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Publications (10 of 49) Show all publications
Finkle, C., Bai, Y., Chandra-Mouli, V., O'Keefe, S., Tetui, M., Fischer, S., . . . Ohkubo, S. (2024). The Challenge Initiative: lessons on rapid scale-up of family planning and adolescent and youth sexual and reproductive health services. Global health, science and practice, 12(Supplement 2), Article ID e2400153.
Open this publication in new window or tab >>The Challenge Initiative: lessons on rapid scale-up of family planning and adolescent and youth sexual and reproductive health services
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2024 (English)In: Global health, science and practice, E-ISSN 2169-575X, Vol. 12, no Supplement 2, article id e2400153Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Johns Hopkins University Press, 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-225490 (URN)10.9745/GHSP-D-24-00153 (DOI)001229845900008 ()38772721 (PubMedID)2-s2.0-85194019921 (Scopus ID)
Available from: 2024-06-10 Created: 2024-06-10 Last updated: 2024-06-10Bibliographically approved
Nanyonjo, A., Nelson, D., Sayers, E., Lall, P., Vernon-Wilson, E., Tetui, M., . . . Siriwardena, N. (2023). Community efforts to promote vaccine uptake in a rural setting: a qualitative interview study. Health Promotion International, 38(4), Article ID daad088.
Open this publication in new window or tab >>Community efforts to promote vaccine uptake in a rural setting: a qualitative interview study
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2023 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 38, no 4, article id daad088Article in journal (Refereed) Published
Abstract [en]

Vaccine hesitancy has been identified as one of the top 10 threats to global health. The causes of low vaccine uptake are many and vary at micro and macro levels. However, rural and remote coastal areas in the UK experience unique vaccine inequalities due to high levels of deprivation and their unique and complex access-related problems. This study aimed to explore community efforts to promote vaccine uptake during the COVID-19 pandemic and understand how the COVID-19 vaccination campaign was experienced by the public. We conducted an exploratory descriptive qualitative study using semi-structured interviews with decision-makers, health professionals and community members in Lincolnshire, a predominantly rural county with a long coastline, a large population of white minority ethnicities, and those living in caravan and temporary housing. Data were analysed using conventional content analysis. Overcoming the various access barriers to vaccination uptake involved working with local media stations, local communities and local community groups, translation of information, bringing vaccines closer to the people through pop-up and mobile clinics and provision of transport and ensuring confidentiality. There is a need to employ inclusive targeted non-conventional care interventions whilst dealing with complex problems as occur in rural and remote coastal regions.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
coastal health, COVID-19 vaccines, qualitative, rural health services, vaccine hesitancy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-212834 (URN)10.1093/heapro/daad088 (DOI)37549195 (PubMedID)2-s2.0-85166783242 (Scopus ID)
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2023-08-16Bibliographically approved
Tetui, M., Tennant, R., Adil, M., Bala, A., Burns, C., Waite, N. & Grindrod, K. (2023). "Flying a plane and building it at the same time": Lessons learned from the dynamic implementation of mass vaccination clinics in the Region of Waterloo, Ontario, Canada. Health Research Policy and Systems, 21(1), Article ID 102.
Open this publication in new window or tab >>"Flying a plane and building it at the same time": Lessons learned from the dynamic implementation of mass vaccination clinics in the Region of Waterloo, Ontario, Canada
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2023 (English)In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 21, no 1, article id 102Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Vaccination plays a critical role during pandemics, and mass vaccination clinics are often an imperative public health measure. These clinics usually consist of multi-disciplinary teams, which can pose significant coordination challenges, yet also present an opportunity for collectively contributing towards mitigating the impact of infection within communities. This study explores the coordination dynamics of the Region of Waterloo's coronavirus disease of 2019 (COVID-19) mass vaccination clinics in Ontario, Canada, between July 2021 and April 2022.

METHODS: This qualitative study included 16 purposively selected participants working in mass vaccination clinics. Participants were individually interviewed for 40-60 min. An inductive and iterative thematic analysis was undertaken, including open coding, grouping, labelling, regrouping and making sense of the themes.

RESULTS: Three interrelated themes were created: (1) unpredictable work environment, which was comprised of changing clinic processes and the impact of clinic adjustments to the running of the clinics; (2) clinic cohesion challenges, which included staff role disparities, limited job preparation and clinic system silos; and (3) adaptable and supportive work environment, which was comprised of staff adaptability, dispositional flexibility and a supportive work environment. While the first two themes created a precarious situation in the clinics, the third countered it, leading to a largely successful clinic implementation.

CONCLUSIONS: The rapid evolution and high transmissibility of COVID-19 in communities required a public health response that felt like flying and building a plane simultaneously - a seemingly impossible yet necessary task. However, an adaptable and supportive work environment was critical for establishing an atmosphere that can overcome challenges from a constantly changing pandemic and the guidance of public health officials. Such lessons gained from understanding the dynamic experiences in mass vaccination clinics are essential for improving the development and operation of future immunization campaigns.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Adaptable, COVID-19 pandemic, Dynamic implementation, Mass vaccination clinics, Multi-disciplinary teams, Rapid evolution, Unpredictable
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-215276 (URN)10.1186/s12961-023-01036-z (DOI)37784061 (PubMedID)2-s2.0-85173063301 (Scopus ID)
Available from: 2023-10-17 Created: 2023-10-17 Last updated: 2023-10-17Bibliographically approved
Tennant, R., Tetui, M., Grindrod, K. & Burns, C. M. (2023). Multi-diciplinary design and implementation of a mass vaccination clinic mobile application to support decision-making. IEEE Journal of Translational Engineering in Health and Medicine, 11, 60-69
Open this publication in new window or tab >>Multi-diciplinary design and implementation of a mass vaccination clinic mobile application to support decision-making
2023 (English)In: IEEE Journal of Translational Engineering in Health and Medicine, E-ISSN 2168-2372, Vol. 11, p. 60-69Article in journal (Refereed) Published
Abstract [en]

Mass vaccination clinics are complex systems that combine professionals who do not typically work together. Coordinating vaccine preparation and patient intake is critically important to maintain patient flow equilibrium, requiring continuous communication and shared decision-making to reduce vaccine waste.

Objectives: (1) To develop a mobile application (app) that can address the information needs of vaccination clinic stakeholders for end-of-day doses decision-making in mass immunization settings; and (2) to understand usability and clinical implementation among multi-disciplinary users.

Methods: Contextual inquiry guided 71.5 hours of observations to inform design characteristics. Rapid iterative testing and evaluation were performed to validate and improve the design. Usability and integration were evaluated through observations, interviews, and the system usability scale.

Results: Designing the app required consolidating contextual factors to support information and workload needs. Twenty-four participants used the app at four clinics who reported its effectiveness in reducing stress and improving communication efficiency and satisfaction. They also discussed positive workflow changes and design recommendations to improve its usefulness. The average system usability score was 87 (n=22).

Discussion: There is significant potential for mobile apps to improve workflow efficiencies for information sharing and decision-making in vaccination clinics when designed for established cultures and usability, thereby providing frontline workers with greater time to focus on patient care and immunization needs. However, designing and implementing digital systems for dynamic settings is challenging when healthcare teams constantly adapt to evolving complexities. System-level barriers to adoption require further investigation. Future research should explore the implementation of the app within global contexts.

Place, publisher, year, edition, pages
IEEE, 2023
Keywords
Decision support systems, human factors, mass vaccination clinics, mobile applications, usability testing
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-202014 (URN)10.1109/JTEHM.2022.3224740 (DOI)000928393000001 ()36654771 (PubMedID)2-s2.0-85144077582 (Scopus ID)
Available from: 2022-12-29 Created: 2022-12-29 Last updated: 2023-03-15Bibliographically approved
Tetui, M., Tennant, R., Patten, A., Giilck, B., Burns, C. M., Waite, N. & Grindrod, K. (2023). Role satisfaction among community volunteers working in mass COVID-19 vaccination clinics, Waterloo Region, Canada. BMC Public Health, 23(1), Article ID 1199.
Open this publication in new window or tab >>Role satisfaction among community volunteers working in mass COVID-19 vaccination clinics, Waterloo Region, Canada
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2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 1199Article in journal (Refereed) Published
Abstract [en]

Introduction: Unpaid community volunteers are a vital public health resource in times of crisis. In response to the COVID-19 pandemic, community volunteers were mobilized to support mass vaccination efforts in many countries. To have this group’s continued engagement, it is essential to understand the community volunteer experience, including the opportunities and challenges they encounter and how these contribute to their role satisfaction. This qualitative study investigated the factors contributing to community volunteers’ role satisfaction at COVID-19 mass vaccination clinics in the Region of Waterloo, Canada.

Methods: Qualitative data were analyzed from 20 volunteers (aged 48–79 years) who had worked at one of four COVID-19 vaccination clinics in the Region of Waterloo, Canada. Data were analyzed thematically using an inductive coding process followed by an iterative process of grouping and identifying linkages and relationships within the themes.

Results: Four interrelated themes were developed from the inductive analysis process. The theme of community volunteers feeling valued or disesteemed in their role depends on the interaction between the three themes of role description, role preparation, and clinic context.

Conclusions: For volunteers in crises such as the COVID-19 pandemic, volunteer role satisfaction depends on how their contributions are valued, the clarity of their role descriptions, volunteer-specific training, and the sentiments of volunteers and staff within the clinic context. Greater role satisfaction can help with retention as volunteers become more resilient and adaptable to the complex dynamic circumstances of a crisis response. Activities such as training and materials development for role preparations should be explicitly planned and well-resourced, even in crisis/pandemic situations. Building clinic managers’ or supervisors’ skills in communication during crisis/pandemic situations and the skills for the creation of team cohesion are critical investment areas.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
COVID-19 mass vaccination, Pandemic, Public health, Role satisfaction, Unpaid community volunteers, Volunteering in emergencies
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-211984 (URN)10.1186/s12889-023-15597-9 (DOI)37344794 (PubMedID)2-s2.0-85163089167 (Scopus ID)
Available from: 2023-07-12 Created: 2023-07-12 Last updated: 2023-08-28Bibliographically approved
AlShurman, B. A., Tetui, M., Nanyonjo, A., Butt, Z. A., Waite, N. M., Vernon-Wilson, E., . . . Grindrod, K. (2023). Understanding the COVID-19 vaccine policy terrain in Ontario Canada: a policy analysis of the actors, content, processes, and context. Vaccines, 11(4), Article ID 782.
Open this publication in new window or tab >>Understanding the COVID-19 vaccine policy terrain in Ontario Canada: a policy analysis of the actors, content, processes, and context
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2023 (English)In: Vaccines, E-ISSN 2076-393X, Vol. 11, no 4, article id 782Article in journal (Refereed) Published
Abstract [en]

(1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework.

(2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context.

(3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities.

(4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
Canada, COVID-19 vaccination policies, health policy, Ontario, policy analysis, policy triangle framework
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-207873 (URN)10.3390/vaccines11040782 (DOI)000978188900001 ()37112694 (PubMedID)2-s2.0-85153732500 (Scopus ID)
Available from: 2023-05-09 Created: 2023-05-09 Last updated: 2023-09-05Bibliographically approved
Vernon-Wilson, E., Tetui, M., Nanyonjo, A., Adil, M., Bala, A., Nelson, D., . . . Grindrod, K. (2023). Unintended consequences of communicating rapid COVID-19 vaccine policy changes: a qualitative study of health policy communication in Ontario, Canada. BMC Public Health, 23(1), Article ID 932.
Open this publication in new window or tab >>Unintended consequences of communicating rapid COVID-19 vaccine policy changes: a qualitative study of health policy communication in Ontario, Canada
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2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 932Article in journal (Refereed) Published
Abstract [en]

Background: The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature.

Methods: Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes.

Results: Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities.

Conclusions: Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities’ access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
COVID-19 pandemic, Policy change, Public health communication, Vaccination policy, Vaccine confidence, Vaccine hesitancy, Vaccine inequity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-209181 (URN)10.1186/s12889-023-15861-y (DOI)000993874800005 ()37221519 (PubMedID)2-s2.0-85159966812 (Scopus ID)
Available from: 2023-06-22 Created: 2023-06-22 Last updated: 2023-08-28Bibliographically approved
Sirili, N., Simba, D., Zulu, J. M., Frumence, G. & Tetui, M. (2022). Accommodate or Reject: The Role of Local Communities in the Retention of Health Workers in Rural Tanzania. International Journal of Health Policy and Management, 11(1), 59-66
Open this publication in new window or tab >>Accommodate or Reject: The Role of Local Communities in the Retention of Health Workers in Rural Tanzania
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2022 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 11, no 1, p. 59-66Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: While over 70% of the population in Tanzania reside in rural areas, only 25% of physicians and 55% of nurses serve these areas. Tanzania operates a decentralised health system which aims to bring health services closer to its people through collaborative citizen efforts. While community engagement was intended as a mechanism to support the retention of the health workforce in rural areas, the reality on the ground does not always match this ideal. This study explored the role local communities in the retention of health workers in rural Tanzania.

METHODS: An exploratory qualitative study was completed in two rural districts from the Kilimanjaro and Lindi regions in Tanzania between August 2015 and September 2016. Nineteen key informant interviews (KIIs) were conducted with district health managers, local government leaders, and health facility in-charges. In addition, three focus group discussions (FGDs) were conducted with 19 members of the governing committees of three health facilities from the two districts. Data were analysed using the thematic analysis technique.

RESULTS: Accommodation or rejection were the two major ways in which local communities influenced the quest for retaining health workers. Communities accommodated incoming health workers by providing them a good reception, assuming responsibility for resolving challenges facing health facilities and health workers, linking health workers to local communities and promoting practices that placed a high value on health workers. On the flip side, communities could also reject health workers by openly expressing lack of trust and labelling them as 'foreigners,' by practicing cultural rituals that health workers feared and discrimination based on cultural differences.

CONCLUSION: Fostering good relationships between local communities and health workers may be as important as incentives and other health system strategies for the retention of health workers in rural areas. The role communities play in rural health worker retention is not sufficiently recognized and is worthy of further research.

Place, publisher, year, edition, pages
Kerman University of Medical Sciences, 2022
Keywords
Community, Health Workforce Retention, Primary Health Care, Rural, Tanzania
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-190057 (URN)10.34172/ijhpm.2021.77 (DOI)000719956200001 ()34380197 (PubMedID)2-s2.0-85124358858 (Scopus ID)
Available from: 2021-12-03 Created: 2021-12-03 Last updated: 2023-03-23Bibliographically approved
Luwangula, A. K., McGough, L., Tetui, M., Wamani, H., Ssennono, M., Agabiirwe, C. N., . . . Muhwezi, A. (2022). Improving iron and folic acid supplementation among pregnant women: an implementation science approach in east-central Uganda. Global Health: Science and Practice (GHSP), 10(6), Article ID e2100426.
Open this publication in new window or tab >>Improving iron and folic acid supplementation among pregnant women: an implementation science approach in east-central Uganda
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2022 (English)In: Global Health: Science and Practice (GHSP), ISSN 2169-575X , Vol. 10, no 6, article id e2100426Article in journal (Refereed) Published
Abstract [en]

Introduction: To address maternal iron-deficiency anemia and low uptake of iron and folic acid supplementation (IFAS) among antenatal care (ANC) clinic attendees in East-Central Uganda, the Anemia Implementation Science Initiative embedded enhanced quality improvement (QI) activities into an integrated health project utilizing QI methodologies.

Methods: To address 2 bottlenecks of stock-outs and inadequate health education for pregnant women during ANC, an enhanced QI intervention was implemented from July 2019 to September 2020 in 2 districts. We conducted a mixed-methods effectiveness quasi-experimental study to assess whether the intervention increased the availability of IFAS in the intervention districts. We used longitudinal facility-level data from 2 treatment districts and 1 comparison district for the quantitative results. Difference-in-difference estimation was used to measure the impact of the intervention on IFAS health education and IFA availability at the health facility. We used logistic regression modeling to control for factors associated with IFAS uptake and potential differences in baseline values. Researchers conducted exit interviews with ANC clients and in-depth interviews with providers and district managers for greater insights into the implementation process.

Results: The intervention increased the probability, at a statistically significant level, of pregnant women both receiving IFAS and receiving health education on IFAS during ANC. According to interviewees, the intervention approach improved stakeholder engagement and buy-in, which brought about change at all levels of the health system.

Discussion: The intervention successfully addressed the 2 main bottlenecks to availability of IFAS for pregnant women attending ANC-inadequate provision of IFAS education and a weak drug quantification process. Even without additional funds to purchase commodities, this approach improved district capacity to advocate for and manage IFAS commodities. It could also be used to strengthen overall ANC quality.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-205012 (URN)10.9745/GHSP-D-21-00426 (DOI)000924183000008 ()2-s2.0-85147765622 (Scopus ID)
Funder
Bill and Melinda Gates Foundation
Available from: 2023-02-22 Created: 2023-02-22 Last updated: 2023-09-05Bibliographically approved
Tetui, M., Grindrod, K., Waite, N., VanderDoes, J. & Taddio, A. (2022). Integrating the CARD (Comfort Ask Relax Distract) system in a mass vaccination clinic to improve the experience of individuals during COVID-19 vaccination: a pre-post implementation study. Human Vaccines & Immunotherapeutics, 18(5), Article ID 2089500.
Open this publication in new window or tab >>Integrating the CARD (Comfort Ask Relax Distract) system in a mass vaccination clinic to improve the experience of individuals during COVID-19 vaccination: a pre-post implementation study
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2022 (English)In: Human Vaccines & Immunotherapeutics, ISSN 2164-5515, E-ISSN 2164-554X, Vol. 18, no 5, article id 2089500Article in journal (Refereed) Published
Abstract [en]

Many people have negative experiences with vaccination due to stress-related reactions including fear and pain. We used a pre-post study design to evaluate the impact of implementing a modified version of the CARD (Comfort-Ask-Relax-Distract) system on stress-related reactions in individuals aged 12 y or older undergoing COVID-19 vaccinations in mass vaccination clinics. Vaccine recipients reported their level of pain, fear and dizziness during vaccination. Clinic staff reported their attitudes about CARD and use of CARD interventions. CARD improved client symptoms across genders and ages with an average reduction in needle pain, fear and dizziness of 75%, 40% and 44%, respectively. CARD was more effective in younger individuals. Clinic staff reported positive attitudes about CARD and uptake of selected CARD interventions. In summary, the modified CARD system reduced stress-related responses in a general population undergoing COVID-19 vaccinations in a mass vaccination clinic, was feasible and acceptable to staff. Future implementation efforts are recommended that include more diverse cultural contexts and incorporate education of individuals about CARD ahead of time.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
CARD system, COVID-19, fear, health services research, Immunization stress-related responses, pain, vaccination
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-203051 (URN)10.1080/21645515.2022.2089500 (DOI)000813680100001 ()35723609 (PubMedID)2-s2.0-85132406638 (Scopus ID)
Available from: 2023-01-17 Created: 2023-01-17 Last updated: 2023-01-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6833-7601

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