International Journal of Health Planning and Management最新文献

Introduction: In Latin America, indigenous populations' access to sexual and reproductive health services is burdened by ideological neocolonial practices.

Methods: Qualitative information was collected in three Latin American countries regarding barriers to sexual and reproductive healthcare access for indigenous populations. Three types of informants were interviewed: pregnant women, health care providers, and key actors.

Results: In the three countries studied, we found some similarities in the social and cultural context of indigenous communities that represent the greatest barriers to guarantee their access to sexual and reproductive healthcare. The similarities revolve around three main themes: roots of inequalities, access to health services, and interculturality.

Discussion: The determinants of indigenous women's access to public sexual and reproductive healthcare services in the three countries are articulated in a complex set of factors. Traditional beliefs about pregnancy, delivery care practices, and newborn care differ significantly from the biomedical perspective of healthcare workers. The latter can be understood as a historical mechanism of colonization and allows understanding the conflictive relationship of indigenous groups towards institutional care practices.

Conclusion: The knowledge and beliefs of indigenous cultures bolster their own ways of understanding and caring for sexual and reproductive health and need to be respected to provide them with appropriate healthcare suited to their needs.

Public health has become politicized in the U.S. Though research shows that limiting public health authority during emergency response puts community wellbeing and health outcomes at risk, during the COVID-19 emergency (2020-2021), some U.S. state policymakers limited the disease-preventing actions local public health agencies could take. This conflicts with public health agencies' mandate to protect lives. Using COVID-19 as a case study, we explored how local public health agencies upheld their mandate when faced with limited public health authority. We conducted qualitative semi-structured focus groups (October 2023) with a purposive sample of U.S. public health officials (n = 14) from seven U.S. states which experienced four types of restrictions on local public health actions (limits on the emergency authority of governor, chief executive, state health officer, and local government health officers). Participants discussed barriers and challenges faced, adaptations made, actions taken, and perspectives for the future. Emergent themes suggest that while limited resources and restricted public health authority caused strain, public health efforts were upheld through cross agency collaboration at the local level which supported innovation. To achieve this, trust-building and communication were vital. Limitations on local public health authority may increase in the U.S. in the coming years. To mitigate risks amidst future public health emergencies, public health leaders must focus on building trust, clear and consistent communication, and bolstering collaborative networks at the local level. The politicization of health policy at the state and federal level also needs to be addressed, as local action can only go so far.

Objective: A prior pre-implementation survey in Tanzania identified moderate feasibility and low acceptability of integrating vaccination services into community drug outlets (CDOs). The qualitative review was conducted to gain deeper insight into the factors influencing the feasibility and acceptability of integrating vaccination services into CDOs, such as community pharmacies and Accredited Drug Dispensing Outlets (ADDOs).

Methods: A descriptive qualitative design was employed as part of an explanatory sequential mixed-methods approach. Interviews were conducted with purposively sampled stakeholders, guided by findings from the prior survey. Interviews were audio-recorded and transcribed verbatim, then thematically analysed using implementation science frameworks, with coding supported by Nvivo software.

Results: A total of 17 qualitative interviews were conducted with 46 participants across Dar es Salaam, Pwani, and Dodoma, including community members, health providers, regulators, and supply chain personnel. Six themes emerged: feasibility, acceptability, training, policy, infrastructure, and economics. Community pharmacies were viewed as more feasible and better equipped than ADDOs, which face more severe challenges related to limited space, inadequate cold chain capacity, and insufficient staffing. Acceptability was higher for pharmacies, though both settings (pharmacy and ADDO) require policy, training, and infrastructure improvements.

Conclusion: Community pharmacies show greater readiness than ADDOs for vaccine delivery due to better infrastructure, professional staffing, and regulatory alignment. However, both face challenges requiring policy reform, training, and support systems. Future studies should assess operational readiness and develop national standards to guide safe, equitable, and sustainable pharmacy-based immunisation services.

Background: The utilization of health research evidence is essential for informed decision-making, especially in health planning and achieving Universal Health Coverage (UHC). However, limited information exists regarding its use in planning in Lower Middle-Income Countries (LMICs), including Tanzania. This study assessed the use of health research evidence and factors influencing its utilization among health planning teams.

Methods: A descriptive qualitative approach was used to examine determinants of evidence use in health planning. Data were collected through six focus group discussions and 34 in-depth interviews with planning team members from regional, council, and health facility levels. The COM-B model (Capability, Opportunity, Motivation) was applied to assess factors influencing evidence use, and thematic analysis was conducted on the transcribed data.

Findings: Although participants reported using available planning guidelines, the incorporation of health research evidence into planning was limited. Capability barriers included inadequate knowledge and skills for evidence-based planning. Opportunities included planning guidelines that supported evidence use, research coordinators, policymaker-researcher interactions, and infrastructure such as computers and the internet; however, access to knowledge translation tools was limited. Motivation was influenced by incentives such as extra duty allowances, promotions, and professional development opportunities.

Conclusion: The use of health research evidence in planning processes in Tanzania is low, influenced by capability, opportunity, and motivation factors. Enhancing capacity-building, fostering collaboration, strengthening policy support, and improving infrastructure are recommended. Future research should evaluate the effectiveness of these interventions and their impact on healthcare planning and delivery. Efforts were made to minimize social desirability and selection biases.

Background: Research facilitation (RF) positions are a developing workforce in health services. This review aimed to map the available research literature and summarise findings related to the role and impact of RF positions in healthcare settings.

Methods: A scoping review was conducted using three inclusion criteria. (1) Population: Articles about RF positions; (2) Concept: Articles that describe the roles and duties of RF positions, and/or report how their impact is evaluated; (3) Context: RF positions employed by, or have a significant role within, health services. Medline, EMBASE and CINAHL electronic databases were searched in June 2022 for records from 2000-present. Full text articles published in English were included. Data were extracted regarding the structure, responsibilities, and evaluation of RF positions.

Results: Eighteen articles were included, representing 86 RF positions. Most positions were orientated to support nursing or allied health research. Position titles and structure varied widely. Whilst key responsibilities were highly heterogeneous, almost all included providing direct support to health service staff to engage in research, and many included facilitating research education. A range of measures were used to evaluate RF positions, with traditional academic outputs such as publications and grants most frequent. Quantitative evidence of the impact of RF positions was weak, though positive. Qualitative evaluations revealed the important role of RF positions in research capacity and evidence-based practice.

Conclusion: RF positions provided a wide variety of supports to clinicians and health services. While there is some positive evidence of the value of RF positions, further research is needed on their structure and outcomes.

The supplementary health sector in Brazil plays an essential role, offering access to private health services for more than a quarter of the population. However, a continuous decrease in the number of Health Insurance Providers (HIPs) indicates a market concentration process, posing socioeconomic risks. To address the impacts of these closures, this study develops a predictive model to identify the key factors leading to corporate failure. A major limitation of existing research is its reliance on ambiguous insolvency proxies, such as negative net equity. This study fills a critical gap by adopting a more robust definition of failure: the compulsory termination of a provider's activities by the national regulatory agency (ANS). Applying logistic regression to a sample of 677 providers from 2014 to 2020, the model identified the EBITDA margin, net equity on total assets, working capital on total revenues, and financial assets on current liability as significant predictors. Notably, the model revealed that high volumes of short-term receivables relative to current liabilities are positively correlated with the probability of failure, suggesting this metric can mask underlying financial distress. Among categorical variables, being a self-insurer or a health cooperative was found to reduce the chances of failure. The model demonstrated high discriminative capacity (92%) and achieved 77.8% accuracy in forecasting failures in the sample test. The findings provide a crucial early warning tool for regulators, HIP managers, and stakeholders to enhance financial risk management and prevent service disruptions in the supplementary health sector.

E-government is widely acknowledged for its benefits to governments and citizens. However, its effectiveness during crises remains underexplored. During the COVID-19 pandemic, contact tracing websites were deployed globally to kerb the virus's spread, raising significant controversies about data privacy and security. This study evaluates the performance of e-government contact tracing websites across 57 countries/regions. Six e-government dimensions are examined, including (1) transparency, (2) accountability, (3) data security, (4) accessibility, (5) e-participation and (6) privacy, in a tailor-made questionnaire. The findings show that the overall performance of e-government is fair. Countries/regions mostly performed satisfactorily in providing transparency and promising accountability, data security and privacy. However, the commitments of accessibility and e-participation are evidently weak. The analysis reveals that regime type significantly influences e-government performance: democratic regimes generally perform better than autocratic ones across most dimensions, except accessibility and e-participation. The study concludes that higher levels of democracy enhance e-government performance as demonstrated by evaluations of contact tracing websites. This research provides an original comparative analysis that evaluates: (1) e-government performance through contact tracing websites, (2) the performance across various countries/regions, and (3) the factors that facilitate e-government. The contribution is to demonstrate that democracy consistently serves as a key factor in strengthening e-health management and safeguarding data protection for citizens during global health crises.

Purpose: An increasing number of patients are opting to utilise online health communities as their access to healthcare. However, there is limited research on the factors influencing patient choice in online health communities. The aim of this study was to explore the impact of physicians' knowledge-sharing in online health communities on patient choice and to analyse the potential theoretical boundaries of the relationship.

Design/methodology/approach: This study used data collected from a large online health community in China for empirical analysis to illustrate a nonlinear relationship between physicians' knowledge-sharing and patients' choices.

Findings: We found there was an inverted U-shaped relationship between physicians' knowledge-sharing and patients' choices. Moreover, the physician's pricing marked the non-linear relationship even steeper.

Originality/value: This research serves to enrich the existing literature concerning determinants of patient choice by investigating the nonlinear impact of physicians' knowledge-sharing. This study has important practical implications for improving the quality of online healthcare services and the physician-patient relationship.

Organizational transformation is a multifaceted process that involves altering an organization's structure, culture, processes, systems, and strategies to better adapt to internal and external changes. This transformative process is characterised by interprofessional interactions that aim to foster collective dynamics. The likelihood of organizational transformation failure is considerable, especially in pluralistic organizations. Our study's research question centred on the interactional mechanisms that come into play in the dynamics of organizational transformation within hospitals during a health crisis, treating the crisis as a valuable learning opportunity. Following a 6-month observation period, 28 semi-structured interviews were conducted between September 2021 and December 2022 with various professionals from different hierarchical levels and professional categories in two French hospitals. This study emphasises the mechanisms that facilitate the development of a social structure and social systems in pluralistic organizations and govern the individual and collective actions that regulate the process of organizational transformation.