Readers are asked to recall that in the beginning of 2020, guidelines for publication in healthcare for Women International were tightened. All authors are now asked to be explicit concerning how their work contributes to global theoretical, methodological or practice literature on women’s health issues. It is now not enough to describe empirically how things work in one country and nor is it sufficient to say something is best practice because female informants tell researchers that they want things to change there. Some of the articles in this collection were accepted before our guidelines changed. The eight articles grouped in this issue are all attempts by scholars to contribute to global literature on what constitutes best practices in women’s healthcare. All published scholars have done good work, and yet in my read their contributions are more theoretical than practical regarding global scholarship.
Most readers are committed conceptually to patient-centered healthcare, yet what constitutes evidence of best practice is yet to be determined. Nevin and colleagues in Lima Peru were informed by a small sample of cancer patients and practitioners. The patients are said to prefer empathic practitioners and practitioners said the infrastructure determines how they interact with patients. The authors report most practitioners are not schooled in addressing patient feelings. This is interesting information, but it does not meet our evidence threshold for practice. Claiming a change in infrastructure would lead to better practice is hypothetical. We need to see the evidence. To make a practice contribution would require providing practitioner education and support for empathic interaction with patients and then subsequent research to “test” the infrastructure regarding its patient-centeredness and then linking the structure of that practice to patient outcomes. Patient preference would be one-such outcome but there are others such as mortality rates, quality of life indicators, adherence to treatment protocols, etc. Niven and colleagues have begun the work, but much more evidence is needed.
Dogan et al., report how patients prefer to receive information concerning breast-imaging results in Turkey. Their preference is for comprehensible reporting by patient providers including but not limited to a radiologist’s report report). Again, the information is interesting, but globally hypothetical. If/when scholars conduct a quasi-experiment comparing patient groups who receive information in different ways and then measuring patient satisfaction, they might provide evidence of best practice regarding patient preference. Subsequently then I would like to see evidence linking patient outcomes in addition to preference.
Hearld and Budhwani seem to be making a familiar best-practice argument, “culture makes a difference,” in their United States study of patient-centered care related to elective vaccines. In their study the behaviors of Muslim women in the United States are compared to those non-Hispanic white women. They also note not all Muslim women in the United States are alike. They did not study changes in the health delivery system to link differences to patient outcomes.
From the study by Groutz and colleagues in Israel about whether gender of practitioners makes a difference to patients we learn that in Israel knowledge and skill of practitioner is more important. The value of their study globally also remains theoretical and will remain so until replicated elsewhere and linked to outcomes other than preference.
In the report by Chandy and colleagues studying adherence to treatment protocols of HIV patients in India the scholars move beyond patient preference to an array of individual factors, community supports, variables associated with healthcare access and patient practitioner communication. Still the contribution remains theoretical outside of India. Most interesting is their theoretical finding that patient perceived community stigma contributed to adherence of recommended treatment which is interesting because it differs from what researchers have reported elsewhere.
Dunleavy makes a practice contribution that is limited to Guatemala in her study of whether Comodronas in Guatemala can help to prevent HIV. That culturally accepted practitioners can be trained to teach local populations what they need to know and to implement the information to prevent HIV elsewhere remains theoretical.
The study by Tripathi and colleagues should serve as an exemplar of what is needed to contribute to best practice literature. Readers are presented with evidence of the model needed for change as well as evidence of its effectiveness. While their study is only in Nigeria and Uganda on how to remove treatment barriers for genital fistula, the model for practice change is replicable anywhere for other practice issues.
Finally, Indonesian scholars (Probandari et al.) collaborated to make a practice contribution regarding using peer educators to teach sex workers the benefits of using female condoms and getting the sex workers to use them. While the practice contribution is currently limited to Surakarta, Indonesia, the practice contribution is potentially global because sex workers are everywhere, and the effectiveness of female condoms is already in the global literature.
As you read the articles, it may help you to understand progress toward contributing to practice literature if you refer to the table I have provided.
As always, read and learn!
Editor-in-Chief
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May 19, 2020