Journal articles on the topic 'Community Support Programme (Nepal). II'
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Lageju, Nimesh, Durga Neupane, and Lokesh Shekher Jaiswal. "The female community health volunteers: unsung heroes." International Journal Of Community Medicine And Public Health 9, no. 4 (March 25, 2022): 1935. http://dx.doi.org/10.18203/2394-6040.ijcmph20220877.
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In the 1980s, Nepal commenced a programme of female community health volunteers (FCHVs), commonly known as “Mahila swoyemsewika”, which means “female volunteer”. Their roles were to support family planning in the early days, especially by distributing birth control pills and condoms. Gradually, their roles were extended to include other programmes. The volunteers are influential in achieving the health-related Millennium Development Goals and other targets. This programme has been the backbone of the health system in Nepal for the past three decades.
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Shrestha, Ramesh, Kamal Baral, and Neil Weir. "Community ear care delivery by community ear assistants and volunteers: a pilot programme." Journal of Laryngology & Otology 115, no. 11 (November 2001): 869–73. http://dx.doi.org/10.1258/0022215011909314.
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Hearing impairment is a major public health problem in Nepal. The present service delivery, however, is mainly hospital based and is limited to large towns. Those people residing in rural areas lack many basic needs including ear care services. The collaborative community volunteer-based ear care pilot programme implemented in Banke, Nepal aims to reach out to those rural areas by establishing sustainable primary ear care services, empowering and utilizing local resources. The focus of the programme is to promote multi-sector improvement in sanitation, nutrition, immunization, breast-feeding and timely care and support to ear patients to help prevent hearing impairment mainly from the sequelae of otitis media.
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Kafley, Govinda Prasad, and Krishna Pokharel. "Pro-poor Leasehold Forestry: A Community-based Tenure Regime in Nepal." Journal of Forest and Livelihood 15, no. 1 (September 4, 2017): 43–56. http://dx.doi.org/10.3126/jfl.v15i1.23085.
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Nepal’s Leasehold Forestry (LHF) programme,which has the twin goals of degraded forest rehabilitation and rural poverty alleviation, started in the early 1990s and is regarded as a priority forestry programme in Nepal.There has been limited documentationof the impact of the LHF programme as well as of the issues and challenges faced by it. On the basis of scarce existing literature and of our long experience working in the programme, we, in this paper, discuss such impacts, issues and challenges. We suggest that the programme has so far been quite positive in meeting the stated objectives; however, there remains a range of issues that deserve on-going attention. While the programme, in general, is criticized for its strategy of handing over poor quality land to the poor people, the communities’ tenure rights over land and forest resources is not fully secured either. Provisions regarding the transfer of tenure rights to the kin and/or in the context of absentees are absent, and the benefit sharing mechanisms are unclear in case of trees which were present at the time of handover, and compete across other overlapping forest management activities. Support services available to the LHF user groups are inadequate and discontinuous, limiting the opportunities for the poor leaseholders to harness their potential to pool resources from other poverty reduction programmes and influence policy processes. We indicate some areas of intervention at policy and programme levels that seek to overcome these issues and to provide wider space for LHF user groups to exercise their agency towards achieving the programme’s goals effectively, efficiently and equitably.
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KHATRI, DIL, KRISHNA SHRESTHA, HEMANT OJHA, GOVINDA PAUDEL, NAYA PAUDEL, and ADAM PAIN. "Reframing community forest governance for food security in Nepal." Environmental Conservation 44, no. 2 (October 17, 2016): 174–82. http://dx.doi.org/10.1017/s0376892916000369.
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SUMMARYThe growing challenge of food insecurity in the Global South has called for new research on the contribution of forests to food security. However, even progressive forest management institutions such as Nepal's community forestry programme have failed to address this issue. We analyse Nepal's community forestry programme and find that forest policies and local institutional practices have historically evolved to regulate forests either as sources of timber or as a means of biodiversity conservation, disregarding food security outcomes for local people. Disciplinary divisions between forestry and the agriculture sector have limited the prospect of strengthening forest–food security linkages. We conclude that the policy and legislative framework and formal bureaucratic practices are influenced by ‘modern forestry science’, which led to community forestry rules and practices not considering the contribution of forests to food security. Furthermore, forestry science has a particularly narrow focus on timber production and conservation. We argue for the need to recognise the importance of local knowledge and community practices of using forests for food. We propose adaptive and transformational approaches to knowledge generation and the application of such knowledge in order to support institutional change and policy reform and to enable landscape-specific innovations in forest–food linkages.
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Paudel, Klara, Ahad Qayyum, Abdul WM Wazil, Sanjib K. Sharma, Kalpana Shrestha, Stanley Fan, Agnes Haris, Fredric O. Finkelstein, and Nishanthe Nanayakkara. "Overcoming barriers and building a strong peritoneal dialysis programme – Experience from three South Asian countries." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 41, no. 5 (June 2, 2021): 480–83. http://dx.doi.org/10.1177/08968608211019986.
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The development of peritoneal dialysis (PD) programmes in lower-resource countries is challenging. This article describes the learning points of establishing PD programmes in three countries in South Asia (Nepal, Sri Lanka and Pakistan). The key barriers identified were government support (financial), maintaining stable supply of PD fluids, lack of nephrologist and nurse expertise, nephrology community bias against PD, lack of nephrology trainee awareness and exposure to this modality. To overcome these barriers, a well-trained PD lead nephrologist (PD champion) is needed, who can advocate for this modality at government, professional and community levels. Ongoing educational programmes for doctors, nurses and patients are needed to sustain the PD programmes. Support from well-established PD centres and international organisations (International Society of Peritoneal Dialysis (ISPD), International Society of Nephrology (ISN), International Pediatric Nephrology Association (IPNA) are essential.
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O'Brien, Kieran S., Valerie M. Stevens, Raghunandan Byanju, Ram Prasad Kandel, Gopal Bhandari, Sadhan Bhandari, Jason S. Melo, Travis C. Porco, Thomas M. Lietman, and Jeremy D. Keenan. "Cluster-randomised trial of community-based screening for eye disease in adults in Nepal: the Village-Integrated Eye Worker Trial II (VIEW II) trial protocol." BMJ Open 10, no. 10 (October 2020): e040219. http://dx.doi.org/10.1136/bmjopen-2020-040219.
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IntroductionThe majority of blindness worldwide could be prevented or reversed with early diagnosis and treatment, yet identifying at-risk and prevalent cases of eye disease and linking them with care remain important obstacles to addressing this burden. Leading causes of blindness like glaucoma, diabetic retinopathy and age-related macular degeneration have detectable early asymptomatic phases and can cause irreversible vision loss. Mass screening for such diseases could reduce visual impairment at the population level.Methods and analysisThis protocol describes a parallel-group cluster-randomised trial designed to determine whether community-based screening for glaucoma, diabetic retinopathy and age-related macular degeneration reduces population-level visual impairment in Nepal. A door-to-door population census is conducted in all study communities. All adults aged ≥60 years have visual acuity tested at the census visit, and those meeting referral criteria are referred to a local eye care facility for further diagnosis and management. Communities are subsequently randomised to a community-based screening programme or to no additional intervention. The intervention consists of a single round of screening including intraocular pressure and optical coherence tomography assessment of all adults ≥60 years old with enhanced linkage to care for participants meeting referral criteria. Four years after implementation of the intervention, masked outcome assessors conduct a repeat census to collect data on the primary outcome, visual acuity. Individuals with incident visual impairment receive a comprehensive ophthalmological examination to determine the cause of visual impairment. Outcomes are compared by treatment arm according to the originally assigned intervention.Ethics and disseminationThe trial has received ethical approval from the University of California San Francisco Institutional Review Board, Nepal Netra Jyoti Sangh and the Nepal Health Research Council. Results of this trial will be disseminated through publication in peer-reviewed journals and presentation at local and international meetings.Trial registration numberNCT03752840
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Choudhury, Sopna, Onaedo Ilozumba, Joydeepa Darlong, Karthikeyan Govindasamy, Paul A. Tsaku, Sunday Udo, Dilip Shrestha, et al. "Investigating the sustainability of self-help programmes in the context of leprosy and the work of leprosy missions in Nigeria, Nepal and India: a qualitative study protocol." BMJ Open 13, no. 5 (May 2023): e070604. http://dx.doi.org/10.1136/bmjopen-2022-070604.
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IntroductionLeprosy occurs among very poor people who may be stigmatised and pushed further to the margins of society. Programmes to improve social integration and stimulate economic development have been implemented to help break the vicious cycle of poverty, reduced quality of life and ulcer recurrence. These involve forming groups of people, with a common concern, to provide mutual support and form saving syndicates—hence the term ‘self-help groups’ (SHGs). While there is literature on the existence and effectiveness of SHGs during the funded periods, little is known about their sustainability. We aim to explore the extent to which SHG programme activities have continued beyond the funding period and record evidence of sustained benefits.Methods and analysisIn India, Nepal and Nigeria, we identified programmes funded by international non-governmental organisations, primarily aimed at people affected by leprosy. In each case, financial and technical support was allocated for a predetermined period (up to 5 years).We will review documents, including project reports and meeting minutes, and conduct semistructured interviews with people involved in delivery of the SHG programme, potential beneficiaries and people in the wider environment who may have been familiar with the programme. These interviews will gauge participant and community perceptions of the programmes and barriers and facilitators to sustainability. Data will be analysed thematically and compared across four study sites.Ethics and disseminationApproval was obtained from the University of Birmingham Biomedical and Scientific Research Ethics Committee. Local approval was obtained from: The Leprosy Mission Trust India Ethics Committee; Federal Capital Territory Health Research Ethics Committee in Nigeria and the Health Research Ethics Committee of Niger State Ministry of Health; University of Nigeria Teaching Hospital and the Nepal Health and Research Council. Results will be disseminated via peer-reviewed journals, conference presentations and community engagement events through the leprosy missions.
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Kshetree, Mukunda Prakash. "Impact of Early Childhood Care and Development Programme in Learning Mathematics." Tribhuvan University Journal 31, no. 1-2 (December 31, 2017): 159–66. http://dx.doi.org/10.3126/tuj.v31i1-2.25351.
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The main focus of the study was to determine overall expected outcomes and learning achievements including assess the effectiveness of Early Childhood Care and Development (ECCD) models conducted in the support of Save the Children (SC) Nepal. The expected outcomes were related to children’s school preparedness, learning progresses, promotion, repetition and dropout status. The study was further focused on comparing achievement scores of the students (with and without ECCD exposure) in mathematics and other major subjects. The study also explored important areas for their corrective measures. The study adopted mixed methods research design which employed both quantitative and qualitative primary and secondary data. For the collection of required data, it administered different research tools including classroom observation, school survey forms and semi-structured interview schedules for teachers, parents, management committee members, community based organization (CBO) members and SC local staffs of three districts. The research tools were piloted in four schools located in Kavre district. The sample districts were selected purposively to involve each eco-zone of Nepal such as Siraha, Baglung and Achham from plain, hilly and mountainous region respectively. The study showed that the SC supported ECCD Centers were found above than average standard subjected to set out criteria. Similarly, the learning outcomes and achievements made by the students in major subjects including mathematics with ECCD experience showed significantly higher than those students having no ECCD experience.
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Dhakal, Raju, Mandira Baniya, Rosie M. Solomon, Chanda Rana, Prajwal Ghimire, Ram Hariharan, Sophie G. Makower, et al. "TEleRehabilitation Nepal (TERN) for People With Spinal Cord Injury and Acquired Brain Injury: A Feasibility Study." Rehabilitation Process and Outcome 11 (January 2022): 117957272211260. http://dx.doi.org/10.1177/11795727221126070.
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BACKGROUND: Spinal Cord Injury (SCI) or Acquired Brain Injury (ABI) leads to disability, unemployment, loss of income, decreased quality of life and increased mortality. The impact is worse in Low-and Middle-Income Countries (LMICs) due to a lack of efficient long-term rehabilitative care. This study aims to explore the feasibility and acceptability of a telerehabilitation programme in Nepal. METHODS: Prospective cohort feasibility study in a community setting following discharge from a specialist rehabilitation centre in Nepal. Patients with SCI or ABI who had previously accessed specialist rehabilitation were connected to a specialist Multidisciplinary Team (MDT) in the centre through a video conference system for comprehensive remote assessments and virtual individualised interventions. Data were captured on recruitment, non-participation rates, retention, acceptability (via end-of-study in-depth interviews with a subset of participants) and outcome measures including the Modified Barthel Index (MBI), Depression Anxiety Stress Scale (DASS) and EuroQol-5D (EQ-5D), completed pre- and post-programme. RESULTS: 97 participants with SCI (n = 82) or ABI (n = 15) discharged from the centre during an 18-month period were approached and enrolled on the study. The telerehabilitation programme facilitated the delivery of support around multiple aspects of rehabilitation care, such as spasticity treatments and pain management. Outcome measures indicated a significant improvement in functional independence ( P < .001), depression, anxiety and stress ( P < .001) and quality of life ( P < .001). Qualitative interviews (n = 18) revealed participants found the programme acceptable, valuing regular contact and input from MDT professionals and avoiding expensive and lengthy travel. CONCLUSION: This is the first study in Nepal to identify telerehabilitation as a feasible and acceptable approach to augment the provision of specialist rehabilitation. Future research is needed to assess the suitability of the programme for other conditions requiring specialist rehabilitation and determine the mechanisms underpinning improved outcomes for people with SCI or ABI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04914650
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Etowa, Josephine, Amy Johnston, Zahra Jama, Kristin M. Eccles, and Alicia Ashton. "Mixed-method evaluation of a community-based postpartum support program: a study protocol." BMJ Open 10, no. 10 (October 2020): e036749. http://dx.doi.org/10.1136/bmjopen-2019-036749.
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IntroductionBecoming a parent is one of the most significant events an individual will experience in their lifetime. The postpartum period can be a difficult time, especially for mothers, who may require extra support during this challenging time. The proposed study seeks to understand the issue of postpartum support for mothers and their families. It will address this aim by using the Mothercraft Ottawa Postpartum Support Drop-in Program as real-life illustration of a community-based service organisation delivering these services.Methods and analysisA three-phased mixed-method programme evaluation guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework and the tenets of community-based participatory research. Instrumental case study methodology will be employed to gain an in-depth understanding of what impact(s) the programme is having on mothers, their partners and their families (phase I-qualitative). A questionnaire, regression modelling, and geospatial analysis will be conducted to gain a deeper understanding of specific programme outputs and to generate information that will help inform programme reach (phase II-quantitative). Study phase III will focus on knowledge translation activities to stakeholders and the broader academic community.Ethics and disseminationEthics approval was granted by the University of Ottawa Research Ethics Board (H-12-18-1492). The results of this study will be disseminated at a community workshop, in an academic thesis, at academic conferences and in peer-reviewed publications.
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Christensen, Julie Hellesøe, Cecilie Karen Ljungmann, Charlotte Skau Pawlowski, Helene Rald Johnsen, Nikoline Olsen, Mathilde Hulgård, Adrian Bauman, and Charlotte Demant Klinker. "ASPHALT II: Study Protocol for a Multi-Method Evaluation of a Comprehensive Peer-Led Youth Community Sport Programme Implemented in Low Resource Neighbourhoods." International Journal of Environmental Research and Public Health 19, no. 22 (November 18, 2022): 15271. http://dx.doi.org/10.3390/ijerph192215271.
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To reduce inequalities in children’s sport participation, studies are needed to explore ways in which children from low resource neighbourhoods can be engaged and retained in sport. GAME Community is a peer-led community sport programme which aims to promote physical activity through participation in inclusive street sports activities targeting 8–15-year-old children living in low resource neighbourhoods. The GAME Community intervention is implemented by the non-profit street sport organisation GAME. Five components support the implementation of GAME Community: (1) training of peer leaders; (2) a focus on inclusion of inactive girls; (3) parental involvement; (4) community engagement; (5) strengthened organisational support to peer leaders. In the ASPHALT II study, we aim to evaluate GAME Community and hence contribute to understanding how children growing up in low resource neighbourhoods can be engaged and retained in physical activity through participation in peer-led, community-based sport and to generate new understandings on the scale up of community interventions. The primary objective of the evaluation is to investigate the implementation of GAME Community and the programme’s reach, and to establish the functioning and mechanisms of the programme. The secondary objective is to establish the health enhancing potential of the programme. The evaluation of GAME Community involves three linked but independent studies that investigate (1) the functioning (i.e., mechanisms and processes), (2) reach, and (3) outcomes. The functioning of the five intervention components is investigated using qualitative methodologies. Programme reach will be investigated based on participant registrations. Systematic observations using a novel combination of validated tools will provide information on outcomes (physical activity level and social behaviour) during GAME Community activities. Investigating functioning, reach, and outcomes of the GAME Community intervention by using multiple methods is a strength, as different data complement and inform each other. This study will provide in-depth insights into if and how children living in low resource neighbourhoods can be engaged and retained in physical activity through participation in peer-led, community-based sport. Contributions of this evaluation include new understanding of the mechanisms and scalability of a community-based street sport intervention.
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Gautam, Susmita. "Impact of Government Policy on Women Empowerment: Evidence from the Poverty Alleviation Fund, Nepal." NUTA Journal 7, no. 1-2 (December 31, 2020): 90–99. http://dx.doi.org/10.3126/nutaj.v7i1-2.39937.
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Traditionally, most of the women in developing countries like Nepal have had to face different forms of inequality and discrimination such as limited access to education, deprivation from property rights and forced early marriage mainly due to the patriarchal structure of society. As a result, gender disparity, forced marriage and violence against them, women have a lower societal status and lower level of education, few accesses to employment and legal rights compared to male. Government policies and programs helps to improve all the aspects of women empowerment. The main objective is to study the impact of government policy based programme for women empowerment. The study demonstrates the role, responsibility, opportunity, and decision-making issues of women. Taking reference of PAF model for women empowerment members of community organizations (CO) involved were selected as a sample. Both qualitative and quantitative data were analyzed. The PAF model takes community demand driven approach and supports the formation of representative community organizations of the poor and helps them identify their own development priorities, needs and solutions. The findings revealed that the women are in the process of their empowerment. They need position help and support from the family, society, and country as well. For this, country should develop gender friendly policies and programs.
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Rautanen, Sanna-Leena, and Pamela White. "Portrait of a successful small-town water service provider in Nepal's changing landscape." Water Policy 20, S1 (March 1, 2018): 84–99. http://dx.doi.org/10.2166/wp.2018.006.
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Abstract This study was made in Nepal's Tarai plains, where rapid population growth over the past decade has transformed a large number of rural bazaars and roadside hubs into vibrant small towns. This study draws a portrait of a distinctly successful small-town water supply scheme and its service provider, the Murgia Water Users and Sanitation Association. Exploring this particular case with regards to social, technological, financial and organisational systems, and by comparing the performance of this case against 63 other water service providers in Nepal, the study asks: how could there be more of this type of successful water service provider? This scheme was constructed during the bilateral Rural Water Supply and Sanitation Support Programme Phase III, Nepal-Finland cooperation (1999–2005), using the typical rural approach, namely community management, with strong capacity building. Since then the service modality in this study case has evolved towards a professional community-managed service delivery. The success is rooted in good water governance principles: participation, responsiveness, financial transparency, accountability and overall strong commitment and vision, as well as strong technical assistance. They have resulted in re-investment in both the capital maintenance expenditure and into new infrastructure, even into an entirely new water supply scheme.
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Pająk, Anna, and Artur Orzeł. "The startegy of sustainable public transport in the city of Kielce for the years 2014 to 2020." AUTOBUSY – Technika, Eksploatacja, Systemy Transportowe 19, no. 10 (October 31, 2018): 38–40. http://dx.doi.org/10.24136/atest.2018.331.
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In the frame of Action 2.1. “Sustainable urban transport” of the II Priority Axis of the Eastern Poland 2014-2020 Operational Programme, the community of Kielce submitted two applications of investment projects of the total value of 295 mln PLN, 220 mln out Submissions of the total amount are going to be covered by programme funds. The main aim of submitted projects is to support complex investments in ecological and integrated public transportation system. Eastern Poland Operational Programme includes five voivodeships in the area of Eastern Poland macroregion : lubelskie, podkarpackie, podlaskie, świętokrzyskie i warmińsko-mazurskie. As an additional territorial instrument of financial support, programme is oriented on complementing implementation of regional and national operational programmes. Programme is also based on the main aims and priorities of “The Strategy of Social and Economic Development of Eastern Poland to 2020” approved by the Council of Ministers in Poland on 11th of July 2013 and is one of the instruments of strategy implementation..
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Higgs, Chris, Margot Skinner, and Leigh Hale. "Outcomes of a community-based lifestyle programme for adults with diabetes or pre-diabetes." Journal of Primary Health Care 8, no. 2 (2016): 130. http://dx.doi.org/10.1071/hc15038.
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Abstract INTRODUCTION Diabetes, a long-term condition increasing in prevalence, requires ongoing healthcare management. Exercise alongside lifestyle education and support is effective for diabetes management. AIM To investigate clinical outcomes and acceptability of a community-based lifestyle programme for adults with diabetes/prediabetes at programme completion and 3-month follow-up. METHODS The 12-week community programme included twice-weekly sessions of self-management education and exercise, supervised by a physiotherapist, physiotherapy students and a nurse. Clinical outcomes assessed were cardiorespiratory fitness, waist circumference, exercise behaviour and self-efficacy. A standardised evaluation form was used to assess programme acceptability. RESULTS Clinically significant improvements were found from baseline (n = 36) to programme completion (n = 25) and 3-months follow-up (n = 20) for the six minute walk test (87 m (95%CI 65–109; p ≤ 0.01), 60 m (95%CI 21–100; p ≤ 0.01)), waist circumference (−3 cm (95%CI −6 to –1), −3 cm (95%CI –6 to 1)), exercise behaviour (aerobic exercise 53 min/week (95%CI 26 to 81; p ≤ 0.01), 71 min/week (95%CI 25 to 118; p ≤ 0.01)) and self-efficacy (0.7 (95%CI −0.2 to 1.6), 0.8 (95%CI 0.04 to 1.5)). Good programme acceptability was demonstrated by themes suggesting a culturally supportive, motivating, friendly, informative atmosphere within the programme. The attrition rate was 30% but there were no adverse medical events related to the programme. DISCUSSION The programme was safe and culturally acceptable and outcomes demonstrated clinical benefit to participants. The attrition rate was largely due to medical reasons unrelated to the programme. This model of a community-based lifestyle programme has the potential to be reproduced in other regions and in adults with similar long-term conditions. KEYWORDS Diabetes Mellitus Type II; Prediabetic state; Co-morbidity; Exercise; Self-management
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Swan, L., F. Horgan, V. Cummins, F. Doyle, R. Galvin, E. Burton, J. Sorensen, et al. "199 EMBEDDING PHYSICAL ACTIVITY WITHIN HOME CARE SERVICES FOR OLDER ADULTS IN IRELAND—A QUALITATIVE STUDY OF BARRIERS AND FACILITATORS." Age and Ageing 50, Supplement_3 (November 2021): i1—i8. http://dx.doi.org/10.1093/ageing/afab216.199.
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Abstract Background In Ireland, over 53,000 older adults are supported in their community by formal home support, amounting to an estimated 19 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the ‘Care to Move’ (CTM) programme through existing home support services. The aim of the present qualitative study was to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in, and delivered the CTM programme. Methods We conducted semi-structured telephone interviews with 22 HCAs involved in the delivery of the programme among older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery. Results Barriers and facilitators were identified under three main themes i) the programme ii) the care setting, iii) the clients. Overall, there was a positive perception of the programme’s focus on ‘movement prompts and motivators’, the ‘fit’ within home support services, and the training provided. Practical challenges of limited time and the task-orientation nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the programme for their clients. Though negative perceptions of older adult’s motivation or ability to engage with physical activity also emerged. Risk, such as injury or pain, was identified but was not a dominant theme. Conclusion Our preliminary findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional ‘task-oriented' care models to more personalised proactive approaches may facilitate this initiative and support ageing in place.
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Harris, Melanie, Phil Jones, Marie Heartfield, Mary Allstrom, Janette Hancock, Sharon Lawn, and Malcolm Battersby. "Changing practice to support self-management and recovery in mental illness: application of an implementation model." Australian Journal of Primary Health 21, no. 3 (2015): 279. http://dx.doi.org/10.1071/py13103.
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Health services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to: (i) identify a well-founded implementation model; and (ii) assess its practical usefulness in introducing a new programme for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health organisations, and that also had corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organisational Readiness to Change Assessment (ORCA) tool were used. The PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new programme showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health organisations. Further practical use and testing of implementation models appears justified in overcoming barriers to change.
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Neupane, Hari, Hemant Ojha, and Chris Garforth. "Scaling up of sustainable soil management practices: some lessons from the hills of Nepal." Journal of Forest and Livelihood 2, no. 1 (April 7, 2024): 75–77. http://dx.doi.org/10.3126/jfl.v2i1.59685.
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A study was conducted to assess the scaling up processes of soil management practices under maize based farming systems in Panchkhal and Sanga areas of Kavre district. The key objectives of the study are to analyze the scaling up processes and pathways of soil management practices in the case study areas and identify factors related to scaling up at different levels. Three principalquestions guiding the analysis were: a) what are the positive aspects of scaling up processes and how can these be built on? b) What are the problems being experienced and how can these be overcome? c) What is the influence of people's livelihood strategies and assets on the processes? Kavre is one of the 10 districts where Sustainable soil Management Programme (SSMP) ofHelvetas has helped local people in the adoption of innovative soil management practices integrated with various cash and subsistence crops. With SMP support and advice, services to farmers in these areas create awareness and build their institutions (CIs) provide extension services to farmers in these areas create awareness and build their institutional capacity onadopting innovative soil management practices. The goal of the project is to improve livelihoods of resource poor farmers.Data for the study were gathered from 29 households through interviews, two workshops with key informants at the community level and a workshop with CIs at district levels, and review of SSMP and partners' documented information on the subject. The research team also made transect visits through the area, and interviewed several staff of the collaborating institutions. Qualitativeanalysis (in terms of perceptions of respondents) as well as quantitative analysis of data was done at household, community and institutional levels.
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Tuladhar, Ramesh M., Rishi Ram Sharma, Saraju Kumar Baidya, Shiva Prasad, Rajendra Sharma, Kamal Datta Acharya, and Jagadishower Karmacharya. "Results-based Monitoring and Evaluation of the Building Resilience to Climate-related Hazards Project: A Legendary Good Practice towards Climate Hazards Resilience." International Journal of Scientific and Management Research 05, no. 05 (2022): 14–24. http://dx.doi.org/10.37502/ijsmr.2022.5502.
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Nepal is a small landlocked country with complex topography and fragile geology which coupled with its lower-middle income economy, natural resources dependent population, and weak institutional capacity, all combine to rank it as the 4th most climate-vulnerable country in the world (http://maplecroft.com). A climate risk assessment carried out specifically for the Strategic Program for Climate Resilience (SPCR) at the sector, district and community levels identified the following critical risks: i) water quantity and quality, ii) food security, iii) ecosystem health, iv) animal and human health, v) vulnerable groups, and vi) economic growth and sustainability. Realizing this potential, the Government of Nepal (GoN) with support from the World Bank (WB) launched the Building Resilience to Climate-related Hazards (BRCH) Project in June 2013 with the aim to minimize overall climate risks in Nepal under the global initiatives of Pilot Program for Climate Resilience (PPCR). It is designed to demonstrate ways that developing countries can make climate risk and resilience part of their core development planning. The results-based monitoring adopted by the BRCH project is a legendary good practice in Nepal, an effective measure towards addressing climate hazards – the ultimate goal of the project and it could be instrumental for the South Asia as well.
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De La Cruz, Monica M., Kimmy Phan, and Janine S. Bruce. "More to offer than books: stakeholder perceptions of a public library-based meal programme." Public Health Nutrition 23, no. 12 (April 21, 2020): 2179–88. http://dx.doi.org/10.1017/s1368980019004336.
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AbstractObjective:To examine the perspectives of librarians and staff about Lunch at the Library, a library-based summer meal programme for children. The study examines: (i) motivating factors behind implementing the meal programme; (ii) issues of feasibility; and (iii) perceived programme outcomes.Design:One-on-one semi-structured interviews with library stakeholders (librarians and staff) from a purposeful sample of California libraries.Setting:Twenty-two library jurisdictions across California that implemented the Lunch at the Library summer meal programme in 2015 in areas of high financial need.Participants:Twenty-five library stakeholders representing twenty-two of the thirty-three Californian library jurisdictions that implemented Lunch at the Library at their sites.Results:Library stakeholders recognised the need for a child meal programme during summer. Despite lack of sufficient resources and personnel, they were motivated to implement the programme not only to fill a community need but also to ensure children at their libraries were primed for learning over the summer. Library stakeholders also perceived the public library’s changing role in society as shifting from reference provision to social service provision either directly or by referral.Conclusions:The public library is an ideal place to provide social services because of its accessibility to all. Librarians and library staff are motivated to address the social needs of their communities. This study demonstrates the feasibility of implementing new social programmes at public libraries. Funding to support these programmes would increase the library’s capacity to address other community needs.
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Galvin, R., E. Burton, V. Cummins, M. O'Sullivan, L. Swan, F. Doyle, J. Sorensen, et al. "255 A QUALITATIVE STUDY OF OLDER ADULTS’ EXPERIENCES OF EMBEDDING PHYSICAL ACTIVITY WITHIN THEIR HOME CARE SERVICES." Age and Ageing 50, Supplement_3 (November 2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.255.
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Abstract Background Physical activity programmes have been shown to improve older adults’ functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the ‘Care to Move’ (CTM) programme. The aim of this qualitative study is to explore older adults’ experiences of the CTM programme. Methods We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery. Results Four themes emerged: i) ‘I’m feeling good about it’, ii) ‘safety and security is the name of the game’, iii) ‘we’re a team as it stands’, iv) ‘it’s [COVID] depressing for everybody at the moment’. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA’s in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery. Conclusion Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.
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Singh, Devendra Raj, Dev Ram Sunuwar, Sunil Kumar Shah, Lalita Kumari Sah, Kshitij Karki, and Rajeeb Kumar Sah. "Food insecurity during COVID-19 pandemic: A genuine concern for people from disadvantaged community and low-income families in Province 2 of Nepal." PLOS ONE 16, no. 7 (July 21, 2021): e0254954. http://dx.doi.org/10.1371/journal.pone.0254954.
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Background Food insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal. Methods The semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software. Results The results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection. Conclusion Food insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community.
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Boenke, A. "The Standards, Measurements and Testing Programme (SMT)—The European Support to Standardisation, Measurements and Testing Projects and its Proposed Activities in the 5th Framework Programme." Journal of Near Infrared Spectroscopy 6, A (January 1998): A1—A6. http://dx.doi.org/10.1255/jnirs.159.
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The objectives of the EC, SMT-Programme include the provision of research and technical support to standardisation and health of the society when it is required to improve the competitive position of European industry, and for the development or implementation of Community policy.1 These objectives led to the EC, SMT-workprogramme, which is divided in the following three THEMES: THEME I: Measurements for Quality European Products Including Written Standards for Industry, THEME II: Measurements Related to Written Standards and Technical Support to Trade, THEME III: Measurements Related to the Needs of Society. These themes were accessible through participation in different calls for proposals. The European Commission's proposal for the 5th Framework Programme explains that harmonised and validated methods, as well as instrumentation in Europe, together with the establishment of international traceability of measurements, are needed to ensure quality and sustainability of industrial products, services, to remove barriers to trade, to promote mutual recognition agreements and to combat fraud. Consequently, the following objectives of Measurements and Testing as a generic activity within the 3rd Thematic Programme, Promoting Competitive and Sustainable Growth, were proposed: (a) pre-normative research and technical support to standardisation, (b) the fight against fraud, (c) improvement of quality of products and services. These objectives include instrumentation (e.g. Sensors, etc.), reference methods and certified Reference Materials (CRM) as important measurement and testing tools.
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Cheema, Abdur Rehman, Shehla Zaidi, Rabia Najmi, Fazal Ali Khan, Sultana Ali Kori, and Nadir Ali Shah. "Availability Does Not Mean Utilisation: Analysis of a Large Micro Health Insurance Programme in Pakistan." Global Journal of Health Science 12, no. 10 (July 20, 2020): 14. http://dx.doi.org/10.5539/gjhs.v12n10p14.
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In recent years, several Micro Health Insurance (MHI) schemes have been initiated in low- and middle-income countries (LMIC) to meet the universal health coverage targets. Evidence on the utilization of these MHI schemes is scarce. Field experiences and lesson learning is crucial to effectively increase access to health care and offer protection against catastrophic health expenditure to the poorest population through the MHI schemes. This paper analyzes community utilization and factors affecting utilization of an MHI provided to the poorest rural households in eight districts of Sindh province of Pakistan. This initiative is part of a larger pro-poor European Union (EU) funded Sindh Union Council and Community Economic Strengthening Support (SUCCESS) Programme implemented by the Rural Support Programs (RSPs). The analysis draws on insurance utilization records and an internal assessment report by the RSPs Network (RSPN). The analysis provides qualitative experiences of the community, empanelled health care providers, the insurance agency and frontline management staff. Our analysis revealed that the overall utilization was very low (0.42%) and the highest number of cases treated at the hospital were of women utilizing obstetric and gynaecology related care. The scheme was noted to prevent catastrophic health expenditure in households that were able to successfully utilize the scheme. Key factors affecting utilization were identified to be around i) awareness creation, ii) distance to empanelled hospitals, and iii) access issues at the health facility level. We aim to add to the knowledge base around MHI for policy makers to design and implement more informed initiatives in the future.
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Finlay-Jones, Amy, Jetro Emanel Ang, Elaine Bennett, Jenny Downs, Sally Kendall, Keerthi Kottampally, Sheila Krogh-Jespersen, et al. "Caregiver-mediated interventions to support self-regulation among infants and young children (0–5 years): a protocol for a realist review." BMJ Open 11, no. 6 (June 2021): e046078. http://dx.doi.org/10.1136/bmjopen-2020-046078.
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IntroductionSelf-regulation is a modifiable protective factor for lifespan mental and physical health outcomes. Early caregiver-mediated interventions to promote infant and child regulatory outcomes prevent long-term developmental, emotional and behavioural difficulties and improve outcomes such as school readiness, educational achievement and economic success. To harness the population health promise of these programmes, there is a need for more nuanced understanding of the impact of these interventions. The aim of this realist review is to understand how, why, under which circumstances and for whom, early caregiver-mediated interventions improve infant and child self-regulation. The research questions guiding this review were based on consultation with families and community organisations that provide early childhood and family services.Methods and analysisRealist reviews take a theory-driven and iterative approach to evidence synthesis, structured around continuous refinement of a programme theory. Programme theories specify context-mechanism-outcome configurations to explain what works, for whom, under which circumstances and how. Our initial programme theory is based on prior work in this field and will be refined through the review process. A working group, comprising service users, community organisation representatives, representatives from specific populations, clinicians and review team members will guide the evidence synthesis and interpretation, as well as the development and dissemination of recommendations based on the findings of the review. The review will involve searching: (i) electronic databases, (ii) connected papers, articles and citations and (iii) grey literature. Decisions to include evidence will be guided by judgements about their contribution to the programme theory and will be made by the research team, with input from the working group. Evidence synthesis will be reported using the Realist and MEta-narrative Evidence Synthesis: Evolving Standards guidelines.Ethics and disseminationEthical approval is not required as this is a review. Findings will be disseminated to our working group and through peer-reviewed publications and conference presentations.Review registration numberThe protocol is registered with Open Science Framework https://osf.io/5ce2z/registrations.
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Poudel, Arjun Prasad. "Teachers' Perception on School Health Services." Journal of Health Promotion 6 (November 25, 2018): 5–10. http://dx.doi.org/10.3126/jhp.v6i0.21779.
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Teaching health and physical education by qualified teachers can support the promotion of health among school children. In Nepal, school health programme has not been run effectively as health and any subject teachers teach physical education subject. On the other hand, government policy makers and school management does not seem serious about this issue. In this context, the study intends to explore perceptions of teachers on students' health promotion through school health services. This study was based on qualitative research design specifically phenomenological approach. Qualitative data were collected from twelve purposefully selected teachers of six different community schools of Kathmandu using in- depth interview technique. The collected data were analyzed by applying thematic approach. The study collected perception of Health and Physical Education (HPE) teachers regarding school health services, health promotive activities, water, sanitation and hygiene that play crucial role to promote healthy behaviour of students. In their perception, school health services should be provided to promote students' health, control the epidemics and communicable diseases and to create healthy school environment. In their perception, child friendly school creates an open-learning environment and keeps students mentally sound, creative and well-motivated in learning. Based on the findings of the study, it can be concluded that teachers' perception on school health programme is fairly satisfactory. However, their health activities are limited within the classroom practices and theoretical notions included in the textbook.Journal of Health Promotion Vol.6 2008, p.5-10
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Yi, Xu, Shuai Liu, Cheng Yu Peng, and Su Fee Lim. "Connecting with Rough Sleepers: Community Volunteer Training and Partnership." International Journal of Integrated Care 23, S1 (December 28, 2023): 207. http://dx.doi.org/10.5334/ijic.icic23399.
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Background: A nationwide study on homelessness in 2019 reported high prevalence of poor health among rough sleepers in Singapore. There are rough sleepers supported by volunteers and community partners within Singapore General Hospital service boundary. Community nursing team engaged Ministry of Social and Family Development (MSF) Partners Engaging and Empowering Rough Sleepers (PEERS) Network and Homeless Heart, a volunteer group, to reach out to this vulnerable population and to understand challenges faced by volunteers. The learning needs survey among 39 volunteers was conducted and showed that less than 8% of them were equipped with basic healthcare knowledge and skills. The top three learning needs were i) healthcare resource for homeless (92.1 %), ii) mental Health (68.4%), iii) basic triaging skills (68.4%).
Interventions: A virtual volunteer training programme was developed based on survey findings and inputs from PEERS Network during COVID-19. It was further extended to shelter operators supporting rough sleepers. The training was conducted by community nurses on alternate weekend from February to March 2022. The mode of delivery included didactic teaching and case discussion. A referral process to community nursing for rough sleepers requiring assistance in chronic disease monitoring was established to ensure care continuity.
Outcomes: A total of 46 participants attended training. All found the program content was useful, relevant to their volunteer activities, and easy to understand. Nearly 80% will recommend this program to their peers. Till date, a total of 5 referrals to Community Nurse Posts were made by volunteers. Nurses conducted health coaching and medication re-consolidation to rough sleepers and also guided volunteers for the subsequent follow up.
Learning Points and Future Plan: It is the first training programme provided by community nurses to volunteers and staff supporting rough sleepers. The programme was tailored to meet participants’ experience and learning needs. Community nursing will further collaborate with PEERS for outreach events and provide onsite training to facilitate effective learning experience. Moving forward, community nurse team will extend the training program to other community service provides and grassroots volunteer, to support the residents’ physical and psychological well-being in the community .
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Belmans, Niels, and Michèle Coeck. "EURAD School of Radioactive Waste Management." Safety of Nuclear Waste Disposal 1 (November 10, 2021): 245–46. http://dx.doi.org/10.5194/sand-1-245-2021.
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Abstract. The European Joint Programme on Radioactive Waste Management (EURAD – H2020, grant agreement No. 847593) aims to achieve a step-wise change in European collaboration towards safe radioactive waste management (RWM) through the development of a robust and sustained science, technology and knowledge management (KM) programme. EURAD has three KM work packages. The main goals are to (i) preserve generated knowledge, (ii) transfer knowledge to Member States with early-stage RWM programmes, (iii) transfer knowledge between generations, and (iv) disseminate knowledge. The EURAD work package (WP) on “Training & mobility” aids in achieving these goals through its “School of Radioactive Waste Management”. The School of RWM supports competence building in RWM matters. Currently four distinguished initiatives can be highlighted: the organization of training courses, the hosting of webinars, the coordination of a mobility programme, and actions to support the EURAD PhD community. The School of RWM has a dedicated webpage (http://www.euradschool.eu, last access: 30 September 2021) where all information on its activities can be found. A portfolio of basic and specialized training courses was set up containing an up-to-date list of existing training initiatives and new training courses. The latter are based on a gap analysis performed within the framework of the priorities set in the EURAD Roadmap and on the end-user needs. The School of RWM gives attention to the best-fitted training format and scientific state-of-the-art is guaranteed through the lecturing by EURAD and/or external subject experts. Besides training courses, webinars on specific topics that are of relevance to the entire EURAD community are hosted on a regular basis. These so-called Lunch & Learn sessions are short, informal online get-togethers, triggering discussion and debate. Presentations are given by experts from the EURAD community and beyond, such as from the International Atomic Energy Agency (IAEA) or the Organisation for Economic Co-operation and Development/Nuclear Energy Agency (OECD/NEA) and can deal with all topics that link to RWM, from very specialized scientific matters to more general and overarching themes. The School of RWM also coordinates a mobility programme, allowing its beneficiaries to perform technical visits to infrastructures from EURAD partners or end-users, to undertake internships and to set up exchange programmes between organizations within EURAD. These activities serve as enhanced training as well as collaboration between all members of the EURAD community. These mobility actions can be complementary to an educational or training programme and/or part of a continuous personal development programme. Last but not least, the initiative was taken to support the EURAD PhD community. As future key players in the field of RWM, they will benefit from the possibilities for early networking with their peers and with established RWM experts. With these four initiatives, the School of RWM, and by extension the “Training & Mobility” WP, is an integral part of EURAD's KM programme. This presentation describes how the School of RWM is linked to the EURAD Roadmap, what its goal and long-term objectives are and how it aids in achieving EURAD's KM goals.
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Baniya, Mandira, Chanda Rana, Raju Dhakal, Sophie G. Makower, Stephen J. Halpin, Ram Hariharan, Manoj Sivan, and Matthew J. Allsop. "The Experience of Limited Access to Care for Community-Based Patients With Spinal Cord Injury and Stroke in Nepal and the Potential of Telerehabilitation: A Qualitative Study." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 60 (January 2023): 004695802211468. http://dx.doi.org/10.1177/00469580221146830.
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This study explores the experiences of care received and management of disability for individuals with spinal cord injury and stroke following discharge from a specialty rehabilitation center, alongside perspectives on the potential role of telerehabilitation. We employed qualitative in-depth face-to-face interviews with patients who had accessed and been discharged from a specialist rehabilitation center in Nepal were used. Interviews sought perspectives of adjusting to, living with, and managing disability alongside the potential role of telerehabilitation in the community setting. Inductive thematic analysis was used to derive themes. A total of 17 participants with spinal cord injuries or stroke were interviewed. Four generated themes included: (i) Difficulties accessing support and perceived mismanagement following initial neurological injury; (ii) Realizing the magnitude and impact of an injury in the absence of clear routes to support; (iii) A multi-faceted symptom burden and its impact; and (iv) The nature and types of interaction with health professionals post-discharge and the potential role of telerehabilitation. We detail accounts of suspended periods with minimal or no support provided from healthcare providers for people with spinal cord injury and stroke following initial acute management. Telerehabilitation could be a worthwhile approach to enhance access to rehabilitation in the community setting but must accompany national efforts to enhance the provision of specialist rehabilitation.
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Nixdorf, Rebecca, Yasuhiro Kotera, Dave Baillie, Paula Garber Epstein, Cerdic Hall, Ramona Hiltensperger, Palak Korde, et al. "Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries." PLOS ONE 19, no. 2 (February 26, 2024): e0298315. http://dx.doi.org/10.1371/journal.pone.0298315.
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Background Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. Method Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. Results 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. Discussion Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.
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Sara, Grant, Myu Arumuganathan, Wendy Chen, Fred Wu, David Currow, Matthew Large, Cornelis Mulder, Parashar Pravin Ramanuj, and Philip M. Burgess. "Cohort profile: Mental Health Living Longer: a population-wide data linkage to understand and reduce premature mortality in mental health service users in New South Wales, Australia." BMJ Open 9, no. 11 (November 2019): e033588. http://dx.doi.org/10.1136/bmjopen-2019-033588.
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PurposeHealth systems must move from recognition to action if we are to address premature mortality in people with mental illness. Population data registers are an essential tool for planning and monitoring improvement efforts. The Mental Health Living Longer (MHLL) programme establishes a population-wide data linkage to support research translation and service reform in New South Wales (NSW), Australia.ParticipantsA total of 8.6 million people who have had contact with NSW public and private health services between July 2001 and June 2018 are currently included in the study. Data include more than 120 million linked records from NSW data collections covering public and private hospital care, emergency departments, ambulance, community mental health services, cancer notifications and care, and death registrations. Linkage is occurring with population-wide breast and cervical cancer screening programmes. Data will be updated 6 monthly.Findings to dateThe cohort includes 970 145 people who have received mental healthcare: 79% have received community mental healthcare, 35% a general hospital admission with a primary mental health diagnosis and 25% have received specialist mental health inpatient care. The most frequent pattern of care is receipt of community mental healthcare only (50%). The median age of the mental health cohort is 34 years, and three-quarters are younger than 53 years. Eleven per cent of the mental health cohort had died during the observation period. Their median age at death was 69 years, which was younger than the median age at death for people accessing other health services.Future plansThe MHLL programme will examine (i) all-cause mortality, (ii) suicide, (iii) cancer mortality and (iv) medical mortality. Within each theme, the programme will quantify the problem in mental health service users compared with the NSW population, describe the people most affected, describe the care received, identify predictors of premature mortality, and identify variation and opportunities for change.
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Evans, Gareth, and David Wright. "Long-Term Evaluation of a UK Community Pharmacy-Based Weight Management Service." Pharmacy 8, no. 1 (February 19, 2020): 22. http://dx.doi.org/10.3390/pharmacy8010022.
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Obesity increases the risk of cardiovascular disease, type 2 diabetes and cancer, reducing both the quality and quantity of life. Consequently, government healthcare costs are significant. A greater than 5% reduction in weight has been shown to result in significant improvements in type II diabetes, blood pressure and cholesterol levels and therefore effective interventions are required. This paper reports the results from 17 years of delivering a private, individualised very low calorie diet (VLCD) programme in community pharmacy. In line with national guidelines, a community pharmacy-based private weight management service was set up to support individuals over the age of 18. After assessment for clinical suitability, individuals were offered either a flexible weight loss plan or a strict weight loss plan using a very low calorie diet (VLCD). The VLCD was delivered using the protocols of the proprietary programme, Lipotrim™. These individuals followed one or more dieting sequences, defined as at least one week of attendance whilst following the VLCD, without discontinuation, producing at least a start and end weight. Data were recorded weekly and audited for this report including weight and BMI on initial presentation, weight and BMI lost and % weight and BMI loss. A total of 1875 dieting sequences were recorded from 1023 dieters. In 1261 (67.3%) sequences, a medically beneficial weight loss of >5% was achieved. Overall, the cohort demonstrated mean (sd) % weight losses of 10.1% (7.7). Mean (sd) % weight losses seen in people with type 2 diabetes was 10.4% (2.7) and 10.6% (5.9) in hypertension. In total, 555 diet sequences accessed long-term weight maintenance support. In 173 (31%) of these cases, a second weight check post weight loss could not be made. The remaining 382 individuals presenting showed a mean (sd) weight gain of only 1.4 kg (4.3) equating to a mean (sd) % weight gain of only 1.8% (4.6) over a mean (sd) number of days post weight-loss of 132 days (179). The results from this long-term review demonstrate that with proper provision of a nutritionally complete VLCD, through private service provision, community pharmacies can make a significant contribution to reducing the obesity epidemic at no cost to state-funded health systems.
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Tran Dong Thai, Han, Huong Van Thuy Qui, Thanh Vu Duy, Jaom Fisher, and Mary Chambers. "A study on biomedical researchers’ perspectives on public engagement in Southeast Asia." Wellcome Open Research 8 (September 8, 2023): 202. http://dx.doi.org/10.12688/wellcomeopenres.19040.2.
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Introduction: Public engagement is increasingly promoted in the scientific community. Although there are studies about researchers’ perspectives on public engagement, these are predominantly from Global North settings and there is little data from the context of Southeast Asia. The Oxford University Clinical Research Unit (OUCRU) is a clinical and public health research programme with sites in Vietnam, Nepal and Indonesia. There is a dedicated public engagement team, and it is recognised as an important part of the research process. Methods: Through this study we explored the views and needs of local researchers with regards to practicing public engagement. We obtained opinions of 70 researchers through an online survey with both open-ended and closed-ended questions. Results: Most researchers perceived public engagement as improving public science literacy, rather than supporting public participation in science and research. While the participants largely see public engagement as a necessary practice, they experienced four main barriers to taking part in public engagement: time, lack of capacity, lack of support and personal perceptions. Most participants indicated they had somewhat to low confidence to communicate about science to the public. Experience, skill and knowledge, and personal preference emerged as factors that influence their perceived confidence for science communication. In our analysis, experience appeared to be the main factor contributing to researchers' high confidence. Recommendations: We recommended to support researchers by not only providing them with training for skills and knowledge, but also with opportunities to conduct public engagement, and a range of methods to suit their personal styles of communicating. It is also evident that more support is needed to build an enabling institutional environment that gives researchers professional recognition for their engagement work. This study, while modest in its scope, has informed our approach to supporting researcher-led engagement, and may guide other institutes wishing to improve this.
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Tran Dong Thai, Han, Huong Van Thuy Qui, Thanh Vu Duy, Jaom E. Fisher, and Mary Chambers. "A study on biomedical researchers’ perspectives on public engagement in Southeast Asia." Wellcome Open Research 8 (May 10, 2023): 202. http://dx.doi.org/10.12688/wellcomeopenres.19040.1.
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Introduction: Public engagement is increasingly promoted in the scientific community. Although there are studies about researchers’ perspectives on public engagement, these are predominantly from Global North settings and there is little data from the context of Southeast Asia. The Oxford University Clinical Research Unit (OUCRU) is a clinical and public health research programme with sites in Vietnam, Nepal and Indonesia. There is a dedicated public engagement team, and it is recognised as an important part of the research process. Methods: Through this study we explored the views and needs of local researchers with regards to practicing public engagement. We obtained opinions of 70 researchers through an online survey with both open-ended and closed-ended questions. Results: Most researchers perceived public engagement as improving public science literacy, rather than supporting public participation in science and research. While the participants largely see public engagement as a necessary practice, they experienced four main barriers to taking part in public engagement: time, lack of capacity, lack of support and personal perceptions. Most participants indicated they had somewhat to low confidence to communicate about science to the public. Experience, skill and knowledge, and personal preference emerged as factors that influence their perceived confidence for science communication. In our analysis, experience appeared to be the main factor contributing to researchers' high confidence. Recommendations: We recommended to support researchers by not only providing them with training for skills and knowledge, but also with opportunities to conduct public engagement, and a range of methods to suit their personal styles of communicating. It is also evident that more support is needed to build an enabling institutional environment that gives researchers professional recognition for their engagement work. This study, while modest in its scope, has informed our approach to supporting researcher-led engagement, and may guide other institutes wishing to improve this.
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Bednarczyk, Robert A., Kyra A. Hester, Sameer M. Dixit, Anna S. Ellis, Cam Escoffery, William Kilembe, Katie Micek, Zoë M. Sakas, Moussa Sarr, and Matthew C. Freeman. "Exemplars in vaccine delivery protocol: a case-study-based identification and evaluation of critical factors in achieving high and sustained childhood immunisation coverage in selected low-income and lower-middle-income countries." BMJ Open 12, no. 4 (April 2022): e058321. http://dx.doi.org/10.1136/bmjopen-2021-058321.
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IntroductionIncreases in global childhood vaccine delivery have led to decreases in morbidity from vaccine-preventable diseases. However, these improvements in vaccination have been heterogeneous, with some countries demonstrating greater levels of change and sustainability. Understanding what these high-performing countries have done differently and how their decision-making processes will support targeted improvements in childhood vaccine delivery.Methods and analysisWe studied three countries—Nepal, Senegal, Zambia—with exemplary improvements in coverage between 2000 and 2018 as part of the Exemplars in Global Health Programme. We apply established implementation science frameworks to understand the ‘how’ and ‘why’ underlying improvements in vaccine delivery and coverage. Through mixed-methods research, we will identify drivers of catalytic change in vaccine coverage and the decision-making process supporting these interventions and activities. Methods include quantitative analysis of available datasets and in-depth interviews and focus groups with key stakeholders in the global, national and subnational government and non-governmental organisation space, as well as community members and local health delivery system personnel.Ethics and disseminationWorking as a multinational and multidisciplinary team, and under oversight from all partner and national-level (where applicable) institutional review boards, we collect data from participants who provided informed consent. Findings are disseminated through a variety of forms, including peer-reviewed manuscripts related to country-specific case studies and vaccine system domain-specific analyses, presentations to key stakeholders in the global vaccine delivery space and narrative dissemination on the Exemplars.Health website.
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Nurjono, Milawaty, Jing Yi Lee, Ezra Ho, Chao Min Tan, Karen Liaw, Angel Lee2, Hubertus Johannes Maria Vrijhoef, Lip Hoe Koh, Foong Ling Ng, and Hong Choon Oh. "Realist Evaluation of Home-Based Palliative Care Programme for Non-Cancer Patients." International Journal of Integrated Care 23, S1 (December 28, 2023): 350. http://dx.doi.org/10.5334/ijic.icic23467.
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Introduction: Disproportionately higher deaths attributed to non-cancer causes in Singapore highlight the need for palliative beyond those with cancers. The Violet Program (ViP) was developed to provide home-based palliative to non-cancer patients residing in the Eastern region of Singapore. VIP aims to (i) reduce unnecessary acute hospital utilization (ii) improve symptoms management (iii) reduce caregiver burden through caregiver support (iv) honour patient preferences better through integrated care while (v) keeping healthcare cost affordable. It is acknowledge that successful implementation and the long-term sustainability of ViP is contingent on its ability to effectively attract, grow and develop its manpower resources. However, identifying, attracting, developing, and retaining competent and engaged community-based palliative care workforce staff remains a major challenge. The aim of this study is to understand attributes of staff and contextual factors well suited for ViP and factors leading to sustainability of such a workforce
Methods: This study was conducted in 2 phases according to realist evaluation principles. First, initial programme theories (IPT) related to sustainability of palliative care manpower were developed through a scoping review and semi-structured interviews with those who were involved in the conceptualization of ViP. IPTs were expressed in Context (C) Mechanism (M) and Outcome (O) configurations. Then, IPTs were tested using interviews with healthcare care workers (HCW) who were involved in ViP. Only CMO configurations supported by substantial evidence were elicited and refined.
Results: 36 HCW of varied roles were interviewed. At the HCW level, (i) familiarity with palliative care framework (ii) comfort in dealing with death (iii) passion for palliative care field (iv) exposure to palliative care during medical/nursing training and (iv) ability to self-care were found to be important attributes for ViP care team. At the institutional level, (continuous) training and provision of socio-emotional support to staff were found to contribute to retention of staff. Self-efficacy for the required tasks, empathy for affected patients/family, passion-driven motivation and dedication to go the extra mile and strong emotional resilience were found to be the key driving forces behind the sustainability of workforce for ViP for the longer term.
Implications: This study illustrated the applicability of using realist evaluation for assessment of context specific insights for the identification of suitable workforce and how to sustain them in the longer term. These insights can potentially be used as selection criteria for recruitment of staff for ViP and points to area for training of staff.
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Ahmad, Khalid Mustafa, Zulfiqar Ahmad Gill, and Toseef Azid. "NGOs, Micro-finance and Poverty Alleviation: Experience of the Rural Poor in Pakistan." Pakistan Development Review 39, no. 4II (December 1, 2000): 771–92. http://dx.doi.org/10.30541/v39i4iipp.771-792.
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Non-governmental organisations (NGOs) continue to be the global ‘flavour of the month’ in international development. They are regarded as “outside” actors perceived to work in the interests of the poor, and in the absence of the state, many NGOs have taken on vital role in the provision of basic services to the poor. The institutional and political environment is attuned to privatisation in whatever form it takes. NGOs are another expression of this trend, but in the case of NGOs no real disillusionment phase has yet set in. But still NGOs remain the favoured vehicle for grass-roots involvement and community development in many countries. The present paper seeks to delineate the role of NGOs in micro finance and study their aggregate impact on poverty reduction in rural Pakistan as a result of micro finance efforts. The paper is organised in four sections. Section I commences with the concepts, promises and limitations of NGOs as a vehicle of micro finance. Section II summarises the record of performance of NGOs in Pakistan. In particular, the role, achievements and set-backs of two noted NGOs in Pakistan, Agha Khan Rural Support Programme (AKRSP) and National Rural Support Programme (NRSP). Which are studied by examining aggregate impact of these NGOs on poverty reduction as result of their micro finance efforts. Section III examines the poverty profile and presents summary of the role of NGOs in the context of poverty lending and, finally Section IV concludes the analysis and proposes some policy recommendations.
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Lemanska, Agnieszka, Karen Poole, Bruce A. Griffin, Ralph Manders, John M. Saxton, Lauren Turner, Joe Wainwright, and Sara Faithfull. "Community pharmacy lifestyle intervention to increase physical activity and improve cardiovascular health of men with prostate cancer: a phase II feasibility study." BMJ Open 9, no. 6 (June 2019): e025114. http://dx.doi.org/10.1136/bmjopen-2018-025114.
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ObjectivesTo assess the feasibility and acceptability of a community pharmacy lifestyle intervention to improve physical activity and cardiovascular health of men with prostate cancer. To refine the intervention.DesignPhase II feasibility study of a complex intervention.SettingNine community pharmacies in the UK.InterventionCommunity pharmacy teams were trained to deliver a health assessment including fitness, strength and anthropometric measures. A computer algorithm generated a personalised lifestyle prescription for a home-based programme accompanied by supporting resources. The health assessment was repeated 12 weeks later and support phone calls were provided at weeks 1 and 6.Participants116 men who completed treatment for prostate cancer.Outcome measuresThe feasibility and acceptability of the intervention and the delivery model were assessed by evaluating study processes (rate of participant recruitment, consent, retention and adverse events), by analysing delivery data and semi-structured interviews with participants and by focus groups with pharmacy teams. Physical activity (measured with accelerometry at baseline, 3 and 6 months) and patient reported outcomes (activation, dietary intake and quality of life) were evaluated. Change in physical activity was used to inform the sample size calculations for a future trial.ResultsOut of 403 invited men, 172 (43%) responded and 116 (29%) participated. Of these, 99 (85%) completed the intervention and 88 (76%) completed the 6-month follow-up (attrition 24%). Certain components of the intervention were feasible and acceptable (eg, community pharmacy delivery), while others were more challenging (eg, fitness assessment) and will be refined for future studies. By 3 months, moderate to vigorous physical activity increased on average by 34 min (95% CI 6 to 62, p=0.018), but this was not sustained over 6 months.ConclusionsThe community pharmacy intervention was feasible and acceptable. Results are encouraging and warrant a definitive trial to assess the effectiveness of the refined intervention.
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Soon, Dinna Kar Nee. "Shaping the future of Heart Failure Care." International Journal of Integrated Care 23, S1 (December 28, 2023): 392. http://dx.doi.org/10.5334/ijic.icic23489.
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Heart failure (HF) hospitalisations are commonly associated with increased mortality and morbidity. The multi-disciplinary HF workgroup was formed in 2016 comprising Cardiologists, HF Case Managers, Advanced Practice Nurses, Cardiac Pharmacists, Allied Health Professionals and Operations personnel. The group focuses on delivering an end-to-end HF care, that aims to improve clinical and functional outcomes, while keeping cost affordable to patients. Our early initiatives were targeted at the inpatient phase; with current shift towards patient-centred and value-driven care, it presents an opportunity to delve deeper into patients’ journey.
Our HF workgroup aims to implement a series of initiatives targeting pre-admission (HF - Extended Diagnostic and Treatment Unit (EDTU)) and post-discharge phases (HF Shared Care (HFSC) and Medical Home (MH)) of the patient’s journey, supporting their health needs in the community, thus reducing avoidable hospital readmissions.
Foremost, the team mapped out the patients’ journey and adopted a multi-pronged approach to i) manage mild HF patients presented to Emergency Department (ED) under HF-EDTU protocol and support ii) stable HF patients with co-morbidities (HFSC programme) and mild-to-moderately decompensated HF patients (MH programme) in the community.
Under HF-EDTU protocol (commenced Mar’ 22), brainstorming sessions were conducted with ED to determine the inclusion criteria to ensure safe discharge from ED. For HFSC programme (commenced Jul’ 22), we engaged Shared Care Partnership Office (SCPO) to partner General Practitioners (GPs) to co-manage stable HF patients with co-morbidities in the community. GP focus group discussions were held to gather inputs for effective implementation of HFSC programme. We also worked with Population Health and Community Transformation (PHCT) team to identify patients with haemodynamically stable medical conditions for MH programme (commenced Jun’ 22) to reduce unnecessary hospitalisation. Regular meetings were conducted to monitor and evaluate the progress of our initiatives.
Collectively, these initiatives contributed to a decrease in 30D readmission rate from 8.4% to 6.8% (≈19% relative reduction) and a decrease in total bill size from $4,847 to $4,802, when comparing across the pre (Apr 2021 – Mar 2022) and post-implementation of initiatives (Apr 2022 onwards).
To date, of the 11 HF-EDTU patients, 5 were discharged from EDTU, avoiding inpatient admission. This resulted in estimated cost savings of $7,595. Separately, 5 patients were enrolled into HFSC programme.
By adopting a strong value-driven methodology, we were able to assess and identify gaps in existing processes to create more value for our patients. Despite the short period of implementation, the drop in 30D readmission rate is testament to better and safer quality of care received by our patients. By working closely with private primary care providers, patients are able to embark on a lifelong relationship with their GPs to manage different aspects of their health (including preventive care). This is crucial as we tackle the wave of an ageing population and the rising impact of multiple chronic diseases.
With the current promising results, continuous Plan-Do-Study-Act cycles will refine and improve the uptake of our initiatives. Lastly, measurement of patient experience outcomes are underway to truly understand what matters to patients in their care journey.
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Quy, Huong Van Thuy, Jaom Fisher, and Mary Chambers. "Evaluation of a Seed Award scheme to promote the involvement of global health researchers in public and community engagement: approaches, challenges and lessons learned." Wellcome Open Research 9 (February 19, 2024): 75. http://dx.doi.org/10.12688/wellcomeopenres.20490.1.
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Background Public and community engagement (PCE) in health research is becoming more common and many research organizations are committed to fostering PCE to strengthen their research culture. However, barriers that may make researchers hesitate to undertake PCE activities may be heightened in Global South research settings. To address these challenges, we set up a PCE Seed Award scheme at the Oxford University Clinical Research Unit (OUCRU) across four research sites in Ho Chi Minh City and Hanoi -Vietnam, Indonesia, and Nepal to enable researchers to incorporate public engagement activities in their research. Methods The Seed Award scheme followed three steps: 1. A call for applications and funding decisions: Researchers were invited to submit grant applications twice per year. Applications were reviewed and funding decisions made by a committee including external reviewers. 2. Supporting and monitoring: Successful awardees were supported to further develop their proposals, strengthen engagement capacity and to plan evaluation. 3. Reporting and evaluation: Awardees were asked to conduct evaluation throughout the activities and to submit an end-of-project report. The scheme itself was evaluated using mixed methods. Results Over a six-year period from 2016-2022, 41 small grants were awarded. The PCE team supporting the scheme delivered 19 training sessions to help strengthen awardees PCE capacity. Conclusions We conclude that the scheme has made a profound impact in encouraging researchers at the OUCRU research units to lead and be involved with PCE activities. During this period, many more researchers, of all grades, were active in engagement projects. The scheme was improved by adding mentoring and training, and one-on-one mentoring helped attract more applicants. In this paper, we describe the process of development and implementation of this award programme, which aims to support and promote researcher-led public engagement and reflect on the challenges and lessons learned.
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Umar, Maimuna Rabo. "RELATIONSHIP BETWEEN PARENTAL OCCUPATION, HOME ENVIRONMENT AND ACADEMIC PERFORMANCE OF PUBLIC SENIOR SECONDARY SCHOOL STUDENTS IN SOKOTO STATE, NIGERIA." Sokoto Educational Review 17, no. 2 (December 29, 2017): 13. http://dx.doi.org/10.35386/ser.v17i2.34.
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This paper discussed the relationship between parental background support in relation to occupation, home environment and students’ academic performance. The research design adopted for this study was correlation research design. The study was based on Conflict theory, which sees the purpose of education as a means of maintaining social inequality and preserving the power of those who dominate the society. The study was carried out using questionnaire, achievement test and focus group discussions, the questionnaire was researcher designed and it was based on closed ended questions with options of A,B,C,D,E and F, respectively all the instruments were validated by the supervisory team and the reliability was obtained by pilot testing of questionnaire and test-retest for achievement test and arrived at co-efficient alpha 0.83 and 0.81 respectively. The population was also all the public senior secondary school students in Sokoto state. A total number of twelve public senior secondary schools, with three thousand four hundred and twenty eight (3,428) as the population of SS II students, were purposively selected within the six educational zones to represent the total population. Qualitative data collected were analyzed through thematic analysis by coding and transcription, while the quantitative data were analyzed using Pearson Product Moment Correlation Co-efficient. The major findings of the study were: Parental background support in relation to occupation has relationship with student’s academic performance. Parental background support in relation to home environment has relationship with student’s academic performance. The study recommended that: parents that are found to be of lower socio-economic status who can not provide support for the academic activities of their children, should utilize those community development programmes meant for poverty eradication and skill acquisition, such as National Poverty Eradication Programme (NAPEP), family support programme, agricultural loan scheme and so on, that will provide financial support and job security. It was also recommended that parents should endeavour to provide required academic support at home such as parental commitment and material support. That is to be fully involved in their children academic activities and to provide study facilities at home, which include teaching and learning materials. This will enhance good academic performance.
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Deng, Shanshan, Chenchen Zhang, Xing Guo, Hekai Lv, Yanyan Fan, Zhuoxin Wang, Dan Luo, Xiaoxia Duan, Xinying Sun, and Fuzhi Wang. "Gaps in the Utilization of Community Health Services for the Elderly Population in Rural Areas of Mainland China: A Systematic Review Based on Cross-Sectional Investigations." Health Services Insights 15 (January 2022): 117863292211343. http://dx.doi.org/10.1177/11786329221134352.
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Background: While the community health service system was initially established in rural areas of mainland China, the utilization of community health service resources by the rural elderly population is not clear. Methods: Cross-sectional studies on the utilization of community health services by the rural elderly population in mainland China published within the last 10 years were retrieved from the China National Knowledge Infrastructure (CNKI), Wan Fang, Medline and Web of Science (WOS) databases. The quality of the article was evaluated by the Critical Appraisal Skills Programme (CASP), and obstacles to the utilization of community health services by the rural elderly population were analyzed based on the Andersen model. Results: Twenty-four studies were analyzed, and 3 gaps were found. (i) The cognition of rural elderly residents does not match the current health security system. (ii) There is a gap between the supply of health service resources in rural communities and the health needs of the elderly residents in these areas. (iii) The health services provided by rural primary health service institutions are not targeted. Conclusions: In mainland China, the provision of community health services to the rural elderly population has improved significantly. However, several factors from the individual level to the system level lead to low levels of access and utilization. This finding means that under the leadership of the government, it is necessary to integrate the strength of multiple departments to cooperate in improving the welfare system, policy publicity, health education, financial support, system guarantees and resource exchange and sharing for the elderly population in rural areas and to jointly promote community health services for the elderly population in rural areas.
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Jones, Julie, Lyndsay Alexander, Elizabeth Hancock, and Kay Cooper. "A collaborative approach to exercise provision for people with Parkinson’s – a feasibility and acceptability study of the PDConnect programme." AMRC Open Research 2 (April 1, 2021): 29. http://dx.doi.org/10.12688/amrcopenres.12936.2.
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Background: Exercise has been shown to be beneficial for people with Parkinson’s (PwP), slowing the rate of decline of motor and non-motor symptoms, with emerging evidence associating exercise with a neuroprotective effect. Current exercise provision is time-limited, and delivered in the absence of strategies to support long-term adherence to exercise. With a growing Parkinson’s population, there is a need to develop long-term sustainable approaches to exercise delivery. The primary aim of this study is to assess the feasibility and acceptability of a multicomponent intervention (PDConnect) aimed at promoting physical activity, and self-management for PwP. Methods: A convergent fixed parallel mixed methods design study will be undertaken. The study aims to recruit 30 PwP, who will be randomly allocated into two groups: (i) the usual care group will receive physiotherapy once a week for six weeks delivered via Microsoft Teams. (ii) The PDConnect group will receive physiotherapy once a week for six weeks which combines exercise, education and behaviour change interventions delivered by NHS Parkinson’s specialist physiotherapists via Microsoft Teams. This will be followed by 12 weekly sessions of group exercise delivered on Microsoft Teams by fitness instructors specially trained in Parkinson’s. Participants will be then contacted by the fitness instructors once per month for three months by video conferencing to support exercise engagement. Primary feasibility data will be collected during the study, with acceptability assessed via semi-structured interviews at the end. Secondary outcomes encompassing motor, non-motor and health and well-being measures will be assessed at baseline, at six, 18, and 30 weeks. Discussion: This pilot study will establish whether PDConnect is feasible and acceptable to PwP. This will provide a platform for a larger evaluation to assess the effectiveness of PDConnect at increasing exercise participation and self-management within the Parkinson’s Community. Trial registration: Registered on ISRCTN (ISRCTN11672329, 4th June 2020).
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Jones, Julie, Lyndsay Alexander, Elizabeth Hancock, and Kay Cooper. "A collaborative approach to exercise provision for people with Parkinson’s – a feasibility and acceptability study of the PDConnect programme." AMRC Open Research 2 (December 10, 2020): 29. http://dx.doi.org/10.12688/amrcopenres.12936.1.
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Background: Exercise has been shown to be beneficial for people with Parkinson’s (PwP), limiting the rate of decline of motor and non-motor symptoms, with emerging evidence associating exercise with a neuroprotective effect. Current exercise provision is time-limited, and delivered in the absence of strategies to support long-term adherence to exercise. With a growing Parkinson’s population, there is a need to develop long-term sustainable approaches to exercise delivery. The primary aim of this study is to assess the feasibility and acceptability of a multicomponent intervention (PDConnect) aimed at promoting physical activity, and self-management for PwP. Methods: A convergent fixed parallel mixed methods design study will be undertaken. The study aims to recruit 30 PwP, who will be randomly allocated into two groups: (i) the usual care group will receive physiotherapy once a week for six weeks delivered via Microsoft Teams. (ii) The PDConnect group will receive physiotherapy once a week for six weeks which combines exercise, education and behaviour change interventions delivered by NHS Parkinson’s specialist physiotherapists via Microsoft Teams. This will be followed by 12 weekly sessions of group exercise delivered on Microsoft Teams by fitness instructors specially trained in Parkinson’s. Participants will be then contacted by the fitness instructors once per month for three months by video conferencing to support exercise engagement. Primary feasibility data will be collected during the study, with acceptability assessed via semi-structured interviews at the end. Secondary outcomes encompassing motor, non-motor and health and well-being measures will be assessed at baseline, at six, 18, and 30 weeks. Discussion: This pilot study will establish whether PDConnect is feasible and acceptable to PwP. This will provide a platform for a larger evaluation to assess the effectiveness of PDConnect at increasing exercise participation and self-management within the Parkinson’s Community. Trial registration: Registered on ISRCTN (ISRCTN11672329, 4th June 2020).
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Kongo, V. M., J. R. Kosgei, G. P. W. Jewitt, and S. A. Lorentz. "Establishment of a catchment monitoring network through a participatory approach in a rural community in South Africa." Hydrology and Earth System Sciences 14, no. 12 (December 13, 2010): 2507–25. http://dx.doi.org/10.5194/hess-14-2507-2010.
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Abstract. The establishment of a catchment monitoring network is a process, from the inception of the idea to its implementation, the latter being the construction of relevant gauging structures and installation of the various instruments. It is useful that the local communities and other stakeholders are involved and participate in such a process, as was highlighted during the establishment of the hydrological monitoring network in the Potshini catchment in Bergville District in the KwaZulu-Natal Province, South Africa. The paper highlights the participatory establishment of a hydrological monitoring network in a small rural inhabited catchment, in line with the overall objective of the Smallholder System Innovations (SSI) research programme, to monitor hydrological processes at both field and catchment scale for water resources management research purposes. The engagement and participation of the Potshini community precipitated a learning opportunity for both the researchers and the local community on (i) the understanding of hydrological processes inherent in the catchment (ii) appreciating the inherent dynamics in establishing a catchment monitoring network in the midst of a community (iii) paradigm shift on how to engage different stakeholders at different levels of participation. The participatory engagement in the monitoring process led to appreciation and uptake of some of the research results by the Potshini community and ensured continued support from all stakeholders. This paper is of the view that the participation of the local community and other stakeholders in catchment monitoring and instilling a sense of ownership and management of natural resources to the local communities needs to be encouraged at all times. Success stories in water resources management by local communities can be realized if such a process is integrated with other development plans in the catchment at all forums, with due recognition of the social dynamics of the communities living in the catchment.
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Rotival, Alexander H. "Beyond the Decade: A Framework for Global Cooperation." Water Science and Technology 23, no. 1-3 (January 1, 1991): 211–13. http://dx.doi.org/10.2166/wst.1991.0417.
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The International Drinking Water Supply and Sanitation Decade (IDWSSD) was launched by the General Assembly of the United Nations in November 1980 with the goal “to provide all people with water of safe quality and adequate quantity and basic sanitary facilities by 1990”. The World Bank estimates that despite the efforts during the Decade less than 50 percent of developing country populations have access to adequate water supplies and only 20 percent to adequate sanitation facilities. Major factors for the situation are the continuing population explosion and the economic stagnation of developing countries. Qualitative breakthroughs have been made however, through (i) improved coordination for sector inputs at the global and country levels, (ii) systematic formulation of country strategies, (iii) rationalization of the management of the sector, and most significantly through (iv) community involvement and (v) the adoption of low-cost sustainable and replicable technologies. The UNDP/World Bank Programme and the UNDP/WHO Decade Programmes have played a catalytic role in developing activities in these five areas. To maintain Decade momentum beyond 1990 and to accelerate the provision of water supply and sanitation services to all, with emphasis on the unserved rural and peri-urban poor, by using a coordinated programme “Decade” approach, a Framework for Global Cooperation has been established. A series of meetings of a Collaborative Council of External Support Agencies (ESAs) is involved, leading to a global consultation in India in 1990 for all developing countries to define and achieve consensus on a water and sanitation sector strategy for “Beyond the Decade”.
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Viljoen, Lario, Tila Mainga, Rozanne Casper, Constance Mubekapi-Musadaidzwa, Dillon T. Wademan, Virginia A. Bond, Triantafyllos Pliakas, et al. "Community-based health workers implementing universal access to HIV testing and treatment: lessons from South Africa and Zambia—HPTN 071 (PopART)." Health Policy and Planning 36, no. 6 (May 8, 2021): 881–90. http://dx.doi.org/10.1093/heapol/czab019.
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Abstract The global expansion of HIV testing, prevention and treatment services is necessary to achieve HIV epidemic control and promote individual and population health benefits for people living with HIV (PLHIV) in sub-Saharan Africa. Community-based health workers (CHWs) could play a key role in supporting implementation at scale. In the HPTN 071 (PopART) trial in Zambia and South Africa, a cadre of 737 study-specific CHWs, working closely with government-employed CHW, were deployed to deliver a ‘universal’ door-to-door HIV prevention package, including an annual offer of HIV testing and referral services for all households in 14 study communities. We conducted a process evaluation using qualitative and quantitative data collected during the trial (2013–2018) to document the implementation of the CHW intervention in practice. We focused on the recruitment, retention, training and support of CHWs, as they delivered study-specific services. We then used these descriptions to: (i) analyse the fidelity to design of the delivery of the intervention package, and (ii) suggest key insights for the transferability of the intervention to other settings. The data included baseline quantitative data collected with the study-specific CHWs (2014–2018); and qualitative data from key informant interviews with study management (n = 91), observations of CHW training events (n = 12) and annual observations of and group discussions (GD) with intervention staff (n = 68). We show that it was feasible for newly recruited CHWs to implement the PopART intervention with good fidelity, supporting the interpretation of the trial outcome findings. This was despite some challenges in managing service quality and CHW retention in the early years of the programme. We suggest that by prioritizing the adoption of key elements of the in-home HIV services delivery intervention model—including training, emotional support to workers, monitoring and appropriate remuneration for CHWs—these services could be successfully transferred to new settings.
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Topp, Stephanie M., Nicole B. Carbone, Jennifer Tseka, Linda Kamtsendero, Godfrey Banda, and Michael E. Herce. "“Most of what they do, we cannot do!” How lay health workers respond to barriers to uptake and retention in HIV care among pregnant and breastfeeding mothers in Malawi." BMJ Global Health 5, no. 6 (June 2020): e002220. http://dx.doi.org/10.1136/bmjgh-2019-002220.
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BackgroundIn the era of Option B+ and ‘treat all’ policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. This qualitative study sought to examine how PMTCT LHW deployed by Malawi’s three most prevalent CFL models respond to known barriers to access and retention to antiretroviral therapy (ART) and PMTCT.MethodsWe conducted a qualitative study, including 43 semi-structured interviews with PMTCT clients; 30 focus group discussions with Ministry of Health (MOH)-employed lay and professional providers and PMTCT LHWs; a facility CFL survey and 2–4 hours of onsite observation at each of 8 sites and in-depth interviews with 13 programme coordinators and MOH officials. Thematic analysis was used, combining inductive and deductive approaches.ResultsAcross all three models, PMTCT LHWs carried out a number of ‘targeted’ activities that respond directly to a range of known barriers to ART uptake and retention. These include: (i) fulfilling counselling and educational functions that responded to women’s fears and uncertainties; (ii) enhancing women’s social connectedness and participation in their own care and (iii) strengthening service function by helping clinic-based providers carry out duties more efficiently and effectively. Beyond absorbing workload or improving efficiency, however, PMTCT LHWs supported uptake and retention through foundational but often intangible work to strengthen CFL, including via efforts to strengthen facility-side responsiveness, and build community members’ recognition of and trust in services.ConclusionPMTCT LHWs in each of the CFL models examined, addressed social, cultural and health system factors influencing client access to, and engagement with, HIV care and treatment. Findings underscore the importance of person-centred design in the ‘treat-all’ era and the contribution LHWs can make to this, but foreground the challenges of achieving person-centredness in the context of an under-resourced health system. Further work to understand the governance and sustainability of these project-funded CFL models and LHW cadres is now urgently required.
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Kealeboga, Kebope Mongie, Mofatiki Eva Manyedi, and Salaminah Moloko-Phiri. "Nurses’ Perceptions on How Recovery-Oriented Mental Health Care Can Be Developed and Implemented." Nursing Research and Practice 2023 (August 23, 2023): 1–11. http://dx.doi.org/10.1155/2023/4504420.
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Aim. This study explored how nurses working in inpatient mental health units perceived the development and implementation of a recovery-oriented mental healthcare programme (ROMHCP). Background. The recovery-oriented mental healthcare approach (ROMHCA) in mental health is regarded as the future of mental health services and has been implemented in different countries worldwide. However, regarding developing and implementing the recovery approach, Africa appears to have been left behind by the rest of the continents. Design. The study used a qualitative approach to describe how a recovery-oriented mental healthcare approach could be developed. Methods. Thirty nurses who worked in Botswana’s four inpatient mental health facilities consented and voluntarily participated in the study. Data were collected from February to mid-March 2022 through online focus group discussions and analysed using thematic analysis. The COREQ checklist was used to report the findings. Results. Two main themes emerged as follows: (i) developing and implementing a recovery-oriented mental healthcare programme is possible and (ii) certain elements are required to develop and implement ROMHCP. Conclusion. The participants believed that people diagnosed with mental illness could recover from the illness and suggested how it could be achieved. They also contended that the programme’s success would lie mainly with multisectoral support from policymakers, facilities, hospital personnel, patients, and the community. Clinical Relevance. ROMHCP has the potential to benefit people with mental illness in the country. In addition, it would allow nurses to improve their knowledge and skills in managing mental illnesses. Patient or Public Contribution. The patients and the general public did not contribute to the study’s concept, design, and outcomes. However, the nurses working in mental health facilities volunteered to participate in the study.
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Shrestha, Manisha, Binod Chapagain, Pooja Pandey, Raj Mandal, Kelly Perry, Bhim Pun, and Amy Weissman. "A Quality Improvement Initiative to Enhance the Treatment of Children With Severe Acute Malnutrition in Nepal." Current Developments in Nutrition 6, Supplement_1 (June 2022): 174. http://dx.doi.org/10.1093/cdn/nzac051.090.
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Abstract Objectives Despite being implemented for decades, Nepal's Integrated Management of Acute Malnutrition program has experienced several implementation challenges such as low coverage, stock outs of ready-to-use therapeutic food supplies, poor reporting, loss to follow up and sub-optimal counselling. To address these and build a culture of continuous service delivery improvement, the Suaahara-II program adopted and assessed a quality improvement (QI) approach. Methods Change ideas, including increasing case identification through various platforms, developing QA standards to measure service quality, and providing incentives for female community health volunteers, were implemented as part of the QI initiative in four pilot municipalities. To assess changes in outcomes such as cure rate and number of cases identified and lost to follow-up, baseline information was collected over six months pre-implementation and performance was monitored throughout the QI implementation cycle of 17 months (February 2019—June 2021). We also analyzed secondary data from the government health management information system and established a monitoring mechanism to ensure data quality for outcome measures. For the outcome measure of service quality score, we developed a quality assurance (QA) checklist to score services while treating children with severe acute malnutrition (SAM). Results Our findings suggest that the QI effort was effective. The SAM cure rate increased from 67.4% pre-implementation to 80% post-implementation and the loss-to-follow-up rate declined from 26% to 8%. The number of new SAM cases fluctuated between 0–20 cases per month likely due to restrictions to mobility caused by the COVID-19 pandemic. Although there is no comparison to facilities that did not participate in the QI pilot, those that did had an average quality assurance score of 82.4%–above the 80% benchmark. Conclusions We found that the QI approach helped improve SAM cure rate, limited loss-to-follow-up and improved quality of case management for children with SAM. To successfully and sustainably implement QI to improve service delivery, leadership and local government accountability, regular coaching support and collaborative team efforts are key. Funding Sources United States Agency for International Development (USAID).