153 research outputs found
Factors associated with homelessness among women:A cross-sectional survey of outpatient mental health service users at the Banyan, India
Background Homelessness has multifaceted and damaging effects on women with mental illness. This makes it imperative to identify and address the factors leading to homelessness among women with mental illness in order to inform policy on providing relevant services for this vulnerable population. Method A cross-sectional survey was conducted among 346 women in active contact with one of four outpatient clinics at The Banyan, a non-profit organization in the Indian state of Tamil Nadu. A semi-structured instrument and modified version of the List of Threatening Experiences Questionnaire was used for data collection. Multivariate logistic regression analysis was used to examine predictive variables for homelessness among women with mental illness. Result 32.65% of participants reported a history of homelessness. Less than 5 years of schooling (OR = 2.914, 95% CI = 1.027-8.269, P < 0.05) and disrupted relationships (OR = 1.807, 95% CI = 1.23-2.655, P < 0.01) were associated with a greater likelihood of women with mental illness to experience homelessness. Conclusion In the study cohort, this was explained mainly by factors rooted in gender-based disadvantage. Further practice and research are needed to develop interventions that address issues with a sociological basis to mental illness and prevent these predictive factors
An evaluation of self-management outcomes among chronic care patients in community home-based care programmes in rural Malawi: A 12-month follow-up study.
"This paper investigates the impact of community
home-based care (CHBC) on self-management outcomes for
chronically ill patients in rural Malawi. A pre- and
post-evaluation survey was administered among 140 chronically
ill patients with HIV and non-communicable diseases, newly
enrolled in four CHBC programmes. We translated, adapted and
administered scales from the Stanford Chronic Disease
Self-Management Programme to evaluate patient's self-management
outcomes (health status and self-efficacy), at four time points
over a 12-month period, between April 2016 and May 2017. The
patient's drop-out rate was approximately 8%. Data analysis
included descriptive statistics, tests of associations,
correlations and pairwise comparison of outcome variables
between time points, and multivariate regression analysis to
explore factors associated with changes in self-efficacy
following CHBC interventions. The results indicate a reduction
in patient-reported pain, fatigue and illness intrusiveness,
while improvements in general health status and quality of life
were not statistically significant. At baseline, the
self-efficacy mean was 5.91, which dropped to 5.1 after
12\xC2\xA0months. Factors associated with this change included
marital status, education, employment and were
condition-related; whereby self-efficacy for non-HIV and
multimorbid patients was much lower. The odds for self-efficacy
improvement were lower for patients with diagnosed conditions of
longer duration. CHBC programme support, regularity of contact
and proximal location to other services influenced
self-efficacy. Programmes maintaining regular home visits had
higher patient satisfaction levels. Our findings suggest that
there were differential changes in self-management outcomes
following CHBC interventions. While self-management support
through CHBC programmes was evident, CHBC providers require
continuous training, supervision and sustainable funding to
strengthen their contribution. Furthermore, sociodemographic and
condition-related factors should inform the design of future
interventions to optimise outcomes. This study provides a
systematic evaluation of self-management outcomes for a
heterogeneous chronically ill patient population and highlights
the potential and relevant contribution of CHBC programmes in
improving chronic care within sub-Saharan Africa.
Context matters: a qualitative study of the practicalities and dilemmas of delivering integrated chronic care within primary and secondary care settings in a rural Malawian district
Background: With the increasing double burden of communicable and non-communicable diseases (NCDs) in subSaharan Africa, health systems require new approaches to organise and deliver services for patients requiring longterm care. There is increasing recognition of the need to integrate health services, with evidence supporting
integration of HIV and NCD services through the reorganisation of health system inputs, across system levels. This
study investigates current practices of delivering and implementing integrated care for chronically-ill patients in
rural Malawi, focusing on the primary level.
Methods: A qualitative study on chronic care in Phalombe district conducted between April 2016 and May 2017,
with a sub-analysis performed on the data following a document analysis to understand the policy context and
how integration is conceptualised in Malawi; structured observations in five of the 15 district health facilities,
selected purposively to represent different levels of care (primary and secondary), and ownership (private and
public). Fifteen interviews with healthcare providers and managers, purposively selected from the above facilities.
Meetings with five non-governmental organisations to study their projects and support towards chronic care in
Phalombe. Data were analysed using a thematic approach and managed in NVivo.
Results: Our study found that, while policies supported integration of various disease-specific programmes at point
of care, integration efforts on the ground were severely hampered by human and health resource challenges e.g.
inadequate consultation rooms, erratic supplies especially for NCDs, and an overstretched health workforce. There
were notable achievements, though most prominent at the secondary level e.g. the establishment of a combined
NCD clinic, initiating NCD screening within HIV services, and initiatives for integrated information systems. Conclusion: In rural Malawi, major impediments to integrated care provision for chronically-ill patients include the
frail state of primary healthcare services and sub-optimal NCD care at the lowest healthcare level. In pursuit of
integrative strategies, opportunities lie in utilising and expanding community-based outreach strategies offering
multi-disease screening and care with strong referral linkages; careful task delegation and role realignment among
care teams supported with proper training and incentive mechanisms; and collaborative partnership between
public and private sector actors to expand the resource-base and promoting cross-programme initiatives
Patientâprovider perspectives on selfâmanagement support and patient empowerment in chronic care: A mixedâmethods study in a rural subâSaharan setting
Aim: To explore how provision of selfâmanagement support to chronicallyâill patients
in resourceâlimited settings contributes to patient empowerment in chronic care.
Design: Concurrent descriptive mixed methods research.
Methods: A survey of 140 patients with chronic conditions administered at four
timeâpoints in 12 months. We conducted 14 interviews and four focusâgroup discusâ
sions with patients (N = 31); 13 healthcare provider interviews; and observations of
four patientâsupport group meetings. Data were collected between April 2016 â May
2017 in rural Malawi. Qualitative data were analysed using a thematic approach and
descriptive statistical analysis performed on survey data.
Results: Healthcare professionals facilitated patient empowerment through health
education, although literacy levels and environmental factors affected selfâmanageâ
ment guidance. Information exchanged during patientâprovider interactions varied
and discussions centred around medical aspects and health promoting behaviour.
Less than 40% of survey patients prepared questions prior to clinic consultations.
Health education was often unstructured and delegated to nonâphysician providers,
mostly untrained in chronic care. Patients accessed psychosocial support from volâ
unteerâled community homeâbased care programmes. HIV supportâgroups regularly
interacted with peers and practical skills exchanged in a supportive environment,
reinforcing patient's selfâmangement competence and proactiveness in health care.
Conclusion: For optimal selfâmanagement, reforms at interâpersonal and organizaâ
tional level are needed including; mutual patientâprovider collaboration, diversifying
access to selfâmanagement support resources and restructuring patient supportâ
groups to cater to diverse chronic conditions.Impact: Our study provides insights and framing of selfâmanagement support and
empowerment for patients in longâterm care in subâSaharan Africa. Lessons drawn
could feed into designing and delivering responsive chronic care interventions
Recommended from our members
Comparative assessment of medicine procurement prices in the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)
Objectives: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), the main primary healthcare provider for 4.9 million Palestinian refugees, spent USD18.3 million on essential medicines dispensed free-of-charge through clinics in five areas of operation (âfieldsâ): Gaza, Jordan, Lebanon, Syria, and the West Bank (2010). Faced with budget contraints and an increasing demand for medicines to treat chronic conditions, the objective of our study was to assess UNRWAâs medicine procurement prices to see if savings could be possible. Methods: In July 2011, data was collected from UNRWA headquarters in Jordan. Price analyses focused on the top 80 medicines by value, accounting for 93% of pharmaceutical expenditure from the General Fund, with comparisons to international, regional and national references. Prices were also compared for the few medicines procured both through UNRWAâs central tender (centrally) and by the fields directly (locally). Results: Central procurement prices did not differ markedly from reference prices: median ratios of UNRWA prices to Management Sciences for Healthâs International Drug Price Indicator Guide, Jordanâs Joint Procurement Department, Gulf Cooperation Council, and IDA Foundation bulk packs were 0.99, 1.00, 0.98 and 1.12 respectively. Applying the lowest comparator price to five comparatively higher priced medicines would yield savings of USD1.4 million. Local procurements were generally less cost-effective than central tender procurement, with notable differences across fields and medicines. Conclusions: Overall, UNRWAâs procurement prices were competitive despite the relatively small quantities procured. Regular monitoring of procurement prices and quantities is needed in order to make informed decisions. Our evaluation also underscores the heavy burden of antidiabetic medicines and antimicrobials on UNRWA procurement expenditure
Critical discourse analysis of perspectives on knowledge and the knowledge society within the Sustainable Development Goals
Critical discourse analysis (CDA) is employed to analyze discourses of knowledge and the knowledge society in the Sustainable Development Goals (SDGs). Discourse analysis is a collective name for a number of scientific methodologies for analyzing semiosis, namely how meaning is created and communicated though written, vocal or sign language. Employing a genealogical approach which locates discourses in the field of prior discourses, two prior discourses of the knowledge society are identified in the key document of the SDGs. The concepts knowledge and knowledge society are found to have a marginal position within the main policy document âTransforming our world,â adopted by the United Nations in September 2015. The technoâscientificâeconomic discourse is found to be dominant at the level of implementation and of goals, while there is some evidence of the pluralistâparticipatory discourse at the level of vision and strategy. Analysis of some of the policy advice provided by international organizations and civil society indicates that more pluralistâparticipatory discourses on knowledge were represented when the SDGs were being formulated. Developed countries and the corporate sector were very influential in determining the final text and were probably instrumental in excluding more transformational discourses and maintaining the status quo
An evaluation of self-management outcomes among chronic care patients in community home-based care programmes in rural Malawi: a 12-month follow-up study.
HEARD, 2021.This paper investigates the impact of community home-based care (CHBC) on self-management outcomes for chronically ill patients in rural Malawi. A pre- and post-evaluation survey was administered among 140 chronically ill patients with HIV and
non-communicable diseases, newly enrolled in four CHBC programmes. We translated, adapted and administered scales from the Stanford Chronic Disease Self-Management Programme to evaluate patient's self-management outcomes (health status and self-efficacy), at four time points over a 12-month period, between April 2016 and May 2017. The patient's drop-out rate was approximately 8%. Data analysis included descriptive statistics, tests of associations, correlations and pairwise comparison of outcome variables between time points, and multivariate regression analysis to explore factors associated with changes in self-efficacy following CHBC interventions. The results indicate a reduction in patient-reported pain, fatigue and illness intrusiveness, while improvements in general health status and quality of life were not statistically significant. At baseline, the self-efficacy mean was 5.91, which dropped to 5.1 after 12 months. Factors associated with this change included marital status, education, employment and were condition-related; whereby self-efficacy for non-HIV and multimorbid patients was much lower. The odds for self-efficacy improvement were lower for patients with diagnosed conditions of longer duration. CHBC programme support, regularity of contact and proximal location to other services influenced self-efficacy. Programmes maintaining regular home visits
had higher patient satisfaction levels. Our findings suggest that there were differential changes in self-management outcomes following CHBC interventions. While self-management support through CHBC programmes was evident, CHBC providers require continuous training, supervision and sustainable funding to strengthen their contribution. Furthermore, sociodemographic and condition-related factors should inform the design of future interventions to optimise outcomes. This study provides a systematic evaluation of self-management outcomes for a heterogeneous chronically ill patient population and highlights the potential and relevant contribution of CHBC programmes in improving chronic care within sub-Saharan Africa
Moving to a strong(er) community health system: analysing the role of community health volunteers in the new national community health strategy in Malawi
Since the Alma Ata Declaration in 1978, community health
volunteers (CHVs) have been at the forefront, providing
health services, especially to underserved communities,
in low-income countries. However, consolidation of
CHVs position within formal health systems has proved
to be complex and continues to challenge countries, as
they devise strategies to strengthen primary healthcare.
Malawiâs community health strategy, launched in 2017,
is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen
service delivery through a team-based approach. The
core community health team (CHT) consists of health
surveillance assistants (HSAs), clinicians, environmental
health officers and CHVs. This paper reviews Malawiâs
strategy, with particular focus on the interface between
HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key
challenges that may impede the strategyâs implementation:
(1) inadequate training, imbalance of skill sets within
CHTs and unclear job descriptions for CHVs; (2) proposed
community-level interventions require expansion of preexisting roles for most CHT members; and (3) district
authorities may face challenges meeting financial
obligations and filling community-level positions. For
effective implementation, attention and further deliberation
is needed on the appropriate forms of CHV support, CHT
composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review
of CHT competencies and workload, strengthening
coordination and communication across all community
actors, and financing mechanisms. Policy support through
the development of an addendum to the strategy, outlining
opportunities for task-shifting between CHT members,
CHVsâ expected duties and interactions with paid CHT
personnel is recommended
Reliving, Replaying Lived Experiences Through Auditory Verbal Hallucinations: Implications on Theories and Management
Objective: This study aims to understand the impact of negative life experience (NLE) in auditory hallucinations (AHs) and explain the heterogeneity in phenomenology of auditory verbal hallucinations (AVHs).Method: In depth interviews were conducted with 21 individuals (7 males and 14 females) experiencing AHs and accessing mental health treatment services at a not-for-profit organization. Maximum variation purposive sampling technique was used to select the sample to ensure variegation is accounted for and was collected until saturation of themes data was obtained.Results: Various different forms and functions of hallucinations are obtained with an evident pattern that links voices back to the NLE of the individual. Implications for therapeutic methods focusing on distress arising from said NLE is emphasized.Conclusions: The results obtained from this study implicate NLEs as a contributing factor in the development and maintenance of hallucinations. Sociocultural factors act as a catalyst with psychological factors creating distress and contributing to the voice-hearing experience. Treatment strategies must thus focus on content of voices and past experiences of the individual to promote recovery. A model toward conceptualization of the diversity in phenomenology is put forth
The role of social cohesion in the implementation and coverage of a mass drug administration trial for malaria control in the Gambia: An in-depth comparison of two intervention villages.
Mass drug administration (MDA), used increasingly in malaria eradication efforts, involves administering medication to an entire target population regardless of individual-level disease status. This strategy requires high levels of coverage and compliance. Previous studies have assessed individual and structural factors affecting MDA coverage, but there is a need to better understand the influence and expressions of community dynamics and social structures, such as social cohesion. We conducted a social science study concurrent to an MDA clinical trial for malaria control in The Gambia; ethnographic research was conducted prior to, throughout, and between MDA implementation July-November 2018, January-March 2019, and July-November 2019. We assessed how social cohesion, as expressed by the trial population, affects trial coverage through an in-depth ethnographic analysis of two trial villages, using observations, interviews, and focus group discussions with community members who took the trial medication and those who did not. We found that the villages had unique expressions of social cohesion. This was reflected through community participation in the trial implementation and may have affected coverage and compliance. The village with low coverage expressed a form of social cohesion where members followed advice to participate through a hierarchal system but did not actively participate in the MDA or its implementation. The village with high coverage expressed social cohesion as more participatory: individuals took the directive to participate but contextualized the trial implementation to their needs and wants. We analyze these different expressions of social cohesion and the important differences they make for the coverage and compliance levels reached in the two different villages
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