Annual gatherings as an integrated knowledge translation strategy to support local and traditional food systems within and across Indigenous community contexts: a qualitative study.

Integrated knowledge translation (IKT) and community-based participatory research (CBPR) are recognized as effective approaches when Indigenous and non-Indigenous partners work together to focus on a common goal. The "Learning Circles: Local Healthy Food to School" (LC:LHF2S) study supported the development and implementation of Learning Circles (LC) in 4 Canadian Indigenous communities with the goal of improving local, community-based healthy food systems. Critical to the research process were annual gatherings (AG) where diverse stakeholders (researchers, Indigenous community members, and partners) visited each community to share knowledge, experiences, and provide support in the research process. Using a qualitative, descriptive method, this paper explores how the AG supported IKT across partners. Yearly interviews involving 19 total participants (with some participating multiple times across the 4 gatherings) elicited their AG experiences in supporting local LC:LHF2S. Three themes with multiple sub-themes were identified: (a) setting the stage for IKT (importance of in-person gatherings for building relationships across partners, learning from each other), (b) enabling meaningful engagement (aligning research with Indigenous values, addressing tensions and building trust over time, ensuring flexibility, and Indigenous involvement and leadership), and (c) supporting food system action at the local level (building local community engagement and understanding, and integrating support for implementation and scale-up of LC). This paper provides useful and practical examples of the principles of Indigenous-engaged IKT and CBPR in action in healthy, local, and traditional food initiatives. AG are a valuable IKT strategy to contribute to positive, transformative change and ethical research practice within Indigenous communities.

The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial.

BACKGROUND: Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period. OBJECTIVE: This study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. METHODS: This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul's Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews. RESULTS: There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain-Health-directed activity: -0.13, 95% CI -0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI -0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI -0.22 to 0.29, P=.77; Self-monitoring and insight: -0.14, 95% CI -0.33 to 0.05, P=.15; Constructive attitudes and approaches: -0.10, 95% CI -0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI -0.18 to 0.27, P=.69; Social integration and support: -0.12, 95% CI -0.34 to 0.10, P=.27; and Health services navigation: -0.05, 95% CI -0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference -0.36, 95% CI -0.66 to -0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program. CONCLUSIONS: The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. TRIAL REGISTRATION: ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.6968.

Perceived opportunities and challenges of family and community members in supporting teen mothers in rural Eastern Uganda.

There is tremendous need for feasible and acceptable community-based interventions to address poor nutrition and health among teen mothers in rural Eastern Uganda. To inform such interventions, we identified facilitators/opportunities and challenges for maternal/child nutrition and health at community level, as perceived by those closest to the problem. In-depth interviews were conducted among 101 teens, family and community members in Budondo sub-county using questions based on social cognitive theory constructs related to nutrition/health. Data were analyzed thematically using Atlas-ti7.5.4. Facilitators included family support for positive teen decision-making regarding healthcare and practices and opportunities included income generation training and availability of healthcare services. Challenges included poor attitude of parents towards community workers, harsh treatment, inability to obtain income generation materials, insufficient land, food or medical supplies and medical understaffing. To exploit opportunities for improved maternal/child health and progress towards global sustainable development goals, this study points to needs for local action.

Effectiveness of social marketing in improving knowledge, attitudes and practice of consumption of vitamin A-fortified oil in Tanzania.

OBJECTIVE: To evaluate the effectiveness of a social marketing intervention in enhancing knowledge, attitudes and practice (KAP) related to consumption of vitamin A-fortified oil. DESIGN: The intervention employed community events, distribution of educational materials and radio broadcasts. The intervention was assessed in a quasi-experimental non-equivalent control group study design by collecting information on KAP regarding vitamin A-fortified oil consumption before and after 9 months of a 13-month intervention. SETTING: Six districts in Manyara and Shinyanga regions in Tanzania were non-randomly selected as the intervention districts and two districts served as the control districts. PARTICIPANTS: At baseline, 568 lactating mothers with children aged <5 years were randomly selected from the intervention and control districts. Of these, 494 mothers were followed up at endline. RESULTS: After 9 months of intervention, knowledge of fortification and actual consumption of adequately fortified oil were significantly higher in the intervention districts compared with the control districts (P <0·05). Knowledge of the health benefits of vitamin A improved significantly from about 33 to 45 % in both the intervention and control districts. The major sources of information for women were health clinics and community health workers (CHW). CONCLUSIONS: The study showed that a social marketing intervention is effective in improving KAP regarding fortified oil consumption at the household level. Clinics and CHW are channels that should be prioritized when communicating health messages, particularly those targeting women.

Needs and Barriers of Teen Mothers in Rural Eastern Uganda: Stakeholders' Perceptions Regarding Maternal/Child Nutrition and Health.

For adolescent mothers in rural Eastern Uganda, nutrition and health may be compromised by many factors. Identifying individual and environmental needs and barriers at local levels is important to inform community-based interventions. This qualitative study used interviews based on constructs from social cognitive theory. 101 adolescent mothers, family members, health-related personnel and community workers in Budondo sub-county (Jinja district), eastern Uganda were interviewed. Young mothers had needs, related to going back to school, home-based small businesses; social needs, care support and belonging to their families, employment, shelter, clothing, personal land and animals, medical care and delivery materials. Barriers to meeting their needs included: lack of skills in income generation and food preparation, harsh treatment, pregnancy and childcare costs, lack of academic qualifications, lack of adequate shelter and land, lack of foods to make complementary feeds for infants, insufficient access to medicines, tailored health care and appropriate communications. Using the social cognitive framework, this study identified myriad needs of young mothers and barriers to improving maternal/child nutrition and health. Adolescent-mother-and-child-friendly environments are needed at local levels while continuing to reduce broader socio-cultural and economic barriers to health equity. Findings may help direct future interventions for improved adolescent maternal/child nutrition and health.

Barriers and facilitators to the integration of depression services in primary care in Vietnam: a mixed methods study.

BACKGROUND: Although the prevalence of depression in Vietnam is on par with global rates, services for depression are limited. The government of Vietnam has prioritized enhancing depression care through primary healthcare (PHC) and efforts are currently underway to test and scale-up psychosocial interventions throughout the country. With these initiatives in progress, it is important to understand implementation factors that might influence the successful integration of depression services into PHC. As the implementers of these new interventions, primary care providers (PHPs) are well placed to provide important insight into implementation factors affecting the integration of depression services into PHC. This mixed-methods study examines factors at the individual, organizational and structural levels that may act as barriers and facilitators to the integration of depression services into PHC in Vietnam from the perspective of PHPs. METHODS: Data collection took place in Hanoi, Vietnam in 2014. We conducted semi-structured interviews with PHPs (n = 30) at commune health centres and outpatient clinics in one rural and one urban district of Hanoi. Theoretical thematic analysis was used to analyse interview data. We administered an online survey to PHPs at n = 150 randomly selected communes across Hanoi. N = 226 PHPs responded to the survey. We used descriptive statistics to describe the study variables acting as barriers and facilitators and used a chi-square test of independence to indicate statistically significant (p < .05) associations between study variables and the profession, location and gender of PHPs. RESULTS: Individual-level barriers include low level of knowledge and familiarity with depression among PHPs. Organizational barriers include low resource availability in PHC and low managerial discretion. Barriers at the structural level include limited mental health training among all PHPs and the existing programmatic structure of PHC in Vietnam, which sets mental health apart from general services. Facilitators at the individual level include positive attitudes among PHPs towards people with depression and interest in undergoing enhanced training in depression service delivery. CONCLUSIONS: While facilitating factors at the individual level are encouraging, considerable barriers at the structural level must be addressed to ensure the successful integration of depression services into PHC in Vietnam.

Conceptualizing depression in Vietnam: Primary health care providers' explanatory models of depression.

The purpose of this qualitative study was to elicit the explanatory models (EMs) of primary healthcare providers (PHPs) in Vietnam in order to (a) understand if and how the concept of depression is understood in Vietnam from the perspective of nonspecialist providers and community members, and (b) to inform the process of introducing services for depression in primary care in Vietnam. We conducted semistructured interviews with 30 PHPs in one rural and one urban district of Hanoi, Vietnam in 2014. We found that although PHPs possess low levels of formal knowledge about depression, they provide consistent accounts of its symptoms and aetiology among their patient population, suggesting that depression is a relevant concept in Vietnam. PHPs describe a predominantly psychosocial understanding of depression, with little mention of either affective symptoms or neurological aetiology. This implies that, with enhanced training, psychosocial approaches to depression care would be appropriate and acceptable in this context. Distinctions were identified between rural and urban populations in both understandings of depression and help-seeking, suggesting that enhanced services should account for the diversity of the Vietnamese context. Alcohol misuse among men emerged as a considerable concern, both in relation to depression and as stand-alone issue facing Vietnamese communities, indicating the need for further research in this area. Low help-seeking for depression in primary care implies the need for enhanced community outreach. The results of this study demonstrate the value of eliciting EMs to inform planning for enhanced mental health service delivery in a global context.

Face-to-face communication between patients and family physicians in Canada: A scoping review.

OBJECTIVE: Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada. METHODS: Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes. RESULTS: Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools. CONCLUSION: Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care. PRACTICE IMPLICATIONS: Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.

Appropriate Reconciliation of Cardiovascular Medications After Elective Surgery and Postdischarge Acute Hospital and Ambulatory Visits.

OBJECTIVE: To describe appropriate discharge reconciliation of cardiovascular medications and assess associations with postdischarge healthcare utilization in surgical patients. DESIGN: Retrospective cohort study from January 2007 to December 2011. SETTING: An academic medical center. PATIENTS: Seven hundred and fifty-two adults undergoing elective noncardiac surgery and taking antiplatelet agents, beta-blockers, renin-angiotensin system inhibitors, or statin lipid-lowering agents before surgery. MEASUREMENTS: Primary predictor: appropriate discharge reconciliation of preoperative cardiovascular medications (continuation without documented contraindications). Primary outcomes: acute hospital visits (emergency department visits or hospitalizations) and unplanned ambulatory visits (primary care or surgical) at 30 days after surgery. RESULTS: Preoperative medications were appropriately reconciled in 436 (58.0%) patients. For individual medications, appropriate discharge reconciliation occurred for 156 of the 327 patients on antiplatelet agents (47.7%), 507 of the 624 patients on beta-blockers (81.3%), 259 of the 361 patients on renin-angiotensin system inhibitors (71.8%), and 302 of the 406 patients on statins (74.4%). In multivariable analyses, appropriate reconciliation of all preoperative medications was not associated with acute hospital (adjusted odds ratio [AOR], 0.94; 95% confidence interval [CI], 0.63-1.41) or unplanned ambulatory visits (AOR, 1.48; 95% CI, 0.94-2.35). Appropriate reconciliation of statin therapy was associated with lower odds of acute hospital visits (AOR, 0.47; 95% CI, 0.26-0.85). There were no other statistically significant associations between appropriate reconciliation of individual medications and either outcome. CONCLUSIONS: Although large gaps in appropriate discharge reconciliation of chronic cardiovascular medications were common in patients undergoing elective surgery, these gaps were not consistently associated with postdischarge acute hospital or ambulatory visits.

The Use of Text Messaging to Improve the Hospital-to-Community Transition in Acute Coronary Syndrome Patients (Txt2Prevent): Intervention Development and Pilot Randomized Controlled Trial Protocol.

BACKGROUND: Acute coronary syndrome, including acute myocardial infarction (AMI), is one of the leading causes for hospitalization, with AMI 30-day readmission rates around 20%. Supporting patient information needs and increasing adherence to recommended self-management behaviors during transition from hospital to home has the potential to improve patient outcomes. Text messages have been effective in other interventions and may be suitable to provide support to patients during this transition period. OBJECTIVE: The goal of this study is to pilot test a text messaging intervention program (Txt2Prevent) that supports acute coronary syndrome patients for 60 days postdischarge. The primary objective is to compare self-management, as measured by the Health Education Impact Questionnaire, between patients receiving only usual care versus those who receive usual care plus the Txt2Prevent intervention. The secondary objectives are to compare medication adherence, health-related quality of life, self-efficacy, health care resource use (and associated costs), all-cause and cardiovascular disease (CVD) readmission, and all-cause and CVD mortality rates between the 2 groups. The third objective is to assess acceptability of the text messaging intervention and feasibility of the study protocol. METHODS: This is a randomized controlled trial with blinding of outcome assessors. The Txt2Prevent program includes automated text messages to patients about standard follow-up care, general self-management, and healthy living. The content of the text messages was informed by and developed based on interviews with patients, discharge materials, theoretical domains of behavior, and a clinical advisory group composed of patients, clinicians, and researchers. We will recruit 76 consecutive cardiac in-patients with acute coronary syndrome who are treated with either medical management or percutaneous coronary intervention from a hospital in Vancouver, Canada. RESULTS: Assessments at baseline will include measures for demographic information, self-management, health-related quality of life, and self-efficacy. Assessments at follow-up will include medication adherence, readmissions, health care resource use, and mortality in addition to the reassessment of baseline measures. Baseline assessments are done in-person while follow-up assessments are completed through a combination of mailed packages and phone calls. Semistructured interviews with participants will also be performed to better understand participant experiences managing their condition and with the text messages. CONCLUSIONS: This study will determine preliminary efficacy, feasibility, and acceptability of the Txt2Prevent program to support acute coronary syndrome patients in the transition to home following hospital discharge. The results of this study will be used to inform a larger trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919 (Archived by WebCite at http://www.webcitation.org/6qMjEqo6O).

Do Women Have a Choice? Care Providers' and Decision Makers' Perspectives on Barriers to Access of Health Services for Birth after a Previous Cesarean.

BACKGROUND: Repeat cesarean delivery is the single largest contributor to the escalating cesarean rate worldwide. Approximately 80 percent of women with a past cesarean are candidates for vaginal birth after a cesarean (VBAC), but in Canada less than one-third plan VBAC. Emerging evidence suggests that these trends may be due in part to nonclinical factors, including care provider practice patterns and delays in access to surgical and anesthesia services. This study sought to explore maternity care providers' and decision makers' attitudes toward and experiences with providing and planning services for women with a previous cesarean. METHODS: In-depth, semi-structured interviews were conducted with family physicians, midwives, obstetricians, nurses, anesthetists, and health service decision makers recruited from three rural and two urban Canadian communities. Constructivist grounded theory informed iterative data collection and analysis. RESULTS: Analysis of interviews (n = 35) revealed that the factors influencing decisions resulted from interactions between the clinical, organizational, and policy levels of the health care system. Physicians acted as information providers of clinical risks and benefits, with limited discussion of patient preferences. Decision makers serving large hospitals revealed concerns related to liability and patient safety. These stemmed from competing access to surgical resources. CONCLUSIONS: To facilitate women's increased access to planned VBAC, it is necessary to address the barriers perceived by care providers and decision makers. Strategies to mitigate concerns include initiating decision support immediately after the primary cesarean, addressing the social risks that influence women's preferences, and managing perceptions of patient and litigation risks through shared decision making.

Seeking control in the midst of uncertainty: Women's experiences of choosing mode of birth after caesarean.

PROBLEM: Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. To support informed choices for birth after caesarean, it is necessary to understand the factors that influence women's decision-making. AIM: The goal of this study was to explore attitudes towards and experiences with decision-making for mode of delivery after caesarean from the perspectives of Canadian women. METHODS: In-depth, semi-structured interviews were conducted with 23 women eligible for VBAC in three rural and two urban communities in British Columbia, Canada, during summer 2015. Constructivist grounded theory informed iterative data collection and analysis. FINDINGS: Women's decision-making experiences were a process of "seeking control in the midst of uncertainty." Women formed early preferences for mode of delivery after their primary caesareans and engaged in careful deliberation during their inter-pregnancy interval, consisting of: reflecting on their birth, clarifying their values, becoming informed, considering the feasibility of options, deliberating with the care team, and making an actual choice. Women struggled to make trade-offs between having a healthy baby and social attributes of delivery, such as uninterrupted bonding with their newborn. CONCLUSIONS: Women begin decision-making for birth after caesarean earlier than previously reported and their choices are influenced by personal experience and psychosocial concerns. Future interventions to support choice of mode of delivery should begin early after the primary caesarean, to reflect when women begin to form preferences.

Selection of depression measures for use among Vietnamese populations in primary care settings: a scoping review.

Depression is an important and growing contributor to the burden of disease around the world and evidence suggests the experience of depression varies cross-culturally. Efforts to improve the integration of services for depression in primary care are increasing globally, meaning that culturally valid measures that are acceptable for use in primary care settings are needed. We conducted a scoping review of 27 studies that validated or used 10 measures of depression in Vietnamese populations. We reviewed the validity of the instruments as reported in the studies and qualitatively assessed cultural validity and acceptability for use in primary care. We found much variation in the methods used to validate the measures, with an emphasis on criterion validity and reliability. Enhanced evaluation of content and construct validity is needed to ensure validity within diverse cultural contexts such as Vietnam. For effective use in primary care, measures must be further evaluated for their brevity and ease of use. To identify appropriate measures for use in primary care in diverse populations, assessment must balance standard validity testing with enhanced testing for appropriateness in terms of culture, language, and gender and for acceptability for use in primary care.

Targeting of chemoprevention to high-risk potentially malignant oral lesions: challenges and opportunities.

Worldwide, oral cancer is responsible for 170,000 deaths per year. Intervention to prevent this disease is a long sought after goal. Chemoprevention studies have focused on clinicopathological features of potentially malignant lesions (PML) in an effort to prevent their progression to cancer. However, prediction of future behavior for such lesions is difficult and remains a major challenge to such intervention. Different approaches to this problem have been tested in the past 20years. Early genetic progression models identified critical regions of allelic imbalance at 3p and 9p, and provided the basis for molecular markers to identify progressing PMLs. Subsequently, technological advances, such as genome-wide high-throughput array platforms, computer imaging, visualization technology and next generation sequencing, have broadened the scope for marker development and have the potential of further improving our ability to identify high-risk lesions in the near future either alone or in combination. In this article, we examine the milestones in the development of markers for PML progression. We emphasize the critical importance of networks among scientists, health professionals and community to facilitate the validation and application of putative markers into clinical practice. With a growing number of new agents to validate, it is necessary to coordinate the design and implementation of strategies for patient recruitment, integration of marker assessment, and the final translation of such approaches into clinical use.

A novel integration of online and flipped classroom instructional models in public health higher education.

BACKGROUND: In 2013, a cohort of public health students participated in a 'flipped' Environmental and Occupational Health course. Content for the course was delivered through NextGenU.org and active learning activities were carried out during in-class time. This paper reports on the design, implementation, and evaluation of this novel approach. METHODS: Using mixed-methods, we examined learning experiences and perceptions of the flipped classroom model and assessed changes in students' self-perceived knowledge after participation in the course. We used pre- and post-course surveys to measure changes in self-perceived knowledge. The post-course survey also included items regarding learning experiences and perceptions of the flipped classroom model. We also compared standard course review and examination scores for the 2013 NextGenU/Flipped Classroom students to previous years when the course was taught with a lecture-based model. We conducted a focus group session to gain more in-depth understanding of student learning experiences and perceptions. RESULTS: Students reported an increase in knowledge and survey and focus group data revealed positive learning experiences and perceptions of the flipped classroom model. Mean examination scores for the 2013 NextGenU/Flipped classroom students were 88.8% compared to 86.4% for traditional students (2011). On a scale of 1-5 (1 = lowest rank, 5 = highest rank), the mean overall rating for the 2013 NextGenU/Flipped classroom students was 4.7/5 compared to prior years' overall ratings of 3.7 (2012), 4.3 (2011), 4.1 (2010), and 3.9 (2009). Two key themes emerged from the focus group data: 1) factors influencing positive learning experience (e.g., interactions with students and instructor); and 2) changes in attitudes towards environmental and occupation health (e.g., deepened interest in the field). CONCLUSION: Our results show that integration of the flipped classroom model with online NextGenU courses can be an effective innovation in public health higher education: students achieved similar examination scores, but NextGenU/Flipped classroom students rated their course experience more highly and reported positive learning experiences and an increase in self-perceived knowledge. These results are promising and suggest that this approach warrants further consideration and research.

Where are the NGOs and why? The distribution of health and development NGOs in Bolivia.

BACKGROUND: The presence and influence of nongovernmental organizations (NGOs) in the landscape of global health and development have dramatically increased over the past several decades. The distribution of NGO activity and the ways in which contextual factors influence the distribution of NGO activity across geographies merit study. This paper explores the distribution of NGO activity, using Bolivia as a case study, and identifies local factors that are related to the distribution of NGO activity across municipalities in Bolivia. METHODS: The research question is addressed using a geographic information system (GIS) and multiple regression analyses of count data. We used count data of the total number of NGO projects across Bolivian municipalities to measure NGO activity both in general and in the health sector specifically and national census data for explanatory variables of interest. RESULTS: This study provides one of the first empirical analyses exploring factors related to the distribution of NGO activity at the national scale. Our analyses show that NGO activity in Bolivia, both in general and health-sector specific, is distributed unevenly across the country. Results indicate that NGO activity is related to population size, extent of urbanization, size of the indigenous population, and health system coverage. Results for NGO activity in general and health-sector specific NGO activity were similar. CONCLUSIONS: The uneven distribution of NGO activity may suggest a lack of co-ordination among NGOs working in Bolivia as well as a lack of co-ordination among NGO funders. Co-ordination of NGO activity is most needed in regions characterized by high NGO activity in order to avoid duplication of services and programmes and inefficient use of limited resources. Our findings also indicate that neither general nor health specific NGO activity is related to population need, when defined as population health status or education level or poverty levels. Considering these results we discuss broader implications for global health and development and make several recommendations relevant for development and health practice and research.

Antibiotic knowledge and self-care for acute respiratory tract infections in Mexico.

OBJECTIVE: To examine knowledge of and self-treatment with antibiotics among medically-insured adults in Mexico. MATERIALS AND METHODS: We conducted a cross-sectional, interviewer-administered survey among 101 adult patients seeking care for acute respiratory tract infections in a family medicine clinic in Mexico. Knowledge scores were calculated as a composite of correct, incorrect and don't know responses. Factors associated with antibiotic knowledge and antibiotic self-treatment were explored with bivariate analyses. RESULTS: 47% of participants were taking antibiotics prior to the visit, 20% were self-treating. Antibiotic knowledge was highly variable. Many participants believed common non-antibiotic treatments for colds and coughs were antibiotics, such as ambroxol (45%), Desenfriol (45%) and paracetamol (44%). Older participants (>40 years) had better knowledge scores. DISCUSSION: Self-treatment with and misperceptions about antibiotics are common among medically insured adults seeking medical attention in Mexico.

Antibiotic knowledge and self-care for acute respiratory tract infections in Mexico / Conocimiento y automedicación de antibióticos para infecciones respiratorias en México

OBJECTIVE: To examine knowledge of and self-treatment with antibiotics among medically-insured adults in Mexico. MATERIALS AND METHODS: We conducted a cross-sectional, interviewer-administered survey among 101 adult patients seeking care for acute respiratory tract infections in a family medicine clinic in Mexico. Knowledge scores were calculated as a composite of correct, incorrect and don't know responses. Factors associated with antibiotic knowledge and antibiotic self-treatment were explored with bivariate analyses. RESULTS: 47% of participants were taking antibiotics prior to the visit, 20% were self-treating. Antibiotic knowledge was highly variable. Many participants believed common non-antibiotic treatments for colds and coughs were antibiotics, such as ambroxol (45%), Desenfriol (45%) and paracetamol (44%). Older participants (>40 years) had better knowledge scores. DISCUSSION: Self-treatment with and misperceptions about antibiotics are common among medically insured adults seeking medical attention in Mexico.

OBJETIVO: Examinar el conocimiento y automedicación de antibióticos en adultos asegurados en México. MATERIAL Y MÉTODOS: Llevamos a cabo un estudio transversal mediante la administración de un cuestionario a 101 pacientes adultos que solicitaban atención médica por infección respiratoria aguda en una clínica de medicina familiar en México. La puntuación de conocimiento estuvo compuesta por respuestas correctas, incorrectas y "no sé", los factores asociados con conocimiento y automedicación de antibióticos fueron explorados mediante análisis bivariado. RESULTADOS: 47% de los participantes tomaron antibióticos previamente y 20% fueron automedicados. La puntuación de conocimiento fue muy variable. Muchos de los participantes creyeron que tratamientos comunes para resfriado y tos eran antibióticos, como ambroxol (45%), Desenfriol (45%) y paracetamol (44%). Los participantes con mayor edad (>40 años) obtuvieron mejores puntuaciones de conocimiento. DISCUSIÓN: Las percepciones erróneas sobre antibióticos y su automedicación son comunes en adultos que buscan atención médica en México.