Capacity Building of "Accredited Social Health Activist" under Rural Health Training Center Regarding Mental Health: An Interventional Study.

Background: Mental health is one of the critical health requirements that society needs to address in the present century. Accredited Social Health Activist (ASHA) can play an important role in identifying mental health problems at the earliest and help in improving community health status. Objectives: The objective of this study was to evaluate the effectiveness of a mental health education program on knowledge, attitude, and practices (KAP) of ASHAs. Materials and Methods: An intervention study was conducted to empower ASHAs for providing mental health services at a district located in Western India during 2016 and 2017. A semi-structured questionnaire was administered to assess KAP regarding mental health in intervention and control groups before and post intervention. An educational program was imparted in two batches. Hybrid methods for imparting teaching/training were utilized. "Paired t-test" was applied to compare pre- and post-results in intervention group and "unpaired t-test" for baseline comparison. Results: There was a statistically significant improvement in KAP of ASHAs after intervention. Majority of ASHAs referred cases of mental health problems to government tertiary care hospitals. Conclusions: The study indicates that it is possible to empower ASHAs with a short course related to mental health to achieve effective outcomes in terms of improved knowledge, attitudes, and practices.

Competency- Based Curriculum for Post- graduation in Community Medicine at a Medical College located in western India.

This article was migrated. The article was marked as recommended. Introduction: Curriculum or course needs to be monitored and evaluated to ensure that it is working as planned and also to identify areas for improvement. Implementing competency-based training in postgraduate medical education poses many challenges, but ultimately requires a demonstration that the learner is truly competent to progress in training or to the next phase of a professional career. Purpose: The purpose of this document was to design a competency-based curriculum in Community Medicine teaching and training of post graduates so that they could efficiently play their roles as Community Physician, Public Health Specialist, Health Manager, Faculty, Researcher and Occupational Physician. Methods: A needs assessment study using cross-sectional design reinforced a strong need of developing a common & structured curriculum in Community Medicine at the department studied and later to be scaled at state level. A Six-Step Approach to Curriculum Development was followed ( Kern et al., 2009) to design and implement the competency based curriculum. Results: Relevant feedback from teachers and students has been incorporated to prepare this document. Almost all students and faculty strongly agreed for the need of introducing formative assessment. They strongly perceived that a formative assessment would be helpful to motivate students and should have weight- age in university exams. It is learnt that there are challenges involved in operationalzing competency-based curriculum viz; requires more time and effort from faculty, at least in the initial phases of development. Other challenges include; finding ways to include internal assessment marks in the university examination. Conclusions: Competency based curriculum is feasible within a conventional medical curriculum. Benefits of such learning include improving knowledge and skills of learner that would lead to improved quality of health care.

Implementation of Foundation Program under "Graduate Medical Regulations 2019" for first professional MBBS students at a Medical College located in western India - A transformative learning experience.

This article was migrated. The article was marked as recommended. Introduction: Students enter new environment in medical colleges at around 17 years of age directly from school which can be challenging. Therefore, in Graduate Medical Regulations 2018 of India, attempt has been made to orient medical learners to MBBS program and provide them with requisite knowledge, communication, technical and language skills through a month-long foundation program. The purpose of this study is to share learning and to document feedback and best practices that would enhance the value and structure of the program in coming years. Methodology: Descriptive evaluation of the foundation program implemented at a medical college located in western India as per the guidelines of the Curriculum Implementation Support Program (CISP). This program was implemented by all medical colleges under the ambit of Medical Council of India from August 2019. Teaching-Learning Methods:Interactive sessions and assessment mainly based on reflective writing or by verbal/written feedback. To help in program evaluation and refinementa pretested semi-structured questionnaire administered to the students and faculty to gather their perceptions about various aspects of the course on a Likert scale of 1-5; 5-Strongly agree, 4-Agree, 3-Uncertain, 2-Disagree, 1-Strongly Disagree and three open-ended questions at the end of the course . Data was entered into Microsoft Excel 2007 and descriptive statistics utilized for interpretation of perceptions, themes and direct quotation used in the analysis. Take Home Message: The enthusiasm, hard work and integrated effort by the faculty members who participated in the program were extremely important for the success of this course. It is learnt that the Foundation program highlights benefits, is a valuable vehicle for increasing students' overall confidence. There are challenges involved in operationalization viz; it requires more time and effort from faculty, at least in the initial phases of program development.

Family Burden in Caregivers of Elderly with Cognitive Impairment residing in Rural and Tribal Population of a District in Western India - A Baseline Study.

STUDY OBJECTIVES: The objective was to assess cognitive impairment (CI) in adults older than 59 years, residing in rural and tribal population and to assess family burden of those who had significant CI. MATERIALS AND METHODS: This cross-sectional study was conducted among adults residing in the rural population of a block in a district located in Western India in 2015. A total of 240 households from 12 villages of the block were selected by multistage and random sampling method. Mini-mental state examination and Zarit Burden Interview tools were used to assess CI and burden. Data were entered in MS Excel 2007 and analyzed with descriptive statistics and Chi-squared test. RESULTS: A total of 212 adults aged over 59 years were studied. The overall prevalence of CI was 42.92%. There was a statistically significant difference seen in CI among females as compared to males. Interview of primary care taker showed that 32 (35.16%) caregivers had little or no burden, 53 (58.24%) had mild-to-moderate burden, and 6 (6.59%) had moderate-to-severe burden, while none had a severe burden. CONCLUSIONS: Enabling caregivers to provide at home care for longer periods before hospitalization would decrease the burden of CI.

Evaluation of input and process components of quality of child health services provided at 24 × 7 primary health centers of a district in Central Gujarat.

CONTEXT: With the critical Indian challenge on child survival and health, time is ripe to initiate focus on quality of services apart from measuring coverage, to bring about improvements. AIMS: To assess the quality of child health services provided at 24 × 7 Primary Health Centers of Vadodara District in Gujarat in terms of Input and Process Indicators. SETTINGS AND DESIGN: The study was carried out in 12 randomly chosen 24 × 7 Primary Health Centers (PHCs) of Vadodara district using a modified quality assessment checklist of the Program on District Quality Assurance for Reproductive and Child Health (RCH) services with use of scores from May 2010 to June 2011. SUBJECTS AND METHODS: Inputs assessment was done by facility survey. Process assessment for the four child health service components used actual observation of service, review of records and interview of service providers and clients. RESULTS: The mean obtained score for facilities in Input section was 65%. Highest score was obtained for Drugs and Consumables (86%) followed by Equipments and Supplies (74%). The score obtained for Infrastructure facility was 65%, Personnel and training was 56% and Essential protocols and guidelines scored 43%. The mean obtained score in the process section was 55%. Highest scores were obtained for immunization at 76%. This was followed by newborn care (52%), growth monitoring (52%). management of sick child (41%). CONCLUSION: Quality improvement efforts should focus not only on resource-intensive structural improvements, but also on cost-effective measures at improving service delivery process, especially adherence to service guidelines by providers.

Randomized double blind placebo control studies, the "Gold Standard" in intervention based studies.

Studies follow a hierarchy in terms of the quality of evidence that they can provide. Randomized double blind placebo control (RDBPC) studies are considered the "gold standard" of epidemiologic studies. And the same is discussed at length in this paper taking example of a real journal article employing this study design to answer the research question; "Does once daily dose of Valacyclovir reduce the risk of transmission of genital herpes in a susceptible partner?" RDBPC studies remain the most convincing research design in which randomly assigning the intervention can eliminate the influence of unknown or immeasurable confounding variables that may otherwise lead to biased and incorrect estimate of treatment effect. Also, randomization eliminates confounding by baseline variables and blinding eliminates confounding by co-interventions, thus eliminating the possibility that the observed effects of intervention are due to differential use of other treatments. The best comparison is placebo control that allows participants, investigators and study staff to be blinded. The advantage of trial over an observational study is the ability to demonstrate causality. Hope, this will be useful to neophyte researchers to understand causal hierarchy when critically evaluating epidemiologic literature.

Reproductive health awareness among urban school going adolescents in Vadodara city.

AIMS: To identify the reproductive health issues associated with adolescence and the readiness to avail services like Adolescent Friendly Clinic (AFC) among urban school going children. MATERIALS AND METHODS: A quantitative survey was carried out using a self-administered structured questionnaire among 1440 (748 girls and 692 boys) students from classes 6 -12 in 7 English medium and 23 Gujarati medium schools. Focus group discussions, 5 each with adolescent boys and girls and teachers were held from Gujarati and English medium schools. RESULTS: A higher proportion of boys and girls could identify visible external changes in the opposite sex as compared to the changes not seen outwardly. The sources of information on human reproduction for most of the boys and girls were schoolbooks, television, teachers, friends and parents in the same order. Over two-thirds of the boys and girls expressed a need for more information on reproduction. Teachers also perceived that adolescents, though curious, lacked opportunities for open discussions to answer their queries related to reproductive health. One-third of the boys and one-fourth of the girls had heard about contraception. Two-thirds of boys and girls had heard of HIV/AIDS, and about half of them correctly knew various modes of transmission of HIV. Majority of the adolescents expressed their readiness to use the services of Adolescent Friendly Centre. CONCLUSIONS AND RECOMMENDATIONS: Information on the human reproductive system and related issues on reproductive health need special attention. Teachers' sensitization to adolescent health care is required.

Reproductive health awareness among rural school going adolescents of Vadodara district.

OBJECTIVES: To identify the reproductive health issues associated with adolescence and their readiness to avail services like Adolescent Friendly Clinic (AFC) among rural school going children. MATERIALS AND METHODS: A quantitative survey was carried out using a self-administered structured questionnaire among 768 (428 boys and 340 girls) students from 15 schools by systematic random sampling from schools (3 schools from 5 talukas). Focus group discussions, 5 each with adolescent boys and girls and teachers were held. RESULTS AND DISCUSSION: Only 31% of the boys and 33% of the girls mentioned that they had heard about contraception. More than half of the adolescent boys and girls knew correctly about various modes of transmission of HIV/AIDS. A large proportion of boys and girls have mentioned changes in the opposite sex such as increase in height, change in voice, breast development, and growth of facial hair, growth of hair in private parts, onset of menstruation in girls, etc. Nearly 70% of adolescents were ready to use AFC. Teachers perceived that adolescents become curious about the changes taking place in them, but they lack information and opportunities for open-discussions to get answers to their queries related to reproductive health. They are willing to take help from teachers but teachers are not equipped with knowledge nor are they comfortable discussing these issues with their students. RECOMMENDATIONS: Information on the human reproductive system and related issues on reproductive health need special attention. Teachers' sensitization to "adolescent health care" is required.