1,721,021 research outputs found
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Multimodal Implementation Research on Primary Health Care Services in sub-Saharan Africa: Implementation Outcomes, Service Readiness and Costs
No full textThesis (Ph.D.)--University of Washington, 2025Primary health Care (PHC) serves as the cornerstone for achieving universal health coverage (UHC), one of the health-related targets in the 2030 Sustainable Development Goals (SDGs). PHC facility managers play a key role in ensuring quality of care by overseeing daily operations, managing human resources, and effectively implementing national PHC guidelines. This dissertation reports findings on implementation outcomes, service readiness, and costs through multimodal implementation research on strategies to improve PHC services in sub-Saharan Africa (sSA). Two of the three research Aims (Aims 2 and 3) are embedded within a district-based implementation and dissemination program in central Mozambique's PHC settings, called the Integrated District Evidence-to-Action (IDEAs) program for neonatal mortality reduction, implemented from 2016 to 2020. IDEAs applied a system-level Audit and Feedback (A&F) strategy that included three core components: routine facility and district readiness assessments, district-level biannual health facility performance review meetings, and targeted facility support through supportive supervision to help health facilities implement their micro-interventions developed during the biannual meetings. There were nine cycles of IDEAs. For Aim 1, this study synthesized implementation strategies and outcomes of evidence-based management interventions for PHC managers in sSA through a systematic review. Nine case studies from six countries—Ethiopia (3 studies), South Africa (2), and one each from Botswana, Kenya, Tanzania, and Zambia—were identified. The interventions included evidence-based training programs, peer-to-peer learning, electronic systems for monitoring management practices, and supportive supervision. Common implementation strategies included training and education, coaching and mentoring, knowledge sharing through learning collaboratives, interactive and continuous learning, and A&F using routine data. Interventions were implemented using more than one strategy. Acceptability was a consistent positive implementation outcome reported, with management effectiveness improving in areas such as financial and resource management, organizational climate, and human resource management.
For Aim 2, we assessed effectiveness of management training and IDEAs intervention on improving basic obstetric and neonatal service readiness in PHC facilities. We found that IDEAs intervention's effectiveness in enhancing service availability was highest when health facility managers in the intervention sites had received management training, with an average increase of 11.1 points out of 100 per year (95% CI: 0.7 to 21.5, p=0.037), after adjusting for potential confounders. Hence, capacitated PHC managers were better able to optimize a system-level A&F strategy to improve PHC services, bundling management training with A&F strategies could enhance effectiveness.
For Aim 3, a mixed costing approach (gross and microcosting) was used to estimate the cost of implementing IDEAs. We found the total cost of the program across 12 districts over five years (2016-2020), discounted to 2020 US dollars was USD 495,323 (23.8%) allocated to capital costs and 36,693; A&F meetings made up 8,255 (22.5%), with vehicle purchase as the main cost driver; Targeted support were divided into two parts, district focused and facility supervision. The performance review meetings occurred biannually, each lasting five days, resulting in a total of 10 days per year per district. The average hours spent per year attending A&F meetings for the seven key positions from health facilities, district and province was 2320 hours (80 hours per person annually per district), while five district staff conducting supervision spent a total of 240 hours per year (60 hours per person annually per district). We were not able to estimate staff hours for routine data collection since it was contracted to local agencies. This study provides new insights into the cost of implementing iterative system-level A&F strategies in low-income settings.
As demonstrated in this dissertation, we applied a multimodal implementation research approach — using evidence synthesis to improve health system coordination and management, strengthen management capacity, and incorporate economic evaluation — helped identify pathways for the systematic integration of national PHC guidelines, offering insights for improving PHC services. The key takeaway is that while implementation research is valuable for improving healthcare systems, there is a significant knowledge gap regarding what works for PHC management in sub-Saharan Africa and the costs associated with implementing a system-level A&F strategy. This dissertation aims to spread knowledge about strengthening health systems to improve primary healthcare and achieve universal health coverage
Strengthening Respectful Maternal and Newborn Care: Advancing Measurement and Implementation Science Across Contexts
No full textThesis (Ph.D.)--University of Washington, 2025Respectful maternal and newborn care is an essential component of high-quality health services, yet women across diverse settings continue to report mistreatment, poor communication, and unmet expectations during childbirth. These concerns are especially pronounced in fragile and humanitarian contexts, where health system constraints can undermine both clinical quality and women’s experiences. Despite growing global emphasis on respectful care, validated measures that capture key aspects of women’s experiences remain limited, and little implementation science evidence exists for how respectful care can be operationalized globally, particularly in Middle Eastern health systems. This dissertation addresses these gaps through three studies: development and validation of mistreatment measures in the occupied Palestinian territory (oPt), validation of a multidimensional satisfaction with childbirth care scale using multi-country data from a World Health Organisation (WHO) study, and a qualitative study exploring health worker perspectives on implementing a labor companionship intervention in three Middle Eastern hospitals. The first study developed concise, domain-specific mistreatment scales using Item Response Theory (IRT) applied to survey data from 745 postpartum women in the occupied Palestinian territory (oPt). For each domain, a full item set (all items) and a brief item set (reduced subset) was evaluated to determine whether shorter item sets retained comparable psychometric properties. Physical abuse and stigma items were excluded as a result of less than 1% responses, while domains related to poor rapport, failure in professional standards of care, and health system conditions and constraints showed strong item discrimination and adequate model fit. Each of these domains produced a brief scale consisting of 3 to 4 mistreatment items, retaining strong psychometric performance. The brief scales performed comparably to the full item set of the community survey, and importantly, odds ratios for associations with dissatisfaction with care were similar for both full and brief scales. For example, poor rapport was associated with 2.8 times higher odds of dissatisfaction using the full item set and 2.7 times higher odds using the brief item set. Failures in professional standards demonstrated a similar pattern, with odds ratios of 2.3 for the full item set and 2.2 for the brief item set. These consistent effect sizes support the feasibility of integrating short, validated mistreatment measures into routine monitoring and accountability systems in constrained settings. The second study validated a satisfaction with childbirth scale using data from 2,672 postpartum women in Ghana, Guinea, Nigeria, and Myanmar. Exploratory and Confirmatory Factor Analyses confirmed a two-factor structure representing Interpersonal Satisfaction and Structural Satisfaction, with Cronbach’s alpha values of 0.82 and 0.71 respectively. Mistreatment exposures were strongly associated with dissatisfaction across both domains. Women who experienced any mistreatment had 1.5 times higher odds of structural dissatisfaction and 2.8 times higher odds of interpersonal dissatisfaction. Specific forms of women-reported mistreatment demonstrated notable associations with the satisfaction scales. Physical abuse increased the odds of dissatisfaction by 1.5 times for structural and 1.9 times for interpersonal experience. Verbal abuse increased the odds by 1.5 and 2.9 respectively. Denial of companionship produced odds ratios of 2.1 for structural dissatisfaction and 3.1 for interpersonal dissatisfaction. Women reporting lack of health worker responsiveness to their needs showed the strongest association, with 11.1 times higher odds of interpersonal dissatisfaction. These patterns provide strong criterion validity and demonstrate that the validated satisfaction scale can meaningfully differentiate women’s experiences across diverse health systems. The third study examined health worker perceptions of implementing a labor companionship model in tertiary hospitals in Egypt, Lebanon, and Syria using qualitative methods guided by the Consolidated Framework for Implementation Research (CFIR). This framework informed exploration of how individual, inner setting, outer setting, and process-level determinants shaped health worker experiences. Health workers described indicated that heavy workloads, overcrowded labor wards, limited staffing, and inconsistent facility policies were major barriers to providing respectful, person-centered care. Despite these challenges, health workers consistently recognized the value of labor companionship for improving communication, reducing anxiety, and enhancing women’s emotional support. Health workers emphasized the need for clearer guidance on lab, supportive supervision, adequate staffing, and training. These findings show that implementing respectful care is shaped by both individual motivation and structural conditions highlighting the importance of the multi-level strategies required for sustainable implementation in complex health system environments. Taken together, the three studies in this dissertation advance the measurement and implementation of respectful maternal and newborn care across diverse settings. The validated mistreatment and satisfaction scales provide robust, context-sensitive tools for monitoring women’s experiences, while the implementation findings identify actionable strategies to strengthen provider behavior, institutional accountability, and feasibility of implementing respectful care interventions. This body of work offers an integrated, evidence-based framework for promoting dignity, equity, and person-centered maternity care across contexts
Self-efficacy and knowledge of Anti-Retroviral Therapy among a cohort of HIV-positive pregnant women in Option B+ from central Mozambique
No full textThesis (Master's)--University of Washington, 2017-06Objective: We assessed patient readiness for medication usage through knowledge of ART concepts and self-efficacy among pregnant HIV-infected patients in antenatal care as part of the Option B+ program in central Mozambique. Methods: Data were collected via in-person interviews conducted by facility nurses during enrollment visits in antenatal care. Study participants were categorized based on timing of first HIV diagnosis (prior to attending antenatal care, at antenatal care prior to study enrolment, or at antenatal care the day of study enrolment). Associations were described between timing of HIV diagnosis and socioeconomic characteristics, clinical characteristics, knowledge of ART concepts, and self-efficacy, accounting for facility level clustering. Knowledge and self-efficacy were categorized as high/low based on responses to questionnaires. Design: A cross-sectional analysis was carried out using baseline data from a cohort of HIV-infected pregnant women attending antenatal care at 10 public sector health facilities in Sofala Province, Mozambique. Results: Of 1,573 patients enrolled, 738 (47%) were first diagnosed with HIV upon study entry during their current pregnancy, 504 (32%) prior to study enrollment during their current pregnancy, and 331 (21%) prior to their current pregnancy. Women who were first diagnosed prior to enrollment, whether during current pregnancy (OR 0.31, 95% CI 0.21, 1.01) or prior to current pregnancy (0.22, 95% CI 0.13, 0.35) were less likely to have low ART knowledge. Additionally, those first diagnosed prior to enrollment, both during (OR 0.64, 95% CI 0.36, 1.12), and before their current pregnancy (OR 0.49, 95% CI 0.24, 0.97), were less likely to have low self-efficacy compared with those diagnosed on the day of study entry. Conclusions: We found that among study participants, women who were enrolled on the day of first HIV diagnosis and ART initiation were more likely to have low knowledge of ART concepts and low self-efficacy than women with a previous HIV diagnosis. These findings may provide an opportunity to identify women at high risk for loss to follow up and or low treatment adherence to achieve the recommended lifelong ART care under the Option B+ delivery model
Priority setting for achieving Universal Health Coverage in Nigeria: A Spatial and Temporal Analysis and Cost-Benefit Analysis
No full textThesis (Ph.D.)--University of Washington, 2023Universal Health Coverage (UHC) is an urgent global priority outlined in the Sustainable Development Goals (SDGs) to ensure the accessibility of health services for all people without causing financial hardship. If current progress continues to 2030, 37% to 61% of the global population will not be covered by essential health services.1 Therefore, we need to accelerate the increase of service coverage to achieve the UHC target by 2030. There are three specific aims of this dissertation; 1) To identify both individual and contextual factors that are consistently associated with utilization of nine essential maternal and child health services (i.e., ANC, facility-based delivery, modern contraceptive use, immunizations, and childhood illnesses), across survey years and household geolocations, using five national representative cross-sectional surveys in Nigeria; 2) To estimate grid-level coverage of selected essential MCH services in Nigeria using generalized additive models (GAMs) and Gradient Boosting (GB) 3) To estimate required costs and avoidable child deaths by increasing selected essential health service coverage in each community, and to identify the priority sub-national areas. This dissertation emphasizes the importance of multi-dimensional priority setting in achieving Universal Health Coverage in Nigeria. By identifying the factors influencing health service utilization, assessing regional disparities, estimating required costs, and quantifying potential impacts, policymakers can make evidence-based decisions to maximize the efficiency and effectiveness of healthcare interventions. The findings and recommendations of this research contribute to the broader global agenda of achieving UHC and improving health outcomes for all populations, particularly in low- and middle-income countries
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
The role of health systems strengthening and HIV in under-five mortality trends: time series analyses from 2000 to 2010 in Mozambique
No full textThesis (Master's)--University of Washington, 2013Globally, the number of deaths of children under 5 (U5) decreased substantially from 12 million in 1990 to about 6.9 million in 2011; during the same period under five mortality (U5M) decreased steadily in Mozambique as a result of the implementation of several interventions. This study aimed to determine the role of health systems strengthening and HIV in U5 mortality trends in Mozambique. We performed an exploratory analysis with U5M as the outcome variable. First, we conducted a univariate analyses by provinces over time periods, as well as Pearson correlations between each independent predictor and the outcome; second a bivariate analysis was performed to determine the association between each independent variable and the outcome variable followed by a multivariate analysis. Model selection was achieved by using backward selection where in each step were removed the variable with the highest p-value, The final significance level selected was 0.05. Overall the U5M in Mozambique dropped substantially during 2000 to 2010 and for each additional year we predicted a decrease of 7.4 per 1000 live births of the U5M on average across all provinces (95% CI: -9.4 , -5.3). After adjusting for time trend population per health facility with β= 2.7 (95% CI 0.19, 5.2), health work force density with β= -0.41 (95% CI: -0.81, -0.01) and institutional birth attendance β= -0.45 (95% CI:-0.77, -0.14) remained significantly associated to U5M. These results suggest that improvements on health human resources particularly with maternal and child nurses and interventions which resulted in improvements of institutional birth attendance were important in the reductions of the U5M rates in Mozambique during the period of the study. If these results are confirmed with other studies, investments on health should prioritize innovative interventions to accelerate human resources trainings, health infrastructure buildings and better access and quality of services for pregnant women
Primary Healthcare Staffing Needs Assessment-- A Discrete Event Simulation Study
No full textThesis (Master's)--University of Washington, 2014Background: Mozambique has a shortage of primary healthcare workers, effecting the quality of primary healthcare delivery. The specific aim of the proposed research is utilizing Industrial & Systems Engineering methods, specifically discrete event simulation, to identify strategies to improve primary healthcare delivery system performance in the Sofala Province of Mozambique. To improve primary healthcare delivery and assist facility-level management with decision-making, the research team decided to study staffing level effects on patient waiting time and develop a decision support tool that determines staffing level needs to maintain an average total wait time of less than 60minutes. Methods: A discrete event simulation study was performed to model primary healthcare facility delivery systems using Arena Simulation software. What-if scenario experiments testing the impact health worker staffing level and patient demand fluctuations have on patient waiting time were designed using Statistical Analysis Software, and the experimental runs were performed using Arena Simulation Process Analyzer application. Minitab was used to perform a regression analysis to find mathematical models of wait time as a function of patient demand and staffing levels. Results: The mathematical relationship of health worker staffing and patient demand levels with average patient wait time was estimated using regression analysis. The number of staff required to provide services was the aggregate of staffing needed for all patient types of a given facility. This approach produced staffing and wait time results that could not be validated and used to create a spreadsheet-based decision support tool. Conclusion: The spreadsheet-based decision support tool aimed to bridge the gap between industrial and systems engineering methods and healthcare stakeholder knowledge of these methods while promoting implementation by allowing decision makers to perform simulations through a user-friendly tool. Although the proposed approach described in this study could not be validated, this method is beneficial when attempting to evaluate performance improvement strategy impacts on measures of performance. To create the spreadsheet-based decision support tool, it is recommended that an alternative approach be used to determine the relationship between wait time, patient demand, and staffing levels, such as queuing analysis
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