Lessening barriers to healthcare in rural Ghana: providers and users' perspectives on the role of mHealth technology. A qualitative exploration.

BACKGROUND: Key barriers to healthcare use in rural Ghana include those of economic, social, cultural and institutional. Amid this, though rarely recognised in Ghanaian healthcare settings, mHealth technology has emerged as a viable tool for lessening most healthcare barriers in rural areas due to the high mobile phone penetration and possession rate. This qualitative study provides an exploratory assessment of the role of mHealth in reducing healthcare barriers in rural areas from the perspective of healthcare users and providers. METHOD: Semi-structured interviews were conducted with 30 conveniently selected healthcare users and 15 purposively selected healthcare providers within the Birim South District in the Eastern Region of Ghana between June 2017 and April 2018. Data were thematically analysed and normative standpoints of participants were presented as quotations. RESULTS: The main findings were that all the healthcare users had functioning mobile phones, however, their knowledge and awareness about mHealth was low. Meanwhile, rural health care users and providers were willing to use mHealth services involving phone call in the future as they perceived the technology to play an important role in lessening healthcare barriers. Nevertheless, factors such as illiteracy, language barrier, trust, quality of care, and mobile network connectivity were perceived as barriers associated with using mHealth in rural Ghana. CONCLUSION: The support for mHealth service is an opportunity for the development of synergistic relationship between health policy planners and mobile network companies in Ghana to design efficient communication and connectivity networks, accessible, localised, user-friendly and cost-effective mobile phone-based health programmes to assist in reducing healthcare barriers in rural Ghana.

Knowledge, attitude, and use of mHealth technology among students in Ghana: A university-based survey.

BACKGROUND: Interest in mHealth interventions, defined as the use of mobile phones to access healthcare is increasingly becoming popular globally. Given its technology-based applications, university students may be key clients of the mHealth adoption but studies are rare in sub-Saharan Africa. This study provides a snapshot and baseline evidence on knowledge, attitude and use of mHealth among university students in Ghana. METHODS: Using a self-administered questionnaire, we collected data between April and June 2017 from 963 randomly sampled undergraduate students at the Kwame Nkrumah University of Science and Technology (KNUST). Pearson's Chi-square (χ2) test assessed the differences between variables whilst  logistic regression models estimated the independent predictors of use of mHealth with p < 0.05 as significant. RESULTS: Knowledge on mHealth was moderately high. Specifically, more than half of the sample reported awareness of mHealth although the prevalence of use of mHealth stood at 51%. Logistic regressions revealed that mHealth use was positively associated with respondents' year (second year: OR = 1.704, 95% CI: 1.185-2.452, and third year: OR = 1.528, 95% CI: 1.060-2.202), and monthly income (OR:3.112, 95%CI: 1.180-8.211). However, ethnicity [(OR = 0.761, 95% CI (0.580-0.997)] was negatively associated with the use of mHealth technology. CONCLUSION: Findings suggest that knowledge of mHealth among university students is low. Policy and public health interventions for urgent awareness creation and promotion of use of mHealth as well as its possible integration into the mainstream healthcare system in Ghana are timely.

"I prefer a male nurse to a female nurse": patients' preference for, and satisfaction with nursing care provided by male nurses at the Komfo Anokye teaching hospital.

BACKGROUND: Although most male nurses join the profession for self-actualisation, the cultural and societal stereotyping of male nurses as "He-Man", "gay" and "troublemakers", and their marginalisation at the hospital during certain personal and intimate care procedures, tend to deepen the existing gender discrimination prevalent within the nursing profession. This study therefore assessed patients' preference for, and satisfaction with nursing care provided by male nurses at the medical and surgical wards of Komfo Anokye Teaching Hospital [KATH]. METHODS: An inferential cross-sectional study design, in which the prevalence of a condition among an identified population is determined, was used. Using convenience sampling, 150 respondents who meet certain practical criteria and are available and willing to participate were sampled. Data from a context-based research instrument on the opinion, preference and satisfaction of patients with male nursing were analysed using χ 2 test, Mann Whitney U test, ordinal logistic regression and logistic regression. RESULTS: The study indicates that more females than males had ever been attended to by a male nurse for the period considered by the study, and females described male nurses as polite and courteous and were comfortable with their treatment. Being single [OR = 0.111, 95% CI (0.013-0.928)] and professing Islamic faiths [OR = 36.533, 95% CI (2.116-630.597)] were functions of respondents' preference for a male nurse. Significantly too, affiliating to a religious sect (OR = 2.347, 95% CI [0.076-1.630]) and being educated (OR = 1.387, 95% CI [0.040-0.615]), were associated with higher odds of falling in one of the higher categories of satisfaction with nursing care provided by male nurses as against the lower categories. CONCLUSION: Although marital status, religious affiliation and educational level were the significant predictors of patients' preference for, and satisfaction with care provided by male nurses, the effect of the other variables should not be overlooked. The finding disproves assertions on the negative effect of religion on male nurses. It is recommended that public awareness be created on the role of male nurses in the healthcare delivery system to promote acceptance of gender diversity in the nursing profession.

A survey of the genesis of stress and its effect on the academic performance of midwifery students in a college in Ghana.

OBJECTIVE: This study assesses the genesis of stress among midwifery students in Ghana and its impact on their academic performance. DESIGN: A contextual cross-sectional design was used, and data were drawn from a 17-modified-item response from the College Undergraduate Stress Scale (CUSS), a rating of students' academic performance and stress management techniques. SETTING: The study took place at the Saint Michael's Midwifery Training School located at Pramso, within the Bosomtwe District, Ashanti Region, Ghana. MEASUREMENTS: The data was analysed using descriptive statistics, factor analysis, χ2 test and ordinal logistic regression models. FINDINGS: Result indicates that academic stressors (schoolwork and less vacation), interpersonal stressors (extracurricular groups, family obligations), intrapersonal stressor (bills/overspending) and environmental stressor (mistakes with expecting mothers) are direct stressors among midwifery students. The study discovered a statistically significant difference in stress management techniques among the study participants (p < 0.05). The multivariate analysis found that respondents' reactions when stressed had a significant effect on their academic performance. However, after adjusting for the stressors, having less vacation had significant effect on respondents' academic performance. Meanwhile, the interaction term significantly strengthens for respondents who had sufficient resting time during vacation. CONCLUSIONS: Considering the extensive and intense nature of midwifery training per the prescribed curriculum, there is the need for orientation of students on the effect of stress on their academic performance and effective coping mechanisms. IMPLICATIONS FOR PRACTICE: Regulation and planning of midwifery curricula in the future should incorporate adequate vacation periods to facilitate synthesis of knowledge among students.

'We are nothing without herbs': a story of herbal remedies use during pregnancy in rural Ghana.

BACKGROUND: Herbal medicine has become the panacea for many rural pregnant women in Ghana despite the modern western antenatal care which has developed in most parts of the country. To our knowledge, previous studies investigating herbal medicine use have primarily reported general attitudes and perceptions of use, overlooking the standpoint of pregnant women and their attitudes, and utilisation of herbal medicine in Ghana. Knowledge of herbal medicine use among rural pregnant women and the potential side effects of many herbs in pregnancy are therefore limited in the country; this qualitative study attempts to address this gap by exploring the perceptions of herbal medicine usage among pregnant women in rural Ghana. METHODS: A sample of 30, conveniently selected pregnant women, were involved in this study from April 11 to June 22, 2017. Data from three different focus group discussions were thematically analysed and presented based on an a posteriori inductive reduction approach. RESULTS: The main findings were that pregnant women used herbal medicine, most commonly ginger, peppermint, thyme, chamomile, aniseeds, green tea, tealeaf, raspberry, and echinacea leaf consistently throughout the three trimesters of pregnancy. Cultural norms and health beliefs in the form of personal philosophies, desire to manage one's own health, illness perceptions, and a holistic healing approach were ascribed to the widespread use of herbs. CONCLUSION: We recommend public education and awareness on disclosure of herbal medicine use to medical practitioners among pregnant women.

Correction to: Religion and health: exploration of attitudes and health perceptions of faith healing users in urban Ghana.

It was highlighted that the original article [1] contained a typesetting error in the name of Razak M. Gyasi. This was incorrectly captured as Razak M. Gyasi Mohammed in the original article which has since been updated.

Religion and Health: exploration of attitudes and health perceptions of faith healing users in urban Ghana.

BACKGROUND: The main aim of the study was to explore the attitudes and health perceptions of faith healing users in Kumasi Metropolis, Ghana. This has become necessary because faith healing practice is an important area but remains neglected in the health care literature. In an age when biowestern medicine is touted as the cure for most diseases, understanding how and why individuals seek alternative treatment, specifically faith healing modalities may help to develop more effective health care interventions. METHODS: We employed exploratory study design of purely qualitative research approach involving 40 conveniently selected participants from four different purposively selected faith healing centres to get a maximum variation of experiences and opinions on the time of consultation, perceived effectiveness and challenges of faith healing practices in Ghana. In-depth interviews were conducted from 10th June to 30th July, 2017. Data were thematically analysed and presented based on the a posteriori inductive reduction approach. RESULTS: The main findings were that faith healers served as the first port of call for disease curing and prevention for most users. Consumers of faith healing perceived their health status to be good due to the perceived effectiveness of faith healing for curing of health problems. However, users faced challenges such as stigmatisation and victimisation in seeking health care. CONCLUSION: This study has provided the first baseline evidence in this important area of inquiry that has been neglected in the scholarly discourse in Ghana. By implication, users' positive attitudes and perceptions toward faith healing call for integration policies that allow formal medical services to have open idea to faith healing practices in Ghana.

Geographical Differences in Perceived Health Status Among Older Adults in Ghana: Do Gender and Educational Status Matter?

Studies have constantly reported mixed evidence on the associations between rural/urban differences and self-rated health (SRH) status among older populations. More importantly, the roles of other relevant sociodemographic characteristics such as gender and educational levels in these associations are mostly overlooked. The current study examines the geographical differences in SRH of older cohorts in Kumasi Metropolis and Bosomtwe District of Ghana. Data from a Spatial Health and Healthcare Study (SHHS) were analyzed using chi-square test and ordinal logistic regression models. Although the study discovered a statistically significant difference in SRH between the rural and urban samples, the multivariate analysis found insignificant effect in SRH between urban and rural samples after adjusting for theoretically relevant covariates. However, the interactions indicated that this association significantly strengthens for rural dwellers who were highly educated. Moreover, age, average monthly income, reporting sickness in the past 90 days, and not noticing any change in health status in retrospective to 12 months were independent predictors of SRH. Effective interventions through collaborative efforts by the Ghanaian sociopolitical structure and micro-level dynamics are needed to ensure holistic improvements in health outcomes among vulnerable older persons.