Implementation and Quality (IMPAQT) – Claudia Hanson's research group

Our aim is to advance knowledge on how to develop, implement, and evaluate strategies to improve the quality of care globally. We focus largely, but not exclusively, on low-resource settings. The team is part of the research group Health Systems and Policy.

Our research

We primarily work on ‘implementation interventions’, thus interventions that support health workers, facilities or health systems to use available resources most effectively for the benefit of improved quality of care. We recognize the complexity of improving health care quality and health systems and that strong and long-term collaborations with universities and research institutions in the global South are essential. Our research is rooted in the contextual realities and the needs of people, health providers and local managers, guided by local and national priorities.

Experience in our groups spans from epidemiology, qualitative methods, implementation science, measurement and metrics and health systems and policy research.

News from the team

Members and contact

Group leader

All members of the group

Teaching

MSc students joining the ALERT study and the IMPAQT research group meeting. Photo: Claudia Hanson

Within our group, we are actively contributing to strengthening the interaction and synergies between education and research. We see education and training as part of our global commitment to thrive to a sustainable development. We are interdisciplinary and intercultural teachers who try to emphasize that teaching needs to go hand in hand with research at a university. Within our group we have members active in education management, course leadership and lecturing. We supervise doctoral and master students in global public health, students from other programs at Karolinska Institutet and at other Universities in and outside of Sweden.

Course organisation

We have the following course organisation responsibilities:

Helle leads a 5-week course in “Qualitative Methods” in the Master’s programme in Public Health Sciences including the 2 tracks on public health epidemiology and health promotion and prevention, https://education.ki.se/programme-syllabus/4FH19

Helle also is responsible for the module on qualitative methods in the course “Research Methods” in the Master’s programme in Global Health, https://education.ki.se/programme-syllabus/3GB12

Claudia leads 2-week “Research management” of the Master’s in Public Health Sciences https://education.ki.se/programme-syllabus/4FH19

Sibylle leads a 8-week course “Health systems and Policy” (10 credits) in the Health Economics, Policy and Management master program  https://education.ki.se/programme/4hm17-masters-in-health-economics-policy-and-management

PhD training courses

We also organise PhD training courses: Claudia leads the 2-week course “Core concepts in Global Health and Global Burden of Disease” and “Research Management for Quality Data Collection)

Doctoral Programme in Biology of Infections and Global Health (BIGH) | Karolinska Institutet (ki.se)

Sibylle leads the course on “Health Policy and Management” of the Doctoral programme in Public Health Science (PHSP) | Medarbetare (ki.se)

Research projects

We work on methods for evaluating quality and evaluate ‘implementation interventions’ thus such interventions that support health workers, facilities or health systems to use available resources most effectively for good quality care.

In our team we have researchers experienced in epidemiology, quantitative and qualitative methods, implementation science, measurement and metrics, health systems, policy and health services research and clinical care.

Our work is rooted in the contextual realities and the needs of people, health providers and local managers, guided by local, national and global priorities. Our research aims to evaluate quality and investigates ‘implementation interventions’ that support health workers, facilities or health systems to use available resources most effectively for good quality care.

ALERT

Full project title: Action Leveraging Evidence to reduce perinatal Mortality and morbidity in Sub-Saharan Africa

The ALERT project is a hospital maternity-based quality improvement and implementation science project in Benin, Malawi, Tanzania and Uganda (2020 – 2024) funded under Horizon 2020.

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Claudia Hanson

Senior Lecturer

QUALI-DEC

Full project title: Appropriate use of Caesarean section through QUALIty DECision-making by women and providers

QUALI-DEC aims to evaluate a 4-component non-clinical intervention to optimise Caesarean sections rates in Argentinian, Burkina Faso, Thailand and Vietnam (2020 – 2024) funded by Horizon 2020.

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Claudia Hanson

Senior Lecturer
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Amanda Cleeve

Assistant Professor
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Companionship

Labour companionship is the continuous presence of a woman’s person of choice through labour and birth. It is a non-clinical intervention recommended by the World Health Organization to improve the quality of maternal care.

Our research team currently supports three PhD students contributing to labour companionship within the ALERT and QUALI-DEC interventions.

Bianca Kandeya’s PhD is nested in the ALERT study and it focuses on perceptions and experiences of women, companions and maternity care providers regarding the opportunities and challenges of companionship in labour. The PhD also aims to understand women's experiences of childbirth with/without companions before and after the ALERT intervention considering existing evidence that having a companion of choice throughout labour and child birth improves women’s’ experience of child birth.

Mercedes Vila Ortiz PhD project focuses on the implementation of labour companionship in Argentina within the QUALIDEC project. Its aim is to describe and explain how companionship is implemented as part of the QUALI-DEC intervention, what changes this stimulated and how the intervention met the needs of health providers, women and companions in eight hospitals of Buenos Aires City, addressing key actors’ perceptions and experiences.  

Soha El Halabi who through her PhD journey aims to inform the implementation of companionship models through understanding the context and processes and determining the effects and costs of available interventions. Her PhD project includes the eight participating countries in ALERT and QUALI-DEC: Argentina, Benin, Burkina Faso, Malawi, Tanzania, Thailand, Uganda and Vietnam.

Vaccine confidence

There are several projects that currently take place in the field of vaccine confidence building within the IMPAQT research group.

Understanding vaccine hesitancy and rumours

This project is funded by FORTE, it studies rumours and trust in vaccine hesitant communities in Sweden. These communities include migrant communities, anthroposophic communities and Swedish speaking online communities. We use qualitative and social media listening methods to study the origin of rumours and explore the concept of trust using participatory action methods.

Africa Vaccine Trust Network

This is an ongoing VR funded project (2023-2024) that connects four African countries (Benin, Ethiopia, Nigeria and Uganda) to develop joint research questions regarding emerging vaccine confidence questions, particularly among health workers.

Vaccine confidence among health workers in Nigeria and Ethiopia

This is a VR funded project (2023-2026) that aims to test an innovative social media intervention that addresses specific vaccine concerns (particularly regarding new vaccines) among health workers.

HPV vaccine confidence in Addis Ababa, Ethiopia

This is a project that has received funding from the Einhorn Foundation. The aim is to understand HPV vaccine hesitancy among adolescents, parents and the community in selected schools in Addis Ababa, Ethiopia that have shown low HPV vaccine uptake.

Global HPV burden study

This is a large-scale project funded by Bill and Melinda Gates that spans across seven countries that have not yet implemented national HPV vaccine programmes. The aim of the project is to establish HPV16 and 18 prevalence and explore intention and barriers to vaccination once vaccines are available.

Vaccine confidence and faith-leaders

This project explored the role that faith-leaders play in building vaccine confidence in Addis Ababa, Ethiopia.

COVID-19 vaccine confidence in Sweden

This project investigated COVID-19 vaccine concerns among migrants and among online communities in Sweden.

See also the news article:

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Sibylle Herzig Van Wees

Assistant Professor
Photo: Claudia Hanson

Kuwa Macho Action

Full project title: Kuwa Macho Action to prevent intrapartum-related complication in Eastern Uganda

This project aims to improve the understanding of contributing factors and long-term morbidity and mortality of hypoxic-ischemic events during childbirth in Uganda (2020-2023) funded by the Swedish Research Council.

Publication

"We give our all": Mothers’ experience of participating in the care of their newborns in newborn care units in Eastern Uganda
Phillip Wanduru, Claudia Hanson, Peter Waiswa, Angelina Kakooza-Mwesige, and Helle Mölsted Alvesson

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Claudia Hanson

Senior Lecturer
Photo: Aziz Ahmad Ally

ONGEZA

Full project title: Cracking the measurement nut for maternal and newborn health. Innovations and applications for quality of care in Southern Tanzania: The Ongeza project

This is a joint project together with a Swedish NGO Shifo and Ifakara Health Institution in Tanzania to piloted and evaluate a scanning technology for processing routine health management information (2018-2020) funded by the Swedish Research Council.

Publication

Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine maternal health information in Southern Tanzania: A mixed-methods study.
Unkels R, Manzi F, Kapologwe NA, Baker U, Ahmad A, Nabiev R, Berndtsson M, Baraka J, Hanson C, Hirose A
PLOS Glob Public Health 2023 ;3(1):e0000972

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Claudia Hanson

Senior Lecturer
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Regine Unkels

Phd Student;Postdoctoral Studies

Essential Emergency and Critical Care (EECC)

Critical illness results in millions of deaths each year. Care for those with critical illness is often neglected due to a lack of prioritisation, co-ordination, and coverage of timely identification and basic life-saving treatments. To improve care, we are working on the innovative concept, Essential Emergency and Critical Care (EECC) – the care that all critically ill patients should receive in all hospitals in the world.

Essential emergency and critical care should be part of universal health coverage, is appropriate for all countries in the world, and is intended for patients irrespective of age, gender, underlying diagnosis, medical specialty, or location in the hospital. Essential emergency and critical care is pragmatic and low-cost and has the potential to improve care and substantially reduce preventable mortality. 

Critical Illness and Sepsis Prevalence and Outcomes Studies (CRISPOS)

We are conducting prospective cohort studies of the prevalence and outcomes of patients with critical illness and sepsis in hospitals in Malawi, Sri Lanka and Sweden. The aims are to determine the proportion of in-patients that are critically ill and that have sepsis and to determine the mortality rates and the relative risk of critical illness and sepsis.

Improving the care of critically ill patients in Malawi and Tanzania

We are conducting several projects in hospitals in Malawi and Tanzania to improve the care and outcomes of patients with critical illness. Projects include the Vital Signs Directed Therapy project, the ICU Register and Outcomes project, paediatric critical care projects and peri-operative mapping projects.

Publications

The global need for essential emergency and critical care.
Schell CO, Gerdin Wärnberg M, Hvarfner A, Höög A, Baker U, Castegren M, Baker T
Crit Care 2018 Oct;22(1):284

Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country.
Baker T, Schell CO, Lugazia E, Blixt J, Mulungu M, Castegren M, Eriksen J, Konrad D
PLoS One 2015 ;10(12):e0144801

Risk Factors for Mortality in Severely Ill Children Admitted to a Tertiary Referral Hospital in Malawi.
Ngwalangwa F, Phiri CHA, Dube Q, Langton J, Hildenwall H, Baker T
Am J Trop Med Hyg 2019 Sep;101(3):670-675

The Prevalence and Outcomes of Sepsis in Adult Patients in Two Hospitals in Malawi.
Kayambankadzanja RK, Schell CO, Namboya F, Phiri T, Banda-Katha G, Mndolo SK, et al
Am. J. Trop. Med. Hyg. 2020 Apr;102(4):896-901

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Tim Baker

Affiliated to Research

Nigeria project of anemia

To be updated.

Bamenda clinic, Cameroon (parents gave consent to take the picture). Photo: Yayah Emerencia Ngah

Children Immunization App (CIMA)

The Children Immunization App (CIMA) aims to test the impact of low-cost solution to improve the children immunization visits in vulnerable settings.

CIMA was tested in the Zaatari camp in Jordan among refugees. The study was funded through Grand Challenges Canada and implemented through collaboration with UNICEF, ECDC, UNHCR, and Jordan University of Science and Technology.

CIMA is being tested as well in Bamenda-Cameroon, using SMS modality, to send reminders and parenting skills to parents using SMS.

List of papers on CIMA: https://tinyurl.com/33dtvrst

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Ziad El-Khatib

Affiliated to Research

Guangdong Provincial Hospital of Chinese Medicine

Full project title: Collaboration with the Guangdong Provincial Hospital of Chinese Medicine and the Health System and Policy research group

Collaboration with the hospital and the HSP research group on research capacity strengthening. The collaboration involves provision of method courses, workshop and supervision of doctoral students (PI is Professor Cecilia Stålsby Lundborg). One of the doctoral students are supervised in our team and  working on the feasibility and acceptability of Chinese Pediatric Massage. We are looking at home- and facility-based prevention and management of recurrent respiratory tract infections in young children in an urban area in southern China.

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Safe abortion care

This project was led by Susan Atuhairwe at Makerere University, Uganda and aimed to  compare the safety, effectiveness and acceptability of medical treatment for incomplete second trimester abortion by midwives and physicians in Uganda, including post abortion family planning uptake.

Publications

Abortion-related near-miss morbidity and mortality in 43 health facilities with differences in readiness to provide abortion care in Uganda.
Atuhairwe S, Gemzell-Danielsson K, Byamugisha J, Kaharuza F, Tumwesigye NM, Hanson C
BMJ Glob Health 2021 Feb;6(2):

Comparison of the effectiveness and safety of treatment of incomplete second trimester abortion with misoprostol provided by midwives and physicians: a randomised, controlled, equivalence trial in Uganda.
Atuhairwe S, Byamugisha J, Kakaire O, Hanson C, Cleeve A, Klingberg-Allvin M, Tumwesigye NM, Gemzell-Danielsson K
Lancet Glob Health 2022 Oct;10(10):e1505-e1513

Evaluating women's acceptability of treatment of incomplete second trimester abortion using misoprostol provided by midwives compared with physicians: a mixed methods study.
Atuhairwe S, Hanson C, Atuyambe L, Byamugisha J, Tumwesigye NM, Ssenyonga R, Gemzell-Danielsson K
BMC Womens Health 2022 Nov;22(1):434

Second trimester post-abortion family planning uptake and associated factors in 14 public health facilities in Central Uganda: a cross-sectional study.
Atuhairwe S, Hanson C, Tumwesigye NM, Gemzell-Danielsson K, Byamugisha J
Contracept Reprod Med 2023 Jan;8(1):4

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Claudia Hanson

Senior Lecturer
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Kristina Gemzell Danielsson

Professor/Senior Physician