{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:12:59Z","timestamp":1778217179782,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2024,9,1]],"date-time":"2024-09-01T00:00:00Z","timestamp":1725148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"DFID SCCF","award":["H4WY-TS73-X7"],"award-info":[{"award-number":["H4WY-TS73-X7"]}]},{"name":"Tropical Health Education Trust","award":["AGP2.16"],"award-info":[{"award-number":["AGP2.16"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat Med"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Palliative care is seldom integrated in healthcare in fragile, conflict affected and vulnerable settings with significant refugee populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>This study aimed to evaluate the integration of palliative care into a fragile, conflict affected and vulnerable community in Northern Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Consecutive Rapid Participatory Appraisals were conducted to evaluate the integration of palliative care in Adjumani District. The first established a baseline and the second, 4\u2009years later, evaluated progress. Data collection included documentary review, key informant interviews and direct observation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/participants:<\/jats:title>\n                    <jats:p>A rural district in Uganda with equal numbers of refugees and host populations living side-by-side. 104 key informants were interviewed, and practice observed in 11 health facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At baseline, palliative care was not routinely integrated in the health system. Barriers included health system challenges, cultural beliefs, understanding and trust, mental health issues, gaps in palliative care provision, the role of the community and beliefs about illness impacted care with the village health teams being a trusted part of the health system. Following integration activities including training, mentorship and community sensitisation, the repeat rapid appraisal after 4\u2009years showed a significant increase in palliative care delivery. New themes identified included increased provision of palliative care, the impact of training and community engagement and ownership of palliative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Community engagement and participation, training interventions and referral pathways enabled the integration of palliative care. Rapid Participatory Appraisal provides a useful framework to evaluate activities aimed at integration of palliative care in a community.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692163241269129","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T09:20:17Z","timestamp":1725960017000},"page":"818-829","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Evaluation of the integration of palliative care in a fragile setting amongst host and refugee communities: Using consecutive rapid participatory appraisals"],"prefix":"10.1177","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1449-0437","authenticated-orcid":false,"given":"Mhoira","family":"Leng","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda"},{"name":"Palliative Care Education and Research Consortium (PcERC), Deans Building Makerere University Medical School, Kampala, Uganda"},{"name":"Cairdeas International Palliative Care Trust, Aberdeen, UK"},{"name":"Global Health Academy, The University of Edinburgh Medical School, Edinburgh, UK"},{"name":"Palliative Care in Humanitarian Aid Situations and Emergencies network, hosted by the Global Health Academy, The University of Edinburgh Medical School, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Downing","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda"},{"name":"Palliative Care Education and Research Consortium (PcERC), Deans Building Makerere University Medical School, Kampala, Uganda"},{"name":"Global Health Academy, The University of Edinburgh Medical School, Edinburgh, UK"},{"name":"International Children\u2019s Palliative Care Network, Whitefriars, Lewins Mead, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gursaran","family":"Purewal","sequence":"additional","affiliation":[{"name":"Palliative Care Education and Research Consortium (PcERC), Deans Building Makerere University Medical School, Kampala, Uganda"},{"name":"Cairdeas International Palliative Care Trust, Aberdeen, UK"},{"name":"Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liz","family":"Namukwaya","sequence":"additional","affiliation":[{"name":"Palliative Care Education and Research Consortium (PcERC), Deans Building Makerere University Medical School, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicky","family":"Opia","sequence":"additional","affiliation":[{"name":"Peace Hospice Adjumani (PEACHOA), On Comboni - Ciforo Road Adjumani, Adjumani, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chitra","family":"Venkateswaran","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Believers Church Medical College, Tiruvalla, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Nabirye","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda"},{"name":"Palliative Care Education and Research Consortium (PcERC), Deans Building Makerere University Medical School, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peace","family":"Bagasha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda"},{"name":"Palliative Care Education and Research Consortium (PcERC), Deans Building Makerere University Medical School, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,9,9]]},"reference":[{"key":"bibr1-02692163241269129","volume-title":"Declaration of Astana: global conference on primary health care: Astana, Kazakhstan","author":"World Health Organization","year":"2019"},{"key":"bibr2-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32513-8"},{"key":"bibr3-02692163241269129","volume-title":"Left behind in pain: extent and causes of global variations in access to morphine for medical use and actions to improve safe access","author":"World Health Organization","year":"2023"},{"key":"bibr4-02692163241269129","volume":"13","author":"Bellizzi S","year":"2023","journal-title":"J Glob Health"},{"key":"bibr5-02692163241269129","volume-title":"States of fragility 2022","author":"Organisation for Economic Co-operation and Development (OECD)","year":"2022"},{"key":"bibr6-02692163241269129","volume-title":"Quality of care in fragile, conflict-affected and vulnerable settings: taking action","author":"World Health Organization"},{"key":"bibr7-02692163241269129","volume-title":"Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises: a WHO guide","author":"World Health Organization","year":"2018"},{"key":"bibr8-02692163241269129","doi-asserted-by":"publisher","DOI":"10.3362\/9781908176738"},{"key":"bibr9-02692163241269129","author":"UNHCR","year":"2020","journal-title":"Integrating Non-communicable Disease Care in Humanitarian Settings: An Operational Guide"},{"key":"bibr10-02692163241269129","volume-title":"Neglected and in crisis: NCDs as a priority in humanitarian settings","author":"NCD Alliance","year":"2024"},{"key":"bibr11-02692163241269129","volume-title":"Addressing noncommunicable diseases in emergencies: a regional framework for action","author":"World Health Organization","year":"2023"},{"key":"bibr12-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1080\/16549716.2022.2074131"},{"key":"bibr13-02692163241269129","volume":"4","author":"Fraser BA","year":"2017","journal-title":"J Glob Oncol"},{"key":"bibr14-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2021.12.015"},{"key":"bibr15-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-54526-0_24"},{"key":"bibr16-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-00930-7"},{"key":"bibr17-02692163241269129","unstructured":"Wachiaya C. Number of refugees fleeing South Sudan tops 1.5 million, https:\/\/www.unhcr.org\/uk\/news\/stories\/number-refugees-fleeing-south-sudan-tops-1-5-million (2017, accessed 18 April 2024)."},{"key":"bibr18-02692163241269129","volume-title":"Health sector integrated refugee response plan 2019-2024","author":"Ministry of Health"},{"key":"bibr19-02692163241269129","volume-title":"Strategic plan 2020\/21-2024\/25","author":"Ministry of Health"},{"key":"bibr20-02692163241269129","unstructured":"Adjumani District Investment Profile. https:\/\/www.ugandainvest.go.ug\/wp-content\/uploads\/2021\/08\/Adjumani-profile.pdf (2021, accessed 18 April 2024)."},{"issue":"2","key":"bibr21-02692163241269129","first-page":"57","volume":"24","author":"Turyamureba M","year":"2023","journal-title":"Tanzania J Hlth Res"},{"key":"bibr22-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1188\/16.ONF.395-398"},{"key":"bibr23-02692163241269129","volume-title":"Guidelines for rapid participatory appraisals to assess community health needs: a focus on health improvements for low-income urban and rural areas","author":"Annett H","year":"1995"},{"key":"bibr24-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1177\/10105395060180030801"},{"issue":"7181","key":"bibr25-02692163241269129","first-page":"440","volume":"318","author":"Murray SA","journal-title":"BMJ 1999"},{"key":"bibr26-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-6-68"},{"key":"bibr27-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6930.698"},{"key":"bibr28-02692163241269129","volume":"381","author":"Saunders CH","year":"2023","journal-title":"BMJ"},{"key":"bibr29-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"bibr30-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1177\/0269216319854264"},{"key":"bibr31-02692163241269129","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951521000894"},{"issue":"2","key":"bibr32-02692163241269129","volume":"3","author":"Schwartz L","year":"2023","journal-title":"PLoS Glob Public Heal"}],"container-title":["Palliative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02692163241269129","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02692163241269129","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02692163241269129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:36:35Z","timestamp":1777660595000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02692163241269129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":32,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1177\/02692163241269129"],"URL":"https:\/\/doi.org\/10.1177\/02692163241269129","relation":{},"ISSN":["0269-2163","1477-030X"],"issn-type":[{"value":"0269-2163","type":"print"},{"value":"1477-030X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}