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      Readiness of primary care centres for a community-based intervention to prevent and control noncommunicable diseases in the Caribbean: A participatory, mixed-methods study

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          Abstract

          Introduction

          Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention.

          Methods

          Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers.

          Results

          Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs.

          Conclusion

          Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.

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          Most cited references29

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          THE INVERSE CARE LAW

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            What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers

            Objective To synthesize current understanding of how community-based health worker (CHW) programs can best be designed and operated in health systems. Methods We searched 11 databases for review articles published between 1 January 2005 and 15 June 2017. Review articles on CHWs, defined as non-professional paid or volunteer health workers based in communities, with less than 2 years of training, were included. We assessed the methodological quality of the reviews according to AMSTAR criteria, and we report our findings based on PRISMA standards. Findings We identified 122 reviews (75 systematic reviews, of which 34 are meta-analyses, and 47 non-systematic reviews). Eighty-three of the included reviews were from low- and middle-income countries, 29 were from high-income countries, and 10 were global. CHW programs included in these reviews are diverse in interventions provided, selection and training of CHWs, supervision, remuneration, and integration into the health system. Features that enable positive CHW program outcomes include community embeddedness (whereby community members have a sense of ownership of the program and positive relationships with the CHW), supportive supervision, continuous education, and adequate logistical support and supplies. Effective integration of CHW programs into health systems can bolster program sustainability and credibility, clarify CHW roles, and foster collaboration between CHWs and higher-level health system actors. We found gaps in the review evidence, including on the rights and needs of CHWs, on effective approaches to training and supervision, on CHWs as community change agents, and on the influence of health system decentralization, social accountability, and governance. Conclusion Evidence concerning CHW program effectiveness can help policymakers identify a range of options to consider. However, this evidence needs to be contextualized and adapted in different contexts to inform policy and practice. Advancing the evidence base with context-specific elements will be vital to helping these programs achieve their full potential. Electronic supplementary material The online version of this article (10.1186/s12960-018-0304-x) contains supplementary material, which is available to authorized users.
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              An introduction to concept mapping as a participatory public health research method.

              In this article, the authors introduce concept mapping as a useful participatory research method for public health researchers interested in generating hypotheses and developing theory. The authors first provide an overview of concept mapping, which combines qualitative approaches with quantitative analytical tools to produce visual displays of the relationship between ideas. Then, they present an illustrative research application of the method to the exploration of women's perceptions of the relationship between residential neighborhood factors and intimate partner violence experiences. They give attention to the data collection and analysis procedures and to demonstrating the intricacies of using concept mapping for public health research purposes. Finally, the article concludes with a discussion of the unique contributions and challenges associated with concept mapping.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Investigation
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 April 2024
                2024
                : 19
                : 4
                : e0301503
                Affiliations
                [1 ] College of Medical Sciences, University of Guyana, Georgetown, Guyana
                [2 ] Faculty of Natural Sciences, University of Guyana, Georgetown, Guyana
                [3 ] School of Medicine, Ross University, Roseau, Dominica
                [4 ] School of Life Course and Population Sciences, King’s College London, London, United Kingdom
                [5 ] Institute of Health Science Education, Georgetown Public Hospital Corporation, Georgetown, Guyana
                [6 ] Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
                [7 ] IQVIA, London, United Kingdom
                [8 ] University of Essex, Essex, United Kingdom
                National Institute of Mental Health and Neurosciences: National Institute of Mental Health and Neuro Sciences, INDIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-2353-430X
                https://orcid.org/0000-0002-3717-9222
                https://orcid.org/0000-0002-7691-9174
                https://orcid.org/0000-0003-1923-8644
                https://orcid.org/0000-0003-0926-219X
                Article
                PONE-D-22-23088
                10.1371/journal.pone.0301503
                11057736
                38683831
                a64531b4-78c3-4e95-80e8-16a3ead65546
                © 2024 Gobin et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 August 2022
                : 15 March 2024
                Page count
                Figures: 4, Tables: 2, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: MR/N015959/1, MR/S003444/1, MR/Y009983/1, MR/X009777/1 and MR/X003078/1
                Award Recipient :
                This work is being funded by the Medical Research Council, grant references MR/N015959/1, MR/S003444/1, MR/Y009983/1, MR/X009777/1 and MR/X003078/1, awarded to SH. https://www.ukri.org/councils/mrc/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                People and places
                Geographical locations
                North America
                Caribbean
                Jamaica
                People and places
                Geographical locations
                South America
                Guyana
                Medicine and Health Sciences
                Health Care
                Communication in Health Care
                Medicine and Health Sciences
                Health Care
                Primary Care
                Medicine and Health Sciences
                Health Care
                Health Services Administration and Management
                Medicine and Health Sciences
                Medical Conditions
                Noncommunicable Diseases
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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                Uncategorized

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