Linda Fogarty - Academia.edu (original) (raw)
Papers by Linda Fogarty
BMC Health Services Research, Jun 8, 2015
Human Resources for Health, Feb 17, 2014
Background: This study describes job satisfaction and intention to stay on the job among primary ... more Background: This study describes job satisfaction and intention to stay on the job among primary health-care providers in countries with distinctly different human resources crises, Afghanistan and Malawi. Methods: Using a cross-sectional design, we enrolled 87 health-care providers in 32 primary health-care facilities in Afghanistan and 360 providers in 10 regional hospitals in Malawi. The study questionnaire was used to assess job satisfaction, intention to stay on the job and five features of the workplace environment: resources, performance recognition, financial compensation, training opportunities and safety. Descriptive analyses, exploratory factor analyses for scale development, bivariate correlation analyses and bivariate and multiple linear regression analyses were conducted. Results: The multivariate model for Afghanistan, with demographic, background and work environment variables, explained 23.9% of variance in job satisfaction (F(9,73) = 5.08; P < 0.01). However, none of the work environment variables were significantly related to job satisfaction. The multivariate model for intention to stay for Afghanistan explained 23.6% of variance (F(8,74) = 4.10; P < 0.01). Those with high scores for recognition were more likely to have higher intention to stay (β = 0.328, P < 0.05). However, being paid an appropriate salary was negatively related to intent to stay (β = −0.326, P < 0.01). For Malawi, the overall model explained only 9.8% of variance in job satisfaction (F(8,332) = 4.19; P < 0.01) and 9.1% of variance in intention to stay (F(10,330) = 3.57; P < 0.01). Conclusions: The construction of concepts of health-care worker satisfaction and intention to stay on the job are highly dependent on the local context. Although health-care workers in both Afghanistan and Malawi reported satisfaction with their jobs, the predictors of satisfaction, and the extent to which those predictors explained variations in job satisfaction and intention to stay on the job, differed substantially. These findings demonstrate the need for more detailed comparative human resources for health-care research, particularly regarding the relative importance of different determinants of job satisfaction and intention to stay in different contexts and the effectiveness of interventions designed to improve health-care worker performance and retention.
Social Science & Medicine, 2004
A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a ... more A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a video vignette using modeling in which a physician discussed the concept of a clinical trial (CT) with a woman who was in the process of making a treatment decision. A pretest-post-test design was used and improvements in clinical trial knowledge and beliefs were assessed. Results indicate that video modeling is a powerful tool for increasing CT knowledge (pretest mean=41.5% correct, post-test mean=77.5% correct) but not for improving CT beliefs. Increased clinical trial knowledge, as measured by change scores, was associated with white race, lower levels of education and pretest breast cancer knowledge, more negative pretest CT beliefs, and a higher estimate of the lifetime probability that a woman will have breast cancer. When pretest CT knowledge was added to the analysis using hierarchical multiple regression, all variables except white race became nonsignificant; an increase in CT knowledge was associated with having lower pretest CT knowledge. Results indicate that the effects of low education, low breast cancer knowledge, and biased probability assessment were mediated through the pretest score. An increase in post-test positive CT beliefs was associated with older age, thinking about breast cancer less often, and having lower pretest CT knowledge in the total sample. When pretest CT beliefs was added to the analysis using hierarchical multiple regression, all other variables became nonsignificant; an increase in CT beliefs was associated with having lower pretest CT beliefs, again indicating mediation of the effects of other variables.
American Journal of Geriatric Psychiatry, Mar 1, 2012
Objectives-This study examined the decision-making process used by individuals asked to participa... more Objectives-This study examined the decision-making process used by individuals asked to participate in dementia research and their opinions on how future proxy research decisions would or should be made, including participants' preferred ethical standards for decision-making. Design-Cross-sectional qualitative methods. Setting-University research institutions. Participants-Informants were 39 of 46 cognitively impaired individuals (i.e., subjects) who were asked to join one of six dementia studies and 46 study partners or surrogate decision-makers. Measurements-Semi-structured individual interviews were audio recorded and transcribed for content analysis. Results-Within dyads, subjects and surrogates often differed in their perspectives on how decisions were made regarding whether to join a study, and no single method was identified as a predominant approach. While there was only fair agreement within dyads on who ultimately made the decision, subjects and surrogates most often said it was the subject. For future proxy research decisions, subjects and surrogates most often preferred the ethical standard of best interests and least often favored substituted judgment. However, many participants preferred a combination of best interests and substituted judgment or a more complex approach that also considers the interests of others. Conclusions-Individuals with mild to moderate cognitive impairment can and do engage to some extent in the decision-making process for dementia research and can discuss their opinions on how they would want such decisions made for them in the future. These findings support the recommended approach for obtaining proxy consent and subject assent if the individual lacks consent capacity.
Journal of Clinical Oncology, Jul 15, 2004
6054 Background: Understanding of prog is crucial for appropriate decision making among acp enrol... more 6054 Background: Understanding of prog is crucial for appropriate decision making among acp enrolling in early phase trials of new agents. Prior research shows acp state inaccurate estimates of their prog, and oncologists (MDs) are inaccurate in prog predictions and/or hesitant to discuss prog. Methods: As part of a larger study seeking to improve acp understanding of early phase trials, we examined the effects of a cd on prog understanding. The cd contained information/videos of acp and MDs talking about multiple issues related to trial enrollment, including prog. Acp potentially eligible for phase I-II trials were randomized to either view the cd or receive a NCI clinical trials pamphlet (containing no prog information). After consulting with an MD, acp who enrolled in phase I or II trials were interviewed with a standardized survey. Results: 255 subjects were randomized, with 157 enrolling in phase I or II trial: Median age 62 (34–80), 56% women, 88% Caucasian; 39% with ≥college degree. Compared to acp...
Ejc Supplements, Sep 1, 2003
American Journal of Orthopsychiatry, Jul 1, 1991
Journal of Urban Health-bulletin of The New York Academy of Medicine, Sep 1, 2000
This paper describes the frequency of women's disclosure of their HIV status, examines the extent... more This paper describes the frequency of women's disclosure of their HIV status, examines the extent to which they experience adverse social and physical consequences when others learn they are infected, and analyzes correlates of these negative outcomes. There were 257 HIV-positive women between the ages of 18 and 44, recruited from HIV/AIDS primary care clinics and from community sites, who completed a faceto-face interview. Women in the sample were 33 years old on average; 92% were African-American; 54% had less than 12 years of education; 56% had used intravenous drugs; and 30% knew they were HIV positive for 5 or more years. There were 97% who disclosed their HIV status; 64% told more than 5 people. Negative consequences associated with others knowing they were HIV-positive were reported by 44%, most commonly the loss of friends (24%), being insulted or sworn at (23%), and being rejected by family (21%). There were 10 women (4%) who reported being physically or sexually assaulted as a result of their being HIV positive, and 16% reported having no one they could count on for money or a place to stay. Violence was widespread in this sample, with 62% having experienced physical or sexual violence, including sexual abuse or rape (27%), being beaten up (34%), and weapon-related violence (26%). Logistic regression analysis indicated that women with a history of physical and sexual violence were significantly more likely to experience negative social and physical consequences when their infection became known to others, adjusting for age and the number of people women had disclosed to, both of which were only marginally significant. Partner notification policies and support programs must be responsive to the potential negative consequences associated with others learning that a woman is HIV positive. The high rates of historical violence in the lives of women living with HIV underscore the need for routine screening and intervention for domestic violence in all settings that provide health care to HW-positive women.
Gates open research, Oct 15, 2020
Oral Pre-Exposure Prophylaxis (PrEP) is highly effective in lowering HIV transmission risk. The B... more Oral Pre-Exposure Prophylaxis (PrEP) is highly effective in lowering HIV transmission risk. The Bill and Melinda Gates-funded Jilinde Project was designed to identify the best ways to introduce and support PrEP services in Kenya for female sex workers, men who have sex with men, and adolescent girls and young women. We chose Developmental Evaluation (DE) as a core project approach because our goal was not just to recruit 20,000 new PrEP users, but to learn how to deliver PrEP effectively to optimally benefit users in a complex, dynamic, resource-limited setting. This paper describes how we incorporated DE into the Jilinde Project, and shares experiences and lessons learned about the value of DE in PrEP service implementation in a real-world situation. With the Ministry of Health, Jilinde developed consensus about the structure and roll-out of PrEP services. The DE evaluator, embedded in Jilinde, designed and implemented the five-step DE methodology-collect, review, reflect, record and act-according to a core set of project guiding principles. The paper describes how we operationalized the five elements, citing findings reported and actions taken reflecting on the data. It summarizes challenges to DE implementation, such as uneven uptake and competing demands, and how we addressed those challenges. Used consistently, DE helped adapt and refine PrEP services, improve service access, reach target audiences and improve continuation rates. The look, feel and yield of our DE efforts evolved over time, increasingly integrated into existing systems and providing deeper and richer understandings, and we learned how to better implement DE in the future.
International journal of gynaecology and obstetrics, Dec 5, 2019
Background: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalitie... more Background: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low-and middleincome countries (LMIC) can save lives. Objective: To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities.
Journal of Aging and Health, Mar 5, 2009
Objectives-This study examines how surrogate decision-makers for dementia patients developed an u... more Objectives-This study examines how surrogate decision-makers for dementia patients developed an understanding of patient preferences about end-of-life (EOL) care and patient wishes. Methods-Semi-structured interviews were conducted with 34 surrogate decision-makers for hospice-eligible nursing home patients with dementia. The data were content analyzed. Results-Most surrogates reported that patients had previously completed an advance directive (59%), discussed preferences for EOL care (56%), or done both (38%). Catalysts for and barriers to completing an advance directive or having EOL care discussions included factors that were both intrinsic and extrinsic to the patient. The most commonly reported wish for EOL care was to not be kept alive by "machines" or "extraordinary measures." Discussion-Health care providers may be able to assist patients and families by normalizing discussions of dying, encouraging advance care planning, helping them identify goals for EOL care, and providing information to support treatment decisions consistent with patients' wishes.
Carolina Digital Repository (University of North Carolina at Chapel Hill), Jun 8, 2011
Background: Gender segregation of occupations, which typically assigns caring/nurturing jobs to w... more Background: Gender segregation of occupations, which typically assigns caring/nurturing jobs to women and technical/managerial jobs to men, has been recognized as a major source of inequality worldwide with implications for the development of robust health workforces. In sub-Saharan Africa, gender inequalities are particularly acute in HIV/AIDS caregiving (90% of which is provided in the home), where women and girls make up the informal (and mostly unpaid) workforce. Men's and boy's entry into HIV/AIDS caregiving in greater numbers would both increase the equity and sustainability of national and community-level HIV/AIDS caregiving and mitigate health workforce shortages, but notions of gender essentialism and male primacy make this far from inevitable. In 2008 the Capacity Project partnered with the Lesotho Ministry of Health and Social Welfare in a study of the gender dynamics of HIV/AIDS caregiving in three districts of Lesotho to account for men's absence in HIV/AIDS caregiving and investigate ways in which they might be recruited into the community and home-based care (CHBC) workforce. Methods: The study used qualitative methods, including 25 key informant interviews with village chiefs, nurse clinicians, and hospital administrators and 31 focus group discussions with community health workers, community members, ex-miners, and HIV-positive men and women. Results: Study participants uniformly perceived a need to increase the number of CHBC providers to deal with the heavy workload from increasing numbers of patients and insufficient new entries. HIV/AIDS caregiving is a gendersegregated job, at the core of which lie stereotypes and beliefs about the appropriate work of men and women. This results in an inequitable, unsustainable burden on women and girls. Strategies are analyzed for their potential effectiveness in increasing equity in caregiving. Conclusions: HIV/AIDS and human resources stakeholders must address occupational segregation and the underlying gender essentialism and male primacy if there is to be more equitable sharing of the HIV/AIDS caregiving burden and any long-term solution to health worker shortages. Policymakers, activists and programmers must redress the persistent disadvantages faced by the mostly female caregiving workforce and the gendered economic, psychological, and social impacts entailed in HIV/AIDS caregiving. Research on gender desegregation of HIV/AIDS caregiving is needed.
Journal of Clinical Oncology, 1999
To use a standardized videotape stimulus to assess the effect of physician compassion on viewers'... more To use a standardized videotape stimulus to assess the effect of physician compassion on viewers' anxiety, information recall, treatment decisions, and assessment of physician characteristics. Participants and Methods: One hundred twentythree healthy female breast cancer survivors and 87 women without cancer were recruited for this study. A randomized pretest/posttest control group design with a standardized videotape intervention was used. Participants completed the State-Trait Anxiety Inventory (STAI), an information recall test, a compassion rating, and physician attribute rating scales. Results: Women who saw an ''enhanced compassion'' videotape rated the physician as warmer and more caring, sensitive, and compassionate than did women who watched the ''standard'' videotape. Women who saw the enhanced compassion videotape were significantly less anxious after watching it than the women in the other group. Nevertheless, information recall was relatively low for both groups, and enhanced compassion did not influence patient decisions. Those who saw the enhanced compassion videotape rated the doctor significantly higher on other positive attributes, such as wanting what was best for the patient and encouraging the patient's questions and involvement in decisions. Conclusion: The enhanced compassion segment was short, simple, and effective in decreasing viewers' anxiety. Further research is needed to translate these findings to the clinical setting, where reducing patient anxiety is a therapeutic goal. J Clin Oncol 17:371-379. 1999 by American Society of Clinical Oncology. ... and as I left his offıce, he said, ''you know, you have a very bad disease, but we are going to take care of you.'' The doctor-patient relationship was incredibly therapeutic and reassuring. I had no qualms, no doubts with putting my life in his hands. I had full confidence in his expertise, his concern and emotional support.
\s=b\Few attempts have been made to look for potential cor¬ relations between psychiatric diagnos... more \s=b\Few attempts have been made to look for potential cor¬ relations between psychiatric diagnoses and psychosocial Stressors in suicides. In this study, we examine relationships between the most common psychiatric illnesses and the most common Stressors in 283 suicides from San Diego County. We found that interpersonal loss/conflicts occurred more frequently near the time of death for substance abusers with and without depression than for persons with "pure" affective disorder. These findings are consistent with those of previous reports, suggesting a difference between the way suicidal persons with substance abuse and pure affective disorder respond to certain external Stressors. (Arch Gen Psychiatry 1988;45:589-592)
Social Science Medicine, 2004
Journal of Health Population and Nutrition, Dec 1, 2006
This study calculated the net benefit of using active management of the third stage of labour (AM... more This study calculated the net benefit of using active management of the third stage of labour (AMTSL) rather than expectant management of the third stage of labour (EMTSL) for mothers in Guatemala and Zambia. Probabilities of events were derived from opinions of experts, publicly available data, and published literature. Costs of clinical events were calculated based on national price lists, observation of resources used in AMTSL and EMTSL, and expert estimates of resources used in managing postpartum haemorrhage and its complications, including transfusion. A decision tree was used for modelling expected costs associated with AMTSL or EMTSL. The base case analysis suggested a positive net benefit from AMTSL, with a net cost-saving of US$ 18,000 in Guatemala (with 100 lives saved) and US$ 145,000 in Zambia (with 467 lives saved) for 100,000 births. Facilities have strong economic incentives to adopt AMTSL if uterotonics are available.
Dementia is a major public health problem that affects about 4.5 million elders in the United Sta... more Dementia is a major public health problem that affects about 4.5 million elders in the United States.&#x27;The prevalence of Alzheimer disease (AD)-one of several types of dementia-is expected to nearly quadruple in the next 40 years. 2 The need for dementia research is ...
Social Science & Medicine, 2004
A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a ... more A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a video vignette using modeling in which a physician discussed the concept of a clinical trial (CT) with a woman who was in the process of making a treatment decision. A pretest-post-test design was used and improvements in clinical trial knowledge and beliefs were assessed. Results indicate that video modeling is a powerful tool for increasing CT knowledge (pretest mean=41.5% correct, post-test mean=77.5% correct) but not for improving CT beliefs. Increased clinical trial knowledge, as measured by change scores, was associated with white race, lower levels of education and pretest breast cancer knowledge, more negative pretest CT beliefs, and a higher estimate of the lifetime probability that a woman will have breast cancer. When pretest CT knowledge was added to the analysis using hierarchical multiple regression, all variables except white race became nonsignificant; an increase in CT knowledge was associated with having lower pretest CT knowledge. Results indicate that the effects of low education, low breast cancer knowledge, and biased probability assessment were mediated through the pretest score. An increase in post-test positive CT beliefs was associated with older age, thinking about breast cancer less often, and having lower pretest CT knowledge in the total sample. When pretest CT beliefs was added to the analysis using hierarchical multiple regression, all other variables became nonsignificant; an increase in CT beliefs was associated with having lower pretest CT beliefs, again indicating mediation of the effects of other variables.
BMC Health Services Research, Jun 8, 2015
Human Resources for Health, Feb 17, 2014
Background: This study describes job satisfaction and intention to stay on the job among primary ... more Background: This study describes job satisfaction and intention to stay on the job among primary health-care providers in countries with distinctly different human resources crises, Afghanistan and Malawi. Methods: Using a cross-sectional design, we enrolled 87 health-care providers in 32 primary health-care facilities in Afghanistan and 360 providers in 10 regional hospitals in Malawi. The study questionnaire was used to assess job satisfaction, intention to stay on the job and five features of the workplace environment: resources, performance recognition, financial compensation, training opportunities and safety. Descriptive analyses, exploratory factor analyses for scale development, bivariate correlation analyses and bivariate and multiple linear regression analyses were conducted. Results: The multivariate model for Afghanistan, with demographic, background and work environment variables, explained 23.9% of variance in job satisfaction (F(9,73) = 5.08; P < 0.01). However, none of the work environment variables were significantly related to job satisfaction. The multivariate model for intention to stay for Afghanistan explained 23.6% of variance (F(8,74) = 4.10; P < 0.01). Those with high scores for recognition were more likely to have higher intention to stay (β = 0.328, P < 0.05). However, being paid an appropriate salary was negatively related to intent to stay (β = −0.326, P < 0.01). For Malawi, the overall model explained only 9.8% of variance in job satisfaction (F(8,332) = 4.19; P < 0.01) and 9.1% of variance in intention to stay (F(10,330) = 3.57; P < 0.01). Conclusions: The construction of concepts of health-care worker satisfaction and intention to stay on the job are highly dependent on the local context. Although health-care workers in both Afghanistan and Malawi reported satisfaction with their jobs, the predictors of satisfaction, and the extent to which those predictors explained variations in job satisfaction and intention to stay on the job, differed substantially. These findings demonstrate the need for more detailed comparative human resources for health-care research, particularly regarding the relative importance of different determinants of job satisfaction and intention to stay in different contexts and the effectiveness of interventions designed to improve health-care worker performance and retention.
Social Science & Medicine, 2004
A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a ... more A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a video vignette using modeling in which a physician discussed the concept of a clinical trial (CT) with a woman who was in the process of making a treatment decision. A pretest-post-test design was used and improvements in clinical trial knowledge and beliefs were assessed. Results indicate that video modeling is a powerful tool for increasing CT knowledge (pretest mean=41.5% correct, post-test mean=77.5% correct) but not for improving CT beliefs. Increased clinical trial knowledge, as measured by change scores, was associated with white race, lower levels of education and pretest breast cancer knowledge, more negative pretest CT beliefs, and a higher estimate of the lifetime probability that a woman will have breast cancer. When pretest CT knowledge was added to the analysis using hierarchical multiple regression, all variables except white race became nonsignificant; an increase in CT knowledge was associated with having lower pretest CT knowledge. Results indicate that the effects of low education, low breast cancer knowledge, and biased probability assessment were mediated through the pretest score. An increase in post-test positive CT beliefs was associated with older age, thinking about breast cancer less often, and having lower pretest CT knowledge in the total sample. When pretest CT beliefs was added to the analysis using hierarchical multiple regression, all other variables became nonsignificant; an increase in CT beliefs was associated with having lower pretest CT beliefs, again indicating mediation of the effects of other variables.
American Journal of Geriatric Psychiatry, Mar 1, 2012
Objectives-This study examined the decision-making process used by individuals asked to participa... more Objectives-This study examined the decision-making process used by individuals asked to participate in dementia research and their opinions on how future proxy research decisions would or should be made, including participants' preferred ethical standards for decision-making. Design-Cross-sectional qualitative methods. Setting-University research institutions. Participants-Informants were 39 of 46 cognitively impaired individuals (i.e., subjects) who were asked to join one of six dementia studies and 46 study partners or surrogate decision-makers. Measurements-Semi-structured individual interviews were audio recorded and transcribed for content analysis. Results-Within dyads, subjects and surrogates often differed in their perspectives on how decisions were made regarding whether to join a study, and no single method was identified as a predominant approach. While there was only fair agreement within dyads on who ultimately made the decision, subjects and surrogates most often said it was the subject. For future proxy research decisions, subjects and surrogates most often preferred the ethical standard of best interests and least often favored substituted judgment. However, many participants preferred a combination of best interests and substituted judgment or a more complex approach that also considers the interests of others. Conclusions-Individuals with mild to moderate cognitive impairment can and do engage to some extent in the decision-making process for dementia research and can discuss their opinions on how they would want such decisions made for them in the future. These findings support the recommended approach for obtaining proxy consent and subject assent if the individual lacks consent capacity.
Journal of Clinical Oncology, Jul 15, 2004
6054 Background: Understanding of prog is crucial for appropriate decision making among acp enrol... more 6054 Background: Understanding of prog is crucial for appropriate decision making among acp enrolling in early phase trials of new agents. Prior research shows acp state inaccurate estimates of their prog, and oncologists (MDs) are inaccurate in prog predictions and/or hesitant to discuss prog. Methods: As part of a larger study seeking to improve acp understanding of early phase trials, we examined the effects of a cd on prog understanding. The cd contained information/videos of acp and MDs talking about multiple issues related to trial enrollment, including prog. Acp potentially eligible for phase I-II trials were randomized to either view the cd or receive a NCI clinical trials pamphlet (containing no prog information). After consulting with an MD, acp who enrolled in phase I or II trials were interviewed with a standardized survey. Results: 255 subjects were randomized, with 157 enrolling in phase I or II trial: Median age 62 (34–80), 56% women, 88% Caucasian; 39% with ≥college degree. Compared to acp...
Ejc Supplements, Sep 1, 2003
American Journal of Orthopsychiatry, Jul 1, 1991
Journal of Urban Health-bulletin of The New York Academy of Medicine, Sep 1, 2000
This paper describes the frequency of women's disclosure of their HIV status, examines the extent... more This paper describes the frequency of women's disclosure of their HIV status, examines the extent to which they experience adverse social and physical consequences when others learn they are infected, and analyzes correlates of these negative outcomes. There were 257 HIV-positive women between the ages of 18 and 44, recruited from HIV/AIDS primary care clinics and from community sites, who completed a faceto-face interview. Women in the sample were 33 years old on average; 92% were African-American; 54% had less than 12 years of education; 56% had used intravenous drugs; and 30% knew they were HIV positive for 5 or more years. There were 97% who disclosed their HIV status; 64% told more than 5 people. Negative consequences associated with others knowing they were HIV-positive were reported by 44%, most commonly the loss of friends (24%), being insulted or sworn at (23%), and being rejected by family (21%). There were 10 women (4%) who reported being physically or sexually assaulted as a result of their being HIV positive, and 16% reported having no one they could count on for money or a place to stay. Violence was widespread in this sample, with 62% having experienced physical or sexual violence, including sexual abuse or rape (27%), being beaten up (34%), and weapon-related violence (26%). Logistic regression analysis indicated that women with a history of physical and sexual violence were significantly more likely to experience negative social and physical consequences when their infection became known to others, adjusting for age and the number of people women had disclosed to, both of which were only marginally significant. Partner notification policies and support programs must be responsive to the potential negative consequences associated with others learning that a woman is HIV positive. The high rates of historical violence in the lives of women living with HIV underscore the need for routine screening and intervention for domestic violence in all settings that provide health care to HW-positive women.
Gates open research, Oct 15, 2020
Oral Pre-Exposure Prophylaxis (PrEP) is highly effective in lowering HIV transmission risk. The B... more Oral Pre-Exposure Prophylaxis (PrEP) is highly effective in lowering HIV transmission risk. The Bill and Melinda Gates-funded Jilinde Project was designed to identify the best ways to introduce and support PrEP services in Kenya for female sex workers, men who have sex with men, and adolescent girls and young women. We chose Developmental Evaluation (DE) as a core project approach because our goal was not just to recruit 20,000 new PrEP users, but to learn how to deliver PrEP effectively to optimally benefit users in a complex, dynamic, resource-limited setting. This paper describes how we incorporated DE into the Jilinde Project, and shares experiences and lessons learned about the value of DE in PrEP service implementation in a real-world situation. With the Ministry of Health, Jilinde developed consensus about the structure and roll-out of PrEP services. The DE evaluator, embedded in Jilinde, designed and implemented the five-step DE methodology-collect, review, reflect, record and act-according to a core set of project guiding principles. The paper describes how we operationalized the five elements, citing findings reported and actions taken reflecting on the data. It summarizes challenges to DE implementation, such as uneven uptake and competing demands, and how we addressed those challenges. Used consistently, DE helped adapt and refine PrEP services, improve service access, reach target audiences and improve continuation rates. The look, feel and yield of our DE efforts evolved over time, increasingly integrated into existing systems and providing deeper and richer understandings, and we learned how to better implement DE in the future.
International journal of gynaecology and obstetrics, Dec 5, 2019
Background: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalitie... more Background: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low-and middleincome countries (LMIC) can save lives. Objective: To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities.
Journal of Aging and Health, Mar 5, 2009
Objectives-This study examines how surrogate decision-makers for dementia patients developed an u... more Objectives-This study examines how surrogate decision-makers for dementia patients developed an understanding of patient preferences about end-of-life (EOL) care and patient wishes. Methods-Semi-structured interviews were conducted with 34 surrogate decision-makers for hospice-eligible nursing home patients with dementia. The data were content analyzed. Results-Most surrogates reported that patients had previously completed an advance directive (59%), discussed preferences for EOL care (56%), or done both (38%). Catalysts for and barriers to completing an advance directive or having EOL care discussions included factors that were both intrinsic and extrinsic to the patient. The most commonly reported wish for EOL care was to not be kept alive by "machines" or "extraordinary measures." Discussion-Health care providers may be able to assist patients and families by normalizing discussions of dying, encouraging advance care planning, helping them identify goals for EOL care, and providing information to support treatment decisions consistent with patients' wishes.
Carolina Digital Repository (University of North Carolina at Chapel Hill), Jun 8, 2011
Background: Gender segregation of occupations, which typically assigns caring/nurturing jobs to w... more Background: Gender segregation of occupations, which typically assigns caring/nurturing jobs to women and technical/managerial jobs to men, has been recognized as a major source of inequality worldwide with implications for the development of robust health workforces. In sub-Saharan Africa, gender inequalities are particularly acute in HIV/AIDS caregiving (90% of which is provided in the home), where women and girls make up the informal (and mostly unpaid) workforce. Men's and boy's entry into HIV/AIDS caregiving in greater numbers would both increase the equity and sustainability of national and community-level HIV/AIDS caregiving and mitigate health workforce shortages, but notions of gender essentialism and male primacy make this far from inevitable. In 2008 the Capacity Project partnered with the Lesotho Ministry of Health and Social Welfare in a study of the gender dynamics of HIV/AIDS caregiving in three districts of Lesotho to account for men's absence in HIV/AIDS caregiving and investigate ways in which they might be recruited into the community and home-based care (CHBC) workforce. Methods: The study used qualitative methods, including 25 key informant interviews with village chiefs, nurse clinicians, and hospital administrators and 31 focus group discussions with community health workers, community members, ex-miners, and HIV-positive men and women. Results: Study participants uniformly perceived a need to increase the number of CHBC providers to deal with the heavy workload from increasing numbers of patients and insufficient new entries. HIV/AIDS caregiving is a gendersegregated job, at the core of which lie stereotypes and beliefs about the appropriate work of men and women. This results in an inequitable, unsustainable burden on women and girls. Strategies are analyzed for their potential effectiveness in increasing equity in caregiving. Conclusions: HIV/AIDS and human resources stakeholders must address occupational segregation and the underlying gender essentialism and male primacy if there is to be more equitable sharing of the HIV/AIDS caregiving burden and any long-term solution to health worker shortages. Policymakers, activists and programmers must redress the persistent disadvantages faced by the mostly female caregiving workforce and the gendered economic, psychological, and social impacts entailed in HIV/AIDS caregiving. Research on gender desegregation of HIV/AIDS caregiving is needed.
Journal of Clinical Oncology, 1999
To use a standardized videotape stimulus to assess the effect of physician compassion on viewers'... more To use a standardized videotape stimulus to assess the effect of physician compassion on viewers' anxiety, information recall, treatment decisions, and assessment of physician characteristics. Participants and Methods: One hundred twentythree healthy female breast cancer survivors and 87 women without cancer were recruited for this study. A randomized pretest/posttest control group design with a standardized videotape intervention was used. Participants completed the State-Trait Anxiety Inventory (STAI), an information recall test, a compassion rating, and physician attribute rating scales. Results: Women who saw an ''enhanced compassion'' videotape rated the physician as warmer and more caring, sensitive, and compassionate than did women who watched the ''standard'' videotape. Women who saw the enhanced compassion videotape were significantly less anxious after watching it than the women in the other group. Nevertheless, information recall was relatively low for both groups, and enhanced compassion did not influence patient decisions. Those who saw the enhanced compassion videotape rated the doctor significantly higher on other positive attributes, such as wanting what was best for the patient and encouraging the patient's questions and involvement in decisions. Conclusion: The enhanced compassion segment was short, simple, and effective in decreasing viewers' anxiety. Further research is needed to translate these findings to the clinical setting, where reducing patient anxiety is a therapeutic goal. J Clin Oncol 17:371-379. 1999 by American Society of Clinical Oncology. ... and as I left his offıce, he said, ''you know, you have a very bad disease, but we are going to take care of you.'' The doctor-patient relationship was incredibly therapeutic and reassuring. I had no qualms, no doubts with putting my life in his hands. I had full confidence in his expertise, his concern and emotional support.
\s=b\Few attempts have been made to look for potential cor¬ relations between psychiatric diagnos... more \s=b\Few attempts have been made to look for potential cor¬ relations between psychiatric diagnoses and psychosocial Stressors in suicides. In this study, we examine relationships between the most common psychiatric illnesses and the most common Stressors in 283 suicides from San Diego County. We found that interpersonal loss/conflicts occurred more frequently near the time of death for substance abusers with and without depression than for persons with "pure" affective disorder. These findings are consistent with those of previous reports, suggesting a difference between the way suicidal persons with substance abuse and pure affective disorder respond to certain external Stressors. (Arch Gen Psychiatry 1988;45:589-592)
Social Science Medicine, 2004
Journal of Health Population and Nutrition, Dec 1, 2006
This study calculated the net benefit of using active management of the third stage of labour (AM... more This study calculated the net benefit of using active management of the third stage of labour (AMTSL) rather than expectant management of the third stage of labour (EMTSL) for mothers in Guatemala and Zambia. Probabilities of events were derived from opinions of experts, publicly available data, and published literature. Costs of clinical events were calculated based on national price lists, observation of resources used in AMTSL and EMTSL, and expert estimates of resources used in managing postpartum haemorrhage and its complications, including transfusion. A decision tree was used for modelling expected costs associated with AMTSL or EMTSL. The base case analysis suggested a positive net benefit from AMTSL, with a net cost-saving of US$ 18,000 in Guatemala (with 100 lives saved) and US$ 145,000 in Zambia (with 467 lives saved) for 100,000 births. Facilities have strong economic incentives to adopt AMTSL if uterotonics are available.
Dementia is a major public health problem that affects about 4.5 million elders in the United Sta... more Dementia is a major public health problem that affects about 4.5 million elders in the United States.&#x27;The prevalence of Alzheimer disease (AD)-one of several types of dementia-is expected to nearly quadruple in the next 40 years. 2 The need for dementia research is ...
Social Science & Medicine, 2004
A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a ... more A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a video vignette using modeling in which a physician discussed the concept of a clinical trial (CT) with a woman who was in the process of making a treatment decision. A pretest-post-test design was used and improvements in clinical trial knowledge and beliefs were assessed. Results indicate that video modeling is a powerful tool for increasing CT knowledge (pretest mean=41.5% correct, post-test mean=77.5% correct) but not for improving CT beliefs. Increased clinical trial knowledge, as measured by change scores, was associated with white race, lower levels of education and pretest breast cancer knowledge, more negative pretest CT beliefs, and a higher estimate of the lifetime probability that a woman will have breast cancer. When pretest CT knowledge was added to the analysis using hierarchical multiple regression, all variables except white race became nonsignificant; an increase in CT knowledge was associated with having lower pretest CT knowledge. Results indicate that the effects of low education, low breast cancer knowledge, and biased probability assessment were mediated through the pretest score. An increase in post-test positive CT beliefs was associated with older age, thinking about breast cancer less often, and having lower pretest CT knowledge in the total sample. When pretest CT beliefs was added to the analysis using hierarchical multiple regression, all other variables became nonsignificant; an increase in CT beliefs was associated with having lower pretest CT beliefs, again indicating mediation of the effects of other variables.