Evaluation of an Education Program on Community Orientation among Community Health Nurses in Fiji.

AIM: The study objective was to evaluate the effectiveness of an education program to improve community orientation among community health nurses in Fiji. A 1.5-day education program was developed that enabled participants to learn a concept through discussion, as they reviewed their experiences. DESIGN: This study used mixed methods research. METHODS: The education program involving 78 community health nurses and supervisors was conducted. The 30-item Community Orientation among Community Health Nurses scale, six-item program evaluation questionnaire, and participant reflection sheets were analyzed using both quantitative and qualitative methods. RESULTS: Program evaluations demonstrated high satisfaction among participants. The content analysis of participant views on community orientation revealed three categories; utilizing community intelligence in community activities, relationships with community members as a community health nurses, and human resource development tool. Our findings suggest that this education program should be held regularly, in conjunction with on-the-job and off-site training.

Needs assessment of caregivers of children with disabilities in resource-limited settings.

Objective: This study aimed to identify and classify the needs of caregivers of children with disabilities living in resource-limited settings and develop a framework for need assessment. Participants and Methods: This study was conducted in the Maha Sarakham Province, Thailand, with 15 caregivers caring for children with disabilities recruited from hospitals, the Association for the Disabled, and primary health centers. Semi-structured interviews were conducted in local dialects, recorded, transcribed, converted into standard Thai, and then into English for thematic analysis. Meaning units corresponding to caregivers' needs were extracted, interpreted, coded, and hierarchically organized into subcategories by comparing similarities and differences among the extracted codes. The subcategories were further grouped and abstracted into categories, and then domains of caregivers' needs were formed. Results: Nineteen categories were identified across five domains of caregivers' needs: health and medical, welfare, educational, social, and informational. Although basic medical treatment was covered, specific support, such as referral to a specialist, rehabilitation, or psychological support, was limited. Financial support and relief from the care burden are the main welfare needs. Educational needs were identified to provide knowledge to children and to offer respite to their caregivers. Social needs revealed ethical problems that arose because of strong rural community ties, making it difficult to maintain privacy. Informational needs were intertwined with the other four domains. In rural areas, where parents of children with disabilities migrate to cities to find work, the special needs of grandparents who were primary caregivers of the children needed to be addressed. Conclusion: This study provides a conceptual framework for comprehensive needs assessment and policy development for caregivers of children with disabilities living in resource-limited settings.

Community Orientation Scale among Community Health Nurses in Fiji: Scale development and psychometric evaluation.

Aim: To develop and evaluate the reliability and validity of the COSCHN, a scale that aims to measure community orientation among community health nurses in Fiji. Design: Descriptive cross-sectional design. Methods: A self-administered questionnaire that included the 51 items in the preliminary COSCHN was distributed to community health nurses in Fiji from April-July 2016. Results: Exploratory factor analysis of 226 responses (77.4% response rate) to the COSCHN revealed 30 items loading on four factors: Community Initiative Promotion, Consensus Building for Community Needs and Activity Goal, Commitment towards Work and Community Members and Mutually Trusting Relationships with Community Members towards Empowerment. Confirmatory factor analysis with high-order factor modelling revealed a reasonable fit to the data. Cronbach's α values for the COSCHN and the four factors ranged from 0.78-0.94. Weak correlations were noted for concurrent validity, while known-groups validity and time stability were generally satisfactory.

Identifying characteristic features of community orientation among community health nurses in Fiji.

AIM: The present study aimed to identify detailed characteristics of community orientation among community health nurses in Fiji. DESIGN: Qualitative descriptive design using semi-structured individual interviews. METHODS: Twenty participants including expert nurses, novice nurses, policymakers and representatives from communities were interviewed between July-August 2015 in Fiji. Data were analysed using descriptive qualitative methods. RESULTS: Three main themes described in detail characteristics of community orientation among community health nurses in Fiji: Trusting Relationships, Commitment and Activity Management. Trusting Relationships and Commitment were interrelated and served as foundations for community orientation that promoted and facilitated Activity Management. Reflection and a sense of self-accomplishment in the CHN experiences during Activity Management further strengthened Commitment and Trusting Relationships. Community orientation leads to superior understanding of community health needs, effective use of resources and increased community participation in activities. Such activity management will contribute to promote health beyond the individual, extending to entire communities.

Development of health literacy scale among Brazilian mothers in Japan.

Japanese-Brazilians were the third largest immigrant group in Japan in 2011. Their health issues have caused concern, as their limited language made them vulnerable by hindering access to health services. Upon considering child health, mothers' health literacy (HL) is very important. This study aimed to develop a health literacy scale among Brazilian mothers (HLSBM) in Japan. Questionnaires in Portuguese were distributed to 1474 mothers from December 2011 to March 2012. Among 698 collected, 558 questionnaires were analyzed. We prepared 29 candidate items for HLSBM based on Nutbeam's concept of functional, interactive and critical literacy. The dimensional structure was determined statistically using confirmatory factor analysis. Validity was also analyzed by Pearson's correlation with Ishikawa's scale and Kendall's coefficient of concordance among researchers. Cronbach's α coefficients were calculated to examine internal consistency. The confirmatory factor analysis revealed a two-factor model (five items for basic literacy and five items for critical literacy) with sufficient goodness of fit (GFI 969, AGFI 945, NFI 959, CFI 972, RMSEA 060). The internal consistency values of the total score, basic and critical literacy sub-scales were 0.819, 0.889 and 0.667, respectively. Kendall's coefficient of concordance showed good agreement of researchers (p < 0.001). Pearson's correlation coefficients with Ishikawa's scale were 0.554 for total score, 0.446 for basic literacy and 0.472 for critical literacy. The HLSBM consisting of two factors was confirmed to be valid and reliable. The HLSBM must be useful for understanding this vulnerable group's health literacy and its associated factors.

Building the capacity of nursing professionals in Cambodia: Insights from a bridging programme for faculty development.

To upgrade nursing instruction capacity in Cambodia, two bridging programmes were opened for the Bachelor of Science in Nursing simultaneously in-country and out-of-country (Thailand). A descriptive qualitative study was conducted to assess effectiveness of both programmes jointly and to explore needs concerning the further development of nursing education. This study included interviews with 34 current or previous programme participants (nursing instructors or hospital preceptors) and 10 managers of collaborating institutions. New learning content, personal outcomes, challenges and obstacles and future needs were qualitatively coded to create categories and subcategories of data. Findings show that programme participants were most influenced by the new content areas (e.g. nursing theory and professionalism), active teaching-learning strategies and the full-time educational immersion afforded by the out-of-country programme. Programme participants who had returned to their workplaces also identified on-going needs for employing new active teaching-learning approaches, curriculum revision, national standardization of nursing curricula and improvements in the teaching-learning infrastructure. Another outcome of this study is the development of a theoretical model for Nursing Capacity Building in Developing Countries that describes the need for intermediate and long-term planning as well as using both Bottom-Up and Edge-Pulling strategies.

Effect of a maternal and child health handbook on maternal knowledge and behaviour: a community-based controlled trial in rural Cambodia.

Maternal and child health (MCH) handbooks are comprehensive home-based booklets designed to integrate MCH records. Although empirical evidence suggests the handbooks are more effective than current card-type records, this has not been scientifically demonstrated. The objectives of this study were to evaluate the impact of the MCH handbook on maternal knowledge and behaviour as measured by antenatal care (ANC) attendance, delivery with skilled birth attendants (SBAs) and delivery at a health facility. The Cambodian version of the MCH handbook was developed and introduced in two health centres, and two other health centres served as controls. Pre-intervention and post-intervention surveys were conducted with 320 women from the intervention areas and 320 women from the control areas who had given birth within 1 year before the survey. We evaluated the impact of the handbook by using difference-in-differences (DID) analysis and calculated adjusted odds ratios for pre-post changes in key indicators by using logistic regression. In addition, we interviewed multiparous women, health staff and health volunteers to assess the acceptance and cultural appropriateness of the handbook. Content analysis was performed with the English-translated transcriptions. The DID analyses revealed that all key indicators increased in the intervention group against counterfactual assumptions. The intervention also increased maternal knowledge of all topics addressed except for the risk of severe bleeding after delivery; this may be attributable to the influence of cultural belief. Logistic regression showed that the intervention increased ANC attendance, delivery with SBAs and delivery at a health facility, even after adjusting for maternal age, education and economic conditions. The qualitative data indicated that the handbook was well received and culturally appropriate. Thus, the MCH handbook is a reasonable and superior alternative to current card-type maternal records.

Sibling care, school performance, and depression among adolescent caretakers in Cambodia.

In many resource-poor countries, home-based care for young children is crucial. Yet little has been known about the negative impacts of sibling caretaking on mental health conditions of adolescent student caretakers. This study explored associations between sibling caretaking, school performance, and depression among 1943 students randomly selected from 11 junior high and high schools in Cambodia. The Asian Adolescent Depression Scale was used to measure depressive symptoms. In bivariate analyses, we used χ(2) test or Fisher's exact test for categorical variables and t-test or one-way analysis of variance for continuous variables. Multiple linear regression models were then constructed. Of total, 60.1% of our participants took care of their younger sibling(s) regularly during the past one year. The number of siblings under their care ranged from one to nine, and the time they spent for sibling care ranged from one to 10h per day. After adjustment, increased levels of depressive symptoms remained significantly associated among boys with sibling caretaking (p<0.001), as well as poor school performance (p=0.001) and perceived likelihood of dropping out of school in the near future (p=0.002). Among girls, increased levels of depressive symptoms retained their significant association with sibling caretaking (p<0.001); also poor school performance (p<0.001). Sibling care responsibility might have negative impact on school performance and the mental health condition of adolescent caretakers.

Sibling caregiving among children orphaned by AIDS: synthesis of recent studies for policy implications.

OBJECTIVE: The HIV/AIDS epidemic has increased the number of orphans who have to care for their younger siblings. However, their caregiving practices are poorly reported. This review aimed to explore and accumulate available evidences on sibling caregiving among children orphaned by AIDS. METHODS: We conducted a systematic review of sibling caregiving among AIDS orphans in developing countries and identified 25 relevant articles. We analysed the compiled literature and extracted information on the prevalence of sibling caregiving, the framework of sibling caregiving, factors influencing caregiving, and the impact of sibling caregiving on caregivers and those cared for. RESULTS: Sibling caregiving, which includes economic, physical, psychological, and educational care, was influenced by children's, familial, community, and policy factors. Unlike sibling caregiving that occurs under adequate adult supervision, sibling caregiving among AIDS orphans negatively impacts both the sibling caregivers and the cared for. However, the lack of studies about such sibling caregiving had prevented measurement of the level of burden and impact of sibling caregiving on orphans. CONCLUSIONS: Policy makers need to be aware that older children caring for younger siblings risk physical and psychological ill health and information must be collected so that measures can be developed to mitigate this burden on orphans.

Determinants of skilled birth attendance in rural Cambodia.

OBJECTIVE: To identify the determinants of skilled and unskilled birth attendance. METHOD: Population-based survey in a rural area in Cambodia, of women aged 15-49 years who had delivered during the previous 3-month period. An analytical framework based on Andersen's behavioural model served to identify determinants according to delivery place (facility vs. non-facility), birth attendant at home births (skilled vs. unskilled), and change of birth attendant during delivery (changed vs. unchanged). We used logistic regression to analyse the data. RESULTS: Of 980 women included in the analyses, 19.8% had skilled attendants present during delivery. The determinants of facility delivery were different from those for having skilled attendants assisting in home births. In case of facility deliveries, previous contact with a skilled attendant through antenatal care was a significant determinant. In case of home births, the type of birth attendant (i.e. skilled or unskilled) at the preceding delivery was a significant determinant. CONCLUSION: Community-based programmes need to reach primiparas, because once a woman has delivered with the aid of an unskilled attendant, she is five to seven times less likely to seek skilled help than a primipara.