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Community-directed mass drug administration is undermined by status seeking in friendship networks and inadequate trust in health advice networks.

ABSTRACT: Over 1.9 billion individuals require preventive chemotherapy through mass drug administration (MDA). Community-directed MDA relies on volunteer community medicine distributors (CMDs) and their achievement of high coverage and compliance. Yet, it is unknown if village social networks influence effective MDA implementation by CMDs. In Mayuge District, Uganda, census-style surveys were conducted for 16,357 individuals from 3,491 households in 17 villages. Praziquantel, albendazole, and ivermectin were administered for one month in community-directed MDA to treat Schistosoma mansoni, hookworm, and lymphatic filariasis. Self-reported treatment outcomes, socioeconomic characteristics, friendship networks, and health advice networks were collected. We investigated systematically missed coverage and noncompliance. Coverage was defined as an eligible person being offered at least one drug by CMDs; compliance included ingesting at least one of the offered drugs. These outcomes were analyzed as a two-stage process using a Heckman selection model. To further assess if MDA through CMDs was working as intended, we examined the probability of accurate drug administration of 1) praziquantel, 2) both albendazole and ivermectin, and 3) all drugs. This analysis was conducted using bivariate Probit regression. Four indicators from each social network were examined: degree, betweenness centrality, closeness centrality, and the presence of a direct connection to CMDs. All models accounted for nested household and village standard errors. CMDs were more likely to offer medicines, and to accurately administer the drugs as trained by the national control programme, to individuals with high friendship degree (many connections) and high friendship closeness centrality (households that were only a short number of steps away from all other households in the network). Though high (88.59%), additional compliance was associated with directly trusting CMDs for health advice. Effective treatment provision requires addressing CMD biases towards influential, well-embedded individuals in friendship networks and utilizing health advice networks to increase village trust in CMDs.

SUBMITTER: Chami GF

PROVIDER: S-EPMC5446315 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Community-directed mass drug administration is undermined by status seeking in friendship networks and inadequate trust in health advice networks.

Chami Goylette F GF Kontoleon Andreas A AA Bulte Erwin E Fenwick Alan A Kabatereine Narcis B NB Tukahebwa Edridah M EM Dunne David W DW

Social science & medicine (1982) 20170408

Over 1.9 billion individuals require preventive chemotherapy through mass drug administration (MDA). Community-directed MDA relies on volunteer community medicine distributors (CMDs) and their achievement of high coverage and compliance. Yet, it is unknown if village social networks influence effective MDA implementation by CMDs. In Mayuge District, Uganda, census-style surveys were conducted for 16,357 individuals from 3,491 households in 17 villages. Praziquantel, albendazole, and ivermectin w ...[more]

PMID: 28458073

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Project description:The current study aims to examine the discourse patterns and strategies of advice-seeking and advice-giving through Arabic computer-mediated communication (CMC) in the medical context. The contribution of this study lies in examining and analyzing the discourse patterns of CMC between patients and doctors in Arabic, how these patterns help doctors understand the advice sought and inquiries made by their patients, and how they help patients understand the comments made by their doctors on their inquiries. The data consist of 300 messages categorized into 150 advice-seeking (postings) and 150 advice-response (replies) messages. They were manually collected from a public medical website by copying and pasting them into an Excel spreadsheet for coding and statistical analyses. Two models were used to analyze the speech acts of advice. Morrow's model was used for advice-seeking, while Hinkel's taxonomy was used for advice responses, after some modifications were made to both models. The findings revealed that advice-seeking and advice-response messages had three parts: opening, middle, and closing. The study revealed that both patients and doctors used the opening and closing parts occasionally, unlike the middle part, which was used more often. For advice-seeking, describing the medical problem was the most frequent strategy used by patients when they asked for advice, followed by yes/no questions. These types of strategies were used in advice-seeking more frequently than others. Additionally, it was found that asking yes/no questions and describing the medical problem was the most frequent compound strategy used by patients seeking advice. However, for advice responses, the results revealed that giving clarification/information was the most frequent strategy used by doctors, followed by direct advice. When compared with other types, these two types were used frequently in the advice responses. The results also demonstrated that giving clarification/information and direct advice was the most frequent compound strategy used by doctors in advice responses.

Project description:BackgroundThis study attempted to identify the sources of job stress according to job position and investigate how friendship networks affect job stress.MethodsQuestionnaires based on The Health Professions Stress Inventory (HPSI) developed by Wolfgang experienced by healthcare providers were collected from 420 nurses, doctors and radiological technologists in two general hospitals in Korea by a multistage cluster sampling method. Multiple regression analysis was used to examine the effects of friendship networks on job stress after controlling for other factors.ResultsThe severity of job stress differed according to level of job demands (p = .006); radiologic technologists experienced the least stress (45.4), nurses experienced moderate stress (52.4), and doctors experienced the most stress (53.6). Those with long-term friendships characterized by strong connections reported lower levels of stress than did those with weak ties to friends among nurses (1.3, p < .05) and radiological technologists (11.4, p < .01). The degree of cohesion among friends had a positive impact on the level of job stress experienced by nurses (8.2, p < .001) and radiological technologists (14.6, p < .1). Doctors who participated in workplace alumni meetings scored higher than those who did not. However, those who participated in alumni meetings outside the workplace showed the opposite tendency, scoring 9.4 (p < .05) lower than those who did not. The resources from their friendship network include both information and instrumental support. As most radiological technologists were male, their instrumental support positively affected their job stress (9.2, p < .05). Life information support was the primary positive contributor to control of nurses' (4.1, p < .05), radiological technologists' (8.0, p < .05) job stress.ConclusionThe strength and density of such friendship networks were related to job stress. Life information support from their friendship network was the primary positive contributor to control of job stress.

Dataset Information

Community-directed mass drug administration is undermined by status seeking in friendship networks and inadequate trust in health advice networks.

Publications

Community-directed mass drug administration is undermined by status seeking in friendship networks and inadequate trust in health advice networks.

Similar Datasets

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