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2.
Afr J Prim Health Care Fam Med ; 10(1): e1-e11, 2018 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-29781688

RESUMO

BACKGROUND:  Patient-provider communication is an interpersonal interaction between a patient and a health care provider. OBJECTIVE:  This study explored patients' communication preferences and perceptions on what factors influence the patient-provider communication in primary health care settings in Rwanda. METHODS:  In-depth semi-structured interviews with 15 individuals including 8 with limited literacy. A thematic inductive analysis was used. RESULTS:  Patients valued communication with providers and expressed the need for interacting with caring, empathic providers who can share all the information they want and involve them in their own care. Health literacy and power issues were factors that may influence patient-provider communication. Patients with limited literacy appeared to rely highly on health care providers for making decisions about and managing their health care. CONCLUSION:  The expressed preferences, including those of patients with limited literacy, aligned well with the patient-centred care model. There were indications of a power imbalance weighing on the provider's side. Although patients with limited literacy were reliant on providers for decision-making, they were ready to be more involved in the care, suggesting a potential for improved patient involvement even for patients with paternalistic care preferences. These patients' insights can impact policies and curricula to optimise clinical practice. Generated knowledge will contribute to the indispensable yet underdeveloped field of health communication in sub-Saharan Africa. PRACTICE IMPLICATIONS:  Findings call for more inclusion of patient perspectives in the patient-provider encounter. This could require more training of professionals and research on the topic, both in Rwanda and in other regions.


Assuntos
Comunicação , Assistência à Saúde , Relações Médico-Paciente , Adulto , Empatia , Feminino , Alfabetização em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Preferência do Paciente , Assistência Centrada no Paciente , Ruanda , Adulto Jovem
3.
Patient Educ Couns ; 101(9): 1601-1610, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29724432

RESUMO

OBJECTIVE: To identify, adapt and validate a measure for providers' communication and interpersonal skills in Rwanda. METHODS: After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed. RESULTS: Identification and adaptation: The 14-item Communication Assessment Tool (CAT) was selected and adapted. VALIDITY AND RELIABILITY TESTING: Content validation found all items highly relevant in the local context except two, which were retained upon understanding the reasoning applied by patients. Eleven providers and 291 patients were involved in the field-testing. Confirmatory factor analysis showed a good fit for the original one factor model. Test-retest reliability assessment revealed a mean quadratic weighted Kappa = 0.81 (range: 0.69-0.89, N = 57). The average proportion of excellent scores was 15.7% (SD: 24.7, range: 9.9-21.8%, N = 180). Differential item functioning was not observed except for item 1, which focuses on greetings, for age groups (p = 0.02, N = 180). CONCLUSION: The Kinyarwanda version of CAT (K-CAT) is a reliable and valid patient-reported measure of providers' communication and interpersonal skills. K-CAT was validated on nurses and its use on other types of providers may require further validation. PRACTICE IMPLICATION: K-CAT is expected to be a valuable feedback tool for providers in practice and in training.

4.
PLoS One ; 13(4): e0195269, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29617429

RESUMO

BACKGROUND: Delivery of effective healthcare is contingent on the quality of communication between the patient and the healthcare provider. Little is known about primary healthcare providers' perceptions of communication with patients in Rwanda. AIM: To explore providers' perceptions of patient-provider communication (PPC) and analyse the ways in which providers present and reflect on communication practice and problems. METHODS: Qualitative, in-depth, semi structured interviews with nine primary health care providers. An abductive analysis supplemented by the framework method was applied. A narrative approach allowed the emergence of archetypical narratives on PPC. RESULTS: Providers shared rich reflections on the importance of proper communication with patients and appeared committed to making their interaction work optimally. Still, providers had difficulty critically analysing limitations of their communication in practice. Reported communication issues included lack of communication training as well as time and workload issues. Two archetypes of narratives on PPC issues and practice emerged and are discussed. CONCLUSION: While providers' narratives put patients at the centre of care, there were indications that patient-provider communication training and practice need further development. In-depth exploration of highlighted issues and adapted strategies to tackle communication drawbacks are prerequisites to improvement. This study contributes to the advancement of knowledge related to communication between the patient and the provider in a resource-limited setting.


Assuntos
Comunicação em Saúde , Pessoal de Saúde/psicologia , Atenção Primária à Saúde , Relações Profissional-Paciente , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Percepção , Pesquisa Qualitativa , Ruanda
5.
Glob Health Action ; 11(1): 1445466, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29547066

RESUMO

BACKGROUND: External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. AIM: To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. METHODS: "External supervision: Provider Evaluation of Supervisor Support" (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test-retest design, the second for confirmatory factor analysis. RESULTS: We included 16 items in section A ('The most recent experience with an external supervisor'), and 13 items in section B ('The overall experience with external supervisors'). Item-content validity index was acceptable. In field test I, test-retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B. CONCLUSIONS: ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Atenção Primária à Saúde/organização & administração , Adulto , Análise Fatorial , Feminino , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Nigéria , Organização e Administração , Psicometria , Reprodutibilidade dos Testes , Ruanda , Inquéritos e Questionários , Uganda
6.
PLoS One ; 13(2): e0189844, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29462144

RESUMO

BACKGROUND: External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. AIM: To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. DESIGN: Qualitative, exploratory study. DATA: Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. RESULTS: Evaluative activities occupied providers' understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers' uncontested accounts that systematic performance evaluations predominated supervisors' work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. CONCLUSION: While external supervisors intended to support providers' professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.


Assuntos
Atenção Primária à Saúde/organização & administração , Grupos Focais , Humanos , Pesquisa Qualitativa , Ruanda
7.
Afr J Prim Health Care Fam Med ; 9(1): e1-e11, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29113446

RESUMO

BACKGROUND: External supervision of Rwandan primary healthcare facilities unfolds as an interaction between supervisors and healthcare providers. Their relationship has not been thoroughly studied in Rwanda, and rarely in Africa. AIM: To explore perceived characteristics and effects of the relationship between providers in public primary healthcare facilities and their external supervisors in Rwanda. SETTING: We conducted three focus group discussions with primary healthcare providers (n = 16), three with external supervisors (n = 15) and one mixed (n = 5). METHODS: Focus groups were facilitated under low-moderator involvement. Findings were extracted thematically and discussed with participating and non-participating providers and supervisors. RESULTS: While external supervision is intended as a source of motivation and professional development in addition to its managerial purpose, it appeared linked to excessive evaluation anxiety among Rwandan primary healthcare providers. Supervisors related this mainly to inescapable evaluations within performance-based financing, whereas providers additionally related it to communication problems. CONCLUSION: External supervision appeared driven by systematic performance evaluations, which may prompt a strongly asymmetric supervisory power relation and challenge intentions to explore providers' experienced work problems. There is a risk that this may harm provider motivation, calling for careful attention to factors that influence the supervisory relationship. It is a dilemma that providers most in need of supervision to improve performance may be most unlikely to benefit from it. This study reveals a need for provider-oriented supportive supervision including constructive attention on providers who have performance difficulties, effective relationship building and communication, objective and diligent evaluation and two-way feedback channels.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Relações Interprofissionais , Satisfação no Emprego , Atenção Primária à Saúde , Adulto , Feminino , Grupos Focais , Humanos , Liderança , Masculino , Motivação , Poder (Psicologia) , Ruanda
8.
Int J Health Policy Manag ; 5(10): 605-606, 2016 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-27694652

RESUMO

The editorial "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians" by Eyal et al describes non-physician clinicians' (NPC) need for mentorship and support from physicians. We emphasise the same need of support for front line generalist primary healthcare providers who carry out complex tasks yet may have an inadequate skill mix.


Assuntos
Mentores , Médicos , África , África ao Sul do Saara , Assistência à Saúde , Humanos , Papel do Médico , Médicos de Atenção Primária , Atenção Primária à Saúde , Papel (figurativo)
10.
Exp Neurol ; 275 Pt 1: 182-98, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26424436

RESUMO

Human immunodeficiency virus (HIV) rapidly penetrates into the brain and establishes a persistent infection of macrophages/microglia. Activation of these cells by HIV results in the secretion of soluble factors that destabilize neuronal calcium homeostasis, encourage oxidative stress and result in neural damage. This damage is thought to underlie the cognitive-motor dysfunction that develops in many HIV-infected patients. Studies have suggested that neurotrophins may protect neurons from the toxic effects of HIV-associated proteins. To better understand the pathogenic mechanisms and the neuroprotective potential of neurotrophin ligands, we evaluated neuronal damage, calcium homeostasis and mitochondrial functions after exposure of cultured rat neurons directly to HIV gp120 or to conditioned medium from human monocyte-derived macrophages treated with gp120. We then assessed the ability of a new non-peptide p75 neurotrophin receptor ligand, LM11A-31, to stabilize calcium homeostasis and prevent the development of pathology. Each toxic challenge resulted in a delayed accumulation of intracellular calcium coupled to a decrease in the rate of calcium clearance from the cell. The delayed calcium accumulation correlated with the development of focal dendritic swellings (beading), cytoskeletal damage and impaired movement of mitochondria. Addition of LM11A-31 to the cultures at nanomolar concentrations eliminated cell death, significantly reduced the pathology, suppressed the delayed accumulation of calcium and restored mitochondrial movements. The potent neuroprotection and the stabilization of calcium homeostasis indicate that LM11A-31 may have excellent potential for the treatment of HIV-associated neurodegeneration.


Assuntos
Encéfalo/efeitos dos fármacos , Cálcio/metabolismo , Infecções por HIV/patologia , Isoleucina/análogos & derivados , Morfolinas/farmacologia , Neurônios/efeitos dos fármacos , Receptor de Fator de Crescimento Neural/metabolismo , Animais , Encéfalo/metabolismo , Encéfalo/patologia , Morte Celular/efeitos dos fármacos , Células Cultivadas , Proteína gp120 do Envelope de HIV/farmacologia , Infecções por HIV/metabolismo , Humanos , Isoleucina/farmacologia , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/metabolismo , Leucócitos Mononucleares/patologia , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Macrófagos/patologia , Microglia/efeitos dos fármacos , Microglia/metabolismo , Microglia/patologia , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Neurônios/metabolismo , Neurônios/patologia , Ratos , Ratos Long-Evans
11.
Int J Gynaecol Obstet ; 132(1): 117-25, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26653397

RESUMO

BACKGROUND: It may be assumed that supportive supervision effectively builds capacity, improves the quality of care provided by frontline health workers, and positively impacts clinical outcomes. Evidence on the role of supervision in Sub-Saharan Africa has been inconclusive, despite the critical need to maximize the workforce in low-resource settings. OBJECTIVES: To review the published literature from Sub-Saharan Africa on the effects of supportive supervision on quality of care, and health worker motivation and performance. SEARCH STRATEGY: A systematic review of seven databases of both qualitative and quantitative studies published in peer-reviewed journals. SELECTION CRITERIA: Selected studies were based in primary healthcare settings in Sub-Saharan Africa and present primary data concerning supportive supervision. DATA COLLECTION AND ANALYSIS: Thematic synthesis where data from the identified studies were grouped and interpreted according to prominent themes. MAIN RESULTS: Supportive supervision can increase job satisfaction and health worker motivation. Evidence is mixed on whether this translates to increased clinical competence and there is little evidence of the effect on clinical outcomes. CONCLUSIONS: Results highlight the lack of sound evidence on the effects of supportive supervision owing to limitations in research design and the complexity of evaluating such interventions. The approaches required a high level of external inputs, which challenge the sustainability of such models.


Assuntos
Assistência à Saúde/métodos , Pessoal de Saúde/organização & administração , Atenção Primária à Saúde/métodos , África ao Sul do Saara , Competência Clínica , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Pessoal de Saúde/psicologia , Humanos , Satisfação no Emprego , Organização e Administração , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde
15.
Ugeskr Laeger ; 174(22): 1518-21, 2012 May 28.
Artigo em Dinamarquês | MEDLINE | ID: mdl-22668645

RESUMO

Global health interventions often focus on specific diseases, thus forming vertical programmes. Studies show that vertical programmes perform poorly, which underlines the need for a horizontal basis: universal community-based primary health care, which improves health equity and outcomes. The diagonal approach supports an integrated patient-centered health-care system. The ''15% by 2015''-initiative suggests that vertical programmes invest 15% of their budgets in strengthening integrated primary health care. Strategies depend on local context.


Assuntos
Saúde Global , Atenção Primária à Saúde/organização & administração , Saúde Pública/métodos , Planejamento em Saúde Comunitária/métodos , Planejamento em Saúde Comunitária/organização & administração , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Países em Desenvolvimento , Saúde Global/economia , Política de Saúde , Disparidades em Assistência à Saúde , Humanos , Atenção Primária à Saúde/economia , Desenvolvimento de Programas/economia , Desenvolvimento de Programas/métodos , Saúde Pública/economia
16.
Ugeskr Laeger ; 174(22): 1521-4, 2012 May 28.
Artigo em Dinamarquês | MEDLINE | ID: mdl-22668646

RESUMO

The global shortage of health workers in a world with interdependence and vast inequalities in health calls for internationally coordinated context-sensitive actions to build a global health workforce of sufficient quantity and quality. This status article describes the global crisis in the health workforce and some solutions and stakeholders in play.


Assuntos
Saúde Global , Mão de Obra em Saúde , África ao Sul do Saara/epidemiologia , Assistência à Saúde , Países em Desenvolvimento , Emigração e Imigração , Saúde Global/ética , Pessoal de Saúde/educação , Pessoal de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/ética , Mão de Obra em Saúde/estatística & dados numéricos , Humanos
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