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- Atkins, Salla-Aija Ailikki
(författare)
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Improving adherence : an evaluation of the enhanced tuberculosis adherence model in Cape Town, South Africa
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Patient adherence to tuberculosis (TB) treatment continues to be problematic despite the wide implementation of directly observed therapy (DOT). In many settings with high HIV and TB co-infection, the two diseases continue to be treated differently: antiretroviral (ARV) programmes often use a patient support and empowerment approach to treatment, while TB programmes use DOT. AIM: To evaluate changing a TB treatment model from DOT to an approach based on the community antiretroviral therapy (ART) model in Cape town, South Africa. METHODS: Four studies were conducted as part of the evaluation of a new model called the Enhanced Tuberculosis Adherence (ETA) programme in primary health clinics. A mixed method approach was used. Study I: Seven key informants involved in the development or implementation of the ETA, or knowledgeable of TB treatment policies in South Africa, were interviewed. Data were analysed using thematic content analysis, and examined for their relation to the Kingdon framework of agenda setting to explore why the ETA was developed. Study II: Six nurses and five adherence counsellors were interviewed, and 64 treatment supporters were included in focus group discussions in order to explore their experiences of the ETA. Data were analysed using thematic content analysis and examined for their relation to the normalization process model. Study III: 28 patients on the ETA intervention and 31 patients in comparison clinics were included in focus group discussions in order to explore their experiences of TB treatment. Two non-adherent patients were interviewed. Data were analysed using thematic content analysis. Study IV: Using a time series design, TB treatment outcome data on 19 357 patients from five intervention and five comparison clinics were collected from the electronic TB register from 1 January 2005 to 31 march 2008. Outcomes were analysed using poisson regression. FINDINGS: Study I: The intervention was developed due to problems in TB management, the availability of an alternative model in the community aRt treatment programme, political changes (including a focus on empowerment), and impending large-scale aRt roll-out. The change was facilitated by key individuals. Study II: The main issues hindering the normalization of the programme within clinics related to hierarchical relationships, teamwork, training needs, insufficient internalisation of the empowerment approach by staff, and logistical and management issues. Study III: Intervention patients seemed to have more positive opinions of TB treatment than comparison clinic patients. there was some indication that ETA patients were more ready to take control over their health, although there was little evidence of patient empowerment. Study IV: There was a significant improvement in smear conversion rates at 2 and 3 months in intervention clinics relative to comparison clinics. There was no significant difference in TB cure or treatment success rates. CONCLUSION: The ETA seems to be an approach that is feasible to implement in primary health clinics. It achieved results not significantly different from those of DOT, but was appreciated by patients. Further efforts are needed to empower TB patients. Overall, the ETA is a promising approach that now needs to be tested on a wider scale, and that could pave the way towards integrating TB treatment programmes with aRt programmes in South Africa and other high-burden settings.
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| 2. |
- Kalyanasundaram, Madhanraj, et al.
(författare)
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Composition analysis (pick analysis) of waste generated from household: A pilot study in Ujjain city, India
- 2023
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Ingår i: Heliyon. - 2405-8440. ; 9:9
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Tidskriftsartikel (refereegranskat)abstract
- Waste segregation is an essential function in improving waste management. Waste segregation not only facilitates recycling and reduces waste going to landfills, rather it can benefit our environment and human in various ways. A pick analysis of waste composition is used to characterize the household waste stream and thus can analyze the segregation rate among the residents. In addition, it can measure the actual waste sorting behaviour at the household/community level. The objective of the study was to assess feasibility of a large-scale waste composition study, identify methodological and operational challenges, and estimate the resources needed to conduct the main waste composition study in order to obtain and get indicative figures about waste generation, composition, and miss-sorted proportions. The study team went door-to-door to collect waste in colour coded bags. We also collected the socio-demographic data of the households. The collected waste was weighed and segregated to analyze the waste composition. The analysis was done among 45 households, and it was found that the per capita waste generation per day is 0.25 kg (0.24 kg from slum and 0.27 kg from non-slum). Challenges identified in conducting waste composition study were lack of standard waste fraction classifications, difficulty in recruitment of personnel to conduct study due to social taboo around waste, challenge in co-coordinating with Ujjain Municipal Corporation waste collection vehicle for collection of waste. 53 household activities were completed in 5 and half hours with INR 24685 (USD 300.5). Pick analysis could be adopted by the Ujjain Municipal Corporation after cost effective analysis to generate precise estimate of waste generation, resource recovery, efficient resource allocation and will help in future interventions and informed policy decision making to improve segregation.
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| 3. |
- Khare, Shweta, et al.
(författare)
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Understanding Internal and External Drivers Influencing the Prescribing Behaviour of Informal Healthcare Providers with Emphasis on Antibiotics in Rural India : A Qualitative Study
- 2022
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Ingår i: Antibiotics. - : MDPI AG. - 2079-6382. ; 11:4
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Tidskriftsartikel (refereegranskat)abstract
- Globally, Antibiotic resistance is a major public health concern, with antibiotic use contributing significantly. Targeting informal healthcare providers (IHCPs) is important to achieve universal health coverage and effective antibiotic stewardship in resource-constrained settings. We, therefore, aimed to analyse the internal and external drivers that influence IHCPs' prescribing behaviour for common illnesses in children under five, with an emphasis on antibiotic use in rural areas of India. A total of 48 IHCPs participated in focus group discussions. Thematic framework analysis with an inductive approach was used, and findings were collated in the theoretical framework based on knowledge, attitude, and practice model which depicted that the decisions made by IHCPs while prescribing antibiotics are complex and influenced by a variety of external and internal drivers. IHCPs' internal drivers included the misconception that it is impossible to treat a patient without antibiotics and that antibiotics increase the effectiveness of other drugs and cure patients faster in order to retain them. Formal healthcare providers were the IHCPs' sources of information, which influences their antibiotic prescribing. We found when it comes to seeking healthcare in rural areas, the factors that influence their choice include 'rapid cure', 'cost of treatment', 'distance' and '24 h availability', instead of qualification, which may create pressure for IHCPs to provide a quick fix. Targeted and coordinated efforts at all levels will be needed to change the antibiotic prescribing practices of IHCPs with a focus on behaviour change and to help resolve misconceptions about antibiotics.
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| 4. |
- Krishnan, Kavya, et al.
(författare)
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Feasibility assessment of crowdsourcing slogans for promoting household waste segregation in India: a cross-sectional study
- 2023
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Ingår i: Frontiers in Public Health. - 2296-2565. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Crowdsourcing is an emerging technique to engage or access a wider set of experts and multiple stakeholders through online platforms, which might effectively be employed in waste management. Therefore, we assessed the feasibility of the crowdsourcing method to provide an alternative approach that can improve household waste segregation using an “online-slogan-contest”.Methods: The contest was promoted via targeted emails to various governmental and non-governmental organizations and through social media platforms for around 4 weeks (25 days). The entries were received through a Google form. The slogans were assessed by the experts and analyzed using content analysis methods.Results: Total 969 entries were received from different geographic regions in India. Of that, 456 were in English and 513 in Hindi. Five themes of waste segregation emerged from the received slogans: (1) Community awareness, responsibility, and support, (2) Significance of household waste segregation, (3) Use of separate dustbins, (4) Health and well-being, and (5) Environment and sustainability.Discussion: Crowdsourcing approaches can be used by local authorities for improving waste management approaches and are recommended as these involve a wider audience within a short time frame. Moreover, this approach is flexible and integrating crowdsourcing approaches strengthens our understanding of existing waste management activities.
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| 5. |
- Sahoo, Krushna Chandra, et al.
(författare)
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Dynamics of Household Waste Segregation Behaviour in Urban Community in Ujjain, India : A Framework Analysis
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:12
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Tidskriftsartikel (refereegranskat)abstract
- Waste segregation practices must be socially acceptable, affordable, context-specific, and participatory, which is essential for promoting waste segregation. Therefore, this study explored the urban community members’ motivation, opportunity, and household waste segregation ability. We performed a qualitative study in Ujjain city, India. Ten focus group discussions and eight in-depth interviews were conducted with female and male household members in residential and slum areas. All interviews were digitally recorded, transcribed, and translated. We used the thematic framework technique using the Motivation-Opportunity-Ability-Behaviour theory for analysis. Three themes were constructed: motivation, where household members are motivated to sort waste yet fear the consequences of improper sorting; ability, where household waste segregation is rapidly gaining acceptance as a social norm; and opportunities, involving convenient facilities and a social support system for household members towards waste segregation. This study contributes to developing a knowledge base on waste segregation behaviour and a repertoire to facilitate evidence-based management and policymaking. There is a need for educational intervention and women’s self-help groups’ involvement to develop community orientation and waste segregation literacy. Finally, this study emphasizes the importance of all three behavioural change components, i.e., motivation, opportunity, and ability, in managing sustainable waste segregation practices.
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| 6. |
- Trushna, Tanwi, et al.
(författare)
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Interventions to promote household waste segregation: A systematic review
- 2024
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Ingår i: Heliyon. - 2405-8440. ; 10:2
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Forskningsöversikt (refereegranskat)abstract
- Waste segregation at source, particularly at the household level, is an integral component of sustainable solid waste management, which is a critical public health issue. Although multiple interventions have been published, often with contradictory findings, few authors have conducted a comprehensive systematic synthesis of the published literature. Therefore, we undertook a systematic review to synthesize all published interventions conducted in any country in the world which targeted household-level waste segregation with or without additional focus on recycling or composting.Following PRISMA guidelines, Web of Science, Medline, Global Health, and Google Scholar were searched using a search strategy created by combining the keywords ‘Waste’, ‘Segregation’, and ‘Household’. Two-stage blinded screening and consensus-based conflict resolution were done, followed by quality assessment, data extraction, and narrative synthesis.8555 articles were identified through the database searches and an additional 196 through grey literature and citation searching. After excluding 2229 duplicates and screening title abstracts of 6522 articles, 283 full texts were reviewed, and 78 publications reporting 82 intervention studies were included in the data synthesis.High methodological heterogeneity was seen, excluding the possibility of a meta-analysis. Most (n = 60) of the interventions were conducted in high-income countries. Interventions mainly focused on information provision. However, differences in the content of information communicated and mode of delivery have not been extensively studied. Finally, our review showed that the comparison of informational interventions with provision of incentives and infrastructural modifications needs to be explored in-depth. Future studies should address these gaps and, after conducting sufficient formative research, should aim to design their interventions following the principles of behaviour change.
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