research in the instagram context approaches and methods

Research in the Instagram Context: Approaches and Methods

Social media is not only an important component for mass communication but also a toolkit to provide people with various services. As the most representative visual-oriented social networking site in the world, Instagram enables users to take photos and videos, as well as share them on other platforms with its accurate target user positioning. There have been many researchers involving with studies on Instagram’s development from different perspectives. This paper conducts an extensive literature review of Instagram, focusing on the research methods that researchers use to collect and analyze data. Based on the review, it can be seen that most scholars collect Instagram data by capturing API data, designing questionnaires, and face-to-face interviews. Both quantitative methods such as data modeling and regression analysis and qualitative methods such as text analysis and context analysis are used to analyze Instagram features. Researchers also utilized advanced technical tools and analytical methods, such as face recognition, comparative analysis, and case studies, to gain a more insightful perception on Instagram.

• Related Documents

The Importance of Communication in Islamic Society

Communication is an integral part of human life because our movements are always associated by communication. At this point, the communication is in terms of Islamic communication, i.e. communication of moral al-karimah or ethics. Communication of morality means the communication that comes from the Quran and hadith (sunnah of the Prophet). Islamic communication is a new form of phrase and thought emerged in academic research started from about three decades ago. The emergence of Islamic communication thoughts and activism is based on the failure of the philosophy, paradigm and implementation of western communication which further optimizes the pragmatic, materialistic and capitalist media values. This failure has negative implications especially on the Muslim community throughout the world due to the different religions, cultures and lifestyles of the (western) countries that are as the producers of the sciences. There are two kinds of communication consisting of: (1) direct communication (face to face) either between individual with individual, or individual with group, or group with group, group with society, hence influence the individual relation (interpersonal) included in understanding the communication; and (2) mass communication that is a process of communication made through the mass media with various purposes of communication and to convey information to a wide audience. The basics of communication principles must be mastered. By mastering the principles of communication in Islamic society, it can be able to organize Islamic education and Islamic communication to form a high-quality communication in the society, professionals, and noble character.

Development of techno-pedagogy approach learning model to improve digital literation of UPN "Veteran" Jawa Timur’s students

The study objectives were 1) to describe the level of digital literacy of UPN "Veteran" Jawa Timur's  students; and 2) Developing a techno-pedagogy approach to improve digital literacy of UPN "Veteran" Jawa Timur's students. This research innovation is developing of a techno-pedagogy approach model and arranging a techno-pedagogy approach to improve students' digital literacy. This innovation is based on the idea of a pedagogical model which is an important aspect in achieving learning goals in the world of education. In the first study objective, quantitative methods are used, the second research objective uses qualitative methods. Research location at UPN "Veteran" Jawa Timur. This option is to provide insight, knowledge, and solutions to integrated pedagogical problems in learning amid the Covid-19 pandemic. Data were collected from questionnaires and in-depth interviews. Among the data needed are online skills; motivation; online video/audio; internet discussion; supporting elements;  ict abilities; blended learning models; teaching contents; frequencies of face-to-face meeting; regulation; culture.

Efek dari Pemberitaan CCTV Lalu Lintas Terhadap Sikap Disiplin Berlalu Lintas

Abstract Dishub Surabaya and traffic Unit Polrestabes Surabaya partners  do speeding tickets through CCTV to reduce traffic violations in traffic and prevent accidents frequently happened. For the socialization of the press role is required so that residents will know  this new traffic regulation. The way of the spread CCTV by the way to traffic gridlock around the continuously to be done in make the community become disciplined in the traffic signs and regulations. The underlying theory is a theory of mass communication, theory of hypodermic needle theory, S-O-R theory, discipline theory, theories of adolescence. The methodology that was used this research is quantitative methods with type of correlational quantitative. In this research that are samples are teenagers klampis semalang 96 respondents. From the results of statistics done shows that significantly is the cctv news traffic to discipline attitude traffic in teenagers Klampis Semalang Urban village Klampis Ngasem in Sukolilo Surabaya city. Keywords : news, cctv traffic, discipline traffic

Uncountable Matter

Humanism returns for the New Materialism in ‘nonhuman’ form as matter. New ‘matter’ and new materialism thus fashion the world to human advantage in the gesture of abjecting us. They commit us to the humanism of masochists. They offer an animistic and paradisiacal realm of immediate transactions, human to human, human to and with nonhuman, face to face, world without end. The impulse is tactically and strategically useful. But ‘matter’ will not help us if we fashion it so that it bears in its concept the signature of a human hand in its making. Can we do otherwise? Only by conceiving matter as what absolutizes what is not-one: matter from which no discipline will normally, normatively, produce an object or take its concept; on which heroical abjection will founder; matter non-human in ways the human animal can neither designate, nor ever count.

Mechanisms of liver damage in COVID-19

At the end of 2019, a new coronavirus (SARS-CoV-2) was discovered in China, causing the coronavirus infection COVID-19. The ongoing COVID-19 pandemic poses a major challenge to health systems around the world. There is still little information on how infection affects liver function and the significance of pre-existing liver disease as a risk factor for infection and severe COVID-19. In addition, some drugs used to treat the new coronavirus infection are hepatotoxic. In this article, we analyze data on the impact of COVID-19 on liver function, as well as on the course and outcome of COVID-19 in patients with liver disease, including hepatocellular carcinoma, or those on immunosuppressive therapy after liver transplantation.

The Traffic in Hierarchy

Looking at Buddhist monasteries as social institutions, this book integrates a thorough description of one such monastery with a wide-ranging study of Burmese social relations, both religious and lay, looking particularly at the matter of gender. Hierarchical assumptions inform all such relations, and higher status implies a person’s greater autonomy. A monk is particularly idealized because he exemplifies the Buddhist ideal of “detachment” and so autonomy. A male head of household represents another masculine ideal, if a somewhat less prestigious one. He enjoys greater autonomy than other members of the household yet remains entangled in the world. Women and trans women are thought to be more invested in attachment than autonomy and are expected to subordinate themselves to men and monks as a result. But everyone must concern themselves with the matter of relative status in all of their interactions. This makes face-to-face encounter fraught. Several chapters detail the ways that individuals try to stave off the risks that interaction necessarily entails. One stratagem is to subordinate oneself to nodes of power, but this runs counter to efforts to demonstrate one’s autonomy. Another is to foster detachment, most dramatically in the practice of meditation.

Giving and Promising

Giving and promise must be thought together. Being-in-the world entails being-with the other, who is both “given” and bearer of a gift promised. But any disclosure may be understood as a gift; it is not anthropomorphic to speak of “self-giving” with a wider reference than person-to-person disclosure. Which implies that no act of giving can exhaust itself in its gift. Present experience never brings closure to self-revealing. Yet giving is crystallized into “the given,” the closure of gift. “The given” is what it is, needing no gift-event to reveal it. But the given, too, is precarious, and can be destabilized when giving brings us face to face with something unfamiliar. Nothing appears without a promise of further appearances, and God himself can never be “given.”

Institutionalized Education: Journalism and Mass Communication Education in Pakistan

This article uses an examination of journalism and mass communication (JMC) education in Pakistan as a case study to explore the consequences of increased homogenization of JMC education around the world. Anchored by a qualitative method that relies heavily on actor-network theory, the study identifies key moments and people in the trajectory of five Pakistani programmes and explores the connection between these programmes and the larger JMC organizational field. The study concludes by questioning the efficacy of the current power structures within the supranational JMC organizational field before discussing how these influences could potentially be mitigated moving forward.

Analysis of Educational Data in the Current State of University Learning for the Transition to a Hybrid Education Model

Currently, the 2019 Coronavirus Disease pandemic has caused serious damage to health throughout the world. Its contagious capacity has forced the governments of the world to decree isolation and quarantine to try to control the pandemic. The consequences that it leaves in all sectors of society have been disastrous. However, technological advances have allowed people to continue their different activities to some extent while maintaining isolation. Universities have great penetration in the use of technology, but they have also been severely affected. To give continuity to education, universities have been forced to move to an educational model based on synchronous encounters, but they have maintained the methodology of a face-to-face educational model, what has caused several problems in the learning of students. This work proposes the transition to a hybrid educational model, provided that this transition is supported by data analysis to identify the new needs of students. The knowledge obtained is contrasted with the performance presented by the students in the face-to-face modality and the necessary parameters for the transition to this modality are clearly established. In addition, the guidelines and methodology of online education are considered in order to take advantage of the best of both modalities and guarantee learning.

Survey of Radon Concentrations in the University of Granada in Southern Spain

The objective of this pilot study was to gather and analyze data on radon concentrations in workplaces in three buildings of Granada University (Southern Spain) constructed in different centuries. All measurements were made at basement or ground floor level under normal use conditions except for one space (mineral store), in which measurements were compared between the door closed and open. Measurements were conducted during different time periods between October 2013 and March 2019 with a Radon-Scout PLUS portable Radonmonitor. The duration of continuous recordings at different sites ranged between 42 and 1104 h. Mean accumulated radon concentrations ranged between 12 and 95 Bq/m3, below the maximal level of 300 Bq/m3 set by the World Health Organization (WHO). Relatively high values were recorded in the oldest building (15th century), which was also poorly ventilated. Ventilation appeared to be an important factor in reducing radon levels, especially in areas less exposed to radon, such as Southern Spain.

Export Citation Format

Share document.

Browse Econ Literature

• Working papers
• Software components
• Book chapters
• JEL classification

More features

• Subscribe to new research

RePEc Biblio

Author registration.

• Economics Virtual Seminar Calendar NEW!

Research in the Instagram Context: Approaches and Methods

• Author & abstract
• Related works & more

Corrections

(Faculty of Humanities, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong International Education College, Henan Polytechnic University, Jiaozuo, China)

Suggested Citation

Download full text from publisher.

Follow serials, authors, keywords & more

Public profiles for Economics researchers

Various research rankings in Economics

RePEc Genealogy

Who was a student of whom, using RePEc

Curated articles & papers on economics topics

Upload your paper to be listed on RePEc and IDEAS

New papers by email

Subscribe to new additions to RePEc

EconAcademics

Blog aggregator for economics research

Cases of plagiarism in Economics

About RePEc

Initiative for open bibliographies in Economics

News about RePEc

Questions about IDEAS and RePEc

RePEc volunteers

Participating archives

Publishers indexing in RePEc

Privacy statement

Found an error or omission?

Opportunities to help RePEc

Get papers listed

Have your research listed on RePEc

Open a RePEc archive

Have your institution's/publisher's output listed on RePEc

Get RePEc data

Use data assembled by RePEc

Instagram Revisited

Files and links (1).

Tama Leaver dot Net

I'm a Professor of Internet Studies at Curtin University.

Home » Instagram » Approaching Instagram: New Methods and Modes for Examining Visual Social Media

Approaching Instagram: New Methods and Modes for Examining Visual Social Media

Due to the global pandemic, this year’s International Communication Association conference was held online. This post shares the abstracts and short videos made for our roundtable on ‘Approaching Instagram: New Methods and Modes for Examining Visual Social Media’. Hopefully it might prove useful to those studying Instagram and thinking about methodologies. The participants in this roundtable were Crystal Abidin (Curtin University), Tim Highfield, (University of Sheffield), Tama Leaver, (Curtin University), Anthony McCosker (Swinburne University of Technology), Adam Suess, (Griffith University), Katie Warfield (Kwantlen Polytechnic University) and Alice Witt (Queensland University of Technology).

The Panel Overview

Instagram has more than a billion users, yet despite being owned by Facebook remains a platform that’s vastly more popular with young people, and synonymous with the visual and cultural zeitgeist. However, compared to parent-company Facebook, or competitors such as Twitter, Instagram has been comparatively under-studied and under-researched. Moreover, as Facebook/Instagram have limited researcher access via their APIs, newer research approaches have had to emerge, some drawing on older qualitative approaches to understand and analyse Instagram media and interactions (from images and videos to comments, emoji, hashtags, stories, and more). The eight initial participants in this roundtable, from Australia, Canada, Finland and the United Kingdom, roundtable have pioneered specific research methods for approaching Instagram (across quantitative and qualitative fields), and our intention is to broaden the discussion moving beyond (just) methods to larger questions and ideas of engaging with Instagram as a visual social media icon on which larger social, cultural changes and questions are necessarily explored.

Contributions set the scene for a larger discussion, examining the invisible labour of the ‘Instagram Husband’ as a highly important but almost always hidden figure, particularly mythologized by online influencers. Broader conceptual questions are also raised in terms of how the Instagram platform reconfigures time from 24-hour Stories, looping Boomerangs, to temporality measured relative to when content was posted, with Instagram becoming the centre of its own time and space. Another contributor argues that Instagram users are always creating and fashioning each other, not just themselves, using the liminal figures of the unborn (via ultrasounds) and the recently deceased as case studies where Instagram users are most obviously creating other people in the feeds. Another contributor asks how the world of art is being reconfigured by the aesthetics and practices of being ‘insta-worthy’. Another contribution asks how to move beyond hashtags as the primary method of discovering collections of content. On a different note, the practices of commercial wedding photographers are examined to ask how weddings are being reimagined and renegotiated in an era of social media visuality. Finally, important questions are raised about the content that is not visualized and not allowed on Instagram at all, and how these moderation practices can be mapped against the ‘black box’ of Instagram’s algorithms.

[1] The Instagram Husband / Crystal Abidin , Curtin University

Social media has become a canvas for the commemoration and celebration of milestones. For the highly prolific and commercially viable vocational internet celebrities known as Influencers, coupling up in a relationship is all the more significant, as it impacts their public personae, their market value to sponsors, and their engagement with followers. However, behind-the-scenes of such young women’s pristine posturing are often their romantic partners capturing viable footage from behind-the-camera, in a phenomenon known in popular discourse as “the Instagram husband”. These (often heterosexual male) romantic partners toggle between ‘commodity’ on camera to ‘creator’ off camera. Although the narrative of the Instagram Husband is usually clouded in the notions of sacrificial romance, the unremunerated work is wrought with strain. Between the domesticity of Influencers’ romantic coupling and the publicness of their branded individualism, this chapter considers the labour, tensions, and latent consequences when Influencers intertwine commodify their relationships into viable entities. Through traditional and digital ethnographic research methods and in-depth data collection among Singaporean women Influencers and their (predominantly heterosexual) partners, the chapter contemplates the phenomenon of the Instagram Husband and its impact on visual representations of romantic relationships online.

View this post on Instagram ICA20 presentation by @wishcrysdotcom for the panel ‘Approaching Instagram’. A post shared by Instagram Book (@polityinstabook) on May 18, 2020 at 4:56pm PDT

[2] Examining Instagram time: aesthetics and experiences / Tim Highfield , University of Sheffield

Temporal concerns are critical underpinnings for the presentation and experience of popular social media platforms. Understanding and transforming the temporal is key to the operation of these platforms, becoming a means for platforms to intervene in user activity. On Instagram, temporality plays out in different ways. Ostensibly describing in-the-moment, as-it-happens sharing and live documentation, the Insta- of Instagram has long been complicated by features of the platform and cultural practices and norms which encourage different types of participation and temporal framing. This contribution focuses on how Instagram time is presented and experienced by the platform and its users, from how content appears in non-linear algorithmic feeds to aesthetics that suggest, or explicitly callback to, older technologies and eras. These create temporal contestation as, for example, the implied permanence of the photo stream is contrasted with the ephemerality of Stories, where content usually lasts for only 24 hours, and the trapped seconds-long loops of Boomerangs. This temporal contestation apparent between different features of the platform also plays out in Instagram’s aesthetics, which include retro throwbacks of filters to the explicit visuals of Story filters reminiscent of VHS tape and physical film. Such platformed approaches then raise questions for researchers about Instagram’s temporality, how it is experienced by its users, and how it is repositioned and reframed by the platform’s own architecture, displays, and affordances.

View this post on Instagram A post shared by Tim H (@timhighfield) on May 19, 2020 at 4:09am PDT

[ Transcript ]

[3] Creating Each Other on Instagram / Tama Leaver, Curtin University

While visual social media platforms such as Instagram are, by definition, about connecting and communication between multiple people, most discussions about Instagram practices presume that accounts, profiles and content are managed by individual users with the agency to make informed choices about their activities. However, Instagram photos and videos more often than not contain other people, and thus the sharing of visual material is often a form of co-creation where the Instagram user is often contributing and shaping another person or group’s online identity (or performance). This contribution outlines some of the larger provocations that occur when examining the way loves ones use Instagram to visualize the very young and the recently deceased. Indeed, even before birth, the sharing of the 12- or 20-week ultrasound photos and gender reveal parties often sees an Instagram identity begin to be shaped by parents before a child is even born. At the other end of life, mourning and funereal media often provide some of the last images and descriptions of a person’s life, something that can prove quite controversial on Instagram. Considering these two examples, this contribution argues that content creation could, and probably should, be considered visual co-creation, and Instagram should be seen as a platform on which users fashion each others identities as much as their own.

[4] Navigating Instagram’s politics of visibility / Anthony McCosker , Swinburne University of Technology

This contribution reflects on several research projects that have had to negotiate Instagram’s depreciated API access, and its increasingly restrictive moderation practices limiting what the company sees as sensitive or harmful content. One project with Australian Red Cross was designed to access and analyse location data for posts engaging with humanitarian activity, in order to generate new insights and information about how to address humanitarian needs particular locations. The other examined users’ engagement with content actively engaged with the depression through hashtag use. Both cases required the adjustment of methods to sustain the research beyond the API restrictions and enable future work to continue to draw insights about the respective research problems. I discuss the development of an inclusive hashtag practices method, data collaborative co-research practices, and visual methods that can account for situational and contextual analysis through a targeted sampling and theory building approach.

[5] Appreciating art through Instagram / Adam Suess , Griffith University

Instagram is an important application for art galleries, museums, and cultural institutions. For arts professionals it is a key tool for promotion, accessibility, participation, and the enhancing of the visitor experience. For arts educators it is an opportunity to influence the number of people who value the arts and seek lifelong learning through the aesthetic experience. Instagram also has pedagogical value in the gallery and is relevant for arts based learning programs. There is limited research about the use of Instagram by visitors to art galleries, museums, and cultural institutions and the role it plays in their social, spatial, and aesthetic experience. This study examined the use of Instagram by visitors to the Gerhard Richter exhibition at the Queensland Gallery of Modern Art (14 October 2017 – 4 February 2018). The research project found that the use of Instagram at the gallery engaged visitors in a manner that transcended the physical space, evolving and extending their aesthetic experience. It also found that Instagram acted as a tool of influence shaping the way visitors engaged with art. This finding is significant for arts educators seeking to engage students and the community through Instagram, centered on their experience of art.

[6] Instagram Visuality and The West Coast Wedding / Katie Warfield , Kwantlen Polytechnic University

The intersection of artsy, youthful, beautiful, and playful aesthetics alongside corporate branding have established certain normative modes of visuality on the globally popular social media platform Instagram.   Adopting a post-phenomenological lens alongside an intersectional feminist critique of the platform, this paper presents the findings of working with six commercial wedding photographers on the west coast of Canada whose photographs are often shared for clients on social media.  Via interviews, photo elicitation, and participant observation, this paper teases apart the multi-stable and manifold socio-technical forces that shape Instagram visuality or the visual sedimented ways of seeing shaped by Instagram and embodied and performed by image producers. This paper shows the habituation of these modes of seeing and argues that Instagram visuality is the result of various and complex intimate conversational negotiations between: discursive visual tropes (e.g. lighting, subject arrangement, and material symbols of union), material technological affordances (in-built filters, product tagging, and the grid layout of user pages), and sedimented discursive-affective “moods” (white material femininity and nature communion) that assemble to shape the normative depictions of west coast weddings.

[7] Probing the black box of content moderation on Instagram: An innovative black box methodology   / Alice Witt , Queensland University of Technology  

The black box around the internal workings of Instagram makes it difficult for users to trust that their expression through content is moderated, or regulated, in ways that are free from arbitrariness. Against the particular backdrop of allegations that the platform is arbitrarily removing some images depicting women’s bodies, this research develops and applies a new methodology for empirical legal evaluation of content moderation in practice. Specifically, it uses innovative digital methods, in conjunction with content and legal document analyses, to identify how discrete inputs (i.e. images) into Instagram’s moderation processes produce certain outputs (i.e. whether an image is removed or not removed). Overall, across two case studies comprising 5,924 images of female forms in total, the methodology provides a range of useful empirical results. One main finding, for example, is that the odds of removal for an expressly prohibited image depicting a woman’s body is 16.75 times higher than for a man’s body. The results ultimately suggest that concerns around the risk of arbitrariness and bias on Instagram, and, indeed, ongoing distrust of the platform among users, might not be unfounded. However, without greater transparency regarding how Instagram sets, maintains and enforces rules around content, and monitors the performance of its moderators for potential bias, it is difficult to draw explicit conclusions about which party initiates content removal, in what ways and for what reasons. This limitation, among others raised by this methodology, underlines that many vital questions of trust in content moderation on Instagram remain unanswered. 

Share this:

Tags: #ica20 , 2020 , International Communication Association

• Adrienne Shaw
• Alice Marwick
• Anne Helmond
• Annette Markham
• Brady Robards
• Catherine Knight Steele
• Centre for Culture and Technology
• Crystal Abidin
• Deborah Lupton
• Digital Child
• Eleanor Sandry
• Henry Jenkins
• Jean Burgess
• Jill Walker Rettberg
• Jonathon Hutchison
• Katrin Tiidenberg
• Luke Webster
• Lynn Schofield Clark
• Michael Zimmer
• Nicholas John
• Rachel Berryman
• Safiya U. Noble
• Sarah T. Roberts
• Sky Croeser
• Social Media Collective
• Steve Jones
• Susanna Paasonen
• Tim Highfield
• Zizi Papacharissi

Powered by WordPress / Academica WordPress Theme by WPZOOM

Journal of Applied Computer Science & Mathematics

A full open access journal.

share this!

May 30, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

trusted source

Researcher develops model of influencer importance within Instagram networks

by David Bradley, Inderscience

A study published in the International Journal of Electronic Marketing and Retailing has provided new insights into social media influencers, particularly focusing on those in the women's fashion sector on the well-known image and video sharing platform Instagram.

In a departure from the approach taken by earlier studies, Jens K. Perret of the International School of Management in Cologne, Germany, has used network statistics and centrality measures to establish a model of influencer importance within their network.

Perret analyzed data from 255 influencers covering a four-year period. Influencers are loosely defined as individuals, or even companies, that have a significant online presence and influence on one or more social media platforms. They typically have a large number of followers and a high level of engagement with that audience in terms of their sharing of content and approval by their fans.

Topics such as fashion, beauty, lifestyle, fitness, and gaming have many prominent influencers. Influencers often work with brands to promote products or services to their followers, and so can have an important effect on marketing strategies for companies.

The work has found four main factors contributing to an influencer's significance: followers, reach, engagement rate, and posting frequency. Through regression analysis and artificial neural networks , Perret examined just how consistent these factors were in affecting the influencer's relationships.

The practical implications of the work are that it offers a methodology for evaluating an influencer's importance using readily available metrics. This could streamline the influencer selection process for companies seeking to recruit influencers for their marketing campaigns. It also provides solid evidence that could be used in fair compensation negotiations between companies and influencers.

While the study focused on Instagram, the same approach could work just as well with other social media platforms and even in other cultural contexts. This could open up the possibility of related research into social media dynamics and influencer marketing.

Provided by Inderscience

Explore further

Feedback to editors

Greener, more effective termite control: Natural compound attracts wood eaters

26 minutes ago

Shear genius: Researchers find way to scale up wonder material, which could do wonders for the Earth

29 minutes ago

New vestiges of the first life on Earth discovered in Saudi Arabia

14 hours ago

Mussels downstream of wastewater treatment plant contain radium, study reports

16 hours ago

A new way to see viruses in action: Super-resolution microscopy provides a nano-scale look

Martian meteorites deliver a trove of information on red planet's structure

New imager acquires amplitude and phase information without digital processing

17 hours ago

AI helps scientists understand cosmic explosions

'Forever chemical' discovery can aid drinking water treatment

Mountain building linked to major extinction event half a billion years ago

Relevant physicsforums posts, cover songs versus the original track, which ones are better, another word i got wrong : vile.

7 hours ago

Etymology of the word 'fart' in a handful of PIE languages

12 hours ago

What's The Opposite Of Subtlety?

13 hours ago

Most Underrated Rock Drummer?

Favorite mashups - all your favorites in one place.

More from Art, Music, History, and Linguistics

Related Stories

Latest in influencer marketing: Why it's time to think small

Jun 29, 2023

Micro-influencers play pivotal role in crises, study reveals

Mar 28, 2024

More bang for the buck in influencer marketing: Focus on influencers with smaller followings, say study

Feb 21, 2024

Benign envy and influencer marketing

Sep 15, 2023

Want to be an influencer? Our research shows what you need to know first

May 14, 2024

Influencer emotional connection can affect purchasing decisions of social media followers

Apr 20, 2023

Recommended for you

Satellite data study shows 1.18 billion people are energy poor, finding no evidence of electricity usage from space

20 hours ago

A surprising result for a group's optimal path to cooperation

Misleading COVID-19 headlines from mainstream sources did more harm on Facebook than fake news, study finds

Most people trust accurate search results when the stakes are high, study finds

Who has the largest burial mound? Study examines differences among the upper classes of prehistoric societies

May 29, 2024

Study finds women are vulnerable in post-war peace processes

Let us know if there is a problem with our content.

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Phys.org in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here .

Loading metrics

Open Access

Study Protocol

Documenting the implementation processes and effects of the data use initiatives in primary health care settings in Tanzania: A before-after mixed methods study protocol

Roles Conceptualization, Funding acquisition, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Public Health, St Francis University college of Health and Allied Sciences, Ifakara, Tanzania, Centre for Reforms, Innovation, Health Policies and Implementation Research (CeRIHI), Dodoma, Tanzania

Roles Methodology, Writing – original draft, Writing – review & editing

Affiliation School of Public Administration and management Mzumbe University, Morogoro, Tanzania

Roles Conceptualization, Methodology, Writing – original draft, Writing – review & editing

Affiliation Department of Health, Social welfare and Nutrition Services, President’s Office Regional Administration and Local Government (PORALG), Dodoma, Tanzania

Roles Methodology, Writing – review & editing

Affiliation UNICEF Tanzania, Dar es Salaam, Tanzania

Roles Conceptualization, Writing – original draft, Writing – review & editing

Affiliation Data For Implementation (Data.FI), Palladium, Tanzania

• Albino Kalolo, 
• Anosisye M. Kesale, 
• Mackfallen Anasel, 
• Ntuli A. Kapologwe, 
• Jennie Jaribu, 
• Stella Mujaya, 
• James T. Kengia

• Published: May 31, 2024
• https://doi.org/10.1371/journal.pone.0303552
• Peer Review
• Reader Comments

The use of data in decision making and planning in primary health care settings is critical for improving efficiency and health outcomes for patients and communities. Implementation research can be used to fully understand the effects, context, challenges, and facilitators of data use, as well as how to scale up data use interventions. However, in the context of low resource settings, little is known about how implementation research can be employed to assess the implementation and impact of data use interventions.

We will conduct a hybrid type 2 effectiveness-implementation study employing a mixed method controlled before and after design to measure the effects of data use interventions while simultaneously understanding the implementation of those initiatives. The controlled before and after entails measurement of the effects of the interventions at baseline and end line in a matched intervention and control health facilities using structured questionnaire to health workers (n = 440) and existing patients (n = 422) while also extracting selected health outcome variable from routine data in all participating health facilities (n = 80). The mixed methods component entails measuring the implementation outcomes (adoption, acceptability, fidelity and maintenance) and their moderators entails the integration of both quantitative and qualitative data collection, analysis, and interpretation (i.e. mixed methods) approach by using a structured questionnaire to implementers (health workers and managers) (n = 400). Experiential dimensions of implementation processes and moderators will be explored using qualitative interviews. Guided by implementation research theories and frameworks, a theory of change (TOC) is developed first to guide the evaluation of implementation processes and effects of the interventions. Descriptive and inferential statistics will be employed to analyze quantitative data whereas thematic analysis approach will be employed for qualitative data.

This study is one of the first to test the simultaneous measurement of effects and implementation processes of data use interventions in the primary health care settings. Findings will support efforts to improve quality of services by optimizing scale up and sustainability of the data use initiatives in primary health care settings.

Citation: Kalolo A, Kesale AM, Anasel M, Kapologwe NA, Jaribu J, Mujaya S, et al. (2024) Documenting the implementation processes and effects of the data use initiatives in primary health care settings in Tanzania: A before-after mixed methods study protocol. PLoS ONE 19(5): e0303552. https://doi.org/10.1371/journal.pone.0303552

Editor: Maryam Afshari, Hamadan University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN

Received: November 21, 2022; Accepted: April 27, 2024; Published: May 31, 2024

Copyright: © 2024 Kalolo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

Funding: This work is supported The United Nations Children's Fund (UNICEF) through a grant to the Centre for Reforms, Innovation, Health Policies and Implementation Research (CeRIHI). UNICEF provided funds for data gathering and analysis but has no role in the design, analysis and interpretation of the results from the proposed study.

Competing interests: Jennie Jaribu works with UNICEF, Tanzania. Other authors declare no competing interests .This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Abbreviations: CERIHI, Center for Reforms, Health Policies and Implementation Research; CFRI, Consolidated Framework for Implementation Research, CHMT: Council Health management Team; COM-B, Capability, Opportunity, Motivation, Behavior; DHFF, Direct Health Facility Financing; DHIS2, District Health Information System 2ANC; HFGCs, Health Facility governing committee; HIMS, Health Management Information Systems; HIV, Human Immunodeficiency Virus; IDI, In-depth Interviews; LMIC, Low and Middle income countries; MOH, Ministry of Health; NaTHREC, National Health Research Ethics Committee; PHC, Primary Health Care; PORALG, President’s Office ‐ Regional Administration and Local Government; PRISM, Performance of Routine Information Systems Management; REAIM, Reach, Effectiveness, Adoption Implementation Maintenance; RHIS, Routine Health Information Systems; RMNCAH, Reproductive, Maternal, Neonatal, Child and Adolescent Health; SDG, Sustainable Development Goals; SOPs, Standard operating procedures; TOC, Theory of Change; UHC, Universal Health Coverage; UNICEF, United Nations Children’s Fund; USAID, United States Agency for International Development; WHO, World Health Organization

Introduction

In an effort to achieve the sustainable development goals (SDGs), specifically so goal number 3: good health and wellbeing, low and middle income countries (LMICs) are striving to hasten the pace under which health system strengthening initiatives are implemented [ 1 , 2 ]. There is growing evidence on the importance of using quality and timely data from the health management information systems (HIMS) to inform the progress of health system strengthening initiates across all the WHO health system building blocks [ 3 – 5 ]. To achieve the targeted health system strengthening goals, quality data is required for the planning and implementation of each of the health system building blocks [ 6 ].Existing evidence indicates that positive data experiences lead to a need for more data and a sustained commitment to improving data quality and data use [ 5 , 7 ]. In addition, there is a relationship of improved information, demand for data, and continued data use and this contributes to improved performance and unexpandable benefits of health programs and policies [ 4 , 5 ].

Existing evidence also attests to the fact that few health facilities use data collected through the routine HIMS for decision making and planning [ 8 – 10 ]. While the use of data at health facility level has benefits in data driven decision making such as in budget preparations, staffing decisions, medical supply and planning clinical services, several factors have been implicated to influence it. The factors reported in literature include: governance (leadership, participatory monitoring, regular review of data and supervision) [ 9 , 11 , 12 ], type (level) of a health facility [ 13 ]; production of information (data analysis ,presentation of results, and data quality); health systems inputs (human workforce, financial resources) [ 9 , 13 ] and health information system resources (electronic health management information systems, organizational structure, training) [ 11 ]. Proactive interventions that promote use of data in primary health care settings may hasten use of data for decision making and planning and therefore help to strengthen health systems. As such, data use initiatives that breakdown barriers to data use, improve availability of ready to use data and build capacity of health workforce to effectively use data may help to improve quality of care, strengthen health systems and hasten achievement of universal health coverage (UHC).

Based on the PRISM ( Performance of Routine Information Systems Management ) framework, for data use intervention to be effective, they should address inputs, processes and outputs or performance of routine health information systems (RHIS) [ 14 ]. The PRISM framework defined RHIS performance as better quality data and continuous use of information. RHIS performance is a function of RHIS processes and their technical, behavioral and organizational determinants. Addressing these determinants may lead to improved quality of care, better health outcomes and system performance.

In Tanzania, UNICEF and the Data For Implementation (Data.FI) project, funded by the United States Agency for International Development (USAID), are implementing a data use initiative in the primary health care settings with a goal of improving data use in decision making and planning at different levels, Data.FI providing support at the council level while UNICEF in collaboration with PORALG providing support at the facility level. The interventions are implemented in the two regions of Tanzania namely Dar es Salaam and Dodoma, in which two local government authorities (councils) in each of the region have been recruited in the intervention.

Interventions to address data use in primary health care settings are often complex with multiple components. Complex interventions require extensive stakeholder involvement, longer time frames, and are subject to strong contextual influences [ 15 , 16 ]. As a result, they pose evaluation design and implementation challenges, necessitating a comprehensive approach to program evaluation and monitoring. Desirable evaluation designs are those that aim at: 1) understanding the implementation processes of the intervention and the moderating factors, specifically describing in detail the adoption, fidelity program reach, beneficiaries/client responsiveness and quality of implementation of key process indicators as well as sustainability indictors 2) Using the implementation outcomes to explain the probable variations of effects observed when measuring the impact of the program.

Intervention implementation strategies targeting data use determinants can improve implementation outcomes, such as adoption, acceptability, fidelity and sustainability. Supportive supervision and technical backstopping designed to overcome implementation barriers and leverage innovations to foster data use initiative implementation represent promising approaches to facilitate implementation [ 11 , 17 , 18 ].

Documenting and assessing program implementation processes, program effects, and understanding contextual factors that may affect both the implementation process and program effects in the context of health system strengthening is a critical component of any robust and comprehensive evaluation effort of complex health system interventions implemented in real-world settings. Studies that explicitly link implementation processes to program outcomes have been found to be informative when taking interventions into scale or implementing in other settings as it is easier to draw lessons [ 10 , 11 ].There is a litany of evidence that the level and process of implementation affect the outcomes of a program [ 18 – 21 ]. It follows that assessing the implementation process of interventions offers potentials to describe the mechanisms through which a given intervention produces outcomes, thus documenting both expected and unexpected effects.

Finding from such evaluations contribute to continuous learning and lesson drawing across settings in the stride forwards to strengthen health systems as countries strive to move towards universal health coverage (UHC). In the data use domain, little is known on how the interventions are implemented, the effectiveness of the intervention and the influence of contextual factors in relation both to implementation and outcomes of the interventions.

The objective of this study is to disentangle the implementation processes of data use initiatives (adoption, acceptability, fidelity, maintenance, and cost), understand the determinants of implementation outcomes, and determine the effects of data use initiatives on quality of care and selected health outcomes.

In this protocol, we aim to unravel the implementation processes (adoption, acceptability, fidelity, maintenance and cost) of the data use initiatives (interventions that focus on promoting data use culture by improving data availability and usability, facilitating use of data by health workers for decision making and planning (routine and long-term) and breaking down barriers to data use) , understand the determinants of implementation outcomes and determine the effects of data use initiatives on quality of care and selected health outcomes

Materials and methods

1. study settings.

Intervention and comparison districts will be purposively selected from Dar es Salaam & Dodoma and Tanga & Mwanza Regions respectively with a view to minimizing contamination between intervention and comparison arms. In each region, the study area will include 20 health facilities, i.e., 10 health facilities from each district council. Health facility surveys will be conducted at baseline and end line in both the intervention and comparison areas, whereas the data use intervention will reach only the intervention district councils (two districts each in Dar es Salaam (Temeke and Kinondoni) and Dodoma (Dodoma City Council & Chamwino). The intervention districts will also be followed up at 6 months to measure the implementation outcomes and their determinants. To contextualize the settings of this study, we describe the study sites and the program.

a. Study sites.

The intervention districts will be selected purposively based on the fact that the data use interventions will be implemented. The control districts will be selected from two regions to match the intervention districts based on geographical location (urban vs. rural). The health facilities from the selected districts were selected based on the following criteria: a primary public health facility, providing services for more than a year. Hereunder the characteristics of the selected districts are described.

Kinondoni and Temeke are urban districts (Municipality) in the Dar es Salaam Region, the business capital of Tanzania Mainland. The census of 2012 showed that the population of Kinondoni was 1,775,049 whereas that of Temeke District is 1,368,881.

Chamwino and Dodoma City councils are districts in Dodoma Region, the administrative capital of the united republic of Tanzania. The census of 2012 showed that the population of Chamwino was 330,543, whereas that of Dodoma city council was 410,956.

Tanga city council and Korogwe are districts in the Tanga region, one of the important cities in the coastal zone of the country. The census of 2012 showed that the population of Korogwe was 56,282 whereas that of Tanga city council was 273,332.

Mwanza city council and Misungwi District council are districts in Mwanza region, one of the important cities in the Lake zone region of the country. The census of 2012 showed that the population of Mwanza city council was 706,453 whereas that of Misungwi was 351,607.

The eight councils represents a mixture of metropolitan (Temeke & Kinondoni), urban (Dodoma City council, Mwanza city council, Tanga city council) and rural district councils (Chamwino, Korogwe and Misungwi). The study areas are suitable of generating outcomes that could easily be transferable to other similar settings in the country.

b. Description of the data use initiatives.

This implementation study is conducted in the context of an intervention that is set to promote data use for decision making and planning to improve the quality of care and health status (outcomes) of the population.

The President’s Office ‐ Regional Administration and Local Government (PO-RALG) requested assistance from UNICEF and USAID to promote and institutionalize a culture of data use at subnational level in the stride forwards to achieve universal health coverage (UHC) and strengthen PHC systems in line with the decentralization policy and related approaches such as the direct health facility financing (DHFF) . USAID engaged the Data for Implementation (Data.FI) project, to support the implementation of the request with the aim of using quality data to support evidence-based health programming and accountability.

In April 2021, UNICEF and Data.FI drafted a proposed joint implementation plan to support implementation of data use for this quality improvement initiative at different levels of the health care system, with Data.FI, providing support at national, regional and council level whereas UNICEF supports the health facility level. The intervention strategies aim to address 1) organizational determinants of data use (governance, equipment & tools and planning ) 2) technical determinants of data use (physical infrastructure, ICT infrastructure , HIS design and operability 3) behavioral determinants of data use (capability, opportunity and Motivation )

2. Study design

This study will adopt an effectiveness-implementation type-2 hybrid design [ 22 ] to evaluate the effectiveness of the data use initiatives in improving quality of health service delivery and health outcomes while simultaneously understanding the implementation of the initiatives. Since the data use initiative is implemented in twenty health facilities of two regions, we plan to carry out a before and after controlled design to estimate the combined effects of the data use initiatives in the intervention sites and matched control regions. Simultaneously we plan to assess the implementation processes of the initiatives and this entails the integration of both quantitative and qualitative data collection, analysis, and interpretation methods (i.e. mixed methods) to understand the implementation processes and the influencing factors.

3. Conceptual frameworks

In order to assess the effects, implementation outcomes and influencers of the data use initiative in the primary health care settings we use a conceptual framework that acknowledges that improving health information systems [ 23 ] in the primary health care settings can improved data use and therefore strengthen the primary health care, improve quality of care and health outcomes (see Fig 1 ).In addition, we acknowledge the contribution of the capability, opportunity, motivation and behavior (COM-B) model in changing behaviors of organizations and individuals to be favorable for data use in the primary health care settings. Our conceptualization is also inspired the implementation science frameworks that include: 1) Conceptual Framework for Implementation Outcomes [ 24 ], in this study, we consider all the three outcomes of implementation research namely, implementation outcomes, service outcomes and client outcomes 2) Reach, Effectiveness Adoption Implementation Maintenance (RE-AIM) framework [ 25 ] 3) Consolidated Framework for Implementation Research (CFIR) [ 26 ]. Additional guidance for specific constructs are derived from the fidelity of implementation framework [ 18 ], theoretical framework for acceptability [ 27 ].

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0303552.g001

4. Study components

The steps to conduct this study will be based on the two main components of the study, that is , effectiveness and implementation process .The effectiveness component entails collecting data to measure outcomes of the initiatives on selected indicators (top level indicators for service areas such as maternal, newborn, adolescents and child health ) at PHC before and one year after the implementation of the program .The implementation process study aims at understanding how the program is implemented amid contextual influences. To complete the components, the study will adopt the following steps.

1) Develop a theory of change (TOC) for data use initiatives and document the process under which such a TOC is developed.

In order to understand the mechanism through which outcomes of data use initiatives are produced, we follow the implementation science steps throughout the conduct of this study. The steps are 1) developing the theory of change (TOC by reviewing internal program documents, attendance to various meetings on the data use initiatives and consultations with program developers and implementation teams and literature review on similar programs targeting primary health care settings 2) Testing the TOC, by developing tools and collecting empirical data in the field 3) Refining the TOC through a qualitative work consisting of in-depth interviews with key stakeholders involved in, or who have a stake in data use initiative, and focus groups and in-depth interviews with program beneficiaries, i.e., the health care mangers and frontline health care workers. The initial TOC has been developed (see Fig 1 & S1 File for a details) in order also to guide the development of data collection tools at all stages of the study.

2) Understand the initial (baseline) situation of data use in the study settings in relation to decision making and comprehensive (council or health facility) planning.

To understand the baseline situation, the four councils implementing the data use initiative will be matched equally with comparable councils where the data use interventions will not be implemented. Stratified sampling (to distinguish the level of facilities) will be used in these four councils to select a representative sample of facilities to be observed for one year after the project is implemented. This step combines quantitative and qualitative methodologies to evaluate the current state of data use in the recipient health facilities.

3) Understand the implementation processes (acceptability, adoption, fidelity and sustainability) of the data use initiatives amid the influence of contextual factors.

Complex interventions are often criticized as being a black box because it is difficult to know exactly why an intervention did (or did not) work. To address this gap and open the black box, a process evaluation will be completed using a convergent parallel mixed methods design to assess acceptability, adoption, fidelity and maintenance of the intervention processes. The convergent parallel mixed methods component refers to the integration of both quantitative and qualitative data collection methods to complete the process evaluation at the same time. The process indicators reflect the immediate outputs of the data use initiatives. In line with existing evidence on intervention uptake and sustainability, the process evaluation will elucidate how the initiatives have been implemented in the intervention councils and why [ 21 , 27 – 31 ]. In turn, this information will be used to explain the probable heterogeneity of effects observed when measuring the effect of the program. Triangulation of data from multiple sources will be done to generate comprehensive information from this study and generate very informative body of knowledge to inform data use related policies and guidelines in the primary health care settings. All the above activities will be guided by the initial TOC developed in this study.

Data will be collected from health managers and frontline workers delivering services in health facilities. Quantitative data collection will be done using structured questionnaire to health care managers and frontline health workers who produce data at multiple points and a document review checklist in order to assesses both the implementation outcomes (acceptability and fidelity) and service outcomes (efficiency, safety and patient centeredness).

The specific research questions in this component will be as follows:

• To what extent the data use initiative has been adopted, accepted and maintained?
• How many users of primary health facility have been reached by the initiative?
• To what extent do the implementers and beneficiaries of the initiative adhere to the initiative protocol?
• Is data use initiative faced with implementation challenges? What are those challenges and how can they be addressed?

To answer the above research questions, the following objectives will have to be addressed

• To assess the extent of adoption of the data use initiatives
• To determine number or proportion of beneficiaries reached by the data use initiative
• To assess the fidelity to data use initiative protocol and SOPs
• To assess acceptability of the data use initiative by primary beneficiaries and other stakeholders
• To assess sustainability of the data use initiative in the intervened primary health facilities
• To determine the implementation challenges and success of the data use initiatives
• Understand the effects of the data use initiative on health system and patient outcomes

To understand the effects of the data use initiative, we will collect data at baseline and end line in order to allow two points measures of the outcome data. In this step, to assess compliance to national and international quality standards, the study team will rely both on the analysis of the routine health information system (at the facility level and district level) and information collected from respondents. Specific research questions include, i) has the quality of primary health facility data improved following implementation of the initiative? ii) What factors have contributed to the observed changes?

Specific objectives:-

• Assess the effect/impact of data use initiative on beneficiaries’ capabilities (knowledge, and skills to analyze and interpret data)
• To evaluate the impact/effect of data use initiative on the quality of data collected in the primary health facilities
• To determine the impact/effect of the initiative on the use of data for decision making and planning
• To evaluate the effect of data use initiative on the performance of primary health facilities in terms of quality of delivered health services (availability drugs, medical supplies and equipment) and client’s satisfaction with the services.

Study component 1 : Measuring effects of the data use initiative . This component aims at establishing the effects of data use initiatives on quality of care and selected health outcomes. To establish and control the counterfactual, data will be collected in the intervention and control councils. This component comprises collection of quantitative and qualitative data at two points (baseline and end line) covering a period of one year.

Sampling and sample sizes . This component will collect information from health facility documents , health care workers, and patients. The samples and sample sizes for this quantitative component are as follows

• We will collect health facility level data to assess the overall situation of quality of care from a total of 80 health facilities (40 from intervention health facilities & 40 from control health facilities).
• From each of the selected health facilities we will collect quantitative data from at least five participants (the chairperson of the health facility governing committee, in charge of the health facility, data focal person , in charge of RMNCAH services and in charge of outpatient services) making a total of 400 participants. This sample is adequate to conduct robust inferential analyses related to the effects of the data use initiative. Moreover, taking p = 50% and applying Cochrane formula while also accounting for refusals and the fact that some health facilities (especially the dispensaries) may not all the five staff, an addition of 10% to the minimum sample will be added to reach 440 participants.
• Also, from the selected facilities exiting patients will be systematically selected after gender stratification following medical consultations. The exit interview with Client/patients will be approached after they have received the services and are ready to go home. Respondents eligible for interview include all exiting patients or relatives of patients (aged above 18 years). They will be sampled to ensure equal numbers of men and women are captured. The sample is calculated using the Cochran formula (1977) [ 32 ]; by taking 50% as a proportion of patients’ perception on quality of primary health care services) and a power of 80% allowing for an estimated error margin of 5%, the sample size obtained was 384 patients. To account for refusals, an additional 10% of the sample will be added (n = 38), making a total of 422 patients.

The qualitative samples and sample sizes for this component are as follows:

We will use purposive sampling technique, to select at least 8 participants for in-depth interviews as a sub-sample of exit interview questionnaire (for exiting patients) from each district, i.e., 4 participants from dispensaries and four participants from health centers, thus making a total of 64 patients. Also, a total of 4 health care workers will purposively be selected for in-depth interview per council, i.e., 2 participants from dispensaries and 2 participants from health centers, thus making a total of 32 in-depth interviews. The exact number of interviews will be based on saturation of information that is the sample could even be smaller or increase depending on saturation. The interviews will explore the process and experiential dimension of quality of care and will complement evidence emerging from the quantitative analysis.

Data collection tools and procedures . To understand the data use situation including their determinants (governance, technical, behavioral and context) and existing initiatives and the indicators related to quality of care at the health facility, we will rely on facility assessment tool, interviews with clients and a structured questionnaire to health care workers and an observation checklist. The tools aim at getting a holistic picture on changes in quality of care and related health outcomes overtime as the initiative is implemented or as a result of changes in time. The tools are described here under and are found in S2 File .

• Facility assessment tool: We will use the star rating tool to understand the baseline situation in relation to quality of care of the health facilities. The star rating tool is a validated instrument that has been used to measure quality of care in the health facilities in Tanzania. We will measure the changes in indicators related health system building block indicators (financing, availability of health commodities, and motivation of human resource for health) that could reflect the effects of data use at health facility level.
• Patient exit interview questionnaire: We will use a patient exit questionnaire to understand patient’s experiences and perceptions on the quality of care provided in health facilities. These questionnaires are also part of the star rating tool, i.e., we will adopt all the questionnaire in the star rating tool NB: The star rating tool consists of facility assessment and exit interview questions and has been used repeatedly to assess quality of health care services in Tanzania [ 33 ]. During the baseline assessment, we will also pilot and validate an organizational readiness tool geared to assess health workers readiness to implement data use interventions
• Health workers questionnaire: We will use a health workers questionnaire to understand the situation in relation to data use and the determinants of data use at the facility
• Observation checklist: We will use an observation checklist that aims at getting the reality in relation to data use tools, equipment and practices related to data use at the health facility
• For the health outcomes: we will extract data from DHIS2 for selected indicators using a document review checklist/DHS2 data extraction checklist. The indicators include: Number of health facility deliveries, number of pregnant mothers completed 4th ANC visit, NC Total Pregnant Women (PW) tested, Number of pregnant women who tested positive for HIV (First Test), Proportion of pregnant women on ARV to prevent HIV transmission and Number of Maternal Deaths

Study component 2 : Measuring implementation process of the data use initiatives . This component aims to establish data use initiative implementation processes as well as influencing (moderating) factors. This component will be implemented in the intervention councils to better understand the initiative’s implementation processes, thus unlocking the data use initiative’s black box by better knowing the initiative’s components and contextual impacts.

Sampling and sample sizes . Our sample for measuring the implementation process (process evaluation) will include implementers of the data use initiative at the council and health facility level. The participants will be implementing partners, health care mangers and health facility governing committee members (CHMT, HFGCs, health facility-in charges and frontline health workers). The fact that all CHMT members are guardians of data use at the council and its respective health facilities, they will all be included in the study (census) thus making a total of 60 CHMT members i.e., at least 15 members from each of the participating council. At least two members of HFGCs will be recruited in the study making a total of 80 HFGC members. A consecutive sample of health care workers from the participating health facilities with a maximum of five participants based on the assumption that the selected facilities should have a minimum of five health care workers, i.e., a total of 200 health workers will be recruited in the study. In addition, routine health facility files and documents will be read and summarized to fit the study context.

Data collection tools and procedures . The domains for the implementation process evaluation are reach, adoption, fidelity of implementation, acceptability and sustainability. Data will be collected from the following types of participants and documents; implementing partners, health care managers and health facility governing committee members (CHMT, HFGCs, health facility -in charges and frontline health workers) and health facility documents. Table 1 provides the details on the set of tools and their alignment to objectives and sources of data. In line with our mixed methods design, quantitative data will be gathered using; structured questionnaires, document review/ observation checklists, and semi-structured in-depth interviews (IDIs).

https://doi.org/10.1371/journal.pone.0303552.t001

The questionnaire for health workers will capture information related to socio-demographics, general knowledge on data use initiative, acceptability of the initiative to health workers, fidelity of implementation, sustainability of data use initiative and moderating factors. The questions in this tool will either be multiple choice, yes/no or Likert scale.

A structured observation checklist will be used to collect data on implementation of data use initiative. This will serve as triangulation of the information obtained from the health care workers. We will use semi structured instruments to collect data from the implementing partners, health care mangers at all levels and frontline health workers. The qualitative component aims at uncovering the participant’s experiences with data use and their expectations on the data use initiatives and its future maintenance at the health facility. All the tools to be used in this study are detailed in S2 File .

5. Analytical procedures

Descriptive analysis will be used to summarize data where by continuous data will be summarized using mean and standard deviation (SD) as well as medians and interquartile range. Dichotomous variables will be summarized using frequency and percentage. Chi-square test or fisher exact will be used to evaluate bivariate associations between categorical variables where by t-test will be used to estimate association in numeric variables and ascertain whether there mean different between categories. We will also use regression analysis.

Audio-recordings of in-depth interviews and focus group discussions will be transcribed verbatim in Kiswahili guided by a transcription guideline and translated to English. Transcription and translations will be done by the research team that conducted the respective IDIs. Codes will be grouped into categories, sub-themes and themes. Thematic analysis will be used to analyze qualitative data using ATLAS.ti 8 software. Table 2 provides details on data collection tools, administration, sample size and analytical techniques.

https://doi.org/10.1371/journal.pone.0303552.t002

6. Ethics approval and consent to participate

This protocol explains a study that is being done as part of the data utilization initiative. The protocol received ethical clearance certificate from National Health Research Ethics Committee (NaTHREC),Ref. NIMR/HQ/R.8a/Vol.IX/3940.Permission to collect data in the regions and councils will be sought from the President’s Office Regional Administration and Local Government, the Ministry of Health(MOH), the Regional Secretariat (RS), and the Local Government Authorities (LGAs). All study participants will be asked to provide written informed consent. In publications resulting from this study, no personally identifying information will be disclosed.

7. Dissemination

The results from the current study will be shared with participating districts and health facilities, disseminated through scientific conference presentation and peer reviewed journals. Authorship of the resulting papers will be decided based on the International Committee of Medical Journal Editors criteria.

Data use initiatives are among the most complex health system interventions implemented at different levels in the health care settings. The interventions in the course of implementation, required articulation of processes and inputs along multiple levels (district, health facility to individual frontline health care workers), actors and actions that required also support and continuous technical backstopping from different levels and actors.

This study represents a first attempt to document the implementation process, determine the implementation outcomes, understand the determinants of implementation processes and outcomes and determine the effects of data use initiatives on quality of care and health outcomes.

Our implementation-effectiveness hybrid design that takes a before and after controlled design to determine the effects of data use initiatives while also understanding the counterfactual is expected to provide a holistic picture on the interaction between implementation outcomes and program outcomes [ 24 ]. The mixed methods design that takes into consideration the implementation process and outcomes amid the influence of contextual factors, is envisaged to provide a comprehensive picture of the influencers of the implementation processes as documented in existing evidence [ 34 ].

The current study is designed to yield the best possible evidence to guide implementation of data use initiatives in the primary health care settings. The development of the TOC and monitoring and evaluation framework that saw a combined team of program developers, implementers and researchers, represents a best practice in designing implementation-effectiveness hybrid studies as proposed also in previous evidence in implementation research [ 35 ].

The use of mixed-methods approaches as well as multiple tools of collecting data will enable the development of recommendations to improve future implementation of the data use initiatives and other implementation studies of similar nature by identifying trends, challenges and potential solutions to implementation challenges amid contextual influences as well as design issues if they exist. We must also acknowledge the limitations that this study may prone to missing data as well as recall bias as collection of data will take place some months after start of the data use interventions.

Although, we will apply matching in the course of selecting the intervention and control facilities, the fact that we will recruit primary health facilities across the four regions which vary in size, geography, population served, there may be some variations in outcomes. Moreover, although the before–after controlled studies can help overcome the problem of confounding, there is always a risk of unidentified confounders when there is no randomization thus leading to some risk for confounding or bias [ 36 ].

This protocol was developed amid the challenges of COVID-19 pandemic that limited face to face meetings. We managed to minimize face to face encounters and relied on virtual communications that could have some effects on same decisions. The various waves of the Covid-19 that presented differently were seen as barriers to face to face meeting and therefore rely on web-based platforms.

In conclusion, this study is expected to generate evidence on the implementation process and outcomes of the data use interventions in Primary health care settings in Tanzania. As such the findings from this study will enhance understanding of whether and how data use initiatives might improve patients and health systems outcomes amid the influence of contextual factors in the course of implementation. The theoretical approaches and methodologies described in our protocol may be useful in informing the design of future studies on the evaluation of complex interventions in primary health care and beyond.

Supporting information

S1 file. theory of change for deploying data use initiatives in the primary health care in tanzania..

https://doi.org/10.1371/journal.pone.0303552.s001

S2 File. Data collection tools.

https://doi.org/10.1371/journal.pone.0303552.s002

• View Article
• Google Scholar
• 2. Reynolds M, Blackmore C, Ison R, Shah R, Wedlock E. The Role of Systems Thinking in the Practice of Implementing Sustainable Development Goals. In: Leal Filho W, editor. Handbook of Sustainability Science and Research [Internet]. Cham: Springer International Publishing; 2018 [cited 2021 Dec 18]. p. 677–98. Available from: https://doi.org/10.1007/978-3-319-63007-6_42
• PubMed/NCBI

Electrospinning Approach for Preparing Nanostructured Scaffolds for Stem Cell Seeding and/or Implantation in Neurotrauma

• First Online: 23 May 2024

Cite this protocol

• Eldar F. Davletshin 1 ,
• Albert A. Rizvanov 1 , 2 , 3 &
• Yana O. Mukhamedshina 1 , 2  

Part of the book series: Methods in Molecular Biology

Preparation of highly porous biocompatible and bioresorbable nerve conduit or scaffold by electrospinning based on synthetic polycaprolactone with a molecular weight of 80 kDa (PCL 80 kDa) has significance in the context of regenerative medicine with special emphasis on their application in neurotrauma. PCL conduits/scaffolds serving as a support structure for seeded stem cells show promising regenerative potential to promote functional recovery and tissue regeneration in models of neurotrauma. Here we describe a standard protocol for the production of conduits by electrospinning at high field-forming voltages (24kB) using a 6% solution of PCL 80 kDa in a chloroform/methanol mixture.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Libro R, Bramanti P, Mazzon E (2017) The combined strategy of mesenchymal stem cells and tissue-engineered scaffolds for spinal cord injury regeneration. Exp Ther Med 14(4):3355–3368. https://doi.org/10.3892/etm.2017.4939

Article   Google Scholar  

Kaplan B, Levenberg S (2022) The role of biomaterials in peripheral nerve and spinal cord injury: a review. Int J Mol Sci 23(3):1244. https://doi.org/10.3390/ijms23031244

de Assis ACC, Reis ALS, Nunes LV, Ferreira LFR, Bilal M, Iqbal HMN, Soriano RN (2023) Stem cells and tissue engineering-based therapeutic interventions: promising strategies to improve peripheral nerve regeneration. Cell Mol Neurobiol 43(2):433–454. https://doi.org/10.1007/s10571-022-01199-3

Hackett JM, Dang TT, Tsai EC, Cao X (2010) Electrospun biocomposite Polycaprolactone/collagen tubes as scaffolds for neural stem cell differentiation. Materials 3(6):3714–3728. https://doi.org/10.3390/ma3063714

Mukhamedshina YO, Masgutov RF, Masgutova GA, Zuravleva MN, Shulman AP, Galieva LR, Rogozin AF, Chelyshev YA, Rizvanov AA (2015) Conduit based on poly(ε-caprolactone) filled with fibrin-based hydrogel with mesenchymal stromal cells for peripheral nerve defect reconstitution. Genes Cells 10(3):83–87. https://doi.org/10.23868/gc120496

Zhou X, Shi G, Fan B, Cheng X, Zhang X, Wang X, Liu S, Hao Y, Wei Z, Wang L, Feng S (2018) Polycaprolactone electrospun fiber scaffold loaded with iPSCs-NSCs and ASCs as a novel tissue engineering scaffold for the treatment of spinal cord injury. Int J Nanomedicine 13:6265–6277. https://doi.org/10.2147/IJN.S175914

Lu N, Wang X, Li X, Shi W, Wang X, Zou Y, Weng Y (2023) EMSCs-seeded micro-stripe patterned Polycaprolactone promoting sciatic nerve regeneration. Adv Mater Interfaces 10(5):2201929. https://doi.org/10.1002/admi.202201929

Download references

Acknowledgments

This study was funded by the subsidy allocated to Kazan Federal University for the state assignment № FZSM-2023-0011 in the sphere of scientific activities.

Author information

Authors and affiliations.

Kazan (Volga Region) Federal University, Kazan, Russia

Eldar F. Davletshin, Albert A. Rizvanov & Yana O. Mukhamedshina

Republic Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russia

Albert A. Rizvanov & Yana O. Mukhamedshina

Division of Medical and Biological Sciences, Tatarstan Academy of Sciences, Kazan, Russia

Albert A. Rizvanov

You can also search for this author in PubMed   Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2024 Springer Science+Business Media, LLC

About this protocol

Davletshin, E.F., Rizvanov, A.A., Mukhamedshina, Y.O. (2024). Electrospinning Approach for Preparing Nanostructured Scaffolds for Stem Cell Seeding and/or Implantation in Neurotrauma. In: Methods in Molecular Biology. Springer, New York, NY. https://doi.org/10.1007/7651_2024_547

Download citation

DOI : https://doi.org/10.1007/7651_2024_547

Published : 23 May 2024

Publisher Name : Springer, New York, NY

• Publish with us

Policies and ethics

• Find a journal
• Track your research

• Skip to main content
• Accessibility help

Information

We use cookies to collect anonymous data to help us improve your site browsing experience.

Click 'Accept all cookies' to agree to all cookies that collect anonymous data. To only allow the cookies that make the site work, click 'Use essential cookies only.' Visit 'Set cookie preferences' to control specific cookies.

Your cookie preferences have been saved. You can change your cookie settings at any time.

Public health: Health Secretary speech

Speech by Cabinet Secretary for Health Neil Gray given at the Usher Institute, Edinburgh on 28 May 2024.

Good morning everybody,

It is an absolute pleasure to be here with you all at the Usher Institute and I thank you for hosting me today.

I am looking forward to being given a tour of the wonderful facilities on offer here.

This facility is emblematic of the extraordinary infrastructure and research excellence here in Scotland, which will play a crucial role in driving forward improvements in our public health. As you know, I was appointed Health Secretary a few months ago.

This is an immense privilege – I would argue that there is no more important and no more impactful role in government.

During my first weeks in office I’ve had the opportunity to travel the length and breadth of Scotland to meet with healthcare professionals and patients.

I’ve seen the extraordinary skill, dedication and compassion of our doctors and nurses, first hand across health and social care.

And I’ve seen some of the exciting technologies that will deliver a healthier future not just for people in Scotland, but for people around the world.

I think we all know that our NHS is under huge pressure. I do not shy away from that fact.

Almost a decade and a half of restrained spending, ongoing recovery from the pandemic and an ageing population are just some of the issues we have to grapple with.

Meeting the immediate challenges in our health service will of course be my foremost priority.

But as Cabinet Secretary, I also feel a duty to lift my head to look to the future – to consider exactly what we want our health service to look like several years – or even decades - from now.

I am no longer happy for our NHS to simply be getting by, year on year.

I want us to have a shared, collective, national vision for what a thriving NHS looks like in the years and decades to come.

Next week I’ll be leading a debate in parliament about healthcare reform, to allow MSPs from all parties to put their ideas forward.

But I do not want this discussion to be limited to political parties. I want this to be a truly national debate – hearing directly from patients, the NHS workforce and everyone with an interest in making our health service the best it can be.

So I am very keen to involve people like you – the researchers and innovators who can play such a crucial role in driving Scotland’s healthier future.

As we approach this debate – and develop this shared, national vision - we have to be clear on the values that will underpin it.

So let me be very clear at the outset – our NHS must always remain true to its founding principles. Publicly owned and free at the point of need.

The Scottish Government will stand against any and all attempts to privatise the NHS by stealth – our health service in Scotland will always be in public hands.

As many of you will know, the First Minister has set out four overarching priorities for his government – improving public services, like our NHS, eradicating child poverty, tackling the climate emergency and driving growth in our economy.

Each of these strongly interconnect with the goal I have set for us today of an NHS that thrives in the decades to come.

We know that it is simply impossible to improve our public services without a vibrant, successful economy. It is growth that will pay for the investment we need in the health service – and our economy will not grow without a healthy workforce. That is the very essence of what a wellbeing economy means.

We know that child poverty is a central driver of poorer health outcomes, not just in childhood but throughout life. Its eradication would have a transformational impact on public health.

Similarly, we know that climate change could have serious health impacts – so tackling it is a moral, economic, environmental and a health imperative.

These four priorities will run through the heart of our actions in government – and for me, the NHS is central to each.

As I have said, we face significant challenges in our NHS and in our public health more generally.

We know that Scotland’s health is not where it should be.

The causes of this are complex, but they are clear.

The Covid pandemic has obviously taken a devastating toll not just on our health but also our services.

Health and social care services are under unprecedented pressure.  That’s true for healthcare systems around the world.  

But it goes beyond Covid. 

The financial context and the cost of living crisis are creating a perfect storm. 

Migration policy continues to make it challenging to attract international staff to our NHS.

Scotland continues to suffer the impact of deep historical inequality.

Even before Covid those in our richest areas were living over 20 years longer in good health than those in poorest areas in our most deprived areas, people live more than a third of their life in poor health.    

So as well as improving NHS services our work must involve radical action on population health, improving health behaviours and ensuring people are empowered to look after their own health.

These issues – along with the opportunities presented by the technological innovations, some of which I have the opportunity to see here today – must all be viewed in the round as we seek to drive improvements.

On the issue of funding, I am proud of my government’s record in office.

Frontline health spending in Scotland is – and has consistently been – higher per head than south of the border.

And we are continuing to prioritise investment in our NHS, in what are incredibly tough times financially right across the public sector.

That is not to say we would not like to invest more – of course I would be willing to invest more.

But the reality is we operate in a financial context, which is set by the UK Government.

As Health Secretary, I will never shirk responsibility or try to pass the buck – to be clear, the buck stops with me.

But we cannot ignore the wider financial context which has a direct impact on our health service.

I will continue to do everything I can to protect and improve our NHS.

But we can never overlook the wider financial context.

Another issue that will be crucial both now and in the years to come is staffing.

Now, in Scotland, we have a positive record – NHS staffing here is the highest in the UK with 29.3 WTE staff per 1000 people.

But I don’t want us just to compare ourselves to others.

I want us to be the best we can possibly be.

However, we already know that health and social care worker visa applications are down by 76 per cent.

International workers play a deeply important role in the health service. To see them choose not to come here is deeply worrying.

We need to be able to take any and all necessary steps to attract talented, hard-working people to Scotland to work in our health service.

And on staffing, it is vital that we continue to support the staff that we have in our NHS now.

They were treated as heroes during the pandemic – and we should treat them as heroes now.

I am incredibly proud that in Scotland, we have not lost a day to strike action.

My commitment today to our NHS workforce is that we will continue to value you in the way you deserve.

I would also like to talk about the opportunity presented to our health service by innovation and new technologies, some of which I have seen here today.

It is clear medical research is moving faster than ever and new preventative technologies facilitated by the NHS are supporting individuals to better manage their own health and prevent and mitigate impacts of disease.

For example, wearable devices are helping people to take more ownership over their own health.

New diagnostics and screening methods are being introduced, such as the NHS-Galleri trial for pre-symptomatic detection of cancer and digital therapies such as our diabetes remission programme can help thousands of people to lose weight.

There is also huge future potential in personalised and precision medicines and gene therapies, AI diagnostics predictive data analytics, and robotic surgery.

These are all examples where we are already making progress and can go further to help us improve outcomes for the patient and make the NHS more productive.

Better use of data and digital technology is critical to how we drive improvements in healthcare and is a key part of our plans to reform services. I am pleased to announced today an investment of £1.2 million this year in Theatre Scheduling software to reduce hospital waiting times and enhance operating theatre efficiency which will be rolled out in NHS boards across Scotland over the next year.

This technology is backed by more than five years’ worth of NHS operating times data and is just one of the initiatives that will help enable us to schedule 1.5 million procedures per year - while improving data quality to help safely increase productivity.

This will help maximise capacity, productivity and build greater resilience and reduce waiting lists.

I am also committed to improving treatment and care for everyone in Scotland affected by diabetes.

Type 1 diabetes is a lifelong condition which affects over 35,000 people in Scotland.

We need to provide tailored solutions, designed and delivered to meet the individual needs, and it is imperative that we harness technology and innovation to help us do this.

That said, we know there is a long way to go in terms of our care models and many people right now are facing long waits for life changing technologies like insulin pumps and Hybrid Closed Loop Systems.

I am delighted today to announce that this year, we will be investing up to £8.8 million to improve access to diabetes technologies.

This funding will provide access to all children and young people that want it and will also allow us to continue increasing provision to adults living with Type 1 diabetes. The key focus of this investment will be to develop a care model for the future – in partnership with those living with diabetes.

These are further steps forward in harnessing the transformative power of scientific innovation and technological progress for our NHS.

I know that is a shared goal for each of us in this room.

As our NHS faces new challenges and new opportunities, that is a goal that I want us all to continue to work to, together.

An NHS with the funding to thrive, with a valued and supported workforce delivering on the potential of the technological revolution.

And crucially – an NHS true to its founding principles. Free at the point of need and always in public hands.

Together, we can strengthen our NHS and ensure it thrives for decades to come.

I look forward to working with you all to deliver exactly that.

Email: [email protected]

There is a problem

Thanks for your feedback

Your feedback helps us to improve this website. Do not give any personal information because we cannot reply to you directly.

• Study Protocol
• Open access
• Published: 01 June 2024

Explaining the perception and experiences of breastfeeding in mothers who have a high risk pregnancy: a protocol study

• Kobra Mirzakhani 1 , 2 ,
• Atefeh Yas 3 &
• Talat Khadivzadeh 1 , 2  

Reproductive Health volume  21 , Article number:  74 ( 2024 ) Cite this article

Metrics details

Introduction

Enhancing breastfeeding practices, even in affluent nations, significantly reduces child mortality rates. Nevertheless, three out of five newborns do not receive breastfeeding within the first hour of birth. Research indicates that under high-risk pregnancy circumstances, there may be challenges in initiating and sustaining breastfeeding. Infants born from high-risk pregnancies are particularly vulnerable to illnesses and mortality. Although breastfeeding serves as a protective measure against various infant and post-infancy ailments, many mothers encounter difficulties in commencing or maintaining breastfeeding due to complications associated with their conditions. The present study aims to illuminate the understanding and experience of breastfeeding in mothers with high-risk pregnancies, considering the cultural and social context of Iran.

This study is a qualitative research utilizing a conventional content analysis approach. In this qualitative study, mothers who have undergone a high-risk pregnancy and currently have infants under 6 months old will be chosen through purposeful and snowball sampling. Their breastfeeding experiences will be gathered through individual, semi-structured, and face-to-face interviews. In addition to interviews, observation and focus groups will also be used to collect data. Data analysis was performed using Graneheim and Lundman’s method with MAXQDA software version 10, VERBI Software GmbH, Berlin. The study will utilize the criteria of Lincoln and Guba (1985) for validity and reliability.

This qualitative study aims to investigate the experiences and challenges of breastfeeding in mothers with high-risk pregnancies to pinpoint breastfeeding barriers in this demographic and develop essential interventions and strategies to address these obstacles.

Breastfeeding is viewed as a distinctive method of nourishing infants, offering both short-term and long-term emotional, nutritional, and immunological advantages [ 1 ]. Boosting breastfeeding rates has the potential to save the lives of up to 800,000 children, even in high-income nations. It also contributes to maternal health, with estimates suggesting that breastfeeding prevents 20,000 deaths annually from breast cancer [ 2 , 3 ]. However, statistics reveal that 3 out of every 5 infants are not breastfed within the first hour after birth, increasing their vulnerability to mortality and illness [ 4 ]. Breastfeeding not only enhances the well-being of both mother and child but is also acknowledge d as a key strategy for attaining sustainable development goals [ 5 ]. Aligned with global health and development targets, the World Health Organization pledged in 2012 to raise the worldwide rate of exclusive breastfeeding in the initial 6 months of life from 37 to 50% by 2025 by supporting breastfeeding initiatives [ 6 ]. A systematic review in Iran showed that the prevalence of exclusive breastfeeding varies from 61 to 82% [ 7 ].

Studies indicate that the presence of risk factors during pregnancy can delay the initiation and continuation of breastfeeding, leading to reduced success for mothers [ 8 ]. Cordero et al. (2016) found that mothers with diabetes, substance abuse, and preterm labor have lower rates of breastfeeding initiation compared to healthy women [ 9 ]. Similarly, Scime et al. [ 10 ] demonstrated that prenatal medical risk is linked to shorter breastfeeding duration. Maternal obesity, a significant risk factor in high-risk pregnancies, is associated with various breastfeeding challenges, reduced initiation, and shorter exclusive breastfeeding duration [ 11 , 12 ]. High-risk pregnant mothers also experience physical and emotional distress due to health concerns, anxiety, and worries about their newborns [ 13 ]. Additionally, there are concerns about the impact of medication use on the quality of breast milk, which can disrupt maternal roles in this group of mothers [ 14 , 15 ]. Therefore, efforts to promote breastfeeding among mothers who have experienced high-risk pregnancies are essential [ 16 ].

In some cases, breastfeeding in high-risk pregnancies can have positive effects on maternal health, such as improving left ventricular function and maternal outcomes in diseases like peripartum cardiomyopathy (PPCM) [ 17 , 18 ]. Long-term breastfeeding in mothers with gestational diabetes can also reduce the risk of maternal diabetes postpartum [ 19 ]. Breastfeeding in mothers with gestational hypertension is associated with lower blood pressure in postpartum [ 20 ].

Research has focused on factors influencing the initiation and continuation of breastfeeding in high-risk pregnant women. Some evidence suggests that parents have the most influence on deciding to start or stop breastfeeding. Official support may also impact breastfeeding practices. Family and friends play a role in encouraging breastfeeding, and environmental support can be crucial [ 8 , 21 , 22 ]. Support in breastfeeding is vital in preventing maternal fatigue and increasing cardiac workload, especially in high-risk pregnancies such as congenital heart diseases (CDH) [ 15 ]. Integration of breastfeeding education and counseling in the care of high-risk pregnant women is necessary to address their knowledge and skill gaps [ 9 ]. Educational and supportive programs can prevent delays in breastfeeding initiation in women with preeclampsia [ 23 ].

Social-cultural factors such as a mother’s beliefs and those of her surroundings about infant nutrition are influential factors in exclusive breastfeeding [ 8 ]. Breastfeeding until the age of two has been emphasized in the Holy Quran. In Iran, it seems that breastfeeding is rooted more in Iranian and Islamic culture dominating society than in scientific advancements [ 7 , 16 ]. On the other hand, healthcare providers need to be aware of the determinants of exclusive breastfeeding with maternal milk to offer preventive solutions to overcome these barriers and help improve the health outcomes of mothers and children [ 8 ].

Improving breastfeeding rates among all mothers, with a focus on groups of the population with the lowest breastfeeding rates, is a key objective of the health sector. Comprehensive interventions involving hospitals, culture, and community are necessary to improve breastfeeding-related indicators [ 16 , 24 ].

Pregnant mothers in high-risk populations face various health consequences and risks. Therefore, understanding their perspective on breastfeeding is crucial for effective interventions. Exploring the breastfeeding experiences of these mothers, identifying barriers and facilitators, can offer valuable insights and guide midwives in designing interventions to enhance maternal and infant health and reduce health disparities. Due to the lack of comprehensive research on the breastfeeding experiences of at-risk pregnant mothers, it is essential to investigate their perceptions of initiating and sustaining breastfeeding and the support they require within the cultural and social context of Iranian society. Hence, a qualitative study has been planned to uncover the experiences of these mothers and develop necessary solutions and interventions to promote successful breastfeeding among high-risk pregnant mothers. Utilizing qualitative research with conventional content analysis methodology is recommended for its ability to elucidate the understanding and experiences of concepts, enabling researchers to address their research inquiries effectively. This approach allows researchers to interpret data authentically and scientifically [ 25 , 26 ].

Main objective

To elucidate the understanding and experience of breastfeeding in mothers with high-risk pregnancies.

Specific objectives

Clarifying the understanding of breastfeeding in mothers with high-risk pregnancies.

Elucidating the experience of breastfeeding in mothers with high-risk pregnancies.

Clarification of health care workers’ understanding of breastfeeding in mothers with high-risk pregnancies.

Primary research question

What is the understanding and experience of breastfeeding in mothers with high-risk pregnancies?

The present study is a qualitative research using a conventional content analysis approach. Qualitative content analysis is a flexible method for analyzing various types of data and information. It can be considered as a research method for interpreting the textual data, involving coding, identifying themes, or designing patterns. This approach aims to condense data, organize data, and develop theories and models. Qualitative content analysis is also applicable in cases where the study aims to achieve a comprehensive and extensive description of a phenomenon, introduce reality, create a new overall perspective or concepts, or create descriptive categories that describe the phenomenon [ 25 ].

Considering the researcher’s intention to comprehensively describe and explain mothers’ understanding and experience after a high-risk pregnancy regarding breastfeeding and their decision-making process for breastfeeding, and considering the sensitivity and cultural aspects of breastfeeding, conventional content analysis appears to be the most appropriate approach for this study.

Inclusion and exclusion criteria

Inclusion criteria include mothers aged 15 to 49 years with a baby under 6 months old, having at least one risk factor during pregnancy such as gestational diabetes, hypertension during pregnancy, BMI over 29, treated mental illness, bleeding during pregnancy, infection, premature birth, internal surgical diseases during pregnancy (e.g., heart, kidney, gastrointestinal diseases), having at least one attempt by the mother to breastfeed and speak in Persian. The exclusion criteria also includes the mother’s unwillingness to participate in the interview.

Setting and sampling

The research environment includes teaching hospitals and healthcare centers in the city of Mashhad. These environments are chosen for easy access and maximum participant diversity. Sampling will be purposeful and based on the snowball method to ensure maximum diversity.

Researchers will commence sampling after obtaining approval from the ethics committee of Mashhad University of Medical Sciences and obtaining a referral letter from the School of Nursing and Midwifery in Mashhad. They will initiate sampling by visiting the research environment officials, providing explanations and outlining the research objectives.

Researchers will aim to ensure maximum diversity in the samples concerning age, infant age, type of baby feeding, socio-economic status, type of pregnancy-related condition, and healthcare interventions. Using the snowball method, employed midwives in health centers will be asked to connect researchers with mothers knowledgeable about the research topic. Subsequently, researchers will contact selected participants via phone, explain the research goals, invite them to join the study, and interview interested mothers who meet the study criteria. Participants will receive necessary information about voluntary participation, confidentiality, and anonymity. The interviews will be conducted by two trained researchers who will establish rapport to gain participants’ trust and obtain written consent. Through semi-structured individual interviews and face-to-face interactions, researchers will explore participants’ emotions, perceptions, and thoughts.

Data collection

An interview with an open-ended question with mothers about their experience of initiating and sustaining breastfeeding will continue with exploratory questions to provide further explanation. An interview guide has been prepared for this purpose (Talk about your experience of starting and continuing breastfeeding, Talk about your experience about deciding to start breastfeeding, Talk about your experience about deciding to continue breastfeeding, Express your understanding of the influence of formal and informal support networks on the decision and continuation of breastfeeding).

During the interview, participants will be encouraged to describe their experiences regarding the initiation and continuation of breastfeeding to clarify the decision-making process and to express the obstacles and facilitating factors that have influenced their decision and ability to breastfeed or reduce and stop it. Participants’ understanding of the impact of their formal and informal support networks on their decisions regarding breastfeeding will also be examined. At the end of the interviews, participants will be asked to take note of any additional experiences or insights that come to mind later and provide them to the researcher. Following expressions of gratitude and appreciation, participants will be informed about the possibility of future face-to-face or remote interviews, and a suitable gift will be provided at the end of the session as a token of appreciation.

The duration of the interviews is estimated to be between 60–90 min, depending on the amount of information and participants’ circumstances. With participants’ permission, the interviews will be fully recorded using an MP3 player. The interviews will take place in a quiet room with adequate facilities for the comfort of breastfeeding mothers, considering the conditions of healthcare centers, homes, or any other location desired by the breastfeeding mother. Sampling will continue until no new information is obtained from the interviews and until data saturation is reached [ 27 ].

The breastfeeding behavior of mothers and communication between mothers and health care workers for breastfeeding will be observed in the hospital after the birth of the baby. A trained qualitative researcher (AY) will carry out the non-participant observations, a method in which the researcher does not participate actively, but just observes a situation without interfering. The observation takes place in natural settings, allowing the observer to evaluate non-verbal cues, thus increasing ecological validity. Prior to requesting consent for the observation, the researcher will clarify that she will be observing the entire session, taking notes, and recording the conversation with a smartphone.

A focus group will be used to explain the health providers’ understanding of breastfeeding in mothers with high-risk pregnancies. Health providers (including midwives, nurses and gynecologists and pediatricians) working in women’s hospital and health centers (with work experience of at least 5 years) will participate in the sessions. It is expected that 3–4 sessions will be held. Approximately 8–12 health care workers will be present in each session. The aims of the focus group will be explained, and consent will be sought for audio recording. The focus group will last approximately 2 h. Researchers will conduct the focus group, one observe and take notes of the discussion and two will conduct the conversation guided by a list of topics prepared prior to the group (How is breastfeeding in mothers with high-risk pregnancies? What factors affect the breastfeeding of this group of mothers?). The focus group’s audio recording will be transcribed verbatim. Then, the researchers team will read the transcripts separately and analysis the data.

Data analysis

Data analysis will be conducted simultaneously with data collection. MAXQDA software version 10, developed by VERBI Software GmbH in Berlin, will be used for managing and organizing the data.

Data analysis was conducted using Graneheim and Lundman’s method in four stages [ 28 ]. Stage 1 involved reading the interviews multiple times to grasp their content and gain insights by exploring both latent and manifest content. In Stage 2, the text of each interview transcript was divided into meaningful units such as words, sentences, and paragraphs, where connections between different texts were identified. Stage 3 focused on condensing the meaningful units and assigning codes to them. In Stage 4, the codes were compared for similarities and differences, with similar codes grouped into initial categories. As the analysis progressed, the initial categories were refined, and subcategories were formed. Finally, main categories emerged from the integration of similar subcategories.

Validity and reliability of the study

In the present research, the validity and reliability of the findings will be evaluated using criteria established by Lincoln and Guba (1985). The researchers have suggested four indicators to bolster the credibility of qualitative research: credibility, dependability, confirmability, and transferability [ 29 ].

To enhance the credibility and acceptance of the data, the researcher aims to offer recorded information and codes to the participants throughout the study to validate the main themes derived from mothers’ accounts of breastfeeding experiences, barriers to initiation, and factors supporting breastfeeding continuation. In this research, information and data are gathered from participants with diverse experiences. Sufficient data collection, selection of appropriate meaningful units, description of category and theme development, explanation of how judgments are made regarding similarities and differences between categories through the use of participants’ quotes all contribute to the credibility of the data.

Researchers will aim to establish effective communication with participants. Additionally, to boost data credibility, all interviews will be recorded verbatim and transcribed word by word. Throughout the research write-up, participants’ statements will be accurately documented, and data will be meticulously maintained. The researcher will clarify how units of meaning are summarized and condensed, how categories are formed, and how themes are developed. The research process and decisions taken along this journey will be reported to facilitate follow-up by other researchers. To ensure auditability, activities will be documented over time so that others can trace the subject by reading these writings. For the transferability of findings, the researcher will offer a detailed description of the research context, participant involvement, sampling methods, and data collection time and location to confirm data transferability for readers.

The prevalence of high-risk pregnancy in Iran has been reported to be 52–8/39% [ 30 , 31 ], and the rate of exclusive breastfeeding in Iran up to 6 months is 53% [ 32 ]. Studies indicate that in high-risk pregnancy conditions or the occurrence of pregnancy risk factors, there is a possibility of reduced success in breastfeeding. While infants born from high-risk pregnancies are at a higher risk of disease and mortality, breastfeeding protects them against many infant and post-infancy diseases. Therefore, identifying facilitators and barriers to breastfeeding in mothers with high-risk pregnancies is of particular importance, and the current research also helps in discovering and explaining the obstacles to breastfeeding in this group of mothers so that by implementing specific actions and interventions to address them, it can contribute to improving breastfeeding indicators.

Availability of data and materials

No datasets were generated or analysed during the current study.

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(1):475–90.

Article   PubMed   Google Scholar  

Increasing breastfeeding could save 800 000 children and US$ 300 billion every year. 2016. http://www.who.int/maternal_child_adolescent/news_events/news/2016/exclusive-breastfeeding/en/ .

Stordal B. Breastfeeding reduces the risk of breast cancer: A call for action in high-income countries with low rates of breastfeeding. Cancer Med. 2023;12(4):4616–25.

Breastfeeding within an hour after birth is critical for saving newborn lives. 2018. https://www.who.int/news/item . Cited 2021.

Kmietowicz Z. Humanitarian leaders call for “redoubling” of aid for crisis engulfing Yemen. BMJ. 2017;358(2):36–42.

Google Scholar  

World Health Organization. Statement from UNICEF Executive Director Anthony Lake and WHO Director-General Margaret Chan on the cholera outbreak in Yemen as suspected cases exceed 200,000. 2017. Cited 2020.

Ranjbaran M, Nakhaei MR, Chizary M, Shamsi M. Prevalence of exclusive breastfeeding in Iran: systematic review and meta-analysis. Epidemiol Health System J. 2016;3(3):294–301.

Balogun OO, Dagvadorj A, Anigo KM, Ota E, Sasaki S. Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: a quantitative and qualitative systematic review. Matern Child Nutr. 2015;11(4):433–51.

Article   PubMed   PubMed Central   Google Scholar  

Cordero L, Oza-Frank R, Moore-Clingenpeel M, Landon M, Nankervis C. Failure to initiate breastfeeding among high risk obstetrical patients who intended to breastfeed. J Neonatal Perinatal Med. 2016;9(4):401–9.

Article   CAS   PubMed   Google Scholar  

Scime NV, Metcalfe A, Nettel-Aguirre A, Tough SC, Chaput KH. Association of prenatal medical risk with breastfeeding outcomes up to 12 months in the All Our Families community-based birth cohort. Int Breastfeed J. 2021;16:1–12.

Article   Google Scholar  

Bever Babendure J, Reifsnider E, Mendias E, Moramarco MW, Davila YR. Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions. Int Breastfeed J. 2015;10(1):1–11.

Garner CD, McKenzie SA, Devine CM, Thornburg LL, Rasmussen KM. Obese women experience multiple challenges with breastfeeding that are either unique or exacerbated by their obesity: discoveries from a longitudinal, qualitative study. Matern Child Nutr. 2017;13(3):e12344.

Ramoo S, Trinh TA, Hirst JE, Jeffery HE. Breastfeeding practices in a hospital-based study of Vietnamese women. Breastfeed Med. 2014;9(9):479–85.

Elkayam U, Goland S, Pieper PG, Silversides CK. High-risk cardiac disease in pregnancy: part I. J Am Coll Cardiol. 2016;68(4):396–410.

Niwa K. Adult congenital heart disease with pregnancy. Korean Circ J. 2018;48(4):251.

Parsa P, Masoumi Z, Parsa N, Parsa B. Parents’ health beliefs influence breastfeeding patterns among Iranian women. Oman Med J. 2015;30(3):187.

McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, et al. Clinical outcomes for peripartum cardiomyopathy in North America: results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol. 2015;66(8):905–14.

Safirstein JG, Ro AS, Grandhi S, Wang L, Fett JD, Staniloae C. Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet. Int J Cardiol. 2012;154(1):27–31.

Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, et al. Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus: a prospective cohort study. Ann Intern Med. 2015;163(12):889–98.

Countouris ME, Schwarz EB, Rossiter BC, Althouse AD, Berlacher KL, Jeyabalan A, et al. Effects of lactation on postpartum blood pressure among women with gestational hypertension and preeclampsia. Am J Obstet Gynecol. 2016;215(2):241.

Article   PubMed Central   Google Scholar  

Dennis CL. Breastfeeding initiation and duration: a 1990–2000 literature review. J Obstet Gynecol Neonatal Nurs. 2002;31(1):12–32.

Manion A, Wideman M, Tutlewski A. Breastfeeding attitudes among adolescent mothers attending a nutrition breastfeeding support group. Clin Nurs Stud. 2018;6(1):28–34.

Horsley K, Chaput K, Da Costa D, Nguyen TV, Dayan N, Tomfohr-Madsen L, et al. Hypertensive disorders of pregnancy and breastfeeding practices: a secondary analysis of data from the All Our Families Cohort. Acta Obstet Gynecol Scand. 2022;101(8):871–9.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Brockway M, Benzies K, Hayden KA. Interventions to improve breastfeeding self-efficacy and resultant breastfeeding rates: a systematic review and meta-analysis. J Hum Lact. 2017;33(3):486–99.

Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

White MD, Marsh EE. Content analysis: a flexible methodology. Libr Trends. 2006;55(1):22–45.

Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health. 2021;13(2):201–16.

Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.

Polit DF, Beck C. Essentials of nursing research: appraising evidence for nursing practice. Lippincott Williams & Wilkins; 2010.

Azizi A. The prevalence of the causes of high-risk pregnancies in pregnant women of Sonqor city, 2011. Iran J Obstet Gynecol Infertil. 2015;18(153):10–9.

Kashani E, Hassanzad A, Ameri M. The rate of the prevalence of high-risk pregnancies and the results on pregnant mothers and the effect on parameters after the birth. Adv Environ Biol. 2012;6(3):1319–24.

Behzadifar M, Saki M, Behzadifar M, Mardani M, Yari F, Ebrahimzadeh F, et al. Prevalence of exclusive breastfeeding practice in the first six months of life and its determinants in Iran: a systematic review and meta-analysis. BMC Pediatr. 2019;19(1):1–10.

Download references

Acknowledgements

We thank the volunteer participants for sharing their experiences and giving their time and help to make this study possible.

This Study is funded by Mashhad University of Medical Sciences.

Author information

Authors and affiliations.

Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Kobra Mirzakhani & Talat Khadivzadeh

Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

Student Research Committee, Mashhad University of Medical Science, Mashhad, Iran

You can also search for this author in PubMed   Google Scholar

Contributions

TKH, KM and AY contributed to the design of the protocol.  TKH and KM contributed to the implementation and analysis plan. TKH, KM and AY have written the first draft of this protocol article and all authors have critically read the text and contributed with inputs and revisions, and all authors read and approved the final manuscript.

Corresponding author

Correspondence to Talat Khadivzadeh .

Ethics declarations

Ethics approval and consent to participate.

Written informed consent will be obtained from each participant. This protocol has been approved by the Ethics Committee of the Mashhad University of Medical Sciences, Mashhad, Iran (ethical code number: IR.MUMS.NURSE.REC.1397.079).

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Mirzakhani, K., Yas, A. & Khadivzadeh, T. Explaining the perception and experiences of breastfeeding in mothers who have a high risk pregnancy: a protocol study. Reprod Health 21 , 74 (2024). https://doi.org/10.1186/s12978-024-01817-x

Download citation

Received : 14 May 2024

Accepted : 21 May 2024

Published : 01 June 2024

DOI : https://doi.org/10.1186/s12978-024-01817-x

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Breastfeeding
• High-risk pregnancy
• Content analysis
• Qualitative study

Reproductive Health

ISSN: 1742-4755

• General enquiries: [email protected]