-risk behaviors remained (P < 0.001). Furthermore, after the intervention, three simultaneous behaviors decreased among the students in the intervention group by 8.4% compared to 1.6% in the control group. The individual consultations among adolescents, who smoked cigarettes or hookahs, drank alcohol, abused drugs or had unprotected sex resulted in high-risk behaviors. Conclusions: To sum up, school-based interventions can improve health behaviors if they target multiple environmental and behavioral dimensions with a complementary strategy in the target society. Therefore, it is recommended for interventions to be designed and tailored to the needs of students and employed continuously to maintain the effect of education.

Abstract P081: Applying Precision Public Health Tools to Address Health Disparities Among African-Americans in Alachua County, Florida

Precision Public Health (PPH) is the application of public health tools to population subsets with tailored interventions resulting in quantitative improvements in overall population health. The goal of PPH is to move from general impact to specific impact with interventions while maintaining a population focus in our outcomes. Precision Public Health at the University of Florida (PPH@UF) is a multi-disciplinary workgroup established in 2017 for the purpose of pursuing PPH practices. The primary product of the workgroup is the PPH@UF Libguide: a PPH focused tool designed to be a single place for public health workers to find necessary resources they need to understand their community and create effective interventions. Using the resources in this tool can help existing or new public health workers and researchers move from general population analysis towards precision in their interpretation of the data. This poster has two goals: 1) To show how the resources from the PPH@UF Libguide can be used to address health disparities among African-Americans in Alachua County and 2) To provide an example of how a PPH tool can increase the precision in population analysis aimed toward recommending interventions. The study utilized the PPH@UF Libguide to investigate a commonly known disparity between African-American and Caucasian diabetes deaths in Alachua County. By translating demographic data and investigating diabetes hospitalization, prevalence of diabetes by age over time, and population characteristics of relevant census tracts in Alachua County, we identified two specific census tracts that have significantly higher density of these individuals at risk. Using data from the Centers for Disease Control and presented by the Robert Wood Johnson Foundation, we were also able to observe that these tracts had very high rates of annual doctor visits but very low insurance rates and few locally available core preventative services. This indicates that interventions focusing on preventative care outside of doctor’s offices and connecting individuals to currently available community resources may be most helpful. The PPH@UF Libguide includes many different community partners who would be able to supply these types of resources and can serve not only as a research tool but also as a way to sort community health providers. Any intervention would include training individuals to access information on the PPH@UF Libguide for the needs of community members. By identifying a major community issue and providing a more precise geographic scope, supportive and integrated data, and a practical focus, the PPH@UF Libguide shows its ability to make efforts to address disparities among African-Americans in our community more effective. In conclusion, community health workers and advocates can utilize PPH tools similar to the PPH@UF Libguide to increase the impact and value of their community interventions.

HRH dimensions of community health workers: a case study of rural Afghanistan

IntroductionThere is ample evidence to indicate that community health workers (CHW) are valuable human resources for health in many countries across the globe, helping to fill the gap created by a chronic health workforce shortage. This shortage is not only in number but also in workforce distribution and skill mix. There remains a lack of evidence, however, concerning the size and distribution of CHWs and their relationship to the professionally regulated and recognized health workforce, such as physicians and nurses, and the unregulated and unrecognized health workforce, such as traditional birth attendants and traditional healers. This is particularly the case in low-income, under-resourced countries, such as Afghanistan.MethodWe conducted a descriptive qualitative analysis involving fieldwork in Afghanistan between 2013 and 2014. We undertook participant observation and in-depth interviews with community members, CHWs, health managers, and policymakers, in an attempt to add more depth to our knowledge of how CHWs function, or could function better, as a recognized health worker.ResultsWe found that the number of CHWs has increased dramatically in recent years and that CHWs play a variety of roles, including work generally associated with professional providers, such as referral, education, and counseling. Although not a replacement for professional health providers, CHWs, in places where the number of and access to such providers is low, become the only option to meet basic health needs of the population. In places where professional providers are available, CHWs have the potential to extend the services to marginalized populations, provide community health services, and become a recognized member of the health provider team. A limitation of their role in health system strengthening is their lack of integration and a clear career path including into more recognized professional roles.ConclusionCHWs provide a critical human resources for health role in Afghanistan, but there are opportunities for improved integration with other providers which can increase their potential to improve service delivery.

Collaborative working to promote the use of an early warning scoring system in the recognition and escalation of acutely ill patients in community healthcare

The National Patient Safety Agency’s (NPSA) National Reporting and Learning System (2007) identified that 11% of deaths in 2005 were the result of deterioration that was not recognised or acted on. In response to this, the Royal College of Physicians (2012) and NPSA (2007) recommended the use in clinical areas of an early warning score (EWS) to identify early signs of deterioration in patients. Traditionally, the EWS has been used in hospitals, but the national early warning score (NEWS) has recently been recommended for use before admission to hospital.Two community health providers undertook a collaborative project in association with the West of England Academic Health Science Network to promote the use of NEWS in community health services across west England. This resulted in suitable community tools and stronger links across the region that help to recognise deteriorating patients sooner.

Relationship between maternal perception and full immunization coverage among children aged 1-3 years in Kalibagor Village, Situbondo District

Background and objectives: Full immunization coverage in Indonesia and East Java Province is reported to remain below the target of Universal Child Immunization. The purpose of the study was to determine the relationship between maternal perception and full immunization coverage among children aged 1-3 years. Methods: A cross-sectional study was conducted with mothers who had children under 3 years in Kalibagor Village, Situbondo District, Situbondo Regency, East Java Province. A total of 116 respondents were selected using systematic random sampling from 133 mothers of children aged 1-3 years. Listing of all mothers was conducted through home visits one month before data collection. Data collection was conducted at respondents' house in October-May 2018. Data collected included sociodemographic characteristics, knowledge on immunization, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, information on immunization, and support from community leader, health provider and peer. Data analysis with logistic regression was conducted to determine the relationship between maternal perception with full immunization coverage.Results: This study showed that 79.3% of respondents reported to have provided full immunization to their children. The results of multivariate analysis showed that full immunization was related to the mother's perception on the benefits of immunization (AOR=59.75; 95%CI: 4.60-76.86), self-efficacy (AOR=6.25; 95%CI: 1,83-21.35) and knowledge on immunization (AOR=7.77; 95% CI: 1.92-31.49).Conclusion: Maternal perceptions on immunization’s benefits, self-efficacy and knowledge are related to the full immunization coverage in children. Education about the benefits of immunization needs to be prioritized in an effort to increase full immunization coverage in children.

Fragile X Associated Primary Ovarian Insufficiency (FXPOI): Case Report and Literature Review.

Abnormalities in the X-linked FMR1 gene are associated with a constellation of disorders, which have broad and profound implications for the person first diagnosed, and extended family members of all ages. The rare and pleiotropic nature of the associated disorders, both common and not, place great burdens on (1) the affected families, (2) their care providers and clinicians, and (3) investigators striving to conduct research on the conditions. Fragile X syndrome, occurring more severely in males, is the leading genetic cause of intellectual disability. Fragile X associated tremor and ataxia syndrome (FXTAS) is a neurodegenerative disorder seen more often in older men. Fragile X associated primary ovarian insufficiency (FXPOI) is a chronic disorder characterized by oligo/amenorrhea and hypergonadotropic hypogonadism before age 40 years. There may be significant morbidity due to: (1) depression and anxiety related to the loss of reproductive hormones and infertility; (2) reduced bone mineral density; and (3) increased risk of cardiovascular disease related to estrogen deficiency. Here we report the case of a young woman who never established regular menses and yet experienced a 5-year diagnostic odyssey before establishing a diagnosis of FXPOI despite a known family history of fragile X syndrome and early menopause. Also, despite having clearly documented FXPOI the woman conceived spontaneously and delivered two healthy children. We review the pathophysiology and management of FXPOI. As a rare disease, the diagnosis of FXPOI presents special challenges. Connecting patients and community health providers with investigators who have the requisite knowledge and expertise about the FMR1 gene and FXPOI would facilitate both patient care and research. There is a need for an international natural history study on FXPOI. The effort should be coordinated by a global virtual center, which takes full advantage of mobile device communication systems.

Lessons Learned from Community Health Providers in Posthurricane Receiving Communities

Abstract There is an accumulating body of research on behavioral health, temporary displacement, and social connectedness after disasters; however, less is known about perceptions of providers regarding services and the effectiveness of the services that are offered. The purpose of this study is to provide an in-depth analysis of reflections from providers who worked immediately after Hurricane Katrina in the Greater Baton Rouge area, which was one of the largest receiving communities. This study provides a response legacy framework with findings that emphasize collaboration, improved understanding of cultural differences, disaster planning and readiness, improved understanding of trauma informed care, self-care, and policy changes. The study also provides ways to support disaster response professionals in their efforts toward increasing social justice and fostering of community resilience. Our study found that providers were satisfied with their postdisaster work and feel that evidence informed changes t...

Utilization of Mobile Integrated Health Providers During a Flood Disaster in South Carolina (USA).

As health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes prehospital personnel in the community as an extension of the traditional health care system. These programs have been labeled as Community Paramedicine (CP) and Mobile Integrated Health (MIH). While variation exists amongst these programs, generally efforts are targeted at individuals with high rates of health care utilization. By assisting with chronic disease management and addressing the social determinants of health care, these programs have been effective in decreasing Emergency Medical Services (EMS) utilization, emergency department visits, and hospital admissions for enrolled patients.The actual training, roles, and structure of these programs vary according to state oversight and community needs, and while numerous reports describe the novel role these teams play in population health, their utilization during a disaster response has not been previously described. This report describes a major flooding event in October 2015 in Columbia, South Carolina (USA). While typical disaster mitigation and response efforts were employed, it became clear during the response that the MIH providers were well-equipped to assist with unique patient and public health needs. Given their already well-established connections with various community health providers and social assistance resources, the MIH team was able to reconnect patients with lost medications and durable medical equipment, connect patients with alternative housing options, and arrange access to outpatient resources for management of chronic illness.Mobile integrated health teams are a potentially effective resource in a disaster response, given their connections with a variety of community resources along with a unique combination of training in both disease management and social determinants of health. As roles for these providers are more clearly defined and training curricula become more developed, there appears to be a unique role for these providers in mitigating morbidity and decreasing costs in the post-disaster response. Training in basic disaster response needs should be incorporated into the curricula and community disaster planning should identify how these providers may be able to benefit their local communities.Gainey CE, Brown HA, Gerard WC. Utilization of mobile integrated health providers during a flood disaster in South Carolina (USA). Prehosp Disaster Med. 2018;33(4):432-435.

Experiences With Navigating and Managing Information in the Community Following Spinal Cord Injury.

Background: People living with spinal cord injury (SCI) have reported difficulties managing information in the community, which can negatively impact their functional independence and ability to prevent secondary complications. Objective: This exploratory qualitative study aimed to describe the experiences of people living with SCI with navigating and managing information in the community from their perspective. Methods: Participants were recruited through the Australian Quadriplegic Association. Twenty-two semi-structured in-depth interviews were conducted with purposively selected participants to ensure representation of age, gender, SCI level, and compensation status. Data were thematically analyzed using a framework approach. Results: People living with SCI reported using multiple, complementary sources of information to prevent and manage secondary conditions. Over time, they learned to appraise the content, relevance, timing, and sources of information. Information delivered by health professionals in the rehabilitation setting was appraised as lacking personalization, but it acted as a springboard to search for more relevant information. Participants described the process of becoming experts about their condition to overcome the lack of knowledge of many general practitioners, guide their own care, and act as a source of information for others. Due to a lack of information provision, some participants missed health improvement opportunities and experienced frustration at the uncertainty of their future with SCI. Conclusion: Greater support is required for individuals with SCI to navigate information sources in the community. Rehabilitation is an opportune time to provide education related to finding and appraising information. Improved access to community health providers with SCI knowledge is also required.

Less time in Hospital; more time at home

Introduction: Navigating the maze of the health system can be challenging for families of children with chronic and complex conditions. These children often slip through the gaps, are managed by multiple teams and become disengaged with primary and local services. The Sydney Children’s Hospitals Network (SCHN) Care Coordination Service helps care teams partner with families and local health services so that children with chronic and complex conditions spend less time in hospital and more time at home. Practice change implemented (methodology): The SCHN Care Coordination program (Kids GPS – Guided Personalised Services) applies a quality improvement framework using ‘Plan, Do, Study, Act’ (PDSA) cycles to continually implement, evaluate and modify approaches to care coordination. The service consists of nurses and social workers – ‘the Care Coordinators’ who work in partnership with the hospital, community and family ‘lead’ to develop a contemporaneous care plan. A strategy of combining ambulatory models of care and a 24/7 telephone service has made this program more robust. The program was implemented in February 2014. Outcomes are measured on a monthly basis with data comparison driving further PDSA cycles. Aim / targeted population: To implement a model of care coordination for children with medical complexity that aims to improve efficiency and patient outcomes by supporting families to navigate services/providers within SCHN, Local Health Districts (LHDs) and Primary Health Networks (PHNs). Care Coordination for this cohort of children intends to reduce avoidable hospital attendance and improve the integration of care between community health providers and the hospital. Highlights (outcomes): Kids GPS has achieved significant outcomes measured both in terms of hospital encounters saved and patient-focussed outcomes. The program currently has 446 children enrolled. Between July 2015 and June 2017, the service demonstrated: 875 hospital encounters saved, equating to approximately $977,000 in financial savings for SCHN 51,500 KM travel saved for families and 370 school absences prevented 204 ED presentations avoided, with implementation of a 24/7 Hotline in August 2016 increasing the average ED presentations saved per month from 1.6 to 16.7 Analysis of the past six months data (Jan-Jun 2017) demonstrates a 400% increase in encounters saved (448 compared to 111 between Jul-Dec 2016) following service design changes though various PDSA cycles. Sustainability and transferability: Members of the SCHN Care Coordination team are part of the Children’s Healthcare Australasia (CHA) Complex Care Special Interest Group. The networking from this group has resulted in referrals of complex patients moving interstate, enabling care coordination to commence prior to the patient relocating. This has proven an innovative way of inter-state agency collaboration. It is anticipated that future funding will lead to additional care coordinators with a focus on aboriginal patients/families, and children/youth presenting frequently to the ED for mental health or behavioural disorders. Conclusion: Effective care coordination can significantly benefit the lives of patients/families with chronic and complex conditions. Key lessons learned: Combining ambulatory models of care with care coordination makes the integrated model of care more robust 24/7 hotline access providesa further safety net to empower parents/carers Outcome measurements that are patient focussed helps to create organisational cultural change

A Protocol for a Feasibility and Acceptability Study of a Participatory, Multi-Level, Dynamic Intervention in Urban Outreach Centers to Improve the Oral Health of Low-Income Chinese Americans.

While the US health care system has the capability to provide amazing treatment of a wide array of conditions, this care is not uniformly available to all population groups. Oral health care is one of the dimensions of the US health care delivery system in which striking disparities exist. More than half of the population does not visit a dentist each year. Improving access to oral health care is a critical and necessary first step to improving oral health outcomes and reducing disparities. Fluoride has contributed profoundly to the improved dental health of populations worldwide and is needed regularly throughout the life course to protect teeth against dental caries. To ensure additional gains in oral health, fluoride toothpaste should be used routinely at all ages. Evidence-based guidelines for annual dental visits and brushing teeth with fluoride toothpaste form the basis of this implementation science project that is intended to bridge the care gap for underserved Asian American populations by improving access to quality oral health care and enhancing effective oral health promotion strategies. The ultimate goal of this study is to provide information for the design and implementation of a randomized controlled trial of a participatory, multi-level, partnered (i.e., with community stakeholders) intervention to improve the oral and general health of low-income Chinese American adults. This study will evaluate the feasibility and acceptability of implementing a partnered intervention using remote data entry into an electronic health record (EHR) to improve access to oral health care and promote oral health. The research staff will survey a sample of Chinese American patients (planned n = 90) screened at three outreach centers about their satisfaction with the partnered intervention. Providers (dentists and community health workers), research staff, administrators, site directors, and community advisory board members will participate in structured interviews about the partnered intervention. The remote EHR evaluation will include group adaptation sessions and workflow analyses via multiple recorded sessions with research staff, administrators, outreach site directors, and providers. The study will also model knowledge held by non-patient participants to evaluate and enhance the partnered intervention for use in future implementations.

Multimorbidity in a large district hospital: A descriptive cross-sectional study.

There is substantial research documenting the burden of disease globally and in the South African (SA) primary care context. Few studies address the disease profile and its implications in the SA hospital setting. To describe the disease profile in the internal medicine department of a large district hospital, using variables related to comorbidity and patient length of stay. The study included specific exploration into the HIV/tuberculosis (TB) syndemic, the acuity of HIV disease, and lifestyle risk factors. The sample population consisted of all consecutive admissions to the internal medicine department of a large district hospital in the Cape metropole during May 2015. A retrospective folder review and subsequent data analysis were completed. Hypertension, HIV, type 2 diabetes mellitus, TB and cardiac failure were the five most prevalent diseases. Extensive multimorbidity was observed, with 86.0% of patients suffering from two or more diseases concurrently. The average number of comorbidities per patient was 3.4, although no clear relationship between the number of comorbidities and length of stay was found. Of the various diseases, only TB and HIV were associated with above-average length of stay, particularly among co-infected patients and those who had defaulted from or never received antiretroviral (ARV) treatment. Compared with patients currently receiving ARVs, much higher proportions of patients who had defaulted from or never received ARV treatment had CD4+ counts &lt;200 cells/µL. Of thelifestyle risk factors investigated, a history of excessive alcohol use and/or drug use wasassociated with an increased length of stay.Most patients were discharged home, with 15.7% being referred to other institutions. Chronic conditions, particularly HIV, TB and non-communicable diseases, represented much of the disease profile in the internal medicine department. Of the comorbidities investigated, the greatest contributor to length of stay was HIV/TB co-infection. Factors such as HIV, TB and substance use that increase length of stay cannot be impacted upon by the district hospital staff in isolation. To improve the health of communities, we require partnerships between doctors, community health providers and patients with their families. Multimorbidity was widespread, suggesting the need to include an understanding of multimorbidity, including the patient perspective, in medical education and health system reform.

Factors That Influence Enrolment and Retention in Ghana' National Health Insurance Scheme.

Background: The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2004 with the goal of achieving universal coverage within 5 years. Evidence, however, shows that expanding NHIS coverage and especially retaining members have remained a challenge. A multilevel perspective was employed as a conceptual framework and methodological tool to examine why enrolment and retention in the NHIS remains low. Methods: A household survey was conducted after 20 months educational and promotional activities aimed at improving enrolment and retention rates in 15 communities in the Central and Eastern Regions (ERs) of Ghana. Observation, indepth interviews and informal conversations were used to collect qualitative data. Forty key informants (community members, health providers and district health insurance schemes’ [DHISs] staff) purposely selected from two casestudy communities in the Central Region (CR) were interviewed. Several community members, health providers and DHISs’ staff were also engaged in informal conversations in the other five communities in the region. Also, four staff of the Ministry of Health (MoH), Ghana Health Service (GHS) and National Health Insurance Authority (NHIA) were engaged in in-depth interviews. Descriptive statistics was used to analyse quantitative data. Qualitative data was analysed using thematic content analysis. Results: The results show that factors that influence enrolment and retention in the NHIS are multi-dimensional and cut across all stakeholders. People enrolled and renewed their membership because of NHIS’ benefits and health providers’ positive behaviour. Barriers to enrolment and retention included: poverty, traditional risk-sharing arrangements influence people to enrol or renew their membership only when they need healthcare, dissatisfaction about health providers’ behaviour and service delivery challenges. Conclusion: Given the multi-dimensional nature of barriers to enrolment and retention, we suggest that the NHIA should engage DHISs, health providers and other stakeholders to develop and implement intervention activities to eliminate corruption, shortage of drugs in health facilities and enforce the compulsory enrolment stated in the NHIS policy to move the scheme towards universal coverage.

Promoting Face-to-Face Dialogue for Community Engagement in a Digital Age.

Background Health researchers in urban centers recognize the need to engage with inner-city community-based organizations. Funding for face-to-face engagement is often limited because most work done by agencies and academics now focuses on the use of digital technology. Purpose This article presents reflections from a grant project aimed at establishing community engagement between academic health researchers and interdisciplinary inner-city community health and social service providers. Method This study utilized a community-based participatory action approach. This study included a 1-day collaborative meeting to promote academic-agency engagement. During this meeting, the research participants brainstormed research priorities and used colored stickers to rank them. The research team met the following day to debrief the meeting and to begin analyzing the data together. Results The findings from this project have stimulated dialogue among the agency partners and project team researchers with respect to current collaborations, services provided, and research priorities. Although digital or virtual meetings have their place, fostering community engagement through a face-to-face meeting proved invaluable to the participants. Conclusions The success of this Canadian Institutes of Health Research-funded project demonstrates the value of academic-agency partnership, the positive aspects of gathering community, and engagement in better meeting the research needs of inner-city organizations.

HIV status and treatment influence on fertility desires among women newly becoming eligible for antiretroviral therapy in western Kenya: insights from a qualitative study

BackgroundFactors influencing fertility desires among HIV-infected individuals remain poorly understood. With new recommendations for universal HIV treatment and increasing antiretroviral therapy (ART) access, we sought to evaluate how access to early ART influences fertility desires among HIV-infected ART-naïve women.MethodsSemi-structured in-depth interviews were conducted with a select subgroup of 20 HIV-infected ART-naïve women attending one of 13 HIV facilities in western Kenya between July and August 2014 who would soon newly become eligible to initiate ART based on the latest national policy recommendations. The interviews covered four major themes: 1) definitions of family and children’s role in community; 2) personal, interpersonal, institutional, and societal factors influencing fertility desires; 3) influence of HIV-positive status on fertility desires; and 4) influence of future ART initiation on fertility desires. An iterative process of reading transcripts, applying inductive codes, and comparing and contrasting codes was used to identify convergent and divergent themes.ResultsThe women indicated their HIV-positive status did influence—largely negatively—their fertility desires. Furthermore, initiating ART and anticipating improved health status did not necessarily translate to increased fertility desires. Instead, individual factors, such as age, parity, current health status, financial resources and number of surviving or HIV-infected children, played a crucial role in decisions about future fertility. In addition, societal influences, such as community norms and health providers’ expectations of their fertility desires, played an equally important role in determining fertility desires.ConclusionsInitiating ART may not be the leading factor influencing fertility desires among previously ART-naïve HIV-infected women. Instead, individual and societal factors appear to be the major determinants of fertility desires among these women.

Advancing Women's Health in India: RAD-AID's Approach to Nursing Education, Mobile Imaging, and Community Health Outreach

RAD-AID International, a nonprofit in official relations with the World Health Organization, works to advance women's health in India through a mobile imaging program called Asha Jyoti and provides cervical, breast, and osteoporosis screenings for women with little or no access to radiology. This article discusses Asha Jyoti's recent expansion and the incorporation of a community health nursing education program to further support the growing demands and challenges faced in providing community health outreach in India.