Integrating depression care within NCD provision in Bangladesh and Pakistan : a qualitative study

Background Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low- and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan. Methods Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients’ expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA

Understanding Potentials of Cloud ERP Adoption by Large Organisations: A Case Study

The emergence of cloud computing has both architectural and financial implications for on-premise ERP systems. ERP designed for and running in the cloud claim to be suitable for digital business environments. However, the cloud ERP adoption literature mostly refers to small and medium enterprises, since large enterprises are constrained by investment in existing resources, and rarely presents the complex stages of decision-making. The context of developing vs developed countries might also vary, given the variance and rate of internal and external environmental turbulence. This case study explores the contributing factors for the initiation stage of migration from on-premise to cloud ERP by a large organisation in a developing country. In-depth interviews with key IT decision makers were analysed and a combination of internal and external factors were identified. The findings have implications for IT decision makers as well as IT innovation researchers, interested in the complexity of the transition decision

The Decision Cloud in Migrating to Cloud ERP Systems: A Developing Country Perspective

Given the emergence of cloud computing technologies in the late 2000s, cloud enterprise resource planning (ERP) systems are becoming the new normal as organisations move their on-premise ERP systems to the cloud. It is the reality for organisations in the industrialised countries which are now considering optimisation in the cloud environment. Developing countries are yet to catch up on their journey to the cloud. Research reveals enthusiasm among small and medium enterprises (SMEs) in developing countries. Nevertheless, large organisations with extensive investment in 3rd party systems are still skeptical about various issues, influencing their decision-making to shift their ERP systems to the cloud. This case study followed an inductive approach to explore strategic constraints involved in the migration decision. In-depth interviews with the IT decision-makers have revealed two-dimensional strategic constraints: operational and existential. Findings from this study have implications for practice, innovation, and research