Readiness Practices Research Articles

Exploring the value of shared responsibility for improving birth preparedness and complications readiness practices: A literature review

Birth Preparedness and Complication Readiness (BPCR) is a comprehensive strategy to ensure a safer pregnancy. The BPCR shared responsibilities matrix describes the roles of policymakers, facility managers, health care providers, communities, families, and women in ensuring that women and newborns receive skilled and timely maternal and newborn care that can positively improve health outcomes for mothers and their babies. The objective of the study was to describe a shared responsibility on roles to improve childbirth readiness practices and readiness in the face of complications. The literature was systematically obtained from online journal databases namely PubMed, Google Scholar, ScienceDirect, and other related sources, from 2018 to 2023. Sixteen articles on BPCR Interventions were described. Existing literature identifies the value of health care providers, communities, families, and women in shared responsibilities that can improve BPCR practices. We conclude that this review indicates that the value of pregnant women, facility managers, and policy makers in BPCR is still limited

Predictors of Birth Preparedness and Complication Readiness Practices Among Pregnant Women in Ethiopia, a Systematic Review and Meta-Analysis.

We conducted this review to identify factors associated with birth preparedness and complication readiness (BPCR) among pregnant women in Ethiopia. BPCR is a comprehensive approach that helps address delays in seeking care for obstetric problems. PRISMA was followed and different databases were used to find studies. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval was used to identify factors. The I2 statistic, funnel plot, and Egger test were used to assess the heterogeneity of studies and publication bias. Knowledge of BPCR, danger signs during pregnancy, labor, and postpartum (AOR = 1.99, 95% CI: 1.51, 2.64, AOR = 1.55; 95% CI: 1.35, 1.80; AOR = 1.45; 95% CI: 1.27, 1.63, and AOR = 1.4; 95% CI: 1.21, 1.63), respectively, residency (AOR = 1.49; 95% CI: 1.32, 1.68), antenatal care visit (AOR = 1.59; 95% CI: 1.43, 1.78), history of stillbirth (AOR = 1.58; 95% CI: 1.36, 1.86), and educational status (AOR = 1.62: 95% CI: 1.45, 1.78) were significantly associated with BPCR practice. This study identified some modifiable factors in the practice of BPCR. Integrating counseling and expanding ANC services in health facilities may improve BPCR practice.

Effectiveness of men in maternity health (MiM) intervention on male involvement in maternal health care to improve maternal health outcomes in Naypyitaw, Myanmar

Background Maternal health care (MHC) is critical for safe motherhood and preventing maternal deaths in Myanmar, but the institutional delivery rates are not yet optimal, increasing preventable maternal deaths. To address this issue, involving men in supporting MHC has been recognized as a strategy to improve MHC outcomes. This study aimed to assess the effectiveness, acceptability, and feasibility of men in maternity health (MiM) intervention on male involvement in MHC and its influence on knowledge, attitudes, and practices related to maternal health and institutional delivery rates in Naypyitaw, Myanmar. Methods This study employed a mixed-methods approach with quantitative surveying of the male partners and qualitative interviewing of both male and female partners and health stakeholders. A 6-month MiM education program on pregnancy complications, antenatal care, delivery care, and birth preparedness was provided to the intervention group. Before and after the intervention, comparisons between intervention and control groups were made. Results The socio-demographic characteristics of male partners were comparable between the intervention and control groups during the pre-intervention assessment. Before MiM intervention, notable differences in male partners’ knowledge, attitudes, birth preparedness and complication readiness practices regarding MHC were not evident between these two groups. After completing the MiM, significant score improvement, including higher ID rates compared to the control group (p<0.001), was observed. The acceptability and feasibility of the MiM program were contributed by positive responses from qualitative findings, highlighting remarkable changes in the perspectives of male partners in supporting MHC. However, challenges, including financial limitations, cultural influences and a shortage of trained personnel, were encountered. Conclusion The MiM program effectively promotes male involvement in MHC, leading to improved MHC outcomes. The MiM intervention offers a promising, evidence-based model to enhance ID rates in Myanmar, requiring tailored approaches to address cultural and financial factors.

IMPROVING NURSING HOME DISASTER READINESS THROUGH IMPLEMENTATION SCIENCE

Abstract The new investigation on the state of emergency preparedness in nursing homes from the Senate Finance and Aging Committee Chairs is a call to action. As large-scale disasters continue to become increasingly common worldwide, nursing homes, whose residents are more vulnerable to disaster-related health and psychosocial shocks, and their staff, are carrying progressively more responsibility for healthcare readiness practices. Implementation science is a research discipline that seeks to improve uptake of evidence-based practices, such as healthcare readiness planning, and thus has potential to improve nursing home care delivery during and after disasters. The purpose of this review was to describe the limited field of existing evidence-based strategies in the peer-reviewed literature that seek to advance healthcare readiness in the nursing home setting and illustrate how implementation science can better support healthcare readiness planning for nursing homes. We discuss three main themes: 1) implementation science frameworks can strengthen nursing home staff engagement around healthcare readiness; 2) implementation science can support tailoring of emergency preparedness plans to individual nursing homes’ unique needs; and 3) implementation science can advance the integration of nursing homes into local, state, and federal healthcare readiness planning initiatives. Finally, research is urgently needed to both generate and disseminate implementation strategies that increase uptake of evidence-based health care readiness practices in the nursing home setting.

Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study.

A large proportion of youth with chronic conditions have mental health comorbidities. However, the effect of these comorbidities on paediatric-adult transition readiness, and the relevance of widely used tools for measuring transition readiness, are unknown. The objectives of this study were to describe and explore the transition readiness of youth with co-occurring chronic health and mental health conditions using a combination of quantitative data obtained from participants completing the Transition Readiness Assessment Questionnaire (TRAQ) and qualitative data. A three-phase sequential explanatory mixed methods design was employed, with the qualitative strand taking priority. First, the TRAQ scores (range 1-5) of youth with co-occurring conditions (n = 61) enroled in a multisite randomized controlled trial were measured, followed by qualitative interviews with a sample of youth (n = 9) to explain the quantitative results. Results from both strands were then integrated, yielding comprehensive insights. Median TRAQ scores ranged from 2.86 on the appointment keeping subscale to 5.00 on the talking with providers subscale. The qualitative results uncovered the complexities faced by this group concerning the impact of a mental health comorbidity on transition readiness and self-management skills across TRAQ domains. The integrated findings identified a diverse and highly individualized set of strengths and challenges amongst this group that did not align with overarching patterns as measured by the TRAQ. This mixed methods study generated novel understandings about how youth with co-occurring conditions develop competencies related to self-care, self-advocacy and self-management in preparation for paediatric-adult service transitions. Results demonstrated the assessment of transition readiness using a generic scale does not address the nuanced and complex needs of youth with co-occurring chronic health and mental health conditions. Our findings suggest tailoring transition readiness practices for this group based on youths' own goals, symptoms, coping mechanisms and resources. This study was conducted in collaboration with five young adult research partners (YARP) with lived experience transitioning from paediatric to adult health/mental health services. The YARP's contributions across study phases ensured the perspectives of young people were centred throughout data collection, analysis, interpretation and presentation of findings. All five YARP co-authored this manuscript.

Improving Nursing Home Disaster Readiness Through Implementation Science

As large-scale disasters continue to become increasingly common worldwide, nursing homes, whose residents are more vulnerable to disaster-related health and psychosocial shocks, and their staff, are carrying progressively more responsibility for health care readiness practices. Implementation science is a research discipline that seeks to improve uptake of evidence-based practices, such as health care readiness planning, and thus has potential to improve nursing home care delivery during and after disasters. We describe the limited field of existing evidence-based strategies in the peer-reviewed literature that seek to advance health care readiness in the nursing home setting and illustrate how implementation science can better support health care readiness planning for nursing homes. We rest on 3 main themes: (1) implementation science frameworks can strengthen nursing home staff engagement around health care readiness; (2) implementation science can support tailoring of emergency preparedness plans to individual nursing homes’ unique needs; and (3) implementation science can advance the integration of nursing homes into local, state, and federal health care readiness planning initiatives. Finally, research is urgently needed to both generate and disseminate implementation strategies that increase uptake of evidence-based health care readiness practices in the nursing home setting.

A framework for assessing clinical trial site readiness.

Clinical trial processes are unnecessarily inefficient and costly, slowing the translation of medical discoveries into treatments for people living with disease. To reduce redundancies and inefficiencies, a group of clinical trial experts developed a framework for clinical trial site readiness based on existing trial site qualifications from sponsors. The site readiness practices are encompassed within six domains: research team, infrastructure, study management, data collection and management, quality oversight, and ethics and safety. Implementation of this framework for clinical trial sites would reduce inefficiencies in trial conduct and help prepare new sites to enter the clinical trials enterprise, with the potential to improve the reach of clinical trials to underserved communities. Moreover, the framework holds benefits for trial sponsors, contract research organizations, trade associations, trial participants, and the public. For novice sites considering future trials, we provide a framework for site preparation and the engagement of stakeholders. For experienced sites, the framework can be used to assess current practices and inform and engage sponsors, staff, and participants. Details in the supplementary materials provide easy access to key regulatory documents and resources. Invited perspective articles provide greater depth from a systems, DEIA (diversity, equity, inclusion, and accessibility) and decentralized trials perspective.

Birth preparedness and complication readiness practice among women attending antenatal care follow up in Yirgalem general hospital, southern Ethiopia.

In developing countries, maternal and newborn mortality is a major public health issue. Birth preparedness and complication readiness is a method to encourage pregnant women to seek professional birth attendants as soon as possible. The aim of this study was to evaluate practice and factors associated with birth preparedness and complication readiness among women attending antenatal care, southern Ethiopia, in 2019. From September 1st to September 30th, 2019, a facility-based cross-sectional study was conducted. 422 pregnant women were randomly selected and interviewed using a structured questionnaire. Epi-data version 3.1 was used to enter data, while SPSS version 21 was used to analyze it. To find factors associated with birth preparedness and complications readiness, researchers used multivariable logistic regression.From 422 study participants, 205(48.6%) (95% CI: 46.9%, 49.8%) have birth preparedness and complication readiness practice. Age of respondent ≥ 37 years (AOR = 4.2, 95% C.I = 1.23, 14.24) and between 25 to 30 (AOR = 2.35, 95% C.I = 1.1, 5.1); level of education College and above(AOR = 5.59, 95% C.I 2.8, 11.2) and secondary school (AOR = 9.5, 95% C.I 3.99-22); previous history of ANC follow up (AOR = 4.33, 95% C.I = 2.46, 7.61), birth outcome with live birth(AOR = 3.53, 95% C.I = 1.51, 8.25), and history of birth at health facility (AOR = 3.09, 95% C.I = 1.72, 5.56) where factors significantly associated with birth preparedness and complication readiness practice. Overall, there was low birth preparedness and complication readiness practices were observed in current study. Age of respondents, level of education, history of ANC follow up, and history of birth at a health facility were factors associated with birth preparedness and complication readiness practice. Governments with other stakeholders should work by focusing on antenatal care and institutional delivery by focusing on older age group mothers with who has no formal education.

Protocol for READY2Exit: a patient-oriented, mixed methods study examining transition readiness in adolescents with co-occurring physical and mental health conditions

AbstractBackgroundUp to 57% of adolescents and young adults (AYA) with chronic physical health conditions experience mental health conditions, the presence of which contributes to increased morbidity and poor quality of life. AYA with co-occurring physical and mental health conditions, therefore, may experience additional challenges as they transition from pediatric to adult services. While transition readiness – the acquisition of self-management and advocacy skills – contributes to successful transitions to adult care, this concept has not been adequately explored for AYA with co-occurring physical and mental health conditions. Research is needed to identify whether the presence of a mental health comorbidity is associated with transition readiness, and what the experiences of AYA with co-occurring conditions are as they exit pediatric services. This paper outlines the protocol for theReadiness andExperiences ofADolescents andYoung Adults with Co-occurring Physical and Mental Health ConditionsExiting Pediatric Services (READY2Exit) study; the first study to address this gap using a patient-oriented, mixed methods design.MethodsA sequential explanatory mixed methods design will be used to understand the transition readiness of 16–21 year olds with physical and mental health conditions using quantitative and qualitative data. First, Transition Readiness Assessment Questionnaire (TRAQ) scores will be compared among AYA with chronic health conditions, with and without mental health comorbidity. Interviews will then be conducted with approximately 15 AYA with co-occurring health and mental health conditions and analyzed using qualitative description. The READY2Exit study will be conducted in collaboration with five Young Adult Research Partners (YARP) aged 18–30 with lived experience in the health/mental health systems across Canada. The YARP will partner in key tasks such as interview guide co-design, data interpretation, and knowledge translation tool development.DiscussionAYA with co-occurring physical and mental health conditions may have unique needs as they prepare for health care transitions. The results of this study will inform the refinement of transition readiness practices to improve care for this group. The active involvement of the YARP across study phases will bring the critical perspectives of young adults to READY2Exit, ensuring the methods, research approaches and outputs align with their needs.

Mental Readiness for Frontline Workers in Homelessness Services in Ottawa, Canada

This study investigated factors related to competency by assessing the mental readiness among highly recognized frontline workers in homelessness services (FWHSs) by means of self-completed questionnaires. A total of 35 highly respected FWHSs in Ottawa, Canada were identified by their peers and supervisors as “exceptional” for various specialty areas: addictions, mental health, hoarding, trauma and post-traumatic stress disorder (PTSD). An Operational Readiness Framework was used to examine how FWHSs perform at their best in challenging situations. A series of questionnaires were completed at a Think Tank to determine their mental readiness before, during and after challenging situations. Quantitative and qualitative analyses of mental readiness were performed to prioritize identified challenges. The study findings were then compared to the “Wheel of Excellence” based on results from elite athletes and other high performers such as surgeons, police, and air traffic controllers. The analysis revealed that mental readiness is required to achieve peak performance in addressing the challenges of homelessness. The balance between readiness (physical, technical and mental) and performance contributed to their competency and resiliency. Common elements of success were found: commitment, self-belief, positive imagery, mental preparation, full focus, distraction control and constructive evaluation. This investigation confirmed many similarities in mental readiness practices engaged by excellent FWHSs and other top professionals. This study offered, for the first time, a comprehensive understanding of specific high-performance readiness practices through a streetwise, frontline-worker perspective. Practical recommendations for training and assessment were provided relevant to excellence in homelessness services.

Design, Validity and Effect of an Intra-Curricular Program for Facilitating Self-Regulation of Learning Competences in University Students with the Support of the 4Planning App

Background: Smartphone applications have the potential to support university students for the benefit of learning in higher education. Objective: To design and evaluate the effect of an intra-curricular program using a mobile application on self-regulated learning strategies in university students. Method: The 4Planning mobile application was designed following a systematic literature review, expert judgement and application. The instrument to assess the effect of the intervention was the SRL Readiness Practices Scale, with a one-factor structure (CFI = 0.98; TLI = 0.97; RMSEA = 0.05) with reliability of α = 0.89. The design was quasi-experimental with pre- and post-test measures and experimental and control groups. The sample consisted of 473 first-year university students (37.02% male) from seven Chilean universities with a mean age of 19.35 (SD = 2.49). Statistical analysis was an ANOVA performed in R software version 4.0.3. Results: Statistically significant differences were identified in the levels of self-regulated learning between the experimental group compared to the control group. Conclusion: The development of the 4Planning app proved to be effective in promoting the development of self-regulated learning strategies in university students.

Building College Readiness: Theories and Practices

The purpose of this study was to 1) explore theories and practices in building college readiness; 2) examine the Ethiopian college readiness policy and the Ethiopian preparatory for higher education curriculum through the lens of the theories and practices around the world.Materials and methods. To achieve these objectives, extant literature reviews were conducted. The international research databases such as Scimago Journal and Country Rank, Web of Science, and Google Scholar were used for the collection of the resources. Some local government reports and research findings were accessed in hard copy. The resources reviewed in this study consist of quantitative, qualitative, mixed-methods empirical research reports, and systematic reviews. This systematic review mainly focused on 1) searching for interventionist approaches, theories, and practices of building college readiness across k-12 education beyond the traditional school-based teaching and learning arena; 2) how the trends in building college readiness focused on narrowing the gap between theory and practices through student supports from early years of schooling as well as how the practices focused on managing and monitoring student learning outcomes effectively.Results. The review analysis shows that the current practice of building college readiness has spread its roots in societal and ecological grounds than ever before. For this reason, the traditional school-based college readiness building tends to be more supplemented by the advanced, research-oriented, and community-based, or ecologically grounded early support and monitoring of student progress. The Ethiopian college readiness curriculum, admission processes, and practices in teaching-learning are highly school-based and traditional compared to the contemporary practices of building college readiness around the world. The early warning and support systems are highly dependent on the teachers’ classroom tests and national assessments that are administered at some grade levels only.Conclusion. Building college readiness is a significant factor in promoting college success and higher education student learning outcomes. The contemporary college readiness and transition to higher education is highly affected by multiple personal and ecological factors, in addition to the traditional school, curriculum, and teachinglearning factors. Multiple community-based and research-oriented early interventions and support systems need to supplement the role of schooling in building college readiness. The curriculum and teaching-learning processes need to be rich enough in narrowing the gap between theories and practices. The teachers play a great role in building college readiness.

Exploration of Mental Readiness for Enhancing Dentistry in an Inter-Professional Climate.

Competencies required for dentistry go far beyond the academic or scientific spheres. They incorporate important mental readiness concepts at its core with an appropriate balance of operational readiness (i.e., technical, physical, mental readiness). The aim of this exploratory study was to investigate the importance of mental readiness for optimal performance in the daily challenges faced by dentists using an Operational Readiness Framework. One-on-one interviews were conducted with a select group of seasoned dentists to determine their mental readiness before, during and after successfully performing in challenging situations. Quantitative and qualitative analyses of mental readiness were applied. Study findings were compared with a Wheel of Excellence based on results from other high-performance domains such as surgery, policing, social services and Olympic athletics. The analysis revealed that specific mental practices are required to achieve peak performance, and the balance between physical, technical and mental readiness underpins these dentists’ competency. Common elements of success were found—commitment, confidence, visualization, mental preparation, focus, distraction control, and evaluation and coping. This exploration confirmed many similarities in mental readiness practices engaged across high-risk professions. Universities, clinics and hospitals are looking for innovative ways to build teamwork and capacity through inter-professional collaboration. Results from these case studies warrant further investigation and may be significant enough to stimulate innovative curriculum design. Based on these preliminary dentistry findings, three training/evaluation tools from other professions in population health were adapted to demonstrate future application.

Birth Preparedness, Complication Readiness, and Determinants Among Women Attending Antenatal Care from Ethiopia: A Cross-sectional Facility-Based Survey

A large number of mothers die from pregnancy complications and childbirth worldwide and Sub-Saharan Africa including Ethiopia accounts for the third. Although several studies were done on birth preparedness and complication readiness in different parts, there is limited information in the current study setting. Hence, the aim of the current study was to assess birth preparedness and complication readiness practices and determinants among pregnant women attending antenatal care in Sibu Sire District, East Wollega Zone, Ethiopia. Accordingly, a facility-based cross-sectional study was conducted on 398 women attending ANC. Data were collected through an interviewer applied structured questionnaire. Data were entered into EPI-INFO version 7 and exported to SPSS version 21 for analysis. After the descriptive statistics, bivariate and multiple variable regression were carried out using the odds ratio and its 95% confidence interval at p<0.05. The response rate was 100% and the magnitude of BPCR among pregnant women in the study setting was 30.2%. Educated elementary, achieved secondary and above, history of live-birth, history of stillbirth, ANC four & above visits, knowledge of danger signs of pregnancy, awareness of BPCR, and knowledge of birth preparedness were significantly associated with BPCR with (AOR=2.59; 95% CI: 1.30-5.18), (AOR=5.88; 95% C/I: 2.57- 13.46), (AOR=4.31; 95% C/I: 2.45-7.60), (AOR=2.00; 95% C/I: 1.01- 3.86), (AOR=2.11; 95% C/I: 1.25-3.55), (AOR=2.21; 95% C/I: 1.17-4.18), (AOR=2.55; 95% CI: 1.48-4.40), (AOR=2.1; 95% C/I: 2.1 (1.24-3.53)) respectively. In conclusion, the magnitude of BPCR practice was low in the area. The key determinants in the study setting were educational status, history of live-birth, history of stillbirth, having ANC ≥ 4 visits, knowledge of danger signs of pregnancy, awareness of BPCR, and knowledge of BPCR. Therefore, improving the means of creating awareness, ANC attendance, and education coverage are recommended based on the finding. Furthermore, to explore the underlined reason a wide scope follow-up study and mixed methods studies is recommended.

Extubation Readiness Practices and Barriers to Extubation in Pediatric Subjects.

Invasive mechanical ventilation is a lifesaving intervention that is associated with short- and long-term morbidities. Extubation readiness protocols aim to decrease extubation failure rates and simultaneously shorten the duration of invasive ventilation. This study sought to analyze extubation readiness practices at one institution and identify barriers to extubation in pediatric patients who have passed an extubation readiness test (ERT). We performed a retrospective chart review of all pediatric subjects admitted between April 2017 and March 2018, and who were on mechanical ventilation. Exclusion criteria were cardiac ICU admission, tracheostomy, chronic ventilator support, limited resuscitation status, and death before extubation attempt. Data with regard to the method of ERT and reasons for delaying extubation were collected. There were 427 subjects included in the analysis with 69% having had an ERT before extubation. Of those, 39% were extubated per our daily spontaneous breathing trial (SBT) protocol, and the daily SBT failed in 30% but they had passed a subsequent pressure support and CPAP trial on the same day. The most common reasons for failing the daily SBT were a lack of spontaneous breathing (30% [75/252]), being intubated < 24 h (24% [60/252]), breathing frequency outside the target range (22% [55/252]), and not meeting tidal volume goal (14% [34/252]). The most common documented reasons for delaying extubation despite passing daily SBT were planned procedure (29% [26/90]), neurologic status (23% [21/90]), and no leak around the endotracheal tube (18% [16/90]). The median time between passing ERT and extubation was 7 h (interquartile range, 5-10). In our institution, there was variation in extubation readiness practices that could lead to a significant delay in liberation from invasive ventilation. Adjustment of our daily SBT to tolerate a higher work of breathing, such as higher breathing frequencies and lower tidal volumes, and incorporating sedation scoring into the protocol could be made without significantly affecting extubation failure rates.

Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria

BackgroundNigeria was among the first African countries to adopt and implement change of treatment policy for severe malaria from quinine to artesunate. Seven years after the policy change health systems readiness and quality of inpatient malaria case-management practices were evaluated in Kano State of Nigeria.MethodsA cross-sectional survey was undertaken in May 2019 at all public hospitals. Data collection comprised hospital assessments, interviews with inpatient health workers and data extraction from medical files for all suspected malaria patients admitted to the paediatric and medical wards in April 2019. Descriptive analyses included 22 hospitals, 154 health workers and 1,807 suspected malaria admissions analysed from malaria test and treat case-management perspective.Results73% of hospitals provided malaria microscopy, 27% had rapid diagnostic tests and 23% were unable to perform any parasitological malaria diagnosis. Artemisinin-based combination therapy (ACT) was available at 96% of hospitals, artemether vials at 68% while injectable quinine and artesunate were equally stocked at 59% of hospitals. 32%, 21% and 15% of health workers had been exposed to relevant trainings, guidelines and supervision respectively. 47% of suspected malaria patients were tested while repeat testing was rare (7%). 60% of confirmed severe malaria patients were prescribed artesunate. Only 4% of admitted non-severe test positive cases were treated with ACT, while 76% of test negative patients were prescribed an anti-malarial. Artemether was the most common anti-malarial treatment for non-severe test positive (55%), test negative (43%) and patients not tested for malaria (45%). In all categories of the patients, except for confirmed severe cases, artemether was more commonly prescribed for adults compared to children. 44% of artesunate-treated patients were prescribed ACT follow-on treatment. Overall compliance with test and treat policy for malaria was 13%.ConclusionsTranslation of new treatment policy for severe malaria into inpatient practice is compromised by lack of malaria diagnostics, stock-outs of artesunate and suboptimal health workers’ practices. Establishment of the effective supply chain and on-going supportive interventions for health workers accompanied with regular monitoring of the systems readiness and clinical practices are urgently needed.

Evaluation of Nurses’ Evidence-based Practice at Primary Health Care Centers in Baghdad City

Objectives: The study aims at evaluating the nurses’ evidence-based practices at primary health care centers in Baghdad City. Methodology: A descriptive design is carried out at Baghdad City’s primary health care centers from January 2en 2019 to June 1st 2020. One instrument is developed for the purpose of the study. A Non-probability, multi stage purposive sample of (52) staff nurses, who are working at primary health care centers in Baghdad City. The instrument is concerned with the evaluation of nurses’ evidence-based practices through (43) items which are divided in to five main domains of attitudes, knowledge, beliefs, readiness and applications of evidence-based practices. Content validity of the questionnaire is determined by panel of (10) experts and Internal consistency reliability, Split-half technique, is obtained through Cronbach alpha correlation coefficient. Data are collected through the use of the study instrument and the interview technique as means of data collection. Data are analyzed through the use of descriptive statistical data analysis approach of frequencies, percentages, total scores and ranges. Results: The study findings indicate that the majority of the staff nurses have experienced poor level of knowledge, attitudes, beliefs, readiness and application as dimensions of nurses’ evidence-based practices. Conclusion: The study findings depict that staff nurses have experienced inadequate evidence-based practices at primary health care centers. Recommendation: Planned training sessions can be designed, constructed and implemented to staff nurses at the primary health care centers relative to evidence-based practices.

Principals' Instructional Leadership in Secondary Schools in Bohlabela District: A Matter of Concern

In the wake of falling academic standards witnessed in recent times in South Africa, ameliorating academic achievement in schools has become the major preoccupation of stakeholders in education. Every organization aims at better performance; this has made the situation more serious as stakeholders see a gloomy future of school leavers. It thus become imperative that researchers, educational planners and policy makers, inter alia, take a well though steps to uplift academic performance of learners. This paper deliberates on the concerns raised about instructional leadership practices in secondary schools in the Bohlabela Education District in the Mpumalanga Department of Basic Education, South Africa. Through literature review and oral interview conducted with selected principals, discussion is focused on such common themes as interpretations of instructional leadership, administrative support to teachers towards effective teaching and learning, and the readiness of the school and the principals’ practice of instructional roles. The study adopted the qualitative design where four(4) principals, one(1) deputy principal, two (2) heads of departments and one (1) experienced teacher were sampled using purposive sampling technique. One major finding emanating from the study indicates that albeit principals understand the concept of instructional leadership, they simply are not dedicated to such role with or without reasons, and this has militated against the teaching and learning process. It was also found that lack of communication skills, uncooperative attitude of teachers and learners, lack of teaching and learning materials, too much work on principal from department, conflict, insufficient knowledge of the curriculum, and lack of training, hampers the schools’ readiness and principals practices of instructional leadership. The relevance of this study lies in its recommendations as to how principals can improve on their instructional leadership practices to occasion better teaching and learning.

Unlocking community capabilities for addressing social norms/practices: behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria

BackgroundMaternal mortality is attributed to combination of contextual factors that cause delay in seeking care, leading to poor utilization of skilled health services. Community participation is one of the acknowledged strategies to improve health services utilization amongst the poor and rural communities. The study aimed at assessing the potentials of improving birth preparedness and complication readiness (BP/CR) using community-driven behavioural change intervention among pregnant women in rural Nigeria.MethodsA pre-post intervention study was conducted from June 2018 to October 2019 on 158 pregnant women selected through multi-stage sampling technique from 10 villages. Data on knowledge and practices of birth preparedness and utilization of facility health services were collected through interviewer-administered pre-tested structured questionnaire. Behavioural change intervention comprising of stakeholders’ engagement, health education, facilitation of emergency transport and fund saving system, and distribution of educational leaflets/posters were delivered by twenty trained volunteer community health workers. The intervention activities focused on sensitization on danger signs of pregnancy, birth preparedness and complication readiness practices and emergency response. Means, standard deviations, and percentages were calculated for descriptive statistics; and T-test and Chi square statistical tests were carried out to determine associations between variables. Statistical significance was set at p-value < 0.05.ResultsThe result showed that after the intervention, mean knowledge score of danger signs of pregnancy increased by 0.37 from baseline value of 3.94 (p < 0.001), and BP/CR elements increased by 0.27 from baseline value of 4.00 (p < 0.001). Mean score for BP/CR practices increased significantly by 0.22 for saving money. The proportion that had antenatal care (76.6%) and had facility delivery (60.0%) increased significantly by 8.2 and 8.3% respectively. Participation in Community-related BP/CR activities increased by 11.6% (p = 0.012).ConclusionWith the improvements recorded in the community-participatory intervention, birth preparedness and complication readiness should be promoted through community, household and male-partner inclusive strategies. Further evaluation will be required to ascertain the sustainability and impact of the programme.

&lt;p&gt;Birth Preparedness and Complication Readiness Practices Among Pregnant Adolescents in Bangkok, Thailand&lt;/p&gt;

BackgroundReducing the maternal mortality ratio is one of the United Nations Sustainable Development Goals. These maternal deaths are preventable with appropriate management and care. Birth preparedness and complication readiness (BPCR) is a strategy to make prompt decisions to seek care from skilled birth attendants, resulting in reduced maternal and neonatal mortality. Despite high global rates of adolescent pregnancy, there has not yet been a study of BPCR status and associated factors among pregnant adolescents.ObjectiveTo assess the proportion of, and associated factors for, good BPCR in adolescent pregnant women attending antenatal clinic in an urban tertiary care hospital.Materials and MethodsThis cross-sectional survey was conducted among adolescent pregnant women attending antenatal clinic at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Thailand, from September 1st, 2018 to March 31st, 2019. A total of 134 adolescent pregnant women were recruited. The participants and their parents or legal guardians were informed of the study process at the antenatal clinic before their parents or legal guardians, granted written consent on their behalf. The participants were interviewed using the BPCR index, which was adapted from the John Hopkins Program for International Education in Gynecology and Obstetrics.ResultsThe proportion of good BPCR in adolescent pregnant women in an urban tertiary care hospital was 78.4%. The most mentioned aspect of BPCR was planning to give birth with a skilled provider (92.5%). The significant associated factor for good BPCR was the number of ANC ≥ 4 (odds ratio 3.2, 95% CI 1.13–9.05, p=0.023).ConclusionThis study demonstrated that the proportion of good BPCR among adolescent pregnant women attending an urban tertiary care hospital was high. The associated factor of good BPCR was the number of ANC ≥ 4.