BURA Collection:

Incentive package for doctors in Ghana

2026-10-14T02:01:08Z

Title: Incentive package for doctors in Ghana Authors: Boye, Bernard Okoe Abstract: Background Ghana continues to face persistent maldistribution of doctors between rural and urban areas. This thesis evaluates the Early Study Leave with Pay policy, introduced in August 2016 to incentivise rural service through earlier access to study leave with continued salary, and examines the broader drivers and barriers influencing doctors’ decisions to work in rural and urban settings. Methods A mixed-methods design combined a systematic review, Interrupted Time Series analysis, and a three-round Delphi study. Caesarean section (CS) activity was used as a proxy for doctor presence. Analyses covered national, regional, district and hospital levels from 2011 to 2022, using segmented regression with Newey-West standard errors. The Delphi study involved doctors and regional health directors and assessed consensus on factors influencing rural and urban working. Results The systematic review identified limited Ghana-specific evidence on incentive schemes and persistent gaps in economic evaluation. Nationally, the intervention was associated with a 228.2% immediate increase in CS cases and a 217.9% reduction in the post-intervention growth rate (p < 0.001). Effects varied substantially across regions and districts. Delphi participants reached consensus on 40 descriptors, 37 of which were considered important. Four themes emerged: financial factors, professional development and career advancement, work-life balance, and community lifestyle factors. The Early Study Leave with Pay scheme itself was not perceived as a key facilitator. Conclusion The policy contributed to measurable but uneven redistribution of healthcare workers. Financial and educational incentives alone are insufficient to resolve rural-urban disparities; sustainable workforce policy should combine them with career progression, family support and hospital-level capacity strengthening. The findings support context-sensitive health workforce strategies in Ghana and comparable low- and middle-income countries. Description: This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University London

Exploring the attitudes and perceptions of parents and healthcare stakeholders to accessing newborn screening for hearing loss in Port Harcourt, Nigeria: A qualitative study

2026-04-28T12:20:49Z

Title: Exploring the attitudes and perceptions of parents and healthcare stakeholders to accessing newborn screening for hearing loss in Port Harcourt, Nigeria: A qualitative study Authors: Nwankwo, Chisom Jolly Abstract: Background: Hearing loss is a major global public health challenge, with over 466 million people affected worldwide, including 34 million children. Early detection through newborn hearing screening (NHS) is critical for timely intervention, yet such services remain largely unavailable in low- and middle-income countries, including Nigeria. Despite evidence supporting the effectiveness of early hearing detection and intervention, uptake of NHS in Nigeria is limited. This study explored the attitudes and perceptions of parents and healthcare stakeholders towards accessing newborn hearing screening in Port Harcourt, Nigeria, with the aim of understanding the socio-cultural, institutional, and economic factors influencing participation. Methods: An interpretivist qualitative research design was employed to capture experiences and meanings from 25 purposively selected participants, including twenty parents and five healthcare stakeholders. Semi-structured interviews were conducted at the University of Port Harcourt Teaching Hospital between June and July 2022. Data were analysed using reflexive thematic analysis to identify recurrent themes and interpret the patterns of perception and behaviour influencing access to screening. Findings: Four overarching themes emerged: “Understanding and Community Perceptions,” “Contradictory and Complex Views,” “Factors in Access,” and “Promoting Access.” Major subthemes under these categories included cultural and religious beliefs framing hearing loss as a spiritual or moral punishment, leading to stigma and delayed health-seeking. Economic hardship, lack of awareness, inadequate infrastructure, and absence of national policy were identified as key barriers, albeit participants expressed openness to screening when made accessible and affordable. Conclusion and Recommendation: Access to newborn hearing screening in Nigeria is shaped by cultural beliefs, socio-economic constraints, and institutional limitations. Improving access requires culturally sensitive health education, inclusion of NHS within routine maternal and child health services, national policy development, and community engagement. These findings contribute context-specific insights to strengthen early hearing detection and intervention in low-resource settings. Description: This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University London

Co-designing tobacco control health communication with young people in Southern Nigeria

2026-03-31T02:00:58Z

Title: Co-designing tobacco control health communication with young people in Southern Nigeria Authors: Aienobe-Asekharen, Charity Agbonisan Abstract: Co-design is a participatory approach that seeks to increase end users’ involvement in designing products and services. However, there is a lack of active participation by young people in the design of tobacco control health communication, especially in African countries. This thesis has therefore engaged young people in determining and designing tobacco control health communication to inform campaign interventions. A scoping review was conducted first to map the types of health communication focused on young people in Africa. Data sources included 20 peer-reviewed papers, WHO Global Health Observatory on anti-tobacco mass-media campaigns for 54 African countries, and 6 WHO Framework Convention reports on Tobacco Control. The review revealed the limited participation in tobacco control health communication design by young people. To address this gap, a co-design approach using creative methods (drawing and writing, group discussions, diary) was employed. Two secondary schools in Benin City were involved in the research, with eighty-nine participants segregated into seven groups (13-19 years) engaging in 4 interconnected phases of the co-design process. The co-design process involved engaging participants in: (1) Discovery, to identify the root causes of smoking using a problem tree; (2) Idea generation, to generate communication ideas to address the identified causes using the socioecological model as a template for idea generation and message framing; (3) Ideation and prototyping, to create a health communication roadmap, including a song, twelve poster designs, and a short film using the generated ideas and messages (4) Feedback, to review co-designed materials which led to the short film being transformed into an animation. From a co-design approach and the use of creative methods, this thesis showed that participants can actively be engaged in tobacco control health communication design in Nigeria, for example via schools. It also revealed that tobacco control campaigns focused on young people could be enhanced textually and visually to align with three key themes; the health consequences of smoking (Seeing is Believing), peer influence (Just Try it: Shades of Influence), and influence of authority figures (Positioning Authority Figures: Dimensions of Power). This thesis has demonstrated that young people are willing to inform health interventions that will impact their lives when they are made aware of the opportunity, and using a process inherently built for sharing knowledge and power. This thesis moreover contributes one of the first examples of a participatory study using co-design in tobacco control health communication with young people in Nigeria and Africa. Description: This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University London

Understanding the eating behaviours of low-income families during the cost-of-living crisis: Informing future interventions

2026-01-23T03:01:03Z

Title: Understanding the eating behaviours of low-income families during the cost-of-living crisis: Informing future interventions Authors: Froome, Hannah Mary Abstract: Establishing healthy dietary behaviours in childhood is critical for long-term growth and development. However, the Cost-of-Living Crisis in the UK has substantially increased food insecurity and diet quality, with food prices rising 25% from 2022 to 2024. This left 4.3 million children in relative poverty in 2024. This has increased demands on food charities supporting low-income families. This PhD thesis addresses key gaps in the literature, including (1) A lack of behaviour change interventions for low-income families, (2) Limited understanding on the impacts of the Cost-of-Living Crisis on dietary interventions, (3) Lack of real-time perspectives and experiences on children’s eating behaviours from charity stakeholders and parents in low-income families. Therefore, this thesis aimed to identify evidence-based proposals for future interventions to promote healthy eating behaviours in children from low-income families during the Cost-of-Living Crisis, through application of the Behaviour Change Wheel and the Theoretical Domains Framework. Study 1 comprised of a systematic review of existing digital interventions targeting child dietary behaviours in low-income families. Using the Behaviour Change Intervention Ontology, five eligible studies were synthesised, identifying key characteristics. The most common Behaviour Change Techniques used amongst the five studies were Goal Setting (k=4), Problem Solving (k=3), Instruction on how to perform a Behaviour (k=3) and Prompts and Cues (k=3). This review highlighted core characteristics and gaps within existing child dietary interventions. Study 2 and 3 explored experiences of stakeholders in 12 food charities (n=22) and parents in low-income families (n=23) using qualitative interviews and dyads. Following an interpretivist methodological approach, a combination of inductive and deductive coding and using reflective thematic analysis was conducted. Findings were mapped to the Theoretical Domains Framework to identify behavioural determinants influencing charity support and parental feeding practices. Across stakeholder and parent perspectives, key barriers and facilitators centered on ‘Physical Opportunity’; resources and environmental constraints, ‘Social Opportunity’; community networks and reducing stigma, ‘Psychological Capability’; knowledge, child involvement and adaptive strategies, and ‘Reflective Motivation’; communication and reaching populations directly, are all required to support child healthy eating during economic crises. Integrating findings across all three studies, the Behaviour Change Wheel was applied to identify intervention functions, policy categories, Behaviour Change Techniques, and mode of deliveries, which inform future intervention design. This thesis demonstrates how combining enablement and service provision with practical social support and flexible delivery modes may strengthen both parental capacity and food support systems. This research contributes a novel, theory-driven, multi-level approach to designing dietary interventions for children in low-income families, highlighting the importance of behavioural and systemic adaptation during periods of economic crisis in the UK. Description: This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University London