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Introduction Recent advances in stroke management and care have resulted in improved survival and outcomes. However, providing equitable access to acute care, rehabilitation and longer-term stroke care is challenging. Recent Irish evidence indicates variation in stroke outcomes across hospitals, and a need for continuous audit of stroke care to support quality improvement. The aim of this project is to develop a core minimum dataset for use in the new Irish National Audit of Stroke (INAS), which aims to improve the standard of stroke care in Ireland. This paper outlines the protocol for conducting a scoping review of international practice and guidelines in auditing acute and non-acute stroke care. Objective Identify data items that are currently collected by stroke audits internationally, and identify audit guidelines that exist for recommending inclusion of content in stroke audit datasets. Methods and analysis This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Grey literature will also be searched for relevant materials, as will relevant websites. Study selection and review will be carried out independently by two researchers, with discrepancies resolved by a third. Data charting and synthesis will involve sub-dividing relevant sources of evidence, and synthesising data into three categories: i) acute stroke care; ii) non-acute stroke care; and iii) audit data collection procedures and resourcing. Data will be charted using a standardised form specific to each category. Consultation with knowledge users will be conducted at all stages of the scoping review. Discussion This scoping review will contribute to a larger project aimed at developing an internationally benchmarked stroke audit tool that will be used prospectively to collect data on all stroke admissions in Ireland, encompassing both acute and non-acute data items.

Background HIV-related self-stigma is a significant barrier to HIV management. However, very little research has explored this phenomenon, particularly in sub-Saharan Africa. This study explored the beliefs, experiences, and impacts of HIV self-stigma amongst adolescents and young adults (AYALHIV) in Harare, Zimbabwe to inform future interventions. It aimed to capture the lived experience of self-stigmatization among AYALHIV and its impact on their social context using Corrigan et al (2009) self-stigma framework of ‘awareness’, ‘agreement’, and ‘application’. Methods Virtual semi-structured key informant interviews were conducted between June and July 2020 with adolescents and young adults (Female = 8; Male = 8) living with HIV (18–24 years) in Harare, Zimbabwe. We conducted the interviews with a purposive sample of AYALHIV enrolled in Africaid’s ‘Zvandiri’ program which provides HIV support services. Interviews were mainly conducted in English and with three in Shona, the main indigenous language. Audio-recorded qualitative data were transcribed, translated into English (where necessary) and deductively coded using Corrigan et al.’s self-stigma framework. The outbreak of SARS-CoV-2 coincided with the commencement of data collection activities, which impacted on both the sample size and a shift from in-person to virtual interviewing methods. Results Sixteen respondents (50% male) took part in the interviews. The mean age of respondents was 22 years. All respondents reported HIV-related self-stigma either occasionally or frequently. Three main themes of self-stigmatizing experiences emerged: disclosure, relationships, and isolation. These themes were then analyzed within the self-stigma development framework by Corrigan et al. (2009) known as ‘the three As’: awareness, agreement, and application of self-stigmatizing thoughts. Respondents’ experiences of self-stigma reportedly led to poor well-being and decreased mental and physical health. Gendered experiences and coping mechanisms of self-stigma were reported. Data suggested that context is key in the way that HIV is understood and how it then impacts the way people living with HIV (PLHIV) live with, and experience, HIV. Conclusions HIV-related negative self-perceptions were described by all respondents in this study, associated with self-stigmatizing beliefs that adversely affected respondents’ quality of life. Study findings supported Corrigan et al.’s framework on how to identify self-stigma and was a useful lens through which to understand HIV-related self-stigma among young people in Harare. Study findings highlight the need for interventions targeting PLHIV and AYALHIV to be context relevant if they are to build individual resilience, while working concurrently with socio-political and systemic approaches that challenge attitudes to HIV at the wider societal levels. Finally, the gendered experiences of self-stigma point to the intersecting layers of self-stigma that are likely to be felt by particularly marginalized populations living with HIV and should be further explored.

Introduction Improvements in stroke survival have resulted in increasing numbers of people living with stroke, and with a rapidly evolving evidence-base for stroke prevention and management, there is a need for robust data and evidence to inform future policy decision-making. Population-based modelling and economic evaluation of alternative policy options is a useful tool to support decision making. However, this process must be aligned to key stakeholder priorities. The aim of the proposed research is to engage with stakeholders in Ireland to identify their priorities for the development of stroke prevention and management strategies and policies. Methods The design is iterative, based on mixed methods. Phase 1 involves a qualitative approach for initial priority gathering, based on an open-ended online survey (target sample: 100-120) and interviews (target sample: 34-40). Stakeholders will include: 1) stroke survivors and family member/main carers, 2) healthcare professionals (HCPs) providing stroke care and 3) people working in stroke research, policy and advocacy. These data will be analysed qualitatively, with the aim of identifying a long-list of specific interventions. Phase 2 involves an interim priority setting exercise, based on a quantitative online survey. Participants will be asked to rank the interventions on the initial long-list. These rankings will be used to inform a final priority-setting workshop (Phase 3), where a small stakeholder group will decide on the final set of priorities. Discussion The rich and detailed quantitative and qualitative data, based on the views of diverse stakeholders, will be directly relevant to policy makers and service planners involved in developing and improving stroke care in Ireland. The information provided will also be essential to inform the Scenario and Intervention Modelling in Ireland for Stroke (SIMI-Stroke) project, a population-based economic and epidemiological modelling study aimed at identifying cost-effective interventions for stroke across the prevention, acute and post-acute care continuum.

Background For most people, choice making is an everyday occurrence, but for adults with an intellectual disability (ID), such opportunities are often limited, if not, absent. Defining choice, and related opportunity capacity and supports continue to feature prominently in academic, practice and policy discourse within the field of ID as reflected in the range of measures available. This paper examines the factor analytic properties of an adapted 14-item choice inventory scale. Method Presence and type of choice were recorded in wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing using a choice inventory scale adapted for the Irish context for 753 participants with ID over age 40 years. Analysis included both an exploratory and confirmatory factor analysis. Descriptive statistics on choice by type of living arrangement, type of interview (proxy, self or supported) and level of ID are presented. Results Exploratory factor analysis indicates good model fit when using both a 3-item and 4-item response with the 4-item version suggesting a two-factor model. Further exploration of this two-factor model through confirmatory factor analysis highlighted an improved fit for the 4-item model. Further improvement in model fit is found when four item pairs are co-varied within the model. Conclusion Two broad types of choice were found to exist for adults with ID – everyday decisions and key life decisions. In addition, the factor analysis support for the inclusion of a ‘no choice’ response may help reduce the potential for missing data.

Objectives In order to improve maternal and neonatal outcomes, it is important to understand how to maximise the utilisation of MNCH services. The supply side (service-driven) factors affecting access to MNCH services are more commonly studied and are better understood than the demand side (community led) factors. The aim of this study was to identify demand and supply determinants of access to MNCH services in Malawi. Methods Research was conducted in two districts of the Central Region of Malawi (Nkhotakota & Mchinji). Qualitative interviews (n = 85) and focus group discussions (n = 20) were conducted with a range of community members, leaders and health workers. Data were managed in NVivo (v10) and analysed using framework analysis, using Levesque et al. (2013) access framework. Results Community members clearly recognise their need for and seek out MNCH care from the formal health system. Women experience difficulties reaching health services and when reached find them limited, characterised by many indirect costs. There are many technical and interpersonal deficits, which results in poor satisfaction and reportedly poor outcomes for women. Conclusions for practice Women are seeking and utilising MNCH services which they find under-resourced and unwelcoming. Utilising the Levesque et al. (2013) framework, a granular analysis of demand and supply factors has identified the many challenges that remain to achieving equitable access to MNCH services in Malawi. Community members experience lack of availability, acceptability and appropriateness of these essential services.

Purpose: Exploring the views of those impacted by stroke is key to the design of an effective and appropriate cognitive rehabilitation intervention for post-stroke cognitive impairment. This qualit...

Sex workers are among the most stigmatised people globally, with sex workers in Vietnam being no exception. Self-stigma affects sex workers adversely, harming psychological health and acting as a barrier to seeking health care. To inform programmes and interventions to improve well-being, identifying unhelpful or negative core beliefs may provide the basis from which individuals can be supported. With this in mind, this study aimed to gain the perspective of sex workers in Vietnam on the contexts of their working lives. Data were collected in Hanoi. Fourteen semi-structured interviews were conducted with Vietnamese sex workers over the age of 18 who were working or formerly worked in Vietnam. Data were analysed manually, informed by theoretical models of self-stigma using inductive thematic analysis. The analysis identified negative/unhelpful core beliefs (disclosure, self-stigma and shame, sexuality, sexual pleasure relationships, health care); contextual life circumstances (sex work, violence, traditional education); and coping mechanisms (problem-focused coping, emotion-focused coping). Findings identify the importance of core beliefs in understanding self-stigma, paving the way for programmes and interventions to address self-stigma among sex workers.

Many methodological approaches have been used to understand cultural dimensions to maternal health issues. Although a well-designed quantitative survey with a representative sample can provide essential information on trends in behavior, it does not necessarily establish a contextualized understanding of the complexity in which different behaviors occur. This article addresses how contextualized data can be collected in a short time and under conditions in which participants in conflict-affected zones might not have established, or time to establish, trust with the researchers. The solution, the Participatory Ethnographic Evaluation and Research (PEER) approach, is illustrated through a study whereby South Sudanese marginalized women were trained to design research instruments, and collect and analyze qualitative data. PEER overcomes the problem that many ethnographic or participatory approaches face—the extensive time and resources required to develop trusting relationships with the community to understand the local context and the social networks they form.

Traditional leaders play a prominent role at the community level in Malawi, yet limited research has been undertaken on their role in relation to policy implementation. This article seeks to analyse the role of traditional leaders in implementing national maternal, newborn and child health (MNCH) policy and programmes at the community level. We consider whether the role of the chief embodies a top-down (utilitarian) or bottom-up (empowerment) approach to MNCH policy implementation. Primary data were collected in 2014/15, through 85 in-depth interviews and 20 focus group discussions in two districts in Malawi. We discovered that traditional leaders play a pivotal role in supporting MNCH service utilization, through mobilization for MNCH campaigns, and encouraging women to give birth at the health facility rather than at home or in the community setting. Women and their families responded to bylaws to deliver in the facility out of respect for the traditional leader, which is ingrained in Malawian culture. Fines were imposed on women for delivering at home, in the form of goats, chickens and money. Fear and coercion were often used by traditional leaders to ensure that women delivered at the health facility. Chiefs who failed to enforce these bylaws were also fined. Although the role of the traditional leader was often positive and encouraging in relation to MNCH service utilization, this was sometimes carried out in a coercive manner. Results show evidence of a utilitarian top-down model of policy implementation, where the goal of health service utilization justified the means, through encouragement, fear, punishment or coercion. Although the bottom-up approach would be associated with a more empowerment approach, it is unlikely that this would have been successful in Malawi, given the hierarchical nature of society. Further research on policy implementation in the context of community participation is needed.

Background The internationalisation of higher level education and the profiles - nationalities, ethnicities and cultural identities - of students who migrate to undertake higher level education programmes in a different country are increasingly complex. This article explores the way in which cultural backgrounds impact the student’s experiences of an international medical school, and how these experiences have the potential to inform the development and design of student support services for those students who are not coping well with the transition. Methods Thirty one first year students were interviewed by sixteen second year students who were trained and supervised by an experienced researcher. Three focus group discussions were also held. Results While many international students had lived in more than one country and region and spoke several languages, most reported difficulties in forming intercultural friendships, especially interactions outside of the academic setting. Some of the challenges faced were similar to what has been reported in the literature, such as difficulties with language and loss of established friendship networks. Other challenges to emerge in this study were the complex interrelatedness of the daily life challenges facing international students regarding the forming and importance of intercultural relations, which is impacted by gender, the presence of alcohol, languages spoken (in addition to English, which was the language used for medical education), and the dominance of the regional grouping the student belongs to. Conclusion The challenges of adaptation and intercultural relations are increasing in complexity and it is important for higher level institutions who enrol international students to understand the nature of the pressures these students experience, outside as well as within the academic environment, and to support them in managing these transitions. Electronic supplementary material The online version of this article (10.1186/s12909-019-1514-1) contains supplementary material, which is available to authorized users.

The study’s objective was to determine the educational value of participation in a consultation/liaison psychiatry service to primary care clinics, from the perspective of Malaysian medical undergraduates. A mixed method design was used. Fourth-year medical students participated in a consultation/liaison psychiatry service to two government-operated primary care clinics. Each student attended two half-day consultations to the clinics during the psychiatry clinical clerkship. Students joined in discussions with primary care clinicians, performed supervised clinical assessments, and administered a depression screening instrument. The learning experience was evaluated through four focus groups, each with 9–10 participants, held throughout the academic year. An end-of-year, anonymous, online questionnaire survey was administered to the entire class. Thematic analysis of focus group transcripts was performed and quantitative statistics were calculated (Stata version 13). Focus group themes included the following: (a) active learning opportunities in primary care psychiatry consultation had perceived added educational value, (b) students benefited from contact with patients with previously undiagnosed common mental disorders, and (c) students’ primary care experience raised their awareness of societal and professional responsibilities. Of the class of 113 students, 93 (82%) responded to the questionnaire. The survey responses reflected the qualitative themes, with 79 respondents (85%) stating that the learning experience met or exceeded their expectations. Academic psychiatry has been criticized for its overreliance on secondary care settings in undergraduate clinical teaching. Our findings suggest that supervised clinical placements in primary care are feasible and provide added educational value as a routine component of the undergraduate psychiatry clinical clerkship.

Background For years, Malawi remained at the bottom of league tables on maternal, neonatal and child health. Although maternal mortality ratios have reduced and significant progress has been made in reducing neonatal morality, many challenges in achieving universal access to maternal, newborn and child health care still exist in Malawi. In Malawi, there is still minimal, though increasing, male involvement in ANC/PMTCT/MNCH services, but little understanding of why this is the case. The aim of this paper is to explore the role and involvement of men in MNCH services, as part of the broader understanding of those community system factors. Methods This paper draws on the qualitative data collected in two districts in Malawi to explore the role and involvement of men across the MNCH continuum of care, with a focus on understanding the community systems barriers and enablers to male involvement. A total of 85 IDIs and 20 FGDs were conducted from August 2014 to January 2015. Semi-structure interview guides were used to guide the discussion and a thematic analysis approach was used for data analysis. Results Policy changes and community and health care provider initiatives stimulated men to get involved in the health of their female partners and children. The informal bylaws, the health care provider strategies and NGO initiatives created an enabling environment to support ANC and delivery service utilisation in Malawi. However, traditional gender roles in the home and the male ‘unfriendly’ health facility environments still present challenges to male involvement. Conclusion Traditional notions of men as decision makers and socio-cultural views on maternal health present challenges to male involvement in MNCH programs. Health care provider initiatives need to be sensitive and mindful of gender roles and relations by, for example, creating gender inclusive programs and spaces that aim at reducing perceptions of barriers to male involvement in MNCH services so that programs and spaces that are aimed at involving men are designed to welcome men as full partners in the overall goals for improving maternal, neonatal and child health outcomes. Electronic supplementary material The online version of this article (10.1186/s12884-017-1523-1) contains supplementary material, which is available to authorized users.

Background Maternity referral systems have been under-documented, under-researched, and under-theorised. Responsive emergency referral systems and appropriate transportation are cornerstones in the continuum of care and central to the complex health system. The pathways that women follow to reach Emergency Obstetric and Neonatal Care (EmONC) once a decision has been made to seek care have received relatively little attention. The aim of this research was to identify patterns and determinants of the pathways pregnant women follow from the onset of labour or complications until they reach an appropriate health facility. Methods This study was conducted in Renk County in South Sudan between 2010 and 2012. Data was collected using Critical Incident Technique (CIT) and stakeholder interviews. CIT systematically identified pathways to healthcare during labour, and factors associated with an event of maternal mortality or near miss through a series of in-depth interviews with witnesses or those involved. Face-to-face stakeholder interviews were conducted with 28 purposively identified key informants. Diagrammatic pathway and thematic analysis were conducted using NVIVO 10 software. Results Once the decision is made to seek emergency obstetric care, the pregnant woman may face a series of complex steps before she reaches an appropriate health facility. Four pathway patterns to CEmONC were identified of which three were associated with high rates of maternal death: late referral, zigzagging referral, and multiple referrals. Women who bypassed nonfunctional Basic EmONC facilities and went directly to CEmONC facilities (the fourth pathway pattern) were most likely to survive. Overall, the competencies of the providers and the functionality of the first point of service determine the pathway to further care. Conclusions Our findings indicate that outcomes are better where there is no facility available than when the woman accesses a non-functioning facility, and the absence of a healthcare provider is better than the presence of a non-competent provider. Visiting non-functioning or partially functioning healthcare facilities on the way to competent providers places the woman at greater risk of dying. Non-functioning facilities and non-competent providers are likely to contribute to the deaths of women. Electronic supplementary material The online version of this article (10.1186/s12884-017-1463-9) contains supplementary material, which is available to authorized users.

The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing. An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive. The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme. Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues. Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety.

Background: There is a substantial body of literature on the principles of good partnerships and the rationale for such partnerships in research capacity strengthening. This paper illustrates the long term effects of a multi-country (8 countries) global partnership for health systems research capacity development (Connecting health Research in Africa and Ireland Consortium-ChRAIC) in relation to its contribution to capacity strengthening, public advocacy and policy influence at different levels and its practical achievements in Sudan in addressing access to maternal health services. Methods: The authors (all members of the global partnership) reflect on the project in one of its' partner countries, Sudan, over its' five year duration. This reflection is supported by specific project data collected over the period of the project (2008-2014). The data collected included: (i) 6 monthly and annual donor reports; (ii) a mid-term internal and end of project independent evaluation of the entire project, and; (ii) a Ph.D study conducted by a member of the Sudanese research team. Results: The ChRAIC project in Sudan achieved the deliverables set out at the beginning of the project. These included a national knowledge synthesis report on Sudan's health system; identification of country level health systems research priorities; research capacity assessment and skills training, and; the training and graduation of a Sudanese team member with a Ph. D. Mechanisms established in Sudan to facilitate these achievements included the adoption of culturally sensitive and locally specific research and capacity strengthening methods at district level; the signing of a Memorandum of Understanding at country level between the Ministry of Health, research and academic institutions in Sudan, and; the establishment of country level initiatives and a research unit. The latter being recognized globally through awards and membership in global health forums. Conclusion: We surmise that the 'network of action' approach adopted to partnership formation facilitated the benefits gained, but that adopting such an approach is not sufficient. More local and contextual factors influenced the extent of the benefits and the sustainability of the network.

International students experience multiple and multi-dimensional educational and life transitions: moving to a new country, moving to a new educational system and moving to higher educational degree programmes. Within these transitions, they experience differences in the social and organisational cultures, languages, and interpersonal expectations, realities and relationships. Their transitions also lead to, and interact with, transitions of professionals, home students and their families. Multi-dimensional Transitions of International Students to Higher Education provides up-to-date literature, research and theoretical constructs that underpin international students’ transitions to Higher Education. This book will help you to understand the opportunities, issues, social-emotional-psychological dimensions and evidence-based interventions that are vital to support an individual through these educational and life transitions. Split into four sections, topics include: Theoretical Underpinning Research in Different Contexts Impact of Educational Practice and Social Systems Interventions and Strategies Used to Enhance International Students’ Affective, Behavioural and Cognitive Transition Experiences This book is essential reading for professionals, students and policy makers and provides significant research insights to academics and researchers in the area of education, psychology and sociology.

The greater number of government efforts to stimulate participative governance in communities using Information and Communication Technology (ICT) often fall short of expectations. In South Africa extending e-government to communities has been in the form of more and/or better equipped ICT-enabled community centres, called Thusong Service Centres. In this paper, based on action research experiences, we report outcomes of interpretive research into ICT-enabled approaches to participative governance in communities. Using the Diffusion of Innovations theory as an analytic lens, the findings reveal a subtlety that is not often mentioned in the call for participative e-governance; people from communities prefer to work in groups rather than individually. The collectiveness inclination is a common denominator of many developing countries where people choose to come together to leverage the few available resources. Individuals become apprehensive when made to work on their own using the ICT. The research reveals the necessity to re-design ICT to suit small groups as part of participative e-governance rather than the normative ICT design that suits individual work styles. Additionally, the research reveals that by working in groups, communities are more willing to accept the government initiatives that are being energised with the use of ICT. Methodologically, the research revealed the ethical issue that arises from action research in its raising of unrealistic expectations in a community.

PurposeThe purpose of this paper is to investigate the implementation process of an open source (OS) enterprise management system in the South African Public Sector. Change management was observed in relation to challenges and opportunities in the alignment of the internal organisational changes to the imperatives of the national free and OS software policy.Design/methodology/approachAn interpretive case study, using interviews, observation and document review was used.FindingsAlignment of the organisational environment, change management strategies and technology is required to address many of the “common” change management challenges. However, information and communication technology policies are formed and adopted in a highly complex environment and have embedded property and power relations which impact the nature and direction of their implementation. In this case one of the main challenges arose from the alignment of internal organisational change to a national policy which did not seem to have the full support of the agency which was tasked with implementing it.Originality/valueMany of the challenges faced by the public sector department are commonly described in change management literature, such as inadequate consideration for the social context in which the change was to take place. What emerges from this paper is a caution that there is not a sole voice within government and in a multi‐levelled and multi‐sectoral institution there exist many different rationalities. The internal alignment of the divergent voices within government would be a prerequisite for the organisational environment, change management strategies and technology to be aligned.

PurposeThrough an evaluation of the information technology (IT) adoption and diffusion models and the free and/or open source policy of the South African Government, the underlying assumption is that the developmental divide between those with and those without access to technology is purely technical. This paper aims to illustrate that if Free and/or Open Source Software is to be used as a building block to bridge the “digital divide” a more social and environmental perspective, which embraces the philosophy behind the software, needs to complement the technical perspective. The human environmental model is presented as a useful alternative which, if embraced, can inform more holistic information and communication technology (ICT) policies.Design/methodology/approachThrough a review of diffusion of innovations models an alternative diffusion framework is described and applied to an interpretive open source case study in South Africa.FindingsContemporary diffusion and innovation models are narrowly focused on IT as a purely technological linear phenomenon. This perspective also underlies many ICT policies. A more socio‐technical adoption model can assist in providing a more holistic approach to ICT policy development.Originality/valueThe application of a new innovation model, the human environmental model, to ICT policy provides a holistic framework in which the complexity of the innovation process can be reflected in policy. Such an approach to ICT policy formulation will assist with broadening the perspective of policy makers from IT as a technical solution to IT as part of a socio‐technical solution and recognise the duality of the innovation process.

In this paper, the role of participation within the domains of information system (IS) research and social development is analyzed. Specifically, we examine how the process of IS development, and the IS itself, can reflect and shape the status of social development. Traditionally, participatory design (PD) research in IS has focused on business contexts in the Western world, with minimal application to developing country settings, especially in the context of social development. This paper seeks to contribute to developing these understandings and bases its analysis on a case study of a community-based health IS in South Africa. The case study involved the design and development of a community-based child health IS in a rural area of South Africa. Nationally, the formal district health 1S in South Africa includes data only on those people who access health services through the health facilities. The premise behind developing a community-based child health IS was to include all the people living in that district in the district health 1S. Analysis of the case study reveals three ways in which traditional PD needs reconceptualization. First, it is not only the users of the IS who should participate, but also those individuals who are affected by the IS, even when those individuals have no direct interaction with the system itself. Second, whereas there is some recognition in PD literature of the need for the participation of people at different levels vertically distributed within an organization, there has been little recognition of the value of involving actors outside the organization or sector. Third, the capacity of the users and those impacted by the system needs to be developed to ensure effective participation in the IS design and development processes. These three approaches to PD in IS, whose purpose is to contribute to social development, are essential components of a participatory strategy.

Background: Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. Discussion: Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. Summary: We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

Background Interviewing is one of the main methods used for data collection in qualitative research. This paper explores the use of semi-structured interviews that were conducted by students with other students in a research study looking at cultural diversity in an international medical school. Specifically this paper documents and gives ‘voice’ to the opinions and experiences of interviewees and interviewers (the peers and the communities) on the value of peer interviewing in the study and outlines (1) the preparation made to address some of the foreseen challenges, (2) the challenges still faced, and (3) the benefits of using peer interviews with respect to the research study, the individual and the institution. Methods Peer interviewing was used as part of a two-year phased-study, 2012–2013, which explored and then measured the impact of cultural diversity on undergraduate students in a medical higher education institution in Ireland. In phase one 16 peer interviewers were recruited to conduct 29 semi-structured interviews with fellow students. In order to evaluate the peer interviewing process two focus group discussions were he ld and an online survey conducted. Results Key findings were that substantial preparations in relation to training, informed consent processes and addressing positionality are needed if peer-interviewing is to be used. Challenges still faced included were related to power, familiarity, trust and practical problems. However many benefits accrued to the research, the individual interviewer and to the university. Conclusions A more nuanced approach to peer interviewing, that recognises commonalities and differences across a range of attributes, is needed. While peer interviewing has many benefits and can help reduce power differentials it does not eliminate all challenges. As part of a larger research project and as a way in which to get ‘buy-in’ from the student body and improve a collaborative research partnership peer interviewing was extremely useful.

There is a need to look beyond the immediate process of implementation of computerized information systems to understand the broader social context in which the information and communication technology is being implemented. Using an interpretive approach to the implementation of a computerized health information system in a rural district in Mozambique we reconstruct an important aspect of this context from our interviews and observations--how the process of collective identity formation and information systems implementation are interconnected. Using this understanding of collective identity, we emphasize the importance of communication and shared meanings in developing and extending the primary health care network and in the successful implementation of a computerized health information system.

Governments in developing countries (DC) are constantly under pressure to achieve participatory governance using Information and Communication Technology (ICT). Although many articles have appeared that clearly underscore the potential of ICT to achieve participatory governance, e-governance, most are focused on how e-governance will lead to democratic reforms. It is hard to find articles that consider how e-governance makes administrative decision-making more efficient. Administrative decision-making refers to the continual process through which government administrators make fair, impartial and just decisions. This paper based on interpretive field research experiences from South Africa proposes an ICT facilitated decision-making approach between government administrators and DC communities for participatory e-governance. The findings make a contribution to government practice and to the Information Systems field of e-governance. For government practice, the theoretically informed approach indicates encouraging results for participatory feedback on existing government services and for strengthening communication channels and capabilities during the process of reaching mutually agreeable decisions with DC communities. For e-governance, the paper proposes an approach that considers the greater antecedents of the occasional democratic participation, the essential day-to-day necessity of administrative decision-making using ICT.

International audience; Information Systems (IS) researchers are increasingly calling for contextual approaches to Information and Communication Technologies (ICT) innovations [1]. The call proceeds from the realization that ICT and e-government policies are often adopted and developed with a blind focus on the ICT artifact, and with little reflection on the contribution of ICT to the context [2]. This paper emanates from an ethnographic study that investigated how ICT can facilitate government policy implementation in a development context. The study found it necessary to understand the role of tradition and its potential influence on ICT implementations in South Africa. The paper reviews the context of the South African government and its conspicuous inclination to the way of life, Ubuntu. Ubuntu is growing in popularity and is increasingly being applied as an African solution to African problems such as poverty, political strife and trade. Using Grounded Theory analysis, the findings revealed the critical importance of ICT not threatening tradition but rather complementing it, the role that ICT could play in enabling or enhancing community assemblies, and the marginalized role of women citing how ICT might be used as a means to empower rather than marginalize women even further. We conclude that e-government needs to be re-conceptualized in South Africa for a more culturally acceptable and relevant approach to the use of ICT innovations for development.

In 2005, the clinical director of the Batho Pele clinic1 in the Gauteng province in South Africa requested the assistance of the Department of Informatics at the University of Pretoria in addressing their IS issues. This request fitted the department’s research interests in health information systems (HIS), as well the broader research focus and commitment to provide outreach services to the community. Knowing the problems of commencing projects without having planned for sustainability and scalability, the HIS research group elected to use the “networks of action” concept to partner and collaborate with the various role players, institutions, and other ART entities. This process of developing interconnecting networks of human and nonhuman entities in South Africa and beyond its borders raised a number of opportunities, challenges, and tensions in initiating this project. To provide a background to this process, the next section introduces the concept of “networks of action” and a brief description of the ART clinic. The following section develops the main focus of this chapter, which is the process of developing these networks. The last section suggests the necessity of developing networks of action as a future trend for sustainable IS.

Purpose – Through an evaluation of the information technology (IT) adoption and diffusion models and the free and/or open source policy of the South African Government, the underlying assumption is that the developmental divide between those with and those without access to technology is purely technical. This paper aims to illustrate that if Free and/or Open Source Software is to be used as a building block to bridge the “digital divide” a more social and environmental perspective, which embraces the philosophy behind the software, needs to complement the technical perspective. The human environmental model is presented as a useful alternative which, if embraced, can inform more holistic information and communication technology (ICT) policies.Design/methodology/approach – Through a review of diffusion of innovations models an alternative diffusion framework is described and applied to an interpretive open source case study in South Africa.Findings – Contemporary diffusion and innovation models are narrow...

1 : abstract In changing the context regarding the situation of vulnerable children in rural South Africa, understanding the role of communication in the design of community-based child health information systems (HIS) is key. Communication goes beyond language. The importance of translation of terms and concepts used to negotiate between different meanings and logics is explored in this paper. In striving for the 'ideal speech situation' (J. Habermas, Struc- tural Transformation of the Public Sphere, The MIT Press, Cambridge, MA, 1989), or, in other words, creating an enabling environment in which people can participate in debate and discussion on equal terms, there is a need to develop a codetermined vision; to understand local meanings of and for childhood illness; to understand communication systems and the context in which they occur; and to connect with networks beyond the localised set- ting, such as provincial or national health authorities. We provide a theoretical and practical framework in which important aspects of communication related to IS design can be high- lighted and against which the implementation of an IS can be reviewed. The South African case study from the UThukela District Child Survival Project in KwaZulu-Natal, illustrates how this approach was used in co-constructing local meanings for child health indicators in a community-based information system.

It is generally considered the ethical option to consult with the end users and other stakeholders when developing business Information Systems or conducting research in the IS discipline, whether with the express intention of empowering them or simply to include multiple points of view. This is also the 'smart' option as it is a way to improve the probability that the system will be useful, usable, and hence used. There are significant similarities between participants who are employees in an organisation for whom the system is being developed or researched and the case where the system is intended to benefit the public and hence the participants are members of civil society. However, there are ethical concerns regarding participatory research in IS that are more pronounced or have somewhat different aspects in community-based IS than in business IS. Conventional social science research ethics include codes which are largely based on four principles: informed consent; absence of deception; privacy and confidentiality, and; accuracy. However, as most of the literature on participatory research is westernised and based on traditional business IS, there is little discussion on ethical participation in community settings. Numerous different issues arise in such settings and are discussed in the paper. These include the need: to clearly define the roles and functions of the participants; to understand the nature of power sharing between participants; to take cognisance of the cost versus gains from participation; to be aware of domination in decision making; to understand local meaning; to develop the capacity to participate, and; to consider divergent expectations of participants. The previous experience of both authors support these arguments and discussion in this paper, but the objective of the paper is to present a conceptual research methodology discussion rather than an empirical research paper

This paper describes a conscious attempt to use metaphor to both promote and reinterpret ideas and values from the global free and open source software movement in the context of South Africa. A case study is given of an initiative launched by the South African Council for Industrial and Scientific Research to stimulate awareness and promote the use of free and open source software in South Africa and the region. The new Open Source Center made use of an African language metaphor to relate the concept of shared intellectual property in software to traditional communal land management. Whereas Western metaphors are commonly used in the field of organizational studies and Information Systems to facilitate meaning, the deliberate use of an African language metaphor to describe software systems is less common (even in Africa). This paper provides a background as to why such a metaphor was chosen as well as some reflection on its effectiveness.

Information systems development uses many different approaches and methodologies, such as soft systems methodology, to assist in the process of development and in the design of more successful information systems. However, many of these methodologies define information systems narrowly and fail to adequately take the larger contextual work environment into account. Activity Theory is a tool, borrowed from the field of psychology and development work research, which facilitates a more holistic view to be adopted by information systems practitioners and developers. In this paper Activity Theory, or more precisely the Activity Analysis and Development (ActAD) model, is used as an analytical tool in the design and development of an information system for an anti-retroviral treatment (ART) clinic in South Africa. The usefulness of applying the ActAD model is shown in this case study which focused on the investigation and observation of the quality of data and its use for decision support in the ART clinic. In addressing the question 'Does Activity Theory assist in highlighting challenges faced by the ART clinic with their current IS and assist in representing what users require from an IS?' we established the usefulness of the ActAD model in four areas. These included the identification of: the need for change; viewing information systems as part of the work activity; recognising the role of different stakeholders, and; the need for on-going support. We conclude that Activity Theory is a useful tool for information systems development and in particular the ActAD model is a tool which enables a more holistic approach to be taken in information systems development.

Participatory approaches to information systems design have evolved over approximately the last three decades, mainly in Scandinavia, Europe, and lately in the US. However there has been limited and peripheral research and debates over participatory design approaches and techniques in developing country settings. This paper explores three case studies in developing countries where participatory approaches have been used in the design and implementation of health information systems. The investigation reveals the politics of design, the nature of participation, and the methods, tools and techniques for carrying out design projects are shaped with respect to the diversity of the socio-economic, cultural and political situations faced in each of these settings. Though common strategies, such as capacity development, could be found that cut across the three case studies it is the importance of the contextual nature of participatory design that emerges most strongly. There is no single algorithmic best practice regarding participatory design in information systems which is applicable to all situations.

BACKGROUND: With the recognition of the need for research capacity strengthening for advancing health and development, this research capacity article explores the use of technology enhanced learning in the delivery of a collaborative postgraduate blended Master's degree in Malawi. Two research questions are addressed: (i) Can technology enhanced learning be used to develop health research capacity?, and: (ii) How can learning content be designed that is transferrable across different contexts? METHODS: An explanatory sequential mixed methods design was adopted for the evaluation of technology enhanced learning in the Masters programme. A number of online surveys were administered, student participation in online activities monitored and an independent evaluation of the programme conducted. RESULTS: Remote collaboration and engagement are paramount in the design of a blended learning programme and support was needed for selecting the most appropriate technical tools. Internet access proved problematic despite developing the content around low bandwidth availability and training was required for students and teachers/trainers on the tools used. Varying degrees of engagement with the tools used was recorded, and the support of a learning technologist was needed to navigate through challenges faced. CONCLUSION: Capacity can be built in health research through blended learning programmes. In relation to transferability, the support required institutionally for technology enhanced learning needs to be conceptualised differently from support for face-to-face teaching. Additionally, differences in pedagogical approaches and styles between institutions, as well as existing social norms and values around communication, need to be embedded in the content development if the material is to be used beyond the pilot resource-intensive phase of a project.

Background Understanding what determines family size is crucial for programmes that aim to provide family planning services during and after conflicts. Recent research found that development agents in post conflict settings do not necessarily take time to understand the context adequately, translate their context understanding into programming, or adjust programming in the light of changes. South Sudan, a country that has been suffering from war for almost 50 years, has one of the highest maternal death rates and the lowest contraceptive utilization rates in the world. Methods This research used Participatory Ethnographic Evaluation and Research (PEER) to provide a contextualised understanding of social and traditional practices and their implications for family planning. Fourteen women were recruited from 14 villages in Renk County in South Sudan in the period 2010–2012. They were trained to design research instruments, conduct interviews, collect narratives and stories and analyse data to identify, prioritize and address their maternal health concerns. Results As a result of wars, people are under pressure to increase their family sizes and thus increase the nation’s population. This is to compensate for the men perished in war and the high child death rates. Large family size is regarded as a national obligation. Women are caught up in a vicious cycle of high fertility and a high rate of child mortality. Determinants of large family size include: 1) Social and cultural practices, 2) Clan lineage and 3) Compensation for loss of family members. Three strategies are used to increase family size: 1) Marry several women, 2) Husbands taking care of women, and 3) Financial stability. Consequences of big families include: 1) Financial burden, 2) Fear of losing children, 3) Borrowing children and 4) Husband shirking responsibility. Conclusion The desire to have a big family will remain in South Sudan until families realise that their children will live longer, that their men will not be taken by the war, and that the costs of living will be met. In order to generate demand for family planning in South Sudan, priority should be given first to improve infant and child health.

Fair publication of qualitative research in health systems : a call by health policy and systems researchers

Background Despite the recognition of power as being central to health research collaborations between high income countries and low and middle income countries, there has been insufficient detailed analysis of power within these partnerships. The politics of research in the global south is often considered outside of the remit of research ethics. This article reports on an analysis of power in north–south public health research, using Zambia as a case study. Methods Primary data were collected in 2011/2012, through 53 in-depth interviews with: Zambian researchers (n = 20), Zambian national stakeholders (n = 8) and northern researchers who had been involved in public health research collaborations involving Zambia and the global north (n = 25). Thematic analysis, utilising a situated ethics perspective, was undertaken using Nvivo 10. Results Most interviewees perceived roles and relationships to be inequitable with power remaining with the north. Concepts from Bourdieu’s theory of Power and Practice highlight new aspects of research ethics: Northern and southern researchers perceive that different habituses exist, north and south - habituses of domination (northern) and subordination (Zambian) in relation to researcher relationships.Bourdieu’s hysteresis effect provides a possible explanation for why power differentials continue to exist. In some cases, new opportunities have arisen for Zambian researchers; however, they may not immediately recognise and grasp them.Bourdieu’s concept of Capitals offers an explanation of how diverse resources are used to explain these power imbalances, where northern researchers are often in possession of more economic, symbolic and social capital; while Zambian researchers possess more cultural capital. Conclusions Inequities and power imbalances need to be recognised and addressed in research partnerships. A situated ethics approach is central in understanding this relationship in north–south public health research.