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Bogren, M., Erlandsson, K., Johansson, A., Kalid, M., Abdi Igal, A., Mohamed, J., . . . Osman, F. (2020). Health workforce perspectives of barriers inhibiting the provision of quality care in Nepal and Somalia: A qualitative study. Sexual and Reproductive Healthcare, 23
Open this publication in new window or tab >>Health workforce perspectives of barriers inhibiting the provision of quality care in Nepal and Somalia: A qualitative study
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2020 (English)In: Sexual and Reproductive Healthcare, ISSN 1877-5756, Vol. 23Article in journal (Refereed) Published
Abstract [en]

Objective

In this paper settings from Nepal and Somalia are used to focus on the perspectives of healthcare providers within two fragile health systems. The objective of this study was to describe barriers inhibiting quality healthcare in Nepal and Somalia from a health workforce perspective.

Methods

Data were collected through 19 semi-structured interviews with healthcare providers working in healthcare facilities. Ten interviews were conducted in Nepal and nine in Somalia.

Results

Various structural barriers inhibiting the availability, accessibility, and acceptability of the quality care were similar in both countries. Barriers inhibiting the availability of quality care were linked to healthcare providers being overburdened with multiple concurrent jobs. Barriers inhibiting the accessibility to quality healthcare included long distances and the uncertain availability of transportation, and barriers to acceptability of quality healthcare was inhibited by a lack of respect from healthcare providers, characterised by neglect, verbal abuse, and lack of competence.

Conclusions

Inequality, poverty, traditional and cultural practices plus the heavy burden placed on healthcare providers are described as the underlying causes of the poor provision of quality care and the consequential shortcomings that emerge from it. In order to improve this situation adequate planning and policies that support the deployment and retention of the healthcare providers and its equitable distribution is required. Another important aspect is provision of training to equip healthcare providers with the ability to provide respectful quality care in order for the population to enjoy good standard of healthcare services.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Healthcare providers, Healthcare services, Health systems, Quality care, Nepal, Somalia
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31176 (URN)10.1016/j.srhc.2019.100481 (DOI)2-s2.0-85075517845 (Scopus ID)
Available from: 2019-12-06 Created: 2019-12-06 Last updated: 2019-12-06Bibliographically approved
Klingberg-Allvin, M., Hatakka, M., Erlandsson, K., Osman, F., Byrskog, U. & Egal, J. (2019). "Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region. Midwifery, 69, 135-142
Open this publication in new window or tab >>"Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 135-142Article in journal (Refereed) Published
Abstract [en]

The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.

Design

In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.

Setting and participants

Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.

Findings

Findings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.

Conclusion

The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.

Keywords
Net-based education, Quality midwifery education, Midwifery care, Somaliland, Capability approach, Choice framework
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29004 (URN)10.1016/j.midw.2018.11.007 (DOI)000454129800018 ()30503998 (PubMedID)2-s2.0-85057779256 (Scopus ID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-01-10Bibliographically approved
Erlandsson, K., Byrskog, U., Osman, F., Pedersen, C., Hatakka, M. & Klingberg-Allvin, M. (2019). Evaluating a model for the capacity building of midwifery eduators in Bangladesh through a blended, web-based master's programme. Global Health Action, 12(1), Article ID 1652022.
Open this publication in new window or tab >>Evaluating a model for the capacity building of midwifery eduators in Bangladesh through a blended, web-based master's programme
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2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1652022Article in journal (Refereed) Published
Abstract [en]

Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master's programme in SRHR and the extent to which these were realized after 12 months of part-time study. Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses. Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students' learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master's programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students' learning and how to foster reflective and critical thinking among them. Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.

Keywords
Bangladesh, Midwifery education, South Asia, capacity building, web-based education
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30616 (URN)10.1080/16549716.2019.1652022 (DOI)000480727300001 ()31411128 (PubMedID)2-s2.0-85071029632 (Scopus ID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-09-17Bibliographically approved
Warner, G., Baghdasaryan, Z., Osman, F., Lampa, E. & Sarkadi, A. (2019). 'I felt like a human being'-An exploratory, multi-method study of refugee involvement in the development of mental health intervention research.. Health Expectations
Open this publication in new window or tab >>'I felt like a human being'-An exploratory, multi-method study of refugee involvement in the development of mental health intervention research.
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2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Great advancements have been made in patient and public involvement (PPI), including the development of guidance on how to conduct, report and evaluate PPI. Despite these efforts, the evidence base remains relatively weak. A substantive methodological development is required. This is particularly important for vulnerable groups within society, for whom PPI can be challenging but has the potential to play a transformative role in shaping research.

OBJECTIVES: To describe the group dynamic characteristics and immediate impact of PPI from the user representatives' perspective in a case study of refugee involvement in the development of mental health intervention research. To pilot and methodologically appraise the Active Involvement of Users in Research Observation Schedule and Questionnaire.

DESIGN: The Active Involvement of Users in Research Observation Schedule and Questionnaire were administered together with a focus group discussion.

SETTING: 'Refugee Advisors' were involved in the development of a randomized controlled trial protocol evaluating a brief group intervention for refugee children experiencing symptoms of post-traumatic stress in Sweden.

RESULTS: The multi-method approach demonstrated good feasibility. There were clear examples of how the advisors influenced research development. The advisors described a perceived impact on the research, equality and acceptance, and knowledge gain. A sense of appreciation and empowerment was also interpreted. However, potential issues relating to the relevance of contributions and use of an interpreter were identified.

DISCUSSION AND CONCLUSION: The methodological approach piloted in this study offers a promising, rigorous way to evaluate PPI. The research tools require further refinement and validation.

Keywords
group dynamics, mental health, observation, patient and public involvement, refugees
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31123 (URN)10.1111/hex.12990 (DOI)000495185400001 ()31705620 (PubMedID)2-s2.0-85074912823 (Scopus ID)
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2019-12-09Bibliographically approved
Osman, F., Flacking, R., Klingberg-Allvin, M. & Schön, U.-K. (2019). Qualitative study showed that a culturally tailored parenting programme improved the confidence and skills of Somali immigrants. Acta Paediatrica, 108(8), 1482-1490
Open this publication in new window or tab >>Qualitative study showed that a culturally tailored parenting programme improved the confidence and skills of Somali immigrants
2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 8, p. 1482-1490Article in journal (Refereed) Published
Abstract [en]

AIM: Parenting programmes tailored to immigrant parents have been reported to improve the mental health of the children and parents, as well as parents' sense of competence in parenting. However, research on parents' experiences of programmes tailored to their needs is scarce. This qualitative study aimed to describe Somali parents' experiences of how a culturally sensitive programme affected their parenting.

METHODS: The study was conducted in a middle-sized city in Sweden in 2015. Data were collected through semi-structured interviews with 50 participants two months after they took part in a parenting support programme. Inductive and deductive qualitative content analyses were used.

RESULTS: A light has been shed was a metaphor that emerged from the analysis and that captured the knowledge the parents gained from the parenting system in Sweden. Parents gained confidence in their parenting role and became emotionally aware of their child's social and emotional needs and how to respond to them. Holding the sessions in the participant's native language was important for the parents' participation and acceptance of the programme.

CONCLUSION: Parenting programmes should be tailored to the specific needs of the participants and cultural sensitivity should be factored into programmes to attract immigrant parents. This article is protected by copyright. All rights reserved.

Keywords
cultural sensitivity, effective parenting, family relationships, immigrants, parenting programmes
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29761 (URN)10.1111/apa.14788 (DOI)000474935600019 ()30896042 (PubMedID)2-s2.0-85064519588 (Scopus ID)
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-07-29Bibliographically approved
Egeh, A.-A., Dugsieh, O., Erlandsson, K. & Osman, F. (2019). The views of Somali religious leaders on birth spacing: A qualitative study. Sexual & Reproductive HealthCare, 20, 27-31
Open this publication in new window or tab >>The views of Somali religious leaders on birth spacing: A qualitative study
2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 27-31Article in journal (Refereed) Published
Abstract [en]

Background

Birth spacing is an important health intervention for women to attain good physical and mental health. In Somalia, religious leaders play a decisive role in approving or rejecting the use of family planning.

Objective

The study aimed to investigate Somali Islamic religious leaders’ views on birth spacing.

Method

Qualitative individual interviews were conducted with 17 Somali Islamic religious leaders aged 28–59 years and analysed through content analysis.

Results

The main category that emerged from the analysis was that the concept “birth spacing should be used and nor family planning to be in accordance with the Islamic religion. Two perspectives of views of birth spacing were identified: accepted ways and unaccepted ways. The accepted ways include breastfeeding, use of contraceptives causing no harm to the women’s health, and coitus interruptus. The preferred method should be determined by a joint agreement between the husband and wife, and that Muslim doctors should play a key role while the couples investigate their preferred method. Using contraceptives with the intention to limit the number of children was against Islamic values and practice. In addition, it was believed that using condoms promoted the temptation to engage in sex outside the marriage and was therefore prohibited.

Conclusion

According to the religious Islamic leaders, selected practice recommendations for contraceptive use is permitted in relation to birth spacing to promote the health of the mother and child. When providing professional contraceptive counselling to Muslim women, the word “birth spacing” is recommended to be used instead of “family planning”.

Keywords
Birth spacing, Contraceptives, Religious leaders, Reproductive health, Somalia
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29565 (URN)10.1016/j.srhc.2019.02.003 (DOI)000470192400006 ()31084814 (PubMedID)2-s2.0-85061449485 (Scopus ID)
Note

Open Access APC beslut 6/2019

Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-06-20Bibliographically approved
Faysal Badal, N., Alo Yusuf, U., Egal, J., Pedersen, C., Erlandsson, K., Osman, F. & Byrskog, U. (2018). With knowledge and support women can attend antenatal care: the views of women in IDP camps in Somaliland. African Journal of Midwifery and Womens' Health, 12(3)
Open this publication in new window or tab >>With knowledge and support women can attend antenatal care: the views of women in IDP camps in Somaliland
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2018 (English)In: African Journal of Midwifery and Womens' Health, ISSN 1759-7374, Vol. 12, no 3Article in journal (Refereed) Published
Abstract [en]

In Somaliland, women’s perceptions of barriers to accessing antenatal care is sparsely described, particularly with regard to marginalized women. The aim was to investigate perceptions of barriers to accessing antenatal care from the perspective of pregnant women living in Internal Displaced Persons camps. Individual semi-structured interviews with fifteen women were conducted and analysed using content analysis. The overriding theme was “With knowledge and support, women can attend antenatal care”.  The findings highlighted that to obtain antenatal care, it is crucial for women to have knowledge and trust regarding antenatal services, a supporting environment, and ways to overcome practical barriers, such as patient fees and long waiting hours. If women and families received relevant information about the structure and benefits of ANC, they would probably prioritize ANC, given that the care is tailored to each woman’s needs. For this, community awareness and trust between women, families and ANC providers are central.

Keywords
Antenatal care, Content analysis, Somaliland
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26593 (URN)10.12968/ajmw.2018.12.3.138 (DOI)
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-11-13Bibliographically approved
Abdillahi, H. A., Hassan, K. A., Kiruja, J., Osman, F., Egal, J. A., Klingberg-Allvin, M. & Erlandsson, K. (2017). A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland. International Journal of Gynecology & Obstetrics, 138(1), 119-124
Open this publication in new window or tab >>A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland
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2017 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 138, no 1, p. 119-124Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent.

METHODS: A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015).

RESULTS: Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Healthcare providers were often prevented from performing emergency cesarean delivery until the required consent had been received from the woman's extended family.

CONCLUSION: Maternity care in Somaliland must be improved, and the issue of legal authority for consent examined, to ensure both safe and timely provision of emergency cesarean delivery. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Cesarean delivery, Consent, Maternal death, Near miss, Somaliland
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24701 (URN)10.1002/ijgo.12176 (DOI)000405092600021 ()28391614 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2017-04-11 Created: 2017-04-11 Last updated: 2017-10-23Bibliographically approved
Osman, F., Salari, R., Klingberg-Allvin, M., Schön, U.-K. & Flacking, R. (2017). Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial. BMJ Open, 7(12), Article ID e017600.
Open this publication in new window or tab >>Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017600Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting.

DESIGN: Randomised controlled trial.

SETTING: A city in the middle of Sweden.

PARTICIPANTS: Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).

INTERVENTION: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.

OUTCOME: The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.

RESULTS: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=-6.72, 95% CI -8.15 to -5.28, p<0.001) and satisfaction (B=-4.48, 95% CI -6.27 to -2.69, p<0.001) for parents in the intervention group. Parents' satisfaction mediated the intervention effect on parental mental health (β=-0.88, 95% CI -1.84 to -0.16, p=0.047).

CONCLUSION: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents' need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.

CLINICAL TRIAL REGISTRATION: NCT02114593.

Keywords
child protection, community child health, mental health, public health
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26770 (URN)10.1136/bmjopen-2017-017600 (DOI)000423826700065 ()29222136 (PubMedID)
Note

Open Access APC beslut 26/2017

Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-02-22Bibliographically approved
Erlandsson, K., Osman, F., Hatakka, M., Egal, J. A., Byrskog, U., Pedersen, C. & Klingberg-Allvin, M. (2017). Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty. Nurse Education in Practice, 25, 96-103
Open this publication in new window or tab >>Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty
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2017 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 25, p. 96-103Article in journal (Refereed) Published
Abstract [en]

To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Online education, Net-based education, Midwifery education, Human rights
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25050 (URN)10.1016/j.nepr.2017.05.007 (DOI)28575755 (PubMedID)2-s2.0-85019746618 (Scopus ID)
Note

Open Access APC beslut 15/2017

Available from: 2017-05-29 Created: 2017-05-29 Last updated: 2017-06-21Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0038-9402

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