Evaluation of an implementation strategy for a World Health Organization (WHO) public health report: The implementation of the International Perspectives on Spinal Cord Injury (IPSCI) in Romania

Aim: This paper aims to evaluate a strategy for the implementation of public health policy recommendations from the World Health Organization’s (WHO) report “International Perspectives on Spinal Cord Injury” in Romania. More specifically, it seeks to: a) evaluate implementation actions with a focus on a number of people reached and status of completion at 12 months follow-up; b) describe implementation activities undertaken in the course of one year, and; c) evaluate perceived barriers and facilitators of implementation at 12 months follow-up. Methods: A cross-sectional design was adopted with two surveys administered in 2014/15 among key implementers in Romania. The questionnaires contained open-ended, multiple choice and 5-point Likert scale questions. Results on the implementation status, implementation activities performed and self-reported barriers and facilitators were analysed and reported using descriptive statistics. Results: Implementation completion rate was 75%, with 4390 persons directly or indirectly benefiting from the implementation-related activities listed in the final implementation plan reporting. A broad range of implementation experiences was reported. Most common activity types were delivery of services, technical trainings, implementation coordination and development meetings. Most useful tools and processes were the Romanian language version summary of the report, educational meetings, and local consensuses processes. Reported outcomes included the direct output produced, evidence of services provided, and individual or organizational level impact. Most barriers were named for the policymakers and academia as stakeholder groups and most facilitating influences for the private sector, with dependence of policymakers on constituency interest scoring highest barrier and the general availability of European Commission and European Structural Funds highest facilitator. Conclusion: The surveys proved to be both feasible and useful tools to expand our understanding of implementation and to supplement the more standard used implementation strategies at country level

Evaluation of an implementation strategy for a World Health Organization (WHO) public health report: The implementation of the International Perspectives on Spinal Cord Injury (IPSCI) in Romania

Aim: This paper aims to evaluate a strategy for the implementation of public health policy recommendations from the World Health Organization’s (WHO) report “International Perspectives on Spinal Cord Injury” in Romania. More specifically, it seeks to: a) evaluate implementation actions with a focus on a number of people reached and status of completion at 12 months follow-up; b) describe implementation activities undertaken in the course of one year, and; c) evaluate perceived barriers and facilitators of implementation at 12 months follow-up.Methods: A cross-sectional design was adopted with two surveys administered in 2014/15 among key implementers in Romania. The questionnaires contained open-ended, multiple choice and 5-point Likert scale questions. Results on the implementation status, implementation activities performed and self-reported barriers and facilitators were analysed and reported using descriptive statistics.Results: Implementation completion rate was 75%, with 4390 persons directly or indirectly benefiting from the implementation-related activities listed in the final implementation plan reporting. A broad range of implementation experiences was reported. Most common activity types were delivery of services, technical trainings, implementation coordination and development meetings. Most useful tools and processes were the Romanian language version summary of the report, educational meetings, and local consensuses processes. Reported outcomes included the direct output produced, evidence of services provided, and individual or organizational level impact. Most barriers were named for the policymakers and academia as stakeholder groups and most facilitating influences for the private sector, with dependence of policymakers on constituency interest scoring highest barrier and the general availability of European Commission and European Structural Funds highest facilitator.Conclusion: The surveys proved to be both feasible and useful tools to expand our understanding of implementation and to supplement the more standard used implementation strategies at country level. 

Using concept mapping to develop a human rights based indicator framework to assess country efforts to strengthen rehabilitation provision and policy: the Rehabilitation System Diagnosis and Dialogue framework (RESYST)

Abstract Background Rehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of “leaving no one behind” countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to assess governments’ efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities. Methods A systems methodology - concept mapping - was used to capture, aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation. Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories. Forty-one participants rated the indicators for importance and feasibility. Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators’ organizing framework which was verified and interpreted by a select number of participants. Results A concept map of 11 clusters of indicators emerged from the analysis grouped into three broader themes: Governance and Leadership (3 clusters); Service Delivery, Financing and Oversight (6 clusters); and Human Resources (2 clusters). The indicator framework was comprehensive and well aligned with the Convention. On average, there was a moderately positive correlation between importance and feasibility of the indicators (r = .58) with experts prioritizing the indicators contained in the clusters of the Governance and Leadership domain. Two of the most important indicators arose from the Service Delivery, Financing and Oversight domain and reflect the need to monitor unmet needs and barriers in access to rehabilitation. In total, 59 indicators achieved above average score for importance and comprised the two–tiered priority set of indicators. Conclusion Concept mapping was successful in generating a shared model that enables a system’s view of the most critical legal, policy and programmatic factors that must be addressed when assessing country efforts to reform, upscale and improve rehabilitation services. The Rehabilitation Systems Diagnosis and Dialogue framework provides a data driven basis for the development of standardized data collection tools to facilitate comparative analysis of rehabilitation systems. Despite agreement on the importance and feasibility of 59 indicators, further research is needed to appraise the applicability and utility of the indicators and secure a realistic assessment of rehabilitation systems

Paschaplegiker? Hilfe- und Ausweichverhalten gegenüber Rollstuhlfahrern an öffentlichen Orten: eine empirische Beobachtungsstudie in der Stadt Luzern

"Mit Hilfe einer quantitativen und qualitativen Inhaltsanalyse, die auf einer Videobeobachtung basiert, wurde das Hilfe- und Ausweichverhalten von Passanten gegenüber einem sich in einer vermeintlichen Problemsituation befindenden Rollstuhlfahrer untersucht. Lediglich 28 von 541 Passanten sprachen den Rollstuhlfahrer an, von denen wiederum 13 Hilfsangebote machten. Nicht nur die Passanten, die vorübergingen, hielten unüblich große Abstände zum Rollstuhlfahrer, sondern auch dessen Gesprächspartner. Ein weiteres Hauptergebnis liegt in der Entdeckung eines 'Ansteckungseffekts', der darin besteht, dass sich Passanten offenbar erst trauen, den Rollstuhlfahrer anzusprechen, wenn dies bereits jemand vor ihnen gemacht hat." (Autorenreferat)"Help and avoidance behaviors of pedestrians towards a wheelchair user in a seemingly problematic situation were observed and videotaped. A quantitative as well as qualitative content analysis was performed. Only 28 of 541 pedestrians contacted the wheelchair user. Of these13 offered help. Pedestrians passing the wheelchair user as well as dialogue partners positioned themselves in an unusually large distance to the wheelchair user. We also discovered a kind of 'contagion effect'. When one pedestrian had contacted the wheelchair user others followed immediately within the same time interval. A by-stander effect could not be confirmed." (author's abstract

The role of transdisciplinarity in building a decolonial bridge between science, policy, and practice

Transdisciplinary research is considered to offer contributions of science to sustainability transformations, partly because transdisciplinary approaches aim to increase the relevance, credibility, and legitimacy of scientific research by ensuring the active participation of non-academic actors in research. However, the possible impact of transdisciplinary research on decolonial sustainability science – understood as actively undoing Euro-North American centricity, dispossession, racism, and ongoing power imbalances in inequitable social-ecological systems – and simultaneous response to scientific rigor remain under debate. Thus, this article assesses the contributions of transdisciplinary research projects to decolonial sustainability science based on empirical infor ma tion. To do so, we analyze a sample of 43 development research projects of the Swiss Programme for Research on Global Issues for Development (r4d programme) in Africa, Asia, and Latin America. We found that despite significant differences in approaches, Global-North-dominated sustainability science still has far to go to achieve the decolonial potential of transdisciplinarity, enabling different actors’ participation

Effect of the Friendship Bench Intervention on Antiretroviral Therapy Outcomes and Mental Health Symptoms in Rural Zimbabwe: A Cluster Randomized Trial.

IMPORTANCE Common mental disorders (CMD), which include depression and anxiety, are prevalent among people living with HIV and are associated with suboptimal antiretroviral therapy (ART) adherence. OBJECTIVE To assess the effect of a lay health worker-led psychological intervention on ART adherence, virologic suppression, and mental health symptoms. DESIGN, SETTING, AND PARTICIPANTS Open-label pragmatic cluster trial with 1:1 block randomization of 16 health facilities in rural Bikita, Zimbabwe. Recruitment occurred from October 2018 to December 2019, and participants were followed up for 12 months, ending in December 2020. Participants were adults aged 18 years and older, who spoke English or Shona, screened positive for CMD (Shona Symptoms Questionnaire [SSQ]-14 score ≥9), received first-line ART for 6 or more months, had no World Health Organization stage 4 disease, no psychosis, were not pregnant, and provided informed consent. Data were analyzed from March 2021 to February 2022. INTERVENTION The Friendship Bench, consisting of 6 lay health worker-led weekly problem-solving therapy sessions and optional peer-led group support. MAIN OUTCOMES AND MEASURES The primary outcome was mean adherence during 2 to 6 months of follow-up, and the secondary outcomes were mean adherence during 1 to 12 months of follow-up, change in SSQ-14 and Patient Health Questionnaire (PHQ-9) scores (3, 6, 9, and 12 months), and viral load suppression (6 and 12 months). RESULTS A total of 516 participants were recruited (244 in Friendship Bench and 272 in enhanced standard care facilities); 438 (84.9%) were female and the mean (SD) age was 45.6 (10.9) years. Mean (SD) adherence between 2 to 6 months was 89.9% (18.4%) in the Friendship Bench group and 87.2% (20.1%) in the control group. The intervention had no statistically significant effect on adherence between 2 to 6 months (unadjusted mean difference, 1.93 percentage points; 95% CI, -1.20 to 5.06 percentage points; P = .23), between months 1 to 12 (mean difference 0.79 percentage points; 95% CI, -2.14 to 3.71 percentage points; P = .60), or viral suppression. Declines in SSQ-14 scores from baseline to 3 months (difference, -1.65; 95% CI, -3.07 to -0.24), 6 months (difference, -1.57; 95% CI, -2.98 to -0.15), and 9 months (difference, -1.63; 95% CI, -3.05 to -0.22) were greater in the Friendship Bench than the standard care group (P < .05). There were no differences in the decline in the SSQ-14 scores from baseline to 12 months and in declines in PHQ-9 scores from baseline to 3, 6, 9, and 12 months. CONCLUSIONS AND RELEVANCE In this randomized trial of HIV-positive participants with CMD, the Friendship Bench intervention had no effect on adherence and viral suppression, possibly due to the absence of skill-based adherence training and a ceiling effect. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03704805

Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study.

We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a South African private-sector HIV programme to examine adherence and viral non-suppression (viral load > 400 copies/mL) of participants with (20,743, 38%) and without (33,635, 62%) mental health diagnoses. Mental health diagnoses were associated with unfavourable adherence patterns. The risk of viral non-suppression was higher among patients with organic mental disorders [adjusted risk ratio (aRR) 1.55, 95% confidence interval (CI) 1.22-1.96], substance use disorders (aRR 1.53, 95% CI 1.19-1.97), serious mental disorders (aRR 1.30, 95% CI 1.09-1.54), and depression (aRR 1.19, 95% CI 1.10-1.28) when compared with patients without mental health diagnoses. The risk of viral non-suppression was also higher among males, adolescents (15-19 years), and young adults (20-24 years). Our study highlights the need for psychosocial interventions to improve HIV treatment outcomes-particularly of adolescents and young adults-and supports strengthening mental health services in HIV treatment programmes

Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study.

OBJECTIVES: To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART). SETTING: Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe. DESIGN: Cross-sectional study. PARTICIPANTS: HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months. OUTCOME MEASURES: The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence. RESULTS: Out of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40-49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50-59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70). CONCLUSIONS: A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe. TRIAL REGISTRATION NUMBER: NCT03704805

Evaluation of an implementation strategy for a World Health Organization (WHO) public health report: The implementation of the International Perspectives on Spinal Cord Injury (IPSCI) in Romania

Aim: This paper aims to evaluate a strategy for the implementation of public health policy recommendations from the World Health Organization’s (WHO) report “International Perspectives on Spinal Cord Injury” in Romania. More specifically, it seeks to: a) evaluate implementation actions with a focus on a number of people reached and status of completion at 12 months follow-up; b) describe implementation activities undertaken in the course of one year, and; c) evaluate perceived barriers and facilitators of implementation at 12 months follow-up. Methods: A cross-sectional design was adopted with two surveys administered in 2014/15 among key implementers in Romania. The questionnaires contained open-ended, multiple choice and 5-point Likert scale questions. Results on the implementation status, implementation activities performed and self-reported barriers and facilitators were analysed and reported using descriptive statistics. Results: Implementation completion rate was 75%, with 4390 persons directly or indirectly benefiting from the implementation-related activities listed in the final implementation plan reporting. A broad range of implementation experiences was reported. Most common activity types were delivery of services, technical trainings, implementation coordination and development meetings. Most useful tools and processes were the Romanian language version summary of the report, educational meetings, and local consensuses processes. Reported outcomes included the direct output produced, evidence of services provided, and individual or organizational level impact. Most barriers were named for the policymakers and academia as stakeholder groups and most facilitating influences for the private sector, with dependence of policymakers on constituency interest scoring highest barrier and the general availability of European Commission and European Structural Funds highest facilitator. Conclusion: The surveys proved to be both feasible and useful tools to expand our understanding of implementation and to supplement the more standard used implementation strategies at country level

Developing an implementation strategy for a World Health Organization public health report: The implementation of the International Perspectives on Spinal Cord Injury (IPSCI) in Romania

AbstractAim: The World Health Organization (WHO) publishes a large number of health reports every year, containing recommendations to overcome societal and system barrier challenges toward targeting unmet health needs. One such report, the International Perspectives on Spi-nal Cord Injury (IPSCI), specifically describes the situation of persons with spinal cord in-jury. Against this backdrop, the question arises about how these recommendations can be incorporated into an implementation strategy. Therefore, the aim of this paper is to describe a phased process of developing an implementation strategy for a WHO public health report with IPSCI serving as a case example.Methods: The process to develop the implementation strategy consisted of specific phases each employing particular mechanisms. The preparatory phase was composed of a group dis-cussion to select development mechanisms. The implementation strategy development phase comprised focus-group interviews, as well as of a stakeholder dialogue. Thematic content analysis was applied to qualitative data.Results: The group discussion led to selection of specific development mechanisms. The focus group mechanism allowed key stakeholders to openly discuss implementation goals and processesand impacted the selection of the core implementation group members and the focus of the stakeholder dialogue (SD) discussion.The SD was instrumental in developing a specific implementation strategy based on the report‟s recommendations. The strategy con-sisted of a detailed implementation plan, provisions to coordinate an implementation group and expert guidance.Conclusion: The findings from the current study can inform the ongoing development of systematic, evidence-informed, participatory and stakeholder-driven processes for the devel-opment of implementation strategies for recommendations from WHO public health reports