ABSTRACT
Background: Open defecation is the leading cause for malnutrition and diarrhoeal deaths in low- and middle-income countries. The negative public health impacts of open defecation could be neutralized by toilet usage. However, the usage of improved sanitation facilities is unsatisfactory in rural India. Objectives: The study was carried out to find the psycho?social barriers among households for not having toilets and for not using the owned toilets and to develop and find out the effect of Behaviour Change Communication (BCC) strategy on toilet construction and usage. Methods: A community?based Embedded Experimental Mixed Methods study was undertaken in the four field practice villages of Urban Health Training Centre, Villupuram. For baseline and end?line surveys, 422 independent sample households who were not having or not using the toilets were selected by Simple Random Sampling. After IEC clearance, interviews and direct observation of the toilets were undertaken. Context?specific multi?faceted BCC strategy was employed through community participation. The data were analyzed in SPSS software. Chi?square test was used to determine the significance of difference and effect size was calculated to estimate the size of the difference between the baseline and end-line data. Results: Toilet ownership and utilization improved by 21.3% and 23.3% points, respectively. There was a significant reduction in households’ perceived psychosocial barriers in toilet adoption. Conclusion: Our intervention demonstrated considerable improvements in both toilet construction and usage surpassing the psycho-social barriers. Future sanitation promotion interventions should focus more on community participation and the key messages should be reinforced multiple times using different channels.
ABSTRACT
Introduction: The Department of Community Medicine has been training medical interns for providing hospital-based palliative care (HBPC) and community-based palliative care (CBPC) services with an interprofessional team. This study was done to evaluate the training program on palliative care developed for medical interns. Material and Methods: It was a retro-pre type of program evaluation done among 172 interns between January 2016 and December 2017. One day program was conducted for the interns by faculty trained in palliative care, followed by placement in HBPC and CBPC program. At the end of training, self-perceived improvement in knowledge was collected on a five-point Likert scale. Certificates were issued on completion. Data were entered and analyzed using Epi Info (version 7.2.2.6) software. Wilcoxon signed-rank test was applied between pre- and post-scores. Manual content analysis was done for open-ended questions. Results: The mean age of the participants was 22.5 ± 0.8 years, with 76 (44.2%) males and 96 (55.8%) females. There was statistically significant improvement in perceived knowledge scores after attending the training. Areas of learning, values learned, and uses of learning in future career and suggestions for improving the training program were the categories obtained. Conclusion: The training program improved the self-perceived knowledge on palliative care among medical interns. The exposure to HBPC and CBPC program had a positive effect on their attitude and perceived skills for caring of chronically ill patients. Such programs can be initiated by other palliative care providing institutions for training medical interns.