Understanding the Factors That Make Public Participation Effective in Health Policy and Planning: A Realist Synthesis

Although researchers argue for the importance of involving the public in developing health policy, there has been little focus on central research questions – such as what techniques of public participation work, in what circumstances, and why. This paper presents a realist synthesis which identifies and explains the underlying mechanisms and specific contextual factors that lead to effective public participation in health policy and planning. Peer-reviewed, English language literature was searched, which resulted in 77 articles for review and synthesis. This synthesis uncovered the underlying mechanism of ‘political commitment’ that generates public participation effectiveness. The other three possible underlying mechanisms, namely: ‘partnership synergy’, ‘inclusiveness’ and ‘deliberativeness’, were found to potentially provide further explanation on public participation effectiveness for health policy and planning. The findings of this review provide evidence that can be useful to health practitioners and decision-makers to actively involve the public when drafting public health policies and programs and, more importantly, guide them in deciding which strategies to best employ for which contexts

A Systematic Literature Review of Nursing Interventions for Postpartum Depression and their Outcomes

Purpose: This study was conducted to bring together studies on the common nursing interventions for postpartum depression (PPD) and their outcomes. It aims to provide interpretation of relevant findings to help further enhance the nursing care of patients with postpartum depression. Design and Methods: A systematic literature review (SLR) approach was utilized to synthesize studies related to the management of postpartum depression and its outcomes. One hundred five studies (105) were initially retrieved from three online databases. Eventually, fifteen studies were included in this review after the screening process on quality and risk of bias assessments. Codes were identified from the included studies and were clustered into themes. Athematic map was formulated to visualize the interconnections of the nursing interventions for postpartum depression and its outcomes. Findings: Nurses caring for patients with postpartum depression usually practice PPD education, perinatal assessment, PPD counseling, nurse-delivered psychotherapy, providing social support, drug administration, complementary and alternative therapy combined with conventional management, and patient referral. These nursing practices for postpartum depression yielded the following outcomes: (1) symptom alleviation, (2) empowerment, (3) positive feedback, and (4) negative outcomes. Conclusions and Recommendations: There is a range of nursing interventions for postpartum depression. This review highlights the significant roles of PPD education and nursing assessment and emphasizes these interventions to be practiced not only after childbirth but also during the prenatal period to identify at-risk patients and provide early intervention. This review also emphasizes the need for more coordinated care and a multidisciplinary approach, including patient referral, to achieve better outcomes in the care of postpartum depression patients. This relates to the acknowledgment of the various factors contributing to the development of postpartum depression and its lack of clear etiology

Systematic Literature Search Strategies for the Health Sciences

Systematic search of literature is an important skill for researchers to help achieve a comprehensive understanding of the topic of interest. Likewise, clinicians need this skill for them to be updated on the recent evidence in providing relevant health care interventions to their patients. However, many health professionals and health science students rely on the use of limited search engines and few databases without systematically performing search and retrieval of relevant studies. This practice commonly yields inadequate references for a research project or clinical decision-making resulting to an incomplete understanding of the topic at hand. This paper aims to provide an introductory guide for researchers as well as clinicians on the step-by-step process of systematic literature search. It also provides information on the available open-access directories and databases as additional or alternative sources of evidence especially in low-resource institutions. However, careful guidelines must be considered in using open-access sources to maintain the quality of research projects and clinical decisions

Incentivizing (and Disincentivizing) Mothers to Utilize Maternal Health Services: A Focus Group Study

Background. In ensuring access to maternal health services, various strategies toward safer health practices and improved health service delivery are important ingredients to eliminate avoidable maternal deaths. A recent household survey showed that access to antenatal care (ANC) (89%) and facility-based delivery (FBD) (82.4%) in the Eastern Visayas region is significantly high, despite the extensive damage to over 500 health facilities caused by Typhoon Haiyan in November 2013. Postpartum care (PPC), however, was relatively low (37.4%). As these findings needed further elaboration, a qualitative study using focus groups was conducted. Method. The focus groups method was utilized to elicit responses from the mothers, BHWs, and midwives to explain what contributed to the high ANC visits, high FBD, and low PPC. Sixteen focus groups were conducted in the local dialect (Waray and Cebuano), and all discussions were audio recorded. Focus groups data were transcribed and subsequently translated to English text, then reviewed and validated by socio-linguistic academics from the region. Other data sources included debriefing session reports and expanded field notes. Nvivo 10 software was used in the coding process and data management. The data analysis referred to the principles of thematic analysis. Results. The findings showed that incentives in the form of free maternal services and cash grants drive mothers to go to the health facility for antenatal care and facility-based deliveries. The free services were provided by PhilHealth (the country\u27s social health insurance), while cash grants were awarded through the government\u27s conditional cash transfer program and other community partners. Mothers were provided with some financial risk protection through these financial incentives. The disincentives came in the form of local ordinances, which prohibited home births. Penalties included fines for both mother and birth attendant when the mother was found to deliver outside the health facility. The unintended stigma, shame, and fear that developed in response to these ordinances also deterred home births. The significantly low use of PPC services in the health facility was attributed to the lack of advices given to mothers regarding the need for follow- up care after delivery. It is also noted that there are no incentives for PPC, which may contribute to its low rates. The role of the community health workers and midwives were to inform and educate the mothers on these incentives and disincentives. However, these incentives and disincentives are extrinsic motivators and are deemed insufficient to provide long-term impact. Conclusion and Recommendations. The implementation of the incentives and disincentives in Eastern Visayas has increased rates of ANC and FBD. The presence of these in the current environment has initially facilitated behavior change, shifting home births to facility births. However, we argue that financial incentives, with a lack of intrinsic motivation, may be insufficient to sustain long-term impact. Disincentives, in the form of local ordinances, forced mothers instead to seek care in facilities. Such an approach may eventually become less effective over time. Incentives and disincentives are both demand-side factors, and to sustain change, concurrent improvements in the supply end need to be implemented. The capacity of facilities to absorb the increased demand should be in place to provide positive experiences for mothers in the health facilities

An Experience of Focus Groups Fieldwork Among Novice Nurses in the Eastern Visayas Region, Philippines

Focus group (FG) as a method of research is becoming popular in nursing. However, limited practical examples on the processes and skills required for its implementation in the Philippines to address the complexity of this method may prevent novice nurses to pursue more FG-based researches. For nurses and other health researchers who intend to use the FG, facilitation and note taking in FG discussions as well as transcribing and translating are important skills to master. Ways to enhance the quality of data should also be devised to improve trustworthiness of findings such as pre-testing of tools, conduct of debriefing sessions and, validation of translations and other data sources. Through appropriate methodological processes and examples, FG research is valuable in exploring and understanding nursing and health-related issues. This article showcases the experience of nine novice Philippine nurse researchers in their aim to achieve high quality FG study on access to maternal health services conducted in the Eastern Visayas region of the Philippines

025: Enhancing Public Participation Effectiveness: What Works, for Whom, in What Circumstances and Why?

BackgroundThis research sought to understand and explain the factors that generate the effectiveness of public participation in health policy. Researchers consider the role of the contextual factors as well as the participation process, especially participation techniques, to influence significantly the effectiveness of public participation. Although these are important factors to consider, these do not sufficiently explain what works, when and why. Objectives This investigation aimed to: (1) explain the causes of participation effectiveness and ineffectiveness, (2) understand the significance of context in achieving participation effectiveness, (3) understand the evidence of participation effectiveness. It ultimately aimed to contribute to the design of effective public participation practice in the Philippine health sector and elsewhere. Methods This study was conducted in two phases. The first phase was a realist synthesis of existing literature on public participation, which included the analysis of 83 journal articles. The result of this phase was a set of mechanisms and the context within which they worked, which have been shown in the literature to promote effective public participation. The second phase included 32 realist interviews of Philippine government leaders and health practitioners to understand which mechanisms from the realist synthesis were occurring or not present in the Philippine context and why. The synthesis of the two phases developed a refined explanation of the causes of participation effectiveness. Result Five key mechanisms were found in both the realist synthesis and the interviews in the Philippines that generate participation effectiveness: political will, partnership synergy, participative voice, inclusiveness and legitimacy. Political expediency and power-over were found to potentially block the effectiveness of public participation. A significant implication of these mechanisms relates to the crucial role of the discretionary power of public officials in aiming for an effective public participation practice. This study also highlighted the need for active populations as well as a diversity of perspectives as important contexts for these mechanisms to operate. Conclusion This study has highlighted that participation effectiveness in the Philippine health sector and elsewhere is caused by several key underlying mechanisms and the understanding of the significant contextual factors that influence the operation of these underlying mechanisms allows us to determine the appropriate interventions (including the participation techniques) that contribute to the generation of participation effectiveness. In a practical sense, this study has shown that understanding the interactions of the context, mechanism, and outcome can provide a direction for planners and practitioners in the design of an effective participation exercise. It clarified in what circumstances a particular participation intervention or strategy could be effective or ineffective by the activation of a particular mechanism

Medical students\u27 perspectives on the program outcome drivers of community immersion: a realist-informed study

Background: The effects of community immersion programs and other forms of community-based medical education on students have been highlighted in the literature. However, the driving factors that generate these outcomes are not emphasized by many authors. Objective: This study aimed to identify and explain the important contextual factors and mechanisms considered as driving factors of the outcomes of community immersion programs. Methodology: An exploratory qualitative inquiry that employed focus group discussions, in-depth interviews, and reflection papers was utilized. The realist approach provided the structure in eliciting and analyzing medical students’ perspectives on the driving factors of the program outcomes of community immersion. Data were analyzed through thematic analysis. Results: The outcomes generated by the community immersion program are consistent with the literature as well as relevant to the course and social outcomes as identified by De La Salle Medical and Health Sciences Institute. Uncovered major driving factors for these program outcomes include: “perceiving things from a different perspective”, and “positive attitude towards community health”. Various contextual factors that trigger these driving factors were further unpacked that provide a backdrop to the community immersion program. Conclusion: Factors that bring about the program outcomes of community immersion are evident in the experiences of medical students. Focusing on these factors may allow community preceptors and administrators to have clearer perspectives on the factors to focus on in teaching community medicine through community immersion. It is recommended that preceptors and administrators consider and nurture these factors during community immersion to be effective in teaching medical students in the community setting and in the provision of primary health services to communities