Looking through a social lens: conceptualising social aspects of knowledge management for global health practitioners

Knowledge management plays a critical role in global health. Global health practitioners require knowledge in every aspect of their jobs, and in resource-scarce contexts, practitioners must be able to rely on a knowledge management system to access the latest research and practice to ensure the highest quality of care. However, we suggest that there is a gap in the way knowledge management is primarily utilized in global health, namely, the systematic incorporation of human and social factors. In this paper, we briefly outline the evolution of knowledge management and then propose a conceptualization of knowledge management that incorporates human and social factors for use within a global health context. Our conceptualization of social knowledge management recognizes the importance of social capital, social learning, social software and platforms, and social networks, all within the context of a larger social system and driven by social benefit. We then outline the limitations and discuss future directions of our conceptualization, and suggest how this new conceptualization is essential for any global health practitioner in the business of managing knowledge

Barriers and facilitators of ART adherence in Hawassa town, Southern Ethiopia: A grounded theory approach

Background: Antiretroviral therapy (ART) has the potential to significantly reduce the risk of HIV transmission and the spread of tuberculosis and improve quality of life. Patient’s adherence is crucial to get the best out of ART. As ART is scaled up in Ethiopia, there is a need for better understanding of the factors that influence patients’ adherence to ART and improve the service. This study aims to explore patients’ and health care professionals’ views about factors that facilitate and hinder adherence to ART among adult HIV patients.Methods: A qualitative grounded theory study using non-participant observation; and in-depth interview with 23 ART users and 5 health professionals were carried out at two health facilities that serve a large number of HIVpositive individuals in Hawassa town, Southern Ethiopia. The study was conducted from February to April 2014. Simultaneous data collection and analysis was conducted and taped Notes were transcribed into Amharic then translated into English. The grounded theory approach was used for analyzing the data. The analysis began by using the constant comparison approach. The coding process was preceded by open coding, axial and selective coding. To manage the overall coding process, Atlas.ti (v.7) software was used.Results: The commonest barriers to adherence-included poverty, substance misuse, forgetfulness and being busy, fear of stigma and discrimination, pill burden and medication side effects. The most frequently emerged facilitators to adherence included disclosure of HIV status, using an adherence aid, prospects of living longer, social support, experiencing better health and trusting health workers.Conclusion: The study revealed a range of barriers to adherence including individual, medical, environmental and economic related factors. The findings from our study can be used to inform the development of effective interventions that address the barriers and facilitators of ART adherence in Ethiopia. Priority should be given to improving adherence by alleviating financial constraints to ART adherence, better access to treatment services, education and counseling to tackle culture related obstacles, stigma and discrimination. [Ethiop. J. Health Dev. 2016;30(2):66-77]Keywords: Grounded theory, ART, HIV/AIDS, qualitative researc

A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention

Health communication has played a pivotal role in HIV prevention efforts since the beginning of the epidemic. The recent paradigm of combination prevention, which integrates behavioral, biomedical, and structural interventions, offers new opportunities for employing health communication approaches across the entire continuum of care. We describe key areas where health communication can significantly enhance HIV treatment, care, and prevention, presenting evidence from interventions that include health communication components. These interventions rely primarily on interpersonal communication, especially individual and group counseling, both within and beyond clinical settings to enhance the uptake of and continued engagement in care. Many successful interventions mobilize a network of trained community supporters or accompagnateurs, who provide education, counseling, psychosocial support, treatment supervision, and other pragmatic assistance across the care continuum. Community treatment supporters reduce the burden on overworked medical providers, engage a wider segment of the community, and offer a more sustainable model for supporting people living with HIV. Additionally, mobile technologies are increasingly seen as promising avenues for ongoing cost-effective communication throughout the treatment cascade. A broader range of communication approaches, traditionally employed in HIV prevention efforts, that address community and sociopolitical levels through mass media, school- or workplace-based education, and entertainment modalities may be useful to interventions seeking to address the full care continuum. Future interventions would benefit from development of a framework that maps appropriate communication theories and approaches onto each step of the care continuum to evaluate the efficacy of communication components on treatment outcomes

Factors Associated With Referring Close Contacts to an App With Individually-Tailored Vaccine Information

Background: Infants too young to be fully vaccinated are vulnerable to potentially deadly influenza and pertussis infections. The cocooning strategy limits this risk by vaccinating those likely to interact with the infant and mother during this vulnerable time, such as close friends and family members. Distribution of accurate and accessible vaccine information through existing social networks could be an important tool in increasing vaccine confidence and coverage. Methods: We surveyed 1095 pregnant women from diverse prenatal care practices in Georgia and Colorado. These women were surveyed through a mobile app to assess vaccine intentions, attitudes, beliefs, norms, and levels of trust, and then presented brief individually-tailored educational videos about maternal and infant vaccines and the cocooning strategy. They were then given the opportunity to refer up to six contacts to enroll in the app and receive similar vaccine education. Results: Twenty-eight percent of these women referred at least one contact, with an average of 2.67 contacts per referring woman. Most referrals (93%) were partners, parents, siblings, relatives, or close friends. Attitudinal constructs significantly associated with increased likelihood of referring contacts included: intention to receive maternal influenza vaccine, perceived safety of maternal Tdap vaccine, perceived efficacy of maternal influenza vaccine, perceived susceptibility to and severity of influenza during pregnancy, and trust in vaccine information from the Centers for Disease Control and Prevention (CDC) and academic institutions. Uncertainty about infant vaccine intentions was associated with decreased likelihood of referring contacts. Conclusions: Pregnant women who valued vaccination and trusted vaccine information from academic institutions were more likely to refer an educational app about vaccines than those who did not. Further research is needed to determine the potential impact of this strategy on vaccine coverage when implemented on a large scale. Trial Registration: The survey informing this article was part of a randomized controlled trial funded by the National Institutes of Health [clinicaltrials.gov registration number NCT02898688]

Bridging the gap: evaluating high TB burden country data needs to support the potential introduction of TB vaccines for adolescents and adults: a workshop report

High tuberculosis (TB) burden countries (HBCs) need to prepare for TB vaccine implementation alongside licensure, to ensure rapid rollout. WHO policy/implementation frameworks have been created to support this effort. Using WHO frameworks, we convened a workshop to ask HBC experts about what epidemiological, impact, feasibility and acceptability data they anticipated they would need to guide TB vaccine introduction. For required data, we asked HBC and global experts which data were already available, data collection planned, or gaps. HBC experts expressed high demand for epidemiological, impact, feasibility and acceptability data, reported variable availability of existing epidemiological data, and low availability for impact, feasibility, and acceptability data. Global experts reported additional knowledge of existing data on impact, upcoming collection of infection prevalence, acceptability and feasibility data, and potential epidemiological data collection on adolescents, adults, people living with HIV, and underweight individuals. HBC and global experts made key recommendations for: a coordinated data collation, collection, analysis and sharing system; updating existing HBC health and economic impact estimates and extending impact analyses to other HBCs; demand/market forecasting; resource gap mapping; aligning delivery strategies; addressing manufacturing, procurement, delivery, and regulatory barriers; sharing potential vaccine licensure timing; incorporating TB vaccine introduction strategies into NSPs, immunization programs, and health services; collecting vaccine hesitancy, mistrust, and misinformation data; collecting adolescent/adult vaccine demand generation data, and identifying funding. Experts recommended expanding this analysis to other areas of the WHO frameworks, including more HBC stakeholders, and repeating this analysis after country and community advocacy and socialization around different vaccine candidates

Politicizing public health: the powder keg of rushing COVID-19 vaccines

Vaccine hesitancy is on the rise, as more individuals are delaying or refusing vaccines. This rise in hesitancy has been primarily driven by vaccine safety concerns, even though the vaccine development process is regulated by a robust and rigorous scientific system. Recent data suggest that many individuals would be unwilling to take a COVID-19 vaccine, once one is available. The Trump administration’s Operation Warp Speed aims to deliver a vaccine in the near future, even though no American or European COVID-19 vaccine has yet completed Phase 3 trials. The administration has used the emergency use authorization mechanism to fast track therapeutic products through the Food and Drug Administration and has not ruled out using the mechanism to fast track a COVID-19 vaccine. Perceived political pressure to push a COVID-19 vaccine will have a multitude of negative consequences. Not only will it lead to sub-optimal levels of vaccine acceptance toward a COVID-19 vaccine, it will reverse progress made in controlling vaccine preventable disease for years to come

Vaccine Communication: Appeals and Messengers Most Effective for COVID-19 Vaccine Uptake in Ukraine

Throughout the COVID-19 pandemic, vaccine communication has been a challenge, particularly as some populations may be highly distrustful of information from public health or government institutions. To better understand the different communication needs in Ukraine, an online survey panel of 168 Ukrainian participants viewed six COVID-19 vaccination ads with three variations on vaccine messaging appeals (potential economic impacts of COVID-19 infection COVID-19 disease outcomes, and social norms related to vaccination) and two different messengers (a peer or a health provider). The ad featuring a health outcome appeal delivered by a healthcare provider was most favored (n = 53, 31.6%); however, across demographic categories, including vaccine hesitancy categories, participants expressed high levels of approval for all six variations of the COVID-19 vaccine ads. When participants ranked reasons why someone may not accept the COVID-19 vaccine, the most prevalent beliefs identified were that the vaccine was not safe, and that the vaccine was not effective. Findings from this study suggest that vaccine appeals focused on health outcomes delivered by healthcare providers are preferred by most individuals in Ukraine; however, individuals are motivated by a myriad of factors suggesting that for vaccine messaging to be most effective, communication should be varied in both appeal and messenger

Designing eLearning courses to meet the digital literacy needs of healthcare workers in lower- and middle-income countries: Experiences from the Knowledge for Health Project

Traditional conceptualizations of knowledge management fail to incorporate the social aspects in which knowledge management work operates. Social knowledge management places people at the center of all knowledge management, including placing the end user at the center when developing eLearning packages, particularly within the context of digital health literacy. As many health professionals working in lower-resource settings face the digital divide, or experience unequal patterns of access and usage capabilities from computer-based information and communication technologies (ICTs), ensuring that eLearning packages are tailored for their specific needs is critical. Grounded in our conceptualization of social knowledge management, we outline two of our experiences with developing eLearning packages for health professionals working primarily in lower- and middle-income countries. The Global Health eLearning Center provides eLearning courses to health professionals primarily working in the lower- and middle-income country context. The courses have robust and exhaustive mechanisms in place to ensure that issues related to digital health literacy are not barriers to taking the courses and subsequently, applying the course material in practice. In Bangladesh, we developed a digital health package for frontline community fieldworkers that was loaded on netbook computers. To develop this package, community fieldworkers were provided support during the implementation phase to ensure that they were able to use the netbooks correctly with their clients. As new digital technologies proliferate, guaranteeing that global health workers have the prerequisite skills to utilize and apply digital health tools is essential for improving health care