Browsing by Subject "Health education"
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Item Embargo Adaptation and Translation of Cancer Stigma Scale to Evaluate Perceived and Experienced Stigma among Pediatric Cancer Patients in Mwanza, Tanzania(2024) Pham, HongBackground: The Cataldo Cancer Stigma Scale (CASS) was developed to measure patient experienced and perceived stigma and was further modified for use in the pediatric patient population. This study aimed to adapt and translate a Swahili version of the CASS for use in the Tanzanian pediatric patient population to measure cancer stigma and identify the types of stigma pediatric cancer patients face. Methods: Approximately 40 items were extracted from two prior developmental and validation studies of the CASS that assessed stigma in adult patients and non-patient cohorts. The survey items, developed initially in English, underwent translation into Swahili, back-translated, reconciled, and screened for duplications. The translated items were refined using concurrent cognitive interviewing. Results: After three rounds of cognitive interviews with 15 respondents, comprehension of the survey questions was assessed and improved with all items reaching at least 80% comprehension. Additional reviews included grammar and specific Swahili word selection changes to clarify the question’s meaning. Duplications or repetition of sentences were also considered to remove questions from the survey. The final survey comprised 25 survey items with 7 stigma sub-categories. Conclusions: This study sheds light on the complex nature of cancer-related stigma in pediatric patients. For future purposes, research is needed to validate the CASS survey with a larger sample of the population, including a comparison stigma assessment to establish validity.
Item Open Access Assessing Facilitators and Barriers to Sickle Cell Disease (SCD) Testing and Treatment and Comparing the Effectiveness of Arts-Based vs. School-Based Community-Engaged SCD Education Outreach Programs for Adolescents in Kalangala, Uganda(2022) Nam, JeehaeAbstractBackground: With the bulk of global sickle cell disease (SCD) research primarily focusing on high-income/low-burden countries, countries such as Uganda continue to report the highest rates of SCD as a result of this inequity. Three out of four of those affected worldwide are born in sub-Saharan Africa (Macharia et al., 2018). The primary goals of the study are to address the current research gap in the acceptability and feasibility of SCD interventions among youth in Kalangala, Uganda by understanding 1) the efficacy of various education modalities to improve SCD knowledge among adolescents, 2) changes in health behaviors, self-perception, and family planning among adolescents after SCD education interventions, and 3) the impact of SCD-related stigma on willingness to access SCD screening, treatment, and knowledge. Youth stakeholders are the primary target population of this study. Youth stakeholders provide a unique perspective apart from their adult counterparts, as this demographic starts to consider the interconnectedness of individual health, family planning, and health access. Methods: Sixty-five stakeholders contributed to a total of 18 interviews (8 focus group discurssion; 10 in-depth interviews). The study incorporated an applied thematic analysis for all interviews to assess knowledge and perceptions of SCD, facilitators and barriers to SCD services, and outlooks on individual and family health. Results: Due to COVID-19 restrictions, this study was permitted to complete in-depth interviews and focus group discussions among youth. Analysis revealed that participants were not aware of the pathology of SCD, but were familiar with the social and health implications of having SCD. The most frequent facilitators and barriers included: access to SCD education; stigma; community engagement; and economic barriers. Conclusions: Findings from this study indicate potential areas for further engagment with youth stakeholders through health interventions that offer education in SCD pathology, and available services in order to mitigate the effects of SCD in a low-resource and vulnerable area. In addition, there is a need to address stigma and misconceptions in SCD, which requires a multi-sectoral and interdisciplinary approach that engages all community stakeholders. This study can inform future SCD interventions among youth members in Kalangala, Uganda.
Item Open Access Association Between E-learning System Usage and Medical Student Academic Performance at the Kilimanjaro Christian Medical University College in Moshi, Tanzania(2018) Murray, MargaretAbstract
Introduction: Due to Tanzania’s rising population and shortage of physicians, there has been an emphasis on the expansion of medical schools in the past two decades, both in number and class size. In order to teach a growing student body, faculty adopted e-learning (electronic learning) systems to distribute materials and educate students. At Kilimanjaro Christian Medical University College (KCMUCo) faculty adopted the e-learning system called Learning Management Content System (LCMS+) in 2011. LCMS+ allowed students to access and download course materials during the year; but the association between the downloaded course materials and final grade was unknown. This study aimed to analyze the association between the downloaded materials and final grade in a course between 2011 and 2016.
Methods: To determine the association between downloaded materials and grade, a retrospective analysis study studied first- and second-year medical students in seven courses from 2011-2016 at KCMUCo. The study initially measured the frequency of downloaded course material (i.e. powerpoints, readings, assignments, course outlines and discussion board posts) from LCMS+ per first and second-year student. The final course grades were then obtained. A linear regression was used to assess the association between (1) downloads and grade and (2) sociodemographic variables and grade.
Results: Of the 1,527 students and 5,205 student-course-years studied, there was a weak or null association between downloaded materials and grade for each year and for different types of downloaded material. The distributions of the grades were approximately normal from 2011-2014 and in 2014-2016 there was a left shift of grade distribution. Additionally the female sex and post-service history were associated with slightly lower grades in some of the student years.
Conclusion: This study demonstrated there was no strong association between the number of downloads and grade. There was also no association between the type of downloaded material and grade and the number of materials did not increase the longer the e-learning system was at KCMUCo. More research on how e-learning systems can benefit students is required and may lead to better training for future generations of health care providers.
Item Embargo Associations Between Perceived Stress, Mental Distress, and Susceptibility to Multiple Tobacco Product Uptake Among U.S. Adolescents and Young Adults Who Have Never Smoked(2024) Frisbee, Suzanne MichelleThe prevalence of single combustible tobacco product use has decreased among adolescents and young adults (AYAs) in recent years, but the introduction of alternative tobacco products has led to increases in dual- or poly-use, especially among AYAs. Understanding susceptibility to multiple tobacco product (MTP) use is crucial, as it predicts initiation and subsequent use. Mental distress, including stress and mental health symptoms, may influence susceptibility and harm perceptions, yet this area remains underexplored in the literature. This dissertation aims to fill this gap by examining the influence of mental distress on susceptibility to MTP use among AYAs and whether it alters harm perceptions. By addressing these questions, this research aims to develop effective prevention techniques to prevent substance use initiation and reduce susceptibility among vulnerable populations, ultimately improving long-term health outcomes.Chapter 1 of this dissertation further introduces the background and context of this critical issue at the intersection of mental health and tobacco uptake among the AYA population in the United States, setting the stage for understanding the multifaceted relationship between mental health, stress, tobacco use, and susceptibility among AYAs, and laying a strong foundation for the subsequent chapters' detailed exploration and analysis. The theoretical framework guiding the dissertation is introduced to provide a structured lens through which to examine the complex interplay of factors influencing tobacco use behaviors among AYAs. This framework incorporates theories from psychology, public health, and dependence studies, offering a comprehensive approach to understanding the pathways and mechanisms that contribute to susceptibility and initiation of tobacco product use in this vulnerable population. Chapter 2 was a systematic scoping review which employed the Joanna Briggs Institute (JBI) method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to explore factors associated with multiple tobacco product (MTP) susceptibility, uptake, and use among U.S. adolescents and young adults. A comprehensive search strategy in PsycINFO and PubMed databases yielded 52 eligible articles published from 2013 onwards. Data extraction focused on demographic, individual, familial, social, environmental, and societal factors influencing MTP use. Key findings revealed higher susceptibility to MTP use among older adolescents and males, with Hispanic and Non-Hispanic Black adolescents also exhibiting elevated susceptibility to MTP use. Factors such as intentions to use tobacco, peer and parental tobacco use, and limited exposure to pro-smoking media were associated with susceptibility to MTP use. Additionally, e-cigarette use was linked to subsequent cigarette smoking initiation, while experimentation with MTP was influenced by parental use and tobacco marketing exposure. Progression to MTP use involved concurrent use of multiple products, with sociodemographic characteristics and environmental influences playing significant roles. These findings underscore the complex interplay of factors shaping tobacco use behaviors among adolescents and young adults, highlighting areas for further research and targeted interventions. Chapter 3 employed two pilot studies to examine the relationship between mental health factors (perceived stress, anxiety, and depression) and susceptibility to hookah tobacco smoking among adolescents and young adults; examining differences based on susceptibility status and exploring the predictive role of these factors while considering known risk factors and covariates. Statistical analyses using were conducted across two studies to explore demographic characteristics and predictor variables related to susceptibility and smoking status among young adults. Chi-square tests, t-tests (Study 1), and ANOVAs (Study 2) were utilized for comparisons, alongside bivariate logistic regression and proportional logistic regression for relationship exploration. Findings from Study 1 revealed that perceived stress was a significant predictor, with susceptible young adults reporting higher stress levels, indicating a potential link to susceptibility to hookah tobacco smoking (HTS). Peer acceptability and harm perceptions also emerged as influential factors. Study 2 showed differences in psychological distress levels between non-susceptible individuals and hookah users, highlighting the role of psychological factors in HTS behaviors. A positive linear trend in stress, anxiety, and depression levels from susceptibility status transitions (i.e., from non-susceptible, to susceptible, to use) underscored the need for comprehensive interventions targeting multiple risk factors. The consistent predictive power of perceived stress emphasizes its importance in addressing susceptibility to HTS among young adults. These findings advocate for tailored interventions addressing psychological, social, and demographic factors collectively to reduce susceptibility and prevent HTS initiation effectively. Chapter 4 utilized a national dataset (the Population Assessment on Tobacco and Health) to explore longitudinal links between multiple tobacco product (MTP) susceptibility, mental health symptoms, product harm perceptions and initiation of MTP use among AYAs in the US. We first examined whether increased externalizing and internalizing symptoms predicted changes in susceptibility to MTP use. Longitudinal parallel-process (LPP) modeling was used, involving multilevel modeling (MLM) and structural equations modeling (SEM) considering age group as the major predictor. We also examined whether harm perceptions mediated any relationships between mental distress and susceptibility, adjusting for covariates. We then examined if harm perceptions predicted MTP uptake. Cox-proportional hazard regression analyzed relationships between harm perceptions and MTP uptake. A linear regression model estimated longitudinal relationships between harm perceptions and susceptibility status. Mediation analysis determined if susceptibility status mediated the relationship between harm perceptions and MTP uptake. Lastly, as an exploratory analysis, we examined the interaction between mental distress and susceptibility on MTP uptake. We utilized intercepts and slopes for each variable in analyses to provide insights into how these factors evolve over time. Among a sample of AYAs who reported never smoking cigarettes, e-cigarettes, hookah tobacco, nor cigars (traditional, filtered, and cigarillos) at Wave 1, we found that non-susceptible individuals had higher perceived harm and lower mental health symptoms than susceptible individuals. Susceptibility was highest during the transition from ages 12-14 to 15-17, highlighting a critical period for intervention. Young adults showed higher initiation rates of MTP by Wave 6, emphasizing the need for targeted interventions during the transition to adulthood. Unexpectedly, higher initial levels of mental distress were associated with reduced susceptibility to MTP use, challenging conventional assumptions. Perceptions of harm mediated these relationships variably, indicating complex pathways influencing MTP use initiation. Further investigation using Cox-proportional hazard regression models confirmed that higher initial and increasing perceptions of harm over time were protective against MTP initiation. However, contrary to expectations, higher initial harm perceptions were associated with increased susceptibility initially. Initial susceptibility partially mediated the relationship between perceptions of harm and MTP initiation, highlighting nuanced interactions. The study suggests that while mental distress influences susceptibility and perceptions of harm, its direct moderation effect on MTP initiation was not significant. These findings underscore the importance of developmental stages and social contexts in shaping MTP use behaviors, advocating for tailored interventions during critical transitions to mitigate tobacco use among AYAs. Chapter 5 concludes the dissertation by synthesizing its findings from all chapters, discussing their implications and recommendations for future research.
Item Open Access Developing a stigma responsive educational program to promote uptake of HPV-based cervical cancer screening and treatment in Kisumu, Kenya(2022) Herfel, EmilyBackground: Despite increasing availability of preventative HPV vaccines and screening strategies, uptake of these effective measures in Kisumu, Kenya is limited by cultural and logistical barriers. Limited understanding and societal perceptions of HPV and cervical cancer are potential sources of stigma that could negatively impact screening behavior. By designing and implementing a stigma-responsive educational intervention, we sought to improve understanding and risk perception and increase the likelihood cervical cancer screening.
Methods: We carried out a study of a stigma responsive strategy to deliver HPV-based cervical cancer prevention services in Kisumu, Kenya. Focus group discussions (FGDs) explored experiences of HPV and cervical cancer screening, health messaging and potential stigma sources. Qualitative analysis of the FGDs informed the development of a stigma-responsive educational video. Four Kisumu County healthcare facilities were randomized to either watch the video or receive standard HPV and cervical cancer education, after which participants at both sites completed a survey to measure HPV- and cervical cancer stigma. Stigma scores were compared between control and intervention groups using linear regression.
Results: Thirty women participated in the focus group discussions. Drivers of stigma included concerns about confidentiality and disclosure of HPV results, fears of cancer or implications of a sexually transmitted infection diagnosis. Anticipated outcomes included illness or death, financial hardship or family abandonment. The FGDs findings informed development of the educational video. A total of 288 women, 109 in the intervention group, completed the stigma survey. Mean HPV and cervical cancer scores were found to be statistically lower in the intervention arm, with Dholuo language associated with higher stigma levels in both arms.
Conclusions: This multi-step study explored knowledge, attitudes and beliefs specific to HPV and cervical cancer health messaging in western Kenya in order to develop and test a stigma-responsive education strategy. The stigma-responsive video demonstrated a quantitative decrease in stigma survey response means for those who watched the video. The pre-pilot design will drive a larger pilot study to examine the effect of the educational video on HPV self-sampling.
Item Open Access Development of a Nutritional Screening Tool for Pediatric Cancer Patients in Uganda and Tanzania: An Exploratory Analysis(2020) Ceesay, AbdoulieBackground: Nutrition is a key determinant of pediatric cancer patient outcomes in sub-Saharan Africa. Accurately identifying pediatric cancer patients at risk of malnutrition remains a challenge. There is a need for a standardized nutritional screening tool, developed and validated in sub-Saharan Africa. Study aims: The aims of this study were to: 1) select candidate variables in the development of a nutritional screening from predictors associated with malnutrition in pediatric cancer patients and, 2) conduct a secondary data analysis estimating the prevalence of pediatric cancer in Uganda from cases presented at the Uganda Cancer Institute between January 1, 2017 and December 31, 2019. Methods: This study is a longitudinal hospital-based study, carried out at the Bugando Medical Center in Tanzania and Uganda Cancer Institute in Uganda. The study enrolled clinically confirmed pediatric cancer patients (<18 years) at the study sites. Measures of interest include: nutritional status, symptom duration, abdominal distention, anthropometric measures such as height, weight, mid-upper arm circumference, abdominal circumference, triceps skinfold thickness, and clinical characteristics such as serum albumin, mean corpuscular volume, and protein. Logistic regression models examined predictors of nutritional status in pediatric cancer patients. Lastly, geospatial analysis estimated the prevalence and examined the country-wide distribution of the pediatric cancers presented at the Uganda Cancer Institute between 2017 and 2019. Results: The sample of 77 pediatric cancer patients enrolled at the two study sites ranged from 1 to 17 years old. Solid tumor malignancies like Wilms tumor comprise of 40% of all diagnoses. 60% of cancer patients were malnourished at baseline. The strongest predictors of nutritional status were mid-upper arm circumference (AOR 0.52, 95% CI: 0.31 – 0.87), abdominal circumference (AOR 1.38, 95% CI: 1.16 – 1.65) and serum albumin (AOR 0.73, 95% CI: 0.62 - 0.86). Secondary analysis of the Uganda Cancer Institute registry shows 11607 patients with confirmed cancer diagnosis between 2017 and 2019. Acute lymphoblastic leukemia (31.4%) is the most common cancer diagnosis, followed by Wilms tumor (19.1%), rhabdomyosarcoma (9.4%) and Burkitt’s lymphoma (6.9%). Blood cancers are most common cancer types, of them the most frequent cases being leukemia (37%). 2018 saw the highest number of cancer presentations within the study timeframe. Conclusions: The results show abdominal circumference, serum albumin, and muac are candidate variables in developing a nutritional screening tool for pediatric cancer patients in SSA. Blood and solid cancers are prevalent in Uganda; thus, a customized nutritional screening tool is much needed.
Item Open Access Evaluating Applied Theatre Using Amateur Community Actors as a Modality for Pedestrian Education Among Primary School Students in Moshi, Tanzania(2014) Dideriksen, ChrissyBackground: The WHO estimates that in 2010 there were over 10,000 road traffic injury related fatalities in Tanzania. Pedestrians accounted for a third of those fatalities. Education is essential to improving Tanzanians' road safety. Theatre has been used as a modality for education for many years, though most efficacy research focuses on professionally created and delivered theatre. The act of creating theatre is an inherently collaborative process, making it a good tool for participatory interventions that involve community members. Collaborative, theatre-based interventions have several benefits for global health projects: 1) they are relatively low-cost; 2) they incorporate community ideas encouraging stakeholder investment; and 3) they have potential to be self sustaining after development aid has stepped away. However, there are two main impediments to using collaborative theatre in global health interventions. First, there is little investigation on the efficacy of collaborative theatre to educate. Second, there are few guidelines to help drama-based programs take advantage of collaboration with amateur community members for health topics.
This study combined qualitative and quantitative methods to understand how participatory theatre with amateur community participants can convey health topics such as road and pedestrian safety in Tanzania. The study measured local primary students' pedestrian knowledge, evaluated theatrical performance as a method to teach pedestrian safety, and explored how community members could use drama techniques to become advocates for road traffic injury prevention. This project sought to adapt a replicable framework of applied theatre exercises to address health issues in a collaborative manner between community members and educators.
Hypothesis: Participatory theatre will increase pedestrian knowledge among primary students.
Methods: Young adult volunteers from Moshi, Tanzania participated in a month long workshop to create a performance to teach road and pedestrian safety. The workshop process was evaluated through qualitative methods, including journaling by the workshop facilitator, daily informal group discussions, and performance response cards from community leaders. At the end of the project, 17 open-ended surveys were administered in Kiswahili among the participants. A focus group with 8 participants was also conducted at the end of the project. A follow up focus group was conducted four months following the end of the project.
Workshop participants presented their play in Kiswahili to local primary schools. Knowledge assessment surveys were administered in Kiswahili to 439 primary school students. Pre and post knowledge assessment surveys were utilized to measure the impact that the community created play had on students' pedestrian knowledge.
Results: Primary school audiences showed statistical improvement between their pre and post survey scores. The average mean score improved from 71.40% of the pedestrian knowledge items correctly answered to 84.39% (P>
Item Open Access Healthy Lifestyles and Attitudes Towards Preventive Counseling: a Survey of Chinese and US Medical Students(2013) Sebranek, Matthew PaulBACKGROUND: Non-communicable diseases are currently the leading cause of death worldwide. Leading healthy lifestyles as a means of prevention is one of the most important aspects of preventing the occurrence of non-communicable diseases. Working from the premise that physicians globally serve as role models for patients and their health beliefs can influence how they interact and counsel patients, this international study ("MedLife") seeks to examine the self-report of health behaviors and clinical practice attitudes towards preventive counseling of medical students at institutions in China and the US, and identify any associations between these behaviors and students' clinical practice attitudes towards preventive counseling of future patients.
METHODS: From 2012-2013, a total of 860/1,216 (response rate = 71%) medical students from Duke University in the US and Peking University Health Science Center and Xi'an Jiaotong University in China completed culturally-adapted web versions of the 33-item "MedLife" questionnaire. Items from the survey were pulled from previously validated survey tools and included questions on diet, exercise, smoking, and alcohol consumption. Alcohol consumption was divided into heavy drinking and binge drinking. Prevalence estimates of health behaviors and attitudes towards preventive counseling in the domains of diet, exercise, smoking, and alcohol consumption were obtained in addition to measures of association between health behaviors and clinical practice attitudes towards counseling future patients on these issues. Finally, multivariate logistic regression analyses were performed to assess the associations between personal habits and clinical practice attitudes towards preventive counseling while adjusting for gender.
RESULTS: The median ages of students at Duke University in years 1, 2, 3, and 4 were 23 years, 24 years, 25 years, and 26 years, respectively. The median ages of students at both schools in China among second, fourth, and seventh year students were 19 years, 22 years, and 24 years, respectively. In addition, the percentage of total females at Duke University and in China who completed the survey was 51% and 54%, respectively. Prevalence estimates of a healthy lifestyle, defined as complying with widely recognized recommendations at Duke University in the domains of diet, exercise, smoking, non-binge drinking, and non-heavy drinking were 30%, 42%, 99%, 41%, and 97%, respectively. Prevalence estimates in China of a healthy lifestyle in diet, exercise, smoking, non-binge drinking, and non-heavy drinking were 17%, 33%, 97%, 94%, and 99%, respectively. Overall, approximately 30% of medical students at Duke and 25% of medical students in China had positive clinical practice attitudes towards preventive counseling in terms of diet, exercise, smoking, and alcohol consumption combined. No statistically significant associations between the self-report of health behaviors and clinical practice towards preventive counseling were found among Duke medical students. Second, fourth, and seventh year medical students in China together who complied with all lifestyle recommendations were two times more likely to have a positive clinical practice attitude towards preventive counseling on all healthy lifestyle domains (diet, exercise, smoking, and alcohol) combined (OR=2.03 95% CI=1.06-3.92; p=0.03). When adjusted for gender, this positive association among Chinese medical students was still statistically significant (OR=1.98 95% CI=1.02-3.83; p=0.04).
CONCLUSION: Medical students self-reported that they led unhealthy lifestyles in the domains of diet, exercise, and alcohol binge drinking at Duke and in the domains of diet and exercise in China. However, there was little evidence of an association between self-report of health behaviors and clinical practice towards preventive counseling for Duke medical students. But there was evidence among Chinese medical students to support an association between an overall self-reported healthy lifestyle and positive clinical practice attitudes towards preventive counseling on diet, exercise, smoking, and alcohol consumption combined, even after adjusting for gender. If clinicians are going to serve as role models and have their behaviors and lifestyle choices influence patients, medical schools need to ensure students lead healthy lifestyles in these areas and improve positive clinical practice attitudes towards preventive counseling on diet, exercise, smoking, and alcohol consumption to help curb the global cardiovascular disease epidemic. Student health and positive clinical practice attitudes towards preventive counseling should be a top priority for all medical schools, and it seems that policies aimed at improving student health in China are likely to be associated with positive clinical practice attitudes towards preventive counseling.
Item Open Access Impact of COVID-19 on maternal and child health services: A qualitative study of donors' perspectives(2021) Farooqi, Zoha WaqarBackground: Previous pandemics have shown that disruption of essential services could undo decades of efforts to reduce maternal and child mortality. Therefore, preventing disruption of essential services such as immunizations, skilled birth delivery, antenatal care etc. and safeguarding adequate sources of maternal and child health funding should be a key priority for governments and health donors. This study will aim to understand the impact of COVID-19 on maternal and child health services and how donors and policymakers are determining financing and policy priorities amid the COVID-19 pandemic. Methods: A qualitative study was conducted with thirteen health experts from key bilateral and multilateral organizations and international NGOs. In addition to these interviews, relevant publications such as donor policies on their responses to COVID-19 were also reviewed and synthesized. Key informants provided written consent and all interviews were audio-recorded. Results: Governments across the world should increase their efforts to sustain essential health services for mothers and children. In addition, donors must provide greater support for weak health systems by granting extensions in loan repayments and providing technical assistance and essential supplies for health workers. Use of digital technologies, collaborative information sharing processes and flexibility in funding streams have been considered the best form of support that donors can provide. Conclusion: This study contributes to understanding the key role played by contemporary global health actors involved in formulating the initial policy responses and guidelines for countries during the COVID-19 pandemic on continuation of essential services such as maternal and child health. The findings can help understand the preliminary steps taken by the donor community to respond to the pandemic and can lay the groundwork to determine the future direction of financing and key health priority areas.
Item Open Access Implementation of the NCAA Sickle Cell Trait Screening Policy: A Survey of Athletic Staff and Student-athletes.(Journal of the National Medical Association, 2018-12) Baker, Charlotte; Powell, Jill; Le, Dominic; Creary, Melissa S; Daley, Lori-Ann; McDonald, Mary Anne; Royal, Charmaine DmOBJECTIVE:To describe the perspectives and experiences of athletic trainers, coaches, and student-athletes approximately three years post-implementation of the NCAA sickle cell trait (SCT) screening policy. PARTICIPANTS:Two-hundred and eight student-athletes, 32 athletic trainers, and 43 coaches from 10 NCAA Division I (DI) institutions in North Carolina from January to June 2014. METHODS:Two online surveys were used to assess knowledge, perspectives, and experiences. RESULTS:Athletic staff were more supportive than student-athletes of the need for the policy. Noted challenges included variation in implementation and follow-up for SCT-positive athletes, financial costs to institutions and athletes, and timing of the screening. CONCLUSIONS:More education about SCT is needed for student-athletes and athletic staff in order to help make the implementation more successful. All parties need to be in agreement regarding the importance of knowing which student-athletes have SCT and how that information will be utilized.Item Open Access Implicit and Explicit Attitudes of Medical Students Towards Mental Illness: A Randomized Controlled Pilot Trial of Service User Videos to Reduce Stigma in Nepal(2018) Tergesen, CoriBackground: Many health providers worldwide stigmatize people living with mental illness, creating a barrier to providing quality mental health services. Interventions aiming to reduce stigma during medical school have utilized education and contact-based methods to improve student attitudes towards mental illness. However, the effectiveness of these methods has never before been compared in medical schools in low-income countries. The aim of this study was to evaluate a video featuring a mental health service user with depression in a randomized controlled pilot trial among medical students in Nepal. Methods: In a three-armed randomized controlled pilot trial, participants were randomized to one of three conditions: a didactic video lecture based on the mental health Gap Action Programme Implementation Guide (mhGAP-IG) depression module, a service user testimonial video about living with depression, and a condition with no video presentation. Participants were 94 second and third year medical students in Nepal. All of the measures were collected post-intervention. The primary outcome was explicit attitudes measured on the Social Distance Scale (SDS). Additional outcomes were implicit attitudes on two Implicit Association Tests (IAT), diagnostic accuracy, treatment knowledge, and symptom knowledge. Results: Both the didactic lesson (SDS mean score, M = 33.32; standard deviation, SD = 9.57) and the service user videos (M= 30.13; SD= 9.16) had lower explicit stigma after the video presentations compared to the control (M= 39.10; SD= 11.14) (F2,91= 6.37, p= 0.003, R2= 0.12), but there was no difference between the two intervention conditions (F1,61= 1.55, p= 0.23, R2= 0.02). There were no significant differences on implicit associations (IAT d score), depression diagnosis, treatment knowledge, and symptom knowledge. Conclusions: Prerecorded videos (whether didactic or service user testimonials) are scalable learning tools that have potential to reduce explicit stigma among medical students in low resources settings. Additional research is necessary to explore the differences between both didactic education and service user testimonial interventions, as well as the potential outcomes when the videos are combined. A full scale randomized controlled trial will be conducted based on these findings.
Clinical Trials Registration: CTRN NCT03231761
Item Open Access Investing in People: Health System Strengthening Through Education(2011) Stoertz, AaronHealth system strengthening is now recognized as a pressing global health priority. Motivated and productive health workers are a critical component of health systems. Low and middle-income countries need many more health workers, but not simply more of the same. Insufficient collaboration between the health and education sectors creates a crippling mismatch between professional health service education and the realities of health service delivery. A transformative scale-up of health education is needed to increase the capacity of health systems to respond to population needs. We make the case for multi-sector innovation during the scale-up of health education-- ranging from new recruitment strategies, faculty development and curricular reform on the institutional level to cross-sector planning and investment on the national level. Such a transformation will require a broad process of multi-sector reform.
In Uganda the lack of formal health management education is a barrier to improved health systems and improved population health outcomes. Duke University partnered with executive leadership from the Ugandan Catholic and Protestant medical bureaus, the public health sector and the three leading schools of health management in Uganda to conduct a series of activities to strengthen the capacity for health management and leadership in Uganda. After a formative research process to describe the national health management training landscape, the partnership surveyed health managers in the Kabarole District in western Uganda. The partnership then designed and led a five day workshop on leadership, management and governance in the Kabarole District in western Uganda.
A series of pre- and post- surveys asked workshop participants to self-report their confidence, previous use and predicted use of skills in each of the five workshop modules as well as evaluate the course content, design and instruction. These data were analyzed to determine if the workshop showed potential for health system improvement.
All but one module demonstrated significant pre to post confidence effect-size change, as well as significant self-reported intent to practice new management skills. A module-based workshop that (1) is designed with evidence gathered with a country-level and local needs assessment; (2) combines global content with local context; and (3) uses experiential learning techniques, may be an effective intervention for organizational change. Further follow-up after post-workshop mentoring activities will be important to document this process. We describe a vision for how this follow-up might take place within the larger context of the partnership's future activities. We also include a manual based on the workshop instructional materials entitled: A Teaching Manual for Health Facility Management, Leadership and Governance in Uganda.
Item Open Access Knowledge, Attitudes and Practices of Obstetric Care Providers in Bugesera District, Rwanda(2011) Puri, RuchiThere is little information regarding the knowledge, attitudes and practices of obstetric care providers in Rwanda, who are a crucial component for providing quality Safe Motherhood care. Despite investments in the structural capacity needed to deliver these services, little has been directed towards understanding the current competency of skilled providers on the front lines of maternal mortality and morbidity prevention. This study surveyed 87% of all obstetric care providers in the Bugesera District of Rwanda to determine their demographic characteristics, competency in Safe Motherhood knowledge, obstetric practices, and attitudes towards patients and training approaches. The study identified the majority of providers to be A2 level nurses (82%) who have received one year of health education in secondary school. In addition, the majority of providers expressed that both their knowledge (60.6%) and skills confidence (72.2%) across fundamental topics of Safe Motherhood care need improvement. There was a low level of demonstrated knowledge in Safe Motherhood services with a mean of 46.4% of 50 questions answered correctly. Performance of knowledge in normal labor (39.3% correct) and obstetric complications (37.1% correct) were the weakest areas identified. A high percentage of providers (60.8%) engage in the potentially harmful practice of fundal pressure during vaginal delivery, while only 15.9% of providers practice steps of the active management of the third stage of labor in 100% of their deliveries. Providers view additional education and training in emergency obstetric care (EMOC) to be very useful, with 89.3% reporting an enthusiastic willingness for participation in a two-day workshop even if it was their day off. Improving knowledge, skills and practices of obstetric providers is an essential step in improving the quality of emergency obstetric care.
Item Open Access Participatory Methods for Climate Change and Mental Health Research: Photovoice in Nepal(2016) MacFarlane, Elizabeth KingBackground: The relationship between mental health and climate change are poorly understood. Participatory methods represent ethical, feasible, and culturally-appropriate approaches to engage community members for mental health promotion in the context of climate change. Aim: Photovoice, a community-based participatory research methodology uses images as a tool to deconstruct problems by posing meaningful questions in a community to find actionable solutions. This community-enhancing technique was used to elicit experiences of climate change among women in rural Nepal and the association of climate change with mental health. Subjects and methods: Mixed-methods, including in-depth interviews and self-report questionnaires, were used to evaluate the experience of 10 women participating in photovoice. Quantitative tools included Nepali versions of Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) and a resilience scale. Results: In qualitative interviews after photovoice, women reported climate change adaptation and behavior change strategies including environmental knowledge-sharing, group mobilization, and increased hygiene practices. Women also reported beneficial effects for mental health. The mean BDI score prior to photovoice was 23.20 (SD=9.00) and two weeks after completion of photovoice, the mean BDI score was 7.40 (SD=7.93), paired t-test = 8.02, p<.001, n=10. Conclusion: Photovoice, as a participatory method, has potential to inform resources, adaptive strategies and potential interventions to for climate change and mental health.
Item Open Access Secondhand Smoke Exposure Reduction Intervention among Children in Rural China: A Cluster Randomized Controlled Trial(2021) Wang, LeitingBackground: Secondhand smoke (SHS) exposure has direct negative impacts on health, especially for vulnerable infants and young children. With the relatively higher smoking rate and lower levels of cigarette smoking-related knowledge and awareness in rural China, children were facing severe SHS exposure within households. The aim of this study is to assess whether a community health worker (CHW)–delivered tobacco control intervention for household smokers will lead to SHS exposure reduction in children in rural settings through 12-month follow-up. Methods: Households with a child aged 5 years or younger at home were randomized to the intervention group (n = 334) to receive smoking hygiene intervention or to the attention-matched comparison group (n = 334). The intervention was delivered by trained CHWs. Outcomes were assessed at 6- and 12- month follow-up. Multilevel mixed-effects logistic regression was used to access the intervention performance. Results: We found that children were less likely to be exposed to SHS in the intervention group (OR: 0.56 95% CI: .32, 1.00 P=0.049) than the children in the comparison group at 12- months as measured by the self-reported number of days smoker smoked in front of children. Our intervention had minor effect on smoking cessation, smoke-free home restriction, and improvement of children’s respiratory health. Conclusions: The findings of this first study in rural China showed that smoking hygiene intervention was promising in reducing children’s exposure to SHS. These findings have implications for improving smoking cessation and reducing SHS exposure provided by CHWs in rural China.
Item Open Access The Munus Triplex: Pastoral Leadership Paradigm for HIV Prevention Ministry in the African American Context(2023) Wiggins-Banister, Tarsha L.Pastoral leaders in African American contexts often play a critical role in conveying messages about what is vital to black and brown people. Pastoral leadership has always been the driving force behind change within the Black Church, especially in times of community suffering. Health disparities such as the HIV epidemic in the Black community have created a crisis just as alarming as the COVID pandemic, and the key to addressing this issue will require pastoral leadership. This research aims to examine the framework of pastoral leadership through the theological model of the Munus Triplex and how it can be utilized and maximized within the congregational context to transform its culture into one in that is HIV competent and inculcated into the cultural fabric of the church.My thesis will focus on the significance of pastoral leadership in the areas of proactive and preventative HIV education, and how the pastor’s influence within the congregation can be best used to positively influence and generate outcomes leading to inclusive practices among members of the congregation in response to HIV stigmas. By examining the work of Christ through the lens of the Munus Triplex, we can ascertain some of the leadership competencies that constitute his roles as priest, prophet, and king. In turn, this can serve as a foundational model for pastoral leadership today. I will explore how each distinctive role of the Munus Triplex informs the pastor’s work towards affecting change within the congregational context. Based upon this work, I will propose a leadership paradigm approach for African American religious leaders to help them embrace their vocational responsibility to care for the whole person free of stigma and harmful theological rhetoric in response to the HIV epidemic.
Item Open Access The Use of Peer Youth Educators for the Promotion of Adolescent Sexual Health: A Case Study of Carolina for Kibera(2011) Whittle, Chelsea KatherineAdolescent sexual health is a global concern because of its associations with HIV, STIs, early and unwanted pregnancies, and post-abortion complications. To address the health burdens associated with sexual and reproductive health in youth, organizations employ several programmatic models to encourage behavior change and to distribute correct and appropriate information. One of those models, discussed here, is the peer education model. The peer education model uses adolescents to target adolescents to achieve program objectives. This paper is a case study of Carolina for Kibera, a non-governmental organization working in Kibera, a large urban slum outside of Nairobi, Kenya. Carolina for Kibera implements this model in its efforts to promote adolescent sexual health. The case study uses a triangulation method, including qualitative focus groups and interviews, document review, and researcher observation to determine how the model is implemented both in the context of the organization and in the context of Kibera. Results of the case study include a completed program description and an assessment of barriers and benefits to implementing this model, and how the context of the urban slum frames programming decisions and success. As a means of discussion and conclusions, implications and recommendations for future programming at Carolina for Kibera, and globally, are presented.
Item Open Access Understanding Antenatal Genetics Services in Sri Lanka: Current Landscape of Screening and Diagnostic Services and Contextual Factors Influencing Their Availability and Uptake(2016) Logan, Jenae ElaineBackground: Too little information is available on Sri Lanka’s current capacity to provide community genetic services—antenatal genetic services in particular—to understand whether building that capacity could further improve and reduce disparity in maternal and child health. This qualitative research project seeks to gather information on congenital disorders, routine antenatal care, and the current state of antenatal screening testing services within that routine antenatal to assess the feasibility of and the need for scaling up antenatal genetics services in Sri Lanka. Methods: Nineteen key informant (KI) interviews were conducted with stakeholders in antenatal care and genetic services. Seven focus group discussions were held with a total of 56 Public Health Midwives (PHMs), the health workers responsible for antenatal care at the field level. Transcripts for all interviews and FGDs were analyzed for key themes, and themes were categorized to address the specific aims of the project. Results: Antenatal genetic services play a minor role in antenatal care, with screening and diagnostic procedures available in the private sector and paid for out-of-pocket. KIs and PHMs expect that demand for antenatal genetic services will increase as patients’ purchasing power and knowledge grow but note that prohibitive abortion laws limit the ability of patients to act on test results. Genetic services compete for limited financial and human resources in the free public health system, and inadequate information on the prevalence of congenital disorders limits the ability to understand whether funding for services related to those disorders should be increased. A number of alternatives to scaling up antenatal genetic services within the free health system might be better suited to the Sri Lankan structural and social context. Conclusions: Scaling up antenatal genetic services within the public health system is not feasible in the current financial, legal, and human resource context. Yet current availability and utilization patterns contribute to regional and economic disparities, suggesting that stasis will not bring continued improvements in maternal and child health. More information on the burden of congenital disorders is necessary to fully understand if and how antenatal genetic service availability should be increased in Sri Lanka, but even before that information is gathered, examination of policies for patient referral, termination of pregnancy, and government support for individuals with genetic disease are steps that might bring extend improvements and reduce disparity in maternal and child health.