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Background Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan’s Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community case management (CCM) of childhood pneumonia and diarrhoea will improve. Methods/Design NIGRAAN is a cluster-randomised trial in District Badin, Pakistan. There are approximately 1100 LHWs supervised by 36 LHSs in Badin. For this study, each LHS serves as a cluster. All LHSs working permanently in Badin who regularly conduct and report field visits are eligible. Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple randomisation technique. Five LHWs from each LHSs are also randomly picked. All 34 LHSs and 170 LHWs will be actively monitored. The intervention consists of training to build LHS knowledge and skills, clinical mentorship and written feedback to LHWs. Pre- and post-intervention assessments of LHSs, LHWs and community caregivers will be conducted via focus group discussions, in-depth interviews, knowledge assessment questionnaires, skill assessment scorecards and household surveys. Primary outcome is improvement in CCM practices of childhood diarrhoea and pneumonia and will be assessed at the cluster level. Discussion NIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practices of childhood diarrhoea and pneumonia. No significant harm to participants is anticipated. The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally. Trial registration NIGRAAN is registered with the ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707

Scientists can improve how they inform politicians and other policymakers on how to make decisions, say Hannah Safford and Austin Brown. Scientists can improve how they inform politicians and other policymakers on how to make decisions, say Hannah Safford and Austin Brown. : Swedish environmental campaigner Greta Thunberg addresses politicians, media and guests with the Houses of Parliament Credit: Leon Neal/Getty

Health care suffers from a persistent disconnect between the capacity of the physician-leadership workforce and the needs of our increasingly complex health systems. Closing this gap will require leadership skills that are not acquired during traditional medical training.

Background Leadership in small and medium-sized enterprises (SMEs) is associated with a variety of challenges and stressors, which are reflected in their managers’ commonly experienced high stress levels. In this context, psychological strain can arise, but compared to large companies, SMEs face particular difficulties in implementing mental health promotion intervention. These difficulties partially originate in a profound lack of comprehensive research on the effectiveness and prospects of success of intervention strategies in SMEs. This study aims to close this gap by evaluating a stress management training for managers in SMEs (KMU-GO). Implementing established stress management strategies and making them more accessible within the SME context, the training aims to improve participants’ psychological and physiological well-being. Methods We conducted a randomized controlled trial with an intervention and a waitlist control group in Germany. The intervention comprised 1.5 days of stress management training and two refresher sessions, focusing on short- and long-term coping strategies and self-reflection. Based on a sample of N  = 155 managers, we conducted a multilevel analysis of covariance on psychological measures, namely stress reactivity, depression, and anxiety. Additionally, changes in physiological stress indices (i.e., hair cortisol concentration and salivary alpha-amylase activity) were examined. Results Regarding the psychological measures, we found significant training effects six months after baseline. Twelve months after baseline, there were no significant differences between the intervention and control groups for either psychological or physiological variables. Conclusion In conclusion, the present stress management training is effective in reducing psychological strain in SME managers. In order to achieve more sustainable effects, a continuation of the refresher sessions could be considered. Trial registration Before including the first participant, the KMU-GO trial is registered at the German Clinical Trial Register (DRKS): DRKS00023457 (registered on 5 November 2020).

You might know what policymakers should know. That doesn’t mean you know how to help them to use that information. You might know what policymakers should know. That doesn’t mean you know how to help them to use that information. Dewey Murdick

Background: The Dr. LEE Jong-wook (LJW) Fellowship Program aims to enhance the capabilities of healthcare personnel in low- and middle-income countries (LMICs) through comprehensive training and education. This study evaluates the satisfaction and effectiveness of the Health Policy Administrator course within the program, focusing on participants from 2021 to 2023. Objective: This study aims to assess the impact of the Dr. LJW Fellowship Program, specifically evaluating participants’ satisfaction, knowledge and competency improvement, and the adoption of learned knowledge in the workplace. Methods: A mixed- methods study design was adopted, utilizing Kirkpatrick’s four-level evaluation framework to assess the program’s impact. A total of 39 public health policymakers from 19 LMICs participated in the training course at an affiliated university. The evaluation focused on training satisfaction, knowledge and competency improvement, competence achievement, and the practical adoption of learned knowledge. Descriptive statistics were used to analyze participant characteristics, while paired t-tests were employed to assess knowledge and competency improvement before and after the program. Results: The program demonstrated high levels of participant satisfaction, with an overall satisfaction score of 92.9. Knowledge scores improved significantly, with an average increase of 61%, particularly in health statistics (77% improvement) and healthcare systems (56.3% improvement). Competency achievement was also high, with an average score of 92.5. However, the job adoption of learned knowledge scored lower, with supervisors and coworkers rating it at 70.9 and 72.1, respectively, indicating challenges in translating training into practical workplace applications. Conclusions: The Dr. LJW Fellowship Program effectively enhanced participants’ knowledge and competencies in health policy administration. However, the lower scores in job adoption suggest a need for improved follow-up support and practical application strategies to ensure that the training’s benefits are fully realized in participants’ work environments.

To address root causes of health inequity, the University of Pennsylvania Health System developed a year-long experience in which community health workers mentor and educate executives about the realities of injustice and partner with them to create structural change.

Clinical trial managers are central to the successful design and delivery of clinical trials, making them crucial within the research landscape. Yet, despite their vital contribution, many trial managers report feeling undervalued, under-supported, and insufficiently recognised for the expertise they bring to their teams. Unlike other research roles, there is no clearly defined career pathway for trial managers, and opportunities for professional growth are often limited. In the UK, those working on academic-led trials are usually employed within universities or NHS trusts, frequently based in UKCRC-registered Clinical Trials Units. In this article, we provide practical guidance for both trial managers and their employers on how to strengthen professional development opportunities and better support this essential workforce.

Urban areas offer many opportunities for people with disabilities, but limited accessibility may prevent their full engagement in society. It has been recommended that the experience-based perspective of people with disabilities should be an integral part of the discussion on urban accessibility, complementing other stakeholder expertise to facilitate the design of more inclusive environments. The goals of this mixed-method study were to develop knowledge mobilization (KM) strategies to share experience-based findings on accessibility and evaluate their impact for various urban stakeholders. Using a participatory approach, various KM strategies were developed including videos, a photo exhibit and an interactive game. These strategies were evaluated based on various impact indicators such as reach, usefulness, partnerships and practice changes, using quantitative and qualitative methods. The findings suggested that the KM strategies were effective in raising the awareness of various urban stakeholders and providing information and guidance to urban planning practices related to accessibility.

Patrick Vallance, who advised the UK government during the height of COVID, says that scientific officials should know four key things when guiding policymakers. Patrick Vallance, who advised the UK government during the height of COVID, says that scientific officials should know four key things when guiding policymakers. Chief Scientific Adviser Sir Patrick Vallance gestures as he speaks during a coronavirus press conference at 10 Downing Street on January 22, 2021 in London, England. Credit: Leon Neal/Getty