Mary Clisbee - Independent Researcher (original) (raw)

Papers by Mary Clisbee

“I Am Half of a Person”: Lived Experiences of Individuals Living With Ostomy After Surgery in Rural Haiti

Qualitative health research, Feb 8, 2024

Journal of Graduate Medical Education, Aug 1, 2019

Trends in health policy and systems research over the past decade: still too little capacity in l... more Trends in health policy and systems research over the past decade: still too little capacity in low-income countries.

Bayo Lapawol (Let Their Voices Be Heard): Haitian Women’s Barriers to and Facilitators of Cervical Cancer Prevention and Control

Health Education & Behavior, Feb 23, 2021

This study aimed to increase understanding of barriers to cervical cancer prevention and control ... more This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women ( n = 25) who were on average 42 years ( SD = 9.8, range: 26–57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model’s dimensions of cultural identity, relationships and expectations, and cultural empowerment, women’s recommendations to overcome barriers spanned education, evaluation, and empowerment, respectively, across individual, interpersonal, and institutional systems. Study results call for more extensive examination of the diversity present in the groups of African origin to unearth transnational, multifaceted determinants of health by biology, beliefs, and behaviors including sociocultural and socioenvironmental access. Future interventions must include development of proactive policies, which deliberately pressure the government and global community to prioritize health infrastructure while simultaneously educating women about and dispelling fear of cervical cancer, thus empowering Haitian women to live their healthiest lives. Accordingly, this study may contribute to understanding global health equity advances and improving public health infrastructure in underresourced settings in low- and middle-income countries in the Caribbean.

Discover Social Science and Health

Background In Sierra Leone, non-communicable diseases (NCDs) are an increasingly important source... more Background In Sierra Leone, non-communicable diseases (NCDs) are an increasingly important source of mortality and morbidity. However, Sierra Leonean NCD patients’ experience of direct exposure to COVID-19-related risks and indirect effects of the COVID-19 pandemic on socioeconomic determinants of health has not been described. Methods We conducted a cross-sectional telephone survey among adult (≥ 18 years) hypertensive, diabetic, and heart failure patients receiving treatment at the NCD clinic at Koidu Government Hospital (KGH) in rural Sierra Leone. We described patient demographics, COVID-19 related knowledge, and practice of infection prevention measures. Patients were categorized into nationally representative wealth quintiles using an asset-based wealth index and measures of social vulnerability were reported by clinical program and wealth category. Result Of the 400 respondents, 80.5% were between 40 and 69 years old and 46.1% were male. The majority of patients (> 90%) kn...

BMC Public Health, Nov 29, 2022

Background Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in... more Background Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in low resource settings resulting in "high" or "low" classifications, assumes that determination of the trait of interest is perfect. This is often not true for diagnostic tests, with imperfect sensitivity and specificity. Here, we develop Lot Quality Assurance Sampling for Imperfect Tests (LQAS-IMP) to address this issue and apply it to a COVID-19 serosurveillance study design in Haiti. Methods We first derive a modified procedure, LQAS-IMP, that accounts for the sensitivity and specificity of a diagnostic test to yield correct classification errors. We then apply the novel LQAS-IMP to design an LQAS system to classify prevalence of SARS-CoV-2 antibodies among healthcare workers at eleven Zanmia Lasante health facilities in Haiti. Finally, we show the performance of the LQAS-IMP procedure in a simulation study. Results We found that when an imperfect diagnostic test is used, the classification errors in the standard LQAS procedure are larger than specified. In the modified LQAS-IMP procedure, classification errors are consistent with the specified maximum classification error. We then utilized the LQAS-IMP procedure to define valid systems for sampling at eleven hospitals in Haiti. Conclusion The LQAS-IMP procedure accounts for imperfect sensitivity and specificity in system design; if the accuracy of a test is known, the use of LQAS-IMP extends LQAS to applications for indicators that are based on laboratory tests, such as SARS-CoV-2 antibodies.

Uterine fibroid: a socially malignant illness in Haiti

Anthropology & Medicine

Bayo Lapawol (Let Their Voices Be Heard): Haitian Women’s Barriers to and Facilitators of Cervical Cancer Prevention and Control

Health Education & Behavior, 2021

Abstract 10078: Facilitators and Barriers to Chronic Care Among Patients with Heart Failure in Rural Haiti: A Qualitative Study

Circulation, 2021

Introduction: Heart failure (HF) is a leading cause of hospitalizations in rural Haiti. However, ... more Introduction: Heart failure (HF) is a leading cause of hospitalizations in rural Haiti. However, few patients hospitalized for HF return for outpatient care. The factors that contribute to chronic HF care access are poorly understood. Objective: To investigate the facilitators and barriers to accessing care for chronic HF from the patients’ perspectives. Methods: We conducted three group interviews and one individual interview with thirteen patients with HF. We recruited patients after discharge from a non-governmental organization-supported academic hospital in rural Haiti. We employed thematic analysis using emergent coding and categorized themes using the socioecological model. Results: Facilitators of chronic care included participants’ knowledge about the importance of HF treatment and engagement with health systems to manage symptoms. Strong social support networks helped participants access clinic visits. Participants reported low cost of care at this subsidized hospital, goo...

Online Professor, Prepare Yourself! Students, are you out there?

This session will appeal to those interested in teaching qualitative research methods using an on... more This session will appeal to those interested in teaching qualitative research methods using an online learning platform. How can we engage our students without ever actually meeting them? How do we make sense of our role as professor while staring at words on a computer screen? Alas! We are qualitative researchers, we love personal interaction! Teaching online creates a peculiar contradiction for us. We are adverse to flat, text based exchanges. We yearn for interaction, dialogue, and connection! Is our positionality different in an online classroom? Is it still our quest to impart our students with our expert knowledge and form meaningful academic relationships, or are we mere guides through a fabricated textual maze? We will share tales of woe and success while on our journeys to become effective online qualitative research professors. We will reflect on instructional strategies, online tools, and feedback loops that we have used in our quest to meet our students’ learning needs w...

Integrating Social Medicine in Residency Programs in Haiti: Training the new generation of healthcare professionals

Academic Medicine, 2020

Revitalizing graduate medical education in global settings: Lessons from post-earthquake Haiti. A... more Revitalizing graduate medical education in global settings: Lessons from post-earthquake Haiti. Acad Med. 3 Unedited content. Used with permission. Unauthorized reproduction prohibited. training the residents. Recruitment of attending physicians will focus on persons dedicated to both teaching and service of Haiti's rural populations.

Developing HIV Primary Prevention Materials for Children in Haiti: A Qualitative Case Study of Cultural and Contextual Implications

The Journal of Global Health Leadership, 2018

The purpose of this qualitative case study was to explore the cultural and contextual implication... more The purpose of this qualitative case study was to explore the cultural and contextual implications to be considered in the development of a human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) primary prevention curriculum for children in Haiti. A qualitative case study approach was followed. Participants were Haitian professionals from the medical and/or education sector. Data were generated through interviews. A primary prevention curriculum for HIV/AIDS is needed and can be developed and delivered in Haiti with the involvement from the medical and education sectors. The program should include parental involvement in the development of the curriculum, contain a strong training component for those delivering the program as well as for parents, and use multiple educational pedagogies. Haiti’s unique culture, history, and mix of religions must be considered. Curricular materials and instructional strategies must be appropriate for the culture, context, and specific development needs of the children.

Gender-Based Differences in the Leadership Style of School Superintendents

Gender Differences in Leadership Style and Female School Superintendents

Leadership style: do male and female superintendents lead differently?

BMJ Global Health, 2022

Academic Psychiatry, 2011

OSCE for evaluating clinical competence still remains limited in France. This study presents the ... more OSCE for evaluating clinical competence still remains limited in France. This study presents the results of the first experimental use of an OSCE as a formative assessment of French general practice trainees. Fifty trainees rotated through a circuit of 15 standardized patient-based OSCE cases. Differences in scores were determined by analysis of variance. Reliability was calculated with the coefficient alpha. Pearson correlations were used to determine the relationship between station scores and overall OSCE score. Written questionnaires based on Likert-type scales were used to measure OSCE feasibility. No difference was found between total session scores. Significant item-total score correlations were found for 12 of the 15 clinical problems. The reliability of the examination was 0.58. Most participants agreed that the clinical situations were realistic, simulated patients were believable and sampling of cases was representative of general practice. These data confirm the feasibility of OSCE in assessing performance of general practice trainees. Optimal training of observers should improve examination reliability. This study warrants further development to confirm its usefulness as a summative assessment tool.

Broward County Sheriff's Office Civil Citation Program Evaluation

Disruptions in maternal health service utilization during the first ten months of the COVID-19 pandemic: Experiences in Haiti, Lesotho, Liberia, Malawi, Mexico, and Sierra Leone, 2022

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with d... more The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.