IntroductionCommunity health workers (CHWs) have been proposed as a means for bridging gaps in healthcare delivery in rural communities. Recent CHW programmes have been shown to improve child and neonatal health outcomes, and it is increasingly being suggested that paid CHWs become an integral part of health systems. Remuneration of CHWs can potentially effect their motivation and focus. Broadly, programmes follow a social, monetary or mixed market approach to remuneration. Conscious understanding of the differences, and of what each has to offer, is important in selecting the most appropriate approach according to the context.Case descriptionsThe objective of this review is to identify and examine different remuneration models of CHWs that have been utilized in large-scale sustained programmes to gain insight into the effect that remuneration has on the motivation and focus of CHWs. A MEDLINE search using Ovid SP was undertaken and data collected from secondary sources about CHW programmes in Iran, Ethiopia, India, Bangladesh and Nepal. Five main approaches were identified: part-time volunteer CHWs without regular financial incentives, volunteers that sell health-related merchandise, volunteers with financial incentives, paid full-time CHWs and a mixed model of paid and volunteer CHWs.Discussion and evaluationBoth volunteer and remunerated CHWs are potentially effective and can bring something to the health arena that the other may not. For example, well-trained, supervised volunteers and full-time CHWs who receive regular payment, or a combination of both, are more likely to engage the community in grass-roots health-related empowerment. Programmes that utilize minimal economic incentives to part-time CHWs tend to limit their focus, with financially incentivized activities becoming central. They can, however, improve outcomes in well-circumscribed areas. In order to maintain benefits from different approaches, there is a need to distinguish between CHWs that are trained and remunerated to be a part of an existing health system and those who, with little training, take on roles and are motivated by a range of contextual factors. Governments and planners can benefit from understanding the programme that can best be supported in their communities, thereby maximizing motivation and effectiveness.

BackgroundAdoption of contemporary evidence-based guidelines for acute stroke management is often delayed due to a range of key enablers and barriers. Recent reviews on such barriers focus mainly on specific acute stroke therapies or generalised stroke care guidelines. This review examined the overall barriers and enablers, as perceived by health professionals which affect how evidence-based practice guidelines (stroke unit care, thrombolysis administration, aspirin usage and decompressive surgery) for acute stroke care are adopted in hospital settings.MethodologyA systematic search of databases was conducted using MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, Cochrane Library and AMED (Allied and Complementary Medicine Database from 1990 to 2016. The population of interest included health professionals working clinically or in roles responsible for acute stroke care. There were no restrictions to the study designs. A quality appraisal tool for qualitative studies by the Joanna Briggs Institute and another for quantitative studies by the Centre for Evidence-Based Management were used in the present study. A recent checklist to classify barriers and enablers to health professionals’ adherence to evidence-based practice was also used.ResultsTen studies met the inclusion criteria out of a total of 9832 search results. The main barriers or enablers identified included poor organisational or institutional level support, health professionals’ limited skills or competence to use a particular therapy, low level of awareness, familiarity or confidence in the effectiveness of a particular evidence-based therapy, limited medical facilities to support evidence uptake, inadequate peer support among health professionals’, complex nature of some stroke care therapies or guidelines and patient level barriers.ConclusionsDespite considerable evidence supporting various specific therapies for stroke care, uptake of these therapies is compromised by barriers across organisational, patients, guideline interventions and health professionals’ domains. As a result, we recommend that future interventions and health policy directions should be informed by these findings in order to optimise uptake of best practice acute stroke care. Further studies from low- to middle-income countries are needed to understand the barriers and enablers in such settings.Trial registrationThe review protocol was registered in the international prospective register of systematic reviews, PROSPERO 2015 (Registration Number: CRD42015023481)Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0599-3) contains supplementary material, which is available to authorized users.

Monitoring of changes in expenditure is required. Policies should ensure that money devoted to ID is allocated in a rational, equitable, and cost-effective manner.

Background: Breast cancer is a leading cause of mortality among women in the United Arab Emirates (UAE). Many young women in the UAE have poor knowledge about breast cancer screening, including risk factors and warning signs/symptoms. We investigated awareness about breast cancer and breast self-examination (BSE) as a screening tool among female students at the University of Sharjah, UAE. Methods: This study used a cross sectional survey design. Participants were 241 undergraduate female students (aged ≥18 years) from three University of Sharjah campuses. Data were collected from March to April 2017 using a self-administered questionnaire. The questionnaire covered: sociodemographic characteristics; knowledge about breast cancer, risk factors, and warning signs/symptoms; and knowledge and practice of BSE. Data were analyzed using descriptive statistics and Pearson's chi-square tests. Results: About 38.6% of participants were from the Medical campus, 37.3% were from the Women's campus, and 24% were from the Fine Arts and Design campus. Most (99%) participants had heard of breast cancer. About 50% were knowledgeable about the risk factors, but only 38% were knowledgeable about warning signs/symptoms. The most commonly identified risk factors were family and personal histories of breast cancer, and the most commonly identified warning sign/symptom was breast lump. There was a significant association between knowledge about risk factors and campus type. Participants from the Medical campus were more knowledgeable about risk factors than participants from the other two campuses. Overall, 68.5% of participants had heard of BSE, but few participants actually performed BSE. Reasons for not performing BSE included "forgetting" and "not knowing how." Conclusions: Although most participants were aware of breast cancer, knowledge about risk factors and warning signs/symptoms was relatively poor. Knowledge about performing BSE was particularly low. This highlights the importance of increasing awareness about breast cancer and BSE among young women in the UAE.