A strong nursing research agenda in Latin America is fundamental to universal health coverage. Nursing science can make important contributions to the health of Latin American people through knowledge generation that directly informs nursing practice, professional education, and health policy.
We used a cross-sectional survey design to assess nursing involvement in health systems and services research in Latin America in five priority areas: Policies and education related to nursing human resources; Structure, organization and dynamics of health systems and services; Science, technology, innovation, and information systems in public health; Health policies, governance, and social control; and Social studies in the health field.
Nursing and midwifery participants (N = 856) from Latin American countries completed the survey. Respondents who reported conducting research focused primarily on Policies and Education related to Nursing Human Resources and Structure, Organization, and Dynamics of Health Systems and Services. Across the five priority areas, more nurses reported using research findings and/or being aware of research than conducting research.
Survey results indicate that nursing research in Latin America is currently disproportionately focused on nursing education and practice. More research focused on information technology, nurse’s impact on public health, and the threats posed by nurse migration is needed to better address health needs of Latin American populations.
Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China.
A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children’s education opportunities, working environment, career promotion speed and bianzhi (formally established post).
A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed).
Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.
BACKGROUND: The global spread of the SARS-CoV-2 virus highlights both the importance of frontline healthcare workers (HCW) in pandemic response and their heightened vulnerability during infectious disease outbreaks. Adequate preparation, including the development of human resources for health (HRH) is essential to an effective response. ICAP at Columbia University (ICAP) partnered with Resolve to Save Lives and MOHs to design an emergency training initiative for frontline HCW in 11 African countries, using a competency-based backward-design approach and tailoring training delivery and health facility selection based on country context, location and known COVID-19 community transmission. METHODS: Pre- and post-test assessments were conducted on participants completing the COVID-19 training. Parametric and non-parametric methods were used to examine average individual-level changes from pre- to post-test, and compare performance between countries, cadres, sex and facility types. A post-evaluation online training survey using Qualtrics was distributed to assess participants' satisfaction and explore training relevance and impact on their ability to address COVID-19 in their facilities and communities. RESULTS: A total of 8797 HCW at 945 health facilities were trained between June 2020 and October 2020. Training duration ranged from 1 to 8 days (median: 3 days) and consisted of in person, virtual or self guided training. Of the 8105 (92%) HCW working at health facilities, the majority (62%) worked at secondary level facilities as these were the HF targeted for COVID-19 patients. Paired pre- and post-test results were available for 2370 (25%) trainees, and 1768 (18%) participants completed the post-evaluation training survey. On average, participants increased their pre- to post-test scores by 15 percentage points (95% CI 0.14, 0.15). While confidence in their ability to manage COVID-19 was high following the training, respondents reported that lack of access to testing kits (55%) and PPE (50%), limited space in the facility to isolate patients (45%), and understaffing (39%) were major barriers. CONCLUSION: Ongoing investment in health systems and focused attention to health workforce capacity building is critical to outbreak response. Successful implementation of an emergency response training such as this short-term IPC training initiative in response to the COVID-19 pandemic, requires speed, rigor and flexibility of its design and delivery while building on pre-existing systems, resources, and partnerships.
Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from Community Health Workers (CHWs). However, little is known about what CHWs know about psychosis and how they manage such cases. This study aimed to explore the CHWs perception of psychosis and their experiences and beliefs about the factors that might enable or hinder care-taking for patients with psychosis in rural settings in Mozambique.
A qualitative study was conducted in rural districts of Maputo Province, a southern region of Mozambique, using six focus group discussions with participation of 79 CHWs. Thematic analysis was used informed by the Capabilities, Opportunities, Motivation and Behaviour framework (COM-B).
Nine primary themes were identified. Overall, CHWs perceived psychosis as treatable medical conditions and held a positive attitude about being part of the care-taking process of patients with psychosis in rural settings. Partnerships with key-stakeholders such as traditional healers, health care workers, and families, were perceived by CHWs as enablers to improve access to care in rural areas. However, stigma, myths, and lack of competencies to treat people with psychosis were perceived by CHWs as barriers for appropriate care.
CHWs, with adequate support, could play an important role in the care of patients with psychosis in rural settings, including identifying patients requiring care and referring them to appropriate healthcare professionals, and following up medicated patients with psychosis. Training of CHWs should consider inclusion of basic mental health care competencies.
Significant progress has been made to advance Maternal, Newborn and Child Health (MNCH) in Ethiopia. Further, the country has enshrined equity as a core value in their strategic and development frameworks and policies. Although national statistics show improved health outcomes, there exists persistent inequities in avoidable health risks and premature deaths. Additionally, the improving health statistics mask the disparities in health outcomes based on education, employment status, income level, gender and ethnicity dimensions.
The EquiFrame framework was used to assess the extent to which equity was entrenched in MNCH health policies and plans. The framework, which describes core concepts against which health policies and plans can be assessed, also provides a scoring criterion for policy assessment. The framework was modified to include the concept of intersectionality, which is increasingly gaining significance in the health policy ecosystems. The policies and plans reviewed in this analysis exercise were selected based on (1) their relevance – only policies and plans in force as of the year 2020 were considered; (2) availability in the public domain as this study was limited to desk research; and (3) relevance to MNCH. A total of five policies and plans were analyzed and evaluated against the 15 core concepts presented in the modified EquiFrame framework. Following the outcomes of the assessment, documents were ranked as either being low, moderate, or high, in exhaustively addressing the core concepts.
The Ethiopia Health Sector Transformation Plan (2016–2020) is the only policy or plan that earned a high ranking. The other four policies and plans were ranked as moderate. This shows that while majority of the Ethiopian health sector policies and plans exist and address the core health equity concepts, they fail to: (i) spell out plans to implement and monitor the proposed interventions; and (ii) demonstrate evidence that the interventions were implemented or monitored. With the global goal of leaving no one behind, future policy development in Ethiopia needs to prioritize equity considerations in order to enhance the ongoing health improvement.
Knowledge of medical specialists' numbers and geographical distribution are essential for planning health services and health workforce supply. However, although the distribution of physicians is a significant concern for society and policymakers in Ecuador, no studies have evaluated the distribution of specialists in the country. This study aimed to explore the geographical and temporal distribution of medical specialists in Ecuador over 18 years from 2000 to 2017 and analyse its implications for health planning and medical training.
We conducted an ecological time-series study based on the National Statistical Register of Resources and Health Activities data. This register provides administrative information for health professionals working in public and private health institutions. Rates of medical specialists by year, geographical area, and speciality were estimated. We used joint-point analyses to identify time trends for medical specialists and physicians in training.
From 2000 to 2017, medical specialists grew from 2737 to 10,929. The rate of medical specialists per 10,000 population increased from 4 in 2000 to 10.3 in 2017. Based on Joint point analysis, two temporal trends were identified. Between 2000 to 2015, specialists increased by 4.1% per year, and between 2015 and 2017, they increased by 20% per year. For the entire study period, three cities (Quito, Guayaquil, and Cuenca) accounted for more than 50% of the specialists in the country. However, medical specialists in other cities and rural areas increased from 37% in 2000 to 46% in 2017. The provinces of Esmeraldas, Carchi, Bolívar and Los Ríos presented rates of less than 6 specialists per 10,000 population by 2017. Of the 46 medical specialities identified by 2017, three represented more than 30% of the professionals (gynaecology 12%, paediatrics 11% and family and community health 8.4%).
This study shows that the number of medical specialists in Ecuador has increased significantly over the last two decades, although with inequalities in the distribution of specialists between provinces and regions. The results of this study provide background for the Ecuadorian health system when introducing Human Resources of Health (HRH) policies.
Occupational therapists are needed to meet the health and occupational needs of the global population, but we know little about the type of findings generated by occupational therapy workforce research conducted worldwide. We aim to synthesize these findings and their range of content to inform future investigations. A scoping review with content analysis was used. Six scientific databases, websites of official institutions, snowballing, and key informants were used for searches. Two independent reviewers took selection decisions against the eligibility criteria published a priori in the review protocol. Of the 1246 unique references detected, 57 papers were included for the last 25 years. A total of 18 papers addressed issues of attractiveness and retention, often in Australia, and 14 addressed the issues of supply, demand, and distribution, often in the US. Only these two categories generated subtopics. Many workforce issues were rarely addressed as a main topic (e.g., race/ethnic representation). Cross-national, cross-regional, or cross-professional studies generated more actionable findings. Overall, we found few discernable trends, minimal evidence of research programs, and various gaps in content coverage or in the use of contemporary research approaches. There is a need for a coordinated strengthening of the occupational therapy workforce research worldwide.
The United Nations’ Sustainable Development Goals (SDGs) were set forth in 2015 as a blueprint for all nations to create a more sustainable future together. These 17 social, environmental, and economic goals have established targets to meet globally by the year 2030, with a focus on pro-poor initiatives, gender equality, and ending hunger. The relationship of the SDGs with neurological disorders and how the achievement of the SDGs intersects with the future of neurological practice have not been comprehensively examined. However, the incidence of neurological disorders, the outcomes of people living with neurological disorders, and the training of future neurologists can be interlinked, directly or indirectly, with programming for the SDGs and their eventual achievement. Each SDG is reviewed in the context of neurology. This lens can inform programming and policy, enhance research and training, and improve inter-sectoral action for neurological disorders worldwide.
INTRODUCTION: Permanent health education (PHE) is a strategy for qualifying work to improve patient care. OBJECTIVE: To analyze dentists' perspectives on the PHE actions in the context of Primary Health Care. METHODS: This qualitative case report study conducted through semi-structured interviews with 26 dentists in primary health care and five managers of PHE actions in the city of Sobral, in the Brazilian Northeast. RESULTS: Data analysis was performed using the Collective Subject Discourse anchored in the following social representations: characterization of PHE actions as educational actions through theoretical-conceptual moments, with an emphasis on technical-scientific approaches and transmissive methodologies of an unprofessional nature; critical reflexivity in indicating improvements for these actions through the incorporation of interprofessional education in PHE actions. CONCLUSION: The involvement of continuing education actions in PHE has the potential to problematize work and develop strategies for the qualification of patient care, without losing the technical and scientific characteristics of each profession. INTRODUÇÃO: A educação permanente em saúde (EPS) é uma estratégia de qualificação do trabalho para a melhoria da atenção ao paciente. OBJETIVO: Analisar as perspectivas dos cirurgiões-dentistas sobre as ações de EPS no contexto da atenção primária à saúde. MÉTODOS: Tratou-se de um estudo de abordagem qualitativa do tipo estudo de caso realizado por meio de entrevistas semiestruturadas com 26 cirurgiões-dentistas da atenção primária à saúde e cinco gestores das ações de EPS na cidade de Sobral no interior do Nordeste brasileiro. RESULTADOS: A análise dos dados se deu por meio do Discurso do Sujeito Coletivo ancorado nas seguintes representações sociais: caracterização das ações de EPS como ações educativas através de momentos teórico-conceituais com ênfase em abordagens técnico-científicas e de metodologias transmissivas de caráter unprofessional; reflexibilidade crítica em indicar possibilidades de melhoria dessas ações por meio da incorporação da educação interprofissional nas ações de EPS. CONCLUSÃO: A perspectiva da inclusão de ações de Educação Continuada como parte das ações de EPS identificada nos cirurgiões-dentistas tem potencial para problematizar o trabalho e desenvolver estratégias de qualificação do cuidado ao paciente, sem perda de características técnico-científicas de cada profissão.
Diabetes mellitus and periodontal disease are among the most frequently occurring conditions that have a substantial effect on the global health economy. The literature regarding medical professionals' knowledge of the bidirectional link between diabetes mellitus and periodontal disease has not been analyzed systematically. The review aimed to investigate the knowledge and understanding of physicians and specialists regarding the two-way relationship between diabetes mellitus and periodontal disease and their approach to referring their patients for a dental consultation. An electronic search of PubMed and Google Scholar databases was conducted to review the studies that assessed knowledge and understanding of medical professionals regarding the relationship between diabetes mellitus and periodontal disease. Data from 13 included studies involved 4,027 participants: 3,256 primary care physicians and 771 medical specialists. Just over 50% of the medical professionals had an understanding of oral health and/or periodontal disease. Over one-third of medical professionals were ignorant of the relationship between oral health and diabetes mellitus. Only 30% reported ever referring their patients for an oral health assessment. Another key finding of the investigation was the absence of interprofessional collaborative care between medical and dental professionals while managing patients with diabetes mellitus. Medical professionals with an integrated knowledge of elementary oral health education and training could play a central role in the timely diagnosis and management of periodontal disease in patients living with diabetes mellitus.
INTRODUCTION: Interprofessional education (IPE) takes place when representatives of at least two professions work and learn together, about and from each other to provide optimal healthcare. For the successful implementation of an IPE programme, conceptualisation, planning, and operationalisation and coordination among the various professions is crucial, to assist students to obtain the desired competencies of such a programme. The purpose is to investigate if a structured IPE programme assisted radiography students to achieve competencies. METHODS: An online questionnaire was compiled from literature and completed by radiography students who participated in a structured, three-week-long IPE programme. The questionnaire was mainly quantitative (using a Likert scale), though it also consisted of qualitative elements (open-ended questions). A Fischer's Exact test was used to compare the responses of three different year groups. RESULTS: Feedback from the radiography students (n=63) indicated that they achieved this IPE programme's specific competencies: role clarification, interprofessional communication, teamwork, person-centered care and values and ethics. There was good correlation between the feedback from all three year groups. The feedback on the open-ended questions correlated with the quantitative feedback, though some students felt excluded, as there was little reference to their particular profession in the simulation session of the IPE programme. CONCLUSION: The results of the study indicate that radiography students achieved the prescribed competencies of a structured IPE programme. The results provide insight into ways to improve the IPE programme. A recommendation emanating from the results of this study is that, to improve the experience of all healthcare professions students, structured IPE programmes have to promote inclusive teaching and learning. IMPLICATIONS FOR PRACTICE: Radiography students that participate in a structured IPE programme develop competencies necessary for effective collaborative clinical practice.
BACKGROUND: Interprofessional education (IPE) for medical and healthcare professions is highly relevant. It increases knowledge and skills, but also helps to foster the development of collaboration, which is essential for optimal patient care. One important aspect of IPE is to better understand profession's individual attitudes and perceptions towards interprofessionalism and the expected roles and skills for future collaboration in the context of patient care. METHODS: We offered IPE workshops using a peer assisted learning approach, with the focus on anatomy in the area of the lower back and hip. The workshops were attended by medical and physiotherapy students and consisted of three consecutive training sessions with the topics anatomical prosections, anatomy in vivo and orthopedics testing. We focused on student's attitudes and perceptions regarding the relevance of IPE and their expected skills in interprofessionalism. An established questionnaire was used as an instrument for self-assessment before and after the interprofessional experience. To evaluate for significance, analysis was carried out for all groups on pre- and post-course item mean differences. RESULTS: Pre-post score comparison for all groups combined demonstrated significant increase in terms of perceptions and attitudes for several items related to interprofessionalism and interprofessional skills. Medical and physiotherapy students rated themselves significantly higher for different questionnaire items. Students, who had obtained a professional qualification prior to their current studies, rated themselves significantly higher on certain items compared to those who had not. CONCLUSIONS: The results from this brief interprofessional anatomy experience are encouraging. The course led to meaningful improvements in competencies that are highly relevant for effective interprofessional collaboration in the future. Furthermore, identification of differences in professional group perceptions can be useful for development of future IPE workshops.
In aiming to train health professional students to collaborate in patient care settings, the purpose of this study was to evaluate the perception of registered nurse (RN) students and occupational therapy (OT) students jointly participating in an interprofessional education (IPE) patient simulation learning experience. Eighty-five RN and OT students engaged in a 3-hour IPE patient simulation in an acute care hospital setting. Each student participant completed a pre- and post-test data collection, assessing interprofessional socialization using the Interprofessional Socialization and Valuing Scale (ISVS) Version 9A and provided qualitative feedback about their experience. Findings indicated a significant change in interprofessional socialization for RN and OT students after engaging in the IPE patient simulation learning experience. Furthermore, qualitative findings described the perceived benefits of IPE and collaboration, simulation as a learning tool, and areas for enhancing IPE patient simulation education for the future. Study findings have implications for using simulated IPE experiences with health professional students to foster interprofessional collaboration and socialization with the goal of delivering person-centered quality healthcare.
Measurement of the impact of interprofessional education (IPE) is the golden chalice educationalists chase. We undertook the development of a scale to measure IPE Academic Behavioral Confidence (IPE-ABC) in allied health, nursing, and social work pre-registration students. This work formed part of the evaluation of a large IPE framework embedded across two Scottish universities. General ABC has been shown to influence student perceptions of study experiences and it is thus reasonable to postulate that ABC could influence student perceptions of IPE. This research developed a questionnaire to ascertain health and social care students' confidence to engage in IPE, utilizing a mixed method approach. Fifteen different professional groups of pre-registration students (n = 565) participated in the assessment of the 38 item questionnaire. Exploratory factor analysis identified three factors: 1/interprofessional teamwork, 2/behaviors underpinning collaboration, and 3/interprofessional communication collectively accounting for 38.2% of the variance. Internal consistency of the overall scale (Cronbach's α = .93) was very good with subscales demonstrating very good internal consistency, 1 (α = .89), or respectable consistency 2 (α = .78) and 3 (α = .79). We conclude the IPE-ABC questionnaire could be utilized to enhance and assess the success of IPE related activities.
Medical education has an important role in developing attitudes, behaviors and cultures that support safe care. Increasingly, however, research has argued for a more interprofessional approach to be taken. This scoping review examines the design and impact of interprofessional education interventions involving medical students that focus on patient safety. We systematically searched PubMed, EMBASE, PsycINFO and CINAHL between January 2000 and November 2019. Studies were eligible if they included medical students and at least one other profession, interactive learning, a strong emphasis on patient safety in the learning objectives, and an empirical method of evaluation. Forty-three studies met these criteria and the diverse range of approaches to intervention design and method of evaluation are detailed in this review. We found that interprofessional patient safety education interventions are generally well received by students with knowledge and skill gain documented; several also reported changes in student behaviour. However, the lack of empirically driven study designs, combined with the lack of rigour when reporting, makes it difficult to draw clear comparisons. Future research should address this, and in particular, report how and why the intervention has been designed to be delivered interprofessionally.
Interprofessional education (IPE) research needs to expand beyond single site, single event inquiry. Multi-institutional studies increase methodologic rigor and generalizability, advancing the pedagogical science of IPE. Four U.S. institutions used three different validated measures to examine early learner interprofessional outcomes. The three assessment tools included the Communication and Teamwork subscale of the University of West England Entry Level Interprofessional Questionnaire (UWE-ELIQ), the Self-Assessed Collaboration Skills (SACS), and the Interprofessional Teamwork and Team-based Practice factor of the Student Perceptions of Interprofessional Clinical Education-Revised, version 2 (SPICE-R2). Across the four institutions, 659 eligible participants, representing 19 programs completed the pre-survey, and 385 completed the post-survey. The UWE-ELIQ showed a statistically significant difference between the pre- and post-survey overall, but the effect size was small. One institution demonstrated a positive change in scores on the UWE-ELIQ with a small effect size, while the other institutions saw no significant change. Two institutions observed lower post-survey scores on the SPICE-R2. Cumulative results from the study indicated no statistically significant change from pre- to post- in total SACS or SPICE-R2 scores. Additional multi-site longitudinal research is needed to investigate use of validated instruments, as well as the impact of curricula and learning environment on educational outcomes.
INTRODUCTION: Interprofessional education (IPE) offers relevant theoretical, conceptual and methodological approaches to the development of effective teamwork competencies. OBJECTIVE: To analyse an interprofessional experience of teaching-service-community integration carried out at a public university in the South of Brazil. METHODS: A case study with a qualitative approach was carried out. The study's participants were thirty-eight undergraduate dental students who attended the IPE activity between 2012 and 2019. Data collection was developed in two sequential steps that included the application of an online instrument and semi-structured interviews. The textual material was interpreted by content analysis, considering Kirkpatrick's evaluation levels (reaction, learning and behaviour). RESULTS: In the reaction level, students highlighted the contents provided by the National Curricular Guidelines regarding public health system and teamwork, as well as the pedagogical teaching proposal by tutoring groups, which stimulated students' autonomy. It was observed that the learning was geared towards the development of collaborative teamwork competencies and cultural competencies. In the behaviour level, students perceived positive changes in their attitudes and behaviours towards patients, focused on needs related to life conditions, realising that dentists may work within a team. The elective/optional nature of the experience allied with the absence of other IPE activities in the curricular grid showed to be challenging. CONCLUSION: IPE in undergraduate education presented positive results related to the reaction, learning and behaviour of dental students. We recommend the inclusion of interprofessional activities of teaching-service-community integration in Dentistry curricular structure to complement uniprofessional education.
Student-led clinics provide a unique opportunity for interprofessional education as part of the education of future allied health professionals. A rapid review was conducted to determine the benefits to allied health students participating in interprofessional education in student-led clinics. Studies were included if they took place within a student-led clinic, reported on outcomes for students and where the clinic involved interprofessional education for students from either two or more allied health professions, or one allied health and one nursing student. Results were analyzed using a descriptive qualitative approach. Five themes were identified: (a) understanding of own role and scope of practice; (b) understanding of the role and scope of practice of other professions; (c) individual benefits to the students; (d) impact on patient-centered care; and (c) understanding of how to work in an interprofessional team. These benefits indicate that student-led clinics are a suitable setting for the delivery of interprofessional education to allied health students. More research is needed that considers the long-term impact on these student outcomes following students' entry into the healthcare profession, as well as on the impact of specific components of the interprofessional education models on student outcomes.
Early interprofessional learning among nursing and medical students provides various benefits for future collaboration among professionals, and high-quality care for patients. Expert committees, thus, urge the integration of interprofessional education (IPE) in undergraduate studies to achieve significant sustainable improvements in health-care practice. In Germany, IPE interventions are already implemented in some health-care disciplines, but Health-care Ethics are scarcely regarded in undergraduate education. There are, however, several reasons why Health-care Ethics is particularly appropriate for teaching in an interprofessional format. Thus, after reviewing the legal framework and the current curricula of both professions, an IPE course on Health-care Ethics for medical and nursing students was developed and implemented, consisting of seven classes of 180 minutes each. Drawing on the evaluation results after two rounds of the course, this interprofessional education and practice guide reports on challenges, obstacles and perspectives for improvement of an IPE course on Health-care Ethics. It aims to provide guidance for teaching pioneers and innovators who implement similar projects and to foster practice-oriented and open discussion about the possibilities and limits of IPE in Health-care Ethics.