Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU.

Community engagement and involvement in managing the COVID-19 pandemic among urban poor in low-and middle-income countries: a systematic scoping review and stakeholders mapping.

BACKGROUND: Community engagement and involvement (CEI) was crucial for the COVID-19 pandemic response, particularly among the urban poor in low-and middle-income countries (LMICs). However, no evidence synthesis explores how CEI can benefit public health emergencies. OBJECTIVE: We conducted a systematic scoping review of the CEI with an emphasis on stakeholder identification, accountability mapping, the support system, and the engagement process among urban poor populations in LMICs during the COVID-19 pandemic. METHODS: We searched eleven databases, including PubMed, Embase, Web of Science, and CINAHL, following the PRISMA-2020 guidelines to find articles published between November 2019 and August 2021. PROSPERO registration No: CRD42021283599. We performed the quality assessment using a mixed-method appraisal tool. We synthesized the findings using thematic framework analysis. RESULTS: We identified 6490 records. After the title and abstract screening, 133 studies were selected for full-text review, and finally, we included 30 articles. Many stakeholders were involved in COVID-19 support, particularly for health care, livelihoods, and WASH infrastructure, and their accountability mapping by adopting an interest - influence matrix. This review emphasizes the significance of meaningful CEI in designing and implementing public health efforts for pandemic management among urban slum populations. The interest - influence matrix findings revealed that specific community volunteers, community-based organizations, and civil society organizations had high interest but less influence, indicating that it is necessary to recognize and engage them. CONCLUSION: Motivation is crucial for those with high influence but less interest, such as corporate responsibility/conscience and private food supply agencies, for the health system's preparedness plan among urban populations.