Browsing by Subject "Qualitative analysis"

Now showing 1 - 4 of 4
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    Barriers to Implementing Antimicrobial Stewardship Programs in Three Low- and Middle-income Country Tertiary Care Settings: Findings from a Multi-site Qualitative Study
    (2021) Rolfe, Jr, Robert Joseph

    Background: Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine perceived barriers to the development and implementation of ASPs in tertiary care centers in three low- and middle-income countries (LMICs). Methods: Interviews were conducted with 45 physicians at tertiary care hospitals in Sri Lanka (n=22), Kenya (12), and Tanzania (11). Interviews assessed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics that inform antimicrobial use, receptiveness to ASPs, and perceived barriers to implementing ASPs. Two independent reviewers coded the interviews using principles of applied thematic analysis, and comparisons of themes were made across the three sites. Results: Barriers to improving antimicrobial prescribing included prohibitively expensive antimicrobials, limited antimicrobial availability, resistance to changing current practices regarding antimicrobial prescribing, and limited diagnostic capabilities. The most frequent of these barriers in all three locations was limited drug availability. Many physicians in all three sites had not heard of ASPs before the interviews. Improved education was a suggested component of ASPs at all three sites. The creation of guidelines was also recommended, without prompting, by interviewees at all three sites. Although most participants felt microbiological results were helpful in tailoring antibiotic courses, some expressed distrust of laboratory culture results. Biomarkers like erythrocyte sedimentation rate and c-reactive protein were not felt to be specific enough to guide antimicrobial therapy. Despite limited or no prior knowledge of ASPs, most interviewees were receptive to implementing protocols that would include documentation and consultation with ASPs regarding antimicrobial prescribing. Conclusions: Our study highlighted several important barriers to implementing ASPs that were shared between three tertiary care centers in LMICs. Improving drug availability, enhancing availability of and trust in microbiologic data, creating local guidelines, and providing education to physicians regarding antimicrobial prescribing are important steps that could be taken by ASPs in these facilities.

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    Durham County Food System: A Qualitative Analysis of Actors, Missions, and Challenges
    (2017-04-28) Sun, Tianshu; Davis, Laura
    In the context of a national movement around local food, our clients, the Duke Campus Farm and World Food Policy Center want to know what they can do to best engage with and support the local food system (LFS) in their community of Durham County, North Carolina. We conducted an exploratory case study to characterize the current network of actors within the Durham LFS and the challenges they face, in order to provide recommendations to our two Duke clients. Qualitative analysis of interview data resulted in a network sociogram showing two main clusters of actors, generally separated by sector and mission. The primary challenges facing these actors include financial barriers, lack of communication, and social environment barricades. We recommend that our clients 1) facilitate communication between network actors 2) assist with collecting baseline data for evaluation, and 3) provide relevant policy analysis.
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    Promoting Investments in Ecosystem Services: the Case of the Peruvian Amazon
    (2010-04-23T15:03:18Z) Romero-Wolf, Robert Martin
    Natural capital and the Ecosystem Services (ES) that flow from it are essential to civilization as they provide both the conditions and the processes that sustain human life. Peru possesses the third largest tropical forest cover in the world and is undoubtedly one of the planet’s mega-diverse countries. This document focuses on exploring the viability of markets for ES as a tool for funding conservation in the Peruvian Amazon given the current highly charged climate surrounding natural resource management policies that the government must deal with. Qualitative research methods were used to analyze interviews conducted with high level government officials, NGO directors and bilateral agency program managers in Peru to gain insights into the gaps in existing natural resource management policies that create risks for developing markets for ES. Issues such as institutional capacity, multi-stakeholder decision making, land-use planning, definition and enforcement of property rights, consultation and free, prior and informed consent from local communities for major investment projects as well as the strictness and enforcement of regulations around Environmental Impact Assessments stand out as key shortcomings in Peru’s natural resources management policies that create risks for the development of ES markets. Most of the key issues identified in this investigation are not specific to ES markets; rather they are general issues that must be considered for good practices in natural resource management. As such, creating ecosystem service markets will do little if anything to improve the long-term sustainability of Peru’s natural capital and the ecosystem services that flow from it if these issues are not addressed as part of an integrated natural resource management strategy.
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    Recommendations for a Surface Water Allocation System in North Carolina: The Upper Tar River Basin Perspective
    (2011-04-28) Schieffer, Emily
    North Carolina is a water-rich state, crisscrossed by more than 40,000 miles of rivers and streams and fed by an average of almost 50 inches of rain a year. Competition for the state’s water resources is increasing, however, and recent droughts and lawsuits have highlighted the fact that there is a limit to this wealth. A more proactive and comprehensive approach to managing water withdrawals is needed. One management tool that has received attention at the General Assembly, but has not yet been implemented, is a statewide allocation system for surface water. My research is a prospective policy analysis, which explores the perspective of four groups of water professionals (primarily) within the Upper Tar River basin, in order to predict the implications and consequences of implementing a statewide surface water allocation policy. Data was collected through a series of hour-long, semi-structured, in-person interviews. Informants included managers of municipal water systems in the Upper Tar River basin, water utility professionals from the private sector who work in the Upper Tar River basin, staff from state resource agencies, and environmental policy experts working on water issues in North Carolina. Data analysis, which drew from discourse analysis and grounded theory methods, explored the text of verbatim interview transcripts to identify the key themes in informants’ discourse related to a surface water allocation policy. From these themes, I articulated a list of the fundamental objectives that an allocation program must meet and then developed a set of policy recommendations to guide development of such a program. My analysis indicates that there is support for a statewide surface water allocation system, within the respondent group. In order to realize the potential benefits identified by informants and minimize their concerns, a successful surface water allocation program should (1) provide a fair process for determining allocations, (2) apply equitably to all user groups, (3) incorporate a comprehensive and integrated approach to understanding, managing, and regulating surface water use, (4) provide a broad planning and decision context, and (5) enable users to adequately plan and prepare for future water conditions. This study provides insight to the perspectives of four stakeholder groups in the Upper Tar River basin and could serve as the basis for larger, perhaps quantitative studies. Future research is needed to investigate the transferability of these findings to other river basins in the state and to explore the perspectives of other important stakeholder groups, including agriculture and electric power generation.