Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Avaliação do conhecimento popular e práticas cotidianas em saúde bucal

OBJETIVO: Avaliar o conhecimento popular e as práticas cotidianas em saúde bucal de usuários de serviços públicos de saúde. MÉTODOS: A população estudada foi selecionada a partir de uma amostra estratificada de usuários que procuraram atendimento nas unidades sanitárias da zona urbana de Santa Maria, RS. Os dados foram coletados por meio de entrevista semi-estruturada e organizados em conjuntos de categorias descritivas, permitindo sua distribuição em tabela de freqüência. RESULTADOS: Verificou-se que predominam usuários entre 21 e 40 anos de idade, do sexo feminino e com padrão socioeconômico baixo. A busca pela saúde e o controle das doenças bucais são atribuídos à responsabilidade individual de realizar a higiene bucal e procurar tratamento dentário. A presença e os benefícios do flúor no creme dental e na água de beber não foram reconhecidos pela população estudada. CONCLUSÕES: Os programas de saúde devem considerar os aspectos relativos ao conhecimento e as práticas em saúde bucal, para viabilizar o processo de capacitação da população e promover a responsabilização coletiva da promoção da saúde em todos os níveis da sociedade.

Profissionais da Estratégia Saúde da Família diante de demandas médico-sociais: dificuldades e estratégias de enfrentamento

Os profissionais da Estratégia Saúde da Família (ESF) atuam em comunidades onde a complexidade de problemáticas médico-sociais pode levá-los a sofrer psicologicamente, com prejuízos ao atendimento aos usuários e à consolidação da ESF como modelo de reorganização da atenção básica no Brasil. Esse estudo investigou as dificuldades e as formas de enfrentamento referidas por profissionais de equipes da ESF frente às demandas médico-sociais apresentadas pelos usuários em seu cotidiano de trabalho. Grupos focais e entrevistas semiestruturadas foram realizados com 68 profissionais de três Unidades de Saúde da Família da cidade de São Paulo. Tráfico e uso de drogas ilícitas, alcoolismo, depressão e violência doméstica são as demandas mais significativas para o grupo estudado. Frente a elas, os profissionais referem formação profissional e capacitação técnica insuficientes, sobrecarga e condições desfavoráveis de trabalho, com sentimentos de impotência e frustração. No enfrentamento das dificuldades, destacam-se as estratégias coletivas, especialmente as reuniões de equipe e apoio matricial, nas quais há troca de experiências, conhecimentos e apoio compartilhado. Os resultados indicam que as dificuldades referidas podem deixar os profissionais da ESF em situação de vulnerabilidade, tal como os usuários por eles atendidos. O investimento no desenvolvimento de competências, o fortalecimento de estratégias de enfrentamento coletivas, assim como maior articulação com as redes de serviços e as lideranças locais, mostram-se necessários para que os profissionais de saúde atuem com menor estresse frente às complexas demandas médico-sociais presentes em seu cotidiano de trabalho, e assim contribuam na consolidação da ESF.

Maternal nutrition and oral health factors in early childhood caries

Background. Early Childhood Caries (ECC) is the most common chronic infectious disease of childhood worldwide. Seven of ten American children have one or more decayed or filled primary teeth by age five. ECC prevalence is especially high in lower socio-economic ethnic populations. Commonly recognized as a diet-induced disease, focal etiological factors include cariogenic bacteria, fermentable carbohydrates, and a susceptible newly erupted tooth. Sequencing of breast and/or bottle feeding and introduction of beikost come at a time when children's defense mechanisms and, perhaps maternal direction of children's dietary patterns, are not yet fully developed or mature. To date, most research has examined biological factors, while maternal factors, especially psychosocial ones, have received scant attention. Objective. To examine the association of psychosocial factors in terms of maternal nutrition and oral health knowledge, attitudes, and beliefs, as well as social support and self-efficacy (KABS2) in a population of socio-economically disadvantaged infants and young children. A secondary aim was to describe ECC prevalence in this population. Methods. This study examined cross-sectionally the relationship between selected maternal psychosocial variables and ECC in a convenience sample of Mexican-American women and very young children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Antonio, Texas. Mothers were surveyed by use of a criteria- and content-valid, reliable questionnaire, and dental examinations were conducted on 191 children, aged 5 to 47 months old. Results. Thirty-nine percent of the children had ECC. As assessed on a 30-question scale, women in whose children were diagnosed with ECC were found to demonstrate lower Knowledge ( p=0.03), Attitudes (p=0.02), Beliefs (p=0.04), and Social Support (p<0.01) scores, compared to women whose children were found to be caries-free. No differences in Self-Efficacy scores were found between the groups. Conclusions. These data indicate that current etiological model depicting relevant factors associated with ECC in Mexican-American infants and children of low socio-economic status should be broadened to include consideration of maternal psychosocial factors such as nutrition and oral health knowledge, attitudes, beliefs, and social support, and that these factors should be considered when planning educational approaches to reduce the occurrence of ECC. ^

Survey analysis on dental infection control & occupational safety from India---1999 & 2010

The objective was to study knowledge, attitudes, practice (KAP) and needs regarding infection control measures using two cross-sectional surveys from 1999 and 2010 conducted in India. Both data collection instruments had only about 35 comparable variables in common. In 1999, there were 456 respondents (dentists) who completed a self-administered survey instrument compared to 272 respondents in 2010. Both the 1999 and 2010 samples were mutually independent with no overlap, had regional differences, and therefore, were not completely comparable for changes in KAP over time. While almost all respondents from both surveys felt that education in dental safety was needed and wanted mandatory dental safety curriculum in dental schools, severe inadequacies in dental safety knowledge, protection against immunizable diseases, and practice of universal precaution were noted. Data from the study demonstrated that there is a substantial opportunity to improve the knowledge, attitude and practice of dental infection control and occupational safety in India. Few respondents (27%) reported that the infectious disease status of a patient is always known and a significant number reported that they had the right to refuse care for patients of known infectious disease status. This indicates that Stigma in treating HIV/AIDS patients remains a concern, which in turn suggests that a stronger focus on educating dentists about dental safety and on stigma and infectious disease is needed. Information obtained from this study could be utilized for developing policies oriented towards increasing dental safety educational efforts, in both dental schools as curriculum, and for practicing dentists through professional updates or continuing dental education.^

Considering Efficacy of an Outdoor Environmental Education Program: Facilitating Elementary Students’ Environmental Knowledge, Attitudes, and Behaviours

Various sources have sought to consider the educational interventions that foster changes in perception of and attitudes toward nature, with the ultimate intent of understanding how education can be used to encourage environmentally responsible behaviours. With these in mind, the current study identified an outdoor environmental education program incorporating these empirically supported interventions, and assessed its ability to influence environmental knowledge, attitudes, and behaviours. Specifically, this study considered the following research questions: 1) To what degree can participation in this outdoor education program foster environmental knowledge and encourage pro-environmental attitudes and self-reported pro-environmental behaviours? 2) How is this effect different among students of different genders, and those who have different prior experiences in nature? Two motivational frameworks guided inquiry in the current study: the Value-Belief-Norm Model of Environmentalism (VBN) and the Theory of Planned Behaviour (TPB). The study employed a quantitative survey methodology, combining contemporary data measuring knowledge, attitudes, and behaviours with archived data collected by program staff, reflecting frequency of environmentally responsible behaviour. Further, a single qualitative item was included for which students provided “the first three words that [came] to mind when [they] think of the word nature.” Terms provided before and after the program were compared for differences in theme to detect subtle or underlying changes. Quantitative results indicated no significant change in student knowledge or attitudes through the outdoor environmental education program. However, a significant change in self-reported behaviour was identified from both the contemporary and archived data. This agreement in positive findings across the two data sets, collected using different measures and different participants, lends evidence of the program’s ability to encourage self-reported pro-environmental behaviour. Further, qualitative results showed some change in students’ perceptions of nature through the program, providing direction for future research. These findings suggest that this particular outdoor education program was successful in encouraging students’ self-reported environmentally responsible behaviour. This change was achieved without significant change in knowledge or environmental attitudes, suggesting that external factors not measured in this study might have played a role in affecting behaviour.

Synthesis of existing knowledge and practice in the field of educational partnerships /

"PIP 93-1102"--P. [4] of cover.

Mental health research and practice in minority communities : development of culturally sensitive training programs /

Item 507-B-5.

The National Health Service Corps practice management guide book.

Prepared under a contract for the National Health Service Corps by Family Health Care, Inc.

Mental health consultation theory, practice, and research 1973-1978 : an annotated reference guide /

Mode of access: Internet.

The knowledge and practice of Christianity made easy to the meanest capacities /

Shaw & Shoemaker

A plain and easy introduction to the knowledge and practice of gardening, with hints on fish-ponds,

Mode of access: Internet.