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Trimmer, C. & Målqvist, M. (2019). Clinical communication and caregivers' satisfaction with child healthcare in Nepal: results from Nepal Health Facility Survey 2015. BMC Health Services Research, 19, Article ID 17.
Open this publication in new window or tab >>Clinical communication and caregivers' satisfaction with child healthcare in Nepal: results from Nepal Health Facility Survey 2015
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, article id 17Article in journal (Refereed) Published
Abstract [en]

Background: Patient satisfaction is an important measure of quality of care and a determinant of health service utilisation and the choice of health facility. Measuring patients' experiences is important for understanding and improving the quality of care at health facilities. The aim of this study was to assess levels and identify associated factors of caregivers' satisfaction and provider-caregiver communication within child healthcare in Nepal.

Methods: Secondary analysis of Sick Child Exit Interviews (n=2092) sourced from 2015 Nepal Health Facility Survey data. Satisfaction was measured through caregivers' satisfaction with services received and their willingness to recommend the health facility visited. Communication indicators were chosen based on the 2014 WHO IMCI guidelines and aggregate communication scores were calculated based on the number of indicators acknowledged during assessments. Logistic regression was used for analysis.

Results: Although most respondents (82.1%) reportedly were satisfied with the care provided, only 35.9% experienced good communication with their providers. Caregivers who had ever attended school were more likely to be satisfied with services (1.44, CI 95% 1.04-1.99). Type of provider, sex of child or who the caregiver was had no association with caregivers' satisfaction. Having been given a diagnosis doubled the chances of satisfaction (AOR 2.04, 95% CI 1.38-3.00), as did discussion of the child's growth (OR 1.71, 95% CI 1.06-2.76) and having discussed any of the included topics (AOR 1.98, CI 95% 1.14-3.45).

Conclusions: Interventions to improve healthcare staff's communication skills are needed in Nepal to further enhance satisfaction with services and increase quality of care. However, this is an area that need further investigation given the high levels of satisfaction displayed despite poor communication. Other factors in the health care exchange between provider and clients are influencing the level of satisfaction and need to be identified and promoted further. High-quality care is no longer a goal for the future or only for high income settings; it is essential for reaching global health goals.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Patient satisfaction, Patient communication, Child health, Nepal
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-375888 (URN)10.1186/s12913-018-3857-4 (DOI)000455209900006 ()30621685 (PubMedID)
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-11-21Bibliographically approved
Niemeyer Hultstrand, J., Tydén, T., Jonsson, M. & Målqvist, M. (2019). Contraception use and unplanned pregnancies in a peri-urban area of eSwatini (Swaziland). Sexual & Reproductive HealthCare, 20, 1-6
Open this publication in new window or tab >>Contraception use and unplanned pregnancies in a peri-urban area of eSwatini (Swaziland)
2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 1-6Article in journal (Refereed) Published
Abstract [en]

Background: Despite reported high levels of contraception use in eSwatini, unplanned pregnancies are common. The aims of this study were to investigate prevalence and determinants of contraception use and unplanned pregnancies in a disadvantaged area in the Kingdom of eSwatini (Swaziland), and to investigate the association between unplanned pregnancies and antenatal care attendance. Methods: This cross-sectional study was conducted at the non-governmental organization Siphilile Maternal and Child Health in Matsapha, a peri-urban industrial area, using data from pre-existing client records. The sample included clients (n = 1436) registered during pregnancy or up to three months postpartum between August 2014 and April 2016. Contraception use before conception and unplanned pregnancies were analysed with logistic regression to find associations with socio-demographic factors and health care utilization. Results: In this population, 59% (n = 737) stated to have used contraception before becoming pregnant. Teenagers and first-time mothers were less likely to have used contraception. Seventy percent (789/1124) of the pregnancies were unplanned. Older women ( 35 years) were less likely while teenagers and multiparas (>= 3 children) were more likely to have an unplanned pregnancy. Women with unplanned pregnancies were less likely to attend the recommended number of antenatal care visits compared to women with planned pregnancies. Conclusion: The rate of unplanned pregnancies is high in this population, especially among teenagers. Family planning interventions need to focus on preconception care for teenagers to enable pregnancy planning including improved antenatal care attendance.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-387926 (URN)10.1016/j.srhc.2019.01.004 (DOI)000470192400002 ()31084811 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Rana, N., Ranneberg, L. J., Målqvist, M., KC, A. & Andersson, O. (2019). Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks. Acta Paediatrica
Open this publication in new window or tab >>Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Other academic) Published
Abstract [en]

Aim: Our aim was to investigate the effects of timing of cord clamping on the risk of hyperbilirubinaemia.

Methods: We recruited 540 normal vaginal deliveries at the Paropakar Maternity and Women’s Hospital in Kathmandu, Nepal, from October 2 to November 21, 2014. They were randomised into two groups: 257/270 were cord clamped within 60 sec‐ onds and 209/270 after 180 seconds. Transcutaneous bilirubin was measured at discharge and 24 hours. At 4 weeks, 506 mothers were successfully contacted by phone, and the health status of the baby and their history of jaundice and treatment was recorded.

Results: Based on transcutaneous bilirubin at discharge, 22/261 (8.4%) in the early group and 25/263 (9.5%) in the delayed group (P = 0.76) were at high risk of subse‐ quent hyperbilirubinemia. At the 4‐week follow‐up, jaundice was reported in 13/253 (5.1%) in the early and 17/253 (6.7%) in the delayed group (P = 0.57) and 3/253 (1.2 %) of the early and 1/253 (0.4%) of the delayed group (P = 0.62) received treatment. All analyses were based on intention‐to‐treat.

Conclusion: Delayed cord clamping was not associated with an increased risk of hy‐ perbilirubinaemia during the first day of life or risk of jaundice within 4 weeks com‐ pared with the early group.

Place, publisher, year, edition, pages
Sweden: , 2019
Keywords
cord clamping, jaundice, neonatal hyperbilirubinaemia, newborn infant, transcutaneous bilirubin
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-389474 (URN)10.1111/apa.14913 (DOI)
Projects
Delayed Cord clamping in Nepal - Evidence for implementation
Available from: 2019-07-15 Created: 2019-07-15 Last updated: 2019-07-15
KC, A., Ewald, U., Basnet, O., Gurung, A., Pyakuryal, S. N., Jha, B. K., . . . Målqvist, M. (2019). Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial. PLoS Medicine, 16(9), Article ID e1002900.
Open this publication in new window or tab >>Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial
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2019 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 16, no 9, article id e1002900Article in journal (Refereed) Published
Abstract [en]

Background Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal. Methods and findings We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 +/- 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided. Conclusion These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-396627 (URN)10.1371/journal.pmed.1002900 (DOI)000489902400012 ()31498784 (PubMedID)
Funder
Swedish Research Council
Available from: 2019-11-08 Created: 2019-11-08 Last updated: 2019-11-08Bibliographically approved
Rana, N., KC, A., Målqvist, M., Subedi, K. & Andersson, O. (2019). Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial.. Neonatology, 115(1), 36-42
Open this publication in new window or tab >>Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial.
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2019 (English)In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 115, no 1, p. 36-42Article in journal (Refereed) Published
Abstract [en]

Background: Delayed cord clamping (DCC) is associated with an improved iron status at 8 months, a reduction of anemia at 12 months, and an improved development at 4 years. Assessment of the development after DCC has not been performed earlier in a setting with a high prevalence of iron deficiency.

Objective: The aim of this paper was to investigate the effects of DCC compared to early cord clamping (ECC) on the development evaluated with the Ages and Stages Questionnaire (ASQ) at 12 months of age.

Method: We conducted a randomized controlled trial investigating the effect of DCC (≥180 s) versus ECC (≤60 s) in 540 full-term deliveries. Twelve months after delivery, the parents reported their infant’s development by ASQ. Infants having a score < 1 standard deviation (SD) under the mean score were considered “at risk” of affected neurodevelopment.

Results: At 12 months of age, 332 (61.5%) infants were assessed. Fewer children in the DCC group were “at risk” of having affected neurodevelopment measured by the ASQ total score, 21 (7.8%) versus 49 (18.1%) in the ECC group. The relative risk was 0.43 (0.26–0.71). Infants in the DCC group had higher mean total scores (SD), 290.4 (10.4) versus 287.2 (10.1), p = 0.01. Significantly fewer infants in the delayed group were “at risk” and had higher scores in the domains “communication”, “gross motor”, and “personal-social”. Conclusions: DCC after 3 min was associated with an improvement of the overall neurodevelopment assessed at 12 months of age as compared to infants in the group with cord clamping within 1 min.

Keywords
Ages and Stages Questionnaire, Delayed umbilical cord clamping, Improved neurodevelopment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-364661 (URN)10.1159/000491994 (DOI)000456665100006 ()30278462 (PubMedID)
Funder
Swedish Society of MedicineSwedish Society for Medical Research (SSMF)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-03-25Bibliographically approved
Rana, N., Brunell, O. & Målqvist, M. (2019). Implementing delayed umbilical cord clamping in Nepal - Delivery care staff's perceptions and attitudes towards changes in practice. PLoS ONE, 14(6), Article ID e0218031.
Open this publication in new window or tab >>Implementing delayed umbilical cord clamping in Nepal - Delivery care staff's perceptions and attitudes towards changes in practice
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 6, article id e0218031Article in journal (Refereed) Published
Abstract [en]

Aim: To explore delivery care staff's perceptions and attitudes towards changes in practice of umbilical cord clamping in order to identify work culture barriers and enablers for improved clinical practice and implementation of the new guidelines on cord clamping.

Method: A purposive sampling strategy was used to include delivery staff at two major hospitals in Kathmandu, Nepal for focus group discussions. Key informant interviews were conducted with ward in-charge and Skilled Birth Attendant trainers at the respective hospitals. Data are analysed through qualitative content analysis.

Result: Participants had positive attitudes towards delayed cord clamping as it was not perceived to be a difficult task and as they perceived it to be beneficial for mother and child. The will to do good and a high level of trust in the hierarchical system and in scientific evidence were identified as promoters of change. Several barriers were mentioned, such as maternal or foetal medical conditions and physical settings, as constrains to performing delayed cord clamping. They also mentioned difficulties in adopting new guidelines due to habitual practice, lack of formal training and poor coherence within the work team. In order to bring change to the practice participants highlighted that authorized national and institutional protocols and regular training are crucial.

Conclusion: Due to poor coherence within the health system and lack of national or institutional protocols, delivery staff have to rely on their own skills development and informal decision making, and are therefore hesitant to apply new routines of delayed cord clamping. In order to change cord clamping practices to comply with evidence and policies health-care staff need to be better supported by the governance structures of the health system, with clear and approved guidelines made available and coherent training and support.

Keywords
Implementing delayed cord clamping, Perception, attitude
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-379561 (URN)10.1371/journal.pone.0218031 (DOI)000471234500047 ()31188895 (PubMedID)
Funder
The Swedish Foundation for International Cooperation in Research and Higher Education (STINT), PT2016-6639Swedish Research Council, 2014-04229
Note

Title in dissertation list of papers: Implementing delayed umbilical cord clamping in Nepal - Delivery care staff's perceptions and attitudes towards changes in practice : Implementing delayed umbilical cord clamping in Nepal

Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-08-08Bibliographically approved
Andersson, O., Rana, N., Ewald, U., Målqvist, M., Stripple, G., Basnet, O., . . . KC, A. (2019). Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III) - a randomized clinical trial.. Maternal health, neonatology and perinatology, 5, Article ID 15.
Open this publication in new window or tab >>Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III) - a randomized clinical trial.
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2019 (English)In: Maternal health, neonatology and perinatology, ISSN 2054-958X, Vol. 5, article id 15Article in journal (Refereed) Published
Abstract [en]

Background: Experiments have shown improved cardiovascular stability in lambs if umbilical cord clamping is postponed until positive pressure ventilation is started. Studies on intact cord resuscitation on human term infants are sparse. The purpose of this study was to evaluate differences in clinical outcomes in non-breathing infants between groups, one where resuscitation is initiated with an intact umbilical cord (intervention group) and one group where cord clamping occurred prior to resuscitation (control group).

Methods: Randomized controlled trial, inclusion period April to August 2016 performed at a tertiary hospital in Kathmandu, Nepal. Late preterm and term infants born vaginally, non-breathing and in need of resuscitation according to the 'Helping Babies Breathe' algorithm were randomized to intact cord resuscitation or early cord clamping before resuscitation. Main outcome measures were saturation by pulse oximetry (SpO2), heart rate and Apgar at 1, 5 and 10 minutes after birth.

Results: At 10 minutes after birth, SpO2 (SD) was significantly higher in the intact cord group compared to the early cord clamping group, 90.4 (8.1) vs 85.4 (2.7) %, P < .001). In the intact cord group, 57 (44%) had SpO2 < 90% after 10 minutes, compared to 93 (100%) in the early cord clamping group, P < 0.001. SpO2 was also significantly higher in the intervention (intact cord) group at one and five minutes after birth. Heart rate was lower in the intervention (intact cord) group at one and five minutes and slightly higher at ten minutes, all significant findings. Apgar score was significantly higher at one, five and ten minutes. At 5 minutes, 23 (17%) had Apgar score < 7 in the intervention (intact cord) group compared to 26 (27%) in the early cord clamping group, P < .07. Newborn infants in the intervention (intact cord) group started to breathe and establish regular breathing earlier than in the early cord clamping group.

Conclusions: This study provides new and important information on the effects of resuscitation with an intact umbilical cord. The findings of improved SpO2 and higher Apgar score, and the absence of negative consequences encourages further studies with longer follow-up.

Trial registration: Clinicaltrials.gov NCT02727517, 2016/4/4.

Keywords
Apgar score, Cord clamping, Pulse oximetry, Resuscitation, Term newborn, Umbilical cord
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-397521 (URN)10.1186/s40748-019-0110-z (DOI)31485335 (PubMedID)
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2019-11-21
Alfven, T., Dahlstrand, J., Humphreys, D., Hellden, D., Hammarstrand, S., Hollander, A.-C., . . . Tomson, G. (2019). Placing children and adolescents at the centre of the Sustainable Development Goals will deliver for current and future generations. Global Health Action, 12(1), Article ID 1670015.
Open this publication in new window or tab >>Placing children and adolescents at the centre of the Sustainable Development Goals will deliver for current and future generations
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2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1670015Article in journal (Refereed) Published
Abstract [en]

Child health is taking the back seat in development strategies. In summarising a newly released collaborative report, this paper calls for a novel conceptual model where child health takes centre stage in relation to the 2030 Agenda and the Sustainable Development Goals. It lays out five principles by which renewed effort and focus would yield the most benefit for children and adolescents. These include: re-defining global child health in the post-2015 era by placing children and adolescents at the centre of the Sustainable Development Goals; striving for equity; realising the rights of the child to thrive throughout the life-course; facilitating evidence informed policy-making and implementation; and capitalising on interlinkages within the SDGs to galvanise multisectoral action. These five principles offer models that together have the potential of improving design, return and quality of global child health programs while re-energising the 2030 Agenda and the Sustainable Development Goals.

Place, publisher, year, edition, pages
Taylor & Francis Ltd, 2019
Keywords
Child health, children, Sustainable Development Goals, multisectoral, health equity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-396447 (URN)10.1080/16549716.2019.1670015 (DOI)000488991800001 ()31587621 (PubMedID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-08Bibliographically approved
Gurung, R., Jha, A. K., Pyakurel, S., Gurung, A., Litorp, H., Wrammert, J., . . . KC, A. (2019). Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN) - a stepped wedge cluster randomized controlled trial in public hospitals. Implementation Science, 14, Article ID 65.
Open this publication in new window or tab >>Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN) - a stepped wedge cluster randomized controlled trial in public hospitals
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2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, article id 65Article in journal (Refereed) Published
Abstract [en]

Background: Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement packageScaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)on intrapartum care and intrapartum-related mortality in public hospitals of Nepal.

Methods: We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo (R)) and neonatal heart rate monitors (Neobeat (R)) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations.

Discussion: With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Quality improvement interventions, Basic neonatal resuscitation, Fetal heart rate monitoring, Stepped wedge cluster randomized control trial, Nepal
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-390196 (URN)10.1186/s13012-019-0917-z (DOI)000472202100001 ()31217028 (PubMedID)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Målqvist, M. (2018). Community agency and empowerment: a need for new perspectives and deepened understanding. Upsala Journal of Medical Sciences, 123(2), 123-130
Open this publication in new window or tab >>Community agency and empowerment: a need for new perspectives and deepened understanding
2018 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 2, p. 123-130Article in journal (Refereed) Published
Abstract [en]

Background: In an increasingly globalized and interlinked world it becomes ever more important to find strategies to prevent, detect, and respond to emerging public health threats. Local communities have a central role in this effort and need to be empowered and strengthened to be able to meet the challenge, and local knowledge and participation are key. This paper outlines a theoretical framework for community intervention dynamics and explores perceptions, priorities, and perspectives of stakeholders involved in community interventions. Methods: A deductive discourse analysis was performed based on the proposed theoretical framework consisting of three levels: intervention design, intervention delivery, and community agency. The setting was a workshop on community preparedness at Uppsala Health Summit 2017. Thirty-eight participants representing government officials, international organizations, and researchers as well as community implementers underwent a value exercise and were asked to prioritize good practices, challenges, and needed solutions to empower communities to meet emerging health threats. Results: The value exercise revealed a large variation in basic values among participants. Discussions mainly focused on intervention delivery and choice of methods. Need and allocation of resources at any level was not an issue. Despite being probed to take a deeper look at contextual factors and the underlying drivers of community engagement, participants scarcely mentioned and problematized community agency mechanisms. Conclusion: There is a need for new perspectives and a deepened reflection among decision-makers and public health implementers engaging at the local level to strengthen communities to face public health threats. A greater understanding and focus on contextual factors is needed which necessitates stronger interdisciplinary approaches.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Agency, community, discourse analysis, empowerment, stakeholder
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-360562 (URN)10.1080/03009734.2018.1474303 (DOI)000438159000008 ()29894212 (PubMedID)
Available from: 2018-09-14 Created: 2018-09-14 Last updated: 2018-09-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8184-3530

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