Escolar Documentos
Profissional Documentos
Cultura Documentos
unintended consequences
during planning and
implementation of Project
SHINE in Tanzania:
A Case Study
Inspiration
Inspiration
OVERDIAGNOSIS
OF MALARIA
Development of
Drug Resistance
Drug Shortages
Economic Costs
to
Patient/Health
System
Under-diagnosis
of non-malaria
febrile illness
(Allen-Scott et al. 2014; DAcremont et al. 2009; DAcremont et al. 2010; English et al. 2009; Chandler et al. 2008)
Inspiration
Key Gaps
Why doesnt it
work?
For whom?
Under what
circumstances?
Absence of
harmful UC
definition and
typology for
PHI
Limited
synthesis of
PHI harmful
UC
LMIC evidence
gap
(Christakis 2009; Ioannidis and Lau 2001; Bernal-Delgado and Fisher 2008; Garner, Kramer et al. 1992)
Framework
Unintended Consequences of
Purposive Social Action
- Merton 1936
Framework
Framework
Pragmatism
POSITIVISM
Determination
Reductionism
Empirical
observation and
measurement
Theory verification
ADVOCACY/PARTICIPAT
ORY
Political
Empowerment
oriented
Collaborative
Change oriented
Socio-ecological Model
CONSTRUCTIVISM
Understanding
Multiple participant
meanings
Social and historical
construction
Theory generation
PRAGMATISM
Consequences of
action
Problem-centered
Pluralistic
Real-world practice
oriented
Methods
Influence and
Commitment
Responsibility and
Authority
i.e. implementers
i.e. critics
Potential
Harmful
Unintended
Consequences
and Solutions
Diverse perspectives
including the
community
i.e. intervention
target population
Methods
Academic (N=20)
Composition: Veterinary
Medicine and Public
Health Faculty, Medical
Doctors, Students
(undergraduate and
graduate) and Local
Research Staff
Immediate Interest
Where does
sanitation and
hygiene fit in your
priorities?
Limited Knowledge
Basic Values
CULTURAL
ECONOMIC
ENVIRONMENTAL
PHYSICAL
POLITICAL
PSYCHOSOCIAL
OMMISSION
Unintended
Harm Think
Tank for
stakeholder
engagement
Examine current
historical or cultural
practices that
promote sanitation
and hygiene
+
Primary Schools
Pastoralist Council
TBAs
Male head of
household
NGOs
Minimization of:
Disempowerment
Cultural push-back
Harm by Omission
Power imbalances
Water Access?
Poverty?
Harm
minimization
Limitations
Partnership
Strength
Expertise in the
Health Issue
i.e. academics
Expertise in Harmful
Unintended
Consequences
Influence and
Commitment
i.e. policy makers
Responsibility and
Authority
i.e. implementers
i.e. critics
Potential
Harmful
Unintended
Consequences
and Solutions
Diverse perspectives
including the
community
i.e. intervention
target population
Value?
http://static4.depositphotos.com/1007959/349/i/950/depositphotos_3490111-Consequences-Green-Road-Sign-Over-Storm-Clouds.jpg
University of Calgary:
Dr. Jennifer Hatfield
Dr. Lynn McIntyre
Dr. Guido van Marle
Dr. Chris Thomas
Dr. Tyrone Donnon
Dr. Sheri Bastien
Dr. Frank van der Meer
Dr. Karin Orsel
Dr. Susan Kutz
Selected References
Allen-Scott, L. K., J. M. Hatfield and L. McIntyre (2014). "A scoping review of unintended harm
associated with public health interventions: towards a typology and an understanding of underlying
factors." Int J Public Health.
Arksey, H. (2003). "Scoping the field: services for carers of people with mental health problems."
Health & Social Care in the Community 11(4): 335-344.
Bernal-Delgado, E. and E. S. Fisher (2008). "Abstracts in high profile journals often fail to report
harm." BMC Med Res Methodol 8: 14.
Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA, Harvard
University Press.
Chandler, C. I., C. J. Drakeley, H. Reyburn and I. Carneiro (2006). "The effect of altitude on parasite
density case definitions for malaria in northeastern Tanzania." Trop Med Int Health 11(8): 11781184.
Christakis, N. A. (2009). "Only Connect Indirectly doing harm." British Medical Journal 339: -.
Creswell, J. W. (2009). Research Design: qualitative, quantitative and mixed methods approaches.
Thousand Oaks, CA, Sage Publications, Inc.
D'Acremont, V., C. Lengeler and B. Genton (2010). "Reduction in the proportion of fevers associated
with Plasmodium falciparum parasitaemia in Africa: a systematic review." Malar J 9: 240.
D'Acremont, V., C. Lengeler, H. Mshinda, D. Mtasiwa, M. Tanner and B. Genton (2009). "Time to
move from presumptive malaria treatment to laboratory-confirmed diagnosis and treatment in
African children with fever." PLoS Med 6(1): e252.
English, M., H. Reyburn, C. Goodman and R. W. Snow (2009). "Abandoning presumptive antimalarial
treatment for febrile children aged less than five years--a case of running before we can walk?"
PLoS Med 6(1): e1000015.
Selected References
Garner, P., M. S. Kramer and I. Chalmers (1992). "Might Efforts to Increase Birth-Weight in
Undernourished Women Do More Harm Than Good." Lancet 340(8826): 1021-1023.
Ioannidis, J. P. and J. Lau (2001). "Completeness of safety reporting in randomized trials: an
evaluation of 7 medical areas." JAMA 285(4): 437-443.
Levac, D., H. Colquhoun and K. K. O'Brien (2010). "Scoping studies: advancing the methodology."
Implement Sci 5: 69.
Merton, R. K. (1936). "The Unanticipated Consequences of Purposive Social Action." American
Sociological Review 1(6): 894-904.
Pawson, R., T. Greenhalgh, G. Harvey and K. Walshe (2005). "Realist review--a new method of
systematic review designed for complex policy interventions." J Health Serv Res Policy 10 Suppl 1:
21-34.
Rose, G. (1985). "Sick individuals and sick populations." Int J Epidemiol 14(1): 32-38.
Whittemore, R. and K. Knafl (2005). "The integrative review: updated methodology." Journal of
Advanced Nursing 52(5): 546-553.
WHO (2009). Systems thinking for health systems strengthening. A. f. H. P. a. S. Research. Geneva,
Switzerland, WHO.
WHO (2010). A conceptual framework for action on the social determinants of health: Social
determinants of health discussion paper 2. WHO. Geneva, World Health Organization.
Wong, G., T. Greenhalgh, G. Westhorp, J. Buckingham and R. Pawson (2013). "RAMESES publication
standards: realist syntheses." BMC Med 11: 21.