Collaborative healthcare education programmes for continuing professional education in low and middle-income countries: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 65.

BACKGROUND: Large discrepancies exist between standards of healthcare provision in high-income (HICs) and low and middle-income countries (LMICs). The root cause is often financial, resulting in poor infrastructure and under-resourced education and healthcare systems. Continuing professional education (CPE) programmes improve staff knowledge, skills, retention, and practice, but remain costly and rare in low-resource settings. One potential solution involves healthcare education collaborations between institutions in HICs and LMICs to provide culturally appropriate CPE in LMICs. To be effective, educational partnerships must address the challenges arising from differences in cultural norms, language, available technology and organisational structures within collaborating countries. METHODS: Seven databases and other sources were systematically searched on 7 July 2020 for relevant studies. Citations, abstracts, and studies were screened and consensus was reached on which to include within the review. 54 studies were assessed regarding the type of educational programme involved, the nature of HIC/LMIC collaboration and quality of the study design. RESULTS: Studies varied greatly regarding the types and numbers of healthcare professionals involved, pedagogical and delivery methods, and the ways in which collaboration was undertaken. Barriers and enablers of collaboration were identified and discussed. The key findings were: 1. The methodological quality of reporting in the studies was generally poor. 2. The way in which HIC/LMIC healthcare education collaboration is undertaken varies according to many factors, including what is to be delivered, the learner group, the context, and the resources available. 3. Western bias was a major barrier. 4. The key to developing successful collaborations was the quality, nature, and duration of the relationships between those involved. CONCLUSION: This review provides insights into factors that underpin successful HIC/LMIC healthcare CPE collaborations and outlines inequities and quality issues in reporting.

All you Need is Trust? Public Perspectives on Consenting to Participate in Genomic Research in the Sri Lankan District of Colombo.

Engagement with genomic medicine and research has increased globally during the past few decades, including rapid developments in Sri Lanka. Genomic research is carried out in Sri Lanka on a variety of scales and with different aims and perspectives. However, there are concerns about participants' understanding of genomic research, including the validity of informed consent. This article reports a qualitative study aiming to explore the understanding, knowledge, and attitudes of the Sri Lankan public towards genomic medicine and to inform the development of an effective and appropriate process for informed consent in that setting. Purposive sampling was employed. Participants were recruited from a sub-group of the public in Colombo, Sri Lanka who had either consented or refused to donate genetic material for a biobank. Data were collected using face-to-face semi-structured interviews. Interview data were transcribed verbatim and translated into English. Conventional content analysis was used. The analysis developed three key themes: a) 'Scientific literacy' describes an apparent lack of scientific knowledge that seems to affect a participant's ability to understand the research, b) 'Motivation' describes narratives about why participants chose (not) to take part in the research, despite not understanding it, and c) 'Trust' describes how trust served to mitigate the apparent ethical deficit created by not being fully informed. In this article, we argue that informed trust is likely an acceptable basis for consent, particularly in settings where scientific literacy might be low. However, researchers must work to be worthy of that trust and ensure that misconceptions are actively addressed.

Factors which influence the effectiveness of clinical supervision for student nurses in Sri Lanka: A qualitative research study.

BACKGROUND: Clinical placements are an essential part of student nurse education, but their effectiveness is influenced by the type and availability of supervision and existing resources. In Sri Lanka, the specific socio-political context in which nursing, and nurse education, operate may also be important. OBJECTIVES: To examine the impact of socio-political factors on Sri Lankan nurses' supervisory practices and student nurses' experiences of clinical supervision. DESIGN: Qualitative descriptive. SETTINGS: Four teaching hospitals and four educational establishments in Colombo district, Sri Lanka. PARTICIPANTS: 217 student nurses in years 2-4 of their programmes. 205 qualified nurses (clinical and academic) with a minimum of two years' supervisory experience. METHODS: Written responses to three open questions, followed by reflexive thematic analysis with inductive, semantic coding. RESULTS: Two themes were identified: 1. Personal and professional development 2. Tensions and conflicts. Sociocultural norms and governance structures, which limited nurses' professional recognition and self-determination, negatively affected clinical supervision. CONCLUSIONS: The sociocultural changes necessary to raise the professional status of Sri Lankan nurses will take time to occur. Approval of a mentorship education programme for supervisors, recognition of their role and greater support for students are important first steps in this process.

Perceptions of mothers on child well-being, changes in everyday life and social sustainability: lessons learned from a community-based health promotion programme in Anuradhapura District, Sri Lanka.

BACKGROUND: From 2012 to 2015, a health promotion intervention (under a project called HADP) aiming to improve children's well-being was implemented in Horowpathana, Sri Lanka. The donor organization reports positive results regarding children's well-being and behaviour changes, but mixed results regarding its sustainability. A need for a complementary evaluation was therefore identified. The current study intended to provide a complementary evaluation at four months after the programme closure and to assess the sustainability of the HP intervention from the perspective of mothers who participated in the HADP. Ethical approval for this study was obtained from the ethics review subcommittee of Faculty of Applied Sciences, RUSL. METHODS: A descriptive qualitative study was carried out using in-depth, semi-structured interviews with a convenient sample of 15 mothers who previously participated in HADP. Data analysis was done using the content analysis method. RESULTS: Mothers attributed diverse perceptions in line with the theme of "health literacy". Two sub-themes emerged: transformation for betterment and sustainability. The sub-theme of transformation for betterment consists of three categories: individual-level transformation, family-level transformation and social/community-level transformation. Sub-theme sustainability consists of two categories: (1) drivers/adaptations for continuation and (2) determinants that hinder the continuation. CONCLUSIONS: The mothers' perspectives were strongly related to the definition of health literacy, which emphasizes people's ability to use health information to make "well-informed" decisions that incorporate a public health perspective. They also acknowledged the responsibility of social organizations to address health literacy. From a health promotion perspective, the findings of our study indicate that people and organizations can use their health literacy skills to improve the health and well-being of their community and its members. Further research is necessary to explore the factors that affect the sustainability of health promotion interventions in the long run.

Description of a telephone and Internet-based intervention to improve community responses to COVID-19 spread.

BACKGROUND: This paper describes the process and results of a health promotion intervention to engage lay communities using telephone and online communication, to improve their current responses to the spread of COVID-19. METHODS: An intervention was conducted from March to July 2020 in three districts of Sri Lanka. Seven 'trigger' stories were shared through telephone or online communication to stimulate brainstorming and to engage selected community members. Determinants were identified and prioritised through discussions, and potentially beneficial actions were implemented as agreed by participants. The process was monitored, outcomes were evaluated monthly, and activities were modified according to ongoing observations. RESULTS: A total of 638 families (both adults and children) involved actively in implementing useful actions and reported an increased sense of personal control. Potential risk groups, best feasible community safety precautions and preparation to face challenges in the event of infection reaching their community were identified during brainstorming sessions with community mobilisers. A majority reported that they felt more confident, united and less anxious about handling potential risks and problems. Other beneficial outcomes include lifestyle changes leading to healthier behaviours and a sense of greater control over the conditions that govern their lives. CONCLUSION: Use of telephone and online communication was effective in generating desirable community changes.

A health promotion intervention to address youth violence among students in a technical college in Sri Lanka guided by the participatory action research approach: a study protocol.

BACKGROUND: Youth violence is a global public health issue and the highest rates are reported in Low and Middle-Income Countries (LMICs). Higher rates of youth violence are reported in Sri Lanka as well. Students who fail to continue higher studies in schools or enter the universities in Sri Lanka, enroll in technical colleges and are associated with a higher number of risk factors of violence. This study aims to empower youth (15-29 years old) of a technical college in Matale district, Sri Lanka, to carry out activities among themselves to improve their knowledge, change perceptions, and violence-related behaviours. METHODS: The Participatory Action Research (PAR) approach will be used. The study participants will be eighty students in a technical college in Matale district, Sri Lanka. The study period will be three years. Study participants will also be collaborators and they will involve actively in all stages of the study. A health promotion intervention will be implemented to identify determinants of youth violence and to design and implement actions while monitoring the changes. The data will be collected mainly through focus group discussions and key informant interviews both before and after the health promotion intervention. Additionally, a self-administered questionnaire will be used and the principal investigator will maintain a reflective diary. The qualitative data will be analysed thematically whereas quantitative data will be analysed using descriptive statistics. Data will be triangulated to increase the rigour of the study. DISCUSSION: According to literature, PAR is not widely used in health promotion. The enabling and empowerment goals of health promotion are fulfilled in PAR. Thus, this will be a novel experience for researchers and this will stimulate discussion on the combination of PAR and health promotion. This study design itself promotes active participant involvement and it may generate effective youth-led, culturally appropriate actions to address youth violence. The findings will describe what works and why it works and will help Sri Lanka and similar LMICs to create safe environments for youth in educational institutes or training colleges.

In this protocol paper, we propose a participatory action research based on the health promotion approach to address youth violence in Sri Lanka which has hitherto not been addressed effectively. We selected this topic in the context where youth violence has become a major public health issue in low and middle-income countries. Since, empowering young people in preventing violence is vital, this study aims to empower the youth of a technical college in Matale district, Sri Lanka to carry out activities among themselves to address youth violence. Thus, we will select eighty students from a Sri Lankan technical college for the study. The students will involve themselves in all stages of the study as research collaborators. We will collectively identify the risk factors of youth violence, design and implement actions to address those risk factors with active youth involvement. The data will be mainly collected before and after the actions to identify the changes in knowledge, perceptions and behaviours that have been taken following the actions. The students who participate in the study will ultimately gain knowledge and skills to address violence in their college and other settings. Further, it will reduce their risk of becoming an offender or a victim of violence. This study is expected to generate effective youth-led, culturally appropriate actions to address youth violence in a selected setting. The findings will be helpful for Sri Lanka and similar low and middle-income countries to create safe environments for youth in educational institutes.