Global ETD Search

1	Development and Evaluation of a Tailored Knowledge Translation Intervention to Improve Lay Health Workers Ability to Effectively Support TB Treatment Adherence in Malawi Puchalski Ritchie, Lisa M. 20 March 2013 (has links) Background: Task shifting provision of basic health care services to lay health workers (LHWs) is increasingly employed to combat the global shortage of skilled health workers, particularly in low and middle income countries, where the shortage is greatest. Despite evidence for the effectiveness of LHWs in improving access to basic health services and positively impacting a variety of health outcomes, questions remain as to how recognized weaknesses in training and supervision are best addressed. This thesis employed a sequential-concurrent mixed-methods design and is composed of 3 studies with the objective of designing and rigorously evaluating a knowledge translation (KT) intervention tailored to address identified barriers to LHWs ability to function optimally as TB adherence supporters in Zomba district, Malawi. Methods & Findings: The first study utilized the qualitative methods of focus groups and interviews conducted with LHWs routinely involved in provision of care to TB patients. Lack of TB knowledge and job-specific training were identified as the key barriers to LHWs in their role as TB adherence supporters. Based on these findings, a KT intervention was developed and tailored to the identified training gaps. The second study, evaluated the effectiveness of the intervention in improving TB treatment adherence in a cluster randomized controlled trial, which showed no evidence for effectiveness of the intervention. The third study, conducted concurrently with the cluster trial, employed qualitative interviews to explore LHWs experiences with the intervention to identify ii aspects of the intervention found to be helpful and areas in need of improvement. Study 3 found that the intervention was well received and valued, with reported benefits to LHWs through improved knowledge and skills, and increased confidence. Suggestions for improvement varied considerably, with an anticipated concern with the lack of stipends and conduct of training on-site, raised as an issue by a minority of participants. Conclusion: This thesis suggests that a multi-component KT strategy tailored to address local barriers, was well received and valued by LHWs, and may represent a cost-effective approach to LHW training. However, given the trend for effectiveness did not reach significance in this underpowered study, further research is needed. knowledge translation lay health workers
2	Development and Evaluation of a Tailored Knowledge Translation Intervention to Improve Lay Health Workers Ability to Effectively Support TB Treatment Adherence in Malawi Puchalski Ritchie, Lisa M. 20 March 2013 (has links) Background: Task shifting provision of basic health care services to lay health workers (LHWs) is increasingly employed to combat the global shortage of skilled health workers, particularly in low and middle income countries, where the shortage is greatest. Despite evidence for the effectiveness of LHWs in improving access to basic health services and positively impacting a variety of health outcomes, questions remain as to how recognized weaknesses in training and supervision are best addressed. This thesis employed a sequential-concurrent mixed-methods design and is composed of 3 studies with the objective of designing and rigorously evaluating a knowledge translation (KT) intervention tailored to address identified barriers to LHWs ability to function optimally as TB adherence supporters in Zomba district, Malawi. Methods & Findings: The first study utilized the qualitative methods of focus groups and interviews conducted with LHWs routinely involved in provision of care to TB patients. Lack of TB knowledge and job-specific training were identified as the key barriers to LHWs in their role as TB adherence supporters. Based on these findings, a KT intervention was developed and tailored to the identified training gaps. The second study, evaluated the effectiveness of the intervention in improving TB treatment adherence in a cluster randomized controlled trial, which showed no evidence for effectiveness of the intervention. The third study, conducted concurrently with the cluster trial, employed qualitative interviews to explore LHWs experiences with the intervention to identify ii aspects of the intervention found to be helpful and areas in need of improvement. Study 3 found that the intervention was well received and valued, with reported benefits to LHWs through improved knowledge and skills, and increased confidence. Suggestions for improvement varied considerably, with an anticipated concern with the lack of stipends and conduct of training on-site, raised as an issue by a minority of participants. Conclusion: This thesis suggests that a multi-component KT strategy tailored to address local barriers, was well received and valued by LHWs, and may represent a cost-effective approach to LHW training. However, given the trend for effectiveness did not reach significance in this underpowered study, further research is needed. knowledge translation lay health workers
3	Rewarding altruism: addressing the issue of payments for volunteers in public health initiatives South, J., Purcell, M.E., Branney, Peter, Gamsu, M., White, J. 16 December 2013 (has links) No / Lay involvement in public health programmes occurs through formalised lay health worker (LHW) and other volunteer roles. Whether such participation should be supported, or indeed rewarded, by payment is a critical question. With reference to policy in England, UK, this paper argues how framing citizen involvement in health only as time freely given does not account for the complexities of practice, nor intrinsic motivations. The paper reports results on payment drawn from a study of approaches to support lay people in public health roles, conducted in England, 2007e9. The first phase of the study comprised a scoping review of 224 publications, three public hearings and a register of projects. Findings revealed the diversity of approaches to payment, but also the contested nature of the topic. The second phase investigated programme support matters in five case studies of public health projects, which were selected primarily to reflect role types. All five projects involved volunteers, with two utilising forms of payment to support engagement. Interviews were conducted with a sample of project staff, LHWs (paid and unpaid), external partners and service users. Drawing on both lay and professional perspectives, the paper explores how payment relates to social context as well as various motivations for giving, receiving or declining financial support. The findings show that personal costs are not always absorbed, and that there is a potential conflict between financial support, whether sessional payment or expenses, and welfare benefits. In identifying some of the advantages and disadvantages of payment, the paper highlights the complexity of an issue often addressed only superficially. It concludes that, in order to support citizen involvement, fairness and value should be considered alongside pragmatic matters of programme management; however policy conflicts need to be resolved to ensure that employment and welfare rights are maintained. / National Institute for Health Research Service Delivery and Organisation Programme (project number 08/1716/206).
4	Lay Health Worker Programmes as aPublic Health Approachin South Africa Daniels, Karen January 2010 (has links) Aim: The overall aim is to assess the appropriateness of Lay Health Worker (LHW)programmes as a public health intervention in South Africa by considering the effectivenessof LHW programmes across the world and the experience of LHW programmeimplementation and policy making in South Africa. Methods: This thesis comprises 4 papers that explore the issue of LHWs: (I) A systematicreview of randomised controlled trials (RCTs) of LHW interventions in primary andcommunity health care for maternal and child health and the management of infectiousdiseases; (II) A study of the experiences of farm dwellers trained to be LHWs, as exploredthrough focus group discussions; (III) A study of three LHW supervisors who worked on anintervention to support infant feeding mothers, as explored through individual interviews;and (IV) A study of the process of LHW policy development from the perspective of 11 keyinformants who were individually interviewed. Findings: LHWs were found to be effective in promoting breastfeeding and in improvingpulmonary TB cure rates (I). There was also some indication that LHWs could be effective inreducing child morbidity and child and neonatal mortality, and in increasing the likelihood ofcaregivers seeking care for childhood illness (I). The experience of LHWs and LHWsupervisors suggests that LHW programmes need adequate support and supervision,especially in protecting the LHWs themselves (II, III). The care and protection of LHWs wasconsidered by policy makers (IV), but policy redevelopment processes did not link the needto ensure that LHWs were not exploited to concerns about gender exploitation. Conclusions: LHW interventions can be effective but implementing them in developingcountries such as South Africa needs to be approached with caution Lay health workers Lay Health worker programmes public health primary health care gender intervention effectiveness intervention experience policy making programme supervision.
5	The role of the farm lay health worker in the rural Western Cape Province Van der Merwe, Bernice Jacqueline 19 January 2015 (has links) Public demands have forced countries to explore new ways of rendering primary health care to reach the poor who are not within reach of the modern health care systems. New categories of health care personnel, like lay health workers emerged. There are vast differences in the roles of these lay health workers as was revealed with an extensive literature search. The phenomenology qualitative research method was used to investigate perceptions of farm lay health workers regarding their roles in rural areas. A convenience, non-random sample (N=5) was used for focus group discussions and in-depth interviews to collect data. The latter revealed five main themes associated with the role of farm lay health workers: (1) community link; (2) carer; (3) community developer; (4) counsellor and (5) role model. Guidelines were formulated to enhance the role of lay health workers in the rural Western Cape Province and to improve the quality of care to rural communities / Health Studies / M.A. (Health Studies) Primary health care Lay health workers Farm lay health worker Rural areas Community link Community developer Counsellor Role model Guidelines 362.104257096873
6	The role of the farm lay health worker in the rural Western Cape Province Van der Merwe, Bernice Jacqueline 19 January 2015 (has links) Public demands have forced countries to explore new ways of rendering primary health care to reach the poor who are not within reach of the modern health care systems. New categories of health care personnel, like lay health workers emerged. There are vast differences in the roles of these lay health workers as was revealed with an extensive literature search. The phenomenology qualitative research method was used to investigate perceptions of farm lay health workers regarding their roles in rural areas. A convenience, non-random sample (N=5) was used for focus group discussions and in-depth interviews to collect data. The latter revealed five main themes associated with the role of farm lay health workers: (1) community link; (2) carer; (3) community developer; (4) counsellor and (5) role model. Guidelines were formulated to enhance the role of lay health workers in the rural Western Cape Province and to improve the quality of care to rural communities / Health Studies / M.A. (Health Studies) Primary health care Lay health workers Farm lay health worker Rural areas Community link Community developer Counsellor Role model Guidelines Carer 362.104257096873
7	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara 29 January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers
8	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara 29 January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers
9	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers

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