Motasem Hamdan - Academia.edu (original) (raw)

Papers by Motasem Hamdan

The Lancet, Mar 1, 2019

Background Dental caries is still the most prevalent chronic disease worldwide. In the occupied P... more Background Dental caries is still the most prevalent chronic disease worldwide. In the occupied Palestinian territory, data about oral health status and its determinants are scarce. This study aimed to assess the prevalence of dental caries and associated factors among schoolchildren in a random sample of marginalised schools in the West Bank. Methods Marginalised schools (according to the School Support Program [SPP] criteria) were stratified by district, gender, and grade level to select a random sample of 20 schools. Students in the sixth and ninth grades were interviewed by senior dental students about their oral hygiene and diet habits. Students' weight, height, gingival health, and dental caries experience were assessed. Senior dental students were trained and calibrated to carry out the interviews and the examinations. Parental informed consents were collected by school administrative staff. Ethics approval for the study was obtained from the Al-Quds University Scientific Research Ethics Committee.

Eastern Mediterranean Health Journal, Nov 1, 2009

To identify the prevalence of disability and characteristics, conditions and needs of those with ... more To identify the prevalence of disability and characteristics, conditions and needs of those with disabilities in rural communities in the north of the West Bank, 10 147 families were screened in a cross-sectional survey. Prevalence was 1.7% (806 persons with disabilities). Physical (34.0%), mental (15.9%) and speech (11.4%) disabilities were the commonest. The major cause as perceived by the families was heredity (30.5%): parental consanguinity was 50.8%. Economic conditions were the major problem for 41.1%, and the main barrier to receiving care: only 49.3% were receiving some kind of care. Integration in educational, work and social activities was low. Pressing needs included medical care, support equipment, and educational, physiotherapy and rehabilitation services.

Health policy, Mar 1, 2002

The objective of this article is to focus on the challenges and opportunities the Palestinian hea... more The objective of this article is to focus on the challenges and opportunities the Palestinian health care system is currently facing in a 'transitional period', which started subsequent to the Oslo Agreement in 1993. The characteristics of 'transition' have to be highlighted in order to understand the context and peculiarities in which the Palestinian health care system is operating. A descriptive analysis is provided of the historical, political, economic and socio-demographic elements to gain an insight into the complex context of the Occupied Palestinian Territories, a country in 'transition'.

Background: Violence against healthcare workers in Palestinian hospitals is common. However, this... more Background: Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods: A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model. Results: The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of incident reporting policy/procedure and management support, previous experience of no action taken, and fear of the consequences. Conclusions: Healthcare workers are at comparably high risk of violent incidents in Palestinian public hospitals. Decision makers need to be aware of the causes and potential consequences of such events. There is a need for intervention to protect health workers and provide safer hospital workplaces environment. The results can inform developing proper policy and safety measures.We acknowledge the Palestinian Ministry of Health cooperation and permission to conduct the study at public hospitals. We also gratefully acknowledge the participants for devoting their time to complete the survey. Finally, thanks go to Mrs. Suzy Dhaher for the English revision

The Lancet, Aug 1, 2017

Background Assessment of safety culture-safety-related norms and behaviours-in health care settin... more Background Assessment of safety culture-safety-related norms and behaviours-in health care settings is receiving increasing attention. Assessment of pharmacy safety culture in the occupied Palestinian territory is scarce. We aimed to investigate patient safety culture in Palestinian hospital pharmacies and its association with hospital characteristics (ie, ownership and number of beds) and pharmacy staff characteristics (including sex, age, education, job title, working hours, and years in profession and working in a hospital). Methods The self-administered safety attitudes questionnaire (SAQ) was translated into Arabic and was then undertaken in February 2012 to April 2012. All pharmacy staff (n=115) working for more than 3 months before taking the survey in 28 public, private, and non-governmental hospitals in the West Bank were targeted. We used IBM-SPSS (version 19) for data analysis.

Oral Health & Preventive Dentistry, Jan 7, 2021

Purpose: To assess factors related to the prevalence of dental caries among adolescent schoolchil... more Purpose: To assess factors related to the prevalence of dental caries among adolescent schoolchildren attending marginalised schools in the West Bank area of Palestine. Materials and methods: A cross-sectional study was conducted in schools participating in the School Support Program (SSP). Fifty schools identified as marginalised by the SSP were stratified by district, student gender and grade level to select a random sample of 20 schools. Students in the 6th and 9th grades were screened by senior dental students to collect data about their weight, height, gingival health and caries experience. In addition, a structured in-person questionnaire was used to collect data about students' oral hygiene practices, dietary habits, mother's education and father's employment. Results: In total, 1282 students completed interviews and clinical screenings. The mean number of Decayed, Missing and Filled Teeth (DMFT) was 6.4 ± 4.4. Sixty-four percent had moderate gingivitis and 73% had fair oral hygiene. 'Recent visit to the dentist' was associated with mother's level of education (X2 = 22.06, p < 0.001) and father's employment (X2 = 24.02, p < 0.001). The final regression model showed that grade (β = 0.31, p < 0.001), gender (β = 0.06, p < 0.03), recent visit to the dentist (β = -0.06, p < 0.03) and drinking fresh juices (β = -0.05, p < 0.05) were statistically significant in explaining the high level of caries in this sample. Conclusions: This study indicates that Palestinian adolescents in marginalised governmental schools suffer the highest burden of dental disease and are disproportionally impacted when compared to other same-age students in the region. A high burden of disease was directly associated with unfavourable dietary habits, poor oral hygiene practices and challenges to accessing dental care services, and was indirectly associated with father's employment and mother's level of education.

Health policy, May 1, 2003

This article is the presentation of part II of the analysis aiming at providing an insight and be... more This article is the presentation of part II of the analysis aiming at providing an insight and better understanding of human resources for health development within a conflicting and transitional context. This part focuses on the human resources for health (HRH) policy development in Palestine taking into consideration the critical elements in policy formulation and implementation, such as sound data based policy and planning, key stakeholders, role and implications of international cooperation. Moreover, it examines recent progress of HRH policy and constraints for implementation. Part I addresses the current situation and recent developments in HRH in Palestine.

BMC Health Services Research, Dec 1, 2012

Background: Violence against healthcare workers in Palestinian hospitals is common. However, this... more Background: Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods: A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson's chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents' characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents' characteristics using logistic regression model. Results: The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males' significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of incident reporting policy/procedure and management support, previous experience of no action taken, and fear of the consequences. Conclusions: Healthcare workers are at comparably high risk of violent incidents in Palestinian public hospitals. Decision makers need to be aware of the causes and potential consequences of such events. There is a need for intervention to protect health workers and provide safer hospital workplaces environment. The results can inform developing proper policy and safety measures.

Culture is described as a critical element of healthcare safety and quality. This study aims to a... more Culture is described as a critical element of healthcare safety and quality. This study aims to assess a patient safety culture in GS hospitals.A cross-sectional, descriptive design was utilized. A total number of 376 clinical and non-clinical hospitals' staff participated in the current study. Data were collected using an Arabic version of the Hospital Survey on Patient Safety Culture (HSOPSC). The study data was evaluated using the SPSS for Windows 20.0. Dimensional-and item-level positive scores were used for results reporting. Additionally descriptive statistics, Chisquare test, independent sample t-test and ANOVA were used for data analyzing. Finding shows,the dimensions which elicited the highest positive ratings were teamwork within units (78%), and organizational learning and continuous improvement (72%); meanwhile those with the lowest ratings included staffing (58%), and non-punitive response to error (48%). Statistically significant differences among hospitals and also in reference to participants working characteristics (P<0.05). Small hospitals recived significantly higher mean safety scores than large hospitals, and physicians were the least positive towards safety than other employees (p<0.05). The study concluded that the status of safety culture in Gaza hospitals is acceptable despite the prevailing difficult conditions, but it can be improved through promoting reporting events, reinforcing management commitment towards safety, and implementing effective communication strategies.

Journal of Patient Safety, Sep 1, 2018

Objectives: To assess the changes in the patient safety culture between 2011 and 2016 after the i... more Objectives: To assess the changes in the patient safety culture between 2011 and 2016 after the implementation of patient safety initiative in Palestinian public hospitals. Methods: A cross-sectional quantitative design employed using the Hospital Survey on Patient Safety Culture to collect data. Participants were 1,229 clinical and nonclinical employees from all public hospitals in the West Bank. Results: Significant improvements were observed in patient safety culture with positive responses to 10 (83.3%) composite categories and 36 (86.0%) items of the Hospital Survey on Patient Safety Culture since the baseline survey in 2011 (P < 0.05). The increase in the percent of positive responses to the survey composites ranged from 9.1% (P < 0.001) to "Frequency of events reported" to 3.8% for "Teamwork across hospital units" (P < 0.001). Significant decrease in positive responses to "Staffing" (11.4%) was observed (P < 0.05); no significant change was observed in "Organizational learning-continuous improvement" (P > 0.05). Most participants (70.5%) rated patient safety level in their units/hospital as 'Excellent/Very good', with an increase of 6.3% from the baseline (P < 0.001); no significant increase in the number of reported events in the past 12 months was observed (P < 0.05). Conclusions: Compared with the baseline survey results, patients' safety initiatives and quality improvement programs had positive effect on the safety culture in public Palestinian hospitals.

Journal of Critical Care, Oct 1, 2013

This study aimed to measure safety culture, examine variations among neonatal intensive care unit... more This study aimed to measure safety culture, examine variations among neonatal intensive care units (NICUs), and assess the associations with caregiver characteristics. Materials and Methods: A cross-sectional design was used, utilizing the Arabic version of the Safety Attitudes Questionnaire, administered to all 305 nurses and physicians working in the 16 NICUs in the West Bank. Results: There were 204 participants, comprising of mainly nurses (80.4%), women (63%), 30 years or younger (62.6%), holding a bachelor's degree or more (66.7%), and with at least 5 years of experience in the profession (60.3%). Safety Attitudes Questionnaire mean domain scores ranged from 71.22 for job satisfaction to 63 for stress recognition on a 100-point scale; the scores varied significantly among NICUs (P b .05). About 85% of the participants rated the safety grade either excellent or very good; 71.0% did not report any event in the past year. Conclusions: We found large variations in safety culture within and between a comprehensive sample of Palestinian NICUs. The findings suggest the need for a customized approach that builds on existing strengths and targets areas of opportunities for improvement to optimize health care delivery to the most vulnerable of patients, sick newborns in the NICU setting.

BMC Health Services Research, Jun 15, 2017

Background: Working in Emergency Departments (EDs) entails high work pressure and stress due to w... more Background: Working in Emergency Departments (EDs) entails high work pressure and stress due to witnessing human suffering and the unpredictable nature of the work. This environment puts personnel at risk of burnout. This analysis aims to assess burnout levels and associated risk factors among health workers in EDs in Palestinian hospitals. Also, it examines the association between burnout and workplace violence, as well as with job turnover. Methods: Cross-sectional design utilising a self-administered questionnaire was used to collect data from all workers at 14 EDs; 8 from the West Bank and 6 from the Gaza Strip. Burnout was measured using Maslach Burnout Inventory-Human Services Survey. Results: A total of 444 workers (response rate 74.5%) participated: 161(36.3%) nurses, 142(32.0%) physicians and 141(31.7%) administrative personnel. Results showed high levels of burnout among EDs workers; 64.0% suffered from high emotional exhaustion, 38.1% from high depersonalization and 34.6% from low personal accomplishment. In addition, high levels of emotional exhaustion (72.3%) was significantly prevalent among physicians compared to nurses (69.8%) and administrative workers (51.4%) (p < 0.05). In comparison, high levels of depersonalization was significantly prevalent among nurses (48.8%) compared to physicians (32.1%) and administrative workers (31.9%) (p < 0.05). However, there were no significant differences in the levels of personal accomplishment burnout among the three groups (p > 0.05). Moreover, high degree of burnout was more prevalent among EDs workers in the West Bank than among those working in the Gaza Strip (OR 2.02, 95% CI = 1.11-3.69, p = 0.019), and higher among younger workers (aged ≤30 years old) than their older counterparts (OR 2.4, 95% CI = 1.302-4.458, p = 0.005). Exposure to physical violence was significantly associated with having a high degree of burnout (OR 2.017 95% CI = 1. 121-3.631, p = 0.019), but no association was observed with regards to exposure to verbal violence (p > 0.05). Finally, burnout was significantly associated with workers' intention to leave work at EDs (p < 0.05). Conclusions: Burnout is considerably prevalent among EDs' workers, especially nurses and physicians. Burnout is positively associated with job turnover intention and also with exposure to workplace violence. Therefore, there is a need for prevention and management strategies to address occupational burnout and reduce negative consequences on workers, patients and organisations.

Journal of Patient Safety, Jun 23, 2015

Underreporting of incidents that happen in health care services undermines the ability of the sys... more Underreporting of incidents that happen in health care services undermines the ability of the systems to improve patient safety. This study assessed the attitudes of physicians and nurses toward incident reporting and the factors influencing reporting in Palestinian hospitals. It also examined clinicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; views about the preferred features of incident reporting system. Cross-sectional self-administered survey of 475 participants, 152 physicians and 323 nurses, from 11 public hospitals in the West Bank; response rate, 81.3%. There was a low level of event reporting among participants in the past year (40.3%). Adjusted for sex and age, physicians were 2.1 times more likely to report incidents than nurses (95% confidence interval, 1.32-3.417; P = 0.002). Perceived main barriers for reporting were grouped under lack of proper structure for reporting, prevalence of blame, and punitive environment. The clinicians indicated fear of administrative sanctions, social and legal liability, and of their competence being questioned (P &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Getting help for patients, learning from mistakes, and ethical obligation were equally indicated motivators for reporting (P &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Meanwhile, clinicians prefer formal reporting (77.8%) of all type of errors (65.5%), disclosure of reporters (52.7%), using reports to improve patient safety (80.3%), and willingness to report to immediate supervisors (57.6%). Clinicians acknowledge the importance of reporting incidents; however, prevalence of punitive culture and inadequate reporting systems are key barriers. Improving feedback about reported errors, simplifying procedures, providing clear guidelines on what and who should report, and avoiding blame are essential to enhance reporting. Moreover, health care organizations should consider the opinions of the clinicians in developing reporting systems.

Background: A growing global interest in patient safety culture has increased the development of ... more Background: A growing global interest in patient safety culture has increased the development of validated instruments to asses this phenomenon. The aim of this study is to investigate the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) and its appropriateness for Arab hospitals. Methods: The 7-step guideline of the Agency for Healthcare Research and Quality was used to translate and validate the HSOPSC. A panel of experts evaluated the face and content validity indexing of the Arabic version. Data were collected from 13 Palestinian hospitals including 2022 healthcare professionals who had direct or indirect interaction with patients, hospital supervisors, managers and administrators. Descriptive statistics and psychometric evaluation (a split-half validation technique) were then used to test and strengthen the validity and reliability of the instrument. Results: With respect to face and content validity, the CVI analysis showed excellent results fo...

English Translation of the Study Survey. (PDF 600Â kb)

Frontiers in Nutrition, 2022

The COVID-19 pandemic has revealed the Eastern Mediterranean Region's food system's fragi... more The COVID-19 pandemic has revealed the Eastern Mediterranean Region's food system's fragility posing severe challenges to maintaining healthy sustainable lifestyle. The aim of this cross-sectional study (N = 13,527 household's family members, mean age: 30.3 ±11.6, 80% women) is to examine the impact of the COVID-19 pandemic on food consumption patterns and household's dietary diversity in 10 Eastern Mediterranean countries. A food frequency questionnaire was used to investigate the consumption patterns along with the calculation of the Food Consumption Score (FCS), a proxy indicator of dietary diversity. Data collected on cooking attitudes, shopping and food stock explore the community mitigation measures. In the overall population, before and during the pandemic, most food groups were consumed less or equal to 4 times per week. As evident from our findings and considering that the pandemic may be better, but it's not over, small to moderate changes in food consu...

Journal of Evaluation in Clinical Practice, 2019

Rationale, aims, and objectives: Clinical pharmacy services are vital in the prevention of advers... more Rationale, aims, and objectives: Clinical pharmacy services are vital in the prevention of adverse drug events (ADEs) in clinical practice, extending beyond the hospital to chronic disease management in outpatient settings. This study sought to evaluate the cost benefit of a clinical pharmacy intervention in resolving treatment-related problems (TRPs) among hospital outpatients with chronic diseases. Methods: From the hospital system perspective, the cost-benefit analysis was based on a randomized clinical trial in the general outpatients of the major hospital in Jordan. Eligible patients were randomly assigned to either an intervention or a control group. TRPs were identified in both study groups, but interventions were delivered only to the intervention group via a home medication management review (HMMR) by a clinical pharmacist. A follow-up in both groups took place 3 months after recruitment. The total economic benefit was the sum of (a) cost savings due to intervention and (b) cost avoidance associated with preventable ADEs. The primary outcome measures were the net benefit and benefit-to-cost ratio with the clinical pharmacist-based HMMR. Results: In both groups, 158 TRPs were identified, and 79 interventions were provided in the study group. The monthly cost of intervention was JD764 (US 1078),andthetotalmonthlybenefitwasJD4570(US1078), and the total monthly benefit was JD4570 (US 1078),andthetotalmonthlybenefitwasJD4570(US6444), leading to a benefit-to-cost ratio of 5.98 and an annual net benefit of JD45 669 (US $64 393). Sensitivity analyses confirmed the robustness of results. Conclusion: The RCT-based cost-benefit evaluation provided evidence-based insight into the economic benefit of a clinical pharmacist-provided HMMR for preventing ADEs in the general chronic diseases outpatients. This intervention method against the TRPs among outpatients is cost beneficial and offers substantial cost savings to the health care hospital payer in Jordan.

BioMed Central, Dec 20, 2012

Background: Violence against healthcare workers in Palestinian hospitals is common. However, this... more Background: Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods: A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model. Results: The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of incident reporting policy/procedure and management support, previous experience of no action taken, and fear of the consequences. Conclusions: Healthcare workers are at comparably high risk of violent incidents in Palestinian public hospitals. Decision makers need to be aware of the causes and potential consequences of such events. There is a need for intervention to protect health workers and provide safer hospital workplaces environment. The results can inform developing proper policy and safety measures.We acknowledge the Palestinian Ministry of Health cooperation and permission to conduct the study at public hospitals. We also gratefully acknowledge the participants for devoting their time to complete the survey. Finally, thanks go to Mrs. Suzy Dhaher for the English revision

Frontiers in Psychiatry, 2020

were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, an... more were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.

The Lancet, Mar 1, 2019

Background Dental caries is still the most prevalent chronic disease worldwide. In the occupied P... more Background Dental caries is still the most prevalent chronic disease worldwide. In the occupied Palestinian territory, data about oral health status and its determinants are scarce. This study aimed to assess the prevalence of dental caries and associated factors among schoolchildren in a random sample of marginalised schools in the West Bank. Methods Marginalised schools (according to the School Support Program [SPP] criteria) were stratified by district, gender, and grade level to select a random sample of 20 schools. Students in the sixth and ninth grades were interviewed by senior dental students about their oral hygiene and diet habits. Students' weight, height, gingival health, and dental caries experience were assessed. Senior dental students were trained and calibrated to carry out the interviews and the examinations. Parental informed consents were collected by school administrative staff. Ethics approval for the study was obtained from the Al-Quds University Scientific Research Ethics Committee.

Eastern Mediterranean Health Journal, Nov 1, 2009

To identify the prevalence of disability and characteristics, conditions and needs of those with ... more To identify the prevalence of disability and characteristics, conditions and needs of those with disabilities in rural communities in the north of the West Bank, 10 147 families were screened in a cross-sectional survey. Prevalence was 1.7% (806 persons with disabilities). Physical (34.0%), mental (15.9%) and speech (11.4%) disabilities were the commonest. The major cause as perceived by the families was heredity (30.5%): parental consanguinity was 50.8%. Economic conditions were the major problem for 41.1%, and the main barrier to receiving care: only 49.3% were receiving some kind of care. Integration in educational, work and social activities was low. Pressing needs included medical care, support equipment, and educational, physiotherapy and rehabilitation services.

Health policy, Mar 1, 2002

The objective of this article is to focus on the challenges and opportunities the Palestinian hea... more The objective of this article is to focus on the challenges and opportunities the Palestinian health care system is currently facing in a 'transitional period', which started subsequent to the Oslo Agreement in 1993. The characteristics of 'transition' have to be highlighted in order to understand the context and peculiarities in which the Palestinian health care system is operating. A descriptive analysis is provided of the historical, political, economic and socio-demographic elements to gain an insight into the complex context of the Occupied Palestinian Territories, a country in 'transition'.

Background: Violence against healthcare workers in Palestinian hospitals is common. However, this... more Background: Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods: A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model. Results: The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of incident reporting policy/procedure and management support, previous experience of no action taken, and fear of the consequences. Conclusions: Healthcare workers are at comparably high risk of violent incidents in Palestinian public hospitals. Decision makers need to be aware of the causes and potential consequences of such events. There is a need for intervention to protect health workers and provide safer hospital workplaces environment. The results can inform developing proper policy and safety measures.We acknowledge the Palestinian Ministry of Health cooperation and permission to conduct the study at public hospitals. We also gratefully acknowledge the participants for devoting their time to complete the survey. Finally, thanks go to Mrs. Suzy Dhaher for the English revision

The Lancet, Aug 1, 2017

Background Assessment of safety culture-safety-related norms and behaviours-in health care settin... more Background Assessment of safety culture-safety-related norms and behaviours-in health care settings is receiving increasing attention. Assessment of pharmacy safety culture in the occupied Palestinian territory is scarce. We aimed to investigate patient safety culture in Palestinian hospital pharmacies and its association with hospital characteristics (ie, ownership and number of beds) and pharmacy staff characteristics (including sex, age, education, job title, working hours, and years in profession and working in a hospital). Methods The self-administered safety attitudes questionnaire (SAQ) was translated into Arabic and was then undertaken in February 2012 to April 2012. All pharmacy staff (n=115) working for more than 3 months before taking the survey in 28 public, private, and non-governmental hospitals in the West Bank were targeted. We used IBM-SPSS (version 19) for data analysis.

Oral Health & Preventive Dentistry, Jan 7, 2021

Purpose: To assess factors related to the prevalence of dental caries among adolescent schoolchil... more Purpose: To assess factors related to the prevalence of dental caries among adolescent schoolchildren attending marginalised schools in the West Bank area of Palestine. Materials and methods: A cross-sectional study was conducted in schools participating in the School Support Program (SSP). Fifty schools identified as marginalised by the SSP were stratified by district, student gender and grade level to select a random sample of 20 schools. Students in the 6th and 9th grades were screened by senior dental students to collect data about their weight, height, gingival health and caries experience. In addition, a structured in-person questionnaire was used to collect data about students' oral hygiene practices, dietary habits, mother's education and father's employment. Results: In total, 1282 students completed interviews and clinical screenings. The mean number of Decayed, Missing and Filled Teeth (DMFT) was 6.4 ± 4.4. Sixty-four percent had moderate gingivitis and 73% had fair oral hygiene. 'Recent visit to the dentist' was associated with mother's level of education (X2 = 22.06, p < 0.001) and father's employment (X2 = 24.02, p < 0.001). The final regression model showed that grade (β = 0.31, p < 0.001), gender (β = 0.06, p < 0.03), recent visit to the dentist (β = -0.06, p < 0.03) and drinking fresh juices (β = -0.05, p < 0.05) were statistically significant in explaining the high level of caries in this sample. Conclusions: This study indicates that Palestinian adolescents in marginalised governmental schools suffer the highest burden of dental disease and are disproportionally impacted when compared to other same-age students in the region. A high burden of disease was directly associated with unfavourable dietary habits, poor oral hygiene practices and challenges to accessing dental care services, and was indirectly associated with father's employment and mother's level of education.

Health policy, May 1, 2003

This article is the presentation of part II of the analysis aiming at providing an insight and be... more This article is the presentation of part II of the analysis aiming at providing an insight and better understanding of human resources for health development within a conflicting and transitional context. This part focuses on the human resources for health (HRH) policy development in Palestine taking into consideration the critical elements in policy formulation and implementation, such as sound data based policy and planning, key stakeholders, role and implications of international cooperation. Moreover, it examines recent progress of HRH policy and constraints for implementation. Part I addresses the current situation and recent developments in HRH in Palestine.

BMC Health Services Research, Dec 1, 2012

Background: Violence against healthcare workers in Palestinian hospitals is common. However, this... more Background: Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods: A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson's chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents' characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents' characteristics using logistic regression model. Results: The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males' significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of incident reporting policy/procedure and management support, previous experience of no action taken, and fear of the consequences. Conclusions: Healthcare workers are at comparably high risk of violent incidents in Palestinian public hospitals. Decision makers need to be aware of the causes and potential consequences of such events. There is a need for intervention to protect health workers and provide safer hospital workplaces environment. The results can inform developing proper policy and safety measures.

Culture is described as a critical element of healthcare safety and quality. This study aims to a... more Culture is described as a critical element of healthcare safety and quality. This study aims to assess a patient safety culture in GS hospitals.A cross-sectional, descriptive design was utilized. A total number of 376 clinical and non-clinical hospitals' staff participated in the current study. Data were collected using an Arabic version of the Hospital Survey on Patient Safety Culture (HSOPSC). The study data was evaluated using the SPSS for Windows 20.0. Dimensional-and item-level positive scores were used for results reporting. Additionally descriptive statistics, Chisquare test, independent sample t-test and ANOVA were used for data analyzing. Finding shows,the dimensions which elicited the highest positive ratings were teamwork within units (78%), and organizational learning and continuous improvement (72%); meanwhile those with the lowest ratings included staffing (58%), and non-punitive response to error (48%). Statistically significant differences among hospitals and also in reference to participants working characteristics (P<0.05). Small hospitals recived significantly higher mean safety scores than large hospitals, and physicians were the least positive towards safety than other employees (p<0.05). The study concluded that the status of safety culture in Gaza hospitals is acceptable despite the prevailing difficult conditions, but it can be improved through promoting reporting events, reinforcing management commitment towards safety, and implementing effective communication strategies.

Journal of Patient Safety, Sep 1, 2018

Objectives: To assess the changes in the patient safety culture between 2011 and 2016 after the i... more Objectives: To assess the changes in the patient safety culture between 2011 and 2016 after the implementation of patient safety initiative in Palestinian public hospitals. Methods: A cross-sectional quantitative design employed using the Hospital Survey on Patient Safety Culture to collect data. Participants were 1,229 clinical and nonclinical employees from all public hospitals in the West Bank. Results: Significant improvements were observed in patient safety culture with positive responses to 10 (83.3%) composite categories and 36 (86.0%) items of the Hospital Survey on Patient Safety Culture since the baseline survey in 2011 (P < 0.05). The increase in the percent of positive responses to the survey composites ranged from 9.1% (P < 0.001) to "Frequency of events reported" to 3.8% for "Teamwork across hospital units" (P < 0.001). Significant decrease in positive responses to "Staffing" (11.4%) was observed (P < 0.05); no significant change was observed in "Organizational learning-continuous improvement" (P > 0.05). Most participants (70.5%) rated patient safety level in their units/hospital as 'Excellent/Very good', with an increase of 6.3% from the baseline (P < 0.001); no significant increase in the number of reported events in the past 12 months was observed (P < 0.05). Conclusions: Compared with the baseline survey results, patients' safety initiatives and quality improvement programs had positive effect on the safety culture in public Palestinian hospitals.

Journal of Critical Care, Oct 1, 2013

This study aimed to measure safety culture, examine variations among neonatal intensive care unit... more This study aimed to measure safety culture, examine variations among neonatal intensive care units (NICUs), and assess the associations with caregiver characteristics. Materials and Methods: A cross-sectional design was used, utilizing the Arabic version of the Safety Attitudes Questionnaire, administered to all 305 nurses and physicians working in the 16 NICUs in the West Bank. Results: There were 204 participants, comprising of mainly nurses (80.4%), women (63%), 30 years or younger (62.6%), holding a bachelor's degree or more (66.7%), and with at least 5 years of experience in the profession (60.3%). Safety Attitudes Questionnaire mean domain scores ranged from 71.22 for job satisfaction to 63 for stress recognition on a 100-point scale; the scores varied significantly among NICUs (P b .05). About 85% of the participants rated the safety grade either excellent or very good; 71.0% did not report any event in the past year. Conclusions: We found large variations in safety culture within and between a comprehensive sample of Palestinian NICUs. The findings suggest the need for a customized approach that builds on existing strengths and targets areas of opportunities for improvement to optimize health care delivery to the most vulnerable of patients, sick newborns in the NICU setting.

BMC Health Services Research, Jun 15, 2017

Background: Working in Emergency Departments (EDs) entails high work pressure and stress due to w... more Background: Working in Emergency Departments (EDs) entails high work pressure and stress due to witnessing human suffering and the unpredictable nature of the work. This environment puts personnel at risk of burnout. This analysis aims to assess burnout levels and associated risk factors among health workers in EDs in Palestinian hospitals. Also, it examines the association between burnout and workplace violence, as well as with job turnover. Methods: Cross-sectional design utilising a self-administered questionnaire was used to collect data from all workers at 14 EDs; 8 from the West Bank and 6 from the Gaza Strip. Burnout was measured using Maslach Burnout Inventory-Human Services Survey. Results: A total of 444 workers (response rate 74.5%) participated: 161(36.3%) nurses, 142(32.0%) physicians and 141(31.7%) administrative personnel. Results showed high levels of burnout among EDs workers; 64.0% suffered from high emotional exhaustion, 38.1% from high depersonalization and 34.6% from low personal accomplishment. In addition, high levels of emotional exhaustion (72.3%) was significantly prevalent among physicians compared to nurses (69.8%) and administrative workers (51.4%) (p < 0.05). In comparison, high levels of depersonalization was significantly prevalent among nurses (48.8%) compared to physicians (32.1%) and administrative workers (31.9%) (p < 0.05). However, there were no significant differences in the levels of personal accomplishment burnout among the three groups (p > 0.05). Moreover, high degree of burnout was more prevalent among EDs workers in the West Bank than among those working in the Gaza Strip (OR 2.02, 95% CI = 1.11-3.69, p = 0.019), and higher among younger workers (aged ≤30 years old) than their older counterparts (OR 2.4, 95% CI = 1.302-4.458, p = 0.005). Exposure to physical violence was significantly associated with having a high degree of burnout (OR 2.017 95% CI = 1. 121-3.631, p = 0.019), but no association was observed with regards to exposure to verbal violence (p > 0.05). Finally, burnout was significantly associated with workers' intention to leave work at EDs (p < 0.05). Conclusions: Burnout is considerably prevalent among EDs' workers, especially nurses and physicians. Burnout is positively associated with job turnover intention and also with exposure to workplace violence. Therefore, there is a need for prevention and management strategies to address occupational burnout and reduce negative consequences on workers, patients and organisations.

Journal of Patient Safety, Jun 23, 2015

Underreporting of incidents that happen in health care services undermines the ability of the sys... more Underreporting of incidents that happen in health care services undermines the ability of the systems to improve patient safety. This study assessed the attitudes of physicians and nurses toward incident reporting and the factors influencing reporting in Palestinian hospitals. It also examined clinicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; views about the preferred features of incident reporting system. Cross-sectional self-administered survey of 475 participants, 152 physicians and 323 nurses, from 11 public hospitals in the West Bank; response rate, 81.3%. There was a low level of event reporting among participants in the past year (40.3%). Adjusted for sex and age, physicians were 2.1 times more likely to report incidents than nurses (95% confidence interval, 1.32-3.417; P = 0.002). Perceived main barriers for reporting were grouped under lack of proper structure for reporting, prevalence of blame, and punitive environment. The clinicians indicated fear of administrative sanctions, social and legal liability, and of their competence being questioned (P &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Getting help for patients, learning from mistakes, and ethical obligation were equally indicated motivators for reporting (P &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Meanwhile, clinicians prefer formal reporting (77.8%) of all type of errors (65.5%), disclosure of reporters (52.7%), using reports to improve patient safety (80.3%), and willingness to report to immediate supervisors (57.6%). Clinicians acknowledge the importance of reporting incidents; however, prevalence of punitive culture and inadequate reporting systems are key barriers. Improving feedback about reported errors, simplifying procedures, providing clear guidelines on what and who should report, and avoiding blame are essential to enhance reporting. Moreover, health care organizations should consider the opinions of the clinicians in developing reporting systems.

Background: A growing global interest in patient safety culture has increased the development of ... more Background: A growing global interest in patient safety culture has increased the development of validated instruments to asses this phenomenon. The aim of this study is to investigate the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) and its appropriateness for Arab hospitals. Methods: The 7-step guideline of the Agency for Healthcare Research and Quality was used to translate and validate the HSOPSC. A panel of experts evaluated the face and content validity indexing of the Arabic version. Data were collected from 13 Palestinian hospitals including 2022 healthcare professionals who had direct or indirect interaction with patients, hospital supervisors, managers and administrators. Descriptive statistics and psychometric evaluation (a split-half validation technique) were then used to test and strengthen the validity and reliability of the instrument. Results: With respect to face and content validity, the CVI analysis showed excellent results fo...

English Translation of the Study Survey. (PDF 600Â kb)

Frontiers in Nutrition, 2022

The COVID-19 pandemic has revealed the Eastern Mediterranean Region's food system's fragi... more The COVID-19 pandemic has revealed the Eastern Mediterranean Region's food system's fragility posing severe challenges to maintaining healthy sustainable lifestyle. The aim of this cross-sectional study (N = 13,527 household's family members, mean age: 30.3 ±11.6, 80% women) is to examine the impact of the COVID-19 pandemic on food consumption patterns and household's dietary diversity in 10 Eastern Mediterranean countries. A food frequency questionnaire was used to investigate the consumption patterns along with the calculation of the Food Consumption Score (FCS), a proxy indicator of dietary diversity. Data collected on cooking attitudes, shopping and food stock explore the community mitigation measures. In the overall population, before and during the pandemic, most food groups were consumed less or equal to 4 times per week. As evident from our findings and considering that the pandemic may be better, but it's not over, small to moderate changes in food consu...

Journal of Evaluation in Clinical Practice, 2019

Rationale, aims, and objectives: Clinical pharmacy services are vital in the prevention of advers... more Rationale, aims, and objectives: Clinical pharmacy services are vital in the prevention of adverse drug events (ADEs) in clinical practice, extending beyond the hospital to chronic disease management in outpatient settings. This study sought to evaluate the cost benefit of a clinical pharmacy intervention in resolving treatment-related problems (TRPs) among hospital outpatients with chronic diseases. Methods: From the hospital system perspective, the cost-benefit analysis was based on a randomized clinical trial in the general outpatients of the major hospital in Jordan. Eligible patients were randomly assigned to either an intervention or a control group. TRPs were identified in both study groups, but interventions were delivered only to the intervention group via a home medication management review (HMMR) by a clinical pharmacist. A follow-up in both groups took place 3 months after recruitment. The total economic benefit was the sum of (a) cost savings due to intervention and (b) cost avoidance associated with preventable ADEs. The primary outcome measures were the net benefit and benefit-to-cost ratio with the clinical pharmacist-based HMMR. Results: In both groups, 158 TRPs were identified, and 79 interventions were provided in the study group. The monthly cost of intervention was JD764 (US 1078),andthetotalmonthlybenefitwasJD4570(US1078), and the total monthly benefit was JD4570 (US 1078),andthetotalmonthlybenefitwasJD4570(US6444), leading to a benefit-to-cost ratio of 5.98 and an annual net benefit of JD45 669 (US $64 393). Sensitivity analyses confirmed the robustness of results. Conclusion: The RCT-based cost-benefit evaluation provided evidence-based insight into the economic benefit of a clinical pharmacist-provided HMMR for preventing ADEs in the general chronic diseases outpatients. This intervention method against the TRPs among outpatients is cost beneficial and offers substantial cost savings to the health care hospital payer in Jordan.

BioMed Central, Dec 20, 2012

Background: Violence against healthcare workers in Palestinian hospitals is common. However, this... more Background: Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods: A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model. Results: The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of incident reporting policy/procedure and management support, previous experience of no action taken, and fear of the consequences. Conclusions: Healthcare workers are at comparably high risk of violent incidents in Palestinian public hospitals. Decision makers need to be aware of the causes and potential consequences of such events. There is a need for intervention to protect health workers and provide safer hospital workplaces environment. The results can inform developing proper policy and safety measures.We acknowledge the Palestinian Ministry of Health cooperation and permission to conduct the study at public hospitals. We also gratefully acknowledge the participants for devoting their time to complete the survey. Finally, thanks go to Mrs. Suzy Dhaher for the English revision

Frontiers in Psychiatry, 2020

were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, an... more were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.