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Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries.

ABSTRACT: Objectives: To describe the process of adapting an intervention integrating occupational safety and health (OSH) and health promotion for manufacturing worksites in India and the challenges faced in implementing it; and explore how globalization trends may influence the implementation of these integrated approaches in India and other low- and middle-income countries (LMICs).

Methods: This study-conducted in 22 manufacturing worksites in Mumbai, India-adapted and implemented an evidence-based intervention tested in the U.S. that integrated OSH and tobacco control. The systematic adaptation process included formative research and pilot testing, to ensure that the tested intervention was tailored to the local setting. We used qualitative methods and process evaluation to assess the extent to which this intervention was implemented, and to explore barriers to implementation.

Results: While participating worksites agreed to implement this intervention, not all components of the adapted intervention were implemented fully in the 10 worksites assigned to the intervention condition. We found that the OSH infrastructure in India focused predominantly on regulatory compliance, medical screening (secondary prevention) and the treatment of injuries. We observed generally low levels of leadership support and commitment to OSH, evidenced by minimal management participation in the intervention, reluctance to discuss OSH issues with the study team or workers, and little receptivity to recommendations resulting from the industrial hygienist's reports.

Conclusion: India presents one example of a LMIC with a rising burden of non-communicable diseases and intensified exposures to both physical and organizational hazards on the job. Our experiences highlight the importance of national and global trends that shape workers' experiences on the job and their related health outcomes. Beyond a singular focus on prevention of non-communicable diseases, coordinated national and international efforts are needed to address worker health outcomes in the context of the conditions of work that clearly shape them.

SUBMITTER: Sorensen G

PROVIDER: S-EPMC5570315 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries.

Sorensen Glorian G Nagler Eve M EM Pawar Pratibha P Gupta Prakash C PC Pednekar Mangesh S MS Wagner Gregory R GR

PloS one 20170824 8

<h4>Objectives</h4>To describe the process of adapting an intervention integrating occupational safety and health (OSH) and health promotion for manufacturing worksites in India and the challenges faced in implementing it; and explore how globalization trends may influence the implementation of these integrated approaches in India and other low- and middle-income countries (LMICs).<h4>Methods</h4>This study-conducted in 22 manufacturing worksites in Mumbai, India-adapted and implemented an evide ...[more]

PMID: 28837688

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Project description:INTRODUCTION:Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs. METHODS:A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project's Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers. RESULTS:The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before-after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6?months after the intervention. CONCLUSION:The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.

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Project description:BackgroundMassive Open Online Courses (MOOCs) have the potential to improve access to quality education for health care workers (HCWs) globally. Although studies have reported on the use of MOOCs in low- and middle-income countries (LMICs), our understanding of the scope of their utilization or access barriers and facilitators for this cohort is limited. We conducted a scoping review to map published peer-reviewed literature on MOOCs for HCW education in LMICs. We systematically searched four academic databases (Scopus, Web of Science, PubMed, ERIC) and Google Scholar, and undertook a two-stage screening process. The analysis included studies that reported on MOOCs relevant to HCWs' education accessed by HCWs based in LMICs.ResultsThe search identified 1,317 studies with 39 studies included in the analysis, representing 40 MOOCs accessed in over 90 LMICs. We found that MOOCs covered a wide range of HCWs' including nurses, midwives, physicians, dentists, psychologists, and other workers from the broader health care sector, mainly at a post-graduate level. Dominant topics covered by the MOOCs included infectious diseases and epidemic response, treatment and prevention of non-communicable diseases, communication techniques and patient interaction, as well as research practice. Time contribution and internet connection were recognized barriers to MOOC completion, whilst deadlines, email reminders, graphical design of the MOOC, and blended learning modes facilitated uptake and completion. MOOCs were predominantly taught in English (20%), French (12.5%), Spanish (7.5%) and Portuguese (7.5%). Overall, evaluation outcomes were positive and focused on completion rate, learner gain, and student satisfaction.ConclusionWe conclude that MOOCs can be an adequate tool to support HCWs' education in LMICs and may be particularly suited for supporting knowledge and understanding. Heterogeneous reporting of MOOC characteristics and lack of cohort-specific reporting limits our ability to evaluate MOOCs at a broader scale; we make suggestions on how standardized reporting may offset this problem. Further research should focus on the impact of learning through MOOCs, as well as on the work of HCWs and the apparent lack of courses covering the key causes of diseases in LMICs. This will result in increased understanding of the extent to which MOOCs can be utilized in this context.

Project description:The hemoglobinopathies, collectively, are cause for significant morbidity and mortality. Children are the most severely affected. Despite much of the genetics and biology of hemoglobinopathies being known for a long time, and being used successfully in some countries to systematically reduce burden of disease, many low and medium income countries remain practically untouched by recent developments in human genomics involving the systematic collection and sharing of variation data to fighting hemoglobinopathies (notably thalassaemias and sickle cell disease, but also G6PD). Commitment to systematic variant data collection is increasing, but this is occurring mostly in high-income countries where much of the diagnosis and testing takes place. There is a risk that countries with the highest burden of these diseases are being left behind in a form of “genomic divide”. Capacity to generate quality data on variants, to store this information so that it can be shared internationally, needs to be built in these countries. Tackling hemoglobinopathies is an ideal entry point for these countries to develop the necessary infrastructure and expertise that can expand into other areas of health. This genomic capacity will enable building: (I) the genetic evidence base for better management of delivery of local treatment, care and eventually even cure; (II) a foundation for genomic medicine by working with national, regional and local health care professionals to raise public awareness of the genetic basis of hemoglobinopathies. Global Globin 2020 Challenge has been initiated with two goals: (I) to see growth in the quality and quantity of curated inputs into internationally recognized genetic databases from low- and middle-income countries participating in the project, and to harmonize the sharing of all relevant variant data between countries in accordance with international best practice that integrates all the relevant ethical and regulatory frameworks and policies required to protect patients at the same time that the biotechnical procedures are developed; (II) to ensure that the storage, curation and sharing of the relevant DNA variation information is sustainable in the medium and longer term by expanding and strengthening the international network of professionals, including curators, researchers, clinicians, bioinformaticians, counsellors, patient groups and policymakers. Pursuit of these goals will raise the profile of genomic medicine in low and middle income countries in national, regional and international research organizations. It will also develop the capability of professionals required for diagnosing, treating and counseling carriers in low and middle income countries thus giving them a greater voice and profile among genomic researchers globally so they can actively participate in regional and international partnerships related to genomic research. Initially the GG2020 Challenge will focus on a group of countries that have already formed groups of the relevant professionals including: Belgium, China, Cyprus, Egypt, France, Malaysia, Mexico, Mozambique, Nigeria, South Africa, Venezuela, Vietnam, Portugal, and The Netherlands. Other countries are ready to be included as the project expands. HVP will utilize its relationship with both UNESCO and WHO to ensure that the necessary international standards and procedures are developed in a consultative and harmonized manner.

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Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries.

Publications

Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries.

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