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Perceptions of health providers towards the use of standardised trauma form in managing trauma patients: a qualitative study from Tanzania.

ABSTRACT: BACKGROUND:Trauma registries (TRs) are essential to informing the quality of trauma care within health systems. Lack of standardised trauma documentation is a major cause of inconsistent and poor availability of trauma data in most low- and middle-income countries (LMICs), hindering the development of TRs in these regions. We explored health providers' perceptions on the use of a standardised trauma form to record trauma patient information in Tanzania. METHODS:An exploratory qualitative research using a semi-structured interview guide was carried out to purposefully selected key informants comprising of healthcare providers working in Emergency Units and surgical disciplines in five regional hospitals in Tanzania. Data were analysed using a thematic analysis approach to identify key themes surrounding potential implementation of the standardised trauma form. RESULTS:Thirty-three healthcare providers participated, the majority of whom had no experience in the use of standardised charting. Only five respondents had prior experience with trauma forms. Responses fell into three themes: perspectives on the concept of a standardised trauma form, potential benefits of a trauma form, and concerns regarding successful and sustainable implementation. CONCLUSION:Findings of this study revealed wide healthcare provider acceptance of moving towards standardised clinical documentation for trauma patients. Successful implementation likely depends on the perceived benefits of using a trauma form as a tool to guide clinical management, standardise care and standardise data reporting; however, it will be important moving forward to factor concerns brought up in this study. Potential barriers to successful and sustainable implementation of the form, including the need for training and tailoring of form to match existing resources and knowledge of providers, must be considered.

SUBMITTER: Sawe HR

PROVIDER: S-EPMC7193390 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Perceptions of health providers towards the use of standardised trauma form in managing trauma patients: a qualitative study from Tanzania.

Sawe Hendry R HR Sirili Nathanael N Weber Ellen E Coats Timothy J TJ Reynolds Teri A TA Wallis Lee A LA

Injury epidemiology 20200501 1

<h4>Background</h4>Trauma registries (TRs) are essential to informing the quality of trauma care within health systems. Lack of standardised trauma documentation is a major cause of inconsistent and poor availability of trauma data in most low- and middle-income countries (LMICs), hindering the development of TRs in these regions. We explored health providers' perceptions on the use of a standardised trauma form to record trauma patient information in Tanzania.<h4>Methods</h4>An exploratory qual ...[more]

PMID: 32354375

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Project description:ObjectivesTrauma registries are an integral part of a well-organised trauma system. Tanzania, like many low and middle-income countries, does not have a trauma registry. We describe the development, structure, implementation and impact of a context appropriate standardised trauma form based on the adaptation of the WHO Data Set for Injury (DSI), for clinical documentation and use in a national trauma registry.SettingOur study was conducted in emergency units of five regional referral hospitals in Tanzania.ProceduresMixed methods participatory action research was employed. After an assessment of baseline trauma documentation, we conducted semi-structured interviews with a purposefully selected sample of 33 healthcare providers from all participating hospitals to understand, develop, pilot and implement a standardised trauma form. We compared the number and types of variables captured before and after the form was implemented.OutcomesChange in proportion of variables of DSI captured after implementation of a standardised trauma documentation form.ResultsPiloting and feedback informed the development of a context appropriate standardised trauma documentation paper form with carbonless copy that could be used as both the clinical chart and data capture. Among 721 patients (seen by 21 clinicians) during the initial 30-day pilot, overall variable capture was 86.4% of required variables. After modifications of the form and training of healthcare providers, the form was implemented for 7 months, during which the capture improved to 96.3% among 6302 patients (seen by 31 clinicians). The providers reported the form was user-friendly, resulted in less time documenting, and served as a guide to managing trauma patients.ConclusionsThe development and implementation of a contextually appropriate, standardised trauma form were successful, yielding increased capture rates of injury variables. This system will facilitate expansion of the trauma registry across the country and inform similar initiatives in Sub-Saharan Africa.

Project description:BackgroundThe management of asthma, which is one of the major causes of childhood morbidity and mortality has been affected by non-adherence to recommended treatment regimens with severe consequences. The aim of the present study was therefore to explore the perceptions of the children with asthma, their caregivers and their healthcare providers towards asthma and barriers to long term childhood asthma management in an institutional setting in Addis Ababa, Ethiopia.MethodsA qualitative descriptive design was followed for the present study that used individual interviews as a data collection method. The study participants were 23 pairs of children with asthma that had treatment follow-ups in two tertiary hospitals and their caregivers and eight healthcare providers who cared for these children. The data was analyzed using thematic analysis approach.ResultsThe study findings revealed that the children's reported adherence to the recommended treatment regimens was low and they along with their caregivers were facing physical, emotional and social burdens related to asthma. Some of the influencing factors affecting childhood asthma management were found to be the low-level implementation of the asthma management guidelines by the healthcare providers, limited awareness about asthma and its management by the children and their caregivers, use of traditional home remedies and religious healing on a complementary and alternative basis and inadequate education received from healthcare professionals. Further identified barriers to the adherence of especially inhaled corticosteroids appear to be the low necessity beliefs towards chronic administration of treatment regimens and concerns related with difficulty of administration, fear of side effects and general negative attitude towards it, in addition to their low availability and affordability.ConclusionsLow awareness of the biomedical treatment regimens and use of traditional home remedies and religious healing by the children with asthma and their caregivers, the low-level implementation of the asthma management guidelines as well as low access to medications may among other things contribute to the low adherence of the children to their recommended regimens. The findings support the need for implementation of asthma management guidelines, institution of strong asthma care and education programs that are sensitive to local and individual patients' and caregiver perceptions and experiences including emotional distress, the need to institute chronic care approach and ways to address patients' medication access issues.

Project description:BackgroundIn recent years, there has been an increased awareness of antimicrobial resistance in both animals and humans, which has triggered concerns over non-judicious antimicrobial use. In the United States, antimicrobial use in food-producing animals for growth promotion or improved feed efficiency is perceived as non-judicious. To facilitate judicious antimicrobial use, the United States Food and Drug Administration implemented the Veterinary Feed Directive, effective from January 1, 2017. Interventions, such as the VFD, designed to ensure the judicious use of antimicrobials among cattle producers may be more effective if the factors that inform and influence producer AMU practices are addressed. The specific objectives of this study were to determine the following among Tennessee beef cattle producers: (1) the most common drivers for using antimicrobials, (2) the perceived alternatives to antimicrobials, (3) the knowledge and perceptions regarding antimicrobial resistance, and (4) the preferred avenues for receiving information on prudent antimicrobial use. A total of 5 focus group meetings with beef producers were conducted in East, Middle, and West Tennessee. Each focus group was video recorded and thematic analysis was performed using NVivo.ResultsThe factors that producers considered to drive antimicrobial use were the type of cattle operation, disease and animal welfare, economic factors, veterinarian consultation, producer's experience and peer support, Veterinary Feed Directive, and perceived drug efficacy. Vaccination, proper nutrition, and other good management practices were considered alternatives to antimicrobial use. To encourage vaccine use among small producers, participants suggested packaging vaccines into smaller quantities. Antimicrobial resistance was perceived to be a problem affecting animal and public health. Participants suggested additional education for cattle producers on the prudent use of antimicrobials as a measure for improving antimicrobial use. The veterinarian, producer associations and meetings, and county extension agents emerged as trusted avenues for channeling information on prudent antimicrobial use to cattle producers.ConclusionsSeveral factors drive antimicrobial use among cattle producers in Tennessee. Participants generally perceived their antimicrobial use to be discreet and only when necessary. More awareness of drivers for the development of antimicrobial resistance and continuing education on prudent antimicrobial use is needed for Tennessee beef producers.

Project description:BackgroundIntimate partner violence against women is a prevailing public health problem in Tanzania, where four of ten women have a lifetime exposure to physical or sexual violence by their male partners. To be able to suggest relevant and feasible community and health care based interventions, we explored community members' understanding and their responses to intimate partner violence.MethodsA qualitative study using focus group discussions with 75 men and women was conducted in a community setting of urban Tanzania. We analysed data using a grounded theory approach and relate our findings to the ecological framework of intimate partner violence.ResultsThe analysis resulted in one core category, "Moving from frustration to questioning traditional gender norms", that denoted a community in transition where the effects of intimate partner violence had started to fuel a wish for change. At the societal level, the category "Justified as part of male prestige" illustrates how masculinity prevails to justify violence. At the community level, the category "Viewed as discreditable and unfair" indicates community recognition of intimate partner violence as a human rights concern. At the relationship level, the category "Results in emotional entrapment" shows the shame and self-blame that is often the result of a violent relationship. At the individual level, the risk factors for intimate partner violence were primarily associated with male characteristics; the category "Fed up with passivity" emerged as an indication that community members also acknowledge their own responsibility for change in actions.ConclusionsPrevailing gender norms in Tanzania accept women's subordination and justify male violence towards women. At the individual level, an increasing openness makes it possible for women to report, ask for help, and become proactive in suggesting preventive measures. At the community level, there is an increased willingness to intervene but further consciousness-raising of the human rights perspective of violence, as well as actively engaging men. At the macro level, preventive efforts must be prioritized through re-enforcement of legal rights, and provision of adequate medical and social welfare services for both survivors and perpetrators.

Project description:BACKGROUND:Self-management of exacerbations in COPD patients is important to reduce exacerbation impact. There is a need for more comprehensive and individualized interventions to improve exacerbation-related self-management behavior. The use of mobile health (mHealth) could help to achieve a wide variety of behavioral goals. Understanding of patients and health care providers perspectives towards using mHealth in promoting self-management will greatly enhance the development of solutions with optimal usability and feasibility. Therefore, the aim of this study was to explore perceptions of COPD patients and their health care providers towards using mHealth for self-management of exacerbations. METHODS:A qualitative study using focus group interviews with COPD patients (n?=?13) and health care providers (HCPs) (n?=?6) was performed to explore perceptions towards using mHealth to support exacerbation-related self-management. Data were analyzed by a thematic analysis. RESULTS:COPD patients and HCPs perceived mostly similar benefits and barriers of using mHealth for exacerbation-related self-management. These perceived benefits and barriers seem to be important drivers in the willingness to use mHealth. Both patients and HCPs strengthen the need for a multi-component and tailored mHealth intervention that improves patients' exacerbation-related self-management by determining their health status and providing adequate information, decision support and feedback on self-management behavior. Most importantly, patients and HCPs considered an mHealth intervention as support to improve self-management and emphasized that it should never replace patients' own feelings nor undermine their own decisions. In addition, the intervention should be complementary to regular contact with HCPs, as personal contact with a HCP was considered to be very important. To optimize engagement with mHealth, patients should have a positive attitude toward using mHealth and an mHealth intervention should be attractive, rewarding and safe. CONCLUSIONS:This study provided insight into perceptions of COPD patients and their HCPs towards using mHealth for self-management of exacerbations. This study points out that future mHealth interventions should focus on developing self-management skills over time by providing adequate information, decision support and feedback on self-management behavior and that mHealth should complement regular care. To optimize engagement, mHealth interventions should be attractive, rewarding, safe and tailored to the patient needs.

Project description:Substance use is a well-established, and potentially modifiable, risk factor for suicide. Suicide prevention interventions are typically framed within the biomedical paradigm and focus on addressing individual risk factors, improving access to psychiatric care, and improving the skills of medical personnel to recognise at-risk individuals. Few studies have focused on contextual factors that hinder suicide prevention in people with substance use disorders, particularly in low-resource settings. The aim of this qualitative study was to explore mental health care providers' perceptions of barriers to suicide prevention in people with substance use disorders in South Africa.Semi-structured interviews were conducted with 18 mental health care providers who worked with suicidal people with substance use disorders in Cape Town, South Africa. Data were analysed using thematic analysis and Atlas.ti software was used to code the data inductively.Two superordinate themes were identified: structural issues in service provision and broad contextual issues that pose barriers to suicide prevention. Participants thought that inadequate resources and insufficient training hindered them from preventing suicide. Fragmented service provision was perceived to lead to patients not receiving the psychiatric, psychological, and social care that they needed. Contextual problems such as poverty and inequality, the breakdown of family, and stigma made participants think that preventing suicide in people with substance use disorders was almost impossible.These findings suggest that structural, social, and economic issues serve as barriers to suicide prevention. This challenges individual risk-factor models of suicide prevention and highlights the need to consider a broad range of contextual and socio-cultural factors when planning suicide prevention interventions. Findings suggest that the responsibility for suicide prevention may need to be distributed between multiple stakeholders, necessitating intersectoral collaboration, more integrated health services, cautious use of task shifting, and addressing contextual factors in order to effectively prevent suicide in people with substance use disorders.

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Perceptions of health providers towards the use of standardised trauma form in managing trauma patients: a qualitative study from Tanzania.

Publications

Perceptions of health providers towards the use of standardised trauma form in managing trauma patients: a qualitative study from Tanzania.

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