Techniques for improving client relations in family planning programs

Demand for children and demand for contraceptives are not independent of the system of supply. And client transactions are the major means for lowering costs. Family planning workers, providers of services and mass media campaigns, are the harbingers of new ideas and new delivery systems that could modify the demand for fertility regulation and patterns of contraceptive use. The authors describe four broad techniques for improving client relations, emphasizing their potential as entry points into program development (systematic change). These techniques are presented as a sampling of experience that can be brought to bear on dysfunctional client relations. Among examples described: Patient flow analysis (PFA). A self-administered time-and-motion diagnosis that allows computerized documentation of patient flow and personnel use in health service clinics. Using relatively unobtrusive data collection, PFA seeks to get a representative snapshot of a program and its dysfunctions, replicating a typical clinic session. Data are later diagnosed and remedies proposed for bottlenecks and inefficiencies. Training and visit (T&V). A managerial approach for dealing with geographically scattered outreach programs. The four main principles of T&V: focus on a few key tasks, frequent in-service training and supervision, regularity and predictability, and face-to-face communication. The T&V model focuses on what workers should be doing with their time in the field to meet client needs. A goal of T&V: to enable all clients to name their worker and the day of the week s/he visits, and identify a few themes from their most recent encounter. Activity planning. The antithesis of T&V, activity planning calls for abandoning rigid time-place-movement schedules and specific messages and replacing them with a fluid work schedule adapted to local conditions. Workers must be well-trained in collecting data, listening and building rapport, and communicating with conviction. The quality of the worker-client relationship is all-important. A weakness is that if the workers have no objective they lose control of the exchange with clients. Training and worker empowerment. Training by itself is not enough for systematic change - training for what? But training can serve as an entry point into organizational development when it is rooted in methodologies that help to develop the participant's technical and interpersonal skills and ability to innovate. But training must be accompanied by changes in the system of supply that supports and facilitates innovation and quality of care. Techniques to improve client relations can address either the client-provider interface directly or the system of underlying determinants. It is important to ask basic questions: Is the idea to fix a single worker-client dysfunction or is it to provide a continuous program for modification and growth? Who will be affected by the change? Whoor what will be responsible for initiating and overseeing the course of action? What are the short- and long-run goals of intervention?Health Monitoring&Evaluation,ICT Policy and Strategies,Adolescent Health,Poverty Monitoring&Analysis,Geographical Information Systems

The Public\u27s Right to Know and the Individual\u27s Right to be Private

The central archival concern is the preservation of the record and access to that record. If archivists wish to be taken seriously as professionals, they must actively participate in resolving the conflict between the public\u27s right of access to part of that record and the right of the individual to privacy and the protection of confidentiality. Having this in a code of ethics is only a first step. Resolution of this conflict is made necessary by research in current history, the size of twentieth century collections, and the data being collected in state, federal, and private data banks

Caroline Ruth Simmons in a Senior Soprano Recital

This is the program for the senior soprano recital of Caroline Ruth Simmons. Ms. Simmons was accompanied on the piano by Cindy Fuller. This recital took place on April 22, 2002, in the McBeth Recital Hall in the Mabee Fine Arts Center

Evaluating Allied Health Clinical Placement Performance: Protocol for a Modified Delphi Study

Background: University-affiliated student-led health care services have emerged in response to the challenges faced by universities in securing quality clinical placements for health care students. Evidence of the health care benefits and challenges of student-led health care services is growing, while evidence of clinical placement performance remains variable and not generalizable. Though there have been previous attempts to develop a framework for evaluation of clinical placement performance, concerns have been raised about the applicability of these frameworks across the various placement settings. Additionally, the perspectives of all key stakeholders on the critical areas of clinical placement performance have yet to be considered. Objective: This study’s objective is to gather information on areas of measurement related to student learning outcomes, experience of placement, and costs of placement and then develop consensus on which of those areas need to be included in a framework for evaluation of clinical placement performance within the context of student-led health care services. The aim of this paper is to outline a protocol for a modified Delphi study designed to gain consensus on what is important to measure when evaluating an allied health clinical placement. Methods: We will recruit up to 30 experts to a heterogeneous expert panel in a modified Delphi study. Experts will consist of those with firsthand experience either coordinating, supervising, or undertaking clinical placement. Purposive sampling will be used to ensure maximum variation in expert panel member characteristics. Experts’ opinions will be sought on measuring student learning outcomes, student experience, and cost of clinical placement, and other areas of clinical placement performance that are considered important. Three rounds will be conducted to establish consensus on what is important to measure when evaluating clinical placement. Each round is anticipated to yield both quantitative data (eg, percentage of agreement) and qualitative data (eg, free-text responses). In each round, quantitative data will be analyzed descriptively and used to determine consensus, which will be defined as ≥70% agreement. Qualitative responses will be analyzed thematically and used to inform the subsequent round. Findings of each round will be presented, both consensus data and qualitative responses in each subsequent round, to inform expert panel members and to elicit further rankings on areas of measurement yet to achieve consensus. Results: Data analysis is currently underway, with a planned publication in 2024. Conclusions: The modified Delphi approach, supported by existing research and its ability to gain consensus through multiround expert engagement, provides an appropriate methodology to inform the development of a framework for the evaluation of clinical placement performance in allied health service

Measuring health outcomes, experience of care and cost of healthcare in student-led healthcare services: a literature review

Introduction: In student-led healthcare services, health students take responsibility for the management and delivery of health services as part of clinical training. Like all healthcare services, student-led healthcare services need to be evaluated to ensure they provide high quality, safe and cost-effective services. The aim of this literature review was to understand how student-led healthcare services have been evaluated to date, and to assess alignment of previous evaluations with the Triple Aim framework. The Triple Aim is a conceptual framework, offering a systematic approach to evaluating healthcare services that may be appropriate for evaluation of student-led services. Methods: Electronic databases were searched for articles describing a student-led healthcare service and were screened for studies that evaluated the impact of a student-led healthcare service on patient outcomes. Results: Fourteen of 211 identified articles met the inclusion criteria. All 14 studies met the Triple Aim measurement principles of “a defined population,” “gather data over time” and “distinguish between measures” while only eight of the 14 studies achieved “comparison data”. All 14 studies measured at least one or more of the Triple Aim dimensions. Discussion/Conclusion: There was little consistency across the evaluations of student-led healthcare services, limiting the extent to which the benefits of student-led healthcare services can be shown to be a valuable resource to the healthcare system. Further investigation is required to determine a suitable evaluation framework for student-led healthcare services

Women\u27s status and family planning in Bangladesh: An analysis of focus group data

This study involved secondary analysis of a substantial set of 1987–88 focus group data from Bangladesh’s Matlab Thana, where the Family Planning and Health Services Project was underway since 1977. The project was highly successful in increasing family planning (FP) acceptance and provided a rich research base for studying the diffusion of FP and its effects. The study involved 36 focus groups with fieldworkers, community women, husbands, educated women, and community leaders. The intent of the present study is to examine the effect of FP on women\u27s status in Bangladesh, and to prepare papers on that topic. Following leads in the data itself, two papers were prepared under this subcontract. One concerns the effect of the FP fieldworkers on the knowledge and attitudes of young, unmarried women toward fertility and FP; the other presents a qualitative analysis of the fertility transition in Bangladesh, contributing to the ongoing debate on whether fertility decline is caused by demand-side or supply-side factors. This report reviews both documents

Investigating rates and risk factors for hepatitis C virus reinfection in people receiving antiviral treatment in England

England has committed to the World Health Organization target to eliminate hepatitis C virus (HCV) as a public threat by the year 2030. Given successful treatments for HCV in recent years, it is unclear whether HCV reinfection will impact England's ability to achieve HCV elimination. We aimed to estimate the HCV reinfection rate among a cohort of patients receiving antiviral treatment using available surveillance data. Linkage between a treatment dataset from 2015-2019 and an HCV RNA testing dataset were used to identify people who experienced reinfection using three criteria. A Cox proportional hazards model was used to determine risk factors associated with HCV reinfection among a cohort who received treatment and had follow-up HCV RNA testing. The reinfection rate among those receiving HCV treatment was 7.91 per 100 person-years (PYs, 95% confidence interval (CI) 7.37-8.49) and highest among current injecting drug users (22.55 per 100 PYs, 95%CI 19.98-25.46) and people who had been in prison (20.42 per 100 PYs, 95%CI 17.21-24.24). In the adjusted model, women had a significantly reduced risk of reinfection. Being of younger age, current injecting drug users, and receipt of first treatment in prison were each significantly associated with increased risk of reinfection. Two-fifths of those with reinfection (43%, n=329/767) were linked to treatment after reinfection, and of those starting treatment, three quarters (75%, n=222/296) achieved a sustained virologic response. Guidance for testing groups at risk of reinfection and harm reduction strategies to minimize transmission should be implemented if England is to achieve HCV elimination targets

Evolution of CD8(+) T Cell Responses after Acute PARV4 Infection

PARV4 is a small DNA human virus that is strongly associated with hepatitis C virus (HCV) and HIV infections. The immunologic control of acute PARV4 infection has not been previously described. We define the acute onset of PARV4 infection and the characteristics of the acute-phase and memory immune responses to PARV4 in a group of HCV- and HIV-negative, active intravenous drug users. Ninety-eight individuals at risk of blood-borne infections were tested for PARV4 IgG. Gamma interferon enzyme-linked immunosorbent spot assays, intracellular cytokine staining, and a tetrameric HLA-A2-peptide complex were used to define the T cell populations responding to PARV4 peptides in those individuals who acquired infection during the study. Thirty-five individuals were found to be PARV4 seropositive at the end of the study, eight of whose baseline samples were found to be seronegative. Persistent and functional T cell responses were detected in the acute infection phase. These responses had an active, mature, and cytotoxic phenotype and were maintained several years after infection. Thus, PARV4 infection is common in individuals exposed to blood-borne infections, independent of their HCV or HIV status. Since PARV4 elicits strong, broad, and persistent T cell responses, understanding of the processes responsible may prove useful for future vaccine design

Homage to Rushikesh M. Maru

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68443/2/10.1177_097206349900100102.pd

Contraceptive introduction and the management of choice: the role of Cyclofem in Indonesia

This paper presents a programmatic perspective on the relationship between the introduction of new contraceptive technology and expanding contraceptive options, using the example of Cyclofem in Indonesia. Past approaches to contraceptive introduction have considered only the characteristics of the new method in the decision-making process. In assessing whether the introduction of a new method actually expands contraceptive choice for women and whether the program has the managerial capabilities to assure quality of care in this process, the authors argue that consideration must be given to all methods within a delivery system and how new technology relates to the management of contraceptive choice. Using this perspective, the authors suggest that choice would not necessarily be expanded with scaled-up service delivery of a new once-a month injectable in the Indonesian public sector context.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31934/1/0000887.pd