Concordance between decision analysis and matching systematic review of randomized controlled trials in assessment of treatment comparisons: a systematic review

BACKGROUND: Systematic review (SR) of randomized controlled trials (RCT) is the gold standard for informing treatment choice. Decision analyses (DA) also play an important role in informing health care decisions. It is unknown how often the results of DA and matching SR of RCTs are in concordance. We assessed whether the results of DA are in concordance with SR of RCTs matched on patient population, intervention, control, and outcomes. METHODS: We searched PubMed up to 2008 for DAs comparing at least two interventions followed by matching SRs of RCTs. Data were extracted on patient population, intervention, control, and outcomes from DAs and matching SRs of RCTs. Data extraction from DAs was done by one reviewer and from SR of RCTs by two independent reviewers. RESULTS: We identified 28 DAs representing 37 comparisons for which we found matching SR of RCTs. Results of the DAs and SRs of RCTs were in concordance in 73% (27/37) of cases. The sensitivity analyses conducted in either DA or SR of RCTs did not impact the concordance. Use of single (4/37) versus multiple data source (33/37) in design of DA model was statistically significantly associated with concordance between DA and SR of RCTs. CONCLUSIONS: Our findings illustrate the high concordance of current DA models compared with SR of RCTs. It is shown previously that there is 50% concordance between DA and matching single RCT. Our study showing the concordance of 73% between DA and matching SR of RCTs underlines the importance of totality of evidence (i.e. SR of RCTs) in the design of DA models and in general medical decision-making

Impact of Telehealth Training on Health Care Providers’ Knowledge in HIV/AIDS Care: A Mixed Methods Evaluation.

Healthcare providers (HCPs) serving HIV-infected patients in rural and underserved areas have limited access to continuing education. A telehealth training programme, Project Extension for Community Healthcare OUtcomes (ECHO), was implemented to enhance knowledge and skills of these HCPs in HIV care. A mixed methods approach including quantitative (multilevel modelling and meta-analysis) and qualitative (thematic analysis) components was used to evaluate the impact of ECHO on HCPs' knowledge. Over three years, 98 training sessions were conducted and 654 HCPs attended. ECHO was associated with an increase in knowledge. Change in HCP knowledge differed within the ECHO sessions, not across sessions. Four HCP-level factors (achievement of self-stated objective for attending the session, amount of time for the session, intention to make practice changes,and number of sessions attended) and one session-level factor (language used in the session) were associated with the change in knowledge. While increasing knowledge, skills and learning were frequently and intensely cited as objectives for attending ECHO, provider-based communication emerged as the key to converting the acquired knowledge into practice. Besides communication, most HCPs expressed intention to improve patient clinical management including linking, engaging, and retaining patients in care. Lack of time to focus on HIV/AIDS care, inadequate skills to convey medical information to patients, and patients' lack of insurance to pay for recommended care emerged as barriers to implementincontent learned. Implications for research are discussed

Strengthening capacity for monitoring and evaluation through short course training in Kenya

Background: Weak monitoring and evaluation (M&E) systems and limited supply of M&E human resources in Africa signal the need to strengthen M&E capacity. Objectives: This exploratory study evaluated the effect of short course training on professionals’ knowledge and skills in the areas of mixed methods research, systematic review and meta-analysis and general principles of M&E. Methods: A partially mixed concurrent dominant status design including quantitative (multilevel modelling and meta-analyses) and qualitative (thematic content analysis) components was employed to evaluate the impact of a 4-day short course training focusing on these areas. Results: Thirty-five participants participated in the training. Participants experienced an increase in knowledge in the three areas; however, average change in knowledge did not differ across participants’ employment settings. Participants’ self-stated objectives considered as SMART and belonging to a higher level in Bloom’s taxonomy were associated with change in knowledge. Based on comments made by participants, majority intended to apply what they learned to their work; clarity of content delivery was the most liked aspect of the training, and the use of more practical sessions was recommended as a way to improve the training. Conclusions: This study provides preliminary evidence of potential of the use of short course training as an approach to strengthening capacity in M&E in less-developed countries such as Kenya. It underscores the importance of participants’ self-stated objective(s) as an element to be considered in the enhancement of knowledge, attitudes and skills needed for acceptable capacity building in M&E

Factors associated with malaria vaccine uptake in Nsanje district, Malawi

Background: Malaria remains a significant global health burden affecting millions of people, children under 5 years and pregnant women being most vulnerable. In 2019, the World Health Organization (WHO) endorsed the introduction of RTS,S/AS01 malaria vaccine as Phase IV implementation evaluation in three countries: Malawi, Kenya and Ghana. Acceptability and factors influencing vaccination coverage in implementing areas is relatively unknown. In Malawi, only 60% of children were fully immunized with malaria vaccine in Nsanje district in 2021, which is below 80% WHO target. This study aimed at exploring factors influencing uptake of malaria vaccine and identify approaches to increase vaccination. Methods: In a cross-sectional study conducted in April–May, 2023, 410 mothers/caregivers with children aged 24–36 months were selected by stratified random sampling and interviewed using a structured questionnaire. Vaccination data was collected from health passports, for those without health passports, data was collected using recall history. Regression analyses were used to test association between independent variables and full uptake of malaria vaccine. Results: Uptake of malaria vaccine was 90.5% for dose 1, but reduced to 87.6%, 69.5% and 41.2% for dose 2, 3, and 4 respectively. Children of caregivers with secondary or upper education and those who attended antenatal clinic four times or more had increased odds of full uptake of malaria vaccine [OR: 2.43, 95%CI 1.08–6.51 and OR: 1.89, 95%CI 1.18–3.02], respectively. Children who ever suffered side-effects following immunization and those who travelled long distances to reach the vaccination centre had reduced odds of full uptake of malaria vaccine [OR: 0.35, 95%CI 0.06–0.25 and OR: 0.30, 95%CI 0.03–0.39] respectively. Only 17% (n = 65) of mothers/caregivers knew the correct schedule for vaccination and 38.5% (n = 158) knew the correct number of doses a child was to receive. Conclusion: Only RTS,S dose 1 and 2 uptake met WHO coverage targets. Mothers/caregivers had low level of information regarding malaria vaccine, especially on numbers of doses to be received and dosing schedule. The primary modifiable factor influencing vaccine uptake was mother/caregiver knowledge about the vaccine. Thus, to increase the uptake Nsanje District Health Directorate should strengthen communities’ education about malaria vaccine. Programmes to strengthen mother/caregiver knowledge should be included in scale-up of the vaccine in Malawi and across sub-Saharan Africa

A Mixed Methods Approach to Examining Factors Related to Time to Attainment of the Doctorate in Education

Over the years, the time that students take to attain the doctorate, particularly in Education, has been increasing. Given the cost incurred in preparing students, the decrease in years of productivity in the chosen professions, and other opportunity costs, this trend is of great concern to students, the university, and society at large. This dissertation examined the timing of doctorate attainment and the factors related to this timing. Using secondary data (N=1,028 students), discrete-time multilevel hazard analysis was employed to determine the relationship between various factors and the timing of doctorate attainment in a College of Education. Complementary to the quantitative analyses, four student and two faculty focus groups and four follow-up student interviews were conducted to identify factors perceived to influence time to attainment of the doctorate (TTD) in one College of Education at a state university. Discrete-time multilevel hazard analysis revealed that the median TTD in Education was 5.8 years; students were most likely to attain the doctorate in the seventh year. In each year during the observation period, students\u27 master\u27s grade point average (GPA) score at admission, percentage of female students in the program, and mean graduate record examination (GRE) quantitative score in the program were each positively associated with the odds of doctorate attainment; whereas the size of the department housing the program was negatively associated with the odds of doctorate attainment. Female students were more likely than males to attain the doctorate in each year during the observation period, however, the difference disappeared when clustering of students into programs was considered. According to students, the way program expectations and requirements are communicated, the nature of the dissertation committee formed, and dissertation topic chosen each had a strong association with TTD. Faculty perceived that whether a student enrolls part-time or full-time, the amount and quality of academic preparation received, and the nature of academic guidance, mentoring and supervision received, each had a strong association with TTD. Both students and faculty concurred that the nature and arrangement of program tasks and resources and the desire to work and attain goals despite obstacles encountered had strong associations with TTD. Implications for policy and practice and suggestions for future research are discussed

Encouraging social innovation for combating poverty : Master's students’ gendered experiences with a service-learning intervention in Kenya and Uganda

Purpose – This study aims to understand master’s students’ experiences of service-learning, following their participation in a workshop with local social innovators whose activities had contributed to combating poverty in East Africa and to determine how this participation affected work on the students’ theses. The authors also explored possible gender differences in this context. Design/methodology/approach – The study was based on pretest–posttest mixed methods research design. Data were collected from master’s students within the social sciences and science, technology, engineering and mathematics (STEM) disciplines, respectively, in Kenya and Uganda, via surveys and interviews before the workshop, immediately afterwards and six months later.Findings -Students’ immediate experience was that the workshop contributed to increased critical awareness, adoption of transdisciplinary community-serving approaches and strengthened self-confidence. Six months later, most had related their projects to social problems (e.g. poverty) in their communities. Moreover, the results motivated integration of gender-sensitive curricula based on service-learning in East Africa.Practical implications - Based on the results, the authors suggest a framework for gender-sensitive curriculum development that can stimulate service-learning in master’s students. Implementation of such a curriculum could eventually contribute to community development, including, e.g. poverty reduction.Originality/value - Studies on service-learning are rare in Africa, especially in postgraduate education. Gender-sensitive studies on service-learning are generally scarce and the same holds for studies on encouraging STEM students to integrate social innovation into their thesis work. By combining these aspects, this study presents an original contribution to existing research