Anne Geniets’s research while affiliated with University Hospital Zürich and other places

Purpose Refugees and asylum seekers worldwide face numerous barriers in accessing health systems. The evidence base regarding who and what helps refugees and asylum seekers facilitate access to and the navigation of the health system in the UK is small. This study aims to address this gap by analysing 14 semi-structured, in-depth interviews with refugees and asylum seekers of different countries of origin in the UK to identify where, when and how they came into contact with the health-care system and what the outcome of these interactions was. Design/methodology/approach Semi-structured, in-depth interviews were chosen as the key method for this study. In total, 14 individual interviews were conducted. A trauma-informed research approach was applied to reduce the risk of re-traumatising participants. Findings The paper identifies key obstacles as well as “facilitators” of refugees’ and asylum seekers’ health-care experience in the UK and suggests that host families, friends and third-party organisations all play an important role in ensuring refugees and asylum seekers receive the healthcare they need. Originality/value To the best of the authors’ knowledge, this is the first qualitative study in the UK that looks at comprehensive health journeys of refugees from their first encounter with health services through to secondary care, highlighting the important role along the way of facilitators such as host families, friends and third-party organisations.

Widespread “lockdowns” during the COVID pandemic in 2020–2021 restricted medical students’ access to patients. We used a scoping review with exploratory thematic synthesis to examine how reports of digital clinical teaching during the first year of the COVID pandemic could inform digital clinical teaching in the post-pandemic world. We looked at strategies used and outcomes reported, lessons learned about how best to use digital methods for clinical teaching, and learning theories used. The eighty-three articles included in the final review fell into four groups. These were telehealth interventions; virtual case-based teaching; multi-modal virtual rotations; and a small group of “other” strategies. Telehealth reports indicated that COVID has probably accelerated the adoption of telehealth, and these skills will be required in future curricula. Engagement with virtual case-based teaching was problematic. Virtual rotations were particularly valued in specialties that relied on visual interpretation such as radiology and dermatology. For general clinical specialties, digital clinical teaching was not a satisfactory substitute for real clinical exposure because it lacked the complexity of usual clinical practice. Sixty-seven articles reported students’ reactions only, and 16 articles reported a change in knowledge or skills. Demands on instructors were considerable. Few studies were theorized and none tested theory, which limited their transferability. While telehealth teaching may be a valuable addition to some curricula, digital clinical teaching is unlikely substantially to replace exposure to real patients outside of specialties that rely on visual interpretation. High demands on instructors suggest little potential for new, scalable digital clinical offerings after COVID.

Neonatal mortality remains disproportionately high in sub-Saharan Africa partly due to insufficient numbers of adequately trained and skilled front-line health workers. Opportunities for improving neonatal care may result from upskilling frontline health workers using innovative technological approaches. This practice paper describes the key steps involved in the design, development and implementation of an innovative smartphone-based training application using an agile, human-centred design approach. The Life-saving Instruction for Emergencies (LIFE) app is a three-dimension (3D) scenario-based mobile app for smartphones and is free to download. Two clinical modules are currently included with further scenarios planned. Whilst the focus of the practice paper is on the lessons learned during the design and development process, we also share key learning related to project management and sustainability plans, which we hope will help researchers working on similar projects.

Systems-thinking is a useful approach to deepen our understanding of the linkages, relationships, interactions, and behaviours that, together, comprise and shape our health systems. Offering a comprehensive range of opinion and scholarship from experts located across the world (Europe, North-America, Africa, Asia, and Oceania), spanning a wide range of disciplines, this book presents a compilation of case studies, prescriptive or retrospective reflections, conceptual pieces, interventions, and methodological approaches to guide and inspire global health practitioners in their application of systems-thinking approaches across topics familiar to the field of Global Health including, but not limited to, maternal and child health, disability, social inclusion, malaria, TB, HIV, and other infectious diseases, tobacco control, mental health, human resources for health, healthcare decentralisation, health information systems, health in conflict and/or fragile contexts, health system strengthening, quality improvement, and nuclear disarmament.

Background Despite the growth in mobile technologies (mHealth) to support Community Health Worker (CHW) supervision, the nature of mHealth-facilitated supervision remains underexplored. One strategy to support supervision at scale could be artificial intelligence (AI) modalities, including machine learning. We developed an open access, machine learning web application (CHWsupervisor) to predictively code instant messages exchanged between CHWs based on supervisory interaction codes. We document the development and validation of the web app and report its predictive accuracy. Methods CHWsupervisor was developed using 2187 instant messages exchanged between CHWs and their supervisors in Uganda. The app was then validated on 1242 instant messages from a separate digital CHW supervisory network in Kenya. All messages from the training and validation data sets were manually coded by two independent human coders. The predictive performance of CHWsupervisor was determined by comparing the primary supervisory codes assigned by the web app, against those assigned by the human coders and calculating observed percentage agreement and Cohen’s kappa coefficients. Results Human inter-coder reliability for the primary supervisory category of messages across the training and validation datasets was ‘substantial’ to ‘almost perfect’, as suggested by observed percentage agreements of 88–95% and Cohen’s kappa values of 0.7–0.91. In comparison to the human coders, the predictive accuracy of the CHWsupervisor web app was ‘moderate’, suggested by observed percentage agreements of 73–78% and Cohen’s kappa values of 0.51–0.56. Conclusions Augmenting human coding is challenging because of the complexity of supervisory exchanges, which often require nuanced interpretation. A realistic understanding of the potential of machine learning approaches should be kept in mind by practitioners, as although they hold promise, supportive supervision still requires a level of human expertise. Scaling-up digital CHW supervision may therefore prove challenging. Trial registration : This was not a clinical trial and was therefore not registered as such.

Learning to code and to develop a range of digital skills has been purported to help nations remain economically competitive. Development of these skills has been touted as a way to prepare workers for tech jobs and increase their social mobility. However, this focus is quite narrow and does not recognize the benefits of learning to code beyond the economic. In this paper, we present results from a qualitative study of ‘go_girl: code + create’, a multidisciplinary computing program that places the needs of marginalised young women, aged 16–21, who are not in education, employment or training (NEET) at its centre. This study, based on in-depth, semi-structured open-ended interviews of nine participants at the beginning, mid-point and end of the program, examines changes in self-concepts of nine participants. This study demonstrates the role technology can play in facilitating changes in self-concepts and contributes to studies that examine the identity/self-concept of young underrepresented women participating in computing initiatives. Qualitative content analysis was applied to the interview data which revealed enhanced self-concepts in relation to education, career aspirations and technology use over the duration of the program. Participants' aspirations were either broadened or clarified and they began to view themselves as makers and not merely consumers of technology.

Many countries around the world rely on community health workers to provide healthcare to those without immediate access, connecting them to formal health systems, and whilst numerous Community Health Worker (CHW) programmes exist, there is little research published on the need for ongoing high-quality training and supervision, or the role technology can play in supporting this. Training for Community Health: Bridging the global health care gap is a practical resource on the nuances and intricacies of CHW programmes today. Written by experienced academics and practitioners in CHW training, education, and supervision, this resource offers a trustworthy overview to this emerging field, with insights from across the globe. Over 13 chapters, this unique resource explores how technology can be used to support structured training programmes, and is interspersed with practical examples of how to design, implement, and evaluate CHW programmes.

Training and supervision are paramount to well-functioning, adaptable Community Health Worker (CHW) programmes. Balancing theoretical and methodological research, lessons from health worker practice, and case studies, this volume has sought to provide a resource to practitioners, policymakers and academics striving to design equitable, participatory CHW programmes. Weaving together interdisciplinary and multiregional perspectives, this book has focussed on the design, implementation and evaluation of technology-based programmes for training and supervision of CHWs, particularly in low- and middle income countries. In doing so, it has set out a roadmap for future equitable, pedagogy-driven CHW programmes.