The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
BMC Health Serv Res. 2020 Jun 17;20(1):551. doi: 10.1186/s12913-020-05367-3.
In an era of increasingly competitive funding, governments and donors will be looking for creative ways to extend and maximise resources. One such means can include building upon professional advice networks to more efficiently introduce, scale up, or change programmes and healthcare provider practices. This cross-sectional, mixed-methods, observational study compared professional advice networks of healthcare workers in eight primary healthcare units across four regions of Ethiopia. Primary healthcare units include a health centre and typically five satellite health posts.
One hundred sixty staff at eight primary healthcare units were interviewed using a structured tool. Quantitative data captured the frequency of healthcare worker advice seeking and giving on providing antenatal, childbirth, postnatal and newborn care. Network and actor-level metrics were calculated including density (ratio of ties between actors to all possible ties), centrality (number of ties incident to an actor), distance (average number of steps between actors) and size (number of actors within the network). Following quantitative network analyses, 20 qualitative interviews were conducted with network study participants from four primary healthcare units. Qualitative interviews aimed to interpret and explain network properties observed. Data were entered, analysed or visualised using Excel 6.0, UCINET 6.0, Netdraw, Adobe InDesign and MaxQDA10 software packages.
The following average network level metrics were observed: density .26 (SD.11), degree centrality .45 (SD.08), distance 1.94 (SD.26), number of ties 95.63 (SD 35.46), size of network 20.25 (SD 3.65). Advice networks for antenatal or maternity care were more utilised than advice networks for post-natal or newborn care. Advice networks were typically limited to primary healthcare unit staff, but not necessarily to supervisors. In seeking advice, a colleague's level of training and knowledge were valued over experience. Advice exchange primarily took place in person or over the phone rather than over email or online fora. There were few barriers to seeking advice.
Informal, inter-and intra-cadre advice networks existed. Fellow primary healthcare unit staff were preferred, particularly midwives, but networks were not limited to the primary healthcare unit. Additional research is needed to associate network properties with outcomes and pilot network interventions with central actors.
在竞争日益激烈的资金时代，政府和捐助者将寻找创造性的方法来延长和最大化资源。一种方法可以包括利用专业建议网络，更有效地引入、扩大或改变方案和医疗保健提供者的做法。本横断面、混合方法、观察性研究比较了埃塞俄比亚四个地区的八个初级保健单位的医疗保健工作者的专业建议网络。初级保健单位包括一个保健中心和通常五个卫星保健站。
使用结构化工具对八个初级保健单位的 160 名工作人员进行了访谈。定量数据捕捉了医疗保健工作者在提供产前、分娩、产后和新生儿护理方面寻求和提供建议的频率。计算了网络和参与者级别的指标，包括密度（参与者之间的联系与所有可能联系的比率）、中心性（与参与者有关的联系数量）、距离（参与者之间的平均步骤数）和大小（网络内的参与者数量）。在进行定量网络分析之后，对来自四个初级保健单位的网络研究参与者进行了 20 次定性访谈。定性访谈旨在解释和解释观察到的网络属性。使用 Excel 6.0、UCINET 6.0、Netdraw、Adobe InDesign 和 MaxQDA10 软件包输入、分析或可视化数据。
观察到以下平均网络级别指标：密度.26（SD.11）、度中心性.45（SD.08）、距离 1.94（SD.26）、联系数 95.63（SD 35.46）、网络规模 20.25（SD 3.65）。产前或产科护理的建议网络比产后或新生儿护理的建议网络使用更频繁。建议网络通常仅限于初级保健单位的工作人员，但不一定限于主管。在寻求建议时，同事的培训和知识水平比经验更受重视。建议交流主要通过当面或电话进行，而不是通过电子邮件或在线论坛进行。寻求建议的障碍很少。
存在非正式的、内部和内部的建议网络。初级保健单位的同事，特别是助产士，是首选的，但网络不限于初级保健单位。需要进一步研究将网络属性与结果联系起来，并对核心参与者进行网络干预试验。
