Health Workers' Perceptions on Data-informed Decision-Makingpracticesin Primary Health Care Units at Awi Zone, Northwest Ethiopia

Background: Data-informed decision making is influenced by organizational, technical, and behavioral factors. Behavioral factors are the major contributing factors for data-informed decision-making practices. This study aimed to explore health workers' perceptions of data-informed decision making at primary health care units in Awi zone. Method: A cross-sectional qualitative study was undertaken to explore health workers' perceptions on the barriers of health data-informed decision-making practices. Eleven healthcare workers were purposively selected from primary hospitals, health centers and health posts. Medical doctors, nurses, midwifes and health extension workers were selected as key informants for the in-depth interview. The selected healthcare workers were asked about their perceptions that affect health data use practices. The data obtained was analyzed through thematic analysis using Open Code software. Analysis was performed using three themes namely, organizational, behavioral, and technical barriers of data-informed decision making. Results: All the health care workers including health extension workers utilized a data-informed decision-making practice at least once during their point of care. Five of the eleven key informants reported their data-informed decision-making practice as reviewing quality of facility data, while none of them reported data-informed decision-making practices for their monthly performance monitoring. Behavioral factors included negligence, workarounds, and skill gaps. Organizational factors included staff turnover and shortage of recording tools. Technical factors included high workloads which lead to data error and paper-based systems were considered major barriers to data-informed decision-making practices.

Women autonomy and demand for maternal health services in Nigeria: Evidence from the Nigeria Demographic and Health Survey

mproving women autonomy can be vital in determining the uptake of healthcare services, especially in a patriarchal society with gender rights concerns. Using the 2013 Nigeria Demographic and Health Survey and employing Zero Inflated Negative Binomial regression, the effect of household decision-making power with considerations to women autonomy on the demand for maternal health services in Nigeria was examined. The result of the analysis suggests that women autonomy in deciding expenditures on household healthcare services, and autonomy in deciding their income expenditures significantly increases the likelihood of demand for maternal healthcare services. On the other hand, when the husband/partner makes sole decision, as well as joint decision making concerning expenditure on household healthcare services and expenditure of woman's income reduces the likelihood of demand for maternal healthcare services in the country. This reduction was however much more when husband alone takes the decision than when decisions were taken jointly. Other socioeconomic variables like higher maternal education, and household wealth, also increased the demand for maternal healthcare services. We recommend that government should put in place policies that will help increase women's participation in household decision-making through the sensitization and capacity building initiatives such as improved educational quality for women. (Afr J Reprod Health 2022; 26[4]: 65-74).

In-hospital interventions to promote relational practice with families in acute care settings: A scoping review

Relational practice is characterised by genuine interaction between families and healthcare professionals that promotes trust and empowerment. Positive clinical outcomes have been associated with relational practice. To assess and examine in-hospital interventions designed to promote relational practice with families in acute care settings of emergency departments, intensive care units and high care units. The preferred reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the design of this scoping review. To identify relevant studies, databases (Academic Search Complete; CINAHL; PubMed; PsyInfo) and the search engine Google Scholar were searched using terms for core elements of relational practice and family engagement. Of the 117 articles retrieved, eight interventional studies met the search criteria. The interventions focused on relational practice elements of collaborating with and creating safe environments for families, whilst only one addressed healthcare professionals being respectful of families' needs and differences. In relation to the nature of engagement of families in interventions, the focus was mainly on improving family functioning. Family engagement in the interventions was focused on involving families in decision-making. The scoping review revealed a limited number of in-hospital interventions designed to promote relational practice with families in acute care settings. Further research is encouraged to develop such interventions. Contribution: The scoping review has highlighted specific elements of relational practice that have been overlooked in the mapped interventions. This provides guidance on where future interventional research may be focused.

Male involvement in family planning in Northern Nigeria: A review of literature

Background: Demand and utilization of family planning (FP) in Northern Nigeria has been consistently low. Evidence from literature has demonstrated that male involvement in FP programming can be successful in increasing demand for FP services. Materials and Methods: A search of peer-reviewed and gray literature was carried out to explore the status of male awareness and utilization of FP methods, and the barriers to male involvement in FP, in Northern Nigeria. Results: Males in the region generally have a good awareness of FP. However, they had negative perceptions, low levels of usage of FP, and poor spousal communication about FP.Sociocultural and religious barriers played major roles in hindering male involvement in FP. Misconceptions about FP, such as that FP is a woman's activity and that it also encourages promiscuity among women, were factors limiting its acceptance. Conclusion: There is a need to address the misconceptions and equip men with complete and correct information about FP. There is also a need for research on effective strategies to address the sociocultural and religious barriers to male involvement in FP in Northern Nigeria and the development of effective culturally sensitive male-involvement FP initiatives

Involvement in decision-making processes and retention of health workers: findings from a cross-sectional study in the Rwandan Public District Hospitals

Introduction: the contribution of the health workforce for better health care service provision is undoubtedly of great merit to any health system. However, the public district hospitals in Rwanda have been faced with the challenges of retaining the health personnel. This study looks into the management approach to address this challenge by investigating into the effect of employee involvement in the hospital decision-making processes on the retention of professional health workers.Methods: a cross-sectional design with quantitative approach was used. With a population of 469 health workers from 3 hospitals, a sample of 252 respondents was considered. Data collection was done by use of survey questionnaire. For data analysis, we used descriptive statistics to report perceived levels of involvement of health workers and intents to stay, and multiple logistic regression at 95% of confidence intervals to assess the effect of health workers? involvement in the hospital decision-making processes on the retention.Results: the findings revealed that health workers who perceived a high level of involvement in the hospital decision-making processes through the determination of teams for quality improvement in the health care service delivery were more likely to stay in the hospital (OR=100.111; P=0.001; CI=5.984-16.747) than those who perceived this function as low. It was also found that while an average level of involvement of health workers in the establishment of systems for suggestion in the hospital was associated with 6 odds of staying (OR=6.005; P=0.010; CI=1.529-23.571), health workers who perceived a high level of involvement were nearly 11 times more likely to stay (OR=10.952; P=0.001; CI=7.730-15.519) than their counterparts with low levels of perceptions.Conclusion: although there are positive associations between involvement of health workers in the hospitals decision-making processes and the intentions to stay, the existing level of staff involvement may have a negative effect on retention capacity in the public district hospitals

An audit of chemical pathology laboratory investigation request forms received at a private tertiary hospital in Nigeria

Context: Laboratory testing constitutes an integral part of patient management and has an extensive influence on medical decision-making. The completion of laboratory investigation request forms is a vital aspect of the highly variable pre-analytical phase of laboratory testing.Aim: We aimed to assess the adequacy of completion of investigation request forms received at our laboratory.Methods: An audit of systematically selected laboratory investigation request forms received over a six-month period at our laboratory was performed to assess the degree of completion of these forms by requesting clinicians. Data was analysed using Microsoft Excel®.Results: Two hundred and fifty four request forms were reviewed. None of the reviewed forms was adequately completed. The clinician's contact number was missing in all the request forms. About two-thirds of the request forms did not have the patient's hospital number (66.1%) and the referring clinician's signature (66.9%) available on them. The clinical diagnosis of the patient was not stated in 18.9% of the request forms. The patient's name, gender and age were the most frequently completed parameters in 100.0%, 98.4% and 97.2% of the request forms respectively.Conclusion: Basic information required for the accurate interpretation of laboratory results are missing in several request forms. This may have deleterious impact on laboratory turn around time, healthcare costs and patient management as most medical decisions are influenced by laboratory results

Individual versus community-level measures of women decision-making involvement and child survival in Nigeria

Background. Although decision-making authority is associated with maternal healthcare utilisation, the evidence on the relative importance of individual-level v. community-level decision-making participation for child survival in sub-Saharan Africa is limited. Objectives. To assess the net effects of individual- and community-level measures of decision-making involvement (DMI) on under-5 mortality in Nigeria. Methods. Data on a nationally representative sample of 31 482 children in the 2013 Nigeria Demographic and Health Survey were analysed. Mothers who reported involvement in decision-making on own healthcare, major household purchases and visits to friends and relatives were categorised as having high DMI. Community-level measures of DMI were derived by aggregating the individual measures at the cluster level. Kaplan-Meier estimates of childhood mortality rates were computed. Multilevel discrete-time hazard models were employed to investigate the net effect of individual- and community-level DMI on childhood mortality. Results. Childhood mortality, at 59 months, was higher among children of women with low DMI (120 per 1 000) compared with those with high DMI (84 per 1 000). The full multilevel model showed that there was no difference in the risk of childhood death between children whose mothers had high v. low DMI (hazard ratio (HR) 1.01, CI 0.90 - 1.12). However, mortality risk was found to be lower among children in communities with medium DMI (HR 0.84, CI 0.74 - 0.96). Maternal age at child's birth, education, household wealth index and preceding birth interval were significantly associated with under-five mortality. Conclusion. Besides socioeconomic and biodemographic characteristics, community- and not individual-level DMI was associated with under-5 mortality. Women's empowerment programmes targeting maternal and child health outcomes should also focus on communities

Access to Information and Decision Making on Teenage Pregnancy Prevention by Females in Tshwane

Background: The increase in the number of teenage pregnancies and its negative consequences has encouraged various researchers to explore the possible causes of teenage pregnancy. Findings from previously-conducted research have indicated different preventable factors that predispose female teenagers to pregnancy; such as staff attitudes and the lack of information resulting from poor access to health facilities.Objective: To explore and describe access to information and decision making on teenage pregnancy prevention by females using a primary healthcare clinic in Tshwane; South Africa.Method: In this study; the researchers used a descriptive qualitative and exploratory research design to explore and describe the verbal reports regarding prevention of teenage pregnancy by females using a primary healthcare clinic in Tshwane; South Africa. Face-to-face semistructured interviews were conducted with 15 female participants aged between 15 and 26; who had been pregnant once or more during their teens.Results: Two themes emerged; namely; access to information and decision making by female teenagers. Five categories that emerged were: access to information on pregnancy prevention; ignoring of provided information; the use of alternative medicine with hormonal contraception; personal reasons for use and non-use of contraception; and decisions made by teenagers to not fall pregnant. Females in this study fell pregnant in their teens; even though they had access to information.Conclusion: Given the complexity of this problem; female teenagers should use their families as primary sources of information for reproductive health promotion and educational institutions should build on this to aid the prevention of teenage pregnancy

Gender Norms and Family Planning Decision-Making in Tanzania: A Qualitative Study

Experience suggests that the incorporation of gender approaches into family planning (FP) and reproductive health (RH) programs may increase their impact and sustainability; but further work is needed to examine the interactions between gender norms and family planning and to incorporate this understanding into behavior change communication (BCC) in specific social contexts. We conducted open-ended; in-depth interviews with 30 young currently married men; 30 young married women and 12 older people who influenced FP decisions. Six focus group interviews were also conducted. The interviews focused on the role of gender norms in reproductive decision-making and contraceptive use among young married men and women in Tanzania. The findings suggest that gender factors; such as men's dominance in decision-making do function as barriers to the use of modern contraceptives; but that fear of side effects; by both men and women; may be even more important deterrents. Results from this research will inform the development of BCC interventions to be tested in a subsequent intervention study in which gender factors and poor information about contraceptive methods will be addressed

Male involvement in family planning decision making in Ile-Ife, Osun State, Nigeria

This study assessed men's awareness, attitude, and practice of modern contraceptive methods, determined the level of spousal communication, and investigated the correlates of men's opinion in family planning decision making in Ile-Ife, Nigeria. Quantitative methodology was employed in this cross-sectional descriptive design using a structured household questionnaire to collect information from 402 male study participants. A multistage sampling procedure was employed. Eighty-nine percent of men approved of the use of family planning while only about 11 percent disapproved of it. Eighty percent of men had ever used contraception while 56 percent of them were current users. Spousal communication about family planning and other family reproductive goals was quite poor. The socio-demographic correlates of men's opinions included religion, marriage type, educational attainment, and occupation (p<0.05). The study concluded that male involvement in family planning decision making was poor and their patronage of family planning services was low (Afr J Reprod Health 2010; 14[4]: 45-52)

Causes of bone injuries and patronage of traditional bone setters in maiduguri; Nigeria

The study as an opinion survey identified Road Traffic Accidents (RTA); falling from height and gunshots/matchets as the causes of bone injuries in Maiduguri; Nigeria. Injuries sustained include fracture and dislocation. Structured Interview Schedule (SIS) and Focused Group Discussion (FGD) were the instruments used to obtain data. Population of study comprised of those involved in bone injuries between January and December; 2008. The sample size of 700 respondents was selected using stratified random sampling technique. Frequency distribution and percentages were employed to analyze data. Findings of the study revealed parents/families; relatives and friends as some of the sources of decision to patronize Traditional Bone Setting (TBS) while culture; phobia for hospitalization; no amputation and less expensive were some of the reasons adduced for patronage. Based on the findings; enactment of stringent laws/bye-laws or re-enforcement of existing ones (if any); counselling and enlightenment were suggested/recommended

Qualitative study on maternal referrals in rural Tanzania: Decision making and acceptance of referral advice

The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected. To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women's empowerment and male involvement in maternal care are necessary. (Afr J Reprod Health 2008; 12[2]:120-131)

Factors Contributing to the Decision by Pregnant Women to be Tested for HIV

The objective of this study was to explore and describe the factors that influence the decision by pregnant women to be tested for HIV. This was achieved through a qualitative research study that was exploratory; descriptive and contextual in nature. A sample of 13 pregnant women participated. Data obtained from semi-structured interviews was analysed according to a protocol based on a combination of methods of analysis. The three main themes; namely factors that contribute to the decision by pregnant women to be tested for HIV; factors that contribute to the decision by pregnant women not to be tested for HIV and organisational factors that influence the decision by pregnant women to be tested for HIV; were divided into nine subthemes. Conclusions and recommendations to promote counselling to pregnant women being tested for HIV are provided

Factors that May Influence South African Nurses' Decisions to Emigrate

Although no accurate statistics about the number of South African nurses working in other countries are available; the Organisation of Economic Cooperation and Development estimated that 35 000 South African nurses were working outside South Africa and/or outside the health care system (Horning; 2005:58). The global shortage of nurses; creating opportunities for South African nurses to work in foreign countries; as well as a variety of factors related to nursing; health care and the general living conditions in South Africa influence nurses' decisions to emigrate. The purpose of this study was to explore and describe the factors that influence nurses' decisions to emigrate. Maslow's Hierarchy of Needs Theory was used as a point of departure to establish what motivates the behaviour of nurses to emigrate from South Africa. A quantitative approach was used. The target population comprised all the nurses (n=3 331) on the registers of the South African Nursing Council (SANC) who completed their basic training during 2002. A random sample of 15 (n=501) of the total population of nurses who completed their basic training during 2002 was selected. Data were collected by structured questionnaires. The analysis of the data indicated that nurses' inadequate remuneration; poor working conditions; excessive workloads; lack of personal growth and career advancement possibilities and inability to meet their safety and security needs were major factors that influenced nurses' decisions to emigrate. The recommendations include improved remuneration for nurses; enhanced working conditions with adequate supplies and equipment; reduced workloads by employing more nurses; expanded career prospects and improved safety

Translating Research into Policy: The case of Orphans and Vulnerable Children in South Africa

Policies are often developed without taking into account social science research findings and recommendations; despite the plethora of such research studies. This is largely because researchers and policy makers often work in isolation; yet if they worked synergistically they could have a significant impact on implementing interventions known to work to improve the lives of populations. Several approaches have been advanced to encourage policy makers to take heed of scientific findings and to urge scientists to take into account the needs of policy makers in designing their research agenda.This paper aims to illustrate how policy has been informed using the case study of the Orphans and Vulnerable Children project in South Africa. It further highlights the successes and challenges encountered thus far with this project. In some countries; particularly those of the north; there has been major progress in bridging this gap between research and policy; however; in developing countries much remains to be done

Gender and decision-making over condom use in two districts in Uganda

Based on a survey of couples in long-term unions in Masaka and Lira districts in Uganda; we critically examine the role of gender inequality in the domain of decision-making about fertility and sex in the discussion and use of condoms. First; we document the sexual context and process of condom negotiation from the perspectives of women and men. Next; we test the hypothesis that increases the relative influence of women; compared to their male partners; in decision-making about sex and fertility should enhance the likelihood of discussion and use of condoms. The results point to barriers that exist for both men and women but show a clear disadvantage for women. they also suggest that; for both partners; a sense of control over fertility has a positive effect on condom use; and that the effect of women's empowerement does not seem to diminish the effect of men's empowerment