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The use of reliable and valid tools to evaluate theory-based health interventions is widely accepted as critical to the behavioral sciences. However, quite often the psychometric properties of survey instruments used to evaluate behavioral interventions are not published, limiting our understanding of how the theory works. The purpose of this study was to present the results of psychometric analyses on measures used to evaluate an HIV/AIDS prevention program for youth in Tanzania. We first began by pilot-testing a self-administered questionnaire with sixth and seventh-grade students in nine schools in 11 villages throughout the Kahe ward of Tanzania (n = 524). Theory-based scales tapped into intrapersonal, social and attitudinal factors. Reliability was evaluated by examining internal consistency, while validity was determined by examining content, construct and discriminant validities. The results indicate that the scales constructed are reasonably reliable and valid measures. Use of these measures should be considered when designing, implementing, and analyzing interventions targeting youth in sub-Saharan Africa.

Adherence to medical protocol (quality) is low in most developing countries. We show that, although the differences in knowledge of protocol among doctors in Arusha region of Tanzania are explained by years of training, the differences in actual adherence to protocol and the gap between knowledge and actual adherence are best understood by examining the types of organizations in which these doctors work. These results suggest that some organizations are better at getting doctors to perform at capacity and that understanding the link between organizational structure and protocol adherence is important in any attempt to increase the quality of care. (Contains 3 tables, 1 figure and 6 footnotes.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.06.003 Byline: Kenneth Leonard (a), Melkiory C. Masatu (b) Keywords: Tanzania; Hawthorne effect; Out patient department quality evaluation; Audit and feedback Abstract: We examine the evidence that the behavior of clinicians is impacted by the fact that they are being observed by a research team. Data on the quality of care provided by clinicians in Arusha region of Tanzania show a marked fall in quality over time as new patients are consulted. By conducting detailed interviews with patients who consulted both before and after our research team arrived we are able to show strong evidence of the Hawthorne effect. Patient-reported quality is steady before we arrive, rises significantly (by 13 percentage points) at the moment we arrive and then falls steadily thereafter. We show that quality after we arrive begins to look similar to quality before we arrived between the 10th and 15th consultations. Implications for quality measurement and policy are discussed. Author Affiliation: (a) Department of Agricultural Economics, University of Maryland, 2200 Symons Hall, College Park, MD 20742, USA (b) Centre for Educational Development in Health, Arusha, Tanzania

This paper reports the results of a comparison between two different methods of examining quality in outpatient services in a developing country. Data from rural and urban Tanzania are used to compare the measures of quality collected by direct clinician observation (DCO) (where clinicians are observed in the course of their normal consultations) and vignettes (unblind case studies with an actor). The vignettes are shown to exhibit a strong connection between the inputs provided during consultation (rational history taking, physical examination and health education) and the ability of the clinician to properly diagnose the presented illness. However, the inputs provided in vignettes are not well correlated with the inputs provided in DCO, suggesting that the inputs provided in the vignette are not well correlated with the inputs that would be provided in an actual consultation. We conclude that since vignettes do not appear to be measuring what would be provided in an actual consultation they are not a good measure of quality. Instead, we suggest that vignettes and DCO be used simultaneously. We show how the scores obtained using vignettes in conjunction with DCO can be used to improve the reliability of DCO and therefore our estimates of actual clinician quality. Keywords: Direct clinician observation; Vignettes; Health services quality; Tanzania

Abstract Background Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania. Methods A cross-sectional survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. Results About 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. Conclusion Adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools.

How do international organizations (IOs) affect access to social services for refugees and host country nationals during humanitarian crises? We explore the quality of care received by Syrian refugees and Lebanese nationals in Lebanese health facilities using data from original surveys in a nationally representative sample of health centers. Given its importance as a site of interactions with host country nationals, health is a key arena for studying local behavior toward refugees. Much research on refugees and intergroup relations suggests that Syrians would receive inferior services, yet other approaches would predict equitable treatment, whether due to intrinsic or extrinsic motivations. We find no difference in the quality of care for Syrians and Lebanese and argue that the comparatively equitable treatment of refugees stems from incentives from IOs at both the organizational and individual levels—a phenomenon we call the "IO effect." The study advances research on IOs and humanitarian crises by focusing on behavior and not only attitudes toward refugees and by highlighting the role of IOs in shaping the experience of everyday life for refugees. [ABSTRACT FROM AUTHOR]

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An author index of contributors to the publication is presented.

Copyright of Dirasat: Educational Sciences is the property of University of Jordan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation. [ABSTRACT FROM AUTHOR]