scholarly journals Quality of Inpatient Tuberculosis Health Care in High-Burden Resource-Limited Settings: Protocol for a Comprehensive Mixed Methods Assessment Study

10.2196/13903 ◽  
2020 ◽  
Vol 9 (1) ◽  
pp. e13903
Author(s):  
Nune Truzyan ◽  
Zaruhi Grigoryan ◽  
Lusine Musheghyan ◽  
Byron Crape ◽  
Varduhi Petrosyan

Background The quality of care for tuberculosis (TB) is deficient in high-burden countries and urgently needs improvement. However, comprehensively identifying the required improvements is challenging. Providing high-quality TB care is an important step toward improving patients’ quality of life and decreasing TB morbidity and mortality. Effective tools for assessing the quality of TB services using international standards and guidelines can identify existing gaps in services and inform improvements to ensure high-quality inpatient TB services. Objective This study aimed to develop evaluation instruments for defining the quality of provision of TB services. Methods To assess quality of services in the largest TB hospital in Armenia, we developed instruments based on the Joint Commission International Accreditation Standards for Hospitals, International Standards for TB Care, TB Laboratories Bio-Safety Standards, and the World Health Organization framework for conducting TB program reviews. A mixed methods approach was utilized, triangulating quantitative (checklists) and qualitative (in-depth interviews) results. A scoring system and strengths, weaknesses, opportunities, and treats analysis was applied to detail results for each of the 122 standards assessed. A scaling approach was used to present overall performances of inpatient services for eight patient-centered functions and five organization management functions. Results Overall, 40 in-depth interviews and 91 checklists (21 observations, 16 policy papers, 20 staff qualification documents, and 34 medical records) were developed, utilized, and analyzed to explore practices of health care professionals, assess inpatient treatment experience of patients and their family members, evaluate facility environmental conditions, and define the degree of compliance to standards. Conclusions The effective comprehensive evaluation instruments and methods developed in this study for quality of inpatient TB services support the implementation of similar effective assessments in other countries. It may also become a platform to develop similar approaches for assessing ambulatory TB services in resource-limited countries. International Registered Report Identifier (IRRID) DERR1-10.2196/13903

2019 ◽  
Author(s):  
Nune Truzyan ◽  
Zaruhi Grigoryan ◽  
Lusine Musheghyan ◽  
Byron Crape ◽  
Varduhi Petrosyan

BACKGROUND The quality of care for tuberculosis (TB) is deficient in high-burden countries and urgently needs improvement. However, comprehensively identifying the required improvements is challenging. Providing high-quality TB care is an important step toward improving patients’ quality of life and decreasing TB morbidity and mortality. Effective tools for assessing the quality of TB services using international standards and guidelines can identify existing gaps in services and inform improvements to ensure high-quality inpatient TB services. OBJECTIVE This study aimed to develop evaluation instruments for defining the quality of provision of TB services. METHODS To assess quality of services in the largest TB hospital in Armenia, we developed instruments based on the Joint Commission International Accreditation Standards for Hospitals, International Standards for TB Care, TB Laboratories Bio-Safety Standards, and the World Health Organization framework for conducting TB program reviews. A mixed methods approach was utilized, triangulating quantitative (checklists) and qualitative (in-depth interviews) results. A scoring system and strengths, weaknesses, opportunities, and treats analysis was applied to detail results for each of the 122 standards assessed. A scaling approach was used to present overall performances of inpatient services for eight patient-centered functions and five organization management functions. RESULTS Overall, 40 in-depth interviews and 91 checklists (21 observations, 16 policy papers, 20 staff qualification documents, and 34 medical records) were developed, utilized, and analyzed to explore practices of health care professionals, assess inpatient treatment experience of patients and their family members, evaluate facility environmental conditions, and define the degree of compliance to standards. CONCLUSIONS The effective comprehensive evaluation instruments and methods developed in this study for quality of inpatient TB services support the implementation of similar effective assessments in other countries. It may also become a platform to develop similar approaches for assessing ambulatory TB services in resource-limited countries. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/13903


10.2196/14051 ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. e14051
Author(s):  
Carol McMara Gibson-Gill ◽  
Joyce Williams ◽  
Denise Fyffe

Background Spinal cord injury (SCI) is a debilitating injury that results in chronic paralysis, impaired functioning, and drastically altered quality of life (QOL). The Department of Veterans Affairs (VA) estimates that approximately 450 newly injured veterans and active-duty members receive rehabilitation at VA’s Spinal Cord Injury/Disorders Centers annually. VA virtual health services use technology and health informatics to provide veterans with better access and more effective care management. The “Triangle of Healthy Caregiving for SCI Veterans” is a patient-centered intervention that incorporates SCI veterans’ caregivers into the VA SCI health care team and extends into the homes of veterans with SCI by using real-time clinical video teleconferencing (CVT). CVT facilitates video-clinic visits, which can include different types of clinical evaluations, therapy (physical/occupational), or psychosocial services. The “Triangle of Healthy Caregiving for SCI Veterans” builds on interactive, interdisciplinary health care relationships that exist between the veterans with SCI, their caregivers, and the VA SCI health care team. SCI veterans’ propensity to multiple secondary complications makes a healthy partnership crucial for the success of keeping better health and functional outcomes as well as quality of life while living in their homes. Objective The goal of the proposed mixed methods project will assess SCI veterans’, their caregivers’, and the VA health care team’s perspectives and experiences in the “Triangle of Healthy Caregiving for SCI Veterans” to determine the benefits, challenges, and outcomes for everyone involved in the intervention. Methods Data collection methods will be implemented over three sequential phases. First, in-depth interviews will be conducted with the telehealth coordinators to systematically document the administrative procedures involved in enrollment of veterans with SCI into the CVT system. Next, structured observation of the CVT enrollment process and logistics of home installation of the CVT system will be conducted to validate the content of the in-depth interviews and highlight any discrepancies observed. Semistructured interviews will be conducted to assess specific elements of the “Triangle of Healthy Caregiving for SCI Veterans” program, their perceived utility, and effectiveness of the CVT system as well as the general impressions of the impact of the intervention on the SCI veterans’ health and function outcomes, caregiver burden, and daily caregiver burden. Finally, the research team will conduct a focus group to evaluate the ways in which the “Triangle of Healthy Caregiving for SCI Veterans” is useful for health care delivery to veterans with SCI and support services to SCI caregivers. Results This proposal was funded in July 2017. It was reviewed and received institutional review board approval in March 2018, and the project was started immediately after, in the same month. As of September 2019, we have completed Phases I and III and have recruited 52 subjects for Phase II. We are beginning the data analysis. The study is projected to be completed in late summer of 2020, and the expected results are to be published in the fall of 2020. Conclusions The findings from this study will highlight the ways in which virtual health care technologies can be used to improve access to SCI specialized care for veterans and provide an estimation of the potential impact on clinical outcomes for veterans with SCI and their caregivers. International Registered Report Identifier (IRRID) DERR1-10.2196/14051


2019 ◽  
Author(s):  
Carol McMara Gibson-Gill ◽  
Joyce Williams ◽  
Denise Fyffe

BACKGROUND Spinal cord injury (SCI) is a debilitating injury that results in chronic paralysis, impaired functioning, and drastically altered quality of life (QOL). The Department of Veterans Affairs (VA) estimates that approximately 450 newly injured veterans and active-duty members receive rehabilitation at VA’s Spinal Cord Injury/Disorders Centers annually. VA virtual health services use technology and health informatics to provide veterans with better access and more effective care management. The “Triangle of Healthy Caregiving for SCI Veterans” is a patient-centered intervention that incorporates SCI veterans’ caregivers into the VA SCI health care team and extends into the homes of veterans with SCI by using real-time clinical video teleconferencing (CVT). CVT facilitates video-clinic visits, which can include different types of clinical evaluations, therapy (physical/occupational), or psychosocial services. The “Triangle of Healthy Caregiving for SCI Veterans” builds on interactive, interdisciplinary health care relationships that exist between the veterans with SCI, their caregivers, and the VA SCI health care team. SCI veterans’ propensity to multiple secondary complications makes a healthy partnership crucial for the success of keeping better health and functional outcomes as well as quality of life while living in their homes. OBJECTIVE The goal of the proposed mixed methods project will assess SCI veterans’, their caregivers’, and the VA health care team’s perspectives and experiences in the “Triangle of Healthy Caregiving for SCI Veterans” to determine the benefits, challenges, and outcomes for everyone involved in the intervention. METHODS Data collection methods will be implemented over three sequential phases. First, in-depth interviews will be conducted with the telehealth coordinators to systematically document the administrative procedures involved in enrollment of veterans with SCI into the CVT system. Next, structured observation of the CVT enrollment process and logistics of home installation of the CVT system will be conducted to validate the content of the in-depth interviews and highlight any discrepancies observed. Semistructured interviews will be conducted to assess specific elements of the “Triangle of Healthy Caregiving for SCI Veterans” program, their perceived utility, and effectiveness of the CVT system as well as the general impressions of the impact of the intervention on the SCI veterans’ health and function outcomes, caregiver burden, and daily caregiver burden. Finally, the research team will conduct a focus group to evaluate the ways in which the “Triangle of Healthy Caregiving for SCI Veterans” is useful for health care delivery to veterans with SCI and support services to SCI caregivers. RESULTS This proposal was funded in July 2017. It was reviewed and received institutional review board approval in March 2018, and the project was started immediately after, in the same month. As of September 2019, we have completed Phases I and III and have recruited 52 subjects for Phase II. We are beginning the data analysis. The study is projected to be completed in late summer of 2020, and the expected results are to be published in the fall of 2020. CONCLUSIONS The findings from this study will highlight the ways in which virtual health care technologies can be used to improve access to SCI specialized care for veterans and provide an estimation of the potential impact on clinical outcomes for veterans with SCI and their caregivers. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14051


2020 ◽  
Vol 4 (1) ◽  
pp. e000822
Author(s):  
Robert C Hughes ◽  
Patricia Kitsao-Wekulo ◽  
Sunil Bhopal ◽  
Elizabeth W Kimani-Murage ◽  
Zelee Hill ◽  
...  

IntroductionThe early years are critical. Early nurturing care can lay the foundation for human capital accumulation with lifelong benefits. Conversely, early adversity undermines brain development, learning and future earning.Slums are among the most challenging places to spend those early years and are difficult places to care for a child. Shifting family and work structures mean that paid, largely informal, childcare seems to be becoming the ‘new normal’ for many preschool children growing up in rapidly urbanising Africa. However, little is known about the quality of this childcare.AimsTo build a rigorous understanding what childcare strategies are used and why in a typical Nairobi slum, with a particular focus on provision and quality of paid childcare. Through this, to inform evaluation of quality and design and implementation of interventions with the potential to reach some of the most vulnerable children at the most critical time in the life course.Methods and analysisMixed methods will be employed. Qualitative research (in-depth interviews and focus group discussions) with parents/carers will explore need for and decision-making about childcare. A household survey (of 480 households) will estimate the use of different childcare strategies by parents/carers and associated parent/carer characteristics. Subsequently, childcare providers will be mapped and surveyed to document and assess quality of current paid childcare. Semistructured observations will augment self-reported quality with observable characteristics/practices. Finally, in-depth interviews and focus group discussions with childcare providers will explore their behaviours and motivations. Qualitative data will be analysed through thematic analysis and triangulation across methods. Quantitative and spatial data will be analysed through epidemiological methods (random effects regression modelling and spatial statistics).Ethics and disseminationEthical approval has been granted in the UK and Kenya. Findings will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content.


2021 ◽  
Vol 30 (8) ◽  
pp. 490-496
Author(s):  
Joanne Garside ◽  
John Stephenson ◽  
Jean Hayles ◽  
Nichola Barlow ◽  
Graham Ormrod

Background: Nurse shortage is an international issue that has adverse effects on health and the quality of care of whole populations. Aims: The study aimed to explore attrition experienced by return-to-practice students attending higher education institutions in England. Methods: A mixed-methods design, involving questionnaires (n=114) and in-depth interviews (n=20), was used. Findings: Just over half (52%) of respondents left nursing after ≥10 years. Most of these (84%) stayed in alternative employment during their break from nursing. There were two distinct reasons for leaving nursing: the inability to maintain a positive work/life balance and a lack of opportunity for career advancement while retaining nursing registration. Respondents reflected positively on their nursing experience yet frequently reported significant personal or professional incidents prompting their decision to leave. Conclusion: The reasons nurses leave are complex. Professional bodies and managers need to work together to address concerns many nurses have during their careers that lead to them deciding to leave the profession.


2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Yubraj Acharya ◽  
Nigel James ◽  
Rita Thapa ◽  
Saman Naz ◽  
Rishav Shrestha ◽  
...  

Abstract Background Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients’ socio-economic gradient. Methods We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users’ characteristics. In the qualitative component, we synthesized users’ and providers’ narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. Results Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. Conclusion The quality of ANC in Nepal’s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.


2021 ◽  
Author(s):  
Jonas Jardim de Paula ◽  
Danielle de Souza Costa ◽  
Antônio Geraldo Silva ◽  
Débora Marques de Miranda ◽  
Leandro Malloy-Diniz

Quality of Life (QoL) is a multidimensional estimate of biopsychosocial health and wellbeing.1 The COVID-19 pandemic led to an abrupt change in our lifestyle, demanding resilience and coping mechanisms2. Health care providers are in the frontline of COVID-19 patients’ diagnosis, treatment, and rehabilitation, and there is a well-documented impact of this context on their physical and mental health2. This might impact their wellbeing and reduce their quality of life. In this research letter, we investigated which factors are associated with QoL in Brazilian healthcare professionals. We aim to investigate both protective and risk factors for the four main aspects of QoL: physical, psychological, social relations, and environment. We assessed 97.771 Brazilian adults, most (92.3%) health professionals of different professions from all the five-country regions. All included individuals agreed in a written consent to participate. Participants showed an average of 35.45 years old (±9.49) and were predominantly female (80%). They answered an online questionnaire about sociodemographic aspects, measures of mental health, and quality of life in the first semester of 2020. A detailed description of the sample and procedures can be found elsewhere3. All participants answered the WHOQoL-BREF, a standardized tool for QoL assessment developed by the World Health Organization. Stepwise linear regression analysis was used to assess the role of sociodemographic factors, previously diagnosed mental disorders, COVID-19 related symptoms as well a series of specific questions regarding participants worries and perceptions about the pandemic, including the protective behaviors' adoption (social distancing, usage of masks and sanitizer, among others). A full list of variables (64 in total) is available on the SAMBE webpage (http://abpbrasil.org.br/pcabp/). Since we have a large sample size our statistical power is about 99% (alpha=0.01) to detect small effect sizes. To simplify our results and allow a more direct application to real-life settings we only included significant predictors which showed at least 1% of adjusted explained variance in the stepwise models. The stepwise regression model was summarized in the figure below. All regression models were significant (p<0.001) as well all the predictors reported in the Figure. Total explained variance was 26% for Physical QoL, 27% for Psychological, 13% for Social Relations, and 19% for Environmental. A history of previous depression, presence of Headache, and the perception of worsening in home relationships were risk factors for lower QoL in all four domains. Our results suggest a multidimensional pattern of determinants of QoL in health care professionals in the early days of the pandemic. Interesting features emerged as predictors of QoL such as changes in home relationships, worsening in work productivity, and mental health. Expected and new predictors may shed light on which factors should be considered in interventions aiming at the development of mitigation of impact QoL in these populations.


2021 ◽  
Vol 22 (2) ◽  
pp. 168-190
Author(s):  
Zuhri Fahruddin

Abstract: The learning carried out by the teacher in the classroom must develop the quality of learning, one of which is learning motivation, students who are not passionate about learning are not optimal and of high quality, from this goal the reality is still far from expectations, many students are not aware of the importance of studying seriously, there is no passion study, there is no fun in the study room. The sampling technique used is Census Sample (Sample Saturated), while criterion-based selection is used when conducting qualitative research, 30 students as primary data sources, two teachers as secondary data sources. Data collection techniques using in-depth interviews, observation, documentation and questionnaires, while data analysis by reducing data, presenting data, drawing conclusions and verification by means of research stages I and II students and teachers with a Da'wah educational background, stage III and IV student informants and teachers with PAI educational background.


Biomedical wastes management is one of the most important issues in public health centers and it is a crucial issue for environmental sectors as well. Wrong and inappropriate management treat the life of human beings in Kandahar City. Currently the population of this city has exponentially increased than ever because of the immigration of many people from neighboring provinces. This research was conducted in 15 districts of Kandahar public and private health care centers to identify the current biomedical waste management in Kandahar city. The qualitative and quantitative date was collected through a questionnaire from public and private hospitals, clinics and health care centers. In addition, discarding, segregating, labeling, transporting and disposing system of biomedical waste were observed. The result showed that 65.3% newly hired biomedical waste staff not received training or instruction. Furthermore, the result indicates that 44% generated biomedical wastes are regulated by municipality and color coding is not followed accordingly. Current biomedical waste is not appropriate based on designed international standards and the criteria suggested by world health organization.


Author(s):  
Sefrina Werni ◽  
Rosita Rosita ◽  
Nita Prihartini ◽  
Mieska Despitasari

Abstrak Bidan sebagai tenaga kesehatan strategis yang berperan dalam pelayanan kesehatan ibu dan anak dituntut memiliki kompetensi tinggi untuk dapat menjalankan fungsinya dengan baik. Kompetensi yang tinggi dapat tercapai bila penyelenggara pendidikan profesi bidan memenuhi standar penyelenggaraan pendidikan. Berdasarkan data Majelis Tenaga Kesehatan Indonesia (MTKI) tahun 2016, nilai rata-rata uji kompetensi DIII kebidanan hanya 41,08. Peserta uji kompetensi yang belum lulus sebanyak 46,5%. Hasil yang masih jauh dari harapan juga ditunjukkan dari rerata try out uji kompetensi tenaga kesehatan tahun 2012 hingga tahun 2015 yang cenderung menurun. Kajian ini bertujuan untuk mendapatkan informasi identifikasi kompetensi bidan berdasarkan Kepmenkes 369/MENKES/SK/III/2007 tentang standar profesi bidan pada hasil Risdiknakes tahun 2017. Kajian dilakukan menggunakan observasi, wawancara mendalam dan literatur review. Informan adalah bidan di puskesmas dan pakar kebidanan. Hasil kajian menunjukkan bahwa kompetensi bidan di fasilitas pelayanan kesehatan masih belum sesuai standar. Beberapa faktor dalam penyelenggaraan pendidikan kebidanan turut membentuk kompetensi bidan yang dihasilkan. Proses rekrutmen calon peserta didik, kualitas dosen, dan proses penyelenggaraan pendidikan kebidanan secara keseluruhan merupakan komponen yang harus menjadi fokus untuk menghasilkan bidan yang sesuai dengan standar kompetensi seperti tercantum dalam Kepmenkes Nomor 369/MENKES/SK/III/2007. Kata kunci: kompetensi bidan, kajian kebidanan, pendidikan bidan, kurikulum kebidanan Abstract Midwives are strategic health workers who play an important role in maternal and child health services. They are required to have well competencies to run their tasks properly. Well, competencies can be achieved if the midwife's professional education providers meet the standards. Based on the Indonesian Health Workers' Assembly (MTKI) data in 2016, the average value of the DIII midwifery-competency test was only 41.08. Participants who failed the competency test were as much as 46.5%. It is still far from the expectation as the average value of health workers’ competency tests try out between 2012 to 2015 tends to decline. This study aims to identify midwife competencies based on Minister of Health's decree No. 369/MENKES/SK/III/2007 on midwives' profession standards and the results of the 2017 Research on Health Workers’ Education (Risdiknakes). The study was conducted using observation, in-depth interviews, and literature review. Informants are midwives at primary health care and midwifery experts. The results of the study indicate that midwife competencies in health care facilities are still not up to standard. Several factors in the administration of midwifery education also shape the competence of the midwives produced. The process of recruiting prospective students, the quality of lecturers, and the process of conducting midwifery education as a whole are components that must be the focus to produce midwives that comply with the competency standards in Minister of Health's decree No. 369/MENKES/SK/III/ 2007. Keywords: midwife competencies, midwifery studies, midwife education


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