On administrative borders and accessibility to public services: : The case of hospitals in Sweden.

An administrative border might hinder the optimal allocation of a given set of resources by restricting the flow of goods, services, and people. In this paper we address the question: Do administrative borders lead to poor accessibility to public service such as hospitals? In answering the question, we have examined the case of Sweden and its regional borders. We have used detailed data on the Swedish road network, its hospitals, and its geo-coded population. We have assessed the population’s spatial accessibility to Swedish hospitals by computing the inhabitants’ distance to the nearest hospital. We have also elaborated several scenarios ranging from strongly confining regional borders to no confinements of borders and recomputed the accessibility. Our findings imply that administrative borders are only marginally worsening the accessibility.

MLCMS actual use, perceived use, and experiences of use

Mobile learning involves use of mobile devices to participate in learning activities. Most elearning activities are available to participants through learning systems such as learning content management systems (LCMS). Due to certain challenges, LCMS are not equally accessible on all mobile devices. This study investigates actual use, perceived usefulness and user experiences of LCMS use on mobile phones at Makerere University in Uganda. The study identifies challenges pertaining to use and discusses how to improve LCMS use on mobile phones. Such solutions are a cornerstone in enabling and improving mobile learning. Data was collected by means of focus group discussions, an online survey designed based on the Technology Acceptance Model (TAM), and LCMS log files of user activities. Data was collected from two courses where Moodle was used as a learning platform. The results indicate positive attitudes towards use of LCMS on phones but also huge challenges whichare content related and technical in nature.

Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

Perceived Work-related Factors and Turnover Intention : A Case Study of a South Korean Construction Company

Purpose – Employee turnover entails considerable costs and is a major problem for the construction industry. By creating an extensive framework, this study aims to examine whether perceived work-related factors affect turnover intention in South Korean construction companies. Research design – The paper is based on the results of a questionnaire of 136 employees that was conducted and provided by a Korean construction company. Research hypotheses were tested via correlation analyses. The most influencing work-related factors, as well as differences among job levels, were determined by multiple regression analyses. Findings – Communication, immediate leaders, organizational commitment, and organizational pride substantially affect turnover intentions. All of these factors can be considered as relational factors. The most influencing factors differ among job levels. Discussion/practical implications – Immediate leaders should be aware of their role in retaining employees and enhance communication, organizational commitment and pride. This study shows how the importance of certain variables differs for groups of employees. Theoretical implications/limitations– This study is based on a sample of employees from a Korean construction company. Therefore, the generalizability of the findings has to be tested. Future research should test the proposed framework with other factors or resources. Originality/value – This study shed light on the turnover subject in the South Korean construction industry. It shows that different factors can influence turnover intention among job levels. A framework was created, which is based on 16 work-related factors including organizational factors, HRM practices and job attitudes.

Perceived Work-related Factors and Turnover Intention : - A Case Study of a South Korean Construction Company

Purpose – Employee turnover entails considerable costs and is a major problem for the construction industry. By creating an extensive framework, this study aims to examine whether perceived work-related factors affect turnover intention in South Korean construction companies. Research design – The paper is based on the results of a questionnaire of 136 employees that was conducted and provided by a Korean construction company. Research hypotheses were tested via correlation analyses. The most influencing work-related factors, as well as differences among job levels, were determined by multiple regression analyses. Findings – Communication, immediate leaders, organizational commitment, and organizational pride substantially affect turnover intentions. All of these factors can be considered as relational factors. The most influencing factors differ among job levels. Discussion/practical implications – Immediate leaders should be aware of their role in retaining employees and enhance communication, organizational commitment and pride. This study shows how the importance of certain variables differs for groups of employees. Theoretical implications/limitations– This study is based on a sample of employees from a Korean construction company. Therefore, the generalizability of the findings has to be tested. Future research should test the proposed framework with other factors or resources. Originality/value – This study shed light on the turnover subject in the South Korean construction industry. It shows that different factors can influence turnover intention among job levels. A framework was created, which is based on 16 work-related factors including organizational factors, HRM practices and job attitudes.