111 research outputs found
'I don't want anyone to know': Experiences of obtaining access to HIV testing by Eastern European, non-European Union sex workers in Amsterdam, the Netherlands.
Historically, the Netherlands has hosted a large number
of migrant sex workers. Since sex work is considered a legal
profession it might serve as an example of better access to
health services, including HIV testing, at least for those
working within the legal framework. However, migrant sex
workers, especially non-European Union (EU) nationals, might not
be eligible to register for official employment and thus face
obstacles in obtaining access to health services, becoming
essentially invisible. This study examined context-specific
vulnerabilities of migrant female sex workers (FSWs) from
Belarus, Moldova, Russia and Ukraine, whether and how they have
access to HIV testing compared to other EE, non-EU migrant FSWs
in Amsterdam in the Netherlands. We conducted a
multi-stakeholder perspective study from November 2015 to
September 2017 in Amsterdam. The study comprised 1)
semi-structured interviews with key stakeholders (N = 19); 2)
in-depth interviews with Eastern European, non-EU migrant FSWs
(N = 5) and field observations of the escort agency working with
them; and 3) in-depth interviews with key stakeholders (N = 12).
We found six key barriers to HIV testing: 1) migration and
sex-work policies; 2) stigma, including self-stigmatization; 3)
lack of trust in healthcare providers or social workers; 4) low
levels of Dutch or English languages; 5) negative experience in
accessing healthcare services in the home country; and 6) low
perceived risk and HIV-related knowledge. Having a family and
children, social support and working at the licensed sex-work
venues might facilitate HIV testing. However, Internet-based sex
workers remain invisible in the sex-work industry. Our findings
indicate the importance of addressing women's diverse
experiences, shaped by intrapersonal, interpersonal, community,
network and policy-level factors, with stigma being at the core.
We call for the scaling up of outreach interventions focusing on
FSWs and, in particular, migrant FSWs working onlin
Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study
Background: Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories.
Objectives: This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes.
Methods: To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers’ assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program.
Results: Our study results highlighted that while the program designers’ assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered.
Conclusions: Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories
'Virus Carriers' and HIV testing: navigating Ukraine's HIV policies and programming for female sex workers
Background: There are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV.
Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living
with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing
policies among female sex workers in Ukraine and how these policies are understood and implemented in practice.
Methods: To analyse past and current national policies, we searched the database of the Ukrainian Parliament and
the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice
of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured
interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the
Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy
context, actors involved in policy formulation and implementation.
Results: HIV testing policies are formed and implemented in the post-Soviet context through a vertical system of
AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive
testing policies have been strongly influenced by international donors and non-governmental organisations.
Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local
non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had
limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since
the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches
were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a
barrier among FSWs to access testing.
Conclusion: Poor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking
international funding, and persisting stigma towards people living with HIV and sex workers might impede the
continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute
to the development and further implementation of HIV testing policies in Ukraine
Targeting strategies of mHealth interventions for maternal health in low and middle-income countries: a systematic review protocol
INTRODUCTION: Recently, there has been a steady increase in
mobile health (mHealth) interventions aimed at improving
maternal health of women in low-income and middle-income
countries. While there is evidence indicating that these
interventions contribute to improvements in maternal health
outcomes, other studies indicate inconclusive results. This
uncertainty has raised additional questions, one of which
pertains to the role of targeting strategies in implementing
mHealth interventions and the focus on pregnant women and health
workers as target groups. This review aims to assess who is
targeted in different mHealth interventions and the importance
of targeting strategies in maternal mHealth interventions.
METHODS AND ANALYSIS: We will search for peer-reviewed,
English-language literature published between 1999 and July 2017
in PubMed, Web of Knowledge (Science Direct, EMBASE) and
Cochrane Central Registers of Controlled Trials. The study scope
is defined by the Population, Intervention, Comparison and
Outcomes framework: P, community members with maternal or
reproductive needs; I, electronic health or mHealth programmes
geared at improving maternal or reproductive health; C, other
non-electronic health or mHealth-based interventions; O,
maternal health measures including family planning, antenatal
care attendance, health facility delivery and postnatal care
attendance. ETHICS AND DISSEMINATION: This study is a review of
already published or publicly available data and needs no
ethical approval. Review results will be published in a
peer-reviewed journal and presented at international
conferences. PROSPERO REGISTRATION NUMBER: CRD42017072280
What Influences Adolescent Girls' Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh
BACKGROUND: Bangladesh has the highest rate of adolescent
pregnancy in South Asia. Child marriage is one of the leading
causes of pregnancies among adolescent girls. Although the
country's contraceptive prevalence rate is quite satisfactory,
only 52% of married adolescent girls use contraceptive methods.
This qualitative study is aimed at exploring the factors that
influence adolescent girls' decision-making process in relation
to contraceptive methods use and childbearing. METHODS AND
RESULTS: We collected qualitative data from study participants
living in Rangpur district, Bangladesh. We conducted 35 in-depth
interviews with married adolescent girls, 4 key informant
interviews, and one focus group discussion with community health
workers. Adolescent girls showed very low decision-making
autonomy towards contraceptive methods use and childbearing.
Decisions were mainly made by either their husbands or
mothers-in-law. When husbands were unemployed and financially
dependent on their parents, then the mothers-in-law played most
important role for contraceptive use and childbearing decisions.
Lack of reproductive health knowledge, lack of negotiation and
communication ability with husbands and family members, and
mistrust towards contraceptive methods also appeared as
influential factors against using contraception resulting in
early childbearing among married adolescent girls. CONCLUSIONS:
Husbands and mothers-in-law of newly married adolescent girls
need to be actively involved in health interventions so that
they make more informed decisions regarding contraceptive use to
delay pregnancies until 20 years of age. Misunderstanding and
distrust regarding contraceptives can be diminished by engaging
the wider societal actors in health intervention including
neighbours, and other family members
Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden
E-mental health interventions may offer innovative means to increase access to psychological support and improve the mental health of refugees. However, there is limited knowledge about how these innovations can be scaled up and integrated sustainably into routine services. This study examined the scalability of a digital psychological intervention called Step-by-Step (SbS) for refugees in Egypt, Germany, and Sweden. We conducted semi-structured interviews (n = 88) with Syrian refugees, and experts in SbS or refugee' mental health systems in the three countries. Data collection and analysis were guided by a system innovation perspective. Interviewees identified three contextual factors that influenced scalability of SbS in each country: increasing use of e-health, the COVID-19 pandemic, and political instability. Nine factors lay at the interface between the innovation and potential delivery systems, and these were categorised by culture (ways of thinking), structure (ways of organising), and practice (ways of doing). Factors related to culture included: perceived need and acceptability of the innovation. Acceptability was influenced by mental health stigma and awareness, digital trust, perceived novelty of self-help interventions, and attitudes towards non-specialist (e-helper) support. Factors related to structure included financing, regulations, accessibility, competencies of e-helpers, and quality control. Factors related to practice were barriers in the initial and continued engagement of end-users. Many actors with a potential stake in the integration of SbS across the three countries were identified, with nineteen stakeholders deemed most powerful. Several context-specific integration scenarios were developed, which need to be tested. We conclude that integrating novel e-mental health interventions for refugees into routine services will be a complex task due to the many interrelated factors and actors involved. Multi-stakeholder collaboration, including the involvement of end-users, will be essential.
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Stakeholder perceptions on patient-centered care at primary health care level in rural eastern Uganda: A qualitative inquiry
Background:
Patient-centered care (PCC) offers opportunities for African health systems to improve quality of care. Nonetheless, PCC continually faces implementation challenges. In 2015, Uganda introduced PCC as a concept in their national quality improvement guidelines. In order to investigate whether and how this is implemented in practice, this study aims to identify relevant stakeholders’ views on the current quality of primary health care services and their understanding of PCC. This is an important step in understanding how the concept of PCC can be implemented in a resource constrained, sub-Saharan context like Uganda.
Methods: This qualitative study was conducted in Uganda at national, district and facility level, with a focus on three public and three private health centres. Data collection consisted of in-depth interviews (n = 49); focus group discussions (n = 7); and feedback meetings (n = 14) across the four main categories of stakeholders identified: patients/communities, health workers, policy makers and academia. Interviews and discussions explored stakeholder perceptions on the interpersonal aspects of quality primary health care and meanings attached to the concept of PCC. A content analysis of Ugandan policy documents mentioning PCC was also conducted. Thematic content analysis was conducted using NVivo 11 to organize and analyze the data.
Findings and conclusion:
While Ugandan stakeholder groups have varying perceptions of PCC, they agree on the following: the need to involve patients in making decisions about their health, the key role of healthcare workers in that endeavor, and the importance of context in designing and implementing solutions. For that purpose, three avenues are recommended: Firstly, fora that include a wide range of stakeholders may offer a powerful opportunity to gain an inclusive vision on PCC in Uganda. Secondly, efforts need to be made to ensure that improved communication and information sharing–important components of PCC–translate to actual shared decision making. Lastly, the Ugandan health system needs to strengthen its engagement of the transformation from a community health worker system to a more comprehensive community health system. Cross-cutting the entire analysis, is the need to address, in a culturally-sensitive way, the many structural barriers in designing and implementing PCC policies. This is essential in ensuring the sustainable and effective implementation of PCC approaches in low- and middle-income contexts
How to scale-up: a comparative case study of scaling up a district health management strengthening intervention in Ghana, Malawi and Uganda
Background
The need to scale up public health interventions in low- and middle-income countries to ensure equitable and sustainable impact is widely acknowledged. However, there has been little understanding of how projects have sought to address the importance of scale-up in the design and implementation of their initiatives. This paper aims to gain insight into the facilitators of the scale-up of a district-level health management strengthening intervention in Ghana, Malawi and Uganda.
Methods
The study took a comparative case study approach with two rounds of data collection (2019 and 2021) in which a combination of different qualitative methods was applied. Interviews and group discussions took place with district, regional and national stakeholders who were involved in the implementation and scale-up of the intervention.
Results
A shared vision among the different stakeholders about how to institutionalize the intervention into the existing system facilitated scale-up. The importance of champions was also identified, as they influence buy-in from key decision makers, and when decision makers are convinced, political and financial support for scale-up can increase. In two countries, a specific window of opportunity facilitated scale-up. Taking a flexible approach towards scale-up, allowing adaptations of the intervention and the scale-up strategy to the context, was also identified as a facilitator. The context of decentralization and the politics and power relations between stakeholders involved also influenced scale-up.
Conclusions
Despite the identification of the facilitators of the scale-up, full integration of the intervention into the health system has proven challenging in all countries. Approaching scale-up from a systems change perspective could be useful in future scale-up efforts, as it focuses on sustainable systems change at scale (e.g. improving district health management) by testing a combination of interventions that could contribute to the envisaged change, rather than horizontally scaling up and trying to embed one particular intervention in the system
Maternal health care-seeking behaviour of married adolescent girls: A prospective qualitative study in Banke District, Nepal
Background: Nepal has one of the highest rates of maternal mortality in the South Asia region, partly due to the underutilization of maternal health services and the high number of adolescent pregnancies. This study explores married Nepali adolescent girls’ healthcare-seeking behaviour throughout their pregnancies, during their delivery and postpartum.
Methods: We conducted a prospective qualitative study in Banke district, Nepal. In-depth interviews were conducted with 27 married adolescent girls before and after delivery. In addition, a focus group discussion was conducted with community health works and key-informant interviews were conducted with family members of adolescent girls, representatives from the government and health care providers. We applied the Social-Ecological Model (SEM) as a framework to guide thematic content analysis and presentation of our qualitative data. Results: Several factors in the SEM influenced maternal health care-seeking behaviour of adolescents. At the individual level, girls’ perceptions, their lack of knowledge about maternal and reproductive health, certain traditional practices, their sole dependency on their husbands and mothers-in-laws and their low decision-making autonomy towards their own health care negatively influenced their utilization of skilled maternal health services. Mothers-in-law and other family members played a critical role in either encouraging or discouraging the use of skilled maternal health services. At the health systems level, lack of adolescent-friendly maternal health services, difficulties in accessing quality maternal health services, and the fixed operating hours of public health facilities restricted their ability to obtain services. The existence of the Safe Motherhood Programme, knowledge sharing platforms such as “women’s groups” and the active role of Female Community Health Volunteers (FCHVs) positively influenced utilization of skilled maternal health services among these girls. Conclusion: Influences on married adolescent girls’ use of skilled maternal health services in Banke District, Nepal were multi-factoral. Ensuring easy access and availability of adolescent-friendly maternal health services are important to encourage adolescent girls to use skilled maternal health services. Moreover, interventions are needed to improve adolescent girls’ knowledge of maternal health, keep them in school, involve family members (mainly mothers-in-law) in health interventions, as well as overcome negative traditional beliefs within the community that discourage care-seeking for skilled maternal health services
Perceptions of Mental Health and Help-Seeking Behavior in an Urban Community in Vietnam: An Explorative Study
This explorative study assesses perceptions of mental health and help-seeking behavior among adults in Vietnam. Methods included questionnaires (200) and focus group discussions (eight). Respondents were often unable to name specific mental illnesses. Frequently mentioned symptoms of mental illness were talking nonsense, talking/laughing alone and wandering. Pressure/stress and studying/thinking too much were often identified causes. Most respondents showed a preference for medical treatment options, often in combination with family care. The results show that perceptions of mental health and help-seeking behaviour are influenced by a lack of knowledge and a mix of traditional and modern views
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