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  1. Article ; Online: “Well, I Signed Up to Be a Soldier; I Have Been Trained and Equipped Well”

    Celene Ting / Alyssa Yenyi Chan / Lai Gwen Chan / Zoe Jane-Lara Hildon

    International Journal of Environmental Research and Public Health, Vol 19, Iss 2477, p

    Exploring Healthcare Workers’ Experiences during COVID-19 Organizational Changes in Singapore, from the First Wave to the Path towards Endemicity

    2022  Volume 2477

    Abstract: 1) Background: As COVID-19 transmission continues despite vaccination programs, healthcare workers (HCWs) face an ongoing pandemic response. We explore the effects of this on (1) Heartware, by which we refer to morale and commitment of HCWs; and ... ...

    Abstract (1) Background: As COVID-19 transmission continues despite vaccination programs, healthcare workers (HCWs) face an ongoing pandemic response. We explore the effects of this on (1) Heartware, by which we refer to morale and commitment of HCWs; and identify how to improve (2) Hardware, or ways of enabling operational safety and functioning. (2) Methods: Qualitative e-diary entries were shared by HCWs during the early phases of the outbreak in Singapore from June to August 2020. Data were collected via an online survey of n = 3616 HCWs of all cadres. Nine institutions—restructured hospitals ( n = 5), affiliated primary partners ( n = 2) and hospices ( n = 2)—participated. Applied thematic analysis was undertaken and organized according to Heartware and Hardware. Major themes are in italics (3) Results: n = 663 (18%) HCWs submitted a qualitative entry. Dominant themes undermining (1) Heartware consisted of burnout from being overworked and emotional exhaustion and at times feeling a lack of appreciation or support at work . The most common themes overriding morale breakers were a stoic acceptance to fight, adjust and hold the line, coupled with motivation from engaging leadership and supportive colleagues . The biggest barrier in (2) Hardware analysis related to sub-optimal segregation strategies within wards and designing better protocols for case detection, triage, and admissions criteria . Overall, the most cited enabler was the timely and well-planned provision of Personal Protective Equipment (PPE) for front-liners , though scope for scale-up was called for by those not considered frontline. Analysis maps internal organizational functioning to wider external public and policy-related narratives. (4) Conclusions: COVID-19 surges are becoming endemic rather than exceptional events. System elasticity needs to build on known pillars coupling improving safety and care delivery with improving HCW morale. Accordingly, a model capturing such facets of Adaptive Pandemic Response derived from our data analyses is ...
    Keywords COVID-19 ; qualitative study ; pandemic preparedness ; healthcare workers’ morale ; quality and safety ; improved systems functioning ; Medicine ; R
    Subject code 360
    Language English
    Publishing date 2022-02-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Evaluating the Effects of Capacity Building Initiatives and Primary Care Networks in Singapore

    Andrew Teik Hong Chen / Gerald Choon-Huat Koh / Ngan Phoon Fong / Jeremy Fung Yen Lim / Zoe Jane-Lara Hildon

    International Journal of Environmental Research and Public Health, Vol 20, Iss 2192, p

    Outcome Harvesting of System Changes to Chronic Disease Care Delivery

    2023  Volume 2192

    Abstract: The high tertiary healthcare utilisation in Singapore due to an ageing population and increasing chronic disease load has resulted in the establishment of primary care networks (PCNs) for private general practitioners (GPs) to provide team-based, ... ...

    Abstract The high tertiary healthcare utilisation in Singapore due to an ageing population and increasing chronic disease load has resulted in the establishment of primary care networks (PCNs) for private general practitioners (GPs) to provide team-based, community care for chronic diseases. A total of 22 PCN leaders and programme managers from 10 PCNs participated in online group discussions and a survey. Outcome harvesting was used to retrospectively link the intended and unintended outcomes to the programme initiatives and intermediate results (IRs). The outcomes were generated, refined and verified before shortlisting for analysis. About 134 positive and 22 negative PCN outcomes were observed since inception in 2018. By establishing PCN headquarters and entrusting PCN leaders with the autonomy to run these, as well as focusing policy direction on GP onboarding, GP engagements and clinical governance, the programme successfully harnessed the collective capabilities of GPs. Developments in the organisation (IR1) and monitoring and evaluation (IR4) were the top two contributors for positive and negative outcomes. Sustainable practice and policy changes represented 46% and 20% of the positive outcomes respectively. Sustainable positive outcomes were predominantly contributed by funding, clear programme policy direction and oversight. Conversely, most negative outcomes were due to the limited programme oversight especially in areas not covered by the programme policy.
    Keywords outcome harvesting ; PCN ; chronic disease management ; chronic disease registry ; ancillary services ; team-based care ; Medicine ; R
    Subject code 690
    Language English
    Publishing date 2023-01-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Exploring COVID-19 circuit breaker (CB) restrictions at a migrant worker dormitory in Singapore

    Chuen Seng Tan / Mark I-Cheng Chen / Kaosar Afsana / Melvyn Chung Pheng Wong / Alyssa Yenyi Chan / Nazrana Khaled / Md Tahmid Hasan / Chitra Panchapakesan / Shilpi Tripathi / May O. Lwin / Zoe Jane-Lara Hildon

    BMJ Open, Vol 12, Iss

    a case study and nested mixed-method analysis of stress management and mental health

    2022  Volume 8

    Abstract: Introduction Measures to mitigate the COVID-19 outbreak in the migrant worker dormitories in Singapore included lockdown and isolation of residents for prolonged periods. In this paper, we explore efforts to ease tensions and support mental health under ... ...

    Abstract Introduction Measures to mitigate the COVID-19 outbreak in the migrant worker dormitories in Singapore included lockdown and isolation of residents for prolonged periods. In this paper, we explore efforts to ease tensions and support mental health under these conditions.Methods Case study of dormitory residents under lockdown from April to August 2020 comprises a nested mixed-method approach using an online questionnaire (n=175) and semistructured interviews (n=23) of migrant workers sampled from the survey (August to September 2020). Logistic regression models were used to analyse survey data. Semistructured interviews were analysed using applied thematic analysis.Results Survey and interview data showed that mental health was largely protected despite initial rising tensions over restrictions during lockdown. Sources of tension negatively affecting low stress responses included job related worries, OR=0.07 (95% CI 0.03 to 0.18, p<0.001), poor communication with employers, OR=0.12 (95% CI 0.03 to 0.44, p<0.001) and loneliness, OR=0.24 (95% CI 0.10 to 0.55, p<0.001). Interview narratives concurrently revealed themes around job insecurity and the effects of the lockdown ‘not being good for mind and body’, the imposition of new rules and regulations compounded by the most emphasised concern—worry about family back home.Interviewees shared how their adaptive capability played a pivotal protective role alongside social support and solidarity; aided by regular use of messaging applications, which supported mental health, OR=4.81 (95% CI 1.54 to 15.21, p<0.01). Employers were described as central to alleviating tensions, providing feedback loops to improve dorm conditions. Employees feeling their employers cared about their health and well-being was especially protective to mental health, OR=17.24 (95% CI 4.00 to 85.74, p<0.001). Gratitude and trust in government and healthcare provision was widely acknowledged. Concurrently, related attitudes such as believing in the timeliness and appropriateness of ...
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2022-08-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: “We have this, with my husband, we live in harmony”

    Zoe Jane-Lara Hildon / Maria Escorcio-Ymayo / Rose Zulliger / Rosario Arias de Aramburú / Nan Lewicky / Hunter Harig / Jose Braz Chidassicua / Carol Underwood / Liliana Pinto / Maria Elena Figueroa

    Malaria Journal, Vol 19, Iss 1, Pp 1-

    exploring the gendered decision-making matrix for malaria prevention and treatment in Nampula Province, Mozambique

    2020  Volume 14

    Abstract: Abstract Background Conceptualizing gender dynamics and ways of bridging entrenched gender roles will contribute to better health promotion, policy and planning. Such processes are explored in relation to malaria in Mozambique. Methods A multi-method, ... ...

    Abstract Abstract Background Conceptualizing gender dynamics and ways of bridging entrenched gender roles will contribute to better health promotion, policy and planning. Such processes are explored in relation to malaria in Mozambique. Methods A multi-method, qualitative study using focus group discussions (FGDs) and in-depth interviews (IDIs) explored the perspectives of community members, leaders and stakeholders on malaria. The study was conducted in Nampula Province, in an intervention district for the Tchova Tchova Stop Malaria (TTSM) gender-sensitive community dialogues, and in a non-intervention district. Results Participants (n = 106) took part in six FGDs and five IDIs in each district. Those exposed to TTSM commonly stated that the programme influenced more equalitarian gender roles, attitudes and uptake of protective malaria-related practices. These positive changes occurred within the context of an observed, gendered decision-making matrix, which aligns inward- or outward-facing decisions with malaria prevention or treatment. Decisions more dependent on male or elder sanctioning at community level are outward-facing decisions, while decisions falling within women’s domain at household level are inward-facing decisions. Related to prevention, using bed nets was largely an inward-facing prevention decision for women, who were generally tasked with hanging, washing and making nets usable. Net purchase and appropriation for malaria prevention (rather than for instance for fishing) was men’s prerogative. Regular net use was associated with sleeping together more regularly, bringing couples closer. Attending antenatal care to access intermittent preventive treatment during pregnancy was often an outward-facing prevention decision, under the purview of older, influential women and ultimately needing sanctioning by men. With respect to seeking care for malaria symptoms, women typically sought help from traditional healers first. This inward-facing treatment decision was within their control, in contrast to the ...
    Keywords Community dialogues ; Gender roles and decision making ; Communication ; Malaria prevention ; Arctic medicine. Tropical medicine ; RC955-962 ; Infectious and parasitic diseases ; RC109-216
    Subject code 360
    Language English
    Publishing date 2020-03-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Informing new or improved vector control tools for reducing the malaria burden in Tanzania

    Christina Makungu / Stephania Stephen / Salome Kumburu / Nicodem J. Govella / Stefan Dongus / Zoe Jane-Lara Hildon / Gerry F. Killeen / Caroline Jones

    Malaria Journal, Vol 16, Iss 1, Pp 1-

    a qualitative exploration of perceptions of mosquitoes and methods for their control among the residents of Dar es Salaam

    2017  Volume 18

    Abstract: Abstract Background The effectiveness of malaria prevention with long-lasting insecticidal nets and indoor residual spraying is limited by emerging insecticide resistance, evasive mosquito behaviours that include outdoor biting, sub-optimal ... ...

    Abstract Abstract Background The effectiveness of malaria prevention with long-lasting insecticidal nets and indoor residual spraying is limited by emerging insecticide resistance, evasive mosquito behaviours that include outdoor biting, sub-optimal implementation and inappropriate use. New vector control interventions are required and their potential effectiveness will be enhanced if existing household perceptions and practices are integrated into intervention design. Methods This qualitative descriptive study used focus groups discussions, in-depth interviews and photovoice methods to explore mosquito control perceptions and practices among residents in four study sites in Dar es Salaam, Tanzania. Results Mosquitoes were perceived as a growing problem, directly attributed to widespread environmental deterioration and lack of effective mosquito control interventions. Malaria and nuisance biting were perceived as the main problem caused by mosquitoes. Breeding sites were clearly distinguished from resting sites but residents did not differentiate between habitats producing malaria vector mosquitoes and others producing mostly nuisance mosquitoes. The most frequently mentioned protection methods in the wealthiest locations were bed nets, aerosol insecticide sprays, window screens, and fumigation, while bed nets were most frequently mentioned and described as ‘part of the culture’ in the least wealthy locations. Mosquito-proofed housing was consistently viewed as desirable, but considered unaffordable outside wealthiest locations. Slapping and covering up with clothing were most commonly used to prevent biting outdoors. Despite their utility outdoors, topical repellents applied to the skin were considered expensive, and viewed with suspicion due to perceived side effects. Improving the local environment was the preferred method for preventing outdoor biting. Affordability, effectiveness, availability, practicality, as well as social influences, such as government recommendations, socialization and internalization ...
    Keywords Mosquito ; Malaria ; Community perceptions ; Qualitative ; Photovoice ; Bed net ; Arctic medicine. Tropical medicine ; RC955-962 ; Infectious and parasitic diseases ; RC109-216
    Subject code 360
    Language English
    Publishing date 2017-10-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Mapping infectious disease hospital surge threats to lessons learnt in Singapore

    Shweta R. Singh / Richard Coker / Hubertus J-M Vrijhoef / Yee Sin Leo / Angela Chow / Poh Lian Lim / Qinghui Tan / Mark I-Cheng Chen / Zoe Jane-Lara Hildon

    BMC Health Services Research, Vol 17, Iss 1, Pp 1-

    a systems analysis and development of a framework to inform how to DECIDE on planning and response strategies

    2017  Volume 14

    Abstract: Abstract Background Hospital usage and service demand during an Infectious Disease (ID) outbreak can tax the health system in different ways. Herein we conceptualize hospital surge elements, and lessons learnt from such events, to help build ... ...

    Abstract Abstract Background Hospital usage and service demand during an Infectious Disease (ID) outbreak can tax the health system in different ways. Herein we conceptualize hospital surge elements, and lessons learnt from such events, to help build appropriately matched responses to future ID surge threats. Methods We used the Interpretive Descriptive qualitative approach. Interviews (n = 35) were conducted with governance and public health specialists; hospital based staff; and General Practitioners. Key policy literature in tandem with the interview data were used to iteratively generate a Hospital ID Surge framework. We anchored our narrative account within this framework, which is used to structure our analysis. Results A spectrum of surge threats from combinations of capacity (for crowding) and capability (for treatment complexity) demands were identified. Starting with the Pyramid scenario, or an influx of high screening rates flooding Emergency Departments, alongside fewer and manageable admissions; the Reverse-Pyramid occurs when few cases are screened and admitted but those that are, are complex; during a ‘Black’ scenario, the system is overburdened by both crowding and complexity. The Singapore hospital system is highly adapted to crowding, functioning remarkably well at constant near-full capacity in Peacetime and resilient to Endemic surges. We catalogue 26 strategies from lessons learnt relating to staffing, space, supplies and systems, crystalizing institutional memory. The DECIDE model advocates linking these strategies to types of surge threats and offers a step-by-step guide for coordinating outbreak planning and response. Conclusions Lack of a shared definition and decision making of surge threats had rendered the procedures somewhat duplicative. This burden was paradoxically exacerbated by a health system that highly prizes planning and forward thinking, but worked largely in silo until an ID crisis hit. Many such lessons can be put into play to further strengthen our current hospital governance and ...
    Keywords Infectious disease outbreaks ; Surge capacity and capability ; Health planning and implementation ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2017-09-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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