Contextualizing Ottawa Charter Frameworks for Type 2 Diabetes Prevention: A Professional Perspective as a Review

BACKGROUND: Type 2 Diabetes remains one of the deadliest non-communicable diseases in the world. Systematically articulating the health issues with emerging policies is very important in preventing chronic diseases like diabetes. This article aims to integrate Ottawa Charter frameworks in prevention of Type 2 diabetes and the way the charter’s application should bring amicable changes if applied as planned.METHOD: We used the aim of the study as a method derivative. Then, we applied the five actions of Ottawa Charter frameworks. We also described and stated the existing scientific literature (knowledge) about the prevention of diabetes. After thoroughly reviewing, possible intervention strategies were included with a brief discussion by comparing different literatures. In our case, diabetes prevention is facilitated by those actions and conditions.EVIDENCE: Setting appropriate goals, lifestyle modifications, appropriate self-monitoring of blood glucose, medications, regular monitoring for complications, and laboratory assessment are important factors to be endorsed within Ottawa Charter five actions. Lifestyle interventions and physical activities are the most important factors recommended in different reviews and interventions. However, none of the studies had integrated disease prevention with existing policy.CONCLUSION: Type 2 Diabetes directed health promotion interventions implemented in various countries were not integrated into Ottawa charter frameworks. As field experts, we believe that applying all the basic principles of health promotion and the idea of Ottawa Charter articulation is very important in disease prevention and behavioral change. Therefore, field specialists should figure out the problem of policy integration through policy evaluation researches.KEYWORDS: Contextualizing, Diabetes, Health Promotion, Ottawa Charte

Testing Psychometrics of Healthcare Empowerment Questionnaires (HCEQ) among Iranian Reproductive Age Women: Persian Version

BACKGROUND: Producing high quality data needs an accurate measurement in any fields of study. This study aimed to test psychometrics of the Persian version Healthcare Empowerment Questionnaire (HCEQ) in relation to personal care among Iranian reproductive age women and to validate the instrument for future use.METHODS: A cross-sectional study was conducted on 549 reproductive age women in a health centers affiliated to Tehran University of Medical Sciences producing a response rate of 100%. Content validity was established using translation and backtranslation procedures, pilot testing, and getting views of expert panel. Construct validity was measured using explanatory factor analysis. Cronbach’s alpha was used to measure internal consistency, and intra-class correlation coefficients were used to confirm stability.RESULTS: The results indicated that explanatory factor analysis of 10 items in three dimensions explained 63.2% of the total variance. Validity and reliability of the 10-items of HCEQ with two response scales (perception of control and motivation of being empowered) assessed for internal quality showed the reliability of internal consistency (α=0.70; range=0.62-0.76). The correlation between convert (10 items) and apparent (3 factors) variables was 0.5 times higher than the revealed convergent validity.CONCLUSION: The findings of this study supported the reliability and validity of the Persian version of HCEQ to assess the degree of individual empowerment in relation to personal healthcare and services among reproductive age women. Therefore, the HCEQPersian version could be a useful, comprehensive, and culturally sensitive scale for assessing healthcare empowerment among reproductive age women.KEYWORDS: Healthcare Empowerment Questionnaire (HCEQ), Reproductive Age, Women, Reliability, Validit

Likelihood of Breast Screening Uptake among Reproductive-aged Women in Ethiopia: A Baseline Survey for Randomized Controlled Trial

BACKGROUND፡ Breast cancer is the most devastating public health problem affecting women in developed and developing world. Therefore, this study was aimed to assess the likelihood of taking breast self-examination as abreast screening behavior among reproductive age women.METHODS: A community based cross-sectional study was conducted on 810 reproductive-age women. Intervieweradministered questionnaires were used to collect data. Studyparticipants were selected using systematic sampling method. Data were analyzed using SPSS version 24.0.RESULTS: The likelihood of performing breast self-examination was 54.3%. However, the comprehensive knowledge of the participants was 11.5%. As independent predictors, perceived severity of breast cancer [AOR (95%CI) = 2.05 (1.03 to 1.07)] and self-efficacy [AOR (95%CI) = 2.97(0.36-0.99)] were positively associated with the likelihood of performing breast selfexamination whereas districts [AOR (95%CI) = 0.58 (0.37 to 0.91)] and place of residence [AOR (95%CI) = 0.69 (0.51 to 0.93)] were negatively associated with the likelihood of performing breast selfexamination. The HBM Model explained 64.2% of the variance in this study.CONCLUSION: Although the likelihood of performing breast selfexamination was relatively good, the comprehensive knowledge of the women was very low. Therefore, breast cancer screening education must address knowledge and socio-cultural factors that influence breast screening through awareness creation using appropriate behavioral change communication strategies.

Undiagnosed Depression among Hypertensive Individuals in Gaza: A Cross-sectional Survey from Palestine

BACKGROUND፡ The aim of this study was to estimate the prevalence and to determine the associated factors of undiagnosed depression amongst hypertensive patients (HTNP) at primary health care centers (PHCC) in Gaza.METHODS: A cross-sectional survey was conducted including 538 HTNP as a recruitment phase of a clustered randomized controlled trial. Data were collected through face-to-face structured interview, and depression status was assessed by Beck's Depression Inventory (BDI-II). Data were analyzed by STATA version 14 using standard complex survey analyses, accounted for unresponsiveness and clustering approach. Generalized linear regression analysis was performed to assess associations.RESULTS: The prevalence of undiagnosed clinical depression was 11.6% (95% confidence interval [CI]: 8.1, 16.3). Moreover, prevalence of 15.4% (95% CI: 10.8, 21.6) was found for mild depression symptoms. We found that non-adherence to antihypertensive medications (AHTNM) (β = 0.9, 95% CI: 0.17, 1.7), having more health-care system support (β = 2.8, 95% CI: 1.6, 3.9) and number of AHTNM (β = 1.5, 95% CI: 0.6, 2.5) remain significantly positively associated with BDI-II score. On the other hand, older age (β = -0.1, 95% CI: -0.2, -0.02), having better social support (β = -6.8, 95% CI: -8.9, -4.7) and having stronger patientdoctor relationship (β = -4.1, 95% CI: -6.9, -1.2) kept significantly negative association.CONCLUSION: The prevalence of undiagnosed depression was about one-quarter of all cases; half of them were moderate to severe. Routine screening of depression status should be a part of the care of HTNP in PHCC

Application of Kingdon and Hall Models to Review Environmental Sanitation and Health Promotion Policy in Ethiopia: A Professional Perspective as a Review

BACKGROUND: In the world, many countries, including Ethiopia, are framing policies to roll back the problem of the sanitation. For this, the Kingdon and Hall models are the two distinct models formed to articulate the policy agenda to the health problem. The Kingdon model includes problem, policy and politics streams whereas the Hall model includes legitimacy, feasibility and support of the health policies. Therefore, this review aims to integrate the two models with diseases prevention and health promotion policies of Ethiopia.METHODS: We used the existing frameworks of the models as a guiding principle. Then, we applied the frameworks of the two models as an important consideration to interlink policy agenda to a given health problem. We also described the existing scientific literature about the sanitation and health promotion. After thoroughly reviewing, possible policy inputs and country setups were included with a brief discussion by comparing different kinds of literatures.RESULTS: The two models are recognized as an opportunity to get an essential sanitation policy. The government settled and has closed links to the new innovation as an emerged discourse. Therefore, the two model streams came together for setting sanitation problem on the policy agenda. The technical feasibility, public acceptability and congruence with existing values were all judged to be favorable.CONCLUSION: The integration of policies within the policy frameworks has very important outputs in various countries. Therefore, the field specialists should figure out the problem of policy integration through policy evaluation researches

Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis

Item does not contain fulltextBACKGROUND: Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES: (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS: We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA: We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS: We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS: We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced thei

Formulating questions to explore complex interventions within qualitative evidence synthesis

When making decisions about complex interventions, guideline development groups need to factor in the sociocultural acceptability of an intervention, as well as contextual factors that impact on the feasibility of that intervention. Qualitative evidence synthesis offers one method of exploring these issues. This paper considers the extent to which current methods of question formulation are meeting this challenge. It builds on a rapid review of 38 different frameworks for formulating questions. To be useful, a question framework should recognise context (as setting, environment or context); acknowledge the criticality of different stakeholder perspectives (differentiated from the target population); accommodate elements of time/timing and place; be sensitive to qualitative data (eg, eliciting themes or findings). None of the identified frameworks satisfied all four of these criteria. An innovative question framework, PerSPEcTiF, is proposed and retrospectively applied to a published WHO guideline for a complex intervention. Further testing and evaluation of the PerSPEcTiF framework is required

How do reproductive age women perceive breast cancer screening in Ethiopia? A qualitative study

Background: Breast cancer remains one of the deadliest non-communicable diseases in the world. In Ethiopia, breast cancer accounts for 33.4% of total cancer diagnosis in women. Objective: This study aims to explore perception about breast screening behavior among reproductive age women. Methods: This qualitative study was conducted as a baseline to identify gaps to design interventions that will enhance breast screening uptake among reproductive age women. Six focus group discussions and 9 in-depth interviews were conducted with women and health workers respectively. Semi-structured questions were used. Data analysis was analyzed by Atlas.ti. 7 and the ideas were put in direct quotation and narration. Results: Lack of awareness is the preceding problem for self-susceptibility to breast cancer as well as for having breast screening. Majority of women thought that the cause of breast cancer was a sin (supernatural power). Self-efficacy and cues to action were the most important correlates of the perception owing to fear of socio-cultural stigma and discrimination. Conclusion: All health belief model constructs identified a critical problem for adaptation of behavior. Therefore, this gives the opportunity to design and develop community-based intervention and explore new intervention mechanism with an accurate method

Barriers of Health Education in Iran’s Health System: A Qualitative study

Introduction: Despite the importance of health education, studies revealed that health education in Iran’s health system is not desirable, so the present study was done to investigate the barriers of health education in Iran’s health system. Method: This qualitative study was done in 2019. Twenty health experts and physician and 26 community-based health workers (CHWs) were selected through purposive sampling method. Data were collected using semi-structured interview and group discussion. The data were analyzed using Lundman and Graneheim content analysis approach. Results: After data analysis, five themes including personal barriers (low capability of CHWs, low personal motivation, and wrong belifes of educator), interpersonal (the weakness of other health care providers in educating CHWs, inaccurate communication, poor commitment, and Customer-related problems), organizational (the weakness in empowerment of health care providers, high workload of CHWs, problems related to educational resources, and inappropriate evaluation and monitoring), social (low credibility of CHWs among Community Members (CMs), economical issues of CMs, and challenges related to using internet and virtual social networks), and contextual barriers (those related to universities, radio and television, and the gap between practical and theoretical education) were extracted. Conclusion: As barriers are multidimensional, so it is recommended to develop a comprehensive plan with cooperation of managers, experts, and health providers for solving the barriers