Search results for: health care delivery
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 11709

Search results for: health care delivery

11409 Improving Knowledge Management Practices in the South African Healthcare System

Authors: Kgabo H. Badimo, Sheryl Buckley

Abstract:

Knowledge is increasingly recognised in this, the knowledge era, as a strategic resource, by public sector organisations, in view of the public sector reform initiatives. People and knowledge play a vital role in attaining improved organisational performance and high service quality. Many government departments in the public sector have started to realise the importance of knowledge management in streamlining their operations and processes. This study focused on knowledge management in the public healthcare service organisations, where the concept of service provider competitiveness pales to insignificance, considering the huge challenges emanating from the healthcare and public sector reforms. Many government departments are faced with challenges of improving organisational performance and service delivery, improving accountability, making informed decisions, capturing the knowledge of the aging workforce, and enhancing partnerships with stakeholders. The purpose of this paper is to examine the knowledge management practices of the Gauteng Department of Health in South Africa, in order to understand how knowledge management practices influence improvement in organisational performance and healthcare service delivery. This issue is explored through a review of literature on dominant views on knowledge management and healthcare service delivery, as well as results of interviews with, and questionnaire responses from, the general staff of the Gauteng Department of Health. Web-based questionnaires, face-to-face interviews and organisational documents were used to collect data. The data were analysed using both the quantitative and qualitative methods. The central question investigated was: To what extent can the conditions required for successful knowledge management be observed, in order to improve organisational performance and healthcare service delivery in the Gauteng Department of Health. The findings showed that the elements of knowledge management capabilities investigated in this study, namely knowledge creation, knowledge sharing and knowledge application, have a positive, significant relationship with all measures of organisational performance and healthcare service delivery. These findings thus indicate that by employing knowledge management principles, the Gauteng Department of Health could improve its ability to achieve its operational goals and objectives, and solve organisational and healthcare challenges, thereby improving organisational.

Keywords: knowledge management, Healthcare Service Delivery, public healthcare, public sector

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11408 The Process of Critical Care Nursing Resilience in Workplace Adversity

Authors: Jennifer Jackson

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Critical care nurses are at risk for burnout when confronted with sustained workplace adversity, which stems from a variety of social, structural, and environmental factors. Researchers have suggested that nurses can become resilient and overcome workplace adversity to achieve positive outcomes. The purpose of this study is to learn more about critical care nurses’ experiences with workplace adversity, and their process of becoming resilient. The research question will be: what is the process of critical care nursing resilience in workplace adversity? In-depth interviews with critical care nurses will provide the data to inductively generate the grounded theory. The resultant grounded theory will provide a framework to inform nurses and managers in developing interventions to support critical care nurses in their workplace. By enhancing nursing resilience, burnout may be avoided, and nurse satisfaction and overall quality of care may be improved.

Keywords: nursing, resilience, burnout, critical care

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11407 An Integrated HCV Testing Model as a Method to Improve Identification and Linkage to Care in a Network of Community Health Centers in Philadelphia, PA

Authors: Catelyn Coyle, Helena Kwakwa

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Objective: As novel and better tolerated therapies become available, effective HCV testing and care models become increasingly necessary to not only identify individuals with active infection but also link them to HCV providers for medical evaluation and treatment. Our aim is to describe an effective HCV testing and linkage to care model piloted in a network of five community health centers located in Philadelphia, PA. Methods: In October 2012, National Nursing Centers Consortium piloted a routine opt-out HCV testing model in a network of community health centers, one of which treats HCV, HIV, and co-infected patients. Key aspects of the model were medical assistant initiated testing, the use of laboratory-based reflex test technology, and electronic medical record modifications to prompt, track, report and facilitate payment of test costs. Universal testing on all adult patients was implemented at health centers serving patients at high-risk for HCV. The other sites integrated high-risk based testing, where patients meeting one or more of the CDC testing recommendation risk factors or had a history of homelessness were eligible for HCV testing. Mid-course adjustments included the integration of dual HIV testing, development of a linkage to care coordinator position to facilitate the transition of HIV and/or HCV-positive patients from primary to specialist care, and the transition to universal HCV testing across all testing sites. Results: From October 2012 to June 2015, the health centers performed 7,730 HCV tests and identified 886 (11.5%) patients with a positive HCV-antibody test. Of those with positive HCV-antibody tests, 838 (94.6%) had an HCV-RNA confirmatory test and 590 (70.4%) progressed to current HCV infection (overall prevalence=7.6%); 524 (88.8%) received their RNA-positive test result; 429 (72.7%) were referred to an HCV care specialist and 271 (45.9%) were seen by the HCV care specialist. The best linkage to care results were seen at the test and treat the site, where of the 333 patients were current HCV infection, 175 (52.6%) were seen by an HCV care specialist. Of the patients with active HCV infection, 349 (59.2%) were unaware of their HCV-positive status at the time of diagnosis. Since the integration of dual HCV/HIV testing in September 2013, 9,506 HIV tests were performed, 85 (0.9%) patients had positive HIV tests, 81 (95.3%) received their confirmed HIV test result and 77 (90.6%) were linked to HIV care. Dual HCV/HIV testing increased the number of HCV tests performed by 362 between the 9 months preceding dual testing and first 9 months after dual testing integration, representing a 23.7% increment. Conclusion: Our HCV testing model shows that integrated routine testing and linkage to care is feasible and improved detection and linkage to care in a primary care setting. We found that prevalence of current HCV infection was higher than that seen in locally in Philadelphia and nationwide. Intensive linkage services can increase the number of patients who successfully navigate the HCV treatment cascade. The linkage to care coordinator position is an important position that acts as a trusted intermediary for patients being linked to care.

Keywords: HCV, routine testing, linkage to care, community health centers

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11406 Availability of TB Infection Control Plans at Rural Hospitals of South Africa

Authors: Takalani Tshitangano

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Background: In Limpopo province the rate of new tuberculosis (TB) cases increase daily. The Infection Control (IC) plan is one of the essential actions for TB IC. This study aimed to establish the availability of these plans at health care facilities. Objectives: The objectives were to explore and describe the awareness and knowledge of health care workers (HCWs) of the availability and content of TB IC plan; and to identity the role of infection control committees from the perspective of HCWs. Method: A qualitative approach using a cross-sectional descriptive design was adopted. The target population was all HCWs from the seven hospitals of Vhembe district. A purposive sampling approach was used to select 57 participants. The approval to conduct this study was obtained from the relevant authorities and participants. Data were collected through seven focus group discussions comprising five to 10 members. An unstructured discussion guide was used to collect data, and an open-coding method was used to analyse the data. Lincoln and Guba’s criteria ensured trustworthiness of the study findings. Results: Findings revealed that HCWs were not aware of the availability and the information contained in the TB IC plans. No person was designated as TB IC officer at hospital level. There was lack of a TB IC Committee and teams as well as ineffective utilisation of those that did exist. Conclusions: It was concluded that if the TB IC plans are not available at health care facilities, then the TB IC practices implemented by HCWs vary, resulting in TB nosocomial infection transmission. It was recommended that the World Health Organisation’s TB IC plans be adopted and implemented in Vhembe district.

Keywords: health care workers' awareness, health care workers' knowledge, availability of TB infection control plans, rural hospitals

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11405 Importance of Assessing Racial Trauma after George Floyd in Children of Color in Schools

Authors: Gabriela Macera DiFilippo

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The world watched in disbelief as George Floyd was killed by a policeman. The images from the scene were made more memorable by Mr. Floyd’s pleas and cries for his mother. In the aftermath of this tragedy, the Black Lives Matter movement gained momentum. Weeks and months after the protests, global interest in learning about tackling systemic racism erupted. One must wonder how school children of color viewed and processed this trauma. This study will examine the kinds of trauma experienced by children of color and the opportunity for school mental health providers to support these children. This study used literature searches that were previously conducted for proven and practical assessment methods that can help deal with racial trauma for children. As part of the assessment, trauma symptoms experienced by children of color were summarized and characterized in a non-imperial manner. The research was also will be done in practical ways to make adequate and effective mental health services available in schools and lessen the stigma. This research study found that there is a need to provide an analysis of the ongoing racial trauma of children of color after the death of George Floyd. Impactful and appropriate assessment methods, such as surveys, were presented to all school professionals. Lastly, this paper attempted to provide mental health professionals with the tools to screen and provide guidance based on unequivocal, unbiased methods for helping these children. There is a need for both schools and community leaders to ensure that every child has access to mental health care and is being assessed for their overall well-being. There is a need to educate the communities about racial trauma and its impact on individuals, especially children. School mental health professionals are encouraged to offer and educate schools and communities about racial trauma awareness, its importance, and ways to cope with it in different settings. The delivery of these informed services should focus on behavioral health and must be sensitive to children of color and different ways of self-care.

Keywords: trauma, children, black psychology, students

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11404 An Exploratory Study of the Meaning of Life of Delivery Agents of Kolkata

Authors: Soumitri Bag Majumder, Anindita Chaudhuri

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This exploratory study delves into the perception of job dignity among delivery agents in Kolkata, focusing on both food and grocery delivery sectors. The rapid expansion of online delivery platforms in India has led to a significant rise in the delivery service industry. Despite its growth, there is a dearth of research addressing the multifaceted challenges faced by delivery agents. This study aims to bridge this gap by shedding light on their experiences. The study’s objectives include exploring the lived experiences of delivery agents, their work-life balance, and their perception of job dignity. Using a qualitative research approach, the study will conduct semi-structured in-depth interviews with a purposive sample of 10 participants from each sector, consisting of individuals with lower socio-economic backgrounds aged between 18 and 35 years. The Three-Layer Coding framework proposed by Charmaz will guide the data analysis process, encompassing open coding, axial coding, and selective coding. Through this method, the study seeks to uncover emergent themes and patterns that illuminate the participants’ perspectives on job dignity, recognition, and the challenges they encounter. By uncovering their perceptions of job dignity and the challenges they face, the research aims to contribute to the well-being of these workers and inform relevant stakeholders for a more equitable work environment.

Keywords: delivery agents, equitable work environment, perception of job dignity, work-life balance

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11403 Adopting the Community Health Workers Master List Registry for Community Health Workforce in Kenya

Authors: Gikunda Aloise, Mjema Saida, Barasa Herbert, Wanyungu John, Kimani Maureen

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Background: Community Health Workforce (CHW) is health care providers at the community level (Level 1) and serves as a bridge between the community and the formal healthcare system. This human resource has enormous potential to extend healthcare services and ensures that the vulnerable, marginalized, and hard-to-reach populations have access to quality healthcare services at the community and primary health facility levels. However, these cadres are neither recognized, remunerated, nor in most instances, registered in a master list. Management and supervision of CHWs is not easy if their individual demographics, training capacity and incentives is not well documented through a centralized registry. Description: In February 2022, Amref supported the Kenya Ministry of Health in developing a community health workforce database called Community Health Workers Master List Registry (CHWML), which is hosted in Kenya Health Information System (KHIS) tracker. CHW registration exercise was through a sensitization meeting conducted by the County Community Health Focal Person for the Sub-County Community Health Focal Person and Community Health Assistants who uploaded information on individual demographics, training undertaken and incentives received by CHVs. Care was taken to ensure compliance with Kenyan laws on the availability and use of personal data as prescribed by the Data Protection Act, 2019 (DPA). Results and lessons learnt: By June 2022, 80,825 CHWs had been registered in the system; 78,174 (96%) CHVs and 2,636 (4%) CHAs. 25,235 (31%) are male, 55,505 (68%) are female & 85 (1%) are transgender. 39,979. (49%) had secondary education and 2500 (3%) had no formal education. Only 27 641 (34%) received a monthly stipend. 68,436 CHVs (85%) had undergone basic training. However, there is a need to validate the data to align with the current situation in the counties. Conclusions/Next steps: The use of CHWML will unlock opportunities for building more resilient and sustainable health systems and inform financial planning, resource allocation, capacity development, and quality service delivery. The MOH will update the CHWML guidelines in adherence to the data protection act which will inform standard procedures for maintaining, updating the registry and integrate Community Health Workforce registry with the HRH system.

Keywords: community health registry, community health volunteers (CHVs), community health workers masters list (CHWML), data protection act

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11402 Needs and Expectations of Digital Support among Parents of Children in Child Healthcare

Authors: Lotha Valan, Åsa Hörnsten, Ulf Isaksson

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Introduction: Sweden has a national child health care program (CHCP) where all parents are offered support to raise their children and support them for lifelong health. A systematic review concludes that there is a request for guidance in using the internet effectively for the health purposes of their children. However, a study about internet use among young mothers means that the internet is not always easy to navigate for parents, and they may need support. To fill this gap and develop a digital channel to complement the child health care (CHC) for the support of parents of children within CHC, there is a demand to investigate parents' needs in relation to this purpose. Methods: The study had a qualitative approach using focus group interviews with parents. The interview data were analyzed using qualitative content analysis. Results: The main theme highlights that parents expected that a digital support channel would be something that might strengthen them toward independence concerning the care of their children in a positive way. However, they also felt that they needed personal support and that relationships with other parents and the child health care nurse were significant and meaningful. Another parental desire that emerged was that a future digital channel would facilitate and simplify access to care, and they suggested having both planned and urgent times available for parents to book. The digital channel was expected to make this possible and be a good complement to the physical contacts the traditional child healthcare currently offers. Discussion/conclusions: The parents in this study believed that digital solutions could increase their parental power in relation to the care of their children. Examples were given as nurse-led parent groups where parents with similar problems and experiences around their children could support each other and were expected to strengthen them over time. The parents stressed that a planned digital support channel also needs satisfactory solutions for both contact and response. It was suggested that there should be bookable times for both planned and urgent needs and also the possibility of rescheduling visits.

Keywords: child healthcare, parents, digital support, nursing

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11401 Involvement in Health Policy and Political Efficacy among Hospital Nurses in Jordan: A Descriptive Survey

Authors: Raeda F. Abualrub, Amani Abdulnabi

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Aim: The aims of this study were to (a) examine the levels of nurses' political efficacy and involvement in health policy; and (b) explore the relationships between political efficacy, involvement in health policy, and participants’ background variables. Background: Nurses as citizens and health care providers have the right to express their opinions and beliefs in regard to issues that are concerned with the health care system or the public health domain. Methods: A descriptive, cross-sectional design using was utilized. A self-administered questionnaire (Political Efficacy Scale & Involvement in Health Policy Scale) was completed by a convenience sample of 302 nurses. Results: The results of this study showed low levels of involvement in health policy and political efficacy and a positive weak correlation between political efficacy and involvement in health policy. The perceived level of political efficacy was associated positively with nurses’ age and experience. Conclusions: Nurse administrators and managers may empower, support, and encourage nurses to enhance their involvement in health policy. Implications for Nursing Management: The findings have implications for nursing leaders and administrators to design appropriate strategies to enhance nurses’ involvement in health policy development.

Keywords: health policy, Jordan, nurses, political efficacy

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11400 Classification of Health Risk Factors to Predict the Risk of Falling in Older Adults

Authors: L. Lindsay, S. A. Coleman, D. Kerr, B. J. Taylor, A. Moorhead

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Cognitive decline and frailty is apparent in older adults leading to an increased likelihood of the risk of falling. Currently health care professionals have to make professional decisions regarding such risks, and hence make difficult decisions regarding the future welfare of the ageing population. This study uses health data from The Irish Longitudinal Study on Ageing (TILDA), focusing on adults over the age of 50 years, in order to analyse health risk factors and predict the likelihood of falls. This prediction is based on the use of machine learning algorithms whereby health risk factors are used as inputs to predict the likelihood of falling. Initial results show that health risk factors such as long-term health issues contribute to the number of falls. The identification of such health risk factors has the potential to inform health and social care professionals, older people and their family members in order to mitigate daily living risks.

Keywords: classification, falls, health risk factors, machine learning, older adults

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11399 Glycemic Control on Self-Efficacy and Self-Care Behaviors among Omani Adults with Type 2 Diabetes

Authors: Melba Sheila D'Souza, Anandhi Amirtharaj, Shreedevi Balachandran

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Background: Type 2 diabetes has a significant impact on individuals’ health and well-being. Glycemic control may influence self-efficacy and self-care behaviors, and reduce the risk of complications among adults with type 2 diabetes. Type 2 diabetes has substantial morbidity and mortality and 60% of adults’ poor self-care. Glycemic control is associated with reported self-efficacy and self-care behavior. Adults with type 2 diabetes with less information were less likely to take diabetes self-care. Aim: To examine the relationship between glycemic control, demographic factors, clinical factors on self-efficacy, self-care behaviors among Omani adults with type 2 diabetes. Methods: A correlational, descriptive study was used. Omani adults with type 2 diabetes (n=140) were recruited from a public hospital in Oman. The data were collected during January-March 2015. Ethical approval was given by the college research and ethics committee, College of Nursing, and the Hospital, Sultan Qaboos University Data was collected on self-efficacy, self-care behaviors and glycemic control. The study was approved by the Institution Ethics and Research Committee. Bivariate and multivariate analyses were conducted. Results: Most adults had a fasting blood glucose >7.2mmol/L (90.7%), with the majority demonstrating ‘uncontrolled or poor HbA1c of > 8%’ (65%). Variance of self-care behavior (20.6%) and 31.3% of the variance of the self-efficacy was explained by the age, duration of diabetes, medication, HbA1c and prevention of activities of living. Adults with type 2 diabetes with poor glycemic control were more likely to have poor self-efficacy and poor self-care behaviors. Conclusion: This study confirms that self-efficacy model on outcome predicts self-efficacy and self-care behavior. Higher understanding of diabetes, prevention of normal daily activities, higher ability to fit diabetes life in a positive manner and high patient-physician communication were significant with self-efficacy and self-care behaviors. Hence, glycemic control has a high effect on improving self-care behaviors like diet, exercise, medication, foot care and self-efficacy among type 2 diabetes. Implications: Using these findings to improve self-efficacy, individualized self-care management is recommended for better self-efficacy and self-care behaviors among adults with type 2 diabetes.

Keywords: self-efficacy, self-care behaviors, self-care management, glycemic control, type 2 diabetes, nurse

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11398 Impact of a Training Course in Cardiopulmonary Resuscitation for Primary Care Professionals

Authors: Luiz Ernani Meira Jr., Antônio Prates Caldeira, Gilson Gabriel Viana Veloso, Jackson Andrade

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Background: In Brazil, primary health care (PHC) system has developed with multidisciplinary teams in facilities located in peripheral areas, as the entrance doors for all patients. So, professionals must be prepared to deal with patients with simple and complex problems. Objective: To evaluate the knowledge and the skills of physicians and nurses of PHC on cardiorespiratory arrest (CRA) and cardiopulmonary resuscitation (CPR) before and after training in Basic Life Support. Methods: This is a before-and-after study developed in a Simulation Laboratory in Montes Claros, Brazil. We included physicians and nurses randomly chosen from PHC services. Written tests on CRA and CPR were carried out and performances in a CPR simulation were evaluated, based on the American Heart Association recommendations. Training practices were performed using special manikins. Statistical analysis included Wilcoxon’s test to compare before and after scores. Results: Thirty-two professionals were included. Only 38% had previous courses and updates on emergency care. Most of professionals showed poor skills to attend to CRA in a simulated situation. Subjects showed an increased in knowledge and skills about CPR after training (p-value=0.003). Conclusion: Primary health care professionals must be continuously trained to assist urgencies and emergencies, like CRA.

Keywords: primary health care, professional training, cardiopulmonary resuscitation, cardiorespiratory, emergency

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11397 European Union Health Policy and the Response to COVID-19 Pandemic: Building a European Health Union

Authors: Aikaterini Tsalampouni

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The European Union has long been the most developed model of economic and political integration that has brought a common market, a common currency and a standardization of national policies in certain areas in consistent with EU values and principles. To this direction, there is a parallel process of social integration that effect public policy decisions of member states. Even though social policy, i.e. social protection and moreover healthcare policy, still remains in state's responsibility to develop, EU applies different mechanisms in order to influence health policy systems, since from a more federalist point of view, EU ought to expand its regulatory and legislative roles in as many policy areas as possible. Recently, the pandemic has become a turning point for health care provision and at the same time has also highlighted the need to strengthen the EU’s role in coordinating health care. This paper analyses the EU health policy in general, as well as the response to COVID-19 pandemic with an attempt to identify indications of interaction between EU policies and the promotion of sustainable and resilient health systems. More analytically, the paper investigates the EU binding legal instruments, non-binding legal instruments, monitoring and assessment instruments and instruments for co-financing concerning health care provision in member states and records the evolution of health policies before and during the COVID-19 pandemic. The paper concludes by articulating some remarks regarding the improvement of health policy in EU. Since the ability to deal with a pandemic depends on continuous and increased investment in health systems, the involvement of the EU can lead to a policy convergence, necessary for the resilience of the systems, maintaining at the same time, a strong health policy framework in Europe.

Keywords: EU health policy, EU response to COVID-19, European Health Union, health systems in Europe

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11396 Disciplined Care for Disciplined Patients: Results from Daily Experiences of Hospitalized Patients with Blindness

Authors: Mahmood Shamshiri

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While visual sensation is the key gate for human-being to understand the world, visual impairment is one of the common cause of disability around the world. There is no doubt about the importance of eye sight in daily life among people, even it is understood the best gift of God to human-beings in many societies. Blind people are admitted to hospital for different health issues. Nurses and other health professionals who provide care for this group of patients need to understand their patients. Understanding the lived experience of blind people helps nurses to expand their knowledge regarding blind patients in order to provide a holistic care and improve the quality of care for blind patients. This phenomenological inquiry aimed to describe the meaning of discipline in daily life of blind people admitted in hospital. An interpretive phenomenology underpinned the philosophical approach of the study. While the interpretive phenomenology played as an umbrella role in the overall point of the study, the six methodical activities which introduced by van Manen helped the researchers to conduct the study. ‘Disciplined care for disciplined patients’ was the main theme emerged from dialogues of blind patients about their daily life in the hospital. Almost all of participants called themselves as disciplined people. The theme ‘disciplined care for disciplined patients’ appeared from four sub-themes including discipline through careful touching and listening, discipline as the ideal way of existence, discipline the preferred way of being independent, desire to take disciplined and detailed care, reactions to the undisciplined caring culture. This phenomenological inquiry to the experiences of patients with blindness in hospital revealed that they commonly are disciplined people and want to be cared in well-organized caring environment. Furthermore, they need to be familiar with the new caring environment. Well-organized and familiar environment help blind patients to increase the level of independency. In addition, blind patients prefer a detail informed and disciplined caring culture. Health professionals have to consider the concept of disciplined care in order to provide a holistic and comprehensive competent care.

Keywords: disciplined people, disciplined care, lived experience, patient with blindness

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11395 Baby Cot’s Indoor Air Quality

Authors: Wim Zeiler

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The indoor quality of occupied space is very important for the well-being of its occupants, especially in the case of babies. The lungs of a young child are still growing and adverse conditions could affect this development. Presently little children spend a lot of their time in day care centers while parents are at work. Little is known about the effects of different indoor environmental factors present in these day care centers and the quality of air of baby cots in which the babies are accommodated in these day care centers. Therefore this research investigated the quality of the accommodation of Dutch day care centers. Besides an extensive literature research actual measurements were performed in baby cots within three-day care center. Some experiments were performed to find out the importance of the configuration and types of baby cots. This research investigated the quality of the accommodation of a Dutch day care center which led to a tool describing the quality needs (e.g., quality standard) for the accommodation of day care centers. The results of our detailed studies were compared with the results of earlier Dutch more global studies in day care centers, in which more than 60 day care centers were investigated. Also the results are compared with the outcomes of research on school ventilation. The results proved that the situation in day care centers is even worse than that of schools within the Netherlands. More attention is needed to improve the current situation.

Keywords: ventilation, baby cots, day care centers, case study

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11394 Witchcraft Belief and HIV/AIDS in Edo State, Nigeria: Implications for Health-Care

Authors: Celestina Omoso Isiramen

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The influence of witchcraft belief on disease causation, cure and public health system in Nigeria cannot be underrated. This paper investigated the nexus between witchcraft phenomenon and health-seeking behaviour of HIV sufferers in Edo state, Nigeria. Survey methodology was adopted and stratified random sampling technique was employed in the selection of 600 sample group spread into 200 HIV sufferers, 200 spiritual healers and 200 bio-medics from the three Senatorial districts of the state. Data were collected through the use of structured questionnaire and in-dept interview and analyzed using simple percentage and frequency. Major findings were: belief in witchcraft significantly influenced the people’s perception of HIV causation and wellness and this impacted adversely on public health-care. Poverty, ignorance and dearth of retroviral drugs enhanced the people’s recourse to spiritual healers. Collaboration between spiritual healing techniques and biomedicine was recommended as panacea for curbing HIV/AIDS related morbidity and mortality. It concluded that socio-economic problems must be addressed while the importance of integrating the values of spiritual healing into biomedicine cannot be overstressed.

Keywords: biomedicine, health care, HIV/AIDS, spirituality, witchcraft

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11393 Home-Based Care with Follow-Up at Outpatient Unit or Community-Follow-Up Center with/without Food Supplementation and/or Psychosocial Stimulation of Children with Moderate Acute Malnutrition in Bangladesh

Authors: Md Iqbal Hossain, Tahmeed Ahmed, Kenneth H. Brown

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Objective: To assess the effect of community-based follow up, with or without food-supplementation and/or psychosocial stimulation, as an alternative to current hospital-based follow-up of children with moderate-acute-malnutrition (WHZ < -2 to -3) (MAM). Design/methods: The study was conducted at the ICDDR,B Dhaka Hospital and in four urban primary health care centers of Dhaka, Bangladesh during 2005-2007. The efficacy of five different randomly assigned interventions was compared with respect to the rate of completion of follow-up, growth and morbidity in 227 MAM children aged 6-24 months who were initially treated at ICDDR,B for diarrhea and/or other morbidities. The interventions were: 1) Fortnightly follow-up care (FFC) at the ICDDR,B’s outpatient-unit, including growth monitoring, health education, and micro-nutrient supplementation (H-C, n=49). 2) FFC at community follow-up unit (CNFU) [established in the existing urban primary health-care centers close to the residence of the child] but received the same regimen as H-C (C-C, n=53). 3) As per C-C plus cereal-based supplementary food (SF) (C-SF, n=49). The SF packets were distributed on recruitment and at every visit in CNFU [@1 packet/day for 6–11 and 2 packets/day for 12-24 month old children. Each packet contained 20g toasted rice-powder, 10g toasted lentil-powder, 5g molasses, and 3g soy bean oil, to provide a total of ~ 150kcal with 11% energy from protein]. 4) As per C-C plus psychosocial stimulation (PS) (C-PS, n=43). PS consisted of child-stimulation and parental-counseling conducted by trained health workers. 5) As per C-C plus both SF+PS (C-SF+PS, n=33). Results: A total of 227children (48.5% female), with a mean ± SD age of 12.6 ±3.8 months, and WHZ of - 2.53±0.28 enrolled. Baseline characteristics did not differ by treatment group. The rate of spontaneous attendance at scheduled follow-up visits gradually decreased in all groups. Follow-up attendance and gain in weight and length were greater in groups C-SF, C-SF+PS, and C-PS than C-C, and these indicators were observed least in H-C. Children in the H-C group more often suffered from diarrhea (25 % vs. 4-9%) and fever (28% vs. 8-11%) than other groups (p < 0.05). Children who attended at least five of the total six scheduled follow-up visits gained more in weight (median: 0.86 vs. 0.62 kg, p=0.002), length (median: 2.4 vs. 2.0 cm, p=0.009) than those who attended fewer. Conclusions: Community-based service delivery, especially including supplementary food with or without psychosocial stimulation, permits better rehabilitation of children with MAM compared to current hospital outpatients-based care. By scaling the community-based follow-up including food supplementation with or without psychosocial stimulation, it will be possible to rehabilitate a greater number of MAM children in a better way.

Keywords: community-based management, moderate acute malnutrition, psychosocial stimulation, supplementary food

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11392 A Mixed Method Systematic Review of the Experience of Communication in the Care of Children with Palliative Care Needs

Authors: Maha Atout, Pippa Hemingway, Jane Seymour

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Background: A mixed method systematic review was undertaken in order to explore issues related to the experiences of health care providers and parents in the care of children with palliative care needs. The aims of this systematic review were to identify existing evidence about the experiences of communication in the care of children with palliative care needs, to appraise the research conducted in this area and to identify gaps in the literature in order to recommend for future related studies. Method: A mixed method systematic review of research on the experience of communication in the care of children with palliative care needs, conducted with parents and health professionals was undertaken. The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period of 2000-2016. Inclusion was limited to studies of communication experience in the care of children with palliative care needs. Result: Thirty-eight studies were found. The studies were conducted in a variety of countries: Uganda, Jordan, USA, UK, Taiwan, Turkey, Ireland, Poland, Brazil, Australia, Switzerland, Sweden, Netherland, Lebanon, Spain, Greece, and China. The current review shows that parents tend to protect their children when they are discussing their illnesses with them, particularly where they have a life-threatening or life-limiting condition. The approach of parents towards the discussion of sensitive issues concerning death with their children is significantly affected by the cultural background of the families. Conservative cultures encourage collusion behaviours which tend to keep children unaware of the incurable nature of the disease. The major communication challenges reported by health professionals are facing difficulties in judging how much information should be given to parents, responding to difficult questions, conflicts with families and inadequate skills to support grieving families. Conclusion: It is probably significant for the future studies to consider the change of parent-child communication experience over time in order to understand how the parents could change their interaction styles with their children according to the different stages of their children’s disease. Moreover, further studies are required to investigate the experience of communication of parents of children with non-malignant life-threatening and life-limiting illnesses.

Keywords: children with life-threatening or life- limiting illnesses, end of life, experience of communication, healthcare care providers, paediatric palliative care

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11391 Kidney Supportive Care in Canada: A Constructivist Grounded Theory of Dialysis Nurses’ Practice Engagement

Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas

Abstract:

Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.

Keywords: dialysis, kidney failure, nursing, supportive care

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11390 Communication Barriers in Midwifery Students in the Field of Perinatal Palliative Care

Authors: Magdalena Hasplova, Katerina Ivanova

Abstract:

Perinatal palliative care is a relatively young and developing field that includes the care of a fetus or newborn with a life-threatening or limiting defect and his family. However, the training of midwives in perinatal palliative care is insufficient and midwives do not feel prepared for this aspect of their work. This fact can affect the barriers to communication with the mother or family of the endangered child. The main aim was to analyze the awareness of midwifery students on the issue of perinatal palliative care in the Czech Republic. Based on the analysis, draw attention to possible communication barriers that may be caused by insufficient information. The research was carried out using a qualitative method, the method of data collection was a semi-structured interview. Eleven female students took part in the research, and the respondents were selected using the Snowballing method. Some methods of grounded theory (open coding and category creation) were used to analyze the data. Based on the results of the research, questions were set in a questionnaire focused on communication barriers between mothers (family) and health care professionals in the care of newborns with life-threatening or limiting disabilities. Based on the analysis of data, categories 1 were determined. Knowledge of perinatal palliative care 2. Education 3. Practical experience 4. Readiness and concerns in the provision of perinatal palliative care 6. Supervision. The questions in the questionnaire were then derived taking into account the data obtained, and the operationalization of health literacy in the field of perinatal palliative care was performed. The analysis of the interviews revealed that the education of midwives in the Czech Republic in the issue of perinatal palliative care is not uniform. The research confirmed the insufficient knowledge and skills of midwifery students preparing to provide perinatal palliative care. Respondents reported feelings of unpreparedness in the areas of communication with a woman after perinatal loss, psychological support for a woman and her family, the care of a stillborn or dying child, or self-coping with death. The questions in the questionnaire then develop these areas. We assumed that by analyzing and interpreting the data obtained from our research, we will help to better understand the concerns and motivations of students in providing holistic perinatal palliative care. We came to the conclusion that it would be appropriate to set up a unified and comprehensive education on this issue in the Czech Republic. Healthcare professionals are in a unique position that can positively or negatively affect the intensity of perinatal loss. Already properly set up education of health professionals leads to overcoming barriers in communication between health professionals and the family, experiencing perinatal loss.

Keywords: midwife, perinatal loss, perinatal palliative care, communication, barriers, mothers, family

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11389 Beliefs on Reproduction of Women in Fish Port Community: An Explorative Study on the Beliefs on Conception, Childbirth, and Maternal Care of Women in Navotas Fish Port Community

Authors: Marie Kristel A. Gabawa

Abstract:

The accessibility of health programs, specifically family planning programs and maternal and child health care (FP/MCH), are generally low in urban poor communities. Moreover, most of FP/MCH programs are directed toward medical terms that are usually not included in ideation of the body of urban poor dwellers. This study aims to explore the beliefs on reproduction that will encompass, but not limited to, beliefs on conception, pregnancy, and maternal and child health care. The site of study will be the 2 barangays of North Bay Boulevard South 1 (NBBS1) and North Bay Boulevard South 2 (NBBS2). These 2 barangays are the nearest residential community within the Navotas Fish Port Complex (NFPC). Data gathered will be analyzed using grounded-theory method of analysis, with the theories of cultural materialism and equity feminism as foundation. Survey questionnaires, key informant interviews, and focus group discussions will be utilized in gathering data. Further, the presentation of data will be recommended to health program initiators and use the data gathered as a tool to customize FP/MCH programs to the perception and beliefs of women residing in NBBS1and NBBS2, and to aid any misinformation for FP/MCH techniques.

Keywords: beliefs on reproduction, fish port community, family planning, maternal and child health care, Navotas

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11388 Understanding of Chinese Organisations Approach to Dementia: A Case Study of Two Community Centres and One Housing Support Service in the UK

Authors: Emily J. Winnall

Abstract:

It is understood that China has the largest population of people living with dementia in the world; however, little is known about this culturally diverse community, specifically the Chinese Communities, which has been poorly represented in past British research Literature. Further research is needed to gain a greater understanding of the support needs of caregivers caring for a relative living with dementia from the Chinese background. Dementia care and caregivers in Chinese communities are less investigated. The study is a case study of two Chinese community centers and one housing support service. Semi-structured one-to-one interviews and a pilot questionnaire were used as the methods for the study. A toolkit will also be created as a document that provides guidance and signposting to health and social care services for Chinese communities. The findings identified three main themes. Caregivers do not receive any formal support from the UK health and social services, and they felt they would have benefited from getting advice on what support they could access. Furthermore, the data also identified that Chinese organisations do not have the knowledge of dementia, to be able to support those living with dementia and their families. Also, people living with dementia and their families rarely present to Chinese organisations and UK health and social care services, meaning they are not receiving the support they are entitled to or need. Additionally, the community center would like to see workshops/courses around dementia for people from Chinese backgrounds. The study concludes that people from Chinese cultural backgrounds do not have sufficient access to support from UK health and social care services. More information needs to be published that will benefit Chinese communities.

Keywords: Chinese, Chinese organisations, Dementia, family caregivers, social care

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11387 Effective Factors on Self-Care in Women with Osteoporosis: A Study with Content Analysis Approach

Authors: Arezoo Fallahi, Siamak Derakhshan, Parvaneh Taymoori, Babak Nematshahrbabaki

Abstract:

Background: Osteoporosis, the most common metabolic bone disease, is an important health care issue. Not only the cost of disease is high but also is one of the causes of disability and mortality and effect on quality of life. Although self-care is effective on disease, s control and treatment but still effective factors on self-care of patient, s viewpoint have not been survey. The aim of this study was to explore effective factors on self-care in women with osteoporosis. Materials and methods: This study was done by conventional content analysis approach in year 2014. Through purposeful sampling 15 women referred to bone mass densitometry centers participated in this study. Inclusion criteria were: Women older than 50 years old with osteoporosis, final diagnosis of osteoporosis for over six –month period, T-score index below -2.5 (lower back or hip), drug use by patients with a physician’s prescription, ability in speaking and attending to participate in the study. Data was collected by face to face and group semi-structure deep interviews and analyzed via content analysis method. To support of rigor of data, criteria credibility, confirmability and transferability were used. Results: during data analysis five categories developed: “hope and disability in the face of illness”, “mutual roles of physician”, “role of family” and “administrative centers and organizations”. To perform self-care behaviors, the participations of this study emphasized on pay attention to their own healthy, regarding patients' rights by physician, pay attention to women's health by men, and the role of media especially radio and television. Conclusion: the finding of the study showed that women’s responsibility with osteoporosis for their health is not a factor but it is multifactorial. Increasing life expectancy in patients, attention to patients needs by physician, increasing health promotion programs in the media and enhancing role of family may provide conditions and infrastructure to empowerment women in doing self-care behavior.

Keywords: women, osteoporosis, self-care, content analysis

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11386 To Identify the Importance of Telemedicine in Diabetes and Its Impact on Hba1c

Authors: Sania Bashir

Abstract:

A promising approach to healthcare delivery, telemedicine makes use of communication technology to reach out to remote regions of the world, allowing for beneficial interactions between diabetic patients and healthcare professionals as well as the provision of affordable and easily accessible medical care. The emergence of contemporary care models, fueled by the pervasiveness of mobile devices, provides better information, offers low cost with the best possible outcomes, and is known as digital health. It involves the integration of collected data using software and apps, as well as low-cost, high-quality outcomes. The goal of this study is to assess how well telemedicine works for diabetic patients and how it impacts their HbA1c levels. A questionnaire-based survey of 300 diabetics included 150 patients in each of the groups receiving usual care and via telemedicine. A descriptive and observational study that lasted from September 2021 to May 2022 was conducted. HbA1c has been gathered for both categories every three months. A remote monitoring tool has been used to assess the efficacy of telemedicine and continuing therapy instead of the customary three monthly meetings like in-person consultations. The patients were (42.3) 18.3 years old on average. 128 men were outnumbered by 172 women (57.3% of the total). 200 patients (66.6%) have type 2 diabetes, compared to over 100 (33.3%) candidates for type 1. Despite the average baseline BMI being within normal ranges at 23.4 kg/m², the mean baseline HbA1c (9.45 1.20) indicates that glycemic treatment is not well-controlled at the time of registration. While patients who use telemedicine experienced a mean percentage change of 10.5, those who visit the clinic experienced a mean percentage change of 3.9. Changes in HbA1c are dependent on several factors, including improvements in BMI (61%) after 9 months of research and compliance with healthy lifestyle recommendations for diet and activity. More compliance was achieved by the telemedicine group. It is an undeniable reality that patient-physician communication is crucial for enhancing health outcomes and avoiding long-term issues. Telemedicine has shown its value in the management of diabetes and holds promise as a novel technique for improved clinical-patient communication in the twenty-first century.

Keywords: diabetes, digital health, mobile app, telemedicine

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11385 Assessment of Knowledge, Attitude, and Practice of Health Care Professionals and Factors Associated with Adverse Drug Reaction Reporting in Public and Private Hospitals of Islamabad

Authors: Zaka Nisa, Farooq Sher

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Adverse drug reactions (ADRs) underreporting is a great challenge to Pharmacovigilance. Health care professionals have to consider ADR reporting as their professional obligation, an effective system of ADR reporting is important to improve patient health care and safety. The present study is designed to assess the knowledge, attitude, practice and factors associated with ADR reporting by health care professionals (physicians and pharmacists) in public and private hospitals of Pakistan. A pretested questionnaire was administered to 384 physicians and pharmacists in public and private hospitals. Respondents were evaluated for their knowledge, attitude, and practice related to ADR reporting. The data was analyzed using the SPSS statistical software, the factors which encourage and discourage respondents in reporting ADRs were determined. Most of the respondents have shown a positive attitude towards ADR reporting. The response rate was 95.32%. Of the 367 questionnaires, including 333 (86.5%) physicians and 34 (8.8%) pharmacists with the mean age 28.34 (SD= 6.69), most of the respondents showed poor ADR reporting knowledge (83.1%). The majority of respondents (78.2%) showed positive attitude towards ADR reporting and only (12.3%) hospitals have good ADR reporting practice. Knowledge of respondents in public hospitals (8.6%) was less as compare to those in the private hospitals (29.7%) (P < 0.001). Attitude of respondents in private hospitals was more positive (92.4%) than those in public hospitals (68.8%) (P < 0.001). No significant difference was observed in practicing of ADR reporting in public (11.8%) and private hospitals (13.1%) (P value 0.89). Seriousness of ADR, unusualness of reaction, new drug involvement and confidence in diagnosis of ADR were the factors which encourage respondents to report ADR, however, lack of knowledge regarding where and how to report ADR, lack of access to ADR reporting form, managing patients was more important than reporting ADR, legal liability issues were the factors which discourage respondents to report ADR. The study reveals poor knowledge and practice regarding ADR reporting. However positive attitude was seen regarding ADR reporting. There is a need of educational training for health care professionals as well as genuine and continuous efforts are required by Government and health authorities to ensure the proper implementation of ADR reporting system in all of the hospitals.

Keywords: adverse drugs reactions (ADR), pharmacovigilance, spontaneous ADR reporting, knowledge of ADR, attitude of health care profesionals, practice of ADR reporting

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11384 Improving Rural Access to Specialist Emergency Mental Health Care: Using a Time and Motion Study in the Evaluation of a Telepsychiatry Program

Authors: Emily Saurman, David Lyle

Abstract:

In Australia, a well serviced rural town might have a psychiatrist visit once-a-month with more frequent visits from a psychiatric nurse, but many have no resident access to mental health specialists. Access to specialist care, would not only reduce patient distress and benefit outcomes, but facilitate the effective use of limited resources. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) was developed to improve access to specialist emergency mental health care in rural and remote communities using telehealth technologies. However, there has been no current benchmark to gauge program efficiency or capacity; to determine whether the program activity is justifiably sufficient. The evaluation of MHEC-RAP used multiple methods and applied a modified theory of access to assess the program and its aim of improved access to emergency mental health care. This was the first evaluation of a telepsychiatry service to include a time and motion study design examining program time expenditure, efficiency, and capacity. The time and motion study analysis was combined with an observational study of the program structure and function to assess the balance between program responsiveness and efficiency. Previous program studies have demonstrated that MHEC-RAP has improved access and is used and effective. The findings from the time and motion study suggest that MHEC-RAP has the capacity to manage increased activity within the current model structure without loss to responsiveness or efficiency in the provision of care. Enhancing program responsiveness and efficiency will also support a claim of the program’s value for money. MHEC-RAP is a practical telehealth solution for improving access to specialist emergency mental health care. The findings from this evaluation have already attracted the attention of other regions in Australia interested in implementing emergency telepsychiatry programs and are now informing the progressive establishment of mental health resource centres in rural New South Wales. Like MHEC-RAP, these centres will provide rapid, safe, and contextually relevant assessments and advice to support local health professionals to manage mental health emergencies in the smaller rural emergency departments. Sharing the application of this methodology and research activity may help to improve access to and future evaluations of telehealth and telepsychiatry services for others around the globe.

Keywords: access, emergency, mental health, rural, time and motion

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11383 Supporting Homeless People in Red Deer, Canada

Authors: Cornelius Ehlers, Lisa Harmatiuk, Sharon Rowland, Michelle Shafers

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The objective of the Street Connect program is to provide client-centered care for the homeless population within the City of Red Deer. The program aims to provide an extended continuum of care (addiction, mental health, and physical health) for high acuity homeless individuals who are not connected to a service provider and/or community service agency. Street Connect includes both primary and secondary streams of service: Overall, Street Connect has demonstrated its ability to support vulnerable populations within the City of Red Deer, specifically those who are homeless and seeking addiction, mental health, and medical assistance. The results from the data extract and chart audit reflect the complexity and vulnerability of the clients enrolled in the Street Connect program. The clients were predominantly male, with an average age of 41 years. The majority did not have a permanent address, and 65% did not have employment. Substance abuse/addiction issues were common, combined with a history of psychiatric diagnoses and previous mental health hospitalizations. The most utilized drugs were street drugs such as methamphetamine, fentanyl, and other opioids.

Keywords: client-centred care, homelessness, mental health, rural

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11382 Preferred Service Delivery options for Female Sex Workers in the Riverine Area of lome, Togo

Authors: Gbone Akou Sophie

Abstract:

Lome state in Togo is considered to have the highest HIV prevalence in Togo according to NAIIS 2023, with the prevalence of 5.5%, Female Sex Workers (FSW) are one of the most vulnerable population, and they are vital in HIV programming. They have the highest HIV prevalence compared to others such as HRM, PWID and Transgender in lome State, Togo. Evidence from Integrated Biological Behavioral Surveillance Survey shows increasing burden of HIV infection from 13.7% in 20018 to 17.2% in 2020 and now 22.9% in 2021 among Female Sex Workers (FSW). This shows their HIV prevalence has been rising over time. The vulnerability status of the FSW in the riverine areas of lome is heightened because of cultural and economic issues where there is exchange of sex for commodities with cross border traders as well as limited access to HIV prevention information. Methods:A cross sectional study which recruited 120 FSW from two Riverine LGAs of Agoe and Kpehenou LGA of Lome State using both snowballing and simple random sampling technique. While semi-structured questionnaire was used as an instrument for data collection among the 120 FSW respondents. Additional information was also elicited from 10 FSW key opinion leaders and community members through in-depth interviews (IDI). Results: 44(36%) of respondents were willing to receive regular HIV care and services as well as visit for STI check-ups at any service point. However, 47(40%) were willing to receive services at private facilities alone, 10 (8%) were willing to receive services at public facilities, 6 (5%) were willing to access services in their homes rather than in the health facility. 13 (11%) were also willing to have peers assist in getting HIV testing services. Conclusion: integrated differentiated model of care for HIV services helps improve HIV services uptake among FSW community especially in the hard- to reach riverine areas which will further lead to epidemic control. Also targeted HIV information should be designed to suit the learning needs of the hard-to reach communities like the riverine areas. More peer educators should be engaged to ensure information and other HIV services reach the riverine communities.

Keywords: female sex workers ( FSW), human immuno-deficiency virus(HIV), prevanlence, service delivery

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11381 The Mental Health of Indigenous People During the COVID-19 Pandemic: A Scoping Review

Authors: Suzanne L. Stewart, Sarah J. Ponton, Mikaela D. Gabriel, Roy Strebel, Xinyi Lu

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Indigenous Peoples have faced unique barriers to accessing and receiving culturally safe and appropriate mental health care while also facing daunting rates of mental health diagnoses and comorbidities. Indigenous researchers and clinicians have well established the connection of the current mental health issues in Indigenous communities as a direct result of colonization by way of intergenerational trauma throughout Canada’s colonial history. Such mental health barriers and challenges have become exacerbated during the COVID-19 pandemic. Throughout the pandemic, access to mental health, cultural, ceremonial, and community services were severely impacted and restricted; however, it is these same cultural activities and community resources that are key to supporting Indigenous mental health from a traditional and community-based perspective. This research employed a unique combination of a thorough, analytical scoping review of the existent mental health literature of Indigenous mental health in the COVID-19 pandemic, alongside narrative interviews employing an oral storytelling tradition methodology with key community informants that provide comprehensive cultural services to the Indigenous community of Toronto, as well as across Canada. These key informant interviews provided a wealth of insights into virtual transitions of Indigenous care and mental health support; intersections of historical underfunding and current financial navigation in technology infrastructure; accessibility and connection with Indigenous youth in remote locations; as well as maintaining community involvement and traditional practices in a current pandemic. Both the scoping review and narrative interviews were meticulously analyzed for overarching narrative themes to best explore the extent of the literature on Indigenous mental health and services during COVID-19; identify gaps in this literature; identify barriers and supports for the Indigenous community, and explore the intersection of community and cultural impacts to mental health. Themes of the scoping review included: Historical Context; Challenges in Culturally-Based Services; and Strengths in Culturally-Based Services. Meta themes across narrative interviews included: Virtual Transitions; Financial Support for Indigenous Services; Health Service Delivery & Wellbeing; and Culture & Community Connection. The results of this scoping review and narrative interviews provide wide application and contribution to the mental health literature, as well as recommendations for policy, service provision, autonomy in Indigenous health and wellbeing, and crucial insights into the present and enduring mental health needs of Indigenous Peoples throughout the COVID-19 pandemic.

Keywords: indigenous community services, indigenous mental health, indigenous scoping review, indigenous peoples and Covid-19

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11380 Country Experience on Regulation of Traditional Medicine in Eritrea

Authors: Liya Abraham

Abstract:

Eritrea is located along the Red Sea, north of the Horn of Africa, between Djibouti and Sudan and has a population of about 3.2 million as of 2010. It has six administrative regions; Anseba, Debub, Debubawi K’eyih Bahri, Gash-Barka, Ma'akel, and Semenawi K’eyih Bahri. Eritrea has got its independence in 1991 after 30 years war of liberation. The country is blessed with various medicinal flora and fauna, and marine and terrestrial biodiversity. Traditional Medicine (TM) has been an integral part of the Eritrean culture for centuries. So far, more than 19 TM modalities have been recognized, and are broadly categorized as; herbal, procedure-based and spiritual. Despite the availability of modern medicine to the majority of the population, TM is still widely practiced. The rationale behind widespread use is accessibility, affordability and cultural acceptability. Hence, TM is of great contribution to the Eritrean health care system. As a matter of fact, harnessing the potential contribution of effective and safe TM in order to attain Universal Health Coverage (UHC) has been emphasized in the WHO TM strategy 2014-2023. The Eritrean TM, however, was operating without regulation and reliable scientific justification behind its safety and efficacy. Thus, the Ministry of Health (MoH), in recognition of the role of TM in primary healthcare and safeguard public health, established a regulatory body for TM so-called as Traditional Medicine Unit (TMU) in 2012. The mission of the unit is to ensure rational TM use through an integrated health service delivery system and contribute to the country’s economic and social development. The unit has established its national TM policy in 2017. The activities of the unit are guided by the National TM Advisory Committee (TMAC), responsible for the provision of technical assistance and advisory role. Moreover, the Legal Framework and Code of Ethics and Practice which provide a legal basis for the regulation of TM have also been drafted. In recognition of the importance of TM research and development, the unit launched a nationwide TM survey in 2017 and had surveyed two zones (Gash-Barka and Debub). The findings of the survey were subjected to a research dissemination workshop and publication in international journals. Furthermore, TM-related adverse events reporting tool (Green Form) aiming to guide regulatory interventions and researches have been established by the unit, and ever since reports are flowing. The unit has also been offering training to THPs, pharmacy students and health care professionals regarding TM and its regulatory activities. In addition, as part of the establishment of the national medicinal plants' database and herbal monograph, more than 329 and 30 medicinal plants, have been compiled respectively. In conclusion, TM is still widely accepted and practiced in Eritrea. The TMU ever since its establishment is endeavoring to ensure the safety and efficacy of the TM, and its integration in the mainstream health service delivery system.

Keywords: efficacy, regulation, safety, traditional medicine, traditional medicine unit, universal health coverage

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