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Levey EJ, Onyeaka H, Bartles SM, Sanchez Calderon E, Sanchez SE, Prom MC, Fesseha EM, Gelaye B. Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study. JMIR Pediatr Parent 2021; 4:e30240. [PMID: 34533473 PMCID: PMC8486997 DOI: 10.2196/30240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. OBJECTIVE This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. METHODS This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. RESULTS All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. CONCLUSIONS These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed.
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Affiliation(s)
- Elizabeth J Levey
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Henry Onyeaka
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Sophia M Bartles
- Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | | | - Sixto E Sanchez
- AC PROESA, Lima, Peru
- Instituto de Investigaciòn, Facultad de Medicina Humana, Universidad de San Martìn de Porres, Lima, Peru
| | - Maria C Prom
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | - Bizu Gelaye
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Shanmugam R, Fulton L, Ramamonjiarivelo Z, Betancourt J, Beauvais B, Kruse CS, Brooks MS. A Report Card on Prevention Efforts of COVID-19 Deaths in US. Healthcare (Basel) 2021; 9:healthcare9091175. [PMID: 34574949 PMCID: PMC8466456 DOI: 10.3390/healthcare9091175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022] Open
Abstract
COVID-19 (otherwise known as coronavirus disease 2019) is a life-threatening pandemic that has been combatted in various ways by the government, public health officials, and health care providers. These interventions have been met with varying levels of success. Ultimately, we question if the preventive efforts have reduced COVID-19 deaths in the United States. To address this question, we analyze data pertaining to COVID-19 deaths drawn from the Centers for Disease Control and Prevention (CDC). For this purpose, we employ incidence rate restricted Poisson (IRRP) as an underlying analysis methodology and evaluate all preventive efforts utilized to attempt to reduce COVID-19 deaths. Interpretations of analytic results and graphical visualizations are used to emphasize our various findings. Much needed modifications of the public health policies with respect to dealing with any future pandemics are compiled, critically assessed, and discussed.
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Sharma AK, Baig VN, Ahuja J, Sharma S, Panwar RB, Katoch VM, Gupta R. Efficacy of IVRS-based mHealth intervention in reducing cardiovascular risk in metabolic syndrome: A cluster randomized trial. Diabetes Metab Syndr 2021; 15:102182. [PMID: 34330073 DOI: 10.1016/j.dsx.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
AIMS Efficacy of mobile-phone based intervention for reducing cardiovascular risk in metabolic syndrome (MetSyn). METHODS We screened adults 20-60 years in 10 villages in India for MetSyn using stratified cluster sampling. Lifestyle and biochemical risk factors were assessed. International Harmonized Criteria were used for diagnosis. Villages were randomized with 5 each in control and intervention groups. Interactive voice response system (IVRS) in Hindi was developed. In intervention clusters two messages for promotion of healthy lifestyle and medical treatment were broadcast daily over 12-months and risk factors reassessed. RESULTS 1012/1200(84%) persons were screened and MetSyn diagnosed in 286(28.3%). Villages were divided into 5 control(n = 136) and 5 intervention(n = 147) clusters. Baseline characteristics in both clusters were similar. Acceptability of intervention was >60% in 80% participants. At 12 months, significantly greater participants in intervention vs control clusters had healthier lifestyle (healthy diet 28.8vs14.7%, physical activity 25.9vs13.1%, tobacco 13.7vs32.5%), anthropometry (waist circumference 85.7 ± 6.3vs88.6 ± 14.0 cm, body mass index 21.9 ± 2.8vs23.1 ± 2.9 kg/m2), systolic BP 123.6 ± 7.7vs128.6 ± 14.1 mmHg, fasting glucose 95.6 ± 19.4vs109.4 ± 43.7 mg/dl, cholesterol 175.5 ± 36.5vs186.4 ± 43.3 mg/dl, and triglycerides 147.6 ± 48.3vs159.5 ± 60.7 mg/dl (p < 0.01). Prevalence of metabolic syndrome declined in intervention group by 22.3%vs3.9%, p < 0.001). CONCLUSION An interactive voice response system based technology significantly reduced multiple cardiovascular risk factors and prevalence of metabolic syndrome.
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Affiliation(s)
- Arvind K Sharma
- Departments of Community Medicine, RUHS College of Medical Sciences, Jaipur, 302033, India.
| | - Vaseem Naheed Baig
- Departments of Community Medicine, RUHS College of Medical Sciences, Jaipur, 302033, India
| | - Jitendra Ahuja
- Departments of Biochemistry, RUHS College of Medical Sciences, Jaipur, 302033, India
| | - Sonali Sharma
- Departments of Biochemistry, RUHS College of Medical Sciences, Jaipur, 302033, India
| | - Raja Babu Panwar
- Academic Research Development Unit, Rajasthan University of Health Sciences, 302033, Jaipur, India
| | - Vishwa Mohan Katoch
- Academic Research Development Unit, Rajasthan University of Health Sciences, 302033, Jaipur, India
| | - Rajeev Gupta
- Academic Research Development Unit, Rajasthan University of Health Sciences, 302033, Jaipur, India
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104
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Islam SMS, Mishra V, Siddiqui MU, Moses JC, Adibi S, Nguyen L, Wickramasinghe N. Smartphone Apps for Diabetes Medication Adherence: A Systematic Review (Preprint). JMIR Diabetes 2021; 7:e33264. [PMID: 35727613 PMCID: PMC9257622 DOI: 10.2196/33264] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/24/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Vinaytosh Mishra
- College of Healthcare Management and Economics, Gulf Medical University, Ajman, United Arab Emirates
| | - Muhammad Umer Siddiqui
- Department of Internal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Sasan Adibi
- School of Information Technology, Deakin University, Burwood, Australia
| | - Lemai Nguyen
- School of Information Technology, Deakin University, Burwood, Australia
| | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
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Passaglia LG, Brant LCC, Silva JLPD, Nascimento BR, Ribeiro ALP. Text Messages to Promote Secondary Prevention after Acute Coronary Syndrome (IMPACS trial). INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ndlovu K, Scott RE, Mars M. Interoperability opportunities and challenges in linking mhealth applications and eRecord systems: Botswana as an exemplar. BMC Med Inform Decis Mak 2021; 21:246. [PMID: 34419020 PMCID: PMC8379582 DOI: 10.1186/s12911-021-01606-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/28/2021] [Indexed: 01/28/2023] Open
Abstract
Background Significant investments have been made towards the implementation of mHealth applications and eRecord systems globally. However, fragmentation of these technologies remains a big challenge, often unresolved in developing countries. In particular, evidence shows little consideration for linking mHealth applications and eRecord systems. Botswana is a typical developing country in sub-Saharan Africa that has explored mHealth applications, but the solutions are not interoperable with existing eRecord systems. This paper describes Botswana’s eRecord systems interoperability landscape and provides guidance for linking mHealth applications to eRecord systems, both for Botswana and for developing countries using Botswana as an exemplar.
Methods A survey and interviews of health ICT workers and a review of the Botswana National eHealth Strategy were completed. Perceived interoperability benefits, opportunities and challenges were charted and analysed, and future guidance derived. Results Survey and interview responses showed the need for interoperable mHealth applications and eRecord systems within the health sector of Botswana and within the context of the National eHealth Strategy. However, the current Strategy does not address linking mHealth applications to eRecord systems. Across Botswana’s health sectors, global interoperability standards and Application Programming Interfaces are widely used, with some level of interoperability within, but not between, public and private facilities. Further, a mix of open source and commercial eRecord systems utilising relational database systems and similar data formats are supported. Challenges for linking mHealth applications and eRecord systems in Botswana were identified and categorised into themes which led to development of guidance to enhance the National eHealth Strategy. Conclusion Interoperability between mHealth applications and eRecord systems is needed and is feasible. Opportunities and challenges for linking mHealth applications to eRecord systems were identified, and future guidance stemming from this insight presented. Findings will aid Botswana, and other developing countries, in resolving the pervasive disconnect between mHealth applications and eRecord systems.
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Affiliation(s)
- Kagiso Ndlovu
- Department of TeleHealth, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. .,Department of Computer Science, University of Botswana, Gaborone, Botswana.
| | - Richard E Scott
- Department of TeleHealth, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maurice Mars
- Department of TeleHealth, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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107
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Kirkwood EK, Clymer C, Imbulana K, Mozumder S, Dibley MJ, Alam NA. What role do mHealth interventions play in changing gender relations? A systematic review of qualitative findings. (Preprint). JMIR Hum Factors 2021; 9:e32330. [PMID: 35862143 PMCID: PMC9353673 DOI: 10.2196/32330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/24/2021] [Accepted: 06/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background The rapid and widespread growth of mobile technologies in low- and middle-income countries can offer groundbreaking ways of disseminating public health interventions. However, gender-based inequalities present a challenge for women in accessing mobile technology. Research has shown that mobile health (mHealth) interventions can affect gender relations in both positive and negative ways; however, few mHealth programs use a gender-sensitive lens when designing, implementing, or analyzing programs. Objective This systematic review aims to identify and summarize the findings of qualitative research studies that explore the impact of mHealth interventions on gender relations as a result of participating in such initiatives in low- and middle-income countries. Methods We performed a systematic literature review to examine empirical evidence of changes in gender relations attributed to participation in an mHealth intervention in low- and middle-income countries. Peer-reviewed articles were included based on whether they evaluated an mHealth intervention and were published between 2013 and 2020. Articles using mHealth that solely targeted health workers, did not assess a specific intervention, used mobile technology for data collection only, or were formative or exploratory in nature were excluded. The search terms were entered into 4 key electronic databases—MEDLINE, EMBASE, PsycINFO, and Scopus—generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report the themes that emerged from our data. Results Of the 578 full-text articles retrieved, 14 (2.4%) were eligible for inclusion in the study. None of the articles appraised gender from the outset. The articles uncovered findings on gender relations through the course of the intervention or postprogram evaluation. Most studies took place in sub-Saharan Africa, with the remainder in South and Southeast Asia. The articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found that mHealth programs could enhance spousal communication, foster emotional support between couples, improve women’s self-efficacy and autonomy in seeking health information and services, and increase their involvement in health-related decision-making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision-makers, and exacerbating relationship problems. Conclusions These results suggest that given the rapid and persistent upscale of mHealth interventions in low- and middle-income settings, it is imperative to design interventions that consider their impact on power dynamics and gender relations. Future research is needed to fill the evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and that they need to actively participate and be empowered by mHealth interventions.
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Affiliation(s)
- Elizabeth K Kirkwood
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | | | | | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Neeloy Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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108
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Beres LK, Mbabali I, Anok A, Katabalwa C, Mulamba J, Thomas AG, Bugos E, Nakigozi G, Grabowski MK, Chang LW. Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial. JMIR Form Res 2021; 5:e22693. [PMID: 34283027 PMCID: PMC8335611 DOI: 10.2196/22693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/12/2020] [Accepted: 05/31/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual's natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. OBJECTIVE To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. METHODS This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non-long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. RESULTS The study included 48 participants (24 per arm; 23/48, 48% women; median age 31 years). EMA data collection was feasible, with 85.5% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6% of days to P2, 4.3% of days; intervention: P1, 7.2% of days to P3, 2.4% of days). Decreases in sex with a non-long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9% of days to 1% of days; intervention: 6.6% of days to 1.3% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6% of days to 76.6% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8% decrease in the mean proportion of days vegetables consumed; intervention: 11.1% increase; P=.01). CONCLUSIONS Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423.
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Affiliation(s)
- Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | - Alvin G Thomas
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
- Department of Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Eva Bugos
- University of Chicago Pritzker School of Medicine, Chicago, IL, United States
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | | | - Mary K Grabowski
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Larry W Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Williams OM, Faboya OM, Omisanjo OA. Parental Post-operative Telephone Follow-Up After Paediatric Day Case Surgery. World J Surg 2021; 45:3222-3229. [PMID: 34223984 DOI: 10.1007/s00268-021-06228-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Paediatric day case surgeries (DCSs) are associated with minimal complications therefore the post-operative follow-up visit usually serves to calm anxious parents and is replaceable with a phone call. This study examines the safety and reliability of post-operative telephone assessment by caregivers and its acceptability to them. METHODS Parents of DCS patients over a 9-month period were recruited for telephone follow-up on third post-operative day for wound assessment. The remote reports were compared with the finding during the in-person visit on fourth post-operative day to determine the reliability of parents' observation. The parents' acceptance of telephone follow-up was also studied. RESULTS The parents of 112 children who had groin surgeries (84%), repair of umbilical hernias (4.5%) and excision of soft tissue masses (11.6%) were recruited. The M:F ratio was 10.2:1. The median age at surgery was 64 months (IQR 43.0-96.8) and median waiting time for surgery was 11.5 months (IQR 3.0-28.8). Most caregivers were mothers (83%) and had a minimum of secondary education (86.6%). The telephone and clinic assessments were matched in 98 of 101 assessed patients. Telephone follow-up would have sufficed for 104 (92.9%) patients and correctly identified those who needed clinic visits. Majority of parents found telephone follow-up acceptable in lieu of clinic visit but some preferred to be given a phone number to initiate the call if necessary. CONCLUSION Telephone call is safe, feasible and acceptable for follow-up after paediatric DCS. A guided parents' assessment of the wound is reliable for determining those who need hospital visit.
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Affiliation(s)
- Omolara Modupe Williams
- Department of Surgery, Lagos State University College of Medicine, and Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
| | | | - Olufunmilade Akinfolarin Omisanjo
- Department of Surgery, Lagos State University College of Medicine, and Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Kong SS, Otalora Rojas LA, Ashour A, Robinson M, Hosterman T, Bhanusali N. Ability and willingness to utilize telemedicine among rheumatology patients-a cross-sectional survey. Clin Rheumatol 2021; 40:5087-5093. [PMID: 34219187 PMCID: PMC8255091 DOI: 10.1007/s10067-021-05759-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 04/20/2021] [Accepted: 05/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION/OBJECTIVES This study aims to assess the patients' ability and willingness to utilize telemedicine (TM) along with identifying some of the barriers to a more widespread adoption of TM in rheumatology. METHODS An observational, cross-sectional study of patients visiting a rheumatology clinic was conducted in 2018. We used a survey to assess patients' attitude on the perceived effectiveness when comparing TM versus in-person visits, as well as patients' access to technology, distance traveled by the patient to attend the clinic visit, and demographic parameters. RESULTS A total of 214 patients were included. Negative correlations were found between the increase in age and access to technologies (front-facing camera (mean age difference - 12.8), telephone (mean age difference - 14.4), and stable internet connection (mean age difference - 15.1)), as well as believing that their needs could be met through TM (r - .224, p < 0.001) and thinking that TM could be an appropriate alternative method of healthcare (r - .298, p < 0.001). Younger patients reported more conflict between appointments and work hours (mean age difference - 11.73). Follow-up patients were more likely to feel that their visit could have been possible over the phone (mean difference - 1.13) or video conferencing (mean difference - 1.13) compared to new patients. Older patients were less likely to think that the purpose of their rheumatology visits could be achieved over the phone (r - .207, p = 0.003) or video conferencing (r - .331, p = 0.001). The further the distance traveled, the more the patients were willing to utilize TM compared to in-person visits (r 0.167, p = 0.019). CONCLUSION Out of necessity due to the COVID-19 pandemic, rheumatology clinics are increasingly turning to TM. The results of this study suggest that access and familiarity with technology may still be limited in certain demographics, particularly the elderly. Furthermore, this study helps to understand some of the additional barriers to more widespread adoption and patients' perceived limitations of TM. Key Points • This study aimed to assess rheumatology patients' willingness to utilize telemedicine (TM) while determining the factors and barriers that may exist for a more widespread adoption of TM, using a cross-sectional survey in the setting of a rheumatologic clinic. • The age of the patient was the most significant contributing factor in a patient's perception of TM, with older patients being less likely to think that the purpose of their rheumatology visits could be achieved over the phone or via videoconferencing. • The social trend of limited access to technology among the elderly population was reinforced by the results in this study. • Patients who had a greater commute to the clinic were more likely to willing to utilize TM consultations. • The results of this study highlight the elevated difficulty elderly patient populations have in utilizing TM. • With the current outbreak of COVID-19, the importance of utilizing TM specifically among the elderly population could prove vital. Future studies to focus on the elderly population and methods for helping these patients become familiar with TM would be beneficial. • Studies such as this can help to orchestrate future guidelines for TM in the field of rheumatology. Based on our study results, the new-patient encounter should be an in-person face-to-face encounter whenever possible, followed by TM visits for established patients who are able and open to using it, depending on the diagnosis and symptoms of the individual patients.
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Affiliation(s)
- Steve S Kong
- Department of Internal Medicine, College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Lilian A Otalora Rojas
- Department of Internal Medicine, College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA.
- HCA Healthcare GME, University of Central Florida, Orlando, FL, USA.
| | - Amnie Ashour
- School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Mathew Robinson
- Department of Internal Medicine, College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Tyler Hosterman
- Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Neha Bhanusali
- Department of Internal Medicine, College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
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111
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Chiang KF, Wang HH, Hsieh HF. Factors influencing the mobile instant messaging application usage behaviours among home healthcare providers. J Clin Nurs 2021; 30:3577-3589. [PMID: 34189775 DOI: 10.1111/jocn.15868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/24/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the practice related to mobile instant messaging applications usage among home healthcare providers in Taiwan; and based on the unified theory of acceptance and usage of technology and perceived risk theory to examine the influencing factors. BACKGROUND Previous work has indicated the potential for using mobile instant messaging applications in chronic disease, disasters and public health emergencies. However, few studies have conducted to understand how healthcare professionals use them. DESIGN A cross-sectional design was used in the study. METHODS A wide-ranging empirical investigation was conducted in Taiwan. A total of 102 home agencies participated in this study, and 331 valid data were collected. The ODS guideline was followed. RESULTS 69% of the participants had used mobile instant messaging applications, with high functionality and interesting value can integrate various messages and contribute to adoption. Performance expectancy, effort expectancy, and social influence were significantly positively correlated with behavioral intention. The perceived risk had a significant negative correlation with performance expectancy and use behavior. Among the relevant influencing factors, different types of organization, job position, and institutional policy were related to significant differences in use behaviors. CONCLUSIONS Our research reported on mobile instant messaging applications usage and behavioral intention among home healthcare providers. This study also highlighted the need to establish regulations within the applications and improve safety and security guidelines. Further research may extend the understanding of the organizations' influencing factors. RELEVANCE TO CLINICAL PRACTICE This study may help programmers, managers and policymakers improve their strategies for expanding usage of mobile instant messaging applications.
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Affiliation(s)
- Kuei-Feng Chiang
- Tainan Sin-Lau Hospital, Tainan, Taiwan.,Chang Jung Christian University, Tainan, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Fen Hsieh
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Lim HM, Dunn AG, Muhammad Firdaus Ooi S, Teo CH, Abdullah A, Woo WJ, Ng CJ. mHealth adoption among primary care physicians in Malaysia and its associated factors: a cross-sectional study. Fam Pract 2021; 38:210-217. [PMID: 32968795 DOI: 10.1093/fampra/cmaa103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND mHealth apps potentially improve health care delivery and patient outcomes, but the uptake of mHealth in primary care is challenging, especially in low-middle-income countries. OBJECTIVE To measure factors associated with mHealth adoption among primary care physicians (PCPs) in Malaysia. METHODS A cross-sectional study using a self-administered questionnaire was conducted among PCPs. The usage of mHealth apps by the PCPs has divided into the use of mHealth apps to support PCPs' clinical work and recommendation of mHealth apps for patient's use. Factors associated with mHealth adoption were analysed using multivariable logistic regression. RESULTS Among 217 PCPs in the study, 77.0% used mHealth apps frequently for medical references, 78.3% medical calculation and 30.9% interacting with electronic health records (EHRs). Only 22.1% of PCPs frequently recommended mHealth apps to patients for tracking health information, 22.1% patient education and 14.3% use as a medical device. Performance expectancy and facilitating conditions were associated with mHealth use for medical references. Family medicine trainees, working in a government practice and performance expectancy were the facilitators for the use of mHealth apps for medical calculation. Internet connectivity, performance expectancy and use by colleagues were associated with the use of mHealth with EHR. Performance expectancy was associated with mHealth apps' recommendation to patients to track health information and provide patient education. CONCLUSIONS PCPs often used mHealth apps to support their clinical work but seldom recommended mHealth apps to their patients. Training for PCPs is needed on the appraisal and knowledge of the mHealth apps for patient use.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adam G Dunn
- University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Chin Hai Teo
- University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wing Jun Woo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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113
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Oviedo Sarmiento OJ, Castro MDM, Lerma YO, Bernal LV, Navarro A, Alexander NDE. Data management plan for a community-level study of the hidden burden of cutaneous leishmaniasis in Colombia. BMC Res Notes 2021; 14:213. [PMID: 34059128 PMCID: PMC8165780 DOI: 10.1186/s13104-021-05618-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/15/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Cutaneous leishmaniasis is a vector-borne parasitic disease whose lasting scars can cause stigmatization and depressive symptoms. It is endemic in remote rural areas and its incidence is under-reported, while the effectiveness, as opposed to efficacy, of its treatments is largely unknown. Here we present the data management plan (DMP) of a project which includes mHealth tools to address these knowledge gaps in Colombia. The objectives of the DMP are to specify the tools and procedures for data collection, data transfer, data entry, creation of analysis dataset, monitoring and archiving. RESULTS The DMP includes data from two mobile apps: one implements a clinical prediction rule, and the other is for follow-up and treatment of confirmed cases. A desktop interface integrates these data and facilitates their linkage with other sources which include routine surveillance as well as paper and electronic case report forms. Multiple user and programming interfaces are used, as well as multiple relational and non-relational database engines. This DMP describes the successful integration of heterogeneous data sources and technologies. However the complexity of the project meant that the DMP took longer to develop than expected. We describe lessons learned which could be useful for future mHealth projects.
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Affiliation(s)
- Oscar Javier Oviedo Sarmiento
- CIDEIM, Calle 18 #122-135 Campus de la Universidad Icesi (Edificio O-CIDEIM), Cali, 760031 Colombia
- Universidad Icesi Grupo de investigación en informática y telecomunicaciones i2t, Calle 18 #122-135, Cali, 760031 Colombia
| | - María del Mar Castro
- CIDEIM, Calle 18 #122-135 Campus de la Universidad Icesi (Edificio O-CIDEIM), Cali, 760031 Colombia
| | - Yenifer Orobio Lerma
- CIDEIM, Calle 18 #122-135 Campus de la Universidad Icesi (Edificio O-CIDEIM), Cali, 760031 Colombia
- Universidad Icesi Grupo de investigación en informática y telecomunicaciones i2t, Calle 18 #122-135, Cali, 760031 Colombia
| | - Leonardo Vargas Bernal
- Universidad Icesi Grupo de investigación en informática y telecomunicaciones i2t, Calle 18 #122-135, Cali, 760031 Colombia
| | - Andrés Navarro
- Universidad Icesi Grupo de investigación en informática y telecomunicaciones i2t, Calle 18 #122-135, Cali, 760031 Colombia
| | - Neal D. E. Alexander
- CIDEIM, Calle 18 #122-135 Campus de la Universidad Icesi (Edificio O-CIDEIM), Cali, 760031 Colombia
- Universidad Icesi Grupo de investigación en informática y telecomunicaciones i2t, Calle 18 #122-135, Cali, 760031 Colombia
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114
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Escobar-Viera CG, Cernuzzi LC, Miller RS, Rodríguez-Marín HJ, Vieta E, González Toñánez M, Marsch LA, Hidalgo-Mazzei D. Feasibility of mHealth interventions for depressive symptoms in Latin America: a systematic review. Int Rev Psychiatry 2021; 33:300-311. [PMID: 34102945 PMCID: PMC8318676 DOI: 10.1080/09540261.2021.1887822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Depression is a prevalent disorder and leading cause of disability in Latin America, where the mental health treatment gap is still above 50%. We sought to synthesise and assess the quality of the evidence on the feasibility of mHealth-based interventions for depression in Latin America. We conducted a literature search of studies published in 2007 and after using four electronic databases. We included peer-reviewed articles, in English, Spanish or Portuguese, that evaluated interventions for depressive symptoms. Two authors independently extracted data using forms developed a priori. We assessed appropriateness of reporting utilising the CONSORT checklist for feasibility trials. Eight manuscripts were included for full data extraction. Appropriate reporting varied greatly. Most (n = 6, 75%) of studies were conducted in primary care settings and sought to deliver psychoeducation or behaviour change interventions for depressive symptoms. We found great heterogeneity in the assessment of feasibility. Two studies used comparator conditions. mHealth research for depression in Latin America is scarce. Included studies showed some feasibility despite methodological inconsistencies. Given the dire need for evidence-based mental health interventions in this region, governments and stakeholders must continue promoting and funding research tailored to cultural and population characteristics with subsequent pragmatic clinical trials.
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Affiliation(s)
- César G. Escobar-Viera
- Center for Research on Behavioral Health, Media, and Technology, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luca C. Cernuzzi
- Facultad de Ciencias y Tecnología, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Rebekah S. Miller
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hugo J. Rodríguez-Marín
- Dirección de Salud Mental, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay;,Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Magalí González Toñánez
- Facultad de Ciencias y Tecnología, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Greve M, Brendel AB, van Osten N, Kolbe LM. Overcoming the barriers of mobile health that hamper sustainability in low-resource environments. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Aim
This research aims to identify response strategies that non-profit organizations (NPOs) can apply to overcome the barriers that hamper the sustainable use of mobile health (mHealth) interventions in low-resource environments (LREs), such as in Sub-Saharan Africa (SSA).
Subject and method
A qualitative study on mHealth initiatives in SSA is conducted through semi-structured interviews with 15 key informants of NPOs that operate and manage mHealth interventions in this region. The interviews focus on identifying existing barriers and response strategies that NPOs apply to enable sustainable and long-term running interventions.
Results
Building on grounded theory techniques, the collected data guided us towards a process model that identifies four aggregated categories of challenging areas that require response strategies (economy, environment, technology, and user acceptance).
Conclusion
This study provides contributions from and implications for NPOs and researchers. Health practitioners are provided with a knowledge base of what barriers to expect and how to overcome them, to strive for sustainable implementation from the very beginning of an intervention. A process model is identified that structures the response strategies in a time-based agenda of mHealth initiatives and thus makes a theoretical contribution. Overall, this study addresses the need for a theoretical consideration of the “pilotitis” phenomenon, which currently hampers the sustainable implementation and scaling up of mHealth initiatives. While the focus is specifically on mHealth initiatives, the overall findings help prevent discontinuance of projects in the future after the pilot, and help facilitate LREs on their way to sustainable health interventions and universal health coverage.
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116
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Osei E, Mashamba-Thompson TP. Mobile health applications for disease screening and treatment support in low-and middle-income countries: A narrative review. Heliyon 2021; 7:e06639. [PMID: 33869857 PMCID: PMC8035664 DOI: 10.1016/j.heliyon.2021.e06639] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/15/2020] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
The advances in mobile technologies and applications are driving the transformation in health services delivery globally. Mobile phone penetration is increasing exponentially in low-and middle-income countries, hence using mobile phones for healthcare services could reach more people in resource-limited settings than the traditional forms of healthcare provision. The review presents recent literature on facilitators and barriers of implementing mHealth for disease screening and treatment support in low-and middle-income countries. We searched for relevant literature from the following electronic databases: MEDLINE; CINAHL with full text via EBSCOhost; Science Direct; PubMed; Google Scholar and Web of Science using the keywords for relevant studies. We searched for published studies from 2015 to August 2020 with no language limitations. A total of 721 articles identified, 125 articles met the inclusion criteria and were included in the qualitative synthesis. The review demonstrates relevant facilitators for the implementation of mHealth, which includes knowledge, attitudes, and perceptions of stakeholders on the use of mHealth and the performance of mHealth for disease diagnosis in low and-middle-income countries. Barriers and challenges hindering the implementation of mHealth applications were also identified. We proposed a framework for improving the implementation of mHealth for disease screening and treatment support in low-and middle-income countries.
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Affiliation(s)
- Ernest Osei
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria, South Africa
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117
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Fisher L, Glasgow RE, Huebschmann A. A Scoping Review and General User's Guide for Facilitating the Successful Use of eHealth Programs for Diabetes in Clinical Care. Diabetes Technol Ther 2021; 23:133-145. [PMID: 32865431 PMCID: PMC8020562 DOI: 10.1089/dia.2020.0383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The vast eHealth literature in diabetes can provide a useful foundation to aid in the selection, adoption, and implementation of eHealth methodologies in clinical care. Despite clear potential to enhance reach, efficiency, and clinical effectiveness, research has yielded mixed and often contradictory results, and wide-spread adoption and maintenance of eHealth programs in clinical care has been limited. Furthermore, few reports have identified the unique challenges that clinicians and health systems face when attempting to incorporate eHealth systems into clinical care. To address these gaps, we address two goals in this report: first, to summarize and integrate the major findings of the diabetes-related eHealth literature based on currently available systematic and narrative reviews; and second, based on the review, to provide practical guidelines to assist clinicians and health systems in selecting and implementing eHealth programs into diabetes care using dissemination and implementation science principles and perspectives.
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Affiliation(s)
- Lawrence Fisher
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Russell E. Glasgow
- Department of Family Medicine, and Adult and Child Consortium for Research in Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amy Huebschmann
- Virtual Diabetes Center, Division of General Internal Medicine, Center for Women's Health Research, and ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Moll V, Mariano ER, Kitzman JM, O'Reilly-Shah VN, Jabaley CS. Regional anesthesia educational material utilization varies by World Bank income category: A mobile health application data study. PLoS One 2021; 16:e0244860. [PMID: 33524031 PMCID: PMC7850494 DOI: 10.1371/journal.pone.0244860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Regional anesthesia offers an alternative to general anesthesia and may be advantageous in low resource environments. There is a paucity of data regarding the practice of regional anesthesia in low- and middle-income countries. Using access data from a free Android app with curated regional anesthesia learning modules, we aimed to estimate global interest in regional anesthesia and potential applications to clinical practice stratified by World Bank income level. METHODS We retrospectively analyzed data collected from the free Android app "Anesthesiologist" from December 2015 to April 2020. The app performs basic anesthetic calculations and provides links to videos on performing 12 different nerve blocks. Users of the app were classified on the basis of whether or not they had accessed the links. Nerve blocks were also classified according to major use (surgical block, postoperative pain adjunct, rescue block). RESULTS Practitioners in low- and middle-income countries accessed the app more frequently than in high-income countries as measured by clicks. Users from low- and middle-income countries focused mainly on surgical blocks: ankle, axillary, infraclavicular, interscalene, and supraclavicular blocks. In high-income countries, more users viewed postoperative pain blocks: adductor canal, popliteal, femoral, and transverse abdominis plane blocks. Utilization of the app was constant over time with a general decline with the start of the COVID-19 pandemic. CONCLUSION The use of an in app survey and analytics can help identify gaps and opportunities for regional anesthesia techniques and practices. This is especially impactful in limited-resource areas, such as lower-income environments and can lead to targeted educational initiatives.
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Affiliation(s)
- Vanessa Moll
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Edward R. Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Jamie M. Kitzman
- Department of Pediatric Anesthesiology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Vikas N. O'Reilly-Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, United States of America
| | - Craig S. Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Kabukye JK, Ilozumba O, Broerse JEW, de Keizer N, Cornet R. Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study. JMIR Mhealth Uhealth 2021; 9:e22061. [PMID: 33496672 PMCID: PMC7872833 DOI: 10.2196/22061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background Cancer awareness is crucial for cancer care and prevention. However, cancer awareness in Uganda is low, and access to cancer information is limited. Objective This study aims to (1) understand the cancer awareness situation in Uganda (perceptions, beliefs, information needs, and challenges to accessing cancer information) and opinions about interactive voice response (IVR) systems; (2) develop cancer awareness messages and implement them in an IVR system; and (3) evaluate user acceptance and use of the IVR system. Methods A participatory design approach was adopted. To understand cancer awareness needs and challenges, 3 interviews and 7 focus group discussions (FGDs) were conducted with cancer health care providers, patients with cancer, caregivers and survivors, administrators, and lay citizens (n=73). On the basis of the resulting qualitative data, audio messages addressing cancer information needs were developed and implemented in an IVR system. The system and messages were tested with users (n=12) during 2 co-design workshops before final rollout. Finally, the system was evaluated over 6 months after going live, using call records and user feedback from telephone interviews with callers (n=40). Results The cancer information needs included general topics such as what cancer is, what causes it, cancer screening and diagnosis, cancer treatment, and practical information on what to expect during cancer care. There were also myths and misconceptions that need to be addressed, such as that cancer is due to witchcraft and has no treatment. Information on COVID-19 was also sought after following the outbreak. We developed 20 audio cancer messages (approximately 2 minutes each) in English and Luganda, along with 14 IVR navigation instructions. These were implemented in an IVR system with 24/7 availability from all over Uganda via a toll-free multi-channel telephone number. The total number of calls made to the IVR system 6 months after going live was 3820. Of these, 2437 (63.8%) lasted at least 30 seconds and were made from 1230 unique telephone numbers. There were 191 voice messages and 760 calls to live agents, most of which (681/951, 71.6%) were in Luganda. Call volumes peaked following advertisement of the system and lockdowns due to COVID-19. Participants were generally familiar with IVR technology, and caller feedback was largely positive. Cited benefits included convenience, toll-free access, and detailed information. Recommendations for improvement of the system included adding live agents and marketing of the system to target users. Conclusions IVR technology provides an acceptable and accessible method for providing cancer information to patients and the general public in Uganda. However, a need remains for health system reforms to provide additional cancer information sources and improve cancer care services in general.
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Affiliation(s)
- Johnblack K Kabukye
- Uganda Cancer Institute, Kampala, Uganda.,Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC - Location AMC, Amsterdam, Netherlands
| | - Onaedo Ilozumba
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC - Location AMC, Amsterdam, Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC - Location AMC, Amsterdam, Netherlands
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120
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Pokhrel P, Karmacharya R, Taylor Salisbury T, Carswell K, Kohrt BA, Jordans MJD, Lempp H, Thornicroft G, Luitel NP. Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal. BMC Med Inform Decis Mak 2021; 21:21. [PMID: 33468120 PMCID: PMC7816321 DOI: 10.1186/s12911-021-01386-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In recent years, a significant change has taken place in the health care delivery systems due to the availability of smartphones and mobile software applications. The use of mobile technology can help to reduce a number of barriers for mental health care such as providers' workload, lack of qualified personnel, geographical and attitudinal barriers to seek treatment. This study assessed the perception of Nepali primary healthcare workers about the feasibility, acceptability, and benefits of using a mobile app-based clinical guideline for mental health care. METHOD A qualitative study was conducted in two districts Chitwan and Ramechhap of Nepal with purposively selected medical officers (n = 8) and prescribing primary healthcare workers (n = 35) who were trained in the World Health Organization mental health Gap Action Program Intervention Guide. Semi-structured interviews and focus group discussions were conducted in Nepali, audio recorded, transcribed and translated into English for data analysis. Data were analysed manually using a thematic analysis approach. RESULTS The majority of the healthcare workers and medical officers reported a high level of interest, motivation and positive attitudes towards the mobile app-based clinical guidelines for detection and treatment of people with mental disorders in primary care. They respondents suggested that several features and functions should be included in the app: suggestive diagnosis and treatment options; clinical data recording system; sending messages to patients to promote follow-up visits; allow offline functions; minimal typing options and content to be available in Nepali language. The study participants reported that the app could help in bringing uniformity in diagnosis and management of mental disorders across all health facilities, enabling remote supervision, helping verification of health workers' diagnosis and treatment; and increasing patients' trust in the treatment. Lack of reliable internet connection in health facilities, possibility of distracting interaction between patient and provider, and confidentiality were the key factors potentially hindering the use of the app. CONCLUSION The suggested functions and features as well as the potential risk factors highlighted by the health workers, will be considered when further developing the mobile app-based clinical guidelines, training modality and materials, and the supervision system.
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Affiliation(s)
- P Pokhrel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - R Karmacharya
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - T Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - B A Kohrt
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.,Department of Psychiatry, George Washington University, Washington, DC, USA
| | - M J D Jordans
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.,Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - H Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - G Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
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121
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Iribarren SJ, Akande TO, Kamp KJ, Barry D, Kader YG, Suelzer E. Effectiveness of Mobile Apps to Promote Health and Manage Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth 2021; 9:e21563. [PMID: 33427672 PMCID: PMC7834932 DOI: 10.2196/21563] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Interventions aimed at modifying behavior for promoting health and disease management are traditionally resource intensive and difficult to scale. Mobile health apps are being used for these purposes; however, their effects on health outcomes have been mixed. OBJECTIVE This study aims to summarize the evidence of rigorously evaluated health-related apps on health outcomes and explore the effects of features present in studies that reported a statistically significant difference in health outcomes. METHODS A literature search was conducted in 7 databases (MEDLINE, Scopus, PsycINFO, CINAHL, Global Index Medicus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews). A total of 5 reviewers independently screened and extracted the study characteristics. We used a random-effects model to calculate the pooled effect size estimates for meta-analysis. Sensitivity analysis was conducted based on follow-up time, stand-alone app interventions, level of personalization, and pilot studies. Logistic regression was used to examine the structure of app features. RESULTS From the database searches, 8230 records were initially identified. Of these, 172 met the inclusion criteria. Studies were predominantly conducted in high-income countries (164/172, 94.3%). The majority had follow-up periods of 6 months or less (143/172, 83.1%). Over half of the interventions were delivered by a stand-alone app (106/172, 61.6%). Static/one-size-fits-all (97/172, 56.4%) was the most common level of personalization. Intervention frequency was daily or more frequent for the majority of the studies (123/172, 71.5%). A total of 156 studies involving 21,422 participants reported continuous health outcome data. The use of an app to modify behavior (either as a stand-alone or as part of a larger intervention) confers a slight/weak advantage over standard care in health interventions (standardized mean difference=0.38 [95% CI 0.31-0.45]; I2=80%), although heterogeneity was high. CONCLUSIONS The evidence in the literature demonstrates a steady increase in the rigorous evaluation of apps aimed at modifying behavior to promote health and manage disease. Although the literature is growing, the evidence that apps can improve health outcomes is weak. This finding may reflect the need for improved methodological and evaluative approaches to the development and assessment of health care improvement apps. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42018106868; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=106868.
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Affiliation(s)
- Sarah J Iribarren
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Tokunbo O Akande
- Department of Pediatrics, Sanford Health, Bemidji, MN, United States
| | - Kendra J Kamp
- Division of Gastroenterology, School of Medicine, University of Washington, Seattle, WA, United States
| | - Dwight Barry
- Enterprise Analytics, Seattle Children's Hospital, Seattle, WA, United States
| | - Yazan G Kader
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Elizabeth Suelzer
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, WI, United States
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Mehraeen E, Noori T, Nazeri Z, Heydari M, Mehranfar A, Moghaddam HR, Aghamohammadi V. Identifying features of a mobile-based application for self-care of people living with T2DM. Diabetes Res Clin Pract 2021; 171:108544. [PMID: 33227362 DOI: 10.1016/j.diabres.2020.108544] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/31/2020] [Accepted: 11/06/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Diabetes self-care requires support to empower patients to improve self-monitoring and maintain the necessary self-care behaviors. We aimed to identify features of a mobile-based application as a technology-based device for self-care of people living with T2DM. METHOD This study was conducted in two main phases in 2020. In the first phase, a literature review study was performed to identify the data elements and technical features of the T2DM self-care application. In the second phase, using the information obtained from the review of similar articles, a questionnaire was designed to validate identified requirements. The statistical population of the present study consisted of 22 endocrinologists and metabolic specialists. RESULTS Identification of 55 data elements and technical features for mobile-based self-care application for people with T2DM, and according to the statistical population, 15data elements for demographic requirements, 16 data elements for clinical requirements, and 17 features for the technical capability of this app were selected. CONCLUSION Blood sugar monitoring, exercise, nutrition, weight monitoring, and educational capabilities were the most highlighted technical features of the T2DM self-care application. Software designers can use these requirements to design a self-care app for people with type-2 diabetes that can help manage and improve patients' health status.
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Affiliation(s)
- Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Tayebeh Noori
- Department of Health Information Technology, Zabol University of Medical Sciences, Zabol, Iran
| | - Zahra Nazeri
- Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Heydari
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Adele Mehranfar
- Department of Electrical and Computer Engineering, Isfahan University of Medical Sciences, Isfahan, Iran
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Basu S. The potential and barriers in the expansion and utilization of a text message-based tobacco cessation service among tobacco users in India. J Smok Cessat 2020; 15:219-222. [DOI: 10.1017/jsc.2020.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractBackgroundThere is growing recognition of the role of the mCessation service (MCS) in promoting tobacco cessation in India.ObjectiveTo examine the potential for expanding the utilization of the MCS for tobacco cessation in India after assessing the dimensions related to literacy, mobile phone access, intention to quit, and advice to quit from the second round of the Global Adult Tobacco Survey.MethodsA cross-sectional analysis of the data collected during the second round of the nationally-representative Global Adult Tobacco Survey (GATS) (2016–17) was conducted.ResultsCurrent tobacco smokers, smokeless tobacco, and dual users compromised 10.7%, 21.4%, and 3.4% of the survey participants, respectively. Quit attempts were reported by 36.3% of the existing tobacco smokers, of whom nearly 72% tried to quit without any assistance, while only 0.3% used the MCS. However, the potential expansion of the MCS was likely among 11.2% tobacco users with an existing intention to quit, being literate, Hindi-speakers and having cell-phone access.ConclusionsThe utilization of the MCS can be considerably expanded among tobacco users in India by enabling multilingual usage and incorporation as standard care practice to allow the opportunistic promotion of tobacco cessation by healthcare providers at their health clinics.
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Margineanu I, Louka C, Vincenti-Gonzalez M, Saktiawati AMI, Schierle J, Abass KM, Akkerman O, Alffenaar JW, Ranchor AV, Stienstra Y. Patients and Medical Staff Attitudes Toward the Future Inclusion of eHealth in Tuberculosis Management: Perspectives From Six Countries Evaluated using a Qualitative Framework. JMIR Mhealth Uhealth 2020; 8:e18156. [PMID: 33136052 PMCID: PMC7669445 DOI: 10.2196/18156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/20/2020] [Accepted: 07/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background Digitally delivering healthcare services is very attractive for tuberculosis (TB) management as this disease has a complex diagnosis and lengthy management and involves multiple medical and nonmedical specialists. Especially in low- and middle-income countries, eHealth could potentially offer cost-effective solutions to bridge financial, social, time, and distance challenges. Objective The goal of the research is to understand what would make eHealth globally applicable and gain insight into different TB situations, opportunities, and challenges. Methods We performed focus group interviews with TB experts and patients from 6 different countries on 4 different continents. The focus group interviews followed the theory of planned behavior framework to offer structured recommendations for a versatile eHealth solution. The focus group interviews were preceded by a general demographic and technology use questionnaire. Questionnaire results were analyzed using basic statistics in Excel (Microsoft Corporation). Focus group interview data were analyzed using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH) by assigning codes to quotations and grouping codes into the 5 domains within the framework. Results A total of 29 patients and 32 medical staff members were included in our study. All medical staff had used the internet, whereas 31% (9/61) of patients had never been online. The codes with the most quotations were information in relation to eHealth (144 quotations) and communication (67 quotations). The consensus among all participants from all countries is that there are important communication and information gaps that could be bridged by an eHealth app. Participants from different countries also highlighted different challenges, such as a majority of asylum-seeker patients or lack of infrastructure that could be addressed with an eHealth app. Conclusions Within the 6 countries interviewed, there is high enthusiasm toward eHealth in TB. A potential app could first target information and communication gaps in TB, with additional modules aimed at setting-specific challenges.
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Affiliation(s)
- Ioana Margineanu
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Pneumology Hospital Iasi, Iasi, Romania
| | - Christina Louka
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Maria Vincenti-Gonzalez
- Department of Medical Microbiology and Infection Prevention, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Antonia Morita Iswari Saktiawati
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Johannes Schierle
- University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Kabiru Mohammed Abass
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Agogo Presbyterian Hospital, Agogo, Ghana
| | - Onno Akkerman
- Department of Pulmonary Diseases and Tuberculosis, Tuberculosis Centrum Beatrixoord, University Medical Centrum Groningen, University of Groningen, Haren, Netherlands
| | - Jan-Willem Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,University of Sydney, Camperdown, Australia.,Westmead Hospital, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - Adelita V Ranchor
- Health Psychology Section, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
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Zhang W, Cheng B, Zhu W, Huang X, Shen C. Effect of Telemedicine on Quality of Care in Patients with Coexisting Hypertension and Diabetes: A Systematic Review and Meta-Analysis. Telemed J E Health 2020; 27:603-614. [PMID: 32976084 DOI: 10.1089/tmj.2020.0122] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: With the development of technology and the need for individualized and continuous support for patients with chronic conditions, telemedicine has been widely used. Despite the potential benefits of telemedicine, little is known about its effect on the quality of care (QoC) in people with hypertension and comorbid diabetes, who face more challenges in disease management than those with hypertension or diabetes alone. This study aimed to examine the effect of telemedicine on QoC for patients with hypertension and comorbid diabetes by synthesizing findings from clinical trials. Methods: This systematic review and meta-analysis were developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four major electronic databases from inception to March 2020 were searched. Studies were screened using predetermined criteria. Data were extracted and tabulated into tables. The primary outcomes were QoC indicators, including outcomes (e.g., blood pressure [BP] and glycemic control), process, and experience of care. Quantitative data were pooled and presented in forest plots. Qualitative narratives were also used. Results: Five studies from four clinical trials were included in this review, with intervention durations ranging from 3 to 6 months. Telemedicine significantly decreased BP by 10.4/4.8 mm/Hg, but its effect on glycemic control was inconsistent. Telemedicine also improved experience of care (e.g., patient perception and engagement). Various indicators for process of care were assessed, including medication adherence, BP monitoring, and self-efficacy, with mixed findings. Conclusions: Telemedicine has great potential to improve the QoC, particularly outcomes of care, for patients with hypertension and comorbid diabetes. Health care professionals may consider using available telemedicine to facilitate communication and interaction with their patients, thereby helping them with disease management. Long-term, large-scale studies are needed to test the generalizability and sustainability of the telemedicine programs.
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Affiliation(s)
- Wenhang Zhang
- Department of Cardiology, The Second Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Bo Cheng
- Department of Cardiology, The Second Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Wei Zhu
- Department of Cardiology, The Second Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Xiaoxia Huang
- Department of Cardiology, The Second Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Changyin Shen
- Department of Cardiology, The Second Affiliated Hospital of Zunyi Medical University, Guizhou, China
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Nyati-Jokomo Z, Dabengwa IM, Makacha L, Nyapwere N, Dube YP, Chikoko L, Vidler M, Makanga PT. RoadMApp: a feasibility study for a smart travel application to improve maternal health delivery in a low resource setting in Zimbabwe. BMC Pregnancy Childbirth 2020; 20:501. [PMID: 32867716 PMCID: PMC7457488 DOI: 10.1186/s12884-020-03200-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/21/2020] [Indexed: 11/12/2022] Open
Abstract
Background Travel time and healthcare financing are critical determinants of the provision of quality maternal health care in low resource settings. Despite the availability of pregnancy-related mHealth and smart travel applications, there is a lack of evidence on their usage to travel to health facilities for routine antenatal care and emergencies. There is a shortage of information about the feasibility of using a custom-made mobile technology that integrates smart travel and mHealth. This paper explores the feasibility of implementing a custom-made geographically enabled mobile technology-based tool (RoadMApp) to counter the adverse effects of long travel times for maternal care in Kwekwe District, Zimbabwe. Methods We frame the paper using the first two steps (listen & plan) of the Spiral Technology Action Research (STAR model). The paper uses an exploratory case study design and Participatory Learning Approaches (PLA) with stakeholders (community members) and in-depth interviews with key informants (health care service providers, pregnant women, transport operators). One hundred ninety-three participants took part in the study. We conducted focus group discussions with pregnant women, women of childbearing age, men (household heads), and elderly women. The discussion questions centered on travel time, availability of transport, cellular network coverage, and perceptions of the RoadMApp application. Data were analysed thematically using Nvivo Pro 12. Results Most parts of rural Kwekwe are far from health facilities and have an inefficient road and telecommunications network. Hence, it is hard to predict if RoadMApp will integrate into the lives of the community - especially those in rural areas. Since these issues are pillars of the design of the RoadMApp mHealth, the implementation will probably be a challenge. Conclusion Communities are keen to embrace the RoadMApp application. However, the feasibility of implementing RoadMApp in Kwekwe District will be a challenge because of maternal health care barriers such as poor road network, poor phone network, and the high cost of transport. There is a need to investigate the social determinants of access to maternity services to inform RoadMApp implementation.
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Affiliation(s)
- Zibusiso Nyati-Jokomo
- The University of Zimbabwe, College of Health Sciences, Parirenyatwa Hospital, Harare, Zimbabwe.
| | - Israel Mbekezeli Dabengwa
- National University of Science and Technology, Faculty of Medicine, Mpilo Hospital, Bulawayo, Zimbabwe
| | - Liberty Makacha
- Surveying and Geomatics, Midlands State University, Senga, Gweru, Zimbabwe
| | - Newton Nyapwere
- Surveying and Geomatics, Midlands State University, Senga, Gweru, Zimbabwe
| | | | - Laurine Chikoko
- Research and Postgraduate Studies, Midlands State University, Gweru, Zimbabwe
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, Canada
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Han H, Guo W, Lu Y, Wang M. Effect of mobile applications on blood pressure control and their development in China: a systematic review and meta-analysis. Public Health 2020; 185:356-363. [PMID: 32738577 DOI: 10.1016/j.puhe.2020.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mobile applications (apps) facilitate aspects of people's lives and are useful auxiliary tools for controlling risk factors for chronic diseases. This meta-analysis and systematic review aimed to explore the effect of app-assisted interventions on blood pressure (BP) control in Chinese adults and summarize the common functions of these apps. STUDY DESIGN This is a systematic review and meta-analysis. METHODS The search was conducted in four databases (PubMed, Embase, China National Knowledge Infrastructure database, and China Biology Medicine database). The identified articles were reviewed independently by two researchers. A random-effects model was used to compute the effect size. Studies were assessed for risk of bias and the transparency and quality of the apps. RESULTS Eighteen studies (n = 2965) were included in the final analysis. App-based interventions achieved additional decreases in BP levels (systolic BP [SBP]: -8.12 mmHg, 95% confidence interval [CI]: -11.47 to -4.77 mmHg, P < 0.001; diastolic BP [DBP]: -6.67 mmHg, 95% CI: -8.92 to -4.41 mmHg, P < 0.001). However, the results showed considerable heterogeneity (SBP: I2 = 97%, P < 0.001; DBP: I2 = 96%, P < 0.001). Four studies reported the BP control rate. The pooled results demonstrated a better control rate achieved via app-based interventions (risk ratio: 1.33; 95% CI: 1.18 to 1.49, P < 0.001) without heterogeneity (I2 = 0%). The transparency and replicability assessment revealed unsatisfying results, and only three studies reported more than half of the 16 items in the mHealth checklist. Few studies described the replicability, data security, and infrastructure of the apps used. We identified 16 app functions, with the top three functions being doctor-patient communication (16/16), health education (15/16), and personalized guidance (12/16). CONCLUSIONS We showed app-based interventions had a positive effect on BP management in Chinese adults. However, there was high heterogeneity among the included studies, which merits further exploration when more standardized research has been conducted. The functions of the apps varied widely, and further development of apps for BP management should abide by appropriate reporting guidelines.
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Affiliation(s)
- Heze Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yifan Lu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Miao Wang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; The Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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128
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Meyer AJ, Armstrong-Hough M, Babirye D, Mark D, Turimumahoro P, Ayakaka I, Haberer JE, Katamba A, Davis JL. Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda. JMIR Mhealth Uhealth 2020; 8:e19552. [PMID: 32673262 PMCID: PMC7385635 DOI: 10.2196/19552] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/01/2020] [Accepted: 06/21/2020] [Indexed: 12/20/2022] Open
Abstract
Background Mobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions. Objective We aimed to characterize the challenges that we encountered in the implementation of a complex mHealth intervention in Uganda. Methods We customized a commercial mobile survey app to facilitate a two-arm household-randomized, controlled trial of home-based tuberculosis (TB) contact investigation. We incorporated digital fingerprinting for patient identification in both study arms and automated SMS messages in the intervention arm only. A local research team systematically documented challenges to implementation in biweekly site visit reports, project management reports, and minutes from biweekly conference calls. We then classified these challenges using the Consolidated Framework for Implementation Research (CFIR). Results We identified challenges in three principal CFIR domains: (1) intervention characteristics, (2) inner setting, and (3) characteristics of implementers. The adaptability of the app to the local setting was limited by software and hardware requirements. The complexity and logistics of implementing the intervention further hindered its adaptability. Study staff reported that community health workers (CHWs) were enthusiastic regarding the use of technology to enhance TB contact investigation during training and the initial phase of implementation. After experiencing technological failures, their trust in the technology declined along with their use of it. Finally, complex data structures impeded the development and execution of a data management plan that would allow for articulation of goals and provide timely feedback to study staff, CHWs, and participants. Conclusions mHealth technologies have the potential to make delivery of public health interventions more direct and efficient, but we found that a lack of adaptability, excessive complexity, loss of trust among end users, and a lack of effective feedback systems can undermine implementation, especially in low-resource settings where digital services have not yet proliferated. Implementers should anticipate and strive to avoid these barriers by investing in and adapting to local human and material resources, prioritizing feedback from end users, and optimizing data management and quality assurance procedures. Trial Registration Pan-African Clinical Trials Registration PACTR201509000877140; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=877
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Affiliation(s)
- Amanda J Meyer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States.,Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Departments of Social and Behavioral Sciences and Epidemiology, School of Global Public Health, New York University, New York, NY, United States
| | - Diana Babirye
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - David Mark
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Patricia Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Irene Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - J Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States.,Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, United States.,Pulmonary, Critical Care and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, United States
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129
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Fagherazzi G, Goetzinger C, Rashid MA, Aguayo GA, Huiart L. Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers. J Med Internet Res 2020; 22:e19284. [PMID: 32501804 PMCID: PMC7298971 DOI: 10.2196/19284] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/22/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has created an urgent need for coordinated mechanisms to respond to the outbreak across health sectors, and digital health solutions have been identified as promising approaches to address this challenge. This editorial discusses the current situation regarding digital health solutions to fight COVID-19 as well as the challenges and ethical hurdles to broad and long-term implementation of these solutions. To decrease the risk of infection, telemedicine has been used as a successful health care model in both emergency and primary care. Official communication plans should promote facile and diverse channels to inform people about the pandemic and to avoid rumors and reduce threats to public health. Social media platforms such as Twitter and Google Trends analyses are highly beneficial to model pandemic trends as well as to monitor the evolution of patients' symptoms or public reaction to the pandemic over time. However, acceptability of digital solutions may face challenges due to potential conflicts with users' cultural, moral, and religious backgrounds. Digital tools can provide collective public health benefits; however, they may be intrusive and can erode individual freedoms or leave vulnerable populations behind. The COVID-19 pandemic has demonstrated the strong potential of various digital health solutions that have been tested during the crisis. More concerted measures should be implemented to ensure that future digital health initiatives will have a greater impact on the epidemic and meet the most strategic needs to ease the life of people who are at the forefront of the crisis.
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130
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O'Donnell A. Commentary on Harder et al. (2020): Ensuring the sustainability of mHealth in low- and middle-income countries-how do we cure 'pilotitis'? Addiction 2020; 115:1061-1062. [PMID: 32072704 DOI: 10.1111/add.14986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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131
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Gimbel RW, Rennert LM, Crawford P, Little JR, Truong K, Williams JE, Griffin SF, Shi L, Chen L, Zhang L, Moss JB, Marshall RC, Edwards KW, Crawford KJ, Hing M, Schmeltz A, Lumsden B, Ashby M, Haas E, Palazzo K. Enhancing Patient Activation and Self-Management Activities in Patients With Type 2 Diabetes Using the US Department of Defense Mobile Health Care Environment: Feasibility Study. J Med Internet Res 2020; 22:e17968. [PMID: 32329438 PMCID: PMC7284404 DOI: 10.2196/17968] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/21/2020] [Accepted: 04/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background Past mobile health (mHealth) efforts to empower type 2 diabetes (T2D) self-management include portals, text messaging, collection of biometric data, electronic coaching, email, and collection of lifestyle information. Objective The primary objective was to enhance patient activation and self-management of T2D using the US Department of Defense’s Mobile Health Care Environment (MHCE) in a patient-centered medical home setting. Methods A multisite study, including a user-centered design and a controlled trial, was conducted within the US Military Health System. Phase I assessed preferences regarding the enhancement of the enabling technology. Phase II was a single-blinded 12-month feasibility study that randomly assigned 240 patients to either the intervention (n=123, received mHealth technology and behavioral messages tailored to Patient Activation Measure [PAM] level at baseline) or the control group (n=117, received equipment but not messaging. The primary outcome measure was PAM scores. Secondary outcome measures included Summary of Diabetes Self-Care Activities (SDSCA) scores and cardiometabolic outcomes. We used generalized estimating equations to estimate changes in outcomes. Results The final sample consisted of 229 patients. Participants were 61.6% (141/229) male, had a mean age of 62.9 years, mean glycated hemoglobin (HbA1c) of 7.5%, mean BMI of 32.7, and a mean duration of T2D diagnosis of 9.8 years. At month 12, the control group showed significantly greater improvements compared with the intervention group in PAM scores (control mean 7.49, intervention mean 1.77; P=.007), HbA1c (control mean −0.53, intervention mean −0.11; P=.006), and low-density lipoprotein cholesterol (control mean −7.14, intervention mean 4.38; P=.01). Both groups showed significant improvement in SDSCA, BMI, waist size, and diastolic blood pressure; between-group differences were not statistically significant. Except for patients with the highest level of activation (PAM level 4), intervention group patients exhibited significant improvements in PAM scores. For patients with the lowest level of activation (PAM level 1), the intervention group showed significantly greater improvement compared with the control group in HbA1c (control mean −0.09, intervention mean −0.52; P=.04), BMI (control mean 0.58, intervention mean −1.22; P=.01), and high-density lipoprotein cholesterol levels (control mean −4.86, intervention mean 3.56; P<.001). Significant improvements were seen in AM scores, SDSCA, and waist size for both groups and in diastolic and systolic blood pressure for the control group; the between-group differences were not statistically significant. The percentage of participants who were engaged with MHCE for ≥50% of days period was 60.7% (68/112; months 0-3), 57.4% (62/108; months 3-6), 49.5% (51/103; months 6-9), and 43% (42/98; months 9-12). Conclusions Our study produced mixed results with improvement in PAM scores and outcomes in both the intervention and control groups. Structural design issues may have hampered the influence of tailored behavioral messaging within the intervention group. Trial Registration ClinicalTrials.gov NCT02949037; https://clinicaltrials.gov/ct2/show/NCT02949037 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.6993
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Affiliation(s)
- Ronald W Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Lior M Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Paul Crawford
- Nellis Family Medicine Residency Program, Mike O'Callaghan Federal Hospital, Las Vegas, NV, United States
| | - Jeanette R Little
- Mobile Health Innovation Center, Telemedicine & Advanced Technologies Research Center, U.S. Army Medical Research & Materials Command, Fort Gordon, GA, United States
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Joel E Williams
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Liwei Chen
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - LingLing Zhang
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Jennie B Moss
- Nellis Family Medicine Residency Program, Mike O'Callaghan Federal Hospital, Las Vegas, NV, United States
| | - Robert C Marshall
- Clinical Informatics Fellowship Program, Madigan Army Medical Center, Tacoma, WA, United States
| | - Karen W Edwards
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Kristy J Crawford
- Nellis Family Medicine Residency Program, Mike O'Callaghan Federal Hospital, Las Vegas, NV, United States
| | - Marie Hing
- Department of Internal Medicine, Madigan Army Medical Center, Tacoma, WA, United States
| | - Amanda Schmeltz
- Mobile Health Innovation Center, Telemedicine & Advanced Technologies Research Center, U.S. Army Medical Research & Materials Command, Fort Gordon, GA, United States
| | - Brandon Lumsden
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Morgan Ashby
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Elizabeth Haas
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Kelly Palazzo
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
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Advances and future directions in the use of mobile health in supportive cancer care: proceedings of the 2019 MASCC Annual Meeting symposium. Support Care Cancer 2020; 28:4059-4067. [DOI: 10.1007/s00520-020-05513-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
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Steinman L, van Pelt M, Hen H, Chhorvann C, Lan CS, Te V, LoGerfo J, Fitzpatrick AL. Can mHealth and eHealth improve management of diabetes and hypertension in a hard-to-reach population? -lessons learned from a process evaluation of digital health to support a peer educator model in Cambodia using the RE-AIM framework. Mhealth 2020; 6:40. [PMID: 33437836 PMCID: PMC7793020 DOI: 10.21037/mhealth-19-249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/22/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is increasing in low- and middle-income countries (LMICs) where NCDs cause 4:5 deaths, disproportionately affect poorer populations, and carry a large economic burden. Digital interventions can improve NCD management for these hard-to-reach populations with inadequate health systems and high cell-phone coverage; however, there is limited research on whether digital health is reaching this potential. We conducted a process evaluation to understand challenges and successes from a digital health intervention trial to support Cambodians living with NCDs in a peer educator (PE) program. METHODS MoPoTsyo, a Cambodian non-governmental organization (NGO), trains people living with diabetes and/or hypertension as PEs to provide self-management education, support, and healthcare linkages for better care management among underserved populations. We partnered with MoPoTsyo and InSTEDD in 2016-2018 to test tailored and targeted mHealth mobile voice messages and eHealth tablets to facilitate NCD management and clinical-community linkages. This cluster randomized controlled trial (RCT) engaged 3,948 people and 75 PEs across rural and urban areas. Our mixed methods process evaluation was guided by RE-AIM to understand impact and real-world implications of digital health. Data included patient (20) and PE interviews (6), meeting notes, and administrative datasets. We triangulated and analyzed data using thematic analysis, and descriptive and complier average causal effects statistics (CACE). RESULTS Reach: intervention participants were more urban (66% vs. 44%), had more PE visits (39 vs. 29), and lower uncontrolled hypertension [12% and 7% vs. 23% and 16% uncontrolled systolic blood pressure (SBP) and diastolic blood pressure (DBP)]. Adoption: patients were sent mean [standard deviation (SD)] 30 [14] and received 14 [8] messages; 40% received no messages due to frequent phone number changes. Effectiveness: CACE found clinically but not statistically significant improvements in blood pressure and sugar for mHealth participants who received at least one message vs. no messages. Implementation: main barriers were limited cellular access and that mHealth/eHealth could not solve structural barriers to NCD control faced by people in poverty. Maintenance: had the intervention been universally effective, it could be paid for from additional revolving drug fund revenue, new agreements with mobile networks, or the government. CONCLUSIONS Evidence for digital health to improve NCD outcomes in LMICs are limited. This study suggests digital health alone is insufficient in countries with low resource health systems and that high cell phone coverage did not translate to access. Adding digital health to an NCD peer network may not significantly benefit an already effective program; mHealth may be better for hard-to-reach populations not connected to other supports. As long as mHealth remains an individual-level intervention, it will not address social determinants of health that drive outcomes. Future digital health research and practice to improve NCD management in LMICs requires engaging government, NGOs, and technology providers to work together to address barriers.
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Affiliation(s)
- Lesley Steinman
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | | | - Heang Hen
- MoPoTsyo Patient Information Center, Phnom Penh, Cambodia
| | | | | | - Vannarath Te
- National Institute of Public Health, Phnom Penh, Cambodia
| | - James LoGerfo
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Annette L. Fitzpatrick
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, Washington, USA
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
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Alami SO, Dulli L, Dal Santo L, Rastagar SH, Seddiqi S, Hemat S, Machlin Burke J, Todd CS. Getting health information to internally displaced youth in Afghanistan: can mobile phone technology bridge the gap? Gates Open Res 2019; 3:1483. [PMID: 32908963 PMCID: PMC7459210 DOI: 10.12688/gatesopenres.13008.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/19/2023] Open
Abstract
Background: Afghanistan ranks among the most disadvantaged globally for many key reproductive, maternal, newborn and child health (RMNCH) indicators, despite important gains in the past decade. Youth (15 to 24 years) are a key audience for RMNCH information as they enter adulthood, marry and begin families; however, reaching Afghan youth with health information is challenging. Internally displaced persons (IDPs), including youth, experience additional challenges to obtaining health-related information and services. This study measured current and preferred RMNCH information channels to explore the feasibility of using mobile phone technology to provide RMNCH information to IDP youth in Afghanistan. Methods: We conducted a sub-group analysis of survey data from a mixed-methods, cross-sectional, formative assessment to understand current access to RMNCH information. The target population for this analysis includes 15-25-year-old male and female IDP youth from three Afghan Provinces. Survey data were collected using a structured questionnaire administered through face-to-face interviews. Data were analyzed descriptively. Results: A total of 450 IDP youth were surveyed in the three provinces (225 male and 225 female). Access to RMNCH information outside of health facilities was limited. Mobile phone ownership was nearly universal among male participants, yet considerably lower among females; nearly all participants without personal phones reported access to phones when needed. Although few participants spontaneously mentioned mobile phones as a preferred source of RMNCH information, most male and female respondents reported they would be very or somewhat likely to use a free, mobile-phone-based system to access such information if offered. Conclusions: Given widespread access and considerable interest voiced by participants, mobile phones may be a viable way to reach IDP youth with important RMNCH health information in this fragile setting. Interventions should be designed and pilot-tested to identify the most appropriate platforms and information content and to further document feasibility and acceptability.
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Affiliation(s)
- Sayed Omar Alami
- Afghanistan Country Office/HEMAYAT Project, FHI 360, Kabul, Afghanistan
| | - Lisa Dulli
- Global Health and Population Research, FHI 360, Durham, NC, 27701, USA
| | - Leila Dal Santo
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, Durham, NC, 27701, USA
| | | | - Sediq Seddiqi
- Assess, Transform, Reach Consulting, Kabul, Afghanistan
| | - Shafiqullah Hemat
- Health Promotions Department, Ministry of Public Health Islamic Republic of Afghanistan, Kabul, Afghanistan
| | | | - Catherine S. Todd
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, Durham, NC, 27701, USA
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Alami SO, Dulli L, Dal Santo L, Rastagar SH, Seddiqi S, Hemat S, Machlin Burke J, Todd CS. Getting health information to internally displaced youth in Afghanistan: can mobile phone technology bridge the gap? Gates Open Res 2019; 3:1483. [PMID: 32908963 PMCID: PMC7459210 DOI: 10.12688/gatesopenres.13008.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Afghanistan ranks among the most disadvantaged globally for many key reproductive, maternal, newborn and child health (RMNCH) indicators, despite important gains in the past decade. Youth (15 to 24 years) are a key audience for RMNCH information as they enter adulthood, marry and begin families; however, reaching Afghan youth with health information is challenging. Internally displaced persons (IDPs), including youth, experience additional challenges to obtaining health-related information and services. This study measured current and preferred RMNCH information channels to explore the feasibility of using mobile phone technology to provide RMNCH information to IDP youth in Afghanistan. Methods: We conducted a sub-group analysis of survey data from a mixed-methods, cross-sectional, formative assessment to understand current access to RMNCH information. The target population for this analysis includes 15-25-year-old male and female IDP youth from three Afghan Provinces. Survey data were collected using a structured questionnaire administered through face-to-face interviews. Data were analyzed descriptively. Results: A total of 450 IDP youth were surveyed in the three provinces (225 male and 225 female). Access to RMNCH information outside of health facilities was limited. Mobile phone ownership was nearly universal among male participants, yet considerably lower among females; nearly all participants without personal phones reported access to phones when needed. Although few participants spontaneously mentioned mobile phones as a preferred source of RMNCH information, most male and female respondents reported they would be very or somewhat likely to use a free, mobile-phone-based system to access such information if offered. Conclusions: Given widespread access and considerable interest voiced by participants, mobile phones may be a viable way to reach IDP youth with important RMNCH health information in this fragile setting. Interventions should be designed and pilot-tested to identify the most appropriate platforms and information content and to further document feasibility and acceptability.
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Affiliation(s)
- Sayed Omar Alami
- Afghanistan Country Office/HEMAYAT Project, FHI 360, Kabul, Afghanistan
| | - Lisa Dulli
- Global Health and Population Research, FHI 360, Durham, NC, 27701, USA
| | - Leila Dal Santo
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, Durham, NC, 27701, USA
| | | | - Sediq Seddiqi
- Assess, Transform, Reach Consulting, Kabul, Afghanistan
| | - Shafiqullah Hemat
- Health Promotions Department, Ministry of Public Health Islamic Republic of Afghanistan, Kabul, Afghanistan
| | | | - Catherine S Todd
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, Durham, NC, 27701, USA
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Kruse CS. Writing a Systematic Review for Publication in a Health-Related Degree Program. JMIR Res Protoc 2019; 8:e15490. [PMID: 31527018 PMCID: PMC6914304 DOI: 10.2196/15490] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/02/2019] [Accepted: 08/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The protocol in this manuscript was designed to help graduate students publish. It is the result of a challenge from our provost in 2013. I developed this protocol over the last 6 years and have exercised the protocol for the last 5 years. The current version of the protocol has remained mostly static for the last 2 years-only small changes have been made to the process. OBJECTIVE The objective of this protocol is to enable students to learn a valuable skill of conducting a systematic review and to write the review in a way that can be published. I have designed the protocol to fit into the schedule of a traditional semester, but also used it in compressed semesters. METHODS An image map was created in HTML 5.0 and imported into a learning management system. It augments traditional instruction by providing references to published articles, examples, and previously recorded instructional videos. Students use the image map outside the classroom after traditional instruction. The image map helps students create manuscripts that follow established practice and are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and whose authorship follows guidelines by the International Committee of Medical Journal Editors. RESULTS Since its inception, this protocol has helped 77 students publish 27 systematic reviews in nine journals worldwide. Some manuscripts take multiple years to progress through multiple review processes at multiple journals submitted in sequence. Two other professors in the School of Health Administration have used this protocol in their classes. CONCLUSIONS So far, this method has helped 51% of graduate students who used it in my graduate courses publish articles (with more manuscripts under consideration whose numbers have remained uncounted in this sum). I wish success to others who might use this protocol.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
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Smith RJ, Bryant RG. Metal substitutions incarbonic anhydrase: a halide ion probe study. Biochem Biophys Res Commun 1975; 66:1281-6. [PMID: 0000-0003-1376-8556 PMCID: PMC10704303 DOI: 10.1016/0006-291x(75)90498-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 02/07/2023]
Abstract
Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders.
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