Frontiers in health services最新文献

Introduction: The World Health Organization (WHO) and UNICEF recommend at least two postnatal home visits by a health provider within the first two weeks of life to improve newborn survival. Kenya's Universal Health Coverage (UHC) initiative includes a home-visit strategy to advance Sustainable Development Goal (SDG) 3.2, which targets reducing neonatal mortality to below 12 per 1,000 live births. We estimated the costs of starting a postnatal home-visit program in a level three health facility in Kenya, based on recommendations from Kenya's Ministry of Health policymakers.

Methods: An ingredients-based costing method was used to determine the actual costs of home visits incurred during a research project conducted in 2019, and to estimate program costs from the government's perspective as the payer. Per-visit costs were calculated for three staffing approaches: Community Health Promoter (CHP), Registered Nurse (RN), and a Combined model where two providers (RN + CHP) visited each home together.

Results: Staff salaries and transportation costs were the main drivers of recurrent program expenses. The CHP approach had the lowest total cost at $27,302 ($24.46 per visit), followed by the RN-only approach at $36.45 per visit, while the Combined model (RN+CHP) was the most expensive at $52.10 per visit. Discussions with policymakers noted that the RN+CHP approach was least feasible and scalable. They proposed an alternative "Hybrid" model in line with current programs being scaled up: weekly RN visits during the first month of life (neonatal period), and quarterly CHP visits thereafter.

Discussion: This study presents a costing tool and generalizable formula that policymakers can use to estimate program costs based on different facility characteristics and staffing needs. The findings can support Kenya's efforts to scale up postnatal home-visit programs to improve maternal and newborn health outcomes within the UHC framework.

Introduction: Knowledge translation in healthcare has been of keen interest to researchers, practitioners, policymakers and administrators as it seeks to confront complex health issues within communities by closing the gap between knowledge generation through research and knowledge application. A paucity of information exists regarding nature of the relationship between Nigerian implementation science researchers and policymakers in the sphere of knowledge translation. This study aimed to identify and discuss barriers to successful engagement between implementation researchers and policymakers as well as to identify strategies for successful engagement between both parties in Nigeria.

Methods: A modified Nominal Group Technique was conducted with 259 diverse health research stakeholders attending the 7th Nigeria Implementation Science Alliance conference in Abuja, Nigeria, to identify barriers to knowledge translation in Nigerian healthcare settings.

Results: Lack of interest in non-aligned priorities of implementation researchers and policymakers, knowledge and capacity gap in stakeholder engagement, and non-existence of engagement framework were ranked as the top three barriers. Developing and sustaining an effective engagement framework, aligning researcher-policymaker interests through collaborative research projects, and joint capacity-building were ranked the topmost facilitators of researcher-policymaker engagement.

Conclusion: This study highlights key barriers to research-to-policy engagement in Nigeria, namely the need for structured engagement frameworks, alignment of priorities, and targeted capacity development, and proposes actionable strategies to address them. Sustainable impact will depend on dedicated financing, governance reforms, and institutional changes, supported by long-term partnerships and robust evaluation systems to advance knowledge translation and improve health outcomes.

Introduction: Developmental and Epileptic Encephalopathies (DEEs) are rare and complex conditions characterized by drug-resistant seizures and severe neurocognitive impairments. Management models for these disorders are often inconsistent, and the transition of care from pediatric to adult services represents a critical phase. This transition is frequently managed in an unstructured manner, leading to significant consequences for care continuity and the quality of life of both patients and their families.

Methods: A cross-sectional observational survey was conducted among specialists (neurologists and pediatric neuropsychiatrists) and caregivers of patients with DEEs, particularly those diagnosed with Lennox-Gastaut Syndrome (LGS). The aim was to analyze organizational models, transition pathways, and patient and caregiver experiences, identifying existing gaps in care and comparing these models with those used for another DEE, Dravet Syndrome (DS).

Results: The survey involved 47 physicians and 30 caregivers. Findings revealed substantial fragmentation in management models and the absence of standardized transition pathways in 54% of respondents. The transition of LGS patients to adult care centers is often left to individual families, with a dropout rate of 40% for LGS-similar to that observed in DS patients (38%). Caregivers reported stress, organizational difficulties, and a perceived decline in the quality of adult care. Furthermore, 53% of caregivers stated they received no support services following diagnosis.

Discussion: The lack of standardization in transition pathways represents a critical barrier to ensuring continuity of care for DEE and LGS patients. Developing structured, best-practice-based transition models, enhancing caregiver support, and fostering a multidisciplinary approach are essential to improve quality of life and ensure effective disease management into adulthood.

Background: In the delivery of environmental health services (EHS), the data that gets collected provides an opportunity to depict the extent of environmental threats to human health in communities and inform required interventions. In this study, the perspectives and role of environmental health managers in improving data management in the delivery of EHS in municipalities in the KwaZulu-Natal province of South Africa were assessed.

Methods: A qualitative phenomenological approach was followed. Data were collected from ten managers via a semi-structured interview guide from February 2024 to April 2024. The transcripts derived from the interviews were analysed via ATLAS.ti version 24.0.0.29576, following which deductive and inductive thematic analysis methods were used.

Results: The results revealed various roles and responsibilities that environmental health managers play to improve data management and enable insight-driven decision-making. Furthermore, it was shown that through data-driven insights, EHS delivery can be strengthened to be impactful and enable better health outcomes in communities amid existing institutional and technical challenges. This indicated a need for a holistic approach to review and modernise environmental health data management in South Africa to maximise available opportunities.

Conclusion: In this juncture, managers have a duty to drive transformation, apply change management and instil a culture of data use in their institutions for impactful service delivery.

Background: Immigrant youth population is more susceptible to poor mental and overall health due to environmental factors, such as higher risks of poverty, trauma, displacement, and settlement period, learning a new language, adapting to a new culture, and a lack or loss of social supports. The overall goal of this project was to identify the research priorities of immigrant youth with lived experience of mental health concerns to guide research in mental health and inform health policy in a partnership with community organizations across Alberta, Canada.

Methods: This patient-oriented research was designed based on the James Lind Alliance Priority Setting Partnership five steps: (1) creating a steering committee; (2) gathering uncertainties (questions which cannot be answered by existing research); (3) refining uncertainties through steering committee; (4) prioritization with immigrant youth via focus groups and with stakeholder involved in the care of immigrant youth through a nominal group technique; and (5) finalizing priority setting, report and dissemination. A steering committee was created with immigrant youth who self-identified with lived experience of mental health issues, leaders from immigrant communities (aged 18-25), researchers, non-profit organization leaders, and healthcare or community service providers. The electronic survey was distributed in rural, remote, suburban, and urban settings to recruit self-identified immigrant ("someone who has permanently located in a country other than their place of home origin") youth between the ages of 15 and 25 residing in Alberta, Canada.

Results: Based on 148 responses from immigrant youth with a mental health concern, 25 uncertainties were refined. The top five priorities were chosen at the focus groups and NGT. Youth prioritized uncertainties related to them and their communities, while key informants emphasized higher-level uncertainties (resources, institutional barriers). Both prioritized community roles in reducing stigma, schools' role in addressing mental health, and the impact of COVID-related isolation.

Conclusions: This study underscores the need for policies that support the tailoring of mental health services to the individual needs of immigrant youth. The findings from this study affirm that immigrant youth recognize mental health as not linear or universal; they seek to support each other and advocate for systemic changes that increase literacy and access to care.

Digital mental health interventions (DMHIs) offer promising solutions to address unmet mental health needs among children and young people, yet how to get DMHIs commissioned into the NHS can seem mystifying for innovators. This perspective paper draws on insights from a collaborative commissioning event focused on the Online Remote Behavioural Intervention for Tics (ORBIT) intervention, a digital behavioural therapy for young people with tic disorders, to explore the barriers and enablers to commissioning DMHIs in England. Key challenges identified include unclear commissioning pathways, limited clinical expertise, integration hurdles, and short-term funding models. Enablers included clinical advocacy, robust research evidence, and alignment with national frameworks. These insights highlight the importance of early collaboration between academics, developers, and policymakers in the product development cycle seeking to bridge the gap between innovation and implementation in digital mental health care.

Background: COVID-19 affected 777 million people globally, with 7.1 million deaths. In Africa, 9.6 million cases and 176,000 deaths were reported. Long COVID, a significant consequence of the COVID-19, presented by chronic symptoms, affects the physical and mental health, thereby impacting the quality of life. While high-income countries implemented rehabilitation programs for managing long COVID symptoms, low- and middle-income countries faced healthcare disparities. In South Africa, limited multidisciplinary interventions were evident. This study aimed to assess the acceptability and feasibility of an 8-week rehabilitation and self-management program for long COVID using mixed-methods approach in Johannesburg.

Methods: Patients and hospital staff who suffered from at least one symptom of long COVID for a period of two months and who consented to participate in the intervention were recruited from Tembisa Provincial Tertiary Hospital. The recruitment was from July to October 2023. Questionnaires were administered and interviews with selected participants were conducted to assess the acceptability and feasibility of the intervention. A descriptive analysis was carried out for the quantitative data, and a deductive thematic analysis was used for the interviews.

Results: The participants had positive perceptions towards the design of the intervention, delivery, materials used and support by research staff and external consultants such as dietitians, physiotherapists, and psychologists. The participants stated that the intervention had improved their knowledge of long COVID and increased their self-confidence. Major barriers related to the intervention perceived by the participants were infrastructure, time and language. Recommendations from the participants included expanding the intervention at the community level and extending the duration of the intervention beyond 8-weeks.

Conclusion: This pilot intervention, that aimed to manage the symptoms of long COVID, was well accepted by the participants and achieved its intended outcome. Similar interventions are required at the clinical as well as community levels.