Peer support interventions in maternal and child healthcare delivery in sub-Saharan Africa: protocol for a realist review.

BACKGROUND: Peer support has been proposed as a promising policy intervention for addressing adverse maternal and child healthcare (MCH) outcomes in sub-Saharan Africa (SSA). Existing reviews on peer support largely draw on evidence from high-income countries or focus on single services like breastfeeding, nutrition or postnatal care. In contrast, this review aims to provide a comprehensive overview of the empirical literature on peer support interventions across various MCH services in sub-Saharan Africa. Specifically, we aim to understand how, why, for whom, and in what circumstances different forms of MCH peer support interventions contribute to improving healthcare outcomes in sub-Saharan Africa. METHODS: This review follows five iterative steps for undertaking realist reviews (1) defining the review scope; (2) developing initial programme theories; (3) searching for evidence; (4) selecting and appraising evidence; and (5) extracting, analysing and synthesising evidence. Four databases-Cochrane Library, PubMed, CINAHL, and EMBASE-were repeatedly searched between March and June 2021. From a large volume of records retrieved from the database and citation search, 61 papers have been selected for review. We will conduct a second search of the same database covering June 2021 to the present before the final extraction and synthesis. The final list of selected papers will be imported into NVivo 12 software and organised, extracted, analysed and synthesised iteratively to examine and illustrate the causal links between contexts, mechanisms and outcomes of MCH peer support interventions in SSA. We have drawn on the existing literature on peer support in healthcare generally to develop initial programme theories. We will then use the empirical literature on MCH peer support interventions in SSA, inputs from a stakeholders' workshop in Ghana and a conference presentation to refine the initial programme theory. DISCUSSION: The review will develop an explicit theory of peer support intervention in healthcare delivery and provide insights for developing evidence-informed policy on the intervention. Drawing lessons from the different national contexts and diverse areas of MCH in SSA, the review will provide an analytically generalizable programme theory that can guide intervention design and implementation. While focusing on MCH peer support interventions in SSA, the review contributes to evolving conversations on the use of theory for health policy planning and complex intervention design and implementation globally. TRIAL REGISTRATION: PROSPERO registration ID: CRD42023427751 .

Talent outsourcing in Ghana: A qualitative study of managed service personnel and technology leadership.

Managed Service Personnel (MSPs) have become critical sources of innovation, expertise and superior technology-enhanced performance. This understanding has, however, generated conflicting outcomes, as some hold a contrary view. This study examined the contribution of MSPs to achieving organizational targets in the northern cluster of a reputable bank in Ghana in order to determine the bank's outsourcing decisions, MSP responsibilities, and how such roles compare with those of permanent staff of the bank. The study employed qualitative approaches involving group and individual interviews with 66 participants. The investigation revealed that, among others, the bank outsourced MSPs for expertise, technology, innovation, and cost efficiency. It was also determined that MSPs outperformed regular staff in the areas of technology-enabled productivity, profitability, quality services, and organizational efficiency using unmatched skills, experience, and expertise. A novelty of the study is the culmination of new insight into a performance outlook developed to help organizational leaders make informed decisions. The performance outlook also present critical implications for theory, policy, and practice.

The impact of social media use on student engagement and acculturative stress among international students in China.

Despite the widespread use of modern social media, relatively less is known about the impact of social media on the acculturation processes of international students in China and their engagement in school activities. Accordingly, this research intends to assess the influence of social media usage while answering questions such as how using social media can improve international students' acculturation process from both psychological/mental and behavioural standpoints, as well as whether international students' acculturation promotes students' engagement in school activities, among other questions. The role of self-identification in mediating the connection between social media usage and international students' acculturation is also investigated. Primary data were gathered from 354 international students studying at various universities around China. The results show that international students use of social media improves their acculturation process and engagement in school activities through information sharing, establishing contacts, and entertainment. The study's limitations and future directions are also highlighted.

Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana.

Ghana's chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist palliative care services. This paper explores the factors influencing referral of patients with nonmalignant chronic diseases for specialist palliative care. A qualitative approach was used to explore these factors from eight (8) participants-four (4) physician specialists and four (4) next of kin of patients with advanced nonmalignant chronic illness. Individual face-to-face interviews were conducted using a semistructured interview guide. Interviews were audio-recorded and data coded, themes and subthemes were identified, and thematic analysis was done. Barriers and motivators identified were categorized as either related to physicians, institution, or family. Barriers to referral were perception of the scope of palliative care, medical paternalism, lack of an institutional referral policy, poor human resource capacity of the palliative care team, and lack of awareness about the existence of specialist palliative care service. Poor economic status of the patient and family, poor prognosis, previous interaction with the palliative care team, and an appreciation of patients' expectations of the healthcare system were identified as motivators for referral. The palliative care team must therefore increase awareness among other health professionals about their services and facilitate the development and availability of a clear policy to guide and improve referrals.