Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
Nuffield Department of Medicine, University of Oxford, Oxford, UK.
BMJ Open. 2023 Mar 13;13(3):e066150. doi: 10.1136/bmjopen-2022-066150.
The informal social ties that health workers form with their colleagues influence knowledge, skills and individual and group behaviours and norms in the workplace. However, improved understanding of these 'software' aspects of the workforce (eg, relationships, norms, power) have been neglected in health systems research. In Kenya, neonatal mortality has lagged despite reductions in other age groups under 5 years. A rich understanding of workforce social ties is likely to be valuable to inform behavioural change initiatives seeking to improve quality of neonatal healthcare.This study aims to better understand the relational components among health workers in Kenyan neonatal care areas, and how such understanding might inform the design and implementation of quality improvement interventions targeting health workers' behaviours.
We will collect data in two phases. In phase 1, we will conduct non-participant observation of hospital staff during patient care and hospital meetings, a social network questionnaire with staff, in-depth interviews, key informant interviews and focus group discussions at two large public hospitals in Kenya. Data will be collected purposively and analysed using realist evaluation, interim analyses including thematic analysis of qualitative data and quantitative analysis of social network metrics. In phase 2, a stakeholder workshop will be held to discuss and refine phase one findings.Study findings will help refine an evolving programme theory with recommendations used to develop theory-informed interventions targeted at enhancing quality improvement efforts in Kenyan hospitals.
The study has been approved by Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/241/4374) and Oxford Tropical Research Ethics Committee (OxTREC 519-22). Research findings will be shared with the sites, and disseminated in seminars, conferences and published in open-access scientific journals.
卫生工作者与其同事之间形成的非正式社会关系会影响工作场所中的知识、技能以及个人和群体行为和规范。然而，在卫生系统研究中，人们对劳动力的这些“软件”方面（例如关系、规范、权力）的理解有所欠缺。在肯尼亚，尽管其他 5 岁以下年龄段的新生儿死亡率有所下降，但新生儿死亡率仍居高不下。深入了解劳动力的社会关系，对于为改善新生儿保健质量而寻求行为改变措施的工作来说，可能是非常有价值的。本研究旨在更好地了解肯尼亚新生儿护理领域卫生工作者之间的关系构成，以及这种了解如何为针对卫生工作者行为的质量改进干预措施的设计和实施提供信息。
我们将分两个阶段收集数据。在第一阶段，我们将在肯尼亚的两家大型公立医院中，对患者护理和医院会议期间的医院工作人员进行非参与式观察、对工作人员进行社会网络问卷调查、深入访谈、关键知情人访谈和焦点小组讨论。将有针对性地收集数据，并使用现实主义评估进行分析，包括对定性数据的主题分析和对社会网络指标的定量分析。在第二阶段，将举行利益攸关方研讨会，讨论和完善第一阶段的发现。研究结果将有助于完善不断发展的方案理论，并提出建议，用于制定针对肯尼亚医院的以理论为依据的干预措施，以增强质量改进工作。
该研究已获得肯尼亚医学研究所（KEMRI/SERU/CGMR-C/241/4374）和牛津热带研究伦理委员会（OxTREC 519-22）的批准。研究结果将与各机构共享，并通过研讨会、会议和发表在开放获取的科学期刊上进行传播。
