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Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services.
Health Research Policy and Systems. 2017 Dec 28; 15(Suppl 2):106.BACKGROUND: Effective stakeholder engagement in research and implementation is important for improving the development and implementation of policies and programmes. A varied number of tools have been employed for stakeholder engagement. In this paper, we discuss two participatory methods for engaging with stakeholders - participatory social network analysis (PSNA) and participatory impact pathways analysis (PIPA). Based on our experience, we derive lessons about when and how to apply these tools. METHODS: This paper was informed by a review of project reports and documents in addition to reflection meetings with the researchers who applied the tools. These reports were synthesised and used to make thick descriptions of the applications of the methods while highlighting key lessons. RESULTS: PSNA and PIPA both allowed a deep understanding of how the system actors are interconnected and how they influence maternal health and maternal healthcare services. The findings from the PSNA provided guidance on how stakeholders of a health system are interconnected and how they can stimulate more positive interaction between the stakeholders by exposing existing gaps. The PIPA meeting enabled the participants to envision how they could expand their networks and resources by mentally thinking about the contributions that they could make to the project. The processes that were considered critical for successful application of the tools and achievement of outcomes included training of facilitators, language used during the facilitation, the number of times the tool is applied, length of the tools, pretesting of the tools, and use of quantitative and qualitative methods. CONCLUSIONS: Whereas both tools allowed the identification of stakeholders and provided a deeper understanding of the type of networks and dynamics within the network, PIPA had a higher potential for promoting collaboration between stakeholders, likely due to allowing interaction between them. Additionally, it was implemented within a participatory action research project. PIPA also allowed participatory evaluation of the project from the perspective of the community. This paper provides lessons about the use of these participatory tools.
Mothers' perception of maternal and child health information disseminated via different modes of ICT in Nigeria.
Health Information and Libraries Journal. 2018 Sep 24;BACKGROUND: A few studies have examined mothers' perception of ICT and maternal and child health (MCH) information promoted using ICT. The effectiveness of different modes of delivery of such information is unclear. OBJECTIVE: To investigate mothers' perceived usefulness of ICT and MCH information disseminated through e-health projects in Nigeria. METHODS: The study was a descriptive survey that was based on the mixed method paradigm. A questionnaire was used to collect data from 1001 mothers involved in ongoing ICT based projects in Nigeria. The mothers were selected using a convenience sampling technique. Four focus group discussion sessions were also organised for thirty mothers. RESULTS: Mobile phones were viewed as useful (35.0%) or very useful (42.2%) and radio as useful (34.8%) or very useful (57.5%%). But they expressed a negative perception towards the use of DVD/TV (Not useful, 66.5%) and the Internet/computer (Not useful 67.7%). Mothers' perception of MCH information disseminated was also positive. They reported the need for more MCH information products in local languages using acceptable ICT. CONCLUSION: Mothers' perception of preferred modes of delivery of maternal and child health information varies according to location. (c) 2018 The Authors. Health Information and Libraries Journal published by John Wiley & Sons Ltd on behalf of Health Libraries Group.
Relationship between orthodox and traditional medical practitioners in the transmission of traditional medical knowledge in Nigeria.
Health Information and Libraries Journal. 2018 Jun; 35(2):130-140.Background: The problem of incomplete transmission of traditional medical knowledge to the younger generation is of concern to information professionals especially in developing countries where most rural communities depend on traditional medicine for primary health care. Objective: The purpose of this study was to investigate the collaboration between orthodox and traditional medical practitioners as well as the implication of the collaboration for transmission of traditional medical knowledge in Nigeria. Method: Eighteen communities were purposively selected from six states in south-western Nigeria. Snowball technique was used in selecting 110 traditional medical practitioners. Three key informant interviews and two focus group discussion sessions were conducted in each state. Data were analysed thematically. Discussion: Results showed the existence of a low level of collaboration mainly in the form of patient referrals which were not performed officially and mostly one sided. This was attributed to the negative perception of traditional medicine by orthodox practitioners and the failure of government to give traditional medicine its due recognition. This was reportedly responsible for the lack of interest by children of traditionalmedical practitioners to acquire traditionalmedical knowledge. Conclusion: The study recommends inclusion of traditional medicine in the health policy and educational curriculum from the basic level.
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The gendered micropolitics of hiding and disclosing: assessing the spread and stagnation of information on two new EMTCT policies in a Malawian village.
Health Policy and Planning. 2017 Nov 1; 32(9):1309-1315.Analysing why certain information spreads-or not-can be highly relevant for understanding an intervention's potential impact. Two recently implemented policy changes related to EMTCT (elimination of mother-to-child transmission of HIV) in the Balaka district of Malawi give ample opportunity to assess how new information trickles through a targeted rural community. One of the policies entails the lifetime provision of ART (anti-retroviral therapy) to all HIV+ pregnant women-a governmental strategy to EMTCT first initiated in Malawi and now being expanded throughout the region. The second new policy concerns a pilot project in which women are financially rewarded for attending antenatal care and delivering in the hospital. An in-depth anthropological approach was used to assess what women in one village community know about the policy changes and how they had come to know about it. Although the policies were implemented more or less at the same time, awareness and knowledge levels among village women differed largely: In case of the first, awareness stagnated at the level of those who directly received the information from health professionals. In the case of the second, highly accurate and up-to-date knowledge had spread throughout the village community. I suggest three reasons for this divergence: (i) perceived talk-worthiness of (issues addressed by) the interventions, (ii) motives for hiding or disclosing involvement in either of the interventions and (iii) the visibility of each intervention, or in other words, the (im)possibility to hide involvement. I argue that these reasons for women's structural silence on one policy change and prompt sharing of information on another follow a distinctly gendered logic. The findings underline that the diffusion of new information is to a great extent shaped by the social particularities of the context in which it is introduced.
Health Research Policy and Systems. 2018 May 22; 16(1):42.BACKGROUND: As countries continue to improve their family planning (FP) programmes, they may draw on WHO's evidence-based FP guidance and tools (i.e. materials) that support the provision of quality FP services. METHODS: To better understand the use and perceived impact of the materials and ways to strengthen their use by countries, we conducted qualitative interviews with WHO regional advisors, and with stakeholders in Ethiopia and Senegal who use WHO materials. RESULTS: WHO uses a multi-faceted strategy to directly and indirectly disseminate materials to country-level decision-makers. The materials are used to develop national family planning guidelines, protocols and training curricula. Participants reported that they trust the WHO materials because they are evidence based, and that they adapt materials to the country context (e.g. remove content on methods not available in the country). The main barrier to the use of national materials is resource constraints. CONCLUSIONS: Although the system and processes for dissemination work, improvements might contribute to increased use of the materials. For example, providers may benefit from additional guidance on how to counsel women with characteristics or medical conditions where contraceptive method eligibility criteria do not clearly rule in or rule out a method.
Health Research Policy and Systems. 2017 Sep 6; 15(1):78.BACKGROUND: Preterm birth (PTB) is the leading cause of death in children under age five. Healthcare policy and other decision-making relevant to PTB may rely on obsolete, incomplete or inapplicable research evidence, leading to worsened outcomes. Appropriate knowledge transfer and exchange (KTE) strategies are an important component of efforts to reduce the global PTB burden. We sought to develop a 'landscape' analysis of KTE strategies currently used in PTB and related contexts, and to make recommendations for optimising programmatic implementation and for future research. METHODS: In the University of California, San Francisco's Preterm Birth Initiative, we convened a multidisciplinary working group and examined KTE frameworks. After selecting a widely-used, adaptable, theoretically-strong framework we reviewed the literature to identify evidence-based KTE strategies. We analysed KTE approaches focusing on key PTB stakeholders (individuals, families and communities, healthcare providers and policymakers). Guided by the framework, we articulated KTE approaches that would likely improve PTB outcomes. We further applied the KTE framework in developing recommendations. RESULTS: We selected the Linking Research to Action framework. Searches identified 19 systematic reviews, including two 'reviews of reviews'. Twelve reviews provided evidence for KTE strategies in the context of maternal, neonatal and child health, though not PTB specifically; seven reviews provided 'cross-cutting' evidence that could likely be generalised to PTB contexts. For individuals, families and communities, potentially effective KTE strategies include community-based approaches, 'decision aids', regular discussions with providers and other strategies. For providers, KTE outcomes may be improved through local opinion leaders, electronic reminders, multifaceted strategies and other approaches. Policy decisions relevant to PTB may best be informed through the use of evidence briefs, deliberative dialogues, the SUPPORT tools for evidence-informed policymaking and other strategies. Our recommendations for research addressed knowledge gaps in regard to partner engagement, applicability and context, implementation strategy research, monitoring and evaluation, and infrastructure for sustainable KTE efforts. CONCLUSIONS: Evidence-based KTE, using strategies appropriate to each stakeholder group, is essential to any effort to improve health at the population level. PTB stakeholders should be fully engaged in KTE and programme planning from its earliest stages, and ideally before planning begins.
Experiences of Indian health workers using WhatsApp for improving aseptic practices with newborns: Exploratory qualitative study.
JMIR Medical Informatics. 2018 Jan-Mar; 6(1):e13.Background: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective: This exploratory qualitative study aimed to examine experiences with WhatsApp as a communication tool among improvement team members and an external coach to improve adherence to aseptic protocols. Methods: Ten QI team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results: WhatsApp was effective for disseminating information, including guidance on QI and clinical practice, and data on performance indicators. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (eg, using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to share information, schedule site visits, and prompt action on behalf of the team. Conclusions: WhatsApp is a productive communication tool that can be used by teams and coaches to disseminate information and prompt action to improve the quality of care, but cannot replace in-person meetings. ©Parika Pahwa, Sarah Lunsford, Nigel Livesley. Open-access.
Evaluation of a Mobile Phone App for Providing Adolescents With Sexual and Reproductive Health Information, New York City, 2013-2016.
Public Health Reports. 2018 May/Jun; 133(3):234-239.The New York City (NYC) Department of Health and Mental Hygiene released the Teens in NYC mobile phone application (app) in 2013 as part of a program to promote sexual and reproductive health among adolescents aged 12-19 in NYC. The app featured a locator that allowed users to search for health service providers by sexual health services, contraceptive methods, and geographic locations. We analyzed data on searches from the Where to Go section of the app to understand the patterns of use of the app's search functionality. From January 7, 2013, through March 20, 2016, the app was downloaded more than 20 000 times, and more than 25 000 unique searches were conducted within the app. Results suggest that the app helped adolescents discover and access a wide range of sexual health services, including less commonly used contraceptives. Those designing similar apps should consider incorporating search functionality by sexual health service (including abortion), contraceptive method, and user location.
Building the evidence base on the HIV programme in India: An integrated approach to document programmatic learnings.
Health Research Policy and Systems. 2018; 16(1)Background: The Knowledge Network project was launched in 2010 to build evidence on the HIV epidemic by using the data generated by HIV programme implementing organisations in India. This paper describes the implementation of the programme and the strategies adopted to enhance the capacity of individuals to document and publish HIV prevention programme learnings. Further, it discusses the outcomes of the initiative. Methods: A multipronged approach was adopted, where a group of experts were brought together to collaborate with programme implementing organisations, review available data, develop research questions and guide peer-reviewed publications. Further, scientific writing courses were conducted to support individuals from HIV programme implementing organisations as well as educational and government organisations (mentees) to build the documentation capacity of individuals leading programme implementation and current and future researchers. The impact and quality of evidence generated was measured by examining the number of papers published, the number of citations, and the number of papers with at least 10 citations. Additionally, course participants' responses to open-ended questions in the anonymous course evaluation questionnaires are presented as verbatim quotes. Results: Overall, 99 papers on HIV programmatic learnings from India were finalised under the programme, of which 95 have been published. In all, 67 papers were co-authored by mentees. Most papers were published in high-impact factor (1 or more) journals and 72% were cited at least once in the literature. The main themes documented include key populations' HIV risk, HIV risk of general population groups, HIV/STI service delivery models and community mobilisation interventions. Conclusion: The study demonstrates that an integrated approach, involving partnership, capacity-building and mentorship, can maximise the use of available data and build the evidence base on HIV programmatic learnings. The capacity-building model adopted in the programme can be used to build scientific writing and documentation capacity in other public health programmes that are implemented at scale. © 2018 The Author(s).
Understanding how Afghan women utilise a gender transformative and economic empowerment intervention: a qualitative study.
Global Public Health. 2018; 1-11.The processes through which women's economic empowerment interventions are envisaged to improve women's health are strongly embedded in notions of building women's agency and autonomy. Yet despite the ubiquity of such interventions, there remains incredibly little qualitative work exploring how women actually utilize interventions to reshape their lives and wellbeing. Drawing on 9 focus groups discussions among 52 women who participated in the Women for Women International intervention in Afghanistan, an economic strengthening and social empowerment intervention, we explore processes of change. Data showed women learnt new skills around numeracy and animal husbandry; they perceived themselves to have become more respected within the household setting; they invested cash they received for intervention attendance in businesses, primarily their husband's or family's, and saved cash. Women did not, however, report their relationships to have been radically restructured. Rather women described incremental changes in their relationships within their household and used what they gained from the intervention to secure and sustain this. This conceptualization of agency and empowerment reflects approaches to understanding agency, which move away from ‘action-oriented’ understandings, to ones that recognize ‘distributed agency’ as pathways to change through interventions.
Arlington, Virginia, SPRING, 2017 Aug. 72 p. (USAID Cooperative Agreement No. AID-OAA-A-11-00031)From 2012 to 2017, SPRING implemented community-based, multi-sectoral, integrated nutrition programs focused on households with pregnant and lactating women (PLW) and children under 2 years of age in 40 upazilas in Barisal and Khulna divisions. During these five years, the program reached over 125,000 PLW through its farmer nutrition school (FNS) program, promoting small, doable actions to improve nutrition and hygiene. In addition to helping FNS participants, the interventions had a significant positive impact on non-FNS community members. This study examines that impact. Because the promoted practices spread easily beyond direct program beneficiaries, we believe they have great potential for scalability and sustainability.
[Washington, D.C.], MCSP, 2017 Nov. 30 p. (USAID Cooperative Agreement No. AID-OAA-A-14-00028)The purpose of this report is to inform the next steps in the consultation process for the development of terms of reference for the proposed Child Health Task Force (CHTF). The findings from the CHTF survey were interpreted in the context of recent reports and ongoing discussions among global child health stakeholders about what the vision and scope of child health should be in view of the UN Secretary General’s Global Strategy on Women’s, Every Woman Every Child (EWEC strategy), which is intended to achieve the child health Sustainable Development Goals (SDGs).
'It's a very complicated issue here': understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study.
Health Policy and Planning. 2017 Apr 01; 32(3):305-313.Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al. 's (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al. 's (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low- and middle-income country perspective. (c) The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Determinants of defaulting from completion of child immunization in Laelay Adiabo District, Tigray Region, Northern Ethiopia: A case-control study.
PloS One. 2017; 12(9):e0185533.BACKGROUND: Globally 2.5 million children under five years of age die every year due to vaccine preventable diseases. In Tigray Region in Northern Ethiopia, full vaccination coverage in children is low. However, the determinants of defaulting from completion of immunization have not been studied in depth. This study aimed to identify the determinants of defaulting from child immunization completion among children aged 9-23 months in the Laelay Adiabo District, North Ethiopia. METHODS: An unmatched community based case-control study design was conducted among children aged 9-23 months in the Laelay Adiabo District from February-March 2015. A survey was conducted to identify the existence of cases and controls. Two hundred and seventy children aged 9-23 months (90 cases and 180 controls) were recruited from 11 kebeles (the smallest administrative units) by a simple random sampling technique using computer based Open Epi software. Cases were children aged 9-23 months who missed at least one dose of the recommended vaccine. Controls were children aged 9-23 months who had received all recommended vaccines. Data were collected from mothers/care givers using structured pretested questionnaire. The data were entered into Epi Info version 3.5.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 21. Bivariate and Multiple logistic regression analysis were used to identify the predictors of the outcome variable. The degree of association was assessed by using odds ratio with 95% Confidence Interval (CI). RESULT: This study shows that mothers who take >30 minutes to reach the vaccination site (Adjusted Odds Ratio (AOR) = 3.56,95%CI:1.58-8.01); households not visited by health extension workers at least monthly (AOR = 2.68,95%CI:1.30-5.51); poor participation in women's developmental groups (AOR = 3.3,95%CI 1.54-7.08); no postnatal care follow-up (AOR = 5.2,95%CI:2.36-11.46); and poor knowledge of child immunization (AOR = 3.3,95%CI:1.87-7.43) were predictors of defaulting from completion of child immunization. CONCLUSION: Postnatal care follow-up, household visits by health extension workers and maternal participation in women's development groups are important mediums for disseminating information and increasing knowledge to mothers about child immunization. To reduce the rate of defaulters, health providers should motivate and counsel mothers to attend postnatal care. Health extension workers should visit households at least once per month and strengthen mothers' participation in the women's development groups.
Assessing the effects of mCenas! SMS education on knowledge, attitudes, and self-efficacy related to contraception among youth in Mozambique.
Washington, D.C., Pathfinder International, Evidence to Action for Strengthened Reproductive Health [E2A], 2015 Mar. 101 p. (USAID Contract No. AID-OAA-A-11-00024)This report describes an assessment E2A conducted of a comprehensive text message program for youth, called mCenas!. mCenas! was implemented by Pathfinder International, with assistance from Dimagi, Inc., from September 2013 to June 2014, in Mozambique’s Matola district of Maputo province and Inhambane City district of Inhambane province. mCenas! targeted youth 15-24 in an interactive two-way SMS system that engaged them with narrative and informational messages to increase their knowledge about contraceptive methods, dispel common myths around contraception, and address common barriers youth face regarding use of contraception. E2A undertook the study to generate evidence on whether delivering information on contraception via SMS is acceptable to youth 18-24 in Mozambique and could lead to improvement in their contraceptive knowledge, attitudes, and self-efficacy. The study also offers youth perspectives on barriers to accessing and utilizing sexual and reproductive health services.
Assessing the effects of mCenas! SMS education on knowledge, attitudes, and self-efficacy related to contraception among youth in Mozambique.
Washington, D.C., E2A, 2015 Mar. 4 p. (USAID Contract No. AID-OAA-A-11-00024)This policy brief is derived from a longer report, which describes an assessment E2A conducted of a comprehensive text message program for youth, called mCenas!. mCenas! was implemented by Pathfinder International, with assistance from Dimagi, Inc., from September 2013 to June 2014, in Mozambique’s Matola district of Maputo province and Inhambane City district of Inhambane province. The policy brief summarizes the study including key findings and recommendations derived from the evidence it generated.
Scientific knowledge dissemination and reproductive health promotion in Africa: The case of AJRH [editorial]
African Journal of Reproductive Health. 2017 Jun; 21(2):104-113.This editorial discusses why it is important for African researchers to produce and disseminate scientific evidence on the determinants, correlates and consequences of the major reproductive health challenges confronting Africa.
Collaborating to advance normative change for adolescent sexual & reproductive health: a global stakeholder analysis to survey the landscape and guide collaboration and action.
Washington, D.C., Georgetown University, Institute for Reproductive Health, 2016. 29 p. (USAID Contract No. AID-OAA-A-15-00042)To inform the Passages Project’s overall vision and strategy, the Institute for Reproductive Health at Georgetown University conducted a stakeholder analysis, “Collaborating to Advance Normative Change for Adolescent Sexual & Reproductive Health: A Global Stakeholder Analysis to Survey the Landscape and Guide Collaboration and Action,” consisting of 147 online surveys and 21 in-depth interviews with stakeholders in the sexual and reproductive health and adolescent health fields. The stakeholder analysis sought to identify the existing knowledge level and attitudes among stakeholders towards normative interventions and their replication and scale-up, and where information is accessed to inform their work in these areas. The analysis also explored how social norms and scale-up evidence is disseminated and applied by practitioners, and related information needs including theoretical models, measurement and evaluation approaches, and implementation tools. The findings contribute to the Passages Project’s global leadership vision and strategy, and will assist Passages to effectively address knowledge and evidence needs in the field.
[Washington, D.C., Georgetown University, Institute for Reproductive Health, 2016 Oct.] 1 p.The FACT project’s PRAGATI intervention in Nepal works through existing social networks to easily diffuse fertility awareness information to individuals via a multi-level package of materials that seek to improve behaviors through service providers and community stakeholders.
Washington, D.C., Georgetown University, Institute for Reproductive Health, Fertility Awareness for Community Transformation [FACT] Project, 2017 Apr. 51 p.Community Transformation (FACT) Project, the Pragati “Fertility Awareness for Quality of Life” intervention aims to increase fertility awareness and family planning use through existing community networks in five districts of Nepal. As a package of nine learning games followed by discussions, Pragati is being implemented in Nepal to diffuse fertility awareness and family planning information and to facilitate community discussions around social and gender norms that inhibit family planning use. This report describes Pragati’s proof of concept phase, carried out in August and September 2016. The main objective of the proof of concept was to determine the feasibility and acceptability of the Pragati games and materials in the five districts. This report summarizes the findings based on the experience of stakeholders who implemented the games in their communities and expands on the changes made to game materials before the roll-out of the intervention in the pilot phase.
[Washington, D.C.], Georgetown University, Institute for Reproductive Health, 2017. 2 p.Working through existing social networks, Pragati uses a series of games to diffuse information about fertility awareness and family planning to individuals, catalyzing conversation with others. Games and topics are introduced and facilitated by influential community partners who are well-positioned to share information and promote reflection among their own family members and peers.