Browsing by Person "Vidal, Nicole L."

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Community and health staff perceptions on non-communicable disease management in El Salvador’s health system: A qualitative study
(BioMed Central, 2020-05-27) Vidal, Nicole L.; León García, Montserrat; Jiménez, Marta; Bermúdez, Keven; De Vos, Pol
Background: Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders’ perceptions about the management of NCDs along the pathways of care in this health system. Methods: During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data. Results: This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management. Conclusions: The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach – including long-term follow-up – with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.
Community and health staff perceptions on non-communicable disease management in primary care in El Salvador: A qualitative study
(2019) Vidal, Nicole L.; Jiménez, Marta; León, Montse; De Vos, Pol
This dataset pertains to a qualitative study examining community perceptions related to the management of non-communicable diseases in El Salvador. During different periods of 2018, three complementary qualitative data collection methods have been applied: illness narrative, social mapping and semi-structured interviews.
Community Participation and Maternal Health: Case Studies from Peru and Malawi
(BGTHA, 2014) Vidal, Nicole L.; Uny, I.
This article examines the role of community participation in improving maternal health outcomes in low and middle income countries. Global interventions emphasising facility-based care and institutional deliveries have undoubtedly resulted in maternal health improvements in many regions. Despite some of these advances however, maternal mortality remains a significant problem among poorer disadvantaged communities. In settings where socio-cultural and systemic barriers affect the accessibility and quality of maternal health services, facility-based care is still largely inaccessible to many women. The lack of progress towards improving maternal health services in these areas indicates possible gaps in such approaches. The role of community participation in the development and implementation of maternal health interventions is thus explored as a complement to facility-based interventions. Drawin g on the authors' respective on-going research in Peru and Malawi, this article examines the strengths and limitations of community participation in support of maternal health. The country examples highlight the importance of communities taking part in the development and implementation of activities designed to meet their health needs. Collaboration between communities and health professionals is identified as an essential component to improving the accessibility and quality of maternal health services. Accordingly, community level providers of care can be a valuable resource to their communities provided they receive sufficient support from the health system.
Comprehensive primary health care and non-communicable diseases management: A case study of El Salvador
(BMC, 2020-04-06) Jimenez Carrillo, Marta; León García, Montserrat; Vidal, Nicole L.; Bermúdez, Keven; De Vos, Pol
One of today's greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders' perceptions related to the management of NCDs in PHC and, in particular, the role of social participation. A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador. The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs. The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.
Crossing boundaries for maternal health: a qualitative investigation into the role of community health workers as frontline providers of maternal care in the Peruvian Andes
(Queen Margaret University, Edinburgh, 2015) Vidal, Nicole L.
Despite its status as a middle income country, Peru has one of the highest maternal mortality rates in the Americas. In the Andes region, poor, rural indigenous women are more likely to die from pregnancy related complications than their urban counterparts because they are denied the same level of maternal health services other women in the country receive. Barriers to care include geographic isolation, health staff members who do not speak indigenous languages, and cultural and ethnic discrimination. As a result, indigenous Andean women in need of maternal health services face a significant degree of social exclusion and institutionalized racism which hinders the accessibility, acceptability, and quality of maternal health services offered to them. One approach to improving access to health services has been through the use of Community Health Worker (CHW) programs. Although CHWs are recognized as an important frontline health source, there is a significant lack of literature concerning their role as community level providers of maternal health services. Using a combined grounded theory and case study methodology, this qualitative study investigates the experiences of CHWs working in Andean communities and their relationships with other community members and health and social service professionals. Findings from this study suggest that CHWs can be enabled to bring care directly to their communities in a way that community members can relate to and feel comfortable with while also forming part of the wider health system. Focusing on participants' reports of challenging cultural and ethnic boundaries through a process of ethnic bargaining and adopting professional affiliation, this study identifies CHWs as a potentially vital link between rural community members and other providers of these services. If the right factors are met, such as finding ways to navigate the tensions between traditional and biomedical health care models, CHWs can be considered critical community level health providers who can communicate the value of both models, thereby improving the accessibility, acceptability and quality of maternal health services. However, the root causes leading to social, structural and institutional boundaries to care still need to be addressed. As such, this study aims to fill a significant gap in current research on the role of CHWs in Peru, specifically in the ways they are enabled to negotiate ethnic discrimination within the health system.
IMPACT study on intervening with a manualised package to achieve treatment adherence in people with tuberculosis: Protocol paper for a mixed-methods study, including a pilot randomised controlled trial
(BMJ, 2019-12-17) Stagg, Helen R.; Abubakar, Ibrahim; Campbell, Colin N. J.; Copas, Andrew; Darvell, Marcia; Horne, Robert; Kielmann, Karina; Kunst, Heinke; Mandelbaum, Mike; Pickett, Elisha; Story, Alistair; Vidal, Nicole L.; Wurie, Fatima; Lipman, Marc
Introduction Compared with the rest of the UK and Western Europe, England has high rates of the infectious disease tuberculosis (TB). TB is curable, although treatment is for at least 6 months and longer when disease is drug resistant. If patients miss too many doses (non-adherence), they may transmit infection for longer and the infecting bacteria may develop resistance to the standard drugs used for treatment. Non-adherence may therefore risk both their health and that of others. Within England, certain population groups are thought to be at higher risk of non-adherence, but the factors contributing to this have been insufficiently determined, as have the best interventions to promote adherence. The objective of this study was to develop a manualised package of interventions for use as part of routine care within National Health Services to address the social and cultural factors that lead to poor adherence to treatment for TB disease.
Impacts of COVID-19 restrictions on Scotland’s Refugees: Sudden-onset isolation in a neglected population group.
(Queen Margaret University, 2021-09-14) Vidal, Nicole L.; Salih, Maleeka; Strang, Alison; Sagan, Olivia; Smith, Cameron
This report summarises the findings of a rapid COVID-19 response research project led by the Institute for Global Health and Development at Queen Margaret University, working with support from the Scottish Refugee Council and Scottish Local Authorities. The research cohort were refugees and asylum seekers receiving services from either the Scottish Refugee Council or Local Authorities and their respective partners.Vidal
Out of Reach: Social Connections and Their Role in Influencing Engagement Between Forcibly Displaced People and Police Scotland
(MDPI, 2025-05-15) Nisbet, Bryony; Vidal, Nicole L.
Forcibly displaced people in Scotland face multiple barriers in accessing health, social care, and policing services. This paper explores how social connections shape engagement with these services, particularly the role of police in community safety and wellbeing. Drawing on qualitative interviews and social connections mapping workshops, this study examines how third-sector organisations act as key intermediaries, shaping how people access statutory services. The findings show that while community policing and partnerships with trusted organisations can improve accessibility, concerns about racial discrimination, the underreporting of hate crime, and the lack of language support continue to undermine confidence in policing. Additionally, the growing reliance on police officers to respond to mental health crises reflects wider gaps in specialist service provision. This paper argues for a shift towards a cross-sector approach that strengthens community-led safety strategies, reduces police involvement in non-criminal matters, and improves language and cultural competency within public services. Strengthening institutional accessibility and trust-building initiatives is key to improving engagement with policing and health and social care services for forcibly displaced communities.
Refugees, political bounding and the pandemic: Material effects and experiences of categorisations amongst refugees in Scotland
(Routledge, 2022-04-25) Burns, Nicola; Mulvey, Gareth; Piacentini, Teresa; Vidal, Nicole L.
Scholars are increasingly interested in and concerned with both the way various migrant populations are categorised, and the lived impacts of that categorisation. In this article, we examine how categorisation was experienced by people at various stages of the refugee journey during the biggest public health crisis for generations. We argue, using original interview data, that the way refugees are categorised, or politically bound, has material impacts on the way they experience their lives, and that this was evident in extremis during the Covid-19 lockdown in Scotland. As populations attempted to traverse public health messaging, this is shown to interact with longstanding state proclivities to control, marginalise and stratify. Consequently, how people experienced and managed the request to ‘stay home and save lives’ varied markedly by where they were in their refugee journey and how they arrived in the UK.
Relational dynamics of treatment behavior among individuals with tuberculosis in high-income countries: A scoping review
(Dove Press, 2021-09-21) Arakelyan, Stella; Karat, Aaron S.; Jones, Annie S. K.; Vidal, Nicole L.; Stagg, Helen R.; Darvell, Marcia; Horne, Rob; Lipman, Marc C. I.; Kielmann, Karina
Although tuberculosis (TB) incidence has significantly declined in high-income, low-incidence (HILI) countries, challenges remain in managing TB in vulnerable populations who may struggle to stay on anti-TB treatment (ATT). Factors associated with non-adherence to ATT are well-documented; however, adherence is often narrowly conceived as a fixed binary variable that places emphasis on individual agency and the act of taking medicines, rather than on the demands of being on treatment more broadly. Further, the mechanisms through which documented factors act upon the experience of ‘being on treatment’ are poorly understood. Adopting a relational approach that emphasizes the embeddedness of individuals within dynamic social, structural, and systems contexts, this scoping review aims to synthesize qualitative evidence on experiences of being on ATT and mechanisms through which socio-ecological factors influence adherence in HILI countries. Six electronic databases were searched for peer-reviewed literature published in English between January 1990 and May 2020. Additional studies were obtained by searching references and citations of included studies. Narrative synthesis was used to analyze qualitative data extracted from included studies. Of 28 included studies, the majority (86%) reported on health systems factors, followed by personal characteristics (82%), structural influences (61%), social factors (57%), and treatment-related factors (50%). Included studies highlighted three points that underpin a relational approach to ATT behavior: (1) individual motivation and capacity to take ATT is dynamic and intertwined with, rather than separate from, social, health systems, and structural factors; (2) individuals’ pre-existing experiences of health-seeking influenced their views on treatment and their ability to commit to long-term regular medicine-taking; and (3) social, cultural, and political contexts play an important role in mediating how specific factors work to support or hinder ATT adherence behavior in different settings. Based on our analysis, we suggest that person-centered clinical management of tuberculosis should (a) acknowledge the ways in which ATT both disrupts and is managed within the everyday lives of individuals with TB; (b) appreciate that circumstances and the support and resources that individuals can access may change over the course of treatment; and (c) display sensitivity towards context-specific social and cultural norms affecting individual and collective experiences of being on ATT.
Rupture and liminality: Experiences of Scotland's refugee population during a time of COVID-19 lockdown
(Elsevier, 2023-08-11) Vidal, Nicole L.; Sagan, Olivia; Strang, Alison; Palombo, Gianluca
The disruption caused by the COVID-19 pandemic had profound effects on refugees. In migrating to seek safety, refugees demonstrate resilience, resourcefulness and the ability to adapt to stressful situations. However, social distancing and self-isolation measures greatly impacted these individuals as they stand to risk the most from interruptions to integration. In this paper, we examine the implications of increased loneliness and isolation for refugees’ experiences with integration. We argue, using original interview data, that the demands placed on some refugees through extremely harsh circumstances can leave many even more vulnerable, as was evident in extreme during the COVID-19 lockdowns. The findings of this study pertain to the refugee pandemic experience in relation to loneliness, hopelessness and, more so: agency, resilience and post-traumatic growth. In recognising that rupture and liminality are intrinsically linked to feelings of loneliness, mental wellbeing, or its erosion, the paper demonstrates the complexity of loneliness and its potential to cause long-term damage to mental and physical health. Our findings suggest the importance of an approach to integration that recognises the unique needs of refugees. Where emotionally supportive social networks are weak or absent, it must be a priority to enable meaningful connections with other trusted human beings.
Seldom-heard Communities: Refugee and asylum-seeker experiences, trust and confidence with Police Scotland.
(Queen Margaret University, 2022) Vidal, Nicole L.; Nisbet, Bryony
This report summarises the findings of research project led by the Institute for Global Health and Development at Queen Margaret University, working with support from Police Scotland and Freedom from Torture. The research cohort were refugees and asylum-seekers receiving services from Freedom from Torture, Police Scotland personnel, and staff from refugee support services.
Support for Scotland’s Afghan refugee people: exploring social connections in Local Authorities with little previous resettlement experience
(Queen Margaret University, 2023) Vidal, Nicole L.; Palombo, Gianluca
The role of social movements in strengthening health systems: The experience of the National Health Forum in El Salvador (2009–2018)
(SAGE Publications, 2020-02-19) León, Montserrat; Jiménez, Marta; Vidal, Nicole L.; Bermúdez, Keven; De Vos, Pol
In 2009, the newly elected FMLN government of El Salvador launched a comprehensive health reform, which gave the National Health Forum (NHF) a key role in developing community participation. This study aims to examine and analyze the content and impact of this social movement during the study period 2009–2018. The context was analyzed through relevant documents, which helped identify key stakeholders. Semi-structured interviews took place at 3 levels of decision making: the political level, the health professionals, and the community. Data were analyzed using a qualitative methodology. Participation is carried by a structure created by the Ministry of Health, the National Health Forum. The NHF developed 3 strategies: (1) leadership building in the communities through the strengthening of social, political, and economic skills, where they developed social accountability mechanisms at all decision-making levels of the health system; (2) the strategy carried by the sectoral working groups, where they responded to prioritized needs identified by the community; and (3) advocacy for human rights-based policies. The NHF, and its role in the strengthening of the National Public Health System, provides strong evidence of community participation strategies and co-governance with the health system within the social determinants of health scope.
"Treatment is of primary importance, and social assistance is secondary": A qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying on TB treatment in Riga, Latvia
(Public Library of Science, 2018-10-17) Kielmann, Karina; Vidal, Nicole L.; Riekstina, Vija; Krutikov, Maria; van der Werf, Marieke J.; Biraua, Evita; Duric, Predrag; Moore, David A. J.
Background Vulnerable individuals with tuberculosis (TB) struggle to access and stay on treatment. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour. Aim To examine the influence of TB service organisation and culture on patients’ experience of starting and staying on treatment in Riga, Latvia. Methods An intervention package to support adherence to TB treatment amongst vulnerable patients in Riga, Latvia was piloted between August 2016 and March 2017. Qualitative observations (5), interviews with staff (20) and with TB patients (10) were conducted mid-way and at the end of the intervention to understand perceptions, processes, and experiences of TB care. Results The organisation of TB services is strongly influenced by a divide between medical and social aspects of TB care. Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care. Support for vulnerable patients is limited because of standardised programmatic approaches, resource constraints and restricted job descriptions for non-medical staff. Conclusion Providing support for vulnerable patients is challenged in this setting by the strict division between medical and social aspects of TB care, and the organisational focus on patient-related rather than systems-related barriers to access and adherence. Potential systems interventions include the introduction of multi-disciplinary approaches and teams in TB care, strengthening patient literacy at the point of treatment initiation, as well as stronger linkages with social care organisations.
Understanding fragility: Implications for global health research and practice
(Oxford University Press, 2019-12-10) Diaconu, Karin; Falconer, Jennifer; Vidal, Nicole L.; O'May, Fiona; Azasi, Esther; Elimian, Kelly; Bou-Orm, Ibrahim; Sarb, Cristina; Witter, Sophie; Ager, Alastair
Advances in population health outcomes risk being slowed—and potentially reversed—by a range of threats increasingly presented as ‘fragility’. Widely used and critiqued within the development arena, the concept is increasingly used in the field of global health, where its relationship to population health, health service delivery, access and utilization is poorly specified. We present the first scoping review seeking to clarify the meaning, definitions and applications of the term in the global health literature. Adopting the theoretical framework of concept analysis, 10 bibliographic and grey literature sources, and five key journals, were searched to retrieve documents relating to fragility and health. Reviewers screened titles and abstracts and retained documents applying the term fragility in relation to health systems, services, health outcomes and population or community health. Data were extracted according to the protocol; all documents underwent bibliometric analysis. Narrative synthesis was then used to identify defining attributes of the concept in the field of global health. A total of 377 documents met inclusion criteria. There has been an exponential increase in applications of the concept in published literature over the last 10 years. Formal definitions of the term continue to be focused on the characteristics of ‘fragile and conflict-affected states’. However, synthesis indicates diverse use of the concept with respect to: level of application (e.g. from state to local community); emphasis on particular antecedent stressors (including factors beyond conflict and weak governance); and focus on health system or community resources (with an increasing tendency to focus on the interface between two). Amongst several themes identified, trust is noted as a key locus of fragility at this interface, with critical implications for health seeking, service utilization and health system and community resilience.