This practice paper describes our experience of implementing accredited social health activists (ASHA) Kirana, a digital technology-enabled Maternal Clinical Assessment Tool (M-CAT) and how the ASHAs felt empowered in the process. M-CAT aimed to train ASHAs to collect data that assists doctors in identifying maternal risks, in Karnataka, India. Systematic clinical assessment is not common in rural public health institutions. High caseloads, a tendency to ‘normalise’ maternal risks, varied competence of doctors and task shifting to insufficiently trained cadres may be some contributing factors. M-CAT was a response to this challenge. ASHAs asked a set symptom-cluster-based questions during home visits that were analysed by software algorithms to generate reports for doctors. M-CAT was implemented in one primary health centre with a group of 14 ASHAs, 2 auxiliary nurse midwives and 349 pregnant and postpartum women over 4 months. Our team worked with the ASHAs to refine the tool and supported them with training, hands-on assistance and regular debrief meetings. By learning how to collect individual-level data that they could interpret and act on, the ASHAs felt empowered with new knowledge on maternal risks. Their perfunctory data collection at home visits changed to substantive interactions with women and families, during which they captured pertinent qualitative information. The information asymmetry between doctors and ASHAs reduced. ASHAs started taking proactive steps on early indications of maternal risks. They changed from being mere transmitters of information to active users of it. Thus, technology-driven initiatives that include empowerment as an objective can strengthen the role of front-line workers in health systems.
In the twenty-first century, the rise of social media and social networking websites dramatically altered the communication environment. Web 2.0 social media is an effective tool for locating and targeting customers, engaging them with companies, and leaving a lasting impression on their minds. According to the findings, marketing and campaigning professionals have used Ephemeral content to build relationships with trendy communities, engage customers, increase sales, communicate offers and limited-time deals, and stay connected with a large audience by monetising "moment marketing" at times. Finally, this study reveals that users' goals increase gratification and improve engagement with ephemeral information on social media. It also suggests that the desire for closure can mitigate the impact of gratification on ephemeral content engagement. The Fear of Missing Out, as well as additional features such as an individual's interests and the immediacy of action taking in that precise time, are the most significant elements that keep the audience hooked on such Ephemeral Content. Ephemeral Content is on the rise, and it's a great way for companies to cash in on platform capabilities in a new and creative way.
The process of adapting universal guidelines to local institutional and cultural settings is recognized as important to their implementation and uptake. However, clarity on what, why and how to adapt in an evidence-based manner is still somewhat elusive. Health providers in low and middle income country contexts often have to deal with widely present co-morbidities and social inequalities among pregnant women. Since neither of these problems finds adequate discussion within the usual guidelines, and given the continual pressures posed by resource scarcity, health providers respond through ad hoc adaptations inimical to maternal safety and equity. We argue for, and describe, a grounded process of systematic adaptation of available guidelines through the example of a handbook on maternal risks for primary care doctors and staff nurses. The systematic adaptation in this practical, action-oriented handbook builds on research for a long-standing community-based project on maternal safety and rights. It takes a case-based problem-solving approach. Reiterating guidelines and best practices in diagnostic decision-making and risk management, it indicates how these can respond to co-morbidities and social inequality via complex clinical cases and new social science information.KEY WORDS: Maternal health; best practices; guidelines; co-morbidity; social inequality; capacity building La traduction du résumé se trouve à la fin de l'article.
BackgroundIn disadvantaged regions, risks like anaemia and pregnancy-induced hypertension contribute majorly to obstetric emergencies. Yet, verbal autopsies conducted as part the Gender and Health Equity Project – an action research initiative aimed at improving functioning of the public health system in northern Karnataka with a particular focus on maternal mortality – indicate that doctors and staff nurses engaged in provision of antenatal and intrapartum care often fail to identify and/or manage these risks. The project also found that prevailing training programmes for skilled birth attendants are altogether weak.In order to support better obstetric practice in disadvantaged regions, the project assessed the quality of diagnostic decision-making in obstetrics and used this evidence to make strategic decisions about the structure and content of a capacity building tool.MethodsStudy respondents included all the doctors (n=72) and select staff nurses (n=48) from primary health centres and community health centres across Koppal district in Karnataka. Respondents were presented case vignettes depicting: (1) pregnancy-induced hypertension; (2) anaemia; (3) postpartum haemorrhage; (4) cortical venous thrombosis; and (5) normal labour. Respondents were encouraged to discuss in-depth each of the cases and elicit additional clinical information from the interviewer to diagnose these cases.A medical doctor and a public health researcher analysed the processes and gaps in diagnostic decision-making from the interview transcripts. Their thematic analysis informed the development of a handbook for doctors and staff nurses.FindingsRegarding evidence on provider competence, we found that the concept of ‘risk’ in obstetrics was poorly understood. Doctors and staff nurses were often inaccurate or incomplete in their diagnoses. Moreover, their process of gathering clinical evidence was unsystematic. Doctors and staff nurses often failed to elicit all of the necessary information to support their diagnoses. By focusing on just one symptom, one sign or one test result, they often failed to account for overall clinical presentation of risk. They responded to the case vignettes with either a ‘checklist approach’ (one that does not establish logical connections between symptoms, signs and test results) or a ‘textbook approach’ (one that considers only typical symptoms). Moreover, they rarely considered the severity of risk.Translating this evidence to support better practice, the handbook – focusing on 15 obstetric and 12 co-morbid risk conditions – engaged with two ideas: (1) women in disadvantaged regions can have co-existing risks; and (2) behavioural responses to symptoms of risk in unhealthy populations can complicate everyday obstetric practice.Our approach to risk identification and assessment was tactile and practical, in tune with the doctors' and staff nurses' bent of mind. Beginning with a systematic clinical evaluation, we enumerated all of the risk indicators (symptoms, signs and test results) that would be elicited thro...
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