Conference Material > Slide Presentation
Sadique S, Beversluis D, Caleo GNC, Carter W, Chowdhury SM, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/5qd0-yj04
Conference Material > Abstract
Sadique S, Beversluis D, Caleo GNC, Carter W, Chowdhury SM, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/bzht-7p36
INTRODUCTION
Addressing occupational injury and disease has been declared a national priority in Bangladesh. However critical gaps remain in improving work safety in small-scale peri-urban factories. We aimed to assess the feasibility of collaborating with owners and workers to design and implement interventions to improve work safety in two metal factories in Kamrangirchar, Dhaka.
METHODS
We implemented a participatory mixed methods before-and-after study with four phases. Phase 1 explored the dynamics of injuries, hazards, and risks using hazard assessments, surveillance, in-depth interviews, and focus group discussions. Triangulation of phase 1 findings informed design and implementation of intervention packages implemented in phase 2. In phases 3 and 4, we repeated hazard assessments and used qualitative methods to document changes in hazards and perspectives at 6- and 12-months post-intervention. Observations captured by field notes complemented data generated throughout the study.
ETHICS
The study was approved by the MSF Ethical Review Board (ERB) and by the ERB of the Centre for Injury Prevention and Research, Bangladesh.
RESULTS
Overall 136 workers in two factories (A and B) participated in the study (with a turnover of 41.5%). Surveillance captured 129 injuries during phase 1 (from 10th March 2019 in factory A and 30th April 2019 in factory B, to 31st July 2019), and all workers aged under 18 years experienced incidents. Hazard assessments documented hazard risk scores (HRS) of 54% in factory A and 36% in factory B. Qualitative data indicated workers perceived their work as risky, but explained it was prioritised over their health due to financial necessity. Phase 2 intervention packages included engineering controls, personal protective equipment, infrastructure safety and training. Factory owners and workers actively participated in design and implementation. Phase 3 showed a two-fold reduction in HRS in factory A (24%) and a 1.5-fold reduction (21%) in factory B. Phase 4 hazard assessment revealed that improvement was sustained in one factory; the final HRS was 27% in factory A, but returned to the pre-intervention score of 36% in factory B. Workers explained they observed improvements in workplace safety but noted challenges in sustainability due to owner commitment and worker turnover. Observation and qualitative data revealed complex power dynamics in the factories, as well as power imbalances and risks faced by female and young workers.
CONCLUSION
It was feasible to collaborate with workers and owners to implement interventions aimed at improving work safety. However, sustainability was mixed, and long-standing structural inequities that contribute to poor safety remain. Findings indicate urgent action is needed to improve safety and build an inclusive model of occupational health, including social and protection components, with particular attention for female workers and workers aged under 18.
CONFLICTS OF INTEREST
None declared
Addressing occupational injury and disease has been declared a national priority in Bangladesh. However critical gaps remain in improving work safety in small-scale peri-urban factories. We aimed to assess the feasibility of collaborating with owners and workers to design and implement interventions to improve work safety in two metal factories in Kamrangirchar, Dhaka.
METHODS
We implemented a participatory mixed methods before-and-after study with four phases. Phase 1 explored the dynamics of injuries, hazards, and risks using hazard assessments, surveillance, in-depth interviews, and focus group discussions. Triangulation of phase 1 findings informed design and implementation of intervention packages implemented in phase 2. In phases 3 and 4, we repeated hazard assessments and used qualitative methods to document changes in hazards and perspectives at 6- and 12-months post-intervention. Observations captured by field notes complemented data generated throughout the study.
ETHICS
The study was approved by the MSF Ethical Review Board (ERB) and by the ERB of the Centre for Injury Prevention and Research, Bangladesh.
RESULTS
Overall 136 workers in two factories (A and B) participated in the study (with a turnover of 41.5%). Surveillance captured 129 injuries during phase 1 (from 10th March 2019 in factory A and 30th April 2019 in factory B, to 31st July 2019), and all workers aged under 18 years experienced incidents. Hazard assessments documented hazard risk scores (HRS) of 54% in factory A and 36% in factory B. Qualitative data indicated workers perceived their work as risky, but explained it was prioritised over their health due to financial necessity. Phase 2 intervention packages included engineering controls, personal protective equipment, infrastructure safety and training. Factory owners and workers actively participated in design and implementation. Phase 3 showed a two-fold reduction in HRS in factory A (24%) and a 1.5-fold reduction (21%) in factory B. Phase 4 hazard assessment revealed that improvement was sustained in one factory; the final HRS was 27% in factory A, but returned to the pre-intervention score of 36% in factory B. Workers explained they observed improvements in workplace safety but noted challenges in sustainability due to owner commitment and worker turnover. Observation and qualitative data revealed complex power dynamics in the factories, as well as power imbalances and risks faced by female and young workers.
CONCLUSION
It was feasible to collaborate with workers and owners to implement interventions aimed at improving work safety. However, sustainability was mixed, and long-standing structural inequities that contribute to poor safety remain. Findings indicate urgent action is needed to improve safety and build an inclusive model of occupational health, including social and protection components, with particular attention for female workers and workers aged under 18.
CONFLICTS OF INTEREST
None declared
Conference Material > Slide Presentation
Sadique S, Lin YD, Walker SA, Rao B, du Cros PAK, et al.
MSF Scientific Days International 2022. 10 May 2022; DOI:10.57740/54qw-5453
Conference Material > Abstract
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/b641-d608
INTRODUCTION
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Conference Material > Abstract
Sadique S, Lin YD, Walker SA, Rao B, du Cros PAK, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/s2se-8951
INTRODUCTION
The crowded conditions within camps for refugees and internally displaced people create risk environments for unmitigated transmission of SARS-CoV-2. Within one such setting, Cox’s Bazar, Bangladesh, MSF distributed face masks in July-August 2020 for use by people living in eight camps to reduce transmission risks. However, uptake of face masks within camp populations and the factors influencing use are not well understood.
METHODS
We conducted a multi-level triangulation mixed-methods study in March 2021 in Cox’s Bazar. Field observations were undertaken in public spaces in four camps, noting individuals’ facemask use (appropriate versus not), use of other types of face covering (e.g., headscarf), and gender. We also analysed photographs posted on Twitter during March 2021 that were geotagged in the Cox’s Bazar area, posted with a specific keyword, or posted by connected accounts and tweets. Photographs were also categorised by facemask/headscarf use and gender. Finally, we conducted 32 in-depth interviews to understand perceptions and barriers around mask use. Qualitative data were analysed thematically using NVivo.
ETHICS
This study was approved by the Office of the Civil Surgeon, Cox’s Bazar, Bangladesh and by the MSF Ethics Review Board.
RESULTS
We made 3,152 public observations. Only 190/3,152 (6%) were using a mask appropriately. Men were more likely to be seen using any visible standard facemask appropriately than women (odds ratio, OR, 1.5, 95% confidence interval 1.1-2.2, p-value 0.037). Most women were observed wearing headscarves that precluded observing if masks were worn underneath. The content of 20 tweets were analysed. One photograph showed one person wearing a mask correctly; in 17 photographs individuals wore no face covering and in 2 wore scarves. Qualitative data suggested participants were aware of the importance of mask use but highlighted several reasons for not wearing them, including the fear of being insulted for wearing a mask due to the association between mask use and having Covid-19; a view that they were unnecessary because there was little Covid-19 in the camps; experiences of physical difficulties or discomfort whilst wearing masks; and a belief that wearing facemasks was unnecessary because “life or death is up to Allah”. Participants highlighted the current shortage of masks in the camps as well as adverse consequences of insufficient masks, and requested further distribution.
CONCLUSION
These findings suggest low adherence to recommendations around mask use in this camp setting. Multiple strategies need to be considered, including better distribution strategies and improved messaging and engagement with religious and community leaders to increase facemask use in settings such as Cox’s Bazar.
CONFLICTS OF INTEREST
None declared.
The crowded conditions within camps for refugees and internally displaced people create risk environments for unmitigated transmission of SARS-CoV-2. Within one such setting, Cox’s Bazar, Bangladesh, MSF distributed face masks in July-August 2020 for use by people living in eight camps to reduce transmission risks. However, uptake of face masks within camp populations and the factors influencing use are not well understood.
METHODS
We conducted a multi-level triangulation mixed-methods study in March 2021 in Cox’s Bazar. Field observations were undertaken in public spaces in four camps, noting individuals’ facemask use (appropriate versus not), use of other types of face covering (e.g., headscarf), and gender. We also analysed photographs posted on Twitter during March 2021 that were geotagged in the Cox’s Bazar area, posted with a specific keyword, or posted by connected accounts and tweets. Photographs were also categorised by facemask/headscarf use and gender. Finally, we conducted 32 in-depth interviews to understand perceptions and barriers around mask use. Qualitative data were analysed thematically using NVivo.
ETHICS
This study was approved by the Office of the Civil Surgeon, Cox’s Bazar, Bangladesh and by the MSF Ethics Review Board.
RESULTS
We made 3,152 public observations. Only 190/3,152 (6%) were using a mask appropriately. Men were more likely to be seen using any visible standard facemask appropriately than women (odds ratio, OR, 1.5, 95% confidence interval 1.1-2.2, p-value 0.037). Most women were observed wearing headscarves that precluded observing if masks were worn underneath. The content of 20 tweets were analysed. One photograph showed one person wearing a mask correctly; in 17 photographs individuals wore no face covering and in 2 wore scarves. Qualitative data suggested participants were aware of the importance of mask use but highlighted several reasons for not wearing them, including the fear of being insulted for wearing a mask due to the association between mask use and having Covid-19; a view that they were unnecessary because there was little Covid-19 in the camps; experiences of physical difficulties or discomfort whilst wearing masks; and a belief that wearing facemasks was unnecessary because “life or death is up to Allah”. Participants highlighted the current shortage of masks in the camps as well as adverse consequences of insufficient masks, and requested further distribution.
CONCLUSION
These findings suggest low adherence to recommendations around mask use in this camp setting. Multiple strategies need to be considered, including better distribution strategies and improved messaging and engagement with religious and community leaders to increase facemask use in settings such as Cox’s Bazar.
CONFLICTS OF INTEREST
None declared.
Conference Material > Slide Presentation
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/pe41-5813
Journal Article > ResearchFull Text
Journal of the American Medical Association (JAMA). 2 August 2019; Volume 2 (Issue 8); DOI:10.1001/jamanetworkopen.2019.9118
Lenglet AD, van Deursen B, Viana R, Abubakar N, Hoare S, et al.
Journal of the American Medical Association (JAMA). 2 August 2019; Volume 2 (Issue 8); DOI:10.1001/jamanetworkopen.2019.9118
IMPORTANCE
Hand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings.
OBJECTIVE
To pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data.
DESIGN, SETTING, AND PARTICIPANTS
This prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018.
EXPOSURES
Multimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time.
MAIN OUTCOMES AND MEASURES
Hand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene.
RESULTS
A total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]).
CONCLUSIONS AND RELEVANCE
This study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.
Hand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings.
OBJECTIVE
To pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data.
DESIGN, SETTING, AND PARTICIPANTS
This prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018.
EXPOSURES
Multimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time.
MAIN OUTCOMES AND MEASURES
Hand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene.
RESULTS
A total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]).
CONCLUSIONS AND RELEVANCE
This study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.
Protocol > Research Protocol
Elston JWT, Snag S, Kazungu DS, Jimissa A, Caleo GNC, et al.
1 July 2018
To describe health seeking behaviour during pregnancy, for childbirth and in children under the age of five years, and to identify barriers to accessing and receiving healthcare services at the time of the study and since the start of the Ebola outbreak in an urban and rural area of Tonkolili District.
PRIMARY OBJECTIVES
1. To estimate utilisation of health facilities by women for childbirth in Magburaka town and Yoni chiefdom since the start of the Ebola outbreak ;
2. To estimate utilisation of healthcare services by children aged <5 years in Magburaka town and Yoni chiefdom during their most recent febrile illness within the three month period preceding the day of the survey.
3. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare during pregnancy and for childbirth
4. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare for febrile illness in children aged <5 years
PRIMARY OBJECTIVES
1. To estimate utilisation of health facilities by women for childbirth in Magburaka town and Yoni chiefdom since the start of the Ebola outbreak ;
2. To estimate utilisation of healthcare services by children aged <5 years in Magburaka town and Yoni chiefdom during their most recent febrile illness within the three month period preceding the day of the survey.
3. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare during pregnancy and for childbirth
4. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare for febrile illness in children aged <5 years
Journal Article > ResearchFull Text
Trials. 4 December 2021; Volume 22; 881 .; DOI:10.1186/s13063-021-05850-0
Wharton-Smith A, Horter SCB, Douch E, Gray NSB, James N, et al.
Trials. 4 December 2021; Volume 22; 881 .; DOI:10.1186/s13063-021-05850-0
BACKGROUND
Addressing the global burden of multidrug-resistant tuberculosis (MDR-TB) requires identification of shorter, less toxic treatment regimens. Médecins Sans Frontières (MSF) is currently conducting a phase II/III randomised controlled clinical trial, to find more effective, shorter and tolerable treatments for people with MDR-TB. Recruitment to the trial in Uzbekistan has been slower than expected; we aimed to study patient and health worker experiences of the trial, examining potential factors perceived to impede and facilitate trial recruitment, as well as general perceptions of clinical research in this context.
METHODS
We conducted a qualitative study using maximum variation, purposive sampling of participants. We carried out in-depth interviews (IDIs) and focus group discussions (FGDs) guided by semi-structured topic guides. In December 2019 and January 2020, 26 interviews were conducted with patients, Ministry of Health (MoH) and MSF staff and trial health workers, to explore challenges and barriers to patient recruitment as well as perceptions of the trial and research in general. Preliminary findings from the interviews informed three subsequent focus group discussions held with patients, nurses and counsellors. Focus groups adopted a person-centred design, brainstorming potential solutions to problems and barriers. Interviews and FGDs were audio recorded, translated and transcribed verbatim. Thematic analysis, drawing on constant comparison, was used to analyse the data.
RESULTS
Health system contexts may compete with new approaches especially when legislative health regulations or policy around treatment is ingrained in staff beliefs, perceptions and practice, which can undermine clinical trial recruitment. Trust plays a significant role in how patients engage with the trial. Decision-making processes are dynamic and associated with relationship to diagnosis, assimilation of information, previous knowledge or experience and influence of peers and close relations.
CONCLUSIONS
This qualitative analysis highlights ways in which insights developed together with patients and healthcare workers might inform approaches towards improved recruitment into trials, with the overall objective of delivering evidence for better treatments.
Addressing the global burden of multidrug-resistant tuberculosis (MDR-TB) requires identification of shorter, less toxic treatment regimens. Médecins Sans Frontières (MSF) is currently conducting a phase II/III randomised controlled clinical trial, to find more effective, shorter and tolerable treatments for people with MDR-TB. Recruitment to the trial in Uzbekistan has been slower than expected; we aimed to study patient and health worker experiences of the trial, examining potential factors perceived to impede and facilitate trial recruitment, as well as general perceptions of clinical research in this context.
METHODS
We conducted a qualitative study using maximum variation, purposive sampling of participants. We carried out in-depth interviews (IDIs) and focus group discussions (FGDs) guided by semi-structured topic guides. In December 2019 and January 2020, 26 interviews were conducted with patients, Ministry of Health (MoH) and MSF staff and trial health workers, to explore challenges and barriers to patient recruitment as well as perceptions of the trial and research in general. Preliminary findings from the interviews informed three subsequent focus group discussions held with patients, nurses and counsellors. Focus groups adopted a person-centred design, brainstorming potential solutions to problems and barriers. Interviews and FGDs were audio recorded, translated and transcribed verbatim. Thematic analysis, drawing on constant comparison, was used to analyse the data.
RESULTS
Health system contexts may compete with new approaches especially when legislative health regulations or policy around treatment is ingrained in staff beliefs, perceptions and practice, which can undermine clinical trial recruitment. Trust plays a significant role in how patients engage with the trial. Decision-making processes are dynamic and associated with relationship to diagnosis, assimilation of information, previous knowledge or experience and influence of peers and close relations.
CONCLUSIONS
This qualitative analysis highlights ways in which insights developed together with patients and healthcare workers might inform approaches towards improved recruitment into trials, with the overall objective of delivering evidence for better treatments.
Protocol > Research Protocol
Verputten M, Siddiqui R, Gray NSB, Casimir CF, Finaldi P, et al.
1 July 2018
2 Research question and objectives
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV