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BACKGROUND: Access to clean water is important for menstrual hygiene practices, an important aspect of health for adolescent girls. In Bangladesh, adolescent girls represent poor menstrual hygiene practices, whereas the practice is worse among vulnerable population groups living in areas experiencing seasonal water scarcity. This study portrays perceived difficulties in menstrual hygiene practices among indigenous adolescent girls during the period of seasonal water scarcity in Bandarban Hill District, Bangladesh. METHOD: Data was collected from 242 indigenous adolescent girls through interviews during the period of water scarcity. Backward stepwise regression model was used to identify factors associated with perceived difficulty in maintaining menstrual hygiene (PD) practices. RESULT: The study participants, mainly living in hard-to-reach areas, reported difficulty in getting adequate water during the water scarcity period, and the quality of water was reported to be poor. PD due to water scarcity was found to be significantly associated with water source degradation (ß = 0.247, < 0.001), the need for boiling/purifying water before use for menstrual hygiene (ß = 0.203, p = 0.005), and experience of water availability when it was necessary to maintain their optimal menstrual hygiene practice (ß = 0.449, p < 0.001), time required to collect water (ß = 0.209, p < 0.001), taking a bath every day (ß = -0.228, p < 0.001), and frequency of washing genitals per day (ß = - 0.094, p = 0.040). CONCLUSION: Indigenous adolescents perceive difficulty in menstrual hygiene practices during the period of water scarcity. Further research could be carried out to observe to what extent the seasonal water scarcity could be attributable to worsen the menstrual hygiene practices and to identify the need for addressing the problems.
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Higiene , Menstruación , Femenino , Adolescente , Humanos , Estudios Transversales , Bangladesh , Estaciones del Año , Inseguridad Hídrica , Conocimientos, Actitudes y Práctica en Salud , AguaRESUMEN
BACKGROUND: Electronic data capturing has the potential to improve data quality and user-friendliness compared to manually processed, paper-based documentation systems. The MyChild system uses an innovative approach to process immunization data by employing detachable vouchers integrated into a vaccination booklet which are then scanned and converted into individual-level health data. The aim was to evaluate the MyChild data capturing system by assessing the proportion of correctly processed vouchers and to compare the user-friendliness in term of time spent on documentation and health worker experiences with the standard health information system at health facilities in Uganda. METHODS: We used a mixed method approach. Documented data were manually copied and compared to processed health records to calculate the proportion of correctly registered vouchers. To compare time spend on documentation we did a continuous observational time-motion study and analyzed data using a Mann-Whitney U test. Semi-structured interviews were conducted to assess health workers' experiences and analyzed using conventional content analysis. Data was collected in 14 health facilities in two districts in Uganda using different systems. RESULTS: The MyChild system processed 97% (224 of 231) of the vouchers correctly. Recording using the MyChild system increased time spend on documentation of vaccination follow-up visits by 24 s compared to the standard system (02:25 vs. 02:01 min/child, Mann-Whitney U = 6293, n1 = 115, n2 = 151, p < 0.001 two-tailed, Z = - 3.861, r = 0.186). However, high variance between health centers using the same health information system suggests that documentation time differences can be attributed to other factors than the way information was processed. Health workers perceived both health management information systems as predominantly functional and easy to use, while the MyChild system achieved a higher level of satisfaction. CONCLUSIONS: The MyChild system electronically processes individual-level immunization data correctly without increasing significantly time spent on recording and is appreciated by health providers making it a potential solution to overcome shortcomings of present paper-based health information systems in health centers.
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Salud Infantil , Documentación/métodos , Procesamiento Automatizado de Datos , Vacunación , Adulto , Niño , Femenino , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estudios de Tiempo y Movimiento , UgandaRESUMEN
BACKGROUND: As health care strives towards the Triple Aim of improved population health, patient experience, and reduced costs, an organization's readiness for change may be a key factor. The concept refers to the collective commitment of organizational members to a change and belief in their shared ability to make that change happen (efficacy). This study aims to assess the organizational readiness for implementing large-scale change at a clinical department in pursuit of the Triple Aim and to determine key associated factors. METHODS: A cross-sectional study at a Danish Obstetrics and Gynecology department faced with external pressure to become more efficient without compromising patient outcomes and experience. The Organisational Readiness for Implementing Change (ORIC) questionnaire was distributed to all employees (n = 403). Descriptive statistics was used to assess overall organizational readiness and single items. The between-group differences in subject characteristics were assessed with independent t-test and non-parametric test. Multiple linear regression was employed to control for potential confounders. RESULTS: Response rate was 72%. The level of agreement with the commitment statements was high, and low with the efficacy statements. We did not observe statistically significant differences in the overall score between organizational sections or in relation to gender, age, or profession. Managerial status (B = 3.2, 95% CI = .52, 5.9, P = .02) or interim employment(B = 2.7, 95% CI = .47, 4.9, P = .02) were significant predictors of a high change efficacy score after controlling for potential confounders. CONCLUSIONS: Changes related to pursuit of the Triple Aim were seen as something that "has to" be done, but left managers, and even more so staff, wondering what "to do" and "how to" do it. Change strategies should therefore address these uncertainties by translating political "have to's" proposals that resonate with staff, spark engagement, and clarify "how to" deal with the complexity of large-scale change.
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Actitud del Personal de Salud , Servicio de Ginecología y Obstetricia en Hospital/organización & administración , Innovación Organizacional , Personal de Hospital , Adulto , Estudios Transversales , Dinamarca , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR. DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool. SETTING: An OR department at a county hospital in Sweden. PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9). RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication. CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system. TRIAL REGISTRATION NUMBER: 2016/264.
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Relaciones Interprofesionales , Comportamiento Multifuncional , Quirófanos , Estudios de Tiempo y Movimiento , Flujo de Trabajo , Carga de Trabajo/psicología , Adulto , Anciano , Comunicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Anestesistas/psicología , Personal de Enfermería/psicología , Seguridad del Paciente , Estudios Prospectivos , Cirujanos/psicología , Suecia , Lugar de TrabajoRESUMEN
BACKGROUND: Organizational change initiatives in health care frequently achieve only partial implementation success. Understanding an organizational readiness for change (ORC) may be a way to develop more effective and efficient change strategies. Denmark, like many countries, has begun a major system-wide structural reform which involves considerable changes in service delivery. Due to the lack of a validated Danish instrument, we aimed to translate and validate a Danish version of the Organizational Readiness for Implementing Change (ORIC) questionnaire. It measures if organizational members are confident in their collective commitment towards and ability (efficacy) to implement organizational change. ORIC is concise, grounded in theory, and designed, but not yet validated among employees in a real hospital setting. METHODS: The 12-item ORIC instrument was translated into Danish and back-translated to English. Employees (N = 284) at a hospital department facing a major organizational change in the Central Denmark Region completed the questionnaire. Face and content validity was ascertained. Exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were used to assess construct validity. Reliability was assessed with Cronbach's alpha. Item response theory (Rasch analysis) was used to determine item and person reliability. RESULTS: Response rate was 72%. A two factor (commitment and efficacy), 11-item scale, of the Danish language ORIC was shown to be valid (CFI = .95, RMSEA = .067, and CMNI/DF = 2.32) and reliable (Cronbach's alpha 0.88) in a health care setting. Item response analysis confirmed acceptable person and item separation reliability. CONCLUSIONS: Our version of ORIC showed acceptable validity and reliability as an instrument for measuring readiness for implementing organizational change in a Danish-speaking health care population. For health care managers interested in evaluating their organizations and tailor change strategies, ORIC's brevity and theoretical underpinnings could make it an appealing and feasible tool to develop more successful change efforts.
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Atención a la Salud/organización & administración , Personal de Salud/organización & administración , Innovación Organizacional , Psicometría/instrumentación , Encuestas y Cuestionarios/normas , Adulto , Dinamarca , Análisis Factorial , Femenino , Humanos , Persona de Mediana Edad , Cultura Organizacional , Psicometría/estadística & datos numéricos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Our study aimed to observe the differences in assessment results between virtual patient simulation (VPS) and regular course exams in an Internal Medicine course for undergraduate medical students. METHODS: Four cohorts of students (n = 216) used: a VPS or lectures for learning (terms 1 and 2); VPS and lectures or only lectures (term 3); and a paired set-up with both VPS and lectures (term 4). The assessment results, measured with both a VPS-based exam and a paper-based exam, were compared. A scoring rubric (0-6), developed and validated for the purpose of the trial, was applied to both types of assessment. Mean score differences of the results were compared for the four cohorts. RESULTS: Both VPS and regular examination results were significantly higher in the VPS group compared to regular exam group (p < 0.001) in terms 1, 2 and 3. The paired mean difference in term 4 was 0.66 (95% confidence interval (CI) 0.50, 0.83; p < 0.001) for haematology and 0.57 (95% CI 0.45, 0.69; p < 0.001) for cardiology. CONCLUSION: Our findings suggest that using VPS both for learning and for assessment supports learning. VPS are better than traditional assessment methods when the virtual application is used for both learning and evaluation.
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Simulación por Computador , Evaluación Educacional , Enseñanza/métodos , Interfaz Usuario-Computador , Femenino , Humanos , Medicina Interna/educación , Masculino , Evaluación de Programas y Proyectos de Salud/métodosRESUMEN
BACKGROUND: Virtual patients (VPs), high-fidelity simulators and standardized patients are powerful educational interventions leading to effective learning and supporting knowledge retention. AIM: This study explored the variations in retention with VP versus regular learning activities. METHOD: We conducted a randomized controlled study on early and delayed assessment results of 49 students using VP for learning and examination of haematology and cardiology topics in an Internal Medicine course, by means of a 0-10 scoring rubric. RESULTS: The mean difference for early assessment with VP (study--control mean score) was 1.43 (95% confidence interval (CI) 0.96, 1.91; p<0.001) for haematology and 1.34 (95% CI 0.93, 1.76; p<0.001) for cardiology. In regular exams, the mean score difference was 2.21 (95% CI 1.3, 3.1; p<0.001) and 1.52 (95% CI 0.76, 2.28; p<0.001), respectively. With delayed assessments, the difference in mean score for Web-SP was 1.48 (95% CI 1.09, 1.86; p<0.001), haematology and 1.16 (95% CI 0.74, 1.58; p<0.001), cardiology; for regular exams the figures were 1.96 (95% CI 0.93, 2.98; p<0.001) and 1.74 (95% CI 0.89, 2.58; p<0.001). The effect size ranged from 0.5 to 0.8. CONCLUSION: Our results indicate better retention with VP than with traditional learning methods.
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Simulación por Computador , Educación Médica/métodos , Medicina Interna/educación , Retención en Psicología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/terapia , Educación Médica/normas , Femenino , Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/terapia , Humanos , Medicina Interna/métodos , Masculino , Adulto JovenRESUMEN
The objective of the study is to translate and examine the reliability and validity of the Jessor and Jessor Social Alienation Scale for use in a Swedish context. The study involved four phases of testing: (1) Translation and back-translation; (2) a pilot test to evaluate the translation; (3) reliability testing; and (4) a validity test. Main participants of this study were 446 students (Age = 15-19, SD = 1.01, Mean = 17). Results from the reliability test showed high internal consistency and stability. Face, content and construct validity were demonstrated using experts and confirmatory factor analysis. The results of testing the Swedish version of the alienation scale revealed an acceptable level of reliability and validity, and is appropriate for use in the Swedish context.
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Escalas de Valoración Psiquiátrica , Aislamiento Social , Adolescente , Análisis Factorial , Femenino , Humanos , Masculino , Psicometría , Reproducibilidad de los Resultados , Estudiantes , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Some research suggests that men and women may experience Angina Pectoris (AP) differently. More research is needed to characterize AP symptoms by gender and to familiarize health care providers with them, to enable proper education, diagnostic evaluation and timely management. OBJECTIVE: This study examines gender differences in the description, intensity and location of AP in patients with CHD. DESIGN: A cross-sectional study was performed to compare AP patients according to gender. SETTINGS: This study was performed on patients residing in Tehran, who were being treated in a hospital and were admitted to cardiac units. PARTICIPANTS: Five hundred patients with AP were selected. The participants were patients with AP who were diagnosed with CHD based on documented results from an angiography. METHOD: Outpatients who were admitted to the cardiac units were screened. Informed consent was obtained from all study participants, who then completed the Iranian version of the AP characteristics questionnaire. RESULTS: Women were significantly more likely to feel pain in the left arm and hand, odds ratio 1.5 (95% CI=1.0-2.1, P=0.04), left scapula, odds ratio 2.3 (95% CI=1.6-3.5, P<0.001), and neck, odds ratio 2.8 (95% CI=1.9-4.1, P<0.0001), while controlling for demographic and clinical factors. Women were significantly more likely to choose the possible pain descriptors for describing their AP and reported significantly greater intensity than men for all the pain descriptors. Significantly higher scores for sensory, affective, total and NRS (Numeric Rating Scale) scores were observed in women (P<0.001). Multiple linear regression analyses revealed that gender remained a statistically significant predictor of pain scores and NRS, while controlling for demographic and clinical factors. CONCLUSION: Women and men differ with respect to description, intensity and location of AP. Educating the general public and informing health care providers about gender variation in AP may help to decrease delays in seeking medical care.