Interventions to provide culturally-appropriate maternity care services: factors affecting implementation

Background The World Health Organization recently made a recommendation supporting ‘culturally-appropriate’ maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women’s use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders’ perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. Methods We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Results Women’s and other stakeholders’ perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups’ access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their families along the continuum of care through pregnancy until after birth. Conclusion Several important factors should be considered and addressed when implementing interventions to provide culturally-appropriate care. These factors reflect more general goals on the international agenda of improving access to skilled maternity care; providing high-quality, respectful care; and community participation

Development of Accident Reduction Factors

The objective of this project is to develop accident reduction factors associated with various types of highway safety improvements. These factors will be used in the cost-optimization procedure to rank safety improvements. The basis of the accident reduction factors developed in this study is a survey of states and a review of literature. The recommended reduction factors are presented in a table which lists the percent reduction in all accidents or specific types of accidents for given types of improvements

Promoting Clean Reliable Energy Through Smart Technologies and Policies: Lessons from Three Distributed Energy Case Studies

Following the blackout of the electric grid in the 1965 it was hypothesized that large central generation would lead to continued reliability problems. More recently, following Hurricane Sandy, there have been additional criticisms of the risks that large centralized electric systems face in terms of system restoration following catastrophic storms. Together these concerns have led some in the electric industry to conclude that bigger is not always better. In 2007, with the passage of the Energy Independence and Security Act, Congress initiated policy support for a smarter more distributed grid. Since then, utilities have begun to experiment with more distributed, micro-scale projects that allow sections of the grid to “island” and serve customers locally during catastrophic power outages. This paper examines three very different approaches to explore the benefits of distributed energy technologies as well as the public policies necessary to promote their vibrant future

Effectiveness of interventions to provide culturally-appropriate maternity care in increasing uptake of skilled maternity care: a systematic review

Addressing cultural factors that affect uptake of skilled maternity care is recognised as an important step in improving maternal and newborn health. This paper describes a systematic review to examine the evidence available on the effects of interventions to provide culturally-appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations’ use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations’ access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognised by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated

Maternity care services and culture: a systematic global mapping of interventions

Background A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps. Methods and Findings Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions. Conclusions The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure the impact of interventions to address cultural factors that affect use of skilled maternity care

Traffic Flow and Safety Evaluation of Fayette County Schools Part II

In cooperation with Fayette County Schools, an evaluation of traffic flow and safety was conducted at school sites in Fayette County. The purpose of this evaluation was to identify potential safety risks currently existing at selected schools, recommend actions to reduce risks, and to decrease traffic congestion in and around school properties. This report is a continuation of the traffic and safety project submitted to Fayette County Schools in September 1996. For this project, three schools were identified by Fayette County Schools as having traffic flow or safety problems that could benefit from detailed evaluation. The three schools were Clays Mill Elementary, Yates Elementary and Dunbar High. The responses to a survey questionnaire were compiled and used in these investigations. An on-site investigation was conducted at these three schools and an evaluation was completed by assessing the current conditions and offering recommendations for improvements. A set of maps was also prepared explaining any changes recommended for each of the school properties

Traffic Flow and Safety Evaluation of Fayette County Schools

In cooperation with Fayette County Schools, an evaluation of traffic flow and safety was conducted at school sites in Fayette County. The purpose of this evaluation was to eliminate potential safety risks currently existing at a number of schools and to reduce traffic congestion in and around school properties. The evaluation was completed in two main phases. First, each school in the district was asked to respond to a survey questionnaire. Second, six schools were identified by Fayette County Schools as having traffic flow or safety problems that could benefit from detailed evaluation. The responses to the survey questionnaire were compiled and used in these investigations. An on-site investigation was conducted at these six schools and an evaluation was completed by assessing the current conditions and offering recommendations for improvements. A set of maps was also prepared explaining any changes recommended for each of the school properties

Detecting Trends in Abundance and Distribution of Seagrasses in Lake Worth Lagoon, Palm Beach County, Florida

Over the past 15 years, seagrass community stability has varied in estuaries throughout Florida. This study sought to model potential patterns of physiochemical parameters and community composition that may correlate with the fluctuation of seagrass populations in Lake Worth Lagoon (LWL), Palm Beach County, FL over time (2007–2019). Seven transects and 4 polygon areas throughout the LWL were established and stratified along a north—south gradient. Sites were sampled annually (May–August) for water quality, seagrass and macroalgal abundance, and community composition. Models developed to explain macrophyte abundance and composition were assessed using Akaike Information Criterion. Interaction between year and site best explained seagrass abundance and community composition in transect and polygon sites. Transect data revealed that seagrass and macroalgae declined after 2012 and continued until barely detected after 2016. This die off was not consistent for all transects and there was site variability in annual dissolved oxygen, nitrate, phosphate, and salinity levels. Polygon sites exhibited a shift in community composition after 2013, initially dominated by seagrass species Syringodium filiforme and Halodule wrightii before transitioning in 2012–2013 to Halophila decipiens and Caulerpa spp. Central lagoon sites transitioned to communities devoid of nearly all vegetative species. The loss of seagrass and the change in community composition could be explained by a transient dry period in 2012 and a subsequent inflow of freshwater. These events (sudden drought followed by an increase in freshwater) likely compounded the stress on the system between 2011–2014, leading to a drastic change in seagrass community