Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Medical students are afraid to include abortion in their future practices : in-depth interviews in Maharastra, India

BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education. METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

International commercial law : principles and practices

International Commercial Law: Principles and practices considers the multifaceted nature of international commercial law and explains the rules, principles, policies and practices that comprise this area of law and the wide-ranging influences that shape it

The book provides an extensive analysis of the wider policy, moral, economic and political considerations underpinning international commercial law.
- It analyses and evaluates existing standards and practices, and suggests proposals for reform.
- It encourages readers to make informed judgments regarding the interpretation of relevant legal standards and to make predictions about how the law is likely to develop.

At Sunny Bay: building students` repertoire of literacy practices through process drama

This collection of resources provides classroom examples and case studies, offers a platform of ideas for teachers to investigate new ways of building the literacy development of their students.

Moving beyond mateship:reconstructing Australian men's practices

In this chapter I will explore the implications of the definitively Australian
style of masculine behaviour called 'mateship' for gender relations in
Australia. Mateship is part of the Australian male heritage; it originated in
colonial days and was glorified in war and sport. The feminist movement
in Australia has challenged the dominant form of masculinity inherent in
mateship and the basic rationale for gender relations that flow from it. In
this context, I will discuss Australian profeminist men's attempts to challenge patriarchal gender relations and construct non-patriarchal subjectivities and practices. Theorizing about masculinity in Australia has tended to be derivative of overseas literature. This is partly because publishers are looking for overseas markets for their books so they discourage writers on masculinity from grounding men's practices in a specifically Australian context. While there are benefits in generalizing about western masculinities, such writing misses the uniqueness of the lived experiences of Australian men. It is this uniqueness that I will address in this chapter. As McGrane and Patience (1995: 15) note, 'Australian masculinism has a history of its own that needs to be recognized at the same time as it can be usefully compared to the masculinisms of similar cultures'.

Influences of spatial practices on pressure ulcer management in the context of spinal cord injury

Nursing practice is significantly influenced by the type and use of space in which nursing is practised. While investigating current patterns of service delivery for the management of pressure ulcers from the perspective of people with spinal cord injuries and their families, the space in which care was delivered was identified as a central determinant of care. Qualitative methods were used to investigate consumer perspectives among patients residing in both metropolitan and rural communities who had been hospitalized for the management of pressure ulcers. Issues related to the spatial practices of the hospital are discussed, demonstrating a link between well-being and the creation of an appropriate caring milieu. It is concluded that service could be improved markedly if health-care professionals placed more consideration on the impact of space on their service delivery.

School health policies and practices in Victoria- a comparison involving socio-economic status

Issue addressed: Health programs have been part of the responsibility of Victorian school education for 90 years. Yet rarely have there been studies to identify what is happening in school health promotion, or what the differences between schools might be, particularly in relation to the socioeconomic status of the school community and whether the school is in a metropolitan or regional area. Methods: In 1997 all Victorian schools (primary and secondary) in the State, Catholic and Independent systems were sent questionnaires in order to promote broader awareness about health promotion, and to identify what health programs, policies and activities the schools believed existed within their school community. A response rate of 43% was achieved, and results were collated under the six domains of the Health Promoting School model as outlined by the Western Pacific Regional Office of the World Health Organisation. Data analysed in this paper compared highest versus lowest quartiles for socioeconomic status (SES), and schools in metropolitan Melbourne versus regional areas. Results: Most differences between schools based on socioeconomic status occurred in secondary schools and were related mainly to environmental policies and practices, use of back packs, the presence of safety policies, involvement of parents in school activities and the provision of services for mental and social health needs. All differences were in favour of the highest SES quartile schools. Environmental policies and procedures, and school-based health and welfare services were present more often in metropolitan schools than in regional and rural schools. Conclusion: Although there were notable differences between schools, the audit results pointed to more similarities than differences between schools in the highest and lowest SES quartiles for health-related policies and practices; there were even fewer differences between metropolitan and non-metropolitan schools. So what: Regardless of the actual advantages and disadvantages schools experience with respect to location or socioeconomic status, it is important to understand that school staff perceive that they can and do have reasonably comprehensive health policies, procedures and practices to address health issues. Nevertheless, clear differences between schools did emerge in certain health areas and findings will assist policy making and the allocation of limited resources.

The desirability of criminal penalties for breaches of part IV of the trade practices act

Following the introduction of criminal sanction, including jail terms, for hard core cartelisation in the United Kingdom, the Dawson Review has recently recommended that criminal penalties be introduced in Australia for individuals and corporations found to have engaged in hard core cartels. A number of reasons have been advanced to justify the introduction of criminal sanctions for this type of conduct, the most common of which are that it would bring Australia in line with other competition regimes and that criminal sanctions are more likely to provide an effective deterrent. This article evaluates those reasons, and others, to determine whether there is any adequate justification for the proposed criminal regime.

Players, clubs, events and the Trade Practices Act : a primer for sporting clubs

The Trade Practices Act (TPA) has had an enormous impact on how corporations in Australia may conduct their business. In relation to sporting clubs, it limits the freedom of clubs to deal with players, each other and the public. While previously many clubs may have escaped the ambit of the TPA because they were not “corporations”, state equivalent Fair Trading legislation and the introduction of the national competition policy in 1995 have effectively expanded the scope of consumer and competition regulation to include individuals and associations. Consequently, an understanding of the nature and scope of trade practices regulation is now important for any sporting organisation—regardless of size or structure. This paper identifies the legislative provisions most likely to impact upon sporting clubs and examines some possible circumstances in which clubs might find themselves exposed to liability.

The relationship between TQM practices, quality performance, and innovation performance: An empirical examination

This empirical study examines the relationship between total quality management (TQM) and innovation performance and compares the nature of this relationship against quality performance. The empirical data were obtained from a survey of 194 managers in Australian industry encompassing both manufacturing and non-manufacturing sectors.