The role of information and communication technologies in health system resilience after the 2015 Nepal earthquake

Olivia Crane graduated from the Master of Public Health (MPH) programme at ScHARR in 2016. She applied for the programme after deciding on a career change away from Communications in the private sector, towards Public Health. The Masters programme built on her background in anthropology and gave huge new insight into the links between health systems and the ways people live and organise themselves socially.
Since graduating from the MPH programme, Olivia has started working with the Public Health Guidelines department at the National Institute of Health and Care Excellence (NICE) as an Assistant Technical Analyst. The skills she learnt during the programme were invaluable in opening up this opportunity!


The title of Olivia's dissertation project was 'The Role of Information and Communication Technologies in Health System Resilience after the 2015 Nepal Earthquake' 
The project was offered through a research attachment to staff from ScHARR and the Department of Politics,  Dr. Julie Balen and Dr. Simon Ruston respectively. The time Olivia spent living in Nepal as a child for 6 years gave her both a passionate interest in the country, and some useful background understanding of language and culture.

Abstract

Background: Information and Communication Technologies (ICTs) are increasingly recognised for their important role, and even greater potential in mitigating, preparing for, responding to, and recovering from natural disasters. However, to date, the vast majority of research into their use in disasters has been conducted in high-income country settings. This research should be expanded into low- and middle-income countries, particularly as vulnerability to natural disasters increases with poverty. Here the role of ICTs during a series of earthquakes that occurred in Nepal in April 2015 is explored.
Methods: In depth semi-structured interviews (n=24) and focus groups (n=4) were conducted in March and April 2016, almost one year post-earthquake. Data collection took place in three settings, namely (i) at village level in Barpak, the epicentre of the earthquake; (ii) at district level in Gorkha, the capital of the district in which Barpak is situated; and (iii) at central level in Kathmandu, the capital city of Nepal. Participants were individuals affected by the earthquake, and those in formal health system roles as well as informal grassroots responders. Data was recorded, professionally translated and transcribed, and underwent thematic analysis using NVIVO 11.
Results: Perceptions of the role of ICTs and their value varied greatly between groups. While access and capability were found to be key barriers to use rurally, ICTs formed a greater part of the response in urban settings. This was particularly true for the informal response, which relied on ICTs for networking and coordination. The response of the formal health system lagged behind in terms of ICTs, generally relying more upon traditional methods of disaster management. Preparation was severely lacking in all areas, including communication planning.
Conclusions: The findings of this study indicate that the complex problems of access and capability remain key barriers to ICT use in Nepal, as seen in other low-income country literature. It demonstrates the potential of ICTs for giving people voice, and in developing community intelligence for the benefit of affected groups as well as for the information of decision makers within the formal system. It also reveals the scope for increased connectedness between the formal health system and the informal health system response, which currently operate separately but with many of the same aims.

Universal health coverage in developing countries and its impact on improving access to antenatal care and maternal health outcomes: A systematic review

Simbiat Olayinka Lawal recently completed the Master of Public Health (MPH) programme at ScHARR. Simbiat chose to study the MPH to gain more knowledge on the role of healthcare policy and management and also to develop her research skills, especially in health services research. In particular, the course developed Simbiat's knowledge of healthcare financing systems and enabled her to develop and refine her research skills. Taking part in the MPH program at ScHARR also equipped Simbiat with several other skills such as team work, time management and an ability to strive. Simbiat believes that the new skills she has obtained from studying the MPH  will enable her to work in a role that will help Africa, and particularly her home country, Nigeria, to achieve universal health coverage and health equality as well as working towards sustainable development goals. In the future, Simbiat plans to pursue a doctorate degree in public health policy and management, alongside conducting research into the Nigerian healthcare system.

The title of Simbiat's dissertation project was: Universal health coverage in developing countries and its impact on improving access to antenatal care and maternal health outcomes: A systematic review.

Abstract

Background: Universal health coverage (UHC) refers to equal access to healthcare services across all socio-economic quintiles and reduction in financial risk incurred from the utilisation of health services. It is an important goal which would help reduce maternal mortality rates. However, the effectiveness of different healthcare financing (UHC) schemes on improving access and utilisation of maternal health services and on selected pregnancy outcomes amongst women of different socio-economic, educational and residential (rural or urban) backgrounds in developing countries, is not well understood.

Aim: This study aimed to examine the utility of UHC in improving access, utilization and pregnancy outcomes in women in developing countries.

Method: A systematic literature review was performed to answer the research question. Electronic databases; Medline, ASSIA, Cochrane library, TRIP, PubMed REMINER, CINAHL and Google scholar were used to retrieve all relevant studies on universal health coverage. Also, references of included studies and online resources of organisations such as WHO, UN and WORLD BANK were also searched to avoid omission of important literature. The inclusion and exclusion criteria were developed using the PICO (population, intervention, comparator and outcome) framework.

Result: A total of 13 studies were included in the review; of which 2 studies were from Bangladesh, 6 from Ghana, 1 from Uganda, 1 from Congo and 3 studies from two or more of the following countries: - (Ghana, Rwanda, Philippines, Senegal and Mali). There was a positive association between UHC and improved access, utility of antenatal health services and better increased access to emergency obstetric care (e.g. C-sections) despite women socioeconomic status, educational and residential (rural and urban) backgrounds: Antenatal health care (three to four or more ANC visits); NHIS (OR=1.182, p=0.05, OR=1.09, p=<0.01), other insurance (OR=2.37, p=<0.05 and OR=2.41, p=<0.05), voucher (OR=2.787, p=<0.001, OR=1.913, p= ≤0.001, (OR=0.2855, p=<0.001). Delivery at a healthcare facility; free delivery policy increased facility delivery by 2.3%, p=0.015, CI 0.50-4.05, NHIS policy increased facility delivery by 7.5%, p= ≤0.001, CI 4.97-9.92, other insurance coverage (e.g. CBHI) (OR=4.74, p= <0.10), and vouchers (OR=2.539, p= ≤0.001). Births attended by a skilled birth attendant; free delivery policy (OR=1.67, p= <0.01), NHIS policy (OR=1.65, p =<0.01 and OR=1.375, p=0.05), other insurance policy (free ANC policy) (OR=1.17, p= <0.01) and voucher scheme (OR=3.582, p= ≤0.001) and (OR=0.2119, p= <0.001). Emergency obstetric care (e.g. C-section); Fee exemption (OR=0.329, p= <0.0001), other insurance OR=1.13 vs. OR=1.26, p=<0.001, vouchers (OR=1.536, p= <0.01).

Conclusion: Universal health coverage through various strategies, if implemented adequately, sufficiently increases the utilization of maternal health care services. More women on UHC received emergency obstetric care such as C-section than those without. Future studies should endeavour to examine whether these benefits spill over to reducing maternal mortality. There should also be efforts to find out the barriers to universal adoption of UHC policies by developing countries, such as sources of funding, suitability of different policies in different developing economies.

Food insecurity and social support among Ghanaians living in Greater Manchester, UK: A qualitative study

Hibbah Araba Saeed joined the University of Sheffield in October 2013, as a PhD student at the School of Health and Related Research, Section of Public Health.  Prior to starting her PhD, Hibbah worked as a Research Assistant at the Noguchi Memorial Institute for Medical Research, Ghana.
Hibbah's PhD research is on Determinants of Dietary Behaviour among Ghanaians living in the United Kingdom.  The research adopts a mixed method research approach to explore the determinants of dietary behaviour, dietary change following migration and household food insecurity among Ghanaians living in the United Kingdom. This article presents the findings from the qualitative aspect of the study.

Food insecurity and social support among Ghanaians living in Greater Manchester, UK: A qualitative study

Abstract

Background: In the UK, minority ethnic groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We explored perceptions of three main components of food insecurity (availability, accessibility, utilization) among Ghanaians. The role of social support in enhancing food security was explored to identify potential coping mechanisms for food insecure households.

Methods: We conducted 29 in-depth interviews using purposive sampling among Ghanaians aged ≥25yrs living in Manchester. Participants varied in socioeconomic status, gender and migration status. Utilizing a framework analysis approach, we analysed themes using the three main components of food security and also generated new themes from the data.

Findings: Overall, participants did not describe their personal experiences of food insecurity but some identified that food insecurity existed among Ghanaians in the community. Participants reported that food insecure household may be reluctant to make use of food banks because of pride/perceived social stigma. Also the type of foods served were considered culturally unappealing. This reluctance does not extend to close and trusted networks including the church. Within the church, people have trusted allies that they engage with for specific needs including financial support when needed.

Conclusion: Our analysis suggests that the church context forms a trusted base in which people operate. We recommend that to be able to reach the most deprived among the Ghanaian community, churches could be used as a channel for interventions.









Click here to view a poster about Hibbah's qualitative research study

Reasons for Variation in the Effectiveness of Cognitive Behavioural Therapy in Physiotherapy Management for Chronic Low Back Pain

Latifa AlEnezi qualified as a physiotherapist in 2007 at the Kuwait University, following which she worked as a clinical physiotherapist. In 2011 she was awarded a scholarship from the Kuwait Government to study for a MSc in Applied Physiotherapy at Sheffield Hallam University. Latifa is now studying for a PhD at ScHARR, University of Sheffield. Her main research interests are in musculoskeletal physiotherapy, pain management and self-care. The subject of Latifa's PhD is the use of cognitive strategies in supporting the management of chronic musculoskeletal pain.


Reasons for Variation in the Effectiveness of Cognitive Behavioural Therapy (CBT) in Physiotherapy Management for Chronic Low Back Pain (CLBP): Mixed Methods Systematic Review

Abstract

Background: Chronic Low Back Pain (CLBP) is one of the most common and recurrent musculoskeletal problems that causes patients to frequently access healthcare services. The Bio-psychosocial model emphasizes that psychological, behavioural and social factors contribute to the development and persistence of CLBP. Cognitive behavioural therapy (CBT) is a psychological pain management strategy that can be used by physiotherapists treating CLBP. However, the effectiveness of CBT for CLBP varies between different studies.

Objectives
To identify studies exploring or explaining the process of implementing CBT in physiotherapy management for CLBP.
To explore the reasons of variation in the effectiveness of CBT.
To identify knowledge gaps in this area.

Methods: Quantitative, qualitative or mixed methods studies using CBT to manage CLBP patients were searched systematically until May 2014. The electronic search was done using the following databases CINAHL plus full text, MEDLINE via Ovid, Cochrane library, Scopus, Pub Med, Web of science, ASSIA and Psych info. All full text studies published in peer review journals were assessed for eligibility. Data extraction was based on population, intervention, comparison and outcome (PICO). Methodological quality and clinical relevance of included studies were assessed.

Results: Thirty- seven studies were included. There were 36 quantitative studies, and one qualitative study as part of a mixed methods study. A qualitative (narrative) analysis was considered due to lack of homogeneity among studies. The majority of studies (24 of 37 studies) had high methodological quality and were considered of moderate -to- high clinically relevance.

Conclusion: Studies were so heterogeneous it was not possible to account for differences in treatment effect. Key differences between studies were study design, setting, and outcome measures. There were no qualitative studies exploring how CBT is effective for CLBP or explaining the reasons for variation in CBT effectiveness. Further research is required to explore perceptions of CBT in physiotherapy.

Click here to view a poster about Latifa's research

A Mixed Method Investigation of Knowledge Sharing in Cross-Professional Teams in Healthcare-Research Methodology Review

Affra Al Shamsi graduated with distinction from her MSc in Information Management at Sheffield University, and started her PhD studies at Sheffield’s School of Health and Related Research (ScHARR) in March 2014. She was award her Postgraduate Higher Diploma in Medical Librarianship with distinction from Sultan Qaboos University (Oman), and holds a BSc in Chemistry from UAE University. Affra is an interdisciplinary scholar both professionally and academically, and her particular areas of interest include interdisciplinary research, learning and teaching, knowledge sharing patterns and behaviour, individual behaviour within teams, EBP (evidence based practice), mixed methods research, multimodal approaches in research and teaching, systematic reviews, public engagement, and research for impact.

Affra is passionate about finding innovative and creative ways to bring research and learning closer to the public. She is working in collaboration with several public engagement groups, aiming to raise awareness of research for impact, public involvement and engagement to PGR students.  She also has special interest in teamwork and improving individual team working skills, with an emphasis on healthcare. She has developed a Masterclass for 4th year medical students designed to help integrate their theoretical learning with clinical practice on ‘Communication and Collaboration among Cross Professional Teams’ (MBChB Masterclass Integrated Learning Activity (ILA)) which she will deliver in August. Affra was the 2009 Yale University International Associate, where she identified approximately $60,000 in medical library cost savings for 2010.

The title of Affra's PhD project is 'Incorporating a Knowledge Management Paradigm into Healthcare: A Mixed Method Investigation of Knowledge Sharing in Cross-Professional Teams in Healthcare'   

Abstract

This investigation maps the intersections between teamwork and knowledge sharing (KS) within healthcare, aiming to reconcile practice and evidence.
It employs a pragmatic epistemology along with mixed methods (MM), as the research focuses on the human factor in tacit KS (communication, perceived ideas, practices, etc.,) on an individual and group level within healthcare teams, to deepen our understanding of factors that increase or lessen healthcare professionals’ tendencies to engage in KS behaviours.
This inductive-driven investigation is built on predominantly qualitative research approaches involving a quantitative component. Qualitative methods are best to identify an ‘unknown’ phenomenon (tacit KS behaviours within healthcare cross-professional teams) and consider potentially influencing factors. The research will offer a holistic understanding through a literature review and document analysis (both qualitative and quantitative), followed by a mixed method systematic review (MMSR), interviews and focus groups, to explore participant views and identify variables associated with KS in healthcare teams. The quantitative component, primarily the questionnaire, will examine the relationships among the variables identified during the previous phases, and the statistical data will allow for replication and generalisation of data. The MMSR framework will be used to analyse qualitative data, with emerging themes used to enhance, develop or group questions in the survey. This holistic approach will bring together all qualitative and quantitative data collected to develop the final instrument of the survey.
This research methodology is innovative in its scope and complexity. A review of current literature on MM highlights that different types of data collected are usually triangulated rather than mixed or integrated. Importantly, this MM research uses a combined approach throughout the research methodology. It builds a solid framework to assist in combining qualitative and quantitative methodologies, and adds rigor through integrating MM in both data collection and analysis, adding unique and new knowledge in this field. 

























Exploring primary school headteachers' perspectives on the barriers and facilitators of preventing childhood obesity

In January 2014, Emma Howard-Drake graduated with distinction from the Master of Public Health (MPH) Management and Leadership.  Alongside academic study, Emma has worked since 2011 as a public health specialist in a local authority.Both professionally and academically, Emma’s particular areas of interest and specialism include obesity, diet and physical activity in children and young people. In October 2014, Emma was awarded a Faculty Scholarship to undertake a mixed methods PhD in ScHARR, enabling her to build on the research undertaken during the MPH.  In August 2016 she is planning to join the East Midlands Public Health training programme.

Emma’s MPH dissertation focused on exploring the perspectives of primary school headteachers on the barriers and facilitators of preventing childhood obesity. Along with her co-author, Emma's research has been published in the Journal of Public Health.

Citation: Howard-Drake, E and Halliday, V (2015) Exploring primary school headteachers' perspectives on the barriers and facilitators of preventing childhood obesity (1): 44-52.doi: 10.1093/pubmed/fdv021


Abstract

Background: Headteachers of primary schools in England are a crucial partner for childhood obesity prevention. Understanding how this works in practice is limited by their views being underrepresented or missing from the evidence base. The aim of this study was to explore primary school headteachers' perspectives on childhood obesity and the perceived barriers and facilitators of prevention.

Methods: A qualitative study with a purposive sample of 14 primary school headteachers from the Yorkshire and Humber region of England was conducted. Semi-structured interviews were audio-taped, transcribed and analysed using an inductive thematic approach.

Results: An extensive range of barriers and facilitators emerged within four key themes; understanding childhood obesity, primary school setting, the role of parents and external partners. A lack of knowledge, awareness and skills to deal with the sensitivity and complexity of childhood obesity across all school stakeholders presents the most significant barrier to effective action.

Conclusions: Headteachers recognize primary schools are a crucial setting for childhood obesity prevention; however their school's often do not have the capability, capacity and confidence to make a meaningful and sustainable impact. To increase headteachers' ability and desire to prevent childhood obesity, schools require specialist and tailored training, resources and support from external partners such as public health teams and school nursing services.