Soundappan Kathirvel

Social mapping: A potential teaching tool in public health

Background: Mapping is a fundamental way of displaying spatial human cognition. It is a rapid technique of summarising and presenting large amount of information. Social map is a technique that finds use as a participatory rural appraisal tool. Aim: To evaluate the feasibility of using social mapping as a public health teaching tool. Methods: A resident doctor posted in the Urban Health Training Centre was assigned to do social mapping of an urban resettlement colony. The area was first divided into segments. The mapping was done by people residing in each segment and compiled with the assistance of the resident doctor. Results: Social mapping helped the student acquire various cognitive, affective and psychomotor skills. It also helped in understanding the geographical area, people, language, cultural practices, social networks and interactions. It trained the student in using rapid appraisal techniques, cartography, effective and succinct summarising and presentation of data of social relevance. The different language and cultural background of the community was the main challenge encountered. Conclusion: Social mapping is an excellent learning and a very practical teaching tool in public health, especially when the researcher/health care provider has little knowledge about his/her field practice area.

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

ABSTRACT Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as ‘catastrophic’ if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US

Development and psychometric testing of an abridged version of Dundee Ready Educational Environment Measure (DREEM)

4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [−0.15 (−0.32, 0.11)] and PCF [−0.06 (−0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [−0.60 (−0.81, –0.39)] and PCF [−0.58 (−0.78, –0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.

Do perceptions about educational environment influence academic performance? a cross-sectional study of undergraduate medical students in madurai, South India

BackgroundDundee Ready Educational Environment Measure (DREEM) is a 50-item tool to assess the educational environment of medical institutions as perceived by the students. This cross-sectional study developed and validated an abridged version of the DREEM-50 with an aim to have a less resource-intensive (time, manpower), yet valid and reliable, version of DREEM-50 while also avoiding respondent fatigue.MethodsA methodology similar to that used in the development of WHO-BREF was adopted to develop the abridged version of DREEM. Medical students (n = 418) from a private teaching hospital in Madurai, India, were divided into two groups. Group I (n = 277) participated in the development of the abridged version. This was performed by domain-wise selection of items that had the highest item-total correlation. Group II (n = 141) participated in the testing of the abridged version for construct validity, internal consistency and test-retest reliability. Confirmatory factor analysis was performed to assess the construct validity of DREEM-12.ResultsThe abridged version had 12 items (DREEM-12) spread over all five domains in DREEM-50. DREEM-12 explained 77.4% of the variance in DREEM-50 scores. Correlation between total scores of DREEM-50 and DREEM-12 was 0.88 (p < 0.001). Confirmatory factor analysis of DREEM-12 construct was statistically significant (LR test of model vs. saturated p = 0.0006). The internal consistency of DREEM-12 was 0.83. The test-retest reliability of DREEM-12 was 0.595, p < 0.001.ConclusionDREEM-12 is a valid and reliable tool for use in educational research. Future research using DREEM-12 will establish its validity and reliability across different settings.

Cross-cultural adaptation of Jefferson scale of empathy-health professions students version: An experience with developing the Tamil translation

The academic underachievers felt that learning strategies which used to work for them earlier do not work now. In India, while learning in medical school is competency based, higher secondary school learning is more knowledge and memory based. Proper pre-course orientation and mentoring throughout the course may help the students adapt better to the newer teaching and learning styles in the medical curriculum. The underachievers also felt that the teaching did not encourage active learning or boost their confidence. Students and faculty need to be sensitized to self-directed learning and newer teaching methods that actively involve students must be adopted. The underachievers thought that the previous year’s work was not an appropriate preparation for the current year. Increasing the number of integrated teaching sessions could help students view and understand subjects in medical school as essential parts of a whole.

Home deliveries in Chandigarh, the beautiful city of India: a tug of war between culture and science

Background: Empathy is a key cognitive attribute among healthcare professionals that fosters better patient– healthcare provider relationships. The Jefferson scale of empathy (JSE) measures self-rated empathy among various groups of healthcare professionals–health professionals, medical students and health professions students (HPS). The authors present the experience in translating the JSE-HPS version into an Indian regional language with insights into the issues faced in every step. Methods: With official permission from the Thomas Jefferson University, the authors embarked on the translation proceeding through forward translation (three rounds of modification), back translation (two independent translates), and synthesis of a final translated version. While targeting literary accuracy, the simplicity and comprehensibility of the instrument by the study population were also ensured. Variations in regional dialects and accents across the population were considered. Results: The back-translated version was evaluated for semantic, content, cultural, and technical equivalence. It was then pretested on ten students followed by a group discussion with them to ensure the comprehensibility of the tool and the differences between written and spoken language were addressed through necessary modifications. Discussion: The Tamil translation of the HPS version of JSE is now approved by and officially available with the Thomas Jefferson University.

Smoking cessation interventions for pulmonary tuberculosis treatment outcomes

There have been various commitments made in the international front to reduce maternal mortality ratio, and India has set its target at <100 maternal deaths/100 000 live-births. One of the strategies is to have 80% of the deliveries take place at healthcare institutions. However, health-related behaviour and decision-making is affected by many factors beyond the availability of health services. We report the case of a fourth gravida, belonging to the Sansi tribe, with son-preference in urban northern India, who delivered her fourth female child at home. We attempt to understand beliefs, norms and practices involved in deciding place of delivery in the context of theory of reasoned action and health belief model so that cultural appropriateness can be ensured in healthcare delivery. The study emphasises that there is need for improvement in cultural appropriateness of healthcare services delivered to the community.