Implementation of clinical guidelines on diabetes and hypertension in urban Mongolia: a qualitative study of primary care providers' perspectives and experiences

BACKGROUND: Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting.

METHODS: A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n = 10) and practice managers (n = 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework.

RESULTS: The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants' commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased workload and long waiting times, time constraints, difficulties with conflicting tasks and low patient health literacy.

CONCLUSIONS: This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low resource primary care settings. It also offers some key lessons that might be carefully considered when other evidence-based clinical guidelines are to be put into effect in low resource settings and elsewhere.

Reflections on teaching and learning online: quality program design, delivery and support issues from a cross-global perspective

This reflective paper began with a discussion of the online program design and delivery experiences of three senior faculty members at the University of Calgary (Canada) and Deakin University (Australia), which was recorded at Deakin University. After drawing on this recording in their research and practice, one faculty member from each institution decided to review and expanded upon their intervening experiences in terms of issues of quality program design, delivery, and support issues when teaching, and learning in different cultural contexts. The authors discovered that these issues are as important today as they were when they met to record the interview, and have concluded their discussion here with thoughts about the teaching, student, and administrative supports that institutions engaged in online program delivery cross-culturally must address in order to successfully deliver quality online programs worldwide.

Alternative approaches to education: Tolstoy’s thinking on teaching and learning and its relevance for today

In this article I reflect upon the educational writings and teaching experiences of the 19th-Century Russian novelist Leo Tolstoy. Tolstoy is known to have attached much importance to his own writing on education, even more than to the literary creations for which he is best remembered. His writings on education have much to contribute to our present-day understanding of the learning process and cover such issues as, ‘learner autonomy’, ‘motivation’, ‘relationship’ and ‘student voice’. Tolstoy’s teaching experience was with multiethnic peasant children in his schools in Yasnaya Polyana. I intend to illustrate that the themes and issues that arose from his experiences in the 1860s can still find resonance with students and teachers in the 21st century.

Workshop and Symposium on Sustainable Small-scale Fisheries: Towards FAO Guidelines on Marine and Inland Small-scale Fisheries, 19-21 September, 2011, Kolkata, West Bengal, India

The workshop and symposium titled Sustainable Small-scale Fisheries: Towards FAO Guidelines on Marine and Inland Small-scale Fisheries was jointly organized by the National Fishworkers’ Forum (NFF) and the Society for Direct Initiative for Social and Health Action (DISHA), in collaboration with the International Collective in Support of Fishworkers (ICSF). The workshop was the first in a series of consultations around the world organized to discuss the Voluntary Guidelines on Small-scale Fisheries (VGSSF) and propose measures, keeping in mind the interests and concerns of small-scale fisheries and fishing communities. The workshop was also a forum to make the role of small-scale fisheries and fishworkers more visible in the context of food security, poverty alleviation and sustainable use of fishery resources. The workshop had 62 participants from both the marine and inland sectors, representing 10 States of India. The participants included fishworkers, representatives of fishworker organizations, policymakers and representatives of multilateral organizations. The workshop was structured to facilitate active interaction and discussion among participants, taking into account linguistic diversity and the contextual differences of the marine and inland sectors. This publication will be useful for fishworkers, fishworker organizations, researchers, policymakers, fish farmers, members of civil society and anyone interested in small-scale fisheries and livelihoods.

Higher education, professionalism and skills in the built environment: the impact of the new urban agenda on teaching and learning

In the mid-to-late 1990s, the New Urban Agenda initiated a rethinking of urban development strategies placing a greater focus on regeneration of central urban spaces. The skills and competencies required by urban planners and built environment professionals to successfully implement regeneration schemes tend to differ from those required for greenfield development. The working paper summarises skills and competencies required by urban regeneration practitioners and how they are delivered through public and/or private sector providers at present. The role of the newly established regional Centres of Excellence and the professional bodies of the Built Environment professions in defining skills and educational requirements and providing training are explored. An analysis of supply and demand of skills training reveals that there is a mismatch rather than a lack of provision. The report draws on a conference where research findings were presented and discussed. It concludes with suggestions for improving the skills provision at the local government as well as community level. Skills audits were found useful tools in defining training needs. A set of sample workshop programmes outline flexible, tailor-made approaches guaranteed to address specific and identified needs.

Teachers' perceptions of effects of terminal examinations on teaching and learning at the secondary school level in Zimbabwe

This study was particularly aimed at the examinations and the effect they have on schooling at the secondary school level in Zimbabwe. The views and opinions of teachers on the use of terminal examinations for certification and the influence they are seen to have on teachers' approach to the curriculum were examined. The literature has shown that there is widespread criticism of the justice and effects of terminal examinations. It is argued that they lead to an over-emphasis of that which is measured, knowledge and intellectual ability, at the expense of that kind of education progress which is almost impossible to measure in an end-of-the-course assessment. Three hundred and six secondary school teachers responded to a survey which asked for teachers' perceptions of examinations and the curriculum. The findings of this study indicated that teaching is structured towards examinations. Although teachers are trying to teach and develop reasoning skills and other activities, the pressure of examinations and the importance of doing well in them force teachers to restrict themselves to examination requirements.

The impact of information and communications technology on teaching and design of flexible, online and distance education courses at Deakin University

This paper describes the use of an online learning environment which has been established for postgraduate students studying at Master’s level in Professional Education and Training Deakin University. A detailed evaluation of the use of computer conferences in an Open and Distance Education specialism was undertaken during 2000 as part of a CUTSD funded project, Learner Centred Evaluation of Computer Facilitated Learning Projects in Higher Education. As the Open and Distance Education specialism is being revised and new units are written, the information gathered in this evaluation is being integrated into the pedagogical planning and the technological decisions being made about the design of the new master’s program.
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EAU guidelines on assessment and nonsurgical management of urinary incontinence

The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology.

Beyond the numbers of maternal near-miss in Rwanda - a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy.

BACKGROUND: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. METHODS: A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. RESULTS: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. CONCLUSION: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.