Urban Primary Health Care Research Articles

Prevalence, pattern and perceived benefits of unani medicines usage in diabetes: A patient-based survey at a Primary Health Centre of Bengaluru, India

Background and objectivesUnani medicine is gaining popularity as primary or adjunct therapy in the treatment of type-2 diabetes; however, no published data on the prevalence of its use, usage pattern and perceived benefits in diabetes patients are available. Therefore, the present study was aimed to estimate the prevalence, pattern of use and perceived benefits of Unani medicines for diabetics. Materials and methodsA hospital-based cross-sectional study on 484 type-2 diabetes patients was conducted from January to December 2018 at an urban primary health centre in Bengaluru, India. Systematic random sampling method was used to obtain the required sample size. Information from patients was gathered through personal interview using a semi-structured questionnaire after obtaining their written informed consent. A treatment satisfaction questionnaire for medication (version 1.4) was used to assess the major dimensions of patient’s satisfaction with treatment. ResultsUnani medicine use was found in 25.6 % of diabetics. Qurs ziabetes was the most used Unani drug, with majority of users taking four tablets three times a day. Most of the patients had been using Unani medicines for 1 year. Usage of Unani medicines improved all aspects of patient satisfaction including effectiveness, safety, and overall satisfaction in comparison to non-users (p = 0.001). Glycemic control was found to be better in Unani medicine users than non-users (P < 0.05). ConclusionThe finding of the study leads us to conclude that a considerable proportion of diabetics utilize Unani medicines together with conventional treatment and that their use was found to be effective and safe in controlling blood sugar levels.

A RETROSPECTIVE OBSERVATIONAL STUDY TO EVALUATE THE IMPACT OF COVID-19 PANDEMIC ON ROUTINE CHILDHOOD IMMUNIZATION AT THE PRIMARY HEALTH CARE CENTERS OF AHMEDABAD CITY.

Background: The COVID-19 pandemic has caused signicant disruptions in the delivery of essential primary health care services including routine immunization services in various countries including India. This temporary interference can lead to soaring of vaccine preventable illnesses. The recent outbreak of Measles worldwide in the last 12 months depicts a clear picture for a secondary health crisis. So, this study brings forth the impact of pandemic on the routine childhood immunizations in primary health care sectors of Ahmedabad, India and developing appropriate strategies to ensure continuity of services. A retrospective observational study wasMethods: carried out at the Urban primary health centers distributed across the seven zones/wards of Ahmedabad region and data of children (under 5 years) registered and vaccinated as per universal immunization Programme schedule were retrieved for a period of four years and divided into two comparison groups as pre covid sessions (1st January 2018 till 31st December 2019) and post covid sessions (1st January 2020 till 31st December 2021). The vaccination trends were compared for these two periods and analyzed. Routine childhood immunizationResults: coverage (among 0 to 5 years old children group) following the pandemic depicted a declining trend with a major set-back recorded in pentavalent and MR vaccination coverage (fall of 40%). Full immunization coverage falls short by 30% (95%+ 2.4% versus 66%+ 3.1%) and it was signicant with p&lt;0.05 and chi square value of 27.7. Barriers to effective routine immunizations have also been enumerated with pandemic related anxiety and difculty in community mobilizations being most common. It is quite evident that the Covid-19 pandemic hasConclusions: been a major backslider for the routine childhood immunizations in India which needs immediate redressal to prevent the outbreaks of vaccine preventable diseases in future.

Effectiveness of health education on knowledge and attitude of health worker (F) about rabies in a urban area

Introduction: Rabies is a highly fatal and completely preventable viral disease of the central nervous system. It’s primarily a zoonotic disease transmitted by bites and licks of rabid animals. Material &amp; Methods: The cross sectional study was carried out over a period of 2 months on the HW(F) who were posted in the various urban Primary Health Centre of Cuttack District. 2 sets of data were collected one before and one after the awareness session on Rabies. Results: Rabies as a viral disease was known to 43% of HW(F) and the corresponding figure became 64% after the awareness session. It is a fatal disease was known to 94% of HW(F) pre-session. About 91% of Health Worker knew rabid dog was the culprit animal and after the awareness session 100% opined that it was transmitted by rabid dog. Only 70% of HW (F) knew that the wound site should be washed with soap and water which became 100% after the session. Only 21% HW (F) knew about the correct dose and total number of doses of anti-rabies vaccines, which became 95% following the awareness session.

Burnout and sleep quality among community health workers during the pandemic in selected city of Andhra Pradesh

BackgroundThis pandemic has resulted in physical and emotional exhaustion among everyone, especially among community healthcare workers (CHWs), resulting in increased burnout and poor sleep quality. This pandemic has increased responsibilities for Accredited Social Health Activist (ASHA) workers and Auxiliary Nurse Midwife (ANM) at the grassroots. Previous studies have shown that infectious diseases like SARS and MERS directly affect sleep. With the COVID-19 pandemic, burnout and poor sleep among healthcare workers are expected to increase. AimTo determine the prevalence of burnout and sleep quality among community health workers Settingsand Design: This Cross-sectional study was conducted from February to April 2020 in Urban Primary Health care centres of Guntur city, Andhra Pradesh. Methods and materialCopenhagen Burnout Inventory scale (CBI) with a 5-point Likert scale and Pittsburgh Sleep Quality Index (PSQI) Questionnaire were used among four hundred and ten study participants. Descriptive statistics and the Chi-square test were used; a p-value of ≤0.05 is considered significant. ResultsThe prevalence of personal burnout was 16.8%, while work-related and pandemic-related burnouts were 10.5% and 25.4%, respectively. The prevalence of poor sleep quality was 35.09%. Fear of contracting the virus was present among 38.3%. Fear of infecting the family members because of their exposure was reported by 36.6% of the respondents; 71.7% and 79.3% reported receiving support from the organisation and colleagues, respectively. ConclusionsThe provision of necessary equipment, regular check-ups and timely interventions will minimise the risk of stress and burnout.

Patient satisfaction in urban primary health centres: case of Lucknow and Prayagraj districts in Uttar Pradesh, India

Background: Patient satisfaction is one of the expected outcomes of healthcare, as it is closely connected to health-care utilization. It reflects patients' views on the quality of healthcare and the responsiveness of the healthcare system. There is a strong correlation that exists between patient’s satisfaction and their willingness to seek care at the preferred facility.Methods: A patient exit interview was carried out among 200 patients attending the urban primary health centre (UPHC) in two rationally selected district of Uttar Pradesh. Information regarding services and atmosphere of the UPHC was gathered using a pre-designed questionnaire during September 2019-December 2019. Binominal logistic regression, both simple and multi-variate were conducted to identify the factors which contribute significantly to patient’s satisfaction.Results: Overall we found that 57 percent of the patients were satisfied with the concerned UPHC and factors like examining authority, availability of medicines, waiting time, convenient opening hours, location of the UPHC and availability of waiting area were significantly associated with the patients’ satisfaction. Having found the opening hours convenient and waiting space available were the strongest predictors of patient satisfaction.Conclusions: In conclusion majority of the patient were satisfied, still there is a need to work upon factors like making adequate space available for the patients to wait and modifying the working hours of the UPHC as per the patients need so as to attain the highest level of patient satisfaction.

A time-motion study of the COVID-19 vaccination process in an urban primary health center of Odisha, India

ABSTRACT Vaccination is a critical tool in protecting against COVID-19. It is essential to know the time for each activity in a COVID-19 vaccination process for better management, especially during a pandemic. Thus, we conducted a time-motion study to identify activities that led to delayed/increased waiting time in an urban primary health center in Bhubaneswar, India. We observed 196 COVID-19 vaccine beneficiaries over one month (June 2021) from when they arrived at the vaccination center until they left the center. A data collection form and a Stopwatch were used to estimate the time taken for various activities involved in COVID-19 vaccine delivery. The time taken was expressed in mean and median. We also compared the time taken during the first and second doses using the Mann-Whitney U test. The total mean time spent at the vaccination center was 40:56 ± 20:52 minutes. The activity that took the longest was ‘waiting time in queue before vaccination’, which was 34:22 ± 20:56 min constituting 82% of the total time. The activity that took longer for the second dose than the first was the beneficiary verification in the Co-WIN portal with a median of 27 seconds and 36 seconds, respectively (p < .001). This study will help program managers formulate better strategies to improve the vaccination process making it more efficient.

Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district

BackgroundTuberculosis (TB) is the leading cause of death from a single infectious agent globally, killing about 1.5 million people annually, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visiting the healthcare facilities. While many countries have scaled-up systematic screening of TB, there has been limited assessment of the extent of its integration into the health system. This study sought to explore factors that shape the integration of systematic screening of TB in outpatient departments of primary healthcare facilities in Kitwe district, Zambia.MethodsThis was a qualitative case study with health providers including district managers, TB focal point persons and laboratory personnel working in six purposively selected primary healthcare facilities. Data was collected through key informant (n = 8) and in-depth (n = 15) interviews. Data analysis was conducted using QDA Miner software and guided by Atun’s Integration framework.ResultsThe facilitators to integration of systematic screening for TB into out patient departments of primary health facilities included the perceived high burden TB, compatibility of the systematic screening for TB program with healthcare workers training and working schedules, stakeholder knowledge of each others interest and values, regular performance management and integrated outreach of TB screening services. Constraining factors to integration of systematic screening for TB into outpatient departments included complexity of screening for TB in children, unbalanced incentivization mechanisms, ownership and legitimacy of the TB screening program, negative health worker attitudes, social cultural misconceptions of TB and societal stigma as well as the COVID-19 pandemic.ConclusionSystematic screening of TB is not fully integrated into the primary healthcare facilities in Zambia to capture all those suspected with active TB that make contact with the health system. Finding the missing TB cases will, therefore, require contextual adaptation of the systematic screening for TB program to local needs and capacities as well as strengthening the health system.

Connecting Healthcare with Income Maximisation Services: A Systematic Review on the Health, Wellbeing and Financial Impacts for Families with Young Children.

Financial counselling and income-maximisation services have the potential to reduce financial hardship and its associated burdens on health and wellbeing in High Income Countries. However, referrals to financial counselling services are not systematically integrated into existing health service platforms, thus limiting our ability to identify and link families who might be experiencing financial hardship. Review evidence on this is scarce. The purpose of this study is to review “healthcare-income maximisation” models of care in high-income countries for families of children aged between 0 and 5 years experiencing financial difficulties, and their impacts on family finances and the health and wellbeing of parent(s)/caregiver(s) or children. A systematic review of the MEDLINE, EMBase, PsycInfo, CINAHL, ProQuest, Family & Society Studies Worldwide, Cochrane Library, and Informit Online databases was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) statement. A total of six studies (five unique samples) met inclusion criteria, which reported a total of 11,603 families exposed to a healthcare-income maximisation model. An average annual gain per person of £1661 and £1919 was reported in two studies reporting one Scottish before–after study, whereby health visitors/midwives referred 4805 clients to money advice services. In another UK before–after study, financial counsellors were attached to urban primary healthcare centres and reported an average annual gain per person of £1058. The randomized controlled trial included in the review reported no evidence of impacts on financial or non-financial outcomes, or maternal health outcomes, but did observe small to moderate effects on child health and well-being. Small to moderate benefits were seen in areas relating to child health, preschool education, parenting, child abuse, and early behavioral adjustment. There was a high level of bias in most studies, and insufficient evidence to evaluate the effectiveness of healthcare-income maximisation models of care. Rigorous (RCT-level) studies with clear evaluations are needed to assess efficacy and effectiveness.

Weight Status Change in Chinese American Children over a Ten-Year Period: Retrospective Study of a Primary Care Pediatric Population.

Weight change from childhood to adolescence has been understudied in Asian Americans. Known studies lack disaggregation by Asian subgroups. This retrospective study assessed the weight status change in 1500 Chinese American children aged 5–11 years from an urban primary care health center between 2007 and 2017. Weight status was categorized using the 2000 CDC growth charts into “underweight/normal weight” and “overweight/obese.” The overweight/obesity prevalence in 2007 and 2017 were determined. McNemar’s test and logistic regression were performed. The prevalence of overweight/obesity decreased from 29.9% in 2007 to 18.6% in 2017. Children who were overweight/obese at 5–11 years had 10.3 increased odds of staying overweight/obese over time (95% CI = 7.6–14.0, p < 0.001) compared to their underweight/normal weight counterparts. Of the children who were overweight/obese in 2007, 45.7% remained overweight/obese ten years later. Childhood overweight/obesity strongly predicts adult overweight/obesity in Chinese Americans. Targeted education and intervention are warranted to prevent adult obesity.

Effects of sociodemographic background on fertility motivation patterns in the Beni-Suef governorate, Upper Egypt

ObjectivesA comprehensive assessment of childbearing motivations in the governorate of Beni-Suef was conducted to better understand fertility patterns, and to develop appropriate familial policies and programs to reduce fertility rates and address the problem of overpopulation in Upper Egypt. Subjects and methodsA cross-sectional study was conducted from May 2019 to May 2021. A total of 1085 married women who attended any health care service in rural or urban primary health care facilities in the Beni-Suef governorate were included in the study. ResultsThe results revealed that 42.1% of participants had a positive desire for childbearing, and 45% of participants had a negative desire for childbearing; the rest of the participants (12.9%) had undecided motivations. The most prevalent positive motive for childbearing was a love of children (40.8%), whereas the most prevalent negative motive for childbearing was economic circumstances (44.7%). A statistically significant difference was observed in fertility motivations among the studied women, depending on age, education, husband's education, age at marriage, marriage duration, number of living siblings, monthly income, occupation, gravidity, parity, and chronic diseases (p = 0.001). ConclusionA great need exists to involve young couples who have not yet attained their desired family size and who do not use family planning methods, in fertility regulation interventions.

Prevalence patterns and associated factors of elder abuse in an urban slum of eastern India

BackgroundThe prevalence of elder abuse in various parts of the world has been reported between 2.2 and 90.4%. According to some studies conducted in India, elder abuse prevalence ranges between 9.6 to 61.7%. Yet, elder abuse is an underreported issue. Most available evidence shows the involvement of close family members and caregivers in the abuse of older adults. Several factors associated with various forms of elder abuse need to be studied further. This study has attempted to capture the prevalence, pattern and associated factors of elder abuse in urban slums.MethodsThis study was a cross-sectional community-based study conducted between August 2019 to August 2020 in an urban field practice area of the All India Institute of Medical Sciences, Bhubaneswar. It covers four wards of the Bhubaneswar Municipal Corporation, served by the Urban Primary Health Centre, IRC Village, Nayapalli. A total of 360 participants aged 60 years and above were included in this study. They were interviewed using various semi-structured interview schedules. Validated study tools such as Activities of Daily Living (ADL- Barthel Index), Hindi Mental Scale Examination (HMSE), Geriatric Depression Scale (GDS), and Vulnerability to Abuse Screening Scale (VASS) were also used to assess various factors.ResultsApproximately one in five (19.4%) older adults reported some form of abuse. The types of elder abuse reported were physical abuse in 12 (3.3%), verbal abuse in 25 (6.9%), emotional abuse in 40 (11.1%), and financial abuse in 15 (4.2%) older adult participants. The sons and daughters-in-law of the older adult participants were the main perpetrators of abuse reported. Depression and past history of abuse were found significantly associated with any type of abuse.ConclusionsThe prevalence of elder abuse in this study was considerably high, with 70 (19.4%) out of the 360 participants reporting some form of abuse. Emotional abuse was the most reported, and physical abuse was the least reported type. The most common perpetrators were those on whom the older adults depended, like their sons and daughters-in-law.

Clients' Perspective for Quality of Services at One of the Urban Primary Health Centres (U-PHC) at Municipal Corporation Area in One of the cities of Western India

Introduction: Client satisfaction surveys are central to quality improvement at health facility. It helps in identifying areas of low satisfaction and steps to maximize patient satisfaction. Objectives: To assess client satisfaction towards services at Out Patient Department (OPD) of at an U-PHC under Ahmedabad Municipal Corporation (AMC), identify areas of low satisfaction and suggest feasible remedial measures for improvement. Method: Out of 74 U PHCs under AMC, 1 was selected through simple random sampling. Quality of care was evaluated through client’s feedback which was gathered through 10 check points (on structure, process and outcome) developed by state level quality team. Responses of 300 adult (&gt; 18 years) subjects and their mean ± standard deviation scores were calculated. These subjects were selected consecutively @ 25 cases (new cases who came first and were willing) on every 2nd and 4th Mondays for 6 months (Sep 2019 – Feb 2020). Results: While availability of drugs was perceived as very satisfying that of investigations was relatively an area of concern. Overall, only 1 client rated the services as average while all rest (99.6%) rated services as very good to excellent. Conclusion: Quality of services at this U PHC was good to excellent and had wider acceptability among its client.

Effectiveness of straight walking on selected parameters among hypertensive participants attending outpatient department in selected urban primary health centre at Puducherry

Chronic non-communicable diseases (NCDs) are the number one cause of mortality and morbidity in the world. World Health Organization and Global Burden of Disease (GBD) study have reported that cardiovascular diseases (CVD) are the most important reason for fatality and disability. Age-adjusted mortality has increased by 31% in last 25 years. Case control studies have reported that hypertension is most important risk factor for CVD in India. The present study was to conduct to evaluate the effectiveness of straight walking on selected parameters among hypertensive participants attending out patient department in selected urban Primary Health Centre at Puducherry. An experimental pre and posttest control group design was utilized. By using simple random sampling technique 60 subjects were selected. The data were collected by using semi-structured questionnaire (demographic performa), bio-physiological and bio-chemical parameters. The data were analyzed by descriptive and inferential statistics. The results showed that The independent ‘t’ test value for heart rate (t=3.800, p=0.0001), respiratory rate (t=4.089, p=0.0001), SPO2 (t=4.068, p=0.0001) and HDL (t=6.018, p=0.0001) was found to statistically significant at p&lt;0.001 level.

Relationship between antibiotic exposure and subsequent mental health disorders in a primary care health system

ObjectiveTo evaluate the relationship between antibiotic exposure and subsequent psychiatric disorders in a Pediatric primary care setting. Study designWe conducted a retrospective cohort study using electronic clinical record data for patients ages 8–20 years seen in the outpatient setting of a large urban primary health care practice from 1/1/13 to 12/1/2018. We employed adjusted Cox regression analyses to study the relationship between prescriptions for anti-infective agents and subsequent diagnosis of anxiety or depression. ResultsPrescription of anti-infective medication was associated with a hazard rate ratio (HRR) of 1.21 (95%-CI ​= ​1.00–1.45). A first prescription for a broad-spectrum antibiotic (compared to those with no prescription, narrow-spectrum prescription, or topical prescription) was associated with an HRR of 1.27 (95%-CI ​= ​1.04–1.54). The number of anti-infectives prescribed over the course of the study period was associated with an HRR of 1.05 (95%-CI ​= ​1.00–1.10). There was no significant relationship between prescription of topical or narrow-spectrum antibiotics, antifungal, or antiviral medication and subsequent diagnosis of anxiety or depression. Stratified analysis revealed that the association between anti-infective prescription and anxiety and depression was driven by males, among whom prescription of any antibiotic was associated with an HRR of 1.45 (95%-CI ​= ​1.05–1.99). ConclusionsInfections treated with broad-spectrum antibiotics were associated with increased risks of anxiety and/or depression, especially in males. Exploration of the relationship between antibiotic exposure and subsequent mental health disorders is warranted along with continued vigilance in antibiotic prescribing practices in children.

Costing of Health and Wellness Centres: A Case Study of Gujarat

The National Health Policy 2017 recommended the establishment of health and wellness centres (HWC) as the primary platform to deliver comprehensive primary health care in India and emphasised that about two-thirds of the health budget of the government should be invested on primary care. In February 2018, the government announced its plan to create 150,000 HWCs under the Ayushman Bharat initiative by transforming the already existing sub-centres (SCs), primary health centres (PHCs) and urban PHCs as HWCs by 2022. The operationalisation of HWCs has been planned in a phased manner. However, for scaling up and replicability, it is imperative for the government to know how much to budget for this initiative, so that there are no interruptions in the smooth flow of services. Taking Gujarat as a case study, the study took a sample of eight HWCs for estimating the total and per-unit costs for each type of HWC. OPD footfalls were taken as an indicator for measuring output. The incremental unit costs were estimated by calculating the difference between the pre and post-conversion unit costs, in order to understand the cost implications of the conversion. The study also estimated the possible total costs in relation to the health budget of the state to understand the financial implications of scaling up HWCs. The results indicated that though the costs have gone up after conversion, outpatient department (OPD) footfalls have also increased at all facilities, but most significantly for the SCs, resulting in costs per OPD footfalls coming down significantly. For nearly all the centres, there has been a fall in the incremental costs per OPD visits indicating that the conversion to HWC has been quite economical. It was estimated that a total of about ₹7.13 billion will be spent on running 1,500 HWCs in the year 2020–2021, though, the incremental costs of scaling up would be significantly less at about ₹940 million. If, however, the entire gamut of services envisaged to be a part of the HWC initiative are added, the costs are likely to increase. More research with additional data points would be required to confirm these tentative findings, but the results could be used as a baseline for future such studies.

Effect of brief interventions to promote behavior change on clinical outcomes of selected non-communicable diseases: The World Health Organization (WHO) Package of Essential Non-communicable disease (PEN) Interventions for primary health care settings – study protocol of a quasi-experimental study

BackgroundThe World Health Organization designed a minimum set of interventions, the World Health Organization Package of Essential Noncommunicable disease interventions (WHO PEN), for detection, prevention, treatment, and care of Non-communicable diseases (NCDs) in resource constraint settings. This intervention study examines the effectiveness of the integration of components of WHO PEN protocols on improved clinical outcomes among patients of cardiovascular disease and diabetes mellitus in urban and rural primary health care settings. MethodsIn this quasi-experimental study (pre-test post-test control group design), trained non-physician health workers will provide behavior change interventions regarding four major NCD risk factors, i.e., tobacco use, excessive alcohol intake, physical inactivity, an unhealthy diet; using ‘Brief Advice’ to the NCD patients enrolled in the experimental arm. The health centers in the control arm will provide the usual care to all the NCD patients. The intervention will last for six months, and the two groups will be followed up at two months, four months, and six months since enrolment in the study. ResultsThe primary outcome is improved mean blood pressure levels and the proportion of patients with controlled blood pressure levels. The secondary outcomes assess medication adherence, self-reported reductions in tobacco and alcohol intake, consumption of a heart-healthy diet, and regular physical activity. DiscussionThis intervention trial will provide evidence for the utility of individual-level behavioral interventions for adequate management of NCDs.Trial registration: Clinical Trial Registry of India: CTRI/2018/12/016707.

Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh.

Background“Contracting Out” is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor’s retention both in managerial as well as service provision level in the contracted-out setting.MethodologyIn this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation.ResultsThe most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion.ConclusionsAn adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

Exploratory randomised trial of face-to-face and mobile phone counselling against usual care for tobacco cessation in Indian primary care: a randomised controlled trial protocol for project CERTAIN

IntroductionDespite widespread use of smokeless tobacco products by people within the Indian subcontinent, there is little awareness among Indians of its health hazards when compared with smoked tobacco. We hypothesise...

Strengthening urban primary healthcare service delivery using electronic health technologies: A qualitative study in urban Nepal.

BackgroundNepal is a South Asian country with a high burden of non-communicable diseases. Electronic health technologies are a promising strategy to mitigate the rising burden of non-communicable diseases by strengthening primary healthcare center service delivery. However, electronic health implementation in Nepal is limited. Furthermore, electronic health use at the primary healthcare center level is chronically understudied. This qualitative study seeks to understand the perceived awareness, benefits, and determinants of electronic health uptake in Nepal, focusing on primary healthcare center-level non-communicable disease management.MethodsWe conducted in-depth interviews with 27 participants including policymakers, health experts, facility administrators, providers, and non-communicable diseases patients in 2019. We selected six urban primary healthcare center facilities via cluster convenience sampling for recruiting facility administrators, providers, and patients, and used convenience sampling to recruit policymakers and experts. We conducted thematic data analysis inductively and deductively using the electronic health readiness assessment framework to understand perceived barriers and facilitators of electronic health implementation.ResultsWhile there was general awareness and acceptance of electronic health, multiple barriers impede readiness for implementation. These include policy making gaps, language barriers, low user technical literacy, concerns of overreliance on technology, and inadequate training for administrators and providers. Stakeholder suggestions include creating electronic health interfaces that meet the needs of end users (providers and patients), providing training to enable end users to effectively use electronic health technologies, and strong policy support at the national level.ConclusionWe identify several determinants for effectively promoting the use of electronic health for non-communicable diseases service delivery at the primary healthcare center level in Nepal.

Data quality and data use in primary health care: A case study from Iran

Informed decision-making in Primary Health Care (PHC) is a foundation of universal health coverage, and depends on high-quality data. This study explores the perception of primary healthcare workers on data quality and data use in a northern Iranian city. A cross-sectional study was conducted with participation of 348 healthcare workers in urban and rural PHC centers of Rasht city. The data were collected using a validated self-administered questionnaire. Then SPSS statistics software was employed for the analysis process. The mean score of data quality and data use were 6.43 ± 1.68 and 5.89 ± 2.18 out of 10, respectively. Data accessibility (7.10 ± 1.88) and data accuracy (5.88 ± 2.18) had the highest and lowest mean scores from the workers' perspective. The volume of the data collected, frequency of training program on HIS, supervision and providing feedback, and the existence of incentive mechanism were associated with data quality and data use. In these settings, the overall perceived data quality and data use were at a relatively desirable level. Reducing the amount of the data collected training health workers on data management, supportive supervision, constructive feedback, and developing incentive mechanisms will improve the data quality and data use in the PHC centers.