Management information systems for community based interventions to improve health::Qualitative study of stakeholder perspectives

Abstract Background Community based providers are well place to deliver behavioural interventions to improve health. Good project management and reliable outcome data are needed to efficiently deliver and evaluate such interventions, and Management information systems (MIS) can facilitate these processes. We explored stakeholders perspectives on the use of MIS in community based behavioural interventions. Methods Stakeholders, purposively selected to provide a range of MIS experience in the delivery of community based behavioural interventions to improve health (public health commissioners, intervention service managers, project officers, health researchers and MIS designers), were invited to participate in individual semi-structured interviews. We used a topic guide and encouraged stakeholders to reflect on their experiences.: Interviews were recorded, transcribed and analysed using five steps of Framework analysis. We applied an agreed coding framework and completed the interviews when no new themes emerged. Results We interviewed 15 stakeholders. Key themes identified were: (i) MIS access; (ii) data and its function; (iii) MIS development and updating. Within these themes the different experiences, needs, use, training and expertise of stakeholders and the variation and potential of MIS were evidenced. Interviews advised the need to involve stakeholders in MIS design and development, build-in flexibility to accommodate MIS refinement and build on effective MIS. Conclusions Findings advised involving stakeholders, early in the design process. Designs should build on existing MIS of proven utility and ensure flexibility in the design, to incorporate adaptations and ongoing system development in response to early MIS use and evolving stakeholder needs

Macroclimatic change expected to transform coastal wetland ecosystems this century

Coastal wetlands, existing at the interface between land and sea, are highly vulnerable to climate change1,2,3. Macroclimate (for example, temperature and precipitation regimes) greatly influences coastal wetland ecosystem structure and function4,5. However, research on climate change impacts in coastal wetlands has concentrated primarily on sea-level rise and largely ignored macroclimatic drivers, despite their power to transform plant community structure6,7,8,9,10,11,12 and modify ecosystem goods and services5,13. Here, we model wetland plant community structure based on macroclimate using field data collected across broad temperature and precipitation gradients along the northern Gulf of Mexico coast. Our analyses quantify strongly nonlinear temperature thresholds regulating the potential for marsh-to-mangrove conversion. We also identify precipitation thresholds for dominance by various functional groups, including succulent plants and unvegetated mudflats. Macroclimate-driven shifts in foundation plant species abundance will have large effects on certain ecosystem goods and services5,14,15,16. Based on current and projected climatic conditions, we project that transformative ecological changes are probable throughout the region this century, even under conservative climate scenarios. Coastal wetland ecosystems are functionally similar worldwide, so changes in this region are indicative of potential future changes in climatically similar regions globally