Ana Manzano | University of Leeds (original) (raw)

Papers by Ana Manzano

International Journal for Equity in Health, 2024

Background Approximately 15% of women in low-and middle-income countries experience common perina... more Background Approximately 15% of women in low-and middle-income countries experience common perinatal mental disorders. Yet, many women, even if diagnosed with mental health conditions, are untreated due to poor quality care, limited accessibility, limited knowledge, and stigma. This paper describes how mental health-related stigma influences pregnant women's decisions not to disclose their conditions and to seek treatment in Vietnam, all of which exacerbate inequitable access to maternal mental healthcare.

Health Policy and Planning , 2024

The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and su... more The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system’s responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phase realist evaluation study, we present Phase 1 findings, which employed systematic and scoping literature reviews and qualitative data collection (focus groups and interviews) with key health system actors in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilization and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, sociocultural, organizational and structural levels. At the sociocultural and structural levels, these barriers included cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy and a lack of mental health workforce. At the organizational level, there was an absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.

Global Health Disparities and Trafficking of Human Beings for the Purpose of Organ Removal. In de Chesnay and Sabella, Human Trafficking: A Global Health Emergency: Perspectives from Nursing, Criminal Justice, and the Social Sciences (pp. 205-218). Cham: Springer International Publishing., 2022

There are many complex reasons why people sell and buy human organs and how global criminal netwo... more There are many complex reasons why people sell and buy human organs and how global criminal networks benefit from this commercialization. This trade includes people who are trafficked for the purpose of removing their organs to sell them for profit. This chapter aims to understand these extreme behaviors by examining the intersectional relationship between inequitable access to health and health care in diverse populations across the globe. Disparities in health outcomes have the potential to encourage the trafficking of human beings for the purpose of organ removal. This chapter will firstly discuss general global health disparities and the particularities of chronic kidney disease, since kidneys are more likely to be sold for profit. Secondly, wealth, national transplant systems, ethnicity and gender disparities in organ donation will be related to organ trafficking. Finally, this chapter will also examine how the COVID-19 pandemic aggravated these intersectional disparities because of the direct impact on transplantation capabilities worldwide and increased vulnerability of populations at risk of trafficking.

Evaluation, 2022

Focus groups are valuable tools for evaluators to help stakeholders to clarify programme theories... more Focus groups are valuable tools for evaluators to help stakeholders to clarify programme theories. In 1987, R.K. Merton, often attributed with the birth of focus groups, wrote about how these were 'being mercilessly misused'. In the 1940s, his team had conceived focus groups as tools for developing middle-range theory, but through their astonishing success focus groups have metamorphosed and are often an 'unchallenged' choice in many evaluation approaches, while their practice seems to provide a philosophically diverse picture. This article examines what knowledge focus group data generate, and how they support theory development. It starts with an overview of the history of focus groups, establishing a relationship between their emergence as a data collection method and the evaluation profession. Practical lessons for conducting groups in realist evaluation are suggested, while exploring how qualitative data can support programme and middle-range theory development using the example of realist evaluation.

Journal of Health Services Research & Policy, 2022

Background Community health workers play an important role in linking communities with formal hea... more Background Community health workers play an important role in linking communities with formal health service providers, thereby improving access to and utilization of health care. A novel cadre of community health workers known as village health workers (VHWs) were recruited to create demand for maternal health services in the Nigerian Subsidy Reinvestment Programme (SURE-P/MCH). In this study, we investigated the role of contextual factors and underlying mechanisms motivating VHWs. Methods We used realist evaluation to understand the impact of a multi-intervention maternal and child health programme on VHW motivation using Anambra State as a case study. Initial working theories and logic maps were developed through literature review and stakeholder engagement; programme theories were developed and tested using focus group discussions and in-depth interviews with various stakeholder groups. Interview transcripts were analysed through an integrated approach of Context, Mechanism and ...

Ethical approvals from the University of Nigeria. (ZIP 1568Â kb)

Neurology: Clinical Practice, 2019

There is a growing need for patient and public involvement (PPI) to inform the way that research ... more There is a growing need for patient and public involvement (PPI) to inform the way that research is developed and performed. International randomized controlled trials are particularly likely to benefit from PPI, but guidance is lacking on how or when it should be incorporated. In this article, we describe the PPI process that occurred during the design and initiation of an international treatment clinical trial in MS. PPI was incorporated using a structured approach, aiming to minimize bias and achieve equivalence in study design, implementation, and interpretation. Methods included PPI representation within the study research team, and the use of focus groups, analyzed using thematic framework analysis. We report the outcomes of PPI and make recommendations on its use in other neurology clinical trials. By sharing our model for PPI, we aim to maximize effectiveness of future public involvement and to allow its effect to be better evaluated.

Open Research Europe

The paper is located at the crossroads of two modern intellectual movements. The first, evidence-... more The paper is located at the crossroads of two modern intellectual movements. The first, evidence-based policy, seeks to locate vital information that will inform and improve key policy decisions on such matters as population health, social welfare, and human wellbeing. The second, complexity theory, describes the nature of the social world and perceives human action as persistently adaptive and social institutions as incessantly self-transformative. The first assumes that policies and programmes can achieve sufficient control to meet specific and measurable objectives. The second assumes that social actions are sufficiently capricious so that the society never conforms to anyone’s plans – even those of the most powerful. The unparalleled resources committed to control the unprecedented attack of the COVID-19 pandemic are the epitome of complexity. The long struggle to contain the virus thus constitutes an ideal test bed to investigate this paradigmatic split. The paper undertakes th...

Social Science & Medicine, 2022

BMJ Global Health, 2020

IntroductionWell-trained, adequately skilled and motivated primary healthcare (PHC) workers are e... more IntroductionWell-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria.MethodsWe adopted a realist evaluation design combining document review with 56 in-depth interviews of PHC workers, facility managers and policy-makers to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers’ motivation and which mechanisms explain how motivation works. We drew on Herzberg’s t...

Frontiers in Public Health, 2021

Background: Increasing access to maternal and child health (MCH) services is crucial to achieving... more Background: Increasing access to maternal and child health (MCH) services is crucial to achieving universal health coverage (UHC) among pregnant women and children under-five (CU5). The Nigerian government between 2012 and 2015 implemented an innovative MCH programme to reduce maternal and CU5 mortality by reducing financial barriers of access to essential health services. The study explores how the implementation of a financial incentive through conditional cash transfer (CCT) influenced the uptake of MCH services in the programme.Methods: The study used a descriptive exploratory approach in Anambra state, southeast Nigeria. Data was collected through qualitative [in-depth interviews (IDIs), focus group discussions (FGDs)] and quantitative (service utilization data pre- and post-programme) methods. Twenty-six IDIs were conducted with respondents who were purposively selected to include frontline health workers (n = 13), National and State policymakers and programme managers (n = 13...

PLOS ONE, 2021

Background Socio-economic growth in many low and middle-income countries has resulted in more ava... more Background Socio-economic growth in many low and middle-income countries has resulted in more available, though not equitably accessible, healthcare. Such growth has also increased demands from citizens for their health systems to be more responsive to their needs. This paper shares a protocol for the RESPONSE study which aims to understand, co-produce, implement and evaluate context-sensitive interventions to improve health systems responsiveness to health needs of vulnerable groups in Ghana and Vietnam. Methods We will use a realist mixed-methods theory-driven case study design, combining quantitative (household survey, secondary analysis of facility data) and qualitative (in-depth interviews, focus groups, observations and document and literature review) methods. Data will be analysed retroductively. The study will comprise three Phases. In Phase 1, we will understand actors’ expectations of responsive health systems, identify key priorities for interventions, and using evidence ...

International Journal of Social Research Methodology, 2021

Background: The Nigerian government introduced and implemented health programmes to improve mater... more Background: The Nigerian government introduced and implemented health programmes to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015 and was followed by increased advocacy for sustaining the MCH as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization and bringing different forces/actors together. Therefore, the study set out to unpack how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcome Methods: The study used a Realist Evaluation through a mixed quantitative and qualitative methods case study approach. The advocacy programme theory (PT) was developed from the literature (three substantive social theories of power politics, media influence communication theory and the three-streams theory of agenda sett...

Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility... more Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility MCH services remain challenges in low and middle-income countries (LMICs). Evidence on barriers to providing and accessing services omits information on role of security within facilities. This paper explores the role of security in provision and use of MCH services in primary healthcare (PHC) facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data was collected from 35 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) with purposively identified key informants. Information gathered was used to build a program theory that was tested with another round of IDIs and FGDs and the literature. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology.Results Security elements (presence or lack of security guards, fencing, lighting and staff accommodation) facilitated or constraine...

Multiple Sclerosis and Related Disorders, 2020

Health Policy and Planning, 2020

Realist evaluations (RE) are increasingly popular in assessing health programmes in low- and midd... more Realist evaluations (RE) are increasingly popular in assessing health programmes in low- and middle-income countries (LMICs). This article reflects on processes of gleaning, developing, testing, consolidating and refining two programme theories (PTs) from a longitudinal mixed-methods RE of a national maternal and child health programme in Nigeria. The two PTs, facility security and patient–provider trust, represent complex and diverse issues: trust is all encompassing although less tangible, while security is more visible. Neither PT was explicit in the original programme design but emerged from the data and was supported by substantive theories. For security, we used theories of fear of crime, which perceive security as progressing from structural, political and socio-economic factors. Some facilities with the support of communities erected fences, improved lighting and employed guards, which altogether contributed to reduced fear of crime from staff and patients and improved provi...

Patient Education and Counseling, 2020

Multiple Sclerosis and Related Disorders, 2018