Browsing by Subject "facilitators"

Background: Hypertension and related complications are major contributors to deaths and disabilities in Nepal. We aim to explore existing work flows, needs and challenges to hypertension care coordination and assess feasibility of establishing a FCHV-based hypertension management program in Kavre, Nepal.

Design: We conducted 23 in depth-interviews and one focus group discussion that consists of nine patients with hypertension, six health workers, four health officials, and 12 FCHVs in two village development committees of Kavre district, Nepal. Applied thematic analysis was performed using NVivo 12.

Results: Health literacy related to hypertension was low. Delay in treatment initiation and lost to follow up were common patterns despite comply with antihypertensive medication. Underutilization of primary healthcare institutions, communication gap and lack of grass-roots level educational campaigns were identified as major health system-related barriers. Community pharmacies, monthly health camps and increasing governmental attention to NCDs were favorable for hypertension management. This study also showed FCHVs have the potential to promote hypertension educational, screening and referral in their catchments, with adequate training and proper motivation.

Conclusions: Barriers and facilitators identified in this study have implications for future hypertension management intervention design. We recommend grassroot level hypertension education and screening across the Nepal. FCHVs have the potential to take on these responsibilities, once they are empowered with appropriate training and motivated by proper incentives.

Keywords: hypertension management, barriers, facilitators, community health workers, female community health volunteers, Nepal, qualitative research

Background: Increasing evidence suggests that early diagnosis of Alzheimer’s disease and related diseases (ADRD) offers opportunities for access to supportive services and disease management. However, most cases of ADRD are diagnosed in the later stages of the disease limiting the benefits of supportive services and increasing challenges related to the disease. This study aimed to understand facilitators and barriers to early ADRD diagnosis among Black and White individuals seeking racial differences in this process. Methods: Our sample included 21 racially diverse caregivers (n= 21) of older adults with ADRD, including Black caregivers (n=11) and White caregivers (n= 10). Semi-structured interviews were conducted individually with participants. Duke University Health System (DUHS). Data were coded for emerging themes and analyzed through the lens of the life course framework using NVIVO analysis software. Results: Facilitators and barriers along the diagnosis process were shaped by the individual, family/caregiver, and interactions with the healthcare system. Racial differences were particularly evident regarding family/caregiver's lower knowledge about ADRD, care approach offered to the care recipient, and prevalent negative interactions with the healthcare system among Black caregivers. Conclusions: The diagnosis process pathways were lengthy, characterized by caregivers' persistence, challenges to receiving an adequate cognitive assessment, and limited access to supportive services. Black caregivers experienced a more prolonged process, lower knowledge about ADRD, and challenging interactions with the healthcare system.

Crises like Covid-19 pandemic have proved that even strong health systems can collapse without strategic preparation for pandemic emergencies. India’s private sector is integral in having control over the Covid-19 pandemic through various Public-Private Partnerships (PPPs). Knowing it is crucial to understand that how India is handling the Covid-19 crisis, we looked at great examples of PPPs in India in response to Covid-19 and conducted a qualitative study with 10 key informant interviews with several key stakeholders from notable private organizations to gain insights from their experiences on those partnerships. The pandemic was described by participants as an unprecedented tragedy at the start, but it was also seen as an opportunity for reform the weak healthcare system, for growth in innovations and addressing long standing health problems. There is a need for direct communication between policy makers and ground level implementers for clear and concise feedback and understanding of the policies. Also, challenges from dealing with different systems within private health sector prompted to have strong regulatory body for fragmented private health sector. For future pandemic preparation, it was suggested by participants that the government must have a designated crisis response team/taskforce with integrated surveillance system with the private sector. India has been successful in leveraging the use of innovations, digital technology, pharmaceutical and startup workforces, and its robust PPPs to combat the pandemic. However, there were also a lot of lessons learned from hasty policies to management mishaps which can be improved through effective engagement with the private sector.