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Elizabeth Rhodes

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article / 3d ago

Our Approach - OpenResearch

Elizabeth Rhodes Research Director. "The future is built, not just imagined—and building it well starts with asking better questions today. We see the ...

article / 3d ago

About Us - OpenResearch

Sam Altman. Board Member. OpenResearch · Chris Clark. Board Member; Chief Operating Officer. OpenResearch · Elizabeth Rhodes. Board Member; Research Director.

paper / 3d ago

Primary healthcare system readiness for the prevention and management of non-communicable diseases in Nepal: a mixed-methods study

Background: Non-communicable diseases (NCDs) contribute to two-thirds of Nepal’s total deaths. In 2016, Nepal adopted the World Health Organization’s Package of Essential Non-Communicable Disease Interventions (WHO-PEN) to curb the growing burden of non-communicable diseases (NCDs). This study evaluated the primary healthcare system’s readiness for the prevention and management of non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), diabetes mellitus (DM), and chronic respiratory diseases (CRDs), and investigated factors associated with NCD-specific service readiness. Methodology: We employed a convergent parallel mixed-methods study design. We adapted the WHO Service Availability and Readiness Assessment (SARA) tool and assessed 105 primary healthcare facilities, which were selected using a multistage stratified random sampling approach. We performed a weighted descriptive analysis and fitted survey-weighted multivariable linear regression to identify factors associated with NCD-specific service readiness. Simultaneously, we conducted 23 key informant interviews with health authorities and 47 in-depth interviews with health service providers involved in the PEN implementation. All interviews were audio recorded, transcribed verbatim, and analyzed using a thematic approach. Results: The overall NCD service readiness score for primary healthcare facilities was highest for CVDs at 48.4 (95% CI: 43.2–53.6), followed by DM at 40.8 (95% CI: 34.5–47.2), and CRDs at 34.8 (95% CI: 29.2–40.5). Primary Healthcare Centers (PHCCs) had higher NCD service readiness than health posts. In regression analysis, we found that primary healthcare facilities located in hilly regions and imposing user fees for some NCD services had significantly higher NCD-specific service readiness compared to those in the mountainous areas and those not imposing user fees, respectively. Qualitative findings revealed that higher NCD service readiness in PHCCs and certain regions was due to better infrastructure, training opportunities, accessibility to medicines and equipment, and social health insurance schemes. High staff turnover and limited supply of NCD drugs and equipment hindered NCD service delivery, particularly in health posts and remote regions. Conclusion: Primary healthcare facilities in Nepal lack equipment, medicines, trained staff, and guidelines for NCD management. The government of Nepal could enhance NCD-specific service readiness by equipping health service providers with medical supplies and building their capacity through regular PEN training and peer coaching sessions.

paper / 3d ago

Factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 in primary healthcare settings in Nepal: a cross-sectional study

Objective To assess factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 at primary healthcare (PHC) facilities in Nepal after healthcare workers received training. Design Cross-sectional study. Setting PHC facilities across various provinces in Nepal. Participants A total of 180 healthcare workers trained in PEN, recruited from a random selection of 105 basic healthcare facilities. Main outcome measures The adoption of PEN Protocol 1 components: blood pressure measurement, blood glucose screening, 10-year cardiovascular disease (CVD) risk assessment using WHO/International Society of Hypertension risk charts and body mass index (BMI) assessment. Factors associated with protocol adoption were assessed using generalised estimating equations for ORs. Results Among participants, 100% reported measuring blood pressure, while 56% measured blood sugar, 28% assessed CVD risk and 27% assessed BMI. The adoption of the CVD risk prediction chart was positively associated with the availability of amlodipine (adjusted OR (aOR) 3.00; 95% CI 1.09 to 8.27). The adoption of BMI assessment was positively associated with access to a stadiometer (aOR 3.23; 95% CI 1.26 to 8.30) and a glucometer (aOR 3.07; 95% CI 1.12 to 8.40), and negatively associated with lack of motivation/inertia of previous practice (aOR 0.60; 95% CI 0.42 to 0.87) and environmental factors such as lack of time and resources (aOR 0.57; 95% CI 0.37 to 0.89). Blood glucose level measurements were positively associated with being at a PHC centre (aOR 7.34; 95% CI 2.79 to 19.3) and the availability of metformin (OR 2.40; 95% CI 1.08 to 5.29). Conclusion Adoption of PEN Protocol 1 varied by component and was influenced by resource availability, provider motivation and system barriers. Addressing these factors is key to optimising implementation in low-resource settings.

paper / 3d ago

Barriers and facilitators to patient utilization of noncommunicable disease services in primary healthcare facilities in Nepal: a qualitative study

The Nepalese government endorsed and implemented the Package of Essential Non-Communicable Disease Interventions (PEN) by the World Health Organization (WHO) to prevent and manage four major non-communicable diseases (NCDs): cardiovascular disease (CVD), diabetes, cancers, and chronic respiratory diseases. This study explored barriers and facilitators to patient utilization of NCD services at primary healthcare facilities in Nepal. We conducted a qualitative study with a 35 purposive sample of patients living with one or more NCDs (hypertension, diabetes, chronic obstructive pulmonary disease (COPD/ asthma) who sought healthcare at primary healthcare facilities in 14 randomly selected districts in seven provinces in Nepal that implemented PEN. Trained qualitative researchers conducted in-depth interviews in person in a private setting using a semi-structured interview guide developed based on the Health Belief Model in the local language. The interviews were audio-recorded, transcribed verbatim, coded inductively and deductively, and analyzed by a framework approach using Dedoose software. From the perspectives of patients, key facilitators of service utilization encompassed free medicines, low-cost services, geographical and financial accessibility, less waiting time, positive interactions with health service providers, experiencing improvements in their health conditions, and support from family and peers. Barriers to utilizing services included inadequate health services (e.g., lack of medications and equipment), inaccessibility and affordability, inadequate health-related information from health service providers, low knowledge of NCD care, and lack of reminders or follow-ups. Enhancing NCD service utilization is potentially attainable through interventions that address patients’ knowledge, self-motivation, and misconceptions. Furthermore, strengthening the availability and accessibility of crucial services such as laboratory investigations, medications, equipment, and the patient-provider relationship is crucial for the sustainable implementation of PEN.