Technical capacities needed to implement the WHO's primary eye care package for Africa: results of a Delphi process.
Ontology highlight
ABSTRACT: Objective
The aim of the study was to establish the technical capacities needed to deliver the WHO African Region's primary eye care package in primary healthcare facilities.Design
A two-round Delphi exercise was used to obtain expert consensus on the technical complexity of each component of the package and the technical capacities needed to deliver them using Gericke's framework of technical feasibility. The panel comprised nine eyecare experts in primary eyecare in sub-Saharan Africa. In each round panel members used a 4-point Likert scale to indicate their level of agreement. Consensus was predefined as ≥70% agreement on each statement. For round 1, statements on technical complexity were identified through a literature search of primary eyecare in sub-Saharan Africa from January 1980 to April 2018. Statements for which consensus was achieved were included in round 2, and the technical capacities were agreed.Results
Technical complexity statements were classified into four broad categories: intervention characteristics, delivery characteristics, government capacity requirements and usage characteristics. 34 of the 38 (89%) statements on health promotion and 40 of the 43 (93%) statements on facility case management were considered necessary technical capacities for implementation.Conclusion
This study establishes the technical capacities needed to implement the WHO Africa Office primary eye care package, which may be generalisable to countries in sub-Saharan Africa.
SUBMITTER: Aghaji A
PROVIDER: S-EPMC7986885 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundWe undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations.MethodsDrawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists.FindingsBetween Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity.InterpretationThis list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges.FundingThe Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission.TranslationsFor the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
| S-EPMC8732284 | biostudies-literature
Project description:ECOUTER (Employing COnceptUal schema for policy and Translation Engagement in Research) - French for 'to listen' - is a new stakeholder engagement method incorporating existing evidence to help participants draw upon their own knowledge of cognate issues and interact on a topic of shared concern. The results of an ECOUTER can form the basis of recommendations for research, governance, practice and/or policy. This paper describes the development of a digital methodology for the ECOUTER engagement process based on currently available mind mapping freeware software. The implementation of an ECOUTER process tailored to applications within health studies are outlined for both online and face-to-face scenarios. Limitations of the present digital methodology are discussed, highlighting the requirement of a purpose built software for ECOUTER research purposes.
| S-EPMC4911626 | biostudies-other
Project description:PurposeTo investigate leadership in clinical genomics and identify likely implications of different leadership approaches for future implementation of clinical genomics.MethodsWe undertook 37 interviews in a cross-sectional qualitative study examining implementation of clinical genomics in Australia. Participants were either nongenetic medical specialists working with genomic initiatives (e.g., immunologists, nephrologists) or working at a service/organizational level (e.g., department heads, chief medical officers). We identified participants as genomic migrants (long-established practitioners) and genomic natives (those medical specialists coming into independent practice with genomic technology in situ). Data were analyzed deductively with reference to leadership approach.ResultsLeadership approaches were often blended or reported to iteratively support development of another. There was concern at both the absence or the excess of entrepreneurial leadership (i.e., risk-taking).ConclusionEntrepreneurial leadership is needed to promote innovativeness, risk-taking, and proactivity, essential in these early stages of clinical genomics. Shared decision-making is required from a wide range of clinicians, calling for both clinical and distributed leadership. Sharing leadership, and the potential loss of positional status from formal senior positions, may prove challenging to genomics "migrants," who are essential for nurturing genomic "natives." Clinicians will need support from their organizations and professional bodies to manage the transition.
| S-EPMC7394877 | biostudies-literature
Project description:BackgroundThere is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes add value for disaster responders. Some studies suggest that disaster responders need not only technical skills but also non-technical skills. Consensus of which non-technical skills are needed and how training for these can be provided is lacking, and little is known about how to apply knowledge of non-technical skills in the recruitment of disaster responders. Therefore, this scoping review aimed to identify the non-technical skills required for the disaster medicine response.MethodA scooping review using the Arksey & O´Malley framework was performed. Structured searches in the databases PuBMed, CINAHL Full Plus, Web of Science, PsycInfo and Scopus was conducted. Thereafter, data were structured and analyzed.ResultsFrom an initial search result of 6447 articles, 34 articles were included in the study. These covered both quantitative and qualitative studies and different contexts, including real events and training. The most often studied real event were responses following earthquakes. Four non-technical skills stood out as most frequently mentioned: communication skills; situational awareness; knowledge of human resources and organization and coordination skills; decision-making, critical-thinking and problem-solving skills. The review also showed a significant lack of uniform use of terms like skills or competence in the reviewed articles.ConclusionNon-technical skills are skills that disaster responders need. Which non-technical skills are most needed, how to train and measure non-technical skills, and how to implement non-technical skills in disaster medicine need further studies.
| S-EPMC10988843 | biostudies-literature
Project description:Visual impairment is a significant public health concern, particularly in low- and middle-income countries where eye care is predominantly provided at the primary healthcare (PHC) level, known as primary eye care. This study aimed to perform an evaluation of primary eye care services in three districts of South Africa and to assess whether an ophthalmic health system strengthening (HSS) package could improve these services. Baseline surveys were conducted in Cape Winelands District, Johannesburg Health District and Mopani District at 14, 25 and 36 PHC facilities, respectively. Thereafter, the HSS package, comprising group training, individual mentoring, stakeholder engagement and resource provision, was implemented in 20 intervention sites in Mopani District, with the remaining 16 Mopani facilities serving as control sites. At baseline, less than half the facilities in Johannesburg and Mopani had dedicated eye care personnel or sufficient space to measure visual acuity. Although visual acuity charts were available in most facilities, <50% assessed patients at the correct distance. Median score for availability of nine essential drugs was <70%. Referral criteria knowledge was highest in Cape Winelands and Johannesburg, with poor clinical knowledge across all districts. Several HSS interventions produced successful outcomes: compared to control sites there was a significant increase in the proportion of intervention sites with eye care personnel and resources such as visual acuity charts (p = 0.02 and <0.01, respectively). However, engaging with district pharmacists did not improve availability of essential drugs (p = 0.47). Referral criteria knowledge improved significantly in intervention sites (p<0.01) but there was no improvement in clinical knowledge (p = 0.76). Primary eye care in South Africa faces multiple challenges with regard to organisation of care, resource availability and clinical competence. The HSS package successfully improved some aspects of this care, but further development is warranted together with debate regarding the positioning of eye services at PHC level.
| S-EPMC5951550 | biostudies-literature
Project description:BackgroundThe Stochastic Process Model (SPM) represents a general framework for modeling the joint evolution of repeatedly measured variables and time-to-event outcomes observed in longitudinal studies, i.e., SPM relates the stochastic dynamics of variables (e.g., physiological or biological measures) with the probabilities of end points (e.g., death or system failure). SPM is applicable for analyses of longitudinal data in many research areas; however, there are no publicly available software tools that implement this methodology.ResultsWe developed an R package stpm for the SPM-methodology. The package estimates several versions of SPM currently available in the literature including discrete- and continuous-time multidimensional models and a one-dimensional model with time-dependent parameters. Also, the package provides tools for simulation and projection of individual trajectories and hazard functions.ConclusionIn this paper, we present the first software implementation of the SPM-methodology by providing an R package stpm, which was verified through extensive simulation and validation studies. Future work includes further improvements of the model. Clinical and academic researchers will benefit from using the presented model and software. The R package stpm is available as open source software from the following links: https://cran.r-project.org/package=stpm (stable version) or https://github.com/izhbannikov/spm (developer version).
| S-EPMC5324240 | biostudies-literature
Project description:This study tested technical and relational processes hypothesized to explain the therapeutic benefit of an efficacious brief motivational interview (BMI). A randomized controlled trial compared the efficacy of a BMI to an attention-matched control (i.e., relaxation training [REL]) for reducing heavy alcohol consumption and associated negative consequences. Participants were underage, past-month heavy drinkers recruited from community settings (N = 167; ages 17-20; 62% female; 59% White). Data were collected on session recordings, using established motivational interviewing process measures. Statistical analyses followed 3 steps. First, a latent class model determined the optimal class solution for characterizing proportion change talk means within BMI and REL. Next, the probability of proportion change talk class membership was examined as a mediator and then as a moderated mediator of BMI efficacy. The latent class model yielded a 3-class solution, including a low-increasing proportion change talk class (n = 61), a moderate-increasing proportion change talk class (n = 97), and a nonlinear proportion change talk class (n = 7). Across the outcomes examined, membership in the moderate-increasing class rather than the low-increasing class mediated BMI effects on alcohol-related consequences at 6 weeks. Mediation tests for consequences at 3 months and heavy drinking were nonsignificant. Moderated mediation results for therapist empathy and MI Spirit were nonsignificant. Findings suggest that moderate increases in prochange statements, relative to anti- or neutral-change statements, help explain BMI effects on reducing alcohol-related negative consequences soon after intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
| S-EPMC6405317 | biostudies-literature
Project description:Background and aimsConsensus regarding an optimal algorithm for endoscopic treatment of papillary adenomas has not been established. We aimed to assess the existing degree of consensus among international experts and develop further concordance by means of a Delphi process.MethodsFifty-two international experts in the field of endoscopic papillectomy were invited to participate. Data were collected between August and December 2019 using an online survey platform. Three rounds were conducted. Consensus was defined as ≥70% agreement.ResultsSixteen experts (31%) completed the full process, and consensus was achieved on 47 of the final 79 statements (59%). Diagnostic workup should include at least an upper endoscopy using a duodenoscope (100%) and biopsy sampling (94%). There should be selected use of additional abdominal imaging (75%-81%). Patients with (suspected) papillary malignancy or over 1 cm intraductal extension should be referred for surgical resection (76%). To prevent pancreatitis, rectal nonsteroidal anti-inflammatory drugs should be administered before resection (82%) and a pancreatic stent should be placed (100%). A biliary stent is indicated in case of ongoing bleeding from the papillary region (76%) or concerns for a (micro)perforation after resection (88%). Follow-up should be started 3 to 6 months after initial papillectomy and repeated every 6 to 12 months for at least 5 years (75%).ConclusionsThis is the first step in developing an international consensus-based algorithm for endoscopic management of papillary adenomas. Surprisingly, in many areas consensus could not be achieved. These aspects should be the focus of future studies.
| S-EPMC8878358 | biostudies-literature
Project description:IntroductionIn the last decade, there has been increased global policy and program momentum to promote early childhood development. The Care for Child Development (CCD) package, developed by UNICEF and the WHO, is a key tool responding to the global demand. The CCD package comprises two age-specific evidence-based recommendations for caregivers to 1) play and communicate and 2) responsively interact with their children (0-5 years) and was designed to be integrated within existing services to strengthen nurturing care for child development. The aim of this report was to provide an up-to-date global review of the implementation and evaluation of the CCD package.MethodsIn addition to a systematic review of 55 reports, we interviewed 23 key informants (including UNICEF and WHO personnel) to better understand the implementation of CCD.ResultsThe CCD package has been or is being implemented in 54 low- and middle-income countries and territories, and it has been integrated into government services across the health, social, and education sectors in 26 countries. Across these contexts, CCD has been adapted in three primary ways: 1) translations of CCD materials (mostly counseling cards) into local language(s), 2) adaptations of CCD materials for the local context, vulnerable children, or a humanitarian/emergency setting (e.g., including local play activities, using activities that are better suited to children with visual impairments), and 3) substantive modifications to the content of CCD materials (e.g., expansion of play and communication activities, addition of new themes, creation of a structured curriculum). While there is promising evidence and examples of good implementation practice, there has been mixed experience about implementation of CCD with respect to adaptation, training, supervision, integration into existing services, and monitoring implementation fidelity and quality. For example, many users of CCD found difficulties with training the workforce, garnering buy-in from governments, and ensuring benefits for families, among others.DiscussionAdditional knowledge on how to improve the effectiveness, implementation fidelity and quality, and acceptance of CCD is needed. Based on the findings of the review we make recommendations for future efforts to implement CCD at-scale.
| S-EPMC9978394 | biostudies-literature
Project description:UnlabelledThe objective of this study was to empirically demonstrate the use of a new framework for describing the strategies used to implement quality improvement interventions and provide an example that others may follow. Implementation strategies are the specific approaches, methods, structures, and resources used to introduce and encourage uptake of a given intervention's components. Such strategies have not been regularly reported in descriptions of interventions' effectiveness, or in assessments of how proven interventions are implemented in new settings. This lack of reporting may hinder efforts to successfully translate effective interventions into "real-world" practice. A recently published framework was designed to standardize reporting on implementation strategies in the implementation science literature. We applied this framework to describe the strategies used to implement a single intervention in its original commercial care setting, and when implemented in community health centers from September 2010 through May 2015. Per this framework, the target (clinic staff) and outcome (prescribing rates) remained the same across settings; the actor, action, temporality, and dose were adapted to fit local context. The framework proved helpful in articulating which of the implementation strategies were kept constant and which were tailored to fit diverse settings, and simplified our reporting of their effects. Researchers should consider consistently reporting this information, which could be crucial to the success or failure of implementing proven interventions effectively across diverse care settings.Trial registrationclinicaltrials.gov Identifier: NCT02299791.
| S-EPMC4975638 | biostudies-literature