SSM - Health Systems最新文献

{"title":"Optimizing the role and functions of CHWs in service of a people-centred community health system in sub-Saharan Africa. A realist synthesis","authors":"Usangiphile E. Buthelezi ,&nbsp;André J. van Rensburg ,&nbsp;Mosa Moshabela ,&nbsp;Zamasomi Luvuno ,&nbsp;Tasneem Kathree ,&nbsp;Arvin Bhana ,&nbsp;Inge Petersen","doi":"10.1016/j.ssmhs.2025.100089","DOIUrl":"10.1016/j.ssmhs.2025.100089","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of Community Health Workers (CHWs) in sub-Saharan Africa is critical to achieve people-centred health systems. Despite a large evidence base, there is a dearth of knowledge regarding the contextual factors and mechanisms that shape CHW performance in providing people-centred care. This study aims to map out conditions that enable people-centred care by CHWs in sub-Saharan Africa by identifying the key mechanisms and contextual factors.</div></div><div><h3>Methodology</h3><div>A realist synthesis approach was employed to explore how, why, and under what conditions CHW interventions lead to desired outcomes for people-centred care. A systematic review of the literature was undertaken from 2014 to 2024, focusing on studies conducted in sub-Saharan Africa. The review followed a six-phase process, including the development of the initial programme theory, search for evidence, evidence review and quality appraisal, data extraction, data synthesis and analysis, and refinement of the programme theory, followed by formulation of context-mechanism-outcome (CMO) configurations.</div></div><div><h3>Results</h3><div>This synthesis included 36 studies from 14 sub-Saharan African countries. In total, 101 CMO configurations were identified and condensed into 17 preliminary configurations. Specific contexts and mechanisms emerged that influence outcomes related to CHW programmes. The study identified trust, motivation, and adaptive leadership as fundamental meta-mechanisms that challenge the siloed structure of the IPCHS framework, emphasizing the need for greater flexibility to capture interactions across different strategies of the framework.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that integrating CHWs into formal systems, aligning CHW-specific interventions with community-based initiatives, establishing intersectoral partnerships, and updating the IPCHS framework to incorporate adaptive leadership and feedback mechanisms can enhance the delivery of people-centred care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a predictive model for resource allocation in healthcare: A case study from an Italian Hospital","authors":"Stanislav Russo ,&nbsp;Sergey Zhitikhin ,&nbsp;Virginia Gulino ,&nbsp;Beatrice Ricci ,&nbsp;Marco Nigro ,&nbsp;Edoardo Gallerani ,&nbsp;Elena Lombardo ,&nbsp;Peter Perger ,&nbsp;Emanuele Padovani ,&nbsp;Anselmo Campagna ,&nbsp;Matteo Buccioli","doi":"10.1016/j.ssmhs.2025.100085","DOIUrl":"10.1016/j.ssmhs.2025.100085","url":null,"abstract":"<div><div>The sustainability and efficiency of healthcare systems remain a global challenge, particularly in resource allocation for elective surgeries. This study examines the case of the Rizzoli Orthopedic Institute, a specialized Italian hospital facing significant waiting list imbalances, with approximately 24,000 patients awaiting surgery. The research employs a predictive modeling approach to optimize hospital resource allocation, particularly operating rooms and inpatient beds, to improve surgical scheduling efficiency. By leveraging statistical and computational methods, including historical data analysis and simulation modeling, this study aims to identify an optimal strategy to balance surgical demand and capacity. Over a sequence of 1811 total hip replacement surgeries, our mean calculated operating time was 74.31 min (SD: 19.41), and the estimate of resource demand calculated 1635 total operating hours (or 258 shifts) and 19 bed spaces to clear the current waiting list. Our model indicated potential for 30 % capacity-demand mismatch for this procedure alone. These findings indicate the need for strategic realignment of hospital resources. Key findings indicate that the existing operating-room capacity and bed assignments are insufficient to handle even a single high-volume surgery procedure (total hip replacements) without delays. In real-life practice, hospital managers can use these findings to inform scheduling policy, make staffing assignment priorities, and maybe even plan temporary capacity boosts or off-site sites for surgery.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of implementing mobile phone text messages in reminding parents to get their children immunized in Nigeria: A narrative inquiry of mothers’ experience","authors":"Umar Yunusa ,&nbsp;Hussaini Muhammad Aikawa ,&nbsp;Khadija Nuhu Nasidi ,&nbsp;Chioma Judith Mba ,&nbsp;Aisha Suleiman Abdullahi ,&nbsp;Amina Suleiman Rajah ,&nbsp;Sumayya Kabir Dandago ,&nbsp;Usman Yahaya ,&nbsp;Umar Abdullahi Musa ,&nbsp;Rahma Balarabe","doi":"10.1016/j.ssmhs.2025.100088","DOIUrl":"10.1016/j.ssmhs.2025.100088","url":null,"abstract":"<div><h3>Background</h3><div>Evidence suggests that mobile phone reminders improve the uptake, completeness and timeliness of routine childhood immunization. However, the implementation of the reminder system in resource limited settings is affected by challenges. Some of the challenges of the reminder interventions in Low- and Middle-Income Countries (LMICs) include: the non-ownership of mobile phones and language barrier. There is however a paucity of evidence on the challenges that may affect such intervention in Nigeria.</div></div><div><h3>Aim</h3><div>This study explored the challenges experienced by mothers who were reminded about the immunization of their children in Nigeria.</div></div><div><h3>Method</h3><div>Using a qualitative narrative inquiry, in-depth interviews were conducted with eligible participants. The participants were purposively selected from mothers who earlier received mobile phone text message reminders on the immunization of their children in Kano State, Nigeria. The recorded interviews were transcribed, translated to English and analysed using thematic analysis.</div></div><div><h3>Results</h3><div>A total of thirteen in-depth interviews were conducted. The themes that emerged are: benefits of the mobile phone reminders, mobile phone ownership, network issues, parental ability to read, and spousal support.</div></div><div><h3>Conclusion</h3><div>While the reminder system was found to be helpful, not owning a mobile phone and the inability to read messages were among the challenges experienced. The active involvement of male spouses/fathers in the reminder system, use of local languages, and phone call reminders are hereby recommended. Deliberate actions towards improving the level of literacy, mobile phone network and infrastructure by policy makers is also recommended to facilitate future implementation of mobile phone reminder interventions.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute febrile illness in remote and rural communities: Perspectives of health providers and managers in Chattogram, Bangladesh","authors":"Marco Liverani ,&nbsp;Sharmin Ahmed ,&nbsp;Aninda Sen ,&nbsp;Rusheng Chew ,&nbsp;Arjun Chandna ,&nbsp;Shayla Islam ,&nbsp;Richard J. Maude ,&nbsp;Akramul Islam ,&nbsp;Yoel Lubell","doi":"10.1016/j.ssmhs.2025.100090","DOIUrl":"10.1016/j.ssmhs.2025.100090","url":null,"abstract":"<div><div>Acute febrile illness is a major public health issue in tropical regions, particularly in remote and rural areas where healthcare access is difficult. In these areas, patients often seek care too late or rely on self-medication, leading to increased risks of complications and death. This qualitative study examined challenges and opportunities for managing acute febrile illness in Chattogram Division, Bangladesh. The research involved interviews with 35 stakeholders across the health sector in Bangladesh, including health managers and frontline health workers, and international experts. Findings show that referral barriers, health seeking behaviour and financial considerations influence case management and outcomes in complex ways. Community health workers are vital in managing local health issues, but they have limited ability to address the evolving concerns about febrile illness. Gaps in the referral system and inadequate emergency care resources further complicate the situation. Many episodes of fever remain undifferentiated and are often managed with presumptive antibiotic treatment, which may be inappropriate and contributes to antimicrobial resistance. This study highlights the pressing need for an integrated approach to febrile illness management in rural Bangladesh, one that accounts for the changing epidemiology of infectious diseases, health seeking behaviour, and the limitations of the existing healthcare infrastructure. Expanding the ability of community health workers to manage patients with non-malarial febrile illnesses, stronger triage and referral systems, and addressing the financial and logistical barriers to care are critical steps toward improving health outcomes in these regions.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of health co-benefit tests in the setting of a screening or health programme: Limited data to inform their potential use to address inequities","authors":"Tayla Schaapveld ,&nbsp;Karen Bartholomew ,&nbsp;Anna Maxwell ,&nbsp;Erin Chambers ,&nbsp;Katrina Poppe ,&nbsp;Robert N. Doughty ,&nbsp;Tracy Murphy","doi":"10.1016/j.ssmhs.2025.100084","DOIUrl":"10.1016/j.ssmhs.2025.100084","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this scoping review is to assess the extent, range and nature of health co-benefit tests and their application to address inequities in a screening or other health programme setting and to inform their potential use for a AAA screening programme in Aotearoa New Zealand.</div></div><div><h3>Methods</h3><div>Electronic databases (MEDLINE, CINAHL and AMED) were searched to find relevant literature published between August 2009 to August 2024. This was supplemented with studies obtained through examination of reference lists, grey literature, and hand searching of key journals. Articles meeting the inclusion criteria were reviewed for relevance, with key data extracted into a coding system.</div></div><div><h3>Results</h3><div>In total, twenty-four papers were included in our review. Although the addition of co-benefit tests to existing programmes was seen as beneficial by both programme designers and participants, to ensure success in addressing inequities there were factors raised that need to be taken into consideration, including improved co-ordination between specialties, and ensuring pathways are put in place to follow-up participants following their tests.</div></div><div><h3>Conclusions</h3><div>While the concept of including co-benefit tests to existing health programmes to address inequities is widely supported, there remain notable gaps in the literature which warrant further investigation. Findings from this review have highlighted the need for more research to be undertaken, with a focus on Indigenous health, inequities and specific settings such as rural health. Future studies should include views of both participants and staff members and not only focus on the acceptance and feasibility of adding co-benefit tests, but also explore the benefits, challenges and sustainability after they have been implemented in a health programme.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A formative evaluation of potential barriers and facilitators to inform effective implementation of a community-based hypertension care program in rural South Africa: The IMPACT-BP trial","authors":"Shafika Abrahams-Gessel ,&nbsp;Thabang Manyaapelo ,&nbsp;Nsika Sithole ,&nbsp;Siphephelo Dlamini ,&nbsp;Nondumiso Mpanza ,&nbsp;Samukelisiwe Nxumalo ,&nbsp;Thabisile Mjilo ,&nbsp;Joanna Orne-Gliemann ,&nbsp;Max Bachmann ,&nbsp;Nombulelo Magula ,&nbsp;Alison Castle ,&nbsp;Mark J. Siedner ,&nbsp;Thomas Gaziano","doi":"10.1016/j.ssmhs.2025.100086","DOIUrl":"10.1016/j.ssmhs.2025.100086","url":null,"abstract":"<div><h3>Background</h3><div>In rural KwaZulu-Natal Province, South Africa, less than 25 % of persons with hypertension have controlled blood pressure. We conducted a formative evaluation of current clinic-based care to identify barriers and facilitators that could impact effective implementation of a community-based hypertension intervention (IMPACT-BP).</div></div><div><h3>Methods</h3><div>We conducted individual interviews and group discussions with clinic managers, nurses, community health workers (CHWs), community leaders, and patients to identify barriers and facilitators experienced in clinic-based hypertension care, which could affect the acceptability, feasibility, and implementation of the IMPACT-BP intervention. The Conceptual Model of Implementation Research and the Theoretical Framework of Acceptability guided the design of data collection instruments and analysis. Qualitative data collection was performed by trained social science research assistants, recorded, transcribed, translated, and analyzed using thematic analysis.</div></div><div><h3>Results</h3><div>Forty-one participants (92 % women) participated in group discussions (n = 32) or individual interviews (n = 9). Barriers to intervention acceptability and feasibility included inadequate levels of staffing, high patient volumes, distrust of CHWs’ work at clinics and in the community, and insufficient training and equipment for CHWs. Facilitators included home delivery of medications by CHWs.</div></div><div><h3>Conclusions</h3><div>Our findings allowed us to identify specific adaptations to the intervention implementation strategy to make the proposed community-based intervention acceptable and feasible in this setting. Adaptations included employing dedicated CHWs and nurses for trial-related activities, developing an expanded CHW training module on hypertension knowledge, teaching CHWs to measure blood pressure and subsequently train patients to do the same, and training CHWs to educate patients about hypertension management.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving access to skilled maternal health services among pregnant women with disabilities in Uganda: What are disability-responsive maternal health services?","authors":"Milly Nakatabira ,&nbsp;Elizabeth Ekirapa-Kiracho ,&nbsp;Christine Aanyu ,&nbsp;Heang-Lee Tan ,&nbsp;Rebecca R. Apolot ,&nbsp;Nukhba Zia ,&nbsp;Dan Kajungu ,&nbsp;Abdulgafoor M. Bachani ,&nbsp;Rosemary Morgan","doi":"10.1016/j.ssmhs.2025.100087","DOIUrl":"10.1016/j.ssmhs.2025.100087","url":null,"abstract":"<div><h3>Background</h3><div>Pregnant women with disabilities (WWDs) face increased challenges in accessing skilled birth health services than women without disabilities, especially in low and middle-income countries, which puts them at a higher risk of worse maternal health outcomes. Limited studies have been conducted in Uganda that address the needs of pregnant WWDs from a health system perspective. This paper aims to explore the demand and supply side needs of pregnant WWDs in Uganda and explain what disability-responsive maternal health services look like at the health systems level.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted in Iganga and Mayuge districts in Eastern Uganda. Thirteen key informant interviews were conducted with district health team members and community leaders. In-depth interviews were conducted with 12 WWDs and 12 caregivers, and eight focus group discussions were conducted with health workers, community members, and traditional birth attendants. Analysis was done manually using the framework approach.</div></div><div><h3>Results</h3><div>Barriers included a lack of disability-friendly transport to get to the facility of choice, a lack of childbirth autonomy, poor attitudes and disrespectful maternity care by health workers, physical inaccessibility of health facility infrastructure, lack of specialized medical equipment to meet the needs of pregnant WWDs, and lack of health worker training to meet the unique needs of WWDs.</div></div><div><h3>Conclusion</h3><div>There is a need for holistic, multifaceted, and multisectoral approaches to ensure disability-responsive maternal health services at the health systems level. This includes policies that support inclusive maternal health services that meet the needs of pregnant WWDs, dedicated funding and prioritization of disability-related health interventions, improved physical environment of health facilities to make them more accessible to PWDs, a trained workforce to meet the health needs of pregnant WWDs at all health system levels and overcome poor attitudes and disrespectful maternity care towards WWDs, and disability data which is disaggregated by key social stratifiers to guide planning, monitoring and decision-making around disability-responsive maternal health services.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using causal loop diagrams to explore the maternal and child health system response to payment for performance in Zambia, and it’s generalisability across settings","authors":"Chitalu Miriam Chama-Chiliba ,&nbsp;Nkenda Sachingongu ,&nbsp;Rachel Cassidy ,&nbsp;Peter Binyaruka ,&nbsp;Collins Chansa ,&nbsp;Agnes Rwashana Semwanga ,&nbsp;Josephine Borghi","doi":"10.1016/j.ssmhs.2025.100082","DOIUrl":"10.1016/j.ssmhs.2025.100082","url":null,"abstract":"<div><div>This study investigates the generalisability of pathways depicted by causal loop diagrams (CLDs) in payment for performance (P4P) schemes by adapting and validating the Tanzanian CLDs to the Zambian context. Specifically, it explores whether the health system pathways represented by CLDs, are consistent across different settings and how variations in programme design and local context influence these pathways. Using a five-stage approach, the study adapted the Tanzanian CLDs to reflect the Zambian P4P programme context, validating them through stakeholder interviews, workshops, and secondary qualitative data. The findings show that while the overarching pathways influencing P4P outcomes are similar, differences in programme design and contextual factors shape their intensity and impact. Notably, Zambia’s higher facility autonomy and stronger trust in the health system contributed to greater health worker motivation and service delivery compared to Tanzania. Programme design features such as safeguards for non-incentivised services and adequate funding for facility investment with provider autonomy influenced performance outcomes. Additionally, contextual factors such as trust in the system mitigated programme delays, while decentralised procurement systems enhanced P4P effectiveness. These findings highlight the need for context-specific adaptation when implementing P4P programmes. The study advances the application of CLDs for cross-country health system analysis, highlighting both their potential and limitations in comparing health interventions across diverse settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity, diet, medication adherence, blood glucose monitoring and foot care in people with type 2 diabetes in Nepal","authors":"Grish Paudel ,&nbsp;Corneel Vandelanotte ,&nbsp;Padam Kanta Dahal ,&nbsp;Abha Shrestha ,&nbsp;Biraj Karmacharya ,&nbsp;Tomohiko Sugishita ,&nbsp;Lal Rawal","doi":"10.1016/j.ssmhs.2025.100083","DOIUrl":"10.1016/j.ssmhs.2025.100083","url":null,"abstract":"<div><h3>Introduction</h3><div>Type 2 diabetes mellitus (T2DM) is among the most common Noncommunicable diseases (NCDs), responsible for an estimated 2 million deaths in 2019. The prevalence of T2DM is increasing in low- and middle-income countries including Nepal. The practice of good self-care behaviours (i.e., physical activity, dietary habits, adherence to medication, blood glucose monitoring, and foot care) plays a vital role in managing disease conditions. This study aims to assess the practice of self-care behaviours and their associated factors among people with T2DM in Nepal.</div></div><div><h3>Methods</h3><div>Data on self-care behaviours were assessed from 481 adults (aged 30–70 years) with T2DM from two districts (Kavrepalanchowk and Nuwakot) in Nepal. Self-care behaviours (dietary habits, physical activity, medication adherence, blood glucose monitoring, and foot care) were assessed using pre-tested and interviewer-administered questionnaires. Multiple logistic regression analysis was used to determine the factors associated with self-care behaviours.</div></div><div><h3>Results</h3><div>Physical activity (80 %) was the most practiced self-care behaviour followed by a healthy diet (49.9 %), medication adherence (48.2 %), blood glucose monitoring (32.2 %), and foot care (1.7 %). Significant associations for age and area of residence were observed for physical activity. Religion and not using tobacco were associated with a healthy diet. Educational status and blood glucose level were associated with blood glucose monitoring. Alcohol use and comorbid conditions were associated with medication adherence.</div></div><div><h3>Conclusion</h3><div>Adherence to a healthy diet, medication, blood glucose monitoring, and foot care were still inadequate among the people with T2DM in Nepal. This implies the need for designing and implementing socially and culturally accepted diabetes self-management programs to empower and motivate people with T2DM to self-manage their disease conditions.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100083"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organisational learning culture in maternity units: A mixed-method study in rural district hospitals in KwaZulu-Natal, South Africa","authors":"Christiane Horwood ,&nbsp;Lyn Haskins ,&nbsp;Veronique Filippi ,&nbsp;Loveday Penn-Kekana ,&nbsp;Samuel Manda ,&nbsp;Sphindile Mapumulo ,&nbsp;Silondile Luthuli ,&nbsp;Ruwayda Petrus ,&nbsp;Tanya Doherty","doi":"10.1016/j.ssmhs.2025.100081","DOIUrl":"10.1016/j.ssmhs.2025.100081","url":null,"abstract":"<div><h3>Background</h3><div>Building organisational learning in health facilities is a health system strengthening strategy that has particular relevance for rural health workers (HWs) who may be geographically isolated without access to learning opportunities or specialist support. We present the findings of a mixed methods study exploring organisational learning in rural hospital maternity units.</div></div><div><h3>Methods</h3><div>Data were collected from all cadres of HWs working in maternity units in 11 health facilities in two districts, including doctors, nurse managers, midwives and nursing assistants. A quantitative survey was conducted with all HWs using the validated Dimensions of Learning Organisation Questionnaire (DLOQ). We then conducted individual in-depth interviews with purposively selected HWs in each facility to explore their perceptions and experiences of learning, teamwork and leadership.</div></div><div><h3>Findings</h3><div>We completed 116 DLOQ self-administered questionnaires and conducted 35 in-depth interviews. Strategic leadership scored highest on the DLOQ, with HWs reporting that managers provided opportunities for mentoring and learning. Doctors and nurse managers experienced team learning, leadership and communication more positively than midwives and nursing assistants. Learning was driven by senior doctors and managers, frequently taking a top-down didactic approach rather than employing reflection and dialogue. This is supported by low DLOQ scores for inquiry and dialogue and empowerment among nurses compared to doctors and managers.</div></div><div><h3>Conclusions</h3><div>There is a need for shifts in learning approaches in maternity units from a didactic clinical focus to participatory dialogue and reflection, including interpersonal issues like respect and communication, and to ensure that all team members have access to learning opportunities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}