Determinants of mobile health (M-Health) application adoption, usage and discontinuity among corporate workers diagnosed with hypertension and diabetes.

PURPOSE: This study examined the determinants of mobile health (M-Health) application, adoption, usage and discontinuation among corporate workers diagnosed with hypertension and diabetes in Ghana. DESIGN/METHODOLOGY/APPROACH: The diffusion innovation and reasoned action theories were employed using an exploratory design. Three hundred corporate workers diagnosed with diabetes and hypertension from three health facilities for the past six months were sampled for the study using a multi-stage sampling technique and administered questionnaires. Descriptive statistics and logistic regression tools were employed in the analysis of data. FINDINGS: The study found a significant number of factors influencing m-health applications adoption, usage and discontinuity. These factors include nature and demand of job, perceived advantage, compatibility, complexity, triability, aesthetics and trust. Aesthetics emerged as the strongest predictive factor for the adoption, usage and discontinuity of use among diabetic and hypertensive corporate workers. With the adoption of M-Health applications, compatibility, as well as nature and demand of job, were significant predictors. With the usage of M-Health applications, complexity, triability, aesthetics and trust were significant predictors. Moreover, perceived advantage, compatibility, complexity and triability influenced significantly the choice to discontinue using M-Health applications. The study concluded that M-Health application functionalities play a valuable role in patients' intention to adopt, use and discontinue the use of an M-Health application in Ghana. ORIGINALITY/VALUE: This exploratory study offers in-depth insight into how major M-Health application features affect its adoption, usage and discontinuity, providing crucial information for future research and the improvement of chronic condition healthcare delivery.

Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs.

BACKGROUND: Patient safety incidents (PSIs) in healthcare settings are a critical concern globally, and Ghana is no exception. Addressing PSIs to improve health outcomes requires various initiatives to be implemented including improving patient safety culture, teamwork and communication between healthcare providers during handoffs. It is essential to acknowledge the significance of teamwork, communication openness, and effective handoffs in preventing and managing such incidents. These factors play a pivotal role in ensuring the well-being of patients and the overall quality of healthcare services. AIM: This study assessed the occurrence and types of PSIs in health facilities in Ghana. It also examined the role of teamwork, handoffs and information exchange, and communication openness in response to PSIs by health professionals. METHODS: A cross-sectional study was conducted among 1651 health workers in three regions of Ghana. Using a multi-staged sampling technique, the Survey on Patient Safety Culture Hospital Survey questionnaire and the nurse-reported scale were used to collect the data and it was analysed by descriptive statistics, Pearson correlation, and linear multiple regression model at a significance of 0.05. RESULTS: There was a reported prevalence of PSIs including medication errors (30.4%), wound infections (23.3%), infusion reactions (24.7%), pressure sores (21.3%), and falls (18.7%) at least once a month. There was a satisfactory mean score for responses to adverse events (3.40), teamwork (4.18), handoffs and information exchange (3.88), and communication openness (3.84) among healthcare professionals. Teamwork, handoffs and information exchange and communication openness were significant predictors of response to PSIs, accounting for 28.3% of the variance. CONCLUSIONS: Effective teamwork, handoffs and information exchange, and communication openness in the healthcare environment are critical strategies to enhance PSI response. Creating a culture that encourages error response through teamwork, communication and handoffs provides healthcare professionals with opportunities for learning and improving patient outcomes. Training programs should therefore target health professionals to improve patient safety and competency. Through the implementation of evidence-based practices and learning from past incidents, the healthcare system will be able to deliver safe and high-quality care to patients nationwide. Patient safety must be recognized as an ongoing process. Therefore, a meaningful improvement in patient outcomes requires all stakeholders' commitment.

A cross-sectional study on coping strategies of frontline healthcare workers amid the COVID-19 pandemic in a developing country.

Objectives: Frontline healthcare workers encountered a heightened susceptibility to negative psychological symptoms and behavioral shifts in light of the coronavirus disease 2019 pandemic. This study determined the coping strategies adopted by frontline healthcare workers in Ghana as well as assessed any differences based on demographics, job title, and ranking in four coronavirus disease 2019-designated centers in the Greater Accra region of Ghana. Methods: Using a hospital-based, mixed-method approach, the study was conducted between May 2021 and September 2021. A total of 94 frontline healthcare workers were randomly sampled and given a self-administered questionnaire, while 13 healthcare workers took in-depth interviews. Data from the survey were analyzed using both IBM SPSS and IBM AMOS and the interview data were transcribed verbatim and coded using thematic analysis. Results: The study revealed that coronavirus disease 2019 has affected the psycho-social life of frontline healthcare workers mainly in the form of depression, anxiety, and stress. The three main coping strategies adopted by frontline healthcare workers include personal preventative measures (most dominant), seeking external expert support, and obtaining institutional support. While healthcare workers within the age group 30-39 years were found most compliant with the adoption of personal preventive measures and those below 30 years were found least compliant. Conclusion: This study concludes that frontline healthcare workers have been affected by a considerable level of anxiety, stress, and depression during the coronavirus disease 2019 pandemic. The study recommends a robust psychological support system at various levels of health care and an Employee Assistance Program with access to a 24-h hotline counseling service for frontline healthcare workers, continuous personal protective equipment provision, regular evidence-based updates on the management of coronavirus disease 2019 patients, and increased commitment from the government in addressing the medical needs of infected frontline healthcare workers.

Comparing patient safety culture in primary, secondary and tertiary hospitals in Ghana.

Objective: This study compared patient safety culture among health professionals in tertiary, secondary and primary hospitals. Design: We conducted a cross-sectional survey among thirteen primary, secondary and tertiary hospitals in Ghana. A structured questionnaire was administered to 1,656 health professionals. Data were analysed using descriptive statistics and One-Way Analysis of Variance (ANOVA). Setting: This study was conducted in the Greater Accra, Bono and Upper East regions, representing the southern, middle and northern ecological zones, respectively. Participants: Health professionals. Main outcome measures: The primary outcome was patient safety culture. Results: Five patient safety culture dimensions were rated moderate positive response, while five were rated high positive response. We found a statistically significant difference in patient safety culture across primary, secondary and tertiary hospitals (p < 0.05). For instance, the mean difference between tertiary and secondary hospitals was statistically significant (p < 0.05). Additionally, the mean difference between tertiary and primary hospitals was statistically significant (p < 0.05). There was also a significant difference in the means between secondary and primary hospitals (p < 0.05). Conclusion: This study has demonstrated a variation in patient safety culture across Ghana's tertiary, secondary and primary hospitals. Therefore, healthcare managers and professionals should prioritise patient safety. Funding: This work was supported by the University of Ghana [UGRF/13/MDG-001/2019-2020].

Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety.

INTRODUCTION: Recognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities. METHODS: The study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model. RESULTS: The majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise. CONCLUSION: Promoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.

Hospital managers' views on the state of patient safety culture across three regions in Ghana.

BACKGROUND: Improving patient safety culture in healthcare organisations contributes positively to the quality of care and patients' attitudes toward care. While hospital managers undoubtedly play critical roles in creating a patient safety culture, in Ghana, qualitative studies focussing on hospital managers' views on the state of patient safety culture in their hospitals remain scanty. OBJECTIVE: This study aimed to explore the views of hospital managers regarding compliance to patient safety culture dimensions in the selected hospitals in the Bono, Greater Accra, and Upper East regions of Ghana. METHODOLOGY: This was a qualitative exploratory study. A purposive sampling of all hospital managers involved in patient safety practices was conducted. The sampled managers were then invited to a focus group discussion. Twelve focus group discussions with each consisting of a maximum of twelve participants were conducted. The ten patient safety culture dimensions adapted from the Agency for Healthcare Research and Quality's patient safety culture composite measures framed the interview guide. Deductive thematic content analysis was done. Lincoln and Guba's methods of trustworthiness were applied to ensure that the findings are valid and reliable. FINDINGS: Positive patient safety culture behaviours such as open communication, organisational learning, and strong teamwork within units, were an established practice in the selected facilities across Ghana. Lack of teamwork across units, fear of reporting adverse events, the existence of a blame culture, inconsistent response to errors, extreme shortage of staff, sub-standard handover, lack of management support with resources constrained the patient safety culture. The lack of standardised policies on reporting adverse events and response to errors encouraged managers to use various approaches, some resulting in a blame culture. Staff shortage contributed to poor quality of safety practices including poor handover which was also influenced by lateness to duty. CONCLUSION: Prompt and appropriate responses by managers to medical errors require improvements in staffing and material resources as well as the enactment of standard policies across health facilities in the country. By so doing, hospital managers would contribute significantly to patient safety, and help build a patient safety culture in the selected hospitals.

Satisfied or not satisfied? Electronic health records system implementation in Ghana: Health leaders' perspective.

BACKGROUND: Electronic Health Records (EHR) has been espoused to be an innovation from the paper-based system, with benefits such as fast access to patient information thereby facilitating healthcare provider communication, healthcare continuity and improved quality of care. However, it is the extent of the quality of the electronic health records that determines the access to these stated benefits. The quality of health care records indirectly contributes to patient safety because inaccurate patient data can lead to improper diagnosis and consequently wrong treatment of patients. Most hospitals in Ghana, have recently transitioned into the EHR system, hence, there is a need to assess its accuracy, impact on workflow, staff training on usage, support from the EHR team, and the overall satisfaction of the EHR system. As health leaders are at the frontline of its implementation, their views on the challenges and successes of the EHR system are imperative. METHOD: This qualitative study sought to explore the views of the health leaders on the implemented electronic health records system in nine (9) hospitals within three (3) regions in Ghana. Following ethical approval, GHS-ERC:007/04/21, focus group discussions were conducted with a minimum of 10 hospital leaders in each facility. These included quasi, government and private hospitals. Data was collected between September and November 2021. RESULTS: The study found poor quality of records, lack of involvement of frontline clinicians in the development of the EHR system, inadequate training of staff and limited workstations as some of the challenges associated with the use of EHR in hospitals. Health leaders were generally not satisfied with the EHR system. CONCLUSION: It is recommended that addressing inputs from end-users as well as circulating more computers will motivate EHR usage and acceptance. Provision of additional workstations for the various units and involvement of staff in the system development would be most prudent to enable health workers to accept the EHR system in improving the quality of care.

Menstrual hygiene management in public high schools in Ghana.

in the ten (10) regions of Ghana. The findings showed that most girls in Public Senior High Schools in Ghana had prior knowledge about menstruation from their mothers and sisters prior to menarche. It was revealed that majority of the girls mentioned hormones as the cause of menstruation, whilst others mentioned the uterus, bladder, vagina, and other parts of the female reproductive system. A few of them had no idea what causes menstruation. The findings again revealed that most girls use sanitary pads, while some use other materials during menstruation. Less than half of the sample of girls in this study were able to change their pads twice daily or more. About half of the girls cleansed their genital parts only when bathing during menstruation using soup and water mostly. Half of the schools used pblic tap/standpipe as their main source of water and the rest used other sources of water. Also, most schools have toilet facilities. Some useful recommendations are proffered with the aim of improving MHM in public high schools in Ghana.

e-health usage and health workers' motivation and job satisfaction in Ghana.

BACKGROUND: The application of digital technology to improve health service delivery is increasing rapidly in Low- and Middle- Income Countries (LMICs). Digital tools such as electronic health (e-health) have been shown to improve healthcare quality, efficiency and patient satisfaction. However, evidence on health workers' experiences using e-health services is limited in LMICs. This study examined the relationship between e-health usage and health workers' motivation and job satisfaction. METHODS: This was a cross-sectional survey design involving health workers across public and private hospitals in the Accra Metropolitan Assembly (AMA). A structured questionnaire was designed and self-administered to 305 respondents. Partial Least Square-Structural Equation Modelling (PLS-SEM) was employed to analyse the data. RESULTS: Findings showed a significant positive association of job satisfaction with e-health (p < 0.01) and type of hospital (p < 0.01) but not motivation (p = 0.42). Although type of hospital significantly influenced job satisfaction (p < 0.01), it had no significant mediating effect on the relationship between e-health and job satisfaction. Finally, type of hospital interacted with e-health to moderate the association between e-health usage and job satisfaction. CONCLUSION: The findings suggest that e-health systems can catalyse health workers job satisfaction. Thus, measures to strengthen e-health structures to improve on their efficiency and effectiveness is crucial.

Performance Assessment of the Juaboso District Office of the National Health Insurance Authority.

OBJECTIVES: To assess the performance of the National Health Insurance Authority (NHIA) in Ghana. METHODS: Using a thorough case study of the Juaboso District Office of the NHIA, this study assessed the community coverage rate, the annual expenditure and income, and the trend of claims payment for the period 2009 to 2012 as well as factors influencing the level of patronage of the National Health Insurance Scheme. A self-administered structured questionnaire was used to gather data from the management of the scheme. Secondary data were also gathered from the scheme's audited financial statements. Informal discussions were held with the premium collectors and clients to throw more light on revenue generation challenges. RESULTS: The study found an increasing trend in the coverage rate on a yearly basis. Over the study period, the rate moved from 30.6 to 60.1, representing an increase of 96.7%. This shows that in terms of coverage rate, the Juaboso District Office of the NHIA is performing very well. The study also found that revenue has increased but the percentage rate of increase has decreased, compared with the coverage percentage rate. Expenditure has been on the rise, increasing by as much as 20.7% in 2011. Again, the study revealed a consistent year-on-year increase in the claims payment, consistent with the national trend. CONCLUSIONS: Constant clinical auditing of claims payments is required to ensure accountability. This would lead to transparency with regard to performance assessment of the claims. The findings have important implications for the effective management of the NHIA.

Socioeconomic determinants of use of reproductive health services in Ghana.

BACKGROUND: The study examines trends in the consumption of reproductive health services (use of modern contraceptives, health facility deliveries, assisted deliveries, first trimester antenatal visit and 4+ antenatal visits) and their determinants using four rounds of Ghana Demographic and Health Surveys (1993, 1998, 2003 and 2008) data. METHODS: The study uses cross-sectional and pooled probit and negative bionomial regressions models to estimate the determinants of use of the above listed reproductive health services for the period from 1993 to 2008. RESULTS: Summary statistics suggest that the above-listed reproductive health services have consistently improved from 1993 to 2008. However, use of traditional methods of contraception increased in urban centers between 2003 and 2008, although the reverse was the case in rural areas. Regression results suggest that place of residence, access to and availability of health services, religion, and birth order are significant correlates of use of reproductive health services. Additionally, the study suggests that the number of living children has the largest effect on use of modern contraception. The effect of a partner's education on use of modern contraception is higher than that of the woman, and a much stronger correlation exists between household wealth and use of reproductive health inputs than expected. CONCLUSION: The study associates the increasing use of traditional contraceptives in urban centers and the much stronger effect of household wealth with urban poverty and the increasing indirect cost of health services, and argues for interventions to improve quality of service in public facilities and reduce inequities in the distribution of health facilities. Finally, the study advocates for family planning-related interventions that involve and target partners given the importance of partner education in the use of modern contraception.

Managing healthcare waste in Ghana: a comparative study of public and private hospitals.

PURPOSE: The paper aims to examine the healthcare waste management practices of selected hospitals in Ghana. DESIGN/METHODOLOGY/APPROACH: The study adopted a multiple case approach, using two public and two private hospitals. FINDINGS: Findings indicate that both public hospitals and one private hospital have a waste management policy. Public and private hospitals have waste management plans and waste management teams. Public hospitals were found to generate more waste than the private hospitals. One private hospital and the public hospitals segregate their waste into different categories. This is done by first identifying the waste type and then separating non-infectious or general waste from infectious waste. Both public and private hospitals have internal storage facilities for temporarily storing the waste before they are finally disposed off-site. On-site transportation in the public hospitals is done by using wheelbarrows, while covered bins with wheels are used to transport waste on-site in the private hospitals. In public and private hospitals, off-site transportation of the hospital waste is undertaken by Municipal Assemblies with the use of trucks. Both public and private hospitals employ standard methods for disposing of healthcare waste. ORIGINALITY/VALUE: The article provides insights into healthcare waste management from a Ghanaian perspective.

Improving maternal healthcare utilisation in sub-Saharan Africa through micro-finance.

PURPOSE: This paper aims to examine links between women's access to micro-finance and how they use maternal healthcare services in sub-Saharan Africa (SSA). DESIGN/METHODOLOGY/APPROACH: The authors use theoretical and empirical literature to propose a framework to sustain and improve women's access to maternal healthcare services through micro-financing. FINDINGS: It is found that improved access to micro-finance by women, combined with education may enhance maternal health service uptake. RESEARCH LIMITATIONS/IMPLICATIONS: The paper does not consider empirical data in the analysis. The authors advocate empirically testing the framework proposed in other SSA countries. SOCIAL IMPLICATIONS: It is important to empower women by facilitating their access to education and micro-finance. This has implications for improving maternal healthcare utilization in SSA. ORIGINALITY/VALUE: The paper moves beyond poor access to maternal health services in SSA and proposes a framework for providing sustainable solutions.

Financing public healthcare institutions in Ghana.

PURPOSE: The financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health is considered a poverty reduction strategy, it is imperative that the hospitals used in the delivery of healthcare services are well financed to accomplish their tasks. The purpose of this paper is to examine how public hospitals in Ghana are financed, and the challenges facing the financing modes adopted. DESIGN/METHODOLOGY/APPROACH: To achieve the objectives of the study, one major public healthcare institution in Ghana became the main focus. FINDINGS: The findings of the study revealed that the main sources of financing the public healthcare institution are government subvention, internally-generated funds and donor-pooled funds. Of these sources, the internally generated fund was regarded as the most reliable, and the least reliable was the donor-pooled funds. Several challenges associated with the various financing sources were identified. These include delay in receipt of government subvention, delay in the reimbursement of services provided to subscribers of health insurance schemes, influence of government in setting user fees, and the specifications to which donor funds are put. ORIGINALITY/VALUE: The findings of this study have important implications for improving the financing of public healthcare institutions in Ghana. A number of recommendations are provided in this regard.

Medical waste management practices in a Southern African hospital.

PURPOSE: The purpose of this paper is to examine the medical waste management practices of a hospital in Southern Africa. DESIGN/METHODOLOGY/APPROACH: A case study methodology was utilised. FINDINGS: The results revealed that the hospital does not quantify medical waste. Segregation of medical waste into infectious waste and non-infectious waste is not conducted according to definite rules and standards. Separation of medical waste and municipal waste is however practiced to a satisfactory extent. Wheeled trolleys are used for on-site transportation of waste. Off-site transportation of waste is outsourced to a private firm. Incineration is used in the final disposal of infectious waste. Non-infectious waste is disposed using land disposal method. There is no policy and plan in place for managing medical waste. A number of problems were identified with respect to medical waste management. ORIGINALITY/VALUE: The paper gives recommendations with the aim of improving medical waste management in hospitals.