Diverse pre-service midwifery education pathways in Cambodia and Malawi: A qualitative study utilising a midwifery education pathway conceptual framework.

OBJECTIVES: Educated and skilled midwives are required to improve maternal and newborn health and reduce stillbirths. There are three main approaches to the pre-service education of midwives: direct entry, post-nursing and integrated programmes combining nursing and midwifery. Within these, there can be multiple programmes of differing lengths and qualifications, with many countries offering numerous pathways. This study explores the history, rationale, benefits and disadvantages of multiple pre-service midwifery education in Malawi and Cambodia. The objectives are to investigate the differences in education, roles and deployment as well as how key informants perceive that the various pathways influence workforce, health care, and wider health systems outcomes in each country. DESIGN: Qualitative data were collected during semi-structured interviews and analysed using a pre-developed conceptual framework for understanding the development and outcomes of midwifery education programmes. The framework was created before data collection. SETTING: The setting is one Asian and one African country: Cambodia and Malawi. PARTICIPANTS: Twenty-one key informants with knowledge of maternal health care at the national level from different Government and non-governmental backgrounds. RESULTS: Approaches to midwifery education have historical origins. Different pathways have developed iteratively and are influenced by a need to fill vacancies, raise standards and professionalise midwifery. Cambodia has mostly focused on direct-entry midwifery while Malawi has a strong emphasis on dual-qualified nurse-midwives. Informants reported that associate midwifery cadres were often trained in a more limited set of competencies, but in reality were often required to carry out similar roles to professional midwives, often without supervision. While some respondents welcomed the flexibility offered by multiple cadres, a lack of coordination and harmonisation was reported in both countries. KEY CONCLUSIONS: The development of midwifery education in Cambodia and Malawi is complex and somewhat fragmented. While some midwifery cadres have been trained to fulfil a more limited role with fewer competencies, in practice they often have to perform a more comprehensive range of competencies. IMPLICATIONS FOR PRACTICE: Education of midwives in the full range of globally established competencies, and leadership and coordination between Ministries of Health, midwife educators and professional bodies are all needed to ensure midwives can have the greatest impact on maternal and newborn health and wellbeing.
Categorías: Investigaciones

Interprofessional education in health professions education programmes in the Arab world: a scoping review protocol.

Search "Educación Interprofesional" - Mié, 23/11/2022 - 04:25
INTRODUCTION: Interprofessional education is a relatively new addition to health professional education curricula in the Arab world. To understand current practice in this area, a scoping review will enable reporting of essential elements for the implementation of interprofessional education. The objective of this scoping review is to report on the implementation components, including presage, process and product, of interprofessional education in prelicensure health professions education programmes in the Arab world. METHODS AND ANALYSIS: A comprehensive and systematic search for literature will be conducted using eight electronic databases from their inception to September 2022. A presearch was devised in PubMed, Scopus and CINAHL using a combination of terms related to population, context and concept. The Covidence Systematic Review tool will be used for blind screening, selection and conflict resolution. Data will be presented in tabular format and as a narrative synthesis and will include elements that support the implementation of interprofessional education. This review will be presented according to the Joanna Briggs Institute methodology.Studies conducted with students and/or faculty in prelicensure health professions education programmes will be included. The concept to be explored is interprofessional education. The context is the region commonly known as the Arab world, which includes 18 countries, sharing many common social and cultural traditions and where Arabic is the first language.Excluded will be studies conducted on collaborative practice of health professionals and postlicensure interprofessional education. ETHICS AND DISSEMINATION: No ethical approval was required. Findings will be disseminated in conference presentations and peer-reviewed articles.

Framing access to essential medicines in the context of Universal Health Coverage: a critical analysis of health sector strategic plans from eight countries in the WHO African region

Abstract Background

Framing affects how issues are understood and portrayed. This profoundly shapes the construction of social problems and how policy options are considered. While access to essential medicines (ATM) in the World Health Organization (WHO) African Region is often framed as a societal problem, there is dominance of medical and technically oriented approaches to analyze and remedy the situation. Hence, the systematic application of social science approaches, such as framing theory, remains under-explored. Through a framing analysis of National Strategic Plans (NSPs) from eight countries, this study explores the applicability and potential usefulness of framing theory to analyze essential medicines policies.

Methods

We inductively coded the relevant NSP textual fragments using the qualitative content analysis software ATLAS.ti.22. Benford and Snow’s conceptualization of framing was used to organize the coded data into three frames: diagnostic (problems), prognostic (solutions) and motivational (values and ideological).

Results

The following five diagnostic frames were dominant or in-frame: medicine unavailability, ineffective regulation, weak supply chain management, proliferation of counterfeit (substandard or falsified) medicines and use of poor quality medicines. Diagnostic frames related to financing, affordability, efficiency and corruption were given limited coverage or out of frame. Prognostic frames corresponded with how these problems were framed. Whilst Universal Health Coverage (UHC) and its guiding principles was the dominant motivational frame, we identified some frame discordance between the global discourse and national level policies.

Conclusions

Social science approaches such as framing analysis are applicable and useful to systematically analyze essential medicine aspects. By applying framing theory, we revealed that ATM aspects in the eight countries we analyzed are more often characterized in relation to availability at the expense of affordability which undermines UHC. We conclude that whilst UHC is a strong motivational frame to guide ATM aspects, it is insufficient to inform a comprehensive approach to address the problems related to ATM at country level. To effectively advance ATM, concerned actors need to realize such limitation and endeavor to gain a deeper understanding of how problems are framed and agendas are set at country level, the processes through which ideas and knowledge become policies, including the political demands, incentives and trade-offs facing decision-makers in selecting policy priorities.

Categorías: Investigaciones

Analysis of factors influencing technical efficiency of public district hospitals in KwaZulu-Natal province, South Africa

Abstract Background

District hospitals are crucial in supporting primary health care and serve as a gateway to more specialist care through a referral system. Majority of South Africans access health care services through the public sector district health system. Given the enormous task assigned to the public district hospital within the country, this study examined factors influencing their technical efficiency.

Method

Data were collected for 38 public district hospitals in KwaZulu-Natal province from 2014/15 to 2016/17. Data envelopment analysis (DEA) was used to determine the technical efficiency of the hospitals, adopting both the constant return to scale (CRS) and variable return to scale (VRS) models. Tobit regression model was used to determine factors related to the technical efficiency of the district hospitals.

Results

This study showed that a significant proportion of the district hospitals were technically inefficient. The Tobit regression model identified catchment population, the proportion of inpatients treated per medical personnel, the proportion of inpatients treated per nursing personnel and expenditure per patient day equivalent as factors influencing technical efficiency of the district hospitals.

Conclusion

Findings from this study suggest that the technical efficiency of the district hospitals can be enhanced through an effective referral system and improved peoples’ health-seeking behaviour. In addition, a standard mix of clinical staff toward efficient service delivery and periodic cost analysis of health services with the view to saving cost and maintaining the quality of health care should be considered.

Categorías: Investigaciones

Pattern and perception of wellbeing, quality of work life and quality of care of health professionals in Southwest Nigeria

Abstract Background

Personal wellbeing (PW) including quality of life and work life is a very complex concept that influences health professionals’ commitment and productivity. Improving PW may result in positive outcomes and good quality of care. Therefore, this study aimed to assess the pattern and perception of wellbeing, quality of work life (QoWL) and quality of care (QoC) of health professionals (HPs) in southwest Nigeria. 

Methods

The study was a convergent parallel mixed method design comprising a cross-sectional survey (1580 conveniently selected participants) and a focus group interview (40 purposively selected participants). Participants’ PW, quality of life (QoL), QoWL, and QoC were assessed using the PW Index Scale, 5-item World Health Organization Well-Being Index, QoWL questionnaire, and Clinician QoC scale, respectively. The pattern of wellbeing, QoWL and quality of care of HPs were evaluated using t-test and ANOVA tests. Binary regression analysis was used to assess factors that could classify participants as having good or poor wellbeing, QoWL, and quality of care of HPs. The qualitative findings were thematically analyzed following two independent transcriptions. An inductive approach to naming themes was used. Codes were assigned to the data and common codes were grouped into categories, leading to themes and subthemes.

Results

Of 1600 administered questionnaires, 1580 were returned, giving a 98.75% response rate. Only 45.3%, 43.9%, 39.8% and 38.4% of HP reported good PW, QoL, QoC and QoWL, respectively; while 54.7%, 56.1%, 60.2% and 61.6% were poor. There were significant gender differences in PW and QoC in favor of females. With an increase in age and years of practice, there was a significant increase in PW, QoWL and QoC. As the work volume increased, there was significant decrease in QoWL. Participants with master's or Ph.D. degrees reported improved QoWL while those with diploma reported better QoC. PWI and QoC were significantly different along the type of appointment, with those who held part-time appointments having the least values. The regression models showed that participant’s characteristics such as age, gender, designation, and work volume significantly classified health professionals who had good or poor QoC, QoWL, PW and QoL. The focus group interview revealed four themes and 16 sub-themes. The four themes were the definitions of QoC, QoWL, and PW, and dimensions of QoC.

Conclusion

More than half of health professionals reported poor quality of work life, quality of life and personal wellbeing which were influenced by personal and work-related factors. All these may have influenced the poor quality of care reported, despite the finding of a good knowledge of what quality of care entails.

Categorías: Investigaciones

Job strain and burnout in Spanish nurses during the COVID-19: resilience as a protective factor in a cross-sectional study

Abstract Background

Nurses are frequently exposed to chronic stress in the workplace generating harmful effects such as job strain and burnout. On the contrary, resilience has been shown to be a beneficial variable. The objective of this study was to analyze the relationship between dimensions of the Job Demand Control-Support model, resilience and burnout in nurses, and examine the mediating role of resilience between job strain and burnout.

Methods

A descriptive, cross-sectional study reported in line with the STROBE guidelines. Active nurses were invited to complete an online questionnaire in September, 2020. With snowball sampling, 1013 nurses, with a mean age of 34.71, filled out the Job Content Questionnaire, the Maslach Burnout Inventory and the Resilience Scale.

Results

The results showed the existence of four groups of professionals based on job strain. The nurses in the “High Strain” group (high demands and low control) showed higher scores in emotional exhaustion and cynicism, while those in the “Active Job” group scored higher in personal realization and resilience. The findings showed that job strain affects burnout in nurses, and this effect is mediated by resilience.

Conclusions

The findings of this study showed that a high level of resilience could exert a fundamental role in ensuring well-being and proper job performance by nurses. Nursing managers should see to the personable variables or competencies that provide and favor an opportunity for nurses to widen and improve their practice, in pursuance of satisfying and responding better to people’s needs and the systems they work for.

Categorías: Investigaciones

How should support for hospital staff during health shocks be improved? A discussion from Japan's experience during the COVID-19 pandemic.

Human resources for health are at the center of healthcare service delivery and play an important role in ensuring the resilience of health systems. Utilizing the results from a case study examining hospital resilience during COVID-19, this article draws on the experience of individual hospital staff during the first and second waves of the pandemic, briefly describes government responses to support human resources for health during the early stages of the pandemic, and argues the importance of constructive discussions about strategies to create an enabling work environment for healthcare providers, both clinical and non-clinical, during future health shocks.
Categorías: Investigaciones

Associations between sociodemographic factors and receiving "ask and advise" services from healthcare providers in India: analysis of the national GATS-2 dataset

Abstract Background

India is home to about 12% of the world's tobacco users, with about 1.35 million tobacco-related deaths each year. The morbidity and mortality rates are socially patterned based on gender, rural vs. urban residence, education, and other factors. Following the World Health Organization's guidance, it is critical to offer tobacco users support for cessation as a complement to policy and environmental changes. Such guidance is typically unavailable in low-resource systems, despite the potential for population-level impact. Additionally, service delivery for tobacco control tends to be patterned by sociodemographic factors. To understand current activity in this area, we assessed the percentage of daily tobacco users being asked about tobacco use and advised to quit by a healthcare provider. We also examined social patterning of receipt of services (related to by rural vs. urban residence, age, gender, education, caste, and wealth).

Methods

We analyzed cross-sectional data from India's 2016-2017 Global Adult Tobacco Survey (GATS-2), a nationally representative survey. Among 74,037 respondents, about 25% were daily users of smoked and/or smokeless tobacco. We examined rates of being asked and advised about tobacco use overall and based on rural vs. urban residence, age, gender, education, caste, and wealth. We also conducted multivariate logistic regression to assess the association of demographic and socioeconomic conditions with participants' receipt of “ask and advise” services.

Results

Nationally, among daily tobacco users, we found low rates of individuals reporting being asked about tobacco use or advised to quit by a healthcare provider (22% and 19%, respectively). Being asked and advised about tobacco use was patterned by age, gender, education, caste, and wealth in our final regression model.

Conclusions

This study offers a helpful starting point in identifying opportunities to address a critical service delivery gap in India. Given the existing burden on the public health and health systems, scale-up will require innovative, resource-appropriate solutions. The findings also point to the need to center equity in the design and scale-up of tobacco cessation supports so that marginalized and underserved groups will have equitable access to these critical services.

Categorías: Investigaciones

Geographic inequalities in health intervention coverage – mapping the composite coverage index in Peru using geospatial modelling

Abstract Background

The composite coverage index (CCI) provides an integrated perspective towards universal health coverage in the context of reproductive, maternal, newborn and child health. Given the sample design of most household surveys does not provide coverage estimates below the first administrative level, approaches for achieving more granular estimates are needed. We used a model-based geostatistical approach to estimate the CCI at multiple resolutions in Peru.

Methods

We generated estimates for the eight indicators on which the CCI is based for the departments, provinces, and areas of 5 × 5 km of Peru using data from two national household surveys carried out in 2018 and 2019 plus geospatial covariates. Bayesian geostatistical models were fit using the INLA-SPDE approach. We assessed model fit using cross-validation at the survey cluster level and by comparing modelled and direct survey estimates at the department-level.

Results

CCI coverage in the provinces along the coast was consistently higher than in the remainder of the country. Jungle areas in the north and east presented the lowest coverage levels and the largest gaps between and within provinces. The greatest inequalities were found, unsurprisingly, in the largest provinces where populations are scattered in jungle territory and are difficult to reach.

Conclusions

Our study highlighted provinces with high levels of inequality in CCI coverage indicating areas, mostly low-populated jungle areas, where more attention is needed. We also uncovered other areas, such as the border with Bolivia, where coverage is lower than the coastal provinces and should receive increased efforts. More generally, our results make the case for high-resolution estimates to unveil geographic inequities otherwise hidden by the usual levels of survey representativeness.

Categorías: Investigaciones

Closing human resources gap in health: Moving beyond production to proactive recruitments.

Human Resources for Health (HRH) plays an integral role in healthcare service delivery. Gap in HRH has been a major concern with our healthcare ecosystem for a long time. It is vital to have adequately staffed public healthcare facilities, which are freely accessible to the population. To understand the reasons, we looked at the production, availability, and vacancies of HRH existing in public sector as well as measures taken for closing HRH gap during the period 2014-2015 to 2019-2020 and best practices adopted by the some of the State/UTs. We relied on official websites and official reports/statistics. While teaching capacity has increased significantly in recent past, and there are sufficient numbers of registered HRH, it has not translated into the recruitment of HRH in public facilities. Measures like campus placement, assured career progression, efficient and transparent recruitment process, modern and responsive HR management system, financial and non-financial incentives and notification of the vacant posts can play a vital role in filling the existing gaps. Some of the states have taken proactive measures for filling the vacancies, which can be replicated. The vacancies need to be filled in a mission mode. States also need to sanction required posts as per the norms. The ratio between different categories of healhtcare staff should be taken into consideration while sanctioning posts for these cadres. Availability of HRH in public sector as per norms would contribute toward achieving Sustainable Development Goal-3, reducing out of pocket expenditure and bring enormous socioeconomic gains.
Categorías: Investigaciones

House officers’ specialist career choices and motivators for their choice– a sequential mixed-methods study from Malaysia

Abstract Purpose

Shortage and maldistribution of medical specialists hamper healthcare quality. The specialist career choices of house officers determines the future composition of healthcare systems. We studied house officers’’ specialist career choices and motivators for their choice.

Participants and methods

We conducted online in-depth interviews among seven house officers using an interview guide developed based on a literature review. The transcripts were analyzed. Major themes were identified. A 33-item questionnaire was developed, and the main and sub-themes were identified as motivators for specialist career choice. An online survey was done among 185 house officers. Content validation of motivators for specialist choice was done using exploratory factor analysis. First, second and third choices for a specialist career were identified. Multinomial logistic regression analyses were done to determine the socio-demographic factors and motivators associated with the first choice.

Results

HOs perceived that specialist training opportunities provide a wide range of clinical competencies through well-structured, comprehensive training programs under existing specialist training pathways. Main challenges were limited local specialist training opportunities and hurdles for ‘on-contract’ HO to pursue specialist training. Motivators for first-choice specialty were related to ‘work schedule’, ‘patient care characteristics’, ‘specialty characteristics’, ‘personal factors’, ‘past work experience’, ‘training factors’, and ‘career prospects.’ House officers’ first choices were specialties related to medicine (40.5%), surgery (31.5%), primary care (14.6%), and acute care (13.5%). On multivariate analysis, “younger age”, “health professional in the family”, “work schedule and personal factors”, “career prospects” and “specialty characteristics” were associated with the first choice.

Conclusions

Medical and surgical disciplines were the most preferred disciplines and their motivators varied by individual discipline. Overall work experiences and career prospects were the most important motivators for the first-choice specialty. The information about motivational factors is helpful to develop policies to encourage more doctors to choose specialties with a shortage of doctors and to provide career specialty guidance.

Categorías: Investigaciones

Financing care for Severe Stigmatizing Skin Diseases (SSSDs) in Liberia: challenges and opportunities

Abstract Introduction

Neglected tropical diseases (NTDs) are an important global health challenge, however, little is known about how to effectively finance NTD related services. Integrated management in particular, is put forward as an efficient and effective treatment modality. This is a background study to a broader health economic evaluation, seeking to document the costs of integrated case management of NTDs versus standard care in Liberia. In the current study, we document barriers and facilitators to NTD care from a health financing perspective.

Methods

We carried out key informant interviews with 86 health professionals and 16 national health system policymakers. 46 participants were active in counties implementing integrated case management and 40 participants were active in counties implementing standard care. We also interviewed 16 patients and community members. All interviews were transcribed and analysed using the thematic framework approach.

Findings

We found that decentralization for NTD financing is not yet achieved – financing and reporting for NTDs is still centralized and largely donor-driven as a vertical programme; government involvement in NTD financing is still minimal, focused mainly on staffing, but non-governmental organisations (NGOs) or international agencies are supporting supply and procurement of medications. Donor support and involvement in NTDs are largely coordinated around the integrated case management. Quantification for goods and budget estimations are specific challenges, given the high donor dependence, particularly for NTD related costs and the government’s limited financial role at present. These challenges contribute to stockouts of medications and supplies at clinic level, while delays in payments of salaries from the government compromise staff attendance and retention. For patients, the main challenges are high transportation costs, with inflated charges due to fear and stigma amongst motorbike taxi riders, and out-of-pocket payments for medication during stockouts and food/toiletries (for in-patients).

Conclusion

Our findings contribute to the limited work on financing of SSSD services in West African settings and provide insight on challenges and opportunities for financing and large costs in accessing care by households, which is also being exacerbated by stigma.

Categorías: Investigaciones

A Odontologia na Residência Multiprofissional em Saúde: experiência da formação na rede de atenção à saúde

Search "Educación Interprofesional" - Lun, 07/11/2022 - 05:07
A Residência Multiprofissional em Saúde, modalidade de pós-graduação lato sensucom formação em serviço e duração de dois anos, permite a articulação de conhecimentos específicos, comuns e de trabalho em equipe, para o alcance do cuidado integral e humanizado ao usuário e comunidade. Esse artigo tem por objetivo relatar a experiência de formação em serviço na área de Odontologia de um Programa de Residência Multiprofissional em Atenção Integral à Saúde na Rede de Atenção à Saúde Bucal. O programa de residência, tem carga horária semanal de 60 horas, envolve atividades teóricas e práticas de ensino divididas em eixos transversais, comum às diferentes áreas, e específico para cada profissão, sendo 60% da carga horária na atenção primária, 20% na atenção secundária e 20% naatenção terciária, em diferentes cenários de prática da rede de atenção à saúde bucal. Conta com 36 residentes multiprofissionais, dentre esses, 6 cirurgiões-dentistas. Nos módulos teóricos, específico e comum, utilizaram-se metodologias ativas e ambientevirtual de aprendizagem para discussão teórica, e a tutoria de campo deu subsídios ao desenvolvimento de práticas interprofissionais colaborativas e à organização do processo de trabalho na atenção primária. A integração com diferentes áreas da saúde e a reflexão e problematização das práticas tem potencializado o trabalho em equipe, visando àintegralidade do cuidado em saúde. Essa modalidade de formação para a área da Odontologia tem se mostrado importante para o desenvolvimento de habilidades e competências colaborativas dos cirurgiões-dentistas e qualificação do Sistema Único de Saúde (AU). The Multiprofessional Residency in Health, a two-year lato sensupost-graduate program with training in service, allows the articulation of specific, common and teamwork knowledge, to achieve comprehensive and humanized care to the user and community. This article aims to report the experience of in-service training inthe field of Dentistry of a Multiprofessional Residency Program in Integral Health Care in the Oral Health Care Network. The residency program, with weekly workload of 60 hours, involves theoretical and practical teaching activities divided into transversal axes, common to different areas, and specific for each profession, being 60% of the workload in primary care, 20% in secondary care and 20% in tertiary care, in different scenarios of practice of the oral health care network. It has 36 multiprofessionalresidents, including 6 dentists. In the theoretical, specific and common modules, active methodologies and virtual learning environment were used for theoretical discussion, and field mentorship support the development of collaborative interprofessional practices and the organization of the work process in primary care. The integration with different areas of health, and reflecting on and problematizing practices, enhanced teamwork aiming at a comprehensive health care. This modality of training for the area of Dentistry has proved important for the development of collaborative skills and competences of dentists and qualification of the Unified Health System (AU).

Estágio Comunitário Interprofissional na formação do estudante de Odontologia: relato de experiência da Universidade Federal de Goiás

Search "Educación Interprofesional" - Lun, 07/11/2022 - 05:07
O Sistema Único de Saúde configura-se como um potente cenário de atuação e campo de formação interprofissional, principalmente,no que se refere aos estágios supervisionados. Esse relato de experiência (RE) tem como objetivo descrever o processo de construção do Estágio Comunitário Interprofissional (ECI) da Universidade Federal de Goiás na perspectiva da formação do cirurgião-dentista. A construção parte das experiências vivenciadas e refletidas pelas autoras/sujeitos do RE: as professoras do estágio em cada curso (enfermagem, nutrição, medicinae odontologia) e a coordenadora da integração ensino-serviço-comunidade do campus do município onde ocorre o estágio. Foram ainda consultados os planos de ensino e projetos pedagógicos dos cursos envolvidos, as memórias das oficinas avaliativas realizadas ao longo do estágioe o Manual do Estágio Comunitário. O contexto do ECI, o processo ensino-aprendizagem na formação interprofissional do estudante de odontologia, a busca da sustentabilidade do estágio e a potencialidade da aprendizagem informal são apresentados e discutidos. Considera-se os avanços históricos alcançados no percurso do ECI e os dispositivos que favorecem tais mudanças na perspectiva da educação e prática interprofissional, além dos potenciais pontos de evolução do estágio para garantir a formação integral do cirurgião-dentista, no que tange às competências colaborativas (AU). The Unified Health System (SUS) in Brazil is a powerful scenario for action and a field of interprofessional education, particularly with regard to supervised internships. This experiencereport (ER) describes the structure of the interprofessional community internship (ICI) at the Federal Universityof Goiás from the perspective of dental education. The articleis based on the experiences and reflectionsofthe authorsand subjectsof the ER: the faculty of each study program (Dentistry, Medicine, Nursing, and Nutrition) and the coordinator for the integration of teaching, service, and community on the campus where the internshiptakes place. The pedagogical projects and teaching plans of the participating programs, the evaluation workshops during the internship, and the community internship manualwere also consulted.The ICI context, the learning process in interprofessional dental student education, the sustainability of the internship, and the potential of informal learning are presented and discussed. The historical advances made during the ICIand the means by which such changes in the perspective of education and interprofessional practice are fostered, as well as the potential points of development of the internshipto ensure the holistic education of dental studentsin terms of collaborativeskills, are considered (AU).

Acadêmicos de Odontologia no combate à COVID-19: percepção discente sobre um projeto de extensão interprofissional

Search "Educación Interprofesional" - Lun, 07/11/2022 - 05:07
Esteartigo tem como objetivo relatar a percepção dos discentes de Odontologia quanto sua participação nas ações extensionistas interprofissionais no enfrentamento da pandemia de COVID-19.Para tanto, foi realizado um estudo qualitativo, transversaledescritivo, por meio de roteiro com perguntas abertas e questionário estruturado autoaplicado, enviado para estudantes participantes no Projeto de ExtensãoUniversitária por meio da atenção às divisas rodoviárias do Estado do Paraná e/ou da atuação como atendentes em serviço de telessaúde para enfrentamento da COVID-19 (Central de Informações COVID-19) e/ou na Farmácia Especial do Estado do Paraná. A análise dos relatos foi realizada por meio do Discurso do Sujeito Coletivo. Todos os estudantesde Odontologia que participaram do projetoaceitaram responder a essa pesquisa. Foram identificadas como principais contribuições do Projeto de Extensão para a sua formação a obtenção de novos conhecimentos, a oportunidade de atuação interprofissional, a aplicação prática dos conhecimentos teóricos, o aprendizado técnico-científico, a promoção de acolhimento, da escuta qualificada e de atendimento humanizado. Deste modo, conclui-se que está atendendo às diretrizes para a Extensão na Educação Superior Brasileira, promovendo a formação integral e cidadã dos estudantes, propiciando a vivência dos seus conhecimentos, de modo interprofissional e interdisciplinar (AU). Thispaper reportsthe perception of Dentistry students concerning their participation in interprofessional extension actions in the management of the COVID-19 pandemic. For that purpose, a qualitative, cross-sectional and descriptive study was performed, using a script with open questions and a self-applied structured questionnaire sent to students participating in the University Extension Project by attention to the road borders of the State of Paraná and/or as attendants in the telehealth service in the management of COVID-19 (COVID-19 Information Center) and/or the Special Pharmacy of the State of Paraná. The reports were analyzed by the Collective SubjectDiscourse. All Dentistry students who participated in the project agreed to respond to this survey. The main contributions of the Extension Project to their training were identified as acquisition of new knowledge, opportunity for interprofessional action, practical application of theoretical knowledge, technical-scientific learning, promotion of reception, qualified listening and humanized care. Thus, it is concluded that the guidelines for Extension in Brazilian Higher Educationare being met, promoting the integral and citizen training of students, providing the experience of their knowledge in an interprofessional and interdisciplinary manner (AU).

Gender composition and wage gaps in the Canadian health policy research workforce in comparative perspective

Abstract Background

Gendered challenges have been shown to persist among health practitioners in countries at all levels of development. Less is known about non-clinical professionals, that is, those who do not deliver services directly but are essential to health systems performance, such as health policy researchers. This national observational study examined gender occupational segregation and wage gaps in the Canadian health policy research workforce using a cross-domain comparative labour market analysis approach.

Methods

Sourcing data from the 2016 population census, we applied linear regression and Oaxaca–Blinder decomposition techniques to assess wage differentials by sex, traditional human capital measures (e.g., age, education, place of work), and social identity variables intersecting with gender (household head, childcare, migrant status) among health policy researchers aged 25–54. We compared the gender composition and wage gap with seven non-health policy and programme domains, as mapped under the national occupational classification by similarity in the types of work performed.

Results

The health policy research workforce (N = 19 955) was characterized by gender segregation: 74% women, compared with 58% women among non-health policy research occupations (N = 102 555). Women health policy researchers earned on average 4.8% (95% CI 1.5‒8.0%) less than men after adjusting for other professional and personal variables. This gap was wider than among education policy researchers with similar gender composition (75% women; adjusted wage gap of 2.6%). Wages among health policy researchers were 21.1% (95% CI 19.4‒22.8%) lower than their counterparts in the male-dominated economics policy domain, all else being equal. Overall, women’s earnings averaged 3.2% lower than men’s due to factors that remained unexplained by policy domain or other measured predictors.

Conclusions

This investigation found that the gender inequalities already widely seen among clinical practitioners are replicated among health policy researchers, potentially hindering the competitiveness of the health sector for attracting and retaining talent. Our findings suggest intersectoral actions are necessary to tackle wage gaps and devaluation of female-dominated health professions. Accountability for gender equity in health must extend to the professionals tasked with conducting equity-informative health policy research.

Categorías: Investigaciones

Examining the variations in the implementation of interventions to address stillbirth from the national to subnational levels: experiences from Uganda

Abstract Background

The current global burden of stillbirth disproportionately affects regions such as sub-Saharan Africa, where Uganda is located. To respond to this burden, policies made at the national level were diffused from the centre and translated into service delivery at the district level, which is charged with implementation under the decentralization of health services arrangement. Variations emerge whenever policy recommendations are moved from national to subnational levels, with some aspects often lost along the way. Tools are available to facilitate knowledge of determinants of policy and innovation implementation within the healthcare system. However, the extent to which these have been applied to explain variations in implementation of interventions to address stillbirth reduction in Uganda remains scant. The aim of this article was to examine the variations in the implementation of interventions to address stillbirth from the national to the subnational levels in Uganda using the Consolidated Framework for Implementation Research (CFIR).

Methods

The study adopted a qualitative case study design. Data were collected from a purposively selected sample of key informants drawn from both the national and subnational levels. All interviews were conducted in English and transcribed verbatim. ATLAS.ti was used to guide the coding process, which used a codebook developed following the CFIR domains as codes and constructs as sub-codes. Analysis followed a content analysis technique.

Results

National-level factors that favoured implementation of interventions to address stillbirth included the desire to comply with global norms, incentives to improve performance for stillbirth reduction indicators for better comparison with global peers, and clear policy alternatives as process implementation advanced by champions. Variations at the subnational level revealed aspirations to address service delivery gaps which fell within maternal health routine standard of care and ongoing health systems strengthening initiatives. Coalescing existing networks around maternal and child health was a key mobilization factor for advocacy and programming, with a promise that the set targets would be operationalized at the subnational level. The key champions were defined by their official roles within the district health systems, which enhanced accountability. Feedback and reflection were distinguished from the national to subnational through joint assemblies and formal audit reviews, respectively.

Conclusions

A heavy influence of the global events directed national-level adaptation of interventions to address stillbirth. Implementation context at the subnational level led to local adaptation and translation of policy provisions from the national level to suit the context, which to a greater extent explains the variations in the final content of policy provisions delivered.

Categorías: Investigaciones

Research and implementation interactions in a social accountability study: utilizing guidance for conducting process evaluations of complex interventions

Abstract Background

In recent years, researchers and evaluators have made efforts to identify and use appropriate and innovative research designs that account for the complexity in studying social accountability. The relationship between the researchers and those implementing the activities and how this impacts the study have received little attention. In this paper, we reflect on how we managed the relationship between researchers and implementers using the United Kingdom Medical Research Council (MRC) guidance on process evaluation of a complex intervention.

Main body

The MRC guidance focuses on three areas of interaction between researchers and stakeholders involved in developing and delivering the intervention: (i) working with program developers and implementers; (ii) communication of emerging findings between researchers/evaluators and implementers; and (iii) overlapping roles of the intervention and research/evaluation. We summarize how the recommendations for each of the three areas were operationalized in the Community and Provider driven Social Accountability Intervention (CaPSAI) Project and provide reflections based on experience. We co-developed various tools, including standard operating procedures, contact lists, and manuals. Activities such as training sessions, regular calls, and meetings were also conducted to enable a good working relationship between the different partners.

Conclusions

Studying social accountability requires the collaboration of multiple partners that need to be planned to ensure a good working relationship while safeguarding both the research and intervention implementation. The MRC guidance is a useful tool for making interaction issues explicit and establishing procedures. Planning procedures for dealing with research and implementers’ interactions could be more comprehensive and better adapted to social accountability interventions if both researchers and implementers are involved. There is a need for social accountability research to include clear statements explaining the nature and types of relationships between researchers and implementers involved in the intervention.

Categorías: Investigaciones

Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education.

Search "Educación Interprofesional" - Mié, 02/11/2022 - 05:03
PURPOSE: Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members' experiences of fulfilling these roles. METHOD: Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby's original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley's 2018 framework informed the analysis. RESULTS: IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics). CONCLUSIONS: This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.

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