Search

Problem Many national child health guidelines In Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation. Approach In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses. Local setting Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries. Relevant changes National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making. Lessons learnt Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development. [phrase omitted] Probleme En Afrique du Sud, au Malawi et au Nigeria, de nombreuses lignes directrices nationales relatives a la sante infantile sont obsoletes et affichent de pietres resultats en termes de rigueur des methodes et d'implication des parties prenantes. Approche S'alignant sur l'importance accordee par l'Organisation mondiale de la Sante (OMS) a la contextualisation des lignes directrices locales, le projet Global Evidence - Local Adaptation (GELA) a apporte son soutien a divers processus de collaboration multilaterale afin d'adapter des recommandations sur la sante infantile etayees par des faits en Afrique du Sud, au Malawi et au Nigeria. L'equipe du projet GELA a constitue des groupes de pilotage nationaux, charges d'effectuer des exercices iteratifs et structures de definition des priorites afin de repertorier les principaux themes. Nous avons identifie des lignes directrices de reference en procedant a une recherche et une selection parmi celles disponibles. Ensuite, nous avons compare les recommandations de ces potentielles lignes directrices de reference avec les questions pertinentes, puis nous avons evalue leur qualite et leur actualite. En nous fondant sur le processus d'elaboration de lignes directrices de l'OMS, nous avons applique la methodologie GRADEADOLOPMENT pour formuler des recommandations contextualisees a partir de lignes directrices existantes. Si aucune analyse ni ligne directrice de reference n'avait pu etre degagee, nous etablissions de nouvelles syntheses de preuves. Environnement local L'Afrique du Sud, le Malawi et le Nigeria sont des pays aux priorites et systemes de sante variables, qui operent tous trois une transition vers une couverture sanitaire universelle. Les structures des lignes directrices different d'un pays a l'autre, les processus etant generalement menes par les Ministeres nationaux de la Sante. Changements significatifs Les groupes charges d'elaborer des lignes directrices nationales, avec l'aide des chercheurs GELA et des partenaires gouvernementaux et universitaires, ont emis cinq recommandations adaptees au contexte en matiere de sante infantile. Dans la plupart des cas, la prise de decisions nationales contextualisees necessitait des preuves supplementaires. Le programme de renforcement des capacites et l'apprentissage sur le terrain ont permis d'ameliorer les competences des chercheurs et contributeurs nationaux dans les processus decisionnels etayes par des faits. Lecons tirees Mettre au point des recommandations propres a chaque contexte demande du temps et des ressources considerables. D'autres investissements dans le renforcement des capacites locales sont indispensables pour perenniser le developpement national de lignes directrices. [phrase omitted] Situacion Muchas directrices nacionales de salud infantil en Malawi, Nigeria y Sudafrica estan obsoletas y obtienen una puntuacion baja respecto a los metodos rigurosos y la participacion de las partes interesadas. Enfoque En consonancia con el enfasis de la Organizacion Mundial de la Salud (OMS) en la contextualizacion local de las directrices, el proyecto Global Evidence-Local Adaptation (GELA) apoyo procesos multisectoriales para adaptar las recomendaciones basadas en la evidencia a la salud infantil en Malawi, Nigeria y Sudafrica. El equipo del proyecto GELA convoco a grupos directivos nacionales, que realizaron ejercicios estructurados e iterativos de fijacion de prioridades para identificar los temas prioritarios. Se identificaron las directrices fuente apropiadas mediante la busqueda sistematica y el analisis de las directrices disponibles. A continuacion, se compararon las recomendaciones de las posibles directrices fuente con las preguntas pertinentes y se evaluo la oportunidad y la calidad de las directrices. A partir del proceso de elaboracion de directrices de la OMS, se aplico el proceso GRADE-ADOLOPMENT para desarrollar recomendaciones contextualizadas partiendo de las directrices existentes. Si no se identificaba ninguna directriz o revision fuente, se realizaban nuevas sintesis de la evidencia. Marco regional Malawi, Nigeria y Sudafrica son paises con prioridades y sistemas sanitarios diversos, todos ellos en transicion hacia la cobertura sanitaria universal. Las estructuras de las directrices difieren de un pais a otro, y los procesos se dirigen en gran medida desde los ministerios de sanidad nacionales. Cambios importantes Los grupos nacionales de directrices, apoyados por investigadores del GELA y socios gubernamentales y academicos, elaboraron cinco recomendaciones de salud infantil adaptadas a cada contexto. Para la mayoria de estas recomendaciones, se necesitaron pruebas adicionales para fundamentar una toma de decisiones nacional adecuada al contexto. La capacitacion formal y el aprendizaje en el lugar de trabajo mejoraron las competencias de los colaboradores e investigadores nacionales en la toma de decisiones basada en evidencias. Lecciones aprendidas La elaboracion de recomendaciones adaptadas al contexto requiere recursos y tiempo considerables. Se necesita una mayor inversion en el fortalecimiento de la capacidad local para el desarrollo sostenible de directrices nacionales., Introduction Implementation of evidence-informed health guidelines tailored to the health system contexts of low- and middle-income countries is needed to improve health outcomes. Evidence-informed health guidelines are documents containing clinical, [...]

Background: Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools., Methods: We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots., Results: Final resources include online lesson plans, teachers' guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode., Conclusion: Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Rosenbaum S et al.)

Background: Healthcare workers sometimes develop their own informal solutions to deliver services. One such solution is to use their personal mobile phones or other mobile devices in ways that are unregulated by their workplace. This can help them carry out their work when their workplace lacks functional formal communication and information systems, but it can also lead to new challenges., Objectives: To explore the views, experiences, and practices of healthcare workers, managers and other professionals working in healthcare services regarding their informal, innovative uses of mobile devices to support their work., Search Methods: We searched MEDLINE, Embase, CINAHL and Scopus on 11 August 2022 for studies published since 2008 in any language. We carried out citation searches and contacted study authors to clarify published information and seek unpublished data., Selection Criteria: We included qualitative studies and mixed-methods studies with a qualitative component. We included studies that explored healthcare workers' views, experiences, and practices regarding mobile phones and other mobile devices, and that included data about healthcare workers' informal use of these devices for work purposes., Data Collection and Analysis: We extracted data using an extraction form designed for this synthesis, assessed methodological limitations using predefined criteria, and used a thematic synthesis approach to synthesise the data. We used the 'street-level bureaucrat' concept to apply a conceptual lens to our findings and prepare a line of argument that links these findings. We used the GRADE-CERQual approach to assess our confidence in the review findings and the line-of-argument statements. We collaborated with relevant stakeholders when defining the review scope, interpreting the findings, and developing implications for practice., Main Results: We included 30 studies in the review, published between 2013 and 2022. The studies were from high-, middle- and low-income countries and covered a range of healthcare settings and healthcare worker cadres. Most described mobile phone use as opposed to other mobile devices, such as tablets. We have moderate to high confidence in the statements in the following line of argument. The healthcare workers in this review, like other 'street-level bureaucrats', face a gap between what is expected of them and the resources available to them. To plug this gap, healthcare workers develop their own strategies, including using their own mobile phones, data and airtime. They also use other personal resources, including their personal time when taking and making calls outside working hours, and their personal networks when contacting others for help and advice. In some settings, healthcare workers' personal phone use, although unregulated, has become a normal part of many work processes. Some healthcare workers therefore experience pressure or expectations from colleagues and managers to use their personal phones. Some also feel driven to use their phones at work and at home because of feelings of obligation towards their patients and colleagues. At best, healthcare workers' use of their personal phones, time and networks helps humanise healthcare. It allows healthcare workers to be more flexible, efficient and responsive to the needs of the patient. It can give patients access to individual healthcare workers rather than generic systems and can help patients keep their sensitive information out of the formal system. It also allows healthcare workers to communicate with each other in more personalised, socially appropriate ways than formal systems allow. All of this can strengthen healthcare workers' relationships with community members and colleagues. However, these informal approaches can also replicate existing social hierarchies and deepen existing inequities among healthcare workers. Personal phone use costs healthcare workers money. This is a particular problem for lower-level healthcare workers and healthcare workers in low-income settings as they are likely to be paid less and may have less access to work phones or compensation. Out-of-hours use may also be more of a burden for lower-level healthcare workers, as they may find it harder to ignore calls when they are at home. Healthcare workers with poor access to electricity and the internet are less able to use informal mobile phone solutions, while healthcare workers who lack skills and training in how to appraise unendorsed online information are likely to struggle to identify trustworthy information. Informal digital channels can help healthcare workers expand their networks. But healthcare workers who rely on personal networks to seek help and advice are at a disadvantage if these networks are weak. Healthcare workers' use of their personal resources can also lead to problems for patients and can benefit some patients more than others. For instance, when healthcare workers store and share patient information on their personal phones, the confidentiality of this information may be broken. In addition, healthcare workers may decide to use their personal resources on some types of patients, but not others. Healthcare workers sometimes describe using their personal phones and their personal time and networks to help patients and clients whom they assess as being particularly in need. These decisions are likely to reflect their own values and ideas, for instance about social equity and patient 'worthiness'. But these may not necessarily reflect the goals, ideals and regulations of the formal healthcare system. Finally, informal mobile phone use plugs gaps in the system but can also weaken the system. The storing and sharing of information on personal phones and through informal channels can represent a 'shadow IT' (information technology) system where information about patient flow, logistics, etc., is not recorded in the formal system. Healthcare workers may also be more distracted at work, for instance, by calls from colleagues and family members or by social media use. Such challenges may be particularly difficult for weak healthcare systems., Authors' Conclusions: By finding their own informal solutions to workplace challenges, healthcare workers can be more efficient and more responsive to the needs of patients, colleagues and themselves. But these solutions also have several drawbacks. Efforts to strengthen formal health systems should consider how to retain the benefits of informal solutions and reduce their negative effects., (Copyright © 2024 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)