Mary Adam - Academia.edu (original) (raw)

Papers by Mary Adam

Global Health Action, 2019

Background and objective: Limited data exist on health conditions of school children in Somalilan... more Background and objective: Limited data exist on health conditions of school children in Somaliland. School Health Intervention Pilot Program (SHIPP) was conducted through Edna Adan University Hospital to screen children and offer interventions. We present the results of the general health screening of the school children, and also describe the association between nutritional status and other variables. Methods: In this cross-sectional study children from two public primary schools in Hargeisa were assessed for general health by nursing students. Nutritional status was assessed by BMIfor-age z-scores and visual acuity by Paediatric Snellen Chart. Results: We screened 2,093 children aged 4-19 years; 58% were boys. Very low BMI-forage (z-score < −3) was detected in 5%; 6% had visual acuity below 0.7; 26% had dental caries. Children reported low exposure to health services: 33% reported no prior vaccination; 46% reported they had never visited a health clinic or hospital. Conclusion: A significant number of children were malnourished, had reduced visual acuity or treatable infections which could impact their ability to learn. Public schools are a feasible entry point for public health action including screening, treatment, and referral in fragile countries.

Disaster Medicine and Public Health Preparedness, 2022

We set out to assess the feasibility of community-focused randomized qualitative assessment at th... more We set out to assess the feasibility of community-focused randomized qualitative assessment at the start of an emergency to identify the root causes of fear-based responses driving the pandemic. We used key informant interviews, focus group discussions, reviewing of government and non-government organization documents, combined with direct field observation. Data were recorded and analyzed for key-themes: (1) lack of evidence-based information about Ebola; (2) lack of support to quarantined families; (3) culturally imbedded practices of caring for ill family members; (4) strong feeling that the government would not help them, and the communities needed to help themselves: (5) distrust of nongovernmental organizations and Ebola treatment centers that the communities viewed as opportunistic. On-the-ground real-time engagement with stakeholders provided deep insight into fear-based-responses during the Ebola epidemic, formed a coherent understanding of how they drove the epidemic, pres...

Dataset of Discrete Choice Experiment data and soiocdemographic data for women in a peri urban se... more Dataset of Discrete Choice Experiment data and soiocdemographic data for women in a peri urban setting in Kenya

In this paper, the quadratic B-spline collocation method is implemented to find numerical solutio... more In this paper, the quadratic B-spline collocation method is implemented to find numerical solution of the Benjamin-Bona-Mahony-Burgers (BBMB) equation. Applying the Von-Neumann stability analysis technique, we show that the method is unconditionally stable. Also the convergence of the method is proved. The method is applied on some test examples, and numerical results have been compared with the exact solution. The numerical solutions show the efficiency of the method computationally.

American Journal of Public Health, 2003

 LETTERS  of a whole range of other advances: preventive, public health, sanitary, and local go... more  LETTERS  of a whole range of other advances: preventive, public health, sanitary, and local government investments and services (such as inspection of foodstuffs, without which the increased food supply emphasized by McKeown would have had little net health benefit for the urban poor). This vast range of measures and activities brought urban populations in the Western world to historically unprecedented health levels by the beginning of the 20th century. Little of it was the medical equivalent of rocket science, but all of it required the political campaigning and agency of that poorrelation branch of the medical profession, the historic public health movement. 1-5 Along the way, the urban populace became re-educated with the health-related knowledge that Lawson rightly values. 6,7,8 Cleanliness may have been appreciated by the poor, but regular washing became a practical possibility only with the political resolve by municipalities to supply all domiciles, regardless of capacity to pay, with a regular, clean water supply and the fittings and fixture to receive the supply. This was something the public health movement had to push for endlessly because of the obvious expense to reluctant middle-class taxpayers. In an age of imperialist perceptions, this political will did not extend in the same measure to the poor peoples of other continents-nor does it yet. 7,9-12

IJQHC Communications

Introduction Poor quality health care is a significant cause of preventable deaths, especially in... more Introduction Poor quality health care is a significant cause of preventable deaths, especially in low- and middle-income countries (LMICs). Quality improvement is multifaceted and includes strategies such as standard setting, quality assurance and clinic audits. In order to move quality improvement in health care into every day practice it is essential to fully engage the frontline where health care is delivered. The objective of this scoping review is to investigate front line health care worker line led quality improvement in Sub Saharan Africa (SSA). Methods We conducted a scoping review to identify, map and synthesize evidence on health care worker led quality improvement initiatives in Sub Sahara Africa using electronic databases PubMed, Cochrane, Embase, CINAHL, Scopus and Psychinfo to identify peer-reviewed literature published between January 2000 and January 2021. To identify grey literature, we used the same search terms in google search to a maximum of 10 pages or when th...

Archives of Pediatrics & Adolescent Medicine, 2005

To investigate ethnic differences in onset of sexual intercourse among Hispanic/Mexican American ... more To investigate ethnic differences in onset of sexual intercourse among Hispanic/Mexican American and white adolescents based on acculturation. Design/Methods: Preprogram survey data from 7270 Hispanic or white teens in 7th to 12th grade involved in the Arizona Abstinence-Only Education Program were used to predict the probability of onset of sexual intercourse based on age, sex, family structure, program location, religiosity, free school lunch, grades, rural residence, acculturation, and ethnicity. Specific attention was given to the influence of acculturation among Hispanic teens. The primary language spoken by the respondents (English, Spanish, or both) was used as a proxy measure for acculturation. Results: Hispanic youth were at a greater risk for experiencing onset of intercourse than white youth, while controlling for all other predictors (odds ratio [OR], 1.40 [95% confidence interval (CI), 1.21-1.63]). This risk was amplified for highly acculturated Hispanic teens (OR, 1.69 [95% CI, 1.43-1.99]). However, less acculturated Hispanic youth were actually less likely to have experienced first intercourse than white youth (OR, 0.59 [95% CI, 0.42-0.82]), English-speaking Hispanic youth (OR, 0.35 [95% CI, 0.25-0.49]), or bilingual Hispanic youth (OR, 0.45 [95% CI, 0.31-0.64]). Conclusions: Low acculturation emerges as a significant protective factor while controlling for other social and cultural factors, in spite of the increased risk of initiating sexual intercourse for Hispanic teens overall. Hispanic Spanish speakers were least likely to have initiated intercourse, while Hispanic English speakers were the most likely.

The American Journal of Tropical Medicine and Hygiene, 2021

ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic has demanded rapid institutional respo... more ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic has demanded rapid institutional responses to meet the needs of patients and employees in the face of a serious new disease. To support the well-being of frontline staff, a series of debriefing sessions was used to drive a rapid-cycle quality-improvement process. The goals were to confidentially determine personal coping strategies used by staff, provide an opportunity for staff cross-learning, identify what staff needed most, and provide a real-time feedback loop for decision-makers to create rapid changes to support staff safety and coping. Data were collected via sticky notes on flip charts to protect confidentiality. Management reviewed the data daily. Institutional responses to problems identified during debrief sessions were tracked, visualized, addressed, and shared with staff. More than 10% of staff participated over a 2-week period. Feedback influenced institutional decisions to improve staff schedules, transportati...

Journal of Applied Measurement, 2011

Ethnic differences in health outcomes are assumed to reflect levels of acculturation, among other... more Ethnic differences in health outcomes are assumed to reflect levels of acculturation, among other factors. Health surveys frequently include language and social interaction items taken from existing acculturation instruments. This study evaluated the dimensionality of responses to typical bilinear items in Latino youth using Rasch modeling. Two seven-item scales measuring Anglo-Hispanic orientation were adapted from Marin and Gamba (1996) and Cuellar, Arnold, and Maldonado (1995). Most of the items fit the Rasch model. However, there were gaps in both the Hispanic and Anglo scales. The Anglo items were not well targeted for the sample because most students reported they always spoke English. The lack of variability found in a heterogeneous sample of Latino youth has negative implications for the common practice of relying on language as a measure of acculturation. Acculturation instruments for youth probably need more sensitive items to discriminate linguistic differences, or to mea...

BMJ Open

ObjectiveTo examine how women living in an informal settlement in Nairobi perceive the quality of... more ObjectiveTo examine how women living in an informal settlement in Nairobi perceive the quality of maternity care and how it influences their choice of a delivery health facility.DesignQualitative study.SettingsDandora, an informal settlement, Nairobi City in Kenya.ParticipantsSix focus group discussions with 40 purposively selected women aged 18–49 years at six health facilities.ResultsFour broad themes were identified: (1) perceived quality of the delivery services, (2) financial access to delivery service, (3) physical amenities at the health facility, and (4) the 2017 health workers’ strike.The four facilitators that influenced women to choose a private health facility were: (1) interpersonal treatment at health facilities, (2) perceived quality of clinical services, (3) financial access to health services at the facility, and (4) the physical amenities at the health facility. The three barriers to choosing a private facility were: (1) poor quality clinical services at low-cost h...

Background: Physicians, health care organizations, governments and communities are increasingly i... more Background: Physicians, health care organizations, governments and communities are increasingly interested in how trust is built throughout the health system. Current science on building trust draws on diverse literature from business and consumer science to healthcare, and theory development has predominately focused on factor based models. We propose a process based theoretical model for trust building which may better reflect the complex and dynamic nature of trust itself. In doing so, we propose a new measurable dimension of the trust building process: reciprocity cycles. Cooperative reciprocal relationships are its building blocks, enabling stakeholders to “try out” their interactions with less risk, and to calibrate their level of effort, time and emotional investment. Reciprocity cycles includes three measurable elements: common goals, self-interests and gratitude/indebtedness.Methods: We applied the model, developing outcomes and measures in close-to-community health partner...

BMJ Open, 2020

Objective To examine how women living in an informal settlement in Nairobi perceive the quality o... more Objective To examine how women living in an informal settlement in Nairobi perceive the quality of maternity care and how it influences their choice of a delivery health facility. Design Qualitative study. Settings Dandora, an informal settlement, Nairobi City in Kenya. Participants Six focus group discussions with 40 purposively selected women aged 18–49 years at six health facilities. Results Four broad themes were identified: (1) perceived quality of the delivery services, (2) financial access to delivery service, (3) physical amenities at the health facility, and (4) the 2017 health workers’ strike. The four facilitators that influenced women to choose a private health facility were: (1) interpersonal treatment at health facilities, (2) perceived quality of clinical services, (3) financial access to health services at the facility, and (4) the physical amenities at the health facility. The three barriers to choosing a private facility were: (1) poor quality clinical services at ...

Systems Research and Behavioral Science, 2020

Background: Physicians, health care organizations, governments and communities are increasingly i... more Background: Physicians, health care organizations, governments and communities are increasingly interested in how trust is built throughout the health system. Current science on building trust draws on diverse literature from business and consumer science to healthcare, and theory development has predominately focused on factor based models. We propose a process based theoretical model for trust building which may better reflect the complex and dynamic nature of trust itself. In doing so, we propose a new measurable dimension of the trust building process: reciprocity cycles. Cooperative reciprocal relationships are its building blocks, enabling stakeholders to "try out" their interactions with less risk, and to calibrate their level of effort, time and emotional investment. Reciprocity cycles includes three measurable elements: common goals, self-interests and gratitude/indebtedness. Methods: We applied the model, developing outcomes and measures in close-to-community health partnerships in Kenya. A 3-day workshop designed to stimulate problem solving and collaborative teamwork using human centered design principles was offered in 2 community health units in diverse contexts (rural agrarian and peri-urban flower farm slum), each with about 30 community health volunteers (CHVs) serving a population of approximately 5,000. Each unit formed separate teams representing specific villages; we followed these 9 teams between 18 to 24 months. Results: All 9 volunteer CHV teams delivered on self-directed public health outcomes across the spectrum of social determinants of health over the follow up period, with no funding, only using their own locally available resources. Projects were diverse, including immunization, composting toilets, hygiene, neonatal and reproductive health and public gardening. All 9 teams demonstrated trust building reciprocity cycles with articulation of common goal, self-interest, and gratitude/indebtedness. Conclusion: A process model of trust building, defined by reciprocity cycles, can be stimulated with a short intervention (illustrated here in close-to-community health systems) resulting in trusting relationships that drive agency and co-production of positive outcomes for health systems. In addition, it offers a simpler, more useful framework for trust building and measurement than traditional models of trust in health systems research. Early findings illustrate reciprocity cycles are

Health Policy and Planning

Human-centred design (HCD) can support complex health system interventions by navigating thorny i... more Human-centred design (HCD) can support complex health system interventions by navigating thorny implementation problems that often derail population health efforts. HCD is a pragmatic, ‘practice framework’, not an intervention protocol. It can build empathy by bringing patient voice, user perspective and innovation to construct and repair pieces of the intervention or health system. However, its emphasis on product development and process change with fixed end points has left it as an approach lacking explanatory power and reproducible measurement. Yet when informed by theory, the tremendous innovation potential of HCD can be harnessed to drive sustainability, mediate implementation problems, frame measurement constructs and ultimately improve population-level health outcomes. In attempting to mine, the potential of HCD we move beyond the pragmatic ‘how it works’, to the theoretical question, ‘why it works’. In doing so, we explore a more fundamental human question, ‘How can partici...

Objective: The substantial prevalence of HIV in Africa underscores the urgent need for effective ... more Objective: The substantial prevalence of HIV in Africa underscores the urgent need for effective HIV prevention programs. This paper reports the results of an effectiveness trial for the I Choose Life-Africa (ICL) HIV prevention program carried out among Kenyan university students. Methods: Longitudinal data was analyzed from182 student volunteers, randomized to an intervention or control group. The intervention group received training as HIV prevention peer educators with a 32 hour theoretically based curriculum. All students were given a pretest survey assessing HIV related attitudes, intentions, knowledge and behaviors and repeated the survey 3 times over the next 6 months. Data was analyzed using Linear Mixed Models (LMM) or Generalized Linear Models (GLM) to compare the rate of change on 13 dependent variables that examined sexual risk behavior (broadly defined). Monitoring data on the types of HIV prevention messages delivered by the peer educators was obtained. Results: Based...

Tienda online donde Comprar Clinical Ethics In Pediatrics, A Case-Based Textbook al precio 43,17 ... more Tienda online donde Comprar Clinical Ethics In Pediatrics, A Case-Based Textbook al precio 43,17 € de Douglas S. Diekema | Mark R. Mercurio | Mary B. Adam, tienda de Libros de Medicina, Libros de Biologia - Bioetica

BMJ Open, 2020

Objective To identify what women want in a delivery health facility and how they rank the attribu... more Objective To identify what women want in a delivery health facility and how they rank the attributes that influence the choice of a place of delivery. Design A discrete choice experiment (DCE) was conducted to elicit rural women’s preferences for choice of delivery health facility. Data were analysed using a conditional logit model to evaluate the relative importance of the selected attributes. A mixed multinomial model evaluated how interactions with sociodemographic variables influence the choice of the selected attributes. Setting Six health facilities in a rural subcounty. Participants Women aged 18–49 years who had delivered within 6 weeks. Primary outcome The DCE required women to select from hypothetical health facility A or B or opt-out alternative. Results A total of 474 participants were sampled, 466 participants completed the survey (response rate 98%). The attribute with the strongest association with health facility preference was having a kind and supportive healthcare...

Global Health Action, 2019

Background and objective: Limited data exist on health conditions of school children in Somalilan... more Background and objective: Limited data exist on health conditions of school children in Somaliland. School Health Intervention Pilot Program (SHIPP) was conducted through Edna Adan University Hospital to screen children and offer interventions. We present the results of the general health screening of the school children, and also describe the association between nutritional status and other variables. Methods: In this cross-sectional study children from two public primary schools in Hargeisa were assessed for general health by nursing students. Nutritional status was assessed by BMIfor-age z-scores and visual acuity by Paediatric Snellen Chart. Results: We screened 2,093 children aged 4-19 years; 58% were boys. Very low BMI-forage (z-score < −3) was detected in 5%; 6% had visual acuity below 0.7; 26% had dental caries. Children reported low exposure to health services: 33% reported no prior vaccination; 46% reported they had never visited a health clinic or hospital. Conclusion: A significant number of children were malnourished, had reduced visual acuity or treatable infections which could impact their ability to learn. Public schools are a feasible entry point for public health action including screening, treatment, and referral in fragile countries.

Disaster Medicine and Public Health Preparedness, 2022

We set out to assess the feasibility of community-focused randomized qualitative assessment at th... more We set out to assess the feasibility of community-focused randomized qualitative assessment at the start of an emergency to identify the root causes of fear-based responses driving the pandemic. We used key informant interviews, focus group discussions, reviewing of government and non-government organization documents, combined with direct field observation. Data were recorded and analyzed for key-themes: (1) lack of evidence-based information about Ebola; (2) lack of support to quarantined families; (3) culturally imbedded practices of caring for ill family members; (4) strong feeling that the government would not help them, and the communities needed to help themselves: (5) distrust of nongovernmental organizations and Ebola treatment centers that the communities viewed as opportunistic. On-the-ground real-time engagement with stakeholders provided deep insight into fear-based-responses during the Ebola epidemic, formed a coherent understanding of how they drove the epidemic, pres...

Dataset of Discrete Choice Experiment data and soiocdemographic data for women in a peri urban se... more Dataset of Discrete Choice Experiment data and soiocdemographic data for women in a peri urban setting in Kenya

In this paper, the quadratic B-spline collocation method is implemented to find numerical solutio... more In this paper, the quadratic B-spline collocation method is implemented to find numerical solution of the Benjamin-Bona-Mahony-Burgers (BBMB) equation. Applying the Von-Neumann stability analysis technique, we show that the method is unconditionally stable. Also the convergence of the method is proved. The method is applied on some test examples, and numerical results have been compared with the exact solution. The numerical solutions show the efficiency of the method computationally.

American Journal of Public Health, 2003

 LETTERS  of a whole range of other advances: preventive, public health, sanitary, and local go... more  LETTERS  of a whole range of other advances: preventive, public health, sanitary, and local government investments and services (such as inspection of foodstuffs, without which the increased food supply emphasized by McKeown would have had little net health benefit for the urban poor). This vast range of measures and activities brought urban populations in the Western world to historically unprecedented health levels by the beginning of the 20th century. Little of it was the medical equivalent of rocket science, but all of it required the political campaigning and agency of that poorrelation branch of the medical profession, the historic public health movement. 1-5 Along the way, the urban populace became re-educated with the health-related knowledge that Lawson rightly values. 6,7,8 Cleanliness may have been appreciated by the poor, but regular washing became a practical possibility only with the political resolve by municipalities to supply all domiciles, regardless of capacity to pay, with a regular, clean water supply and the fittings and fixture to receive the supply. This was something the public health movement had to push for endlessly because of the obvious expense to reluctant middle-class taxpayers. In an age of imperialist perceptions, this political will did not extend in the same measure to the poor peoples of other continents-nor does it yet. 7,9-12

IJQHC Communications

Introduction Poor quality health care is a significant cause of preventable deaths, especially in... more Introduction Poor quality health care is a significant cause of preventable deaths, especially in low- and middle-income countries (LMICs). Quality improvement is multifaceted and includes strategies such as standard setting, quality assurance and clinic audits. In order to move quality improvement in health care into every day practice it is essential to fully engage the frontline where health care is delivered. The objective of this scoping review is to investigate front line health care worker line led quality improvement in Sub Saharan Africa (SSA). Methods We conducted a scoping review to identify, map and synthesize evidence on health care worker led quality improvement initiatives in Sub Sahara Africa using electronic databases PubMed, Cochrane, Embase, CINAHL, Scopus and Psychinfo to identify peer-reviewed literature published between January 2000 and January 2021. To identify grey literature, we used the same search terms in google search to a maximum of 10 pages or when th...

Archives of Pediatrics & Adolescent Medicine, 2005

To investigate ethnic differences in onset of sexual intercourse among Hispanic/Mexican American ... more To investigate ethnic differences in onset of sexual intercourse among Hispanic/Mexican American and white adolescents based on acculturation. Design/Methods: Preprogram survey data from 7270 Hispanic or white teens in 7th to 12th grade involved in the Arizona Abstinence-Only Education Program were used to predict the probability of onset of sexual intercourse based on age, sex, family structure, program location, religiosity, free school lunch, grades, rural residence, acculturation, and ethnicity. Specific attention was given to the influence of acculturation among Hispanic teens. The primary language spoken by the respondents (English, Spanish, or both) was used as a proxy measure for acculturation. Results: Hispanic youth were at a greater risk for experiencing onset of intercourse than white youth, while controlling for all other predictors (odds ratio [OR], 1.40 [95% confidence interval (CI), 1.21-1.63]). This risk was amplified for highly acculturated Hispanic teens (OR, 1.69 [95% CI, 1.43-1.99]). However, less acculturated Hispanic youth were actually less likely to have experienced first intercourse than white youth (OR, 0.59 [95% CI, 0.42-0.82]), English-speaking Hispanic youth (OR, 0.35 [95% CI, 0.25-0.49]), or bilingual Hispanic youth (OR, 0.45 [95% CI, 0.31-0.64]). Conclusions: Low acculturation emerges as a significant protective factor while controlling for other social and cultural factors, in spite of the increased risk of initiating sexual intercourse for Hispanic teens overall. Hispanic Spanish speakers were least likely to have initiated intercourse, while Hispanic English speakers were the most likely.

The American Journal of Tropical Medicine and Hygiene, 2021

ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic has demanded rapid institutional respo... more ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic has demanded rapid institutional responses to meet the needs of patients and employees in the face of a serious new disease. To support the well-being of frontline staff, a series of debriefing sessions was used to drive a rapid-cycle quality-improvement process. The goals were to confidentially determine personal coping strategies used by staff, provide an opportunity for staff cross-learning, identify what staff needed most, and provide a real-time feedback loop for decision-makers to create rapid changes to support staff safety and coping. Data were collected via sticky notes on flip charts to protect confidentiality. Management reviewed the data daily. Institutional responses to problems identified during debrief sessions were tracked, visualized, addressed, and shared with staff. More than 10% of staff participated over a 2-week period. Feedback influenced institutional decisions to improve staff schedules, transportati...

Journal of Applied Measurement, 2011

Ethnic differences in health outcomes are assumed to reflect levels of acculturation, among other... more Ethnic differences in health outcomes are assumed to reflect levels of acculturation, among other factors. Health surveys frequently include language and social interaction items taken from existing acculturation instruments. This study evaluated the dimensionality of responses to typical bilinear items in Latino youth using Rasch modeling. Two seven-item scales measuring Anglo-Hispanic orientation were adapted from Marin and Gamba (1996) and Cuellar, Arnold, and Maldonado (1995). Most of the items fit the Rasch model. However, there were gaps in both the Hispanic and Anglo scales. The Anglo items were not well targeted for the sample because most students reported they always spoke English. The lack of variability found in a heterogeneous sample of Latino youth has negative implications for the common practice of relying on language as a measure of acculturation. Acculturation instruments for youth probably need more sensitive items to discriminate linguistic differences, or to mea...

BMJ Open

ObjectiveTo examine how women living in an informal settlement in Nairobi perceive the quality of... more ObjectiveTo examine how women living in an informal settlement in Nairobi perceive the quality of maternity care and how it influences their choice of a delivery health facility.DesignQualitative study.SettingsDandora, an informal settlement, Nairobi City in Kenya.ParticipantsSix focus group discussions with 40 purposively selected women aged 18–49 years at six health facilities.ResultsFour broad themes were identified: (1) perceived quality of the delivery services, (2) financial access to delivery service, (3) physical amenities at the health facility, and (4) the 2017 health workers’ strike.The four facilitators that influenced women to choose a private health facility were: (1) interpersonal treatment at health facilities, (2) perceived quality of clinical services, (3) financial access to health services at the facility, and (4) the physical amenities at the health facility. The three barriers to choosing a private facility were: (1) poor quality clinical services at low-cost h...

Background: Physicians, health care organizations, governments and communities are increasingly i... more Background: Physicians, health care organizations, governments and communities are increasingly interested in how trust is built throughout the health system. Current science on building trust draws on diverse literature from business and consumer science to healthcare, and theory development has predominately focused on factor based models. We propose a process based theoretical model for trust building which may better reflect the complex and dynamic nature of trust itself. In doing so, we propose a new measurable dimension of the trust building process: reciprocity cycles. Cooperative reciprocal relationships are its building blocks, enabling stakeholders to “try out” their interactions with less risk, and to calibrate their level of effort, time and emotional investment. Reciprocity cycles includes three measurable elements: common goals, self-interests and gratitude/indebtedness.Methods: We applied the model, developing outcomes and measures in close-to-community health partner...

BMJ Open, 2020

Objective To examine how women living in an informal settlement in Nairobi perceive the quality o... more Objective To examine how women living in an informal settlement in Nairobi perceive the quality of maternity care and how it influences their choice of a delivery health facility. Design Qualitative study. Settings Dandora, an informal settlement, Nairobi City in Kenya. Participants Six focus group discussions with 40 purposively selected women aged 18–49 years at six health facilities. Results Four broad themes were identified: (1) perceived quality of the delivery services, (2) financial access to delivery service, (3) physical amenities at the health facility, and (4) the 2017 health workers’ strike. The four facilitators that influenced women to choose a private health facility were: (1) interpersonal treatment at health facilities, (2) perceived quality of clinical services, (3) financial access to health services at the facility, and (4) the physical amenities at the health facility. The three barriers to choosing a private facility were: (1) poor quality clinical services at ...

Systems Research and Behavioral Science, 2020

Background: Physicians, health care organizations, governments and communities are increasingly i... more Background: Physicians, health care organizations, governments and communities are increasingly interested in how trust is built throughout the health system. Current science on building trust draws on diverse literature from business and consumer science to healthcare, and theory development has predominately focused on factor based models. We propose a process based theoretical model for trust building which may better reflect the complex and dynamic nature of trust itself. In doing so, we propose a new measurable dimension of the trust building process: reciprocity cycles. Cooperative reciprocal relationships are its building blocks, enabling stakeholders to "try out" their interactions with less risk, and to calibrate their level of effort, time and emotional investment. Reciprocity cycles includes three measurable elements: common goals, self-interests and gratitude/indebtedness. Methods: We applied the model, developing outcomes and measures in close-to-community health partnerships in Kenya. A 3-day workshop designed to stimulate problem solving and collaborative teamwork using human centered design principles was offered in 2 community health units in diverse contexts (rural agrarian and peri-urban flower farm slum), each with about 30 community health volunteers (CHVs) serving a population of approximately 5,000. Each unit formed separate teams representing specific villages; we followed these 9 teams between 18 to 24 months. Results: All 9 volunteer CHV teams delivered on self-directed public health outcomes across the spectrum of social determinants of health over the follow up period, with no funding, only using their own locally available resources. Projects were diverse, including immunization, composting toilets, hygiene, neonatal and reproductive health and public gardening. All 9 teams demonstrated trust building reciprocity cycles with articulation of common goal, self-interest, and gratitude/indebtedness. Conclusion: A process model of trust building, defined by reciprocity cycles, can be stimulated with a short intervention (illustrated here in close-to-community health systems) resulting in trusting relationships that drive agency and co-production of positive outcomes for health systems. In addition, it offers a simpler, more useful framework for trust building and measurement than traditional models of trust in health systems research. Early findings illustrate reciprocity cycles are

Health Policy and Planning

Human-centred design (HCD) can support complex health system interventions by navigating thorny i... more Human-centred design (HCD) can support complex health system interventions by navigating thorny implementation problems that often derail population health efforts. HCD is a pragmatic, ‘practice framework’, not an intervention protocol. It can build empathy by bringing patient voice, user perspective and innovation to construct and repair pieces of the intervention or health system. However, its emphasis on product development and process change with fixed end points has left it as an approach lacking explanatory power and reproducible measurement. Yet when informed by theory, the tremendous innovation potential of HCD can be harnessed to drive sustainability, mediate implementation problems, frame measurement constructs and ultimately improve population-level health outcomes. In attempting to mine, the potential of HCD we move beyond the pragmatic ‘how it works’, to the theoretical question, ‘why it works’. In doing so, we explore a more fundamental human question, ‘How can partici...

Objective: The substantial prevalence of HIV in Africa underscores the urgent need for effective ... more Objective: The substantial prevalence of HIV in Africa underscores the urgent need for effective HIV prevention programs. This paper reports the results of an effectiveness trial for the I Choose Life-Africa (ICL) HIV prevention program carried out among Kenyan university students. Methods: Longitudinal data was analyzed from182 student volunteers, randomized to an intervention or control group. The intervention group received training as HIV prevention peer educators with a 32 hour theoretically based curriculum. All students were given a pretest survey assessing HIV related attitudes, intentions, knowledge and behaviors and repeated the survey 3 times over the next 6 months. Data was analyzed using Linear Mixed Models (LMM) or Generalized Linear Models (GLM) to compare the rate of change on 13 dependent variables that examined sexual risk behavior (broadly defined). Monitoring data on the types of HIV prevention messages delivered by the peer educators was obtained. Results: Based...

Tienda online donde Comprar Clinical Ethics In Pediatrics, A Case-Based Textbook al precio 43,17 ... more Tienda online donde Comprar Clinical Ethics In Pediatrics, A Case-Based Textbook al precio 43,17 € de Douglas S. Diekema | Mark R. Mercurio | Mary B. Adam, tienda de Libros de Medicina, Libros de Biologia - Bioetica

BMJ Open, 2020

Objective To identify what women want in a delivery health facility and how they rank the attribu... more Objective To identify what women want in a delivery health facility and how they rank the attributes that influence the choice of a place of delivery. Design A discrete choice experiment (DCE) was conducted to elicit rural women’s preferences for choice of delivery health facility. Data were analysed using a conditional logit model to evaluate the relative importance of the selected attributes. A mixed multinomial model evaluated how interactions with sociodemographic variables influence the choice of the selected attributes. Setting Six health facilities in a rural subcounty. Participants Women aged 18–49 years who had delivered within 6 weeks. Primary outcome The DCE required women to select from hypothetical health facility A or B or opt-out alternative. Results A total of 474 participants were sampled, 466 participants completed the survey (response rate 98%). The attribute with the strongest association with health facility preference was having a kind and supportive healthcare...