The use of focus groups to develop a culturally relevant quality of life tool for lymphatic filariasis in Bangladesh

Impact of mobile health in diabetic retinopathy awareness and eye care behavior among Indigenous women

BACKGROUND

Diabetes is increasingly widespread among Indigenous people, and diabetic retinopathy (DR) is a diabetes eye complication and a common cause of vision loss among adults in Canada. Indigenous women have a high risk of diabetes which increases their risk for DR. This study explored utilizing mobile health (mHealth) via text messages to provide DR awareness and improve diabetic-eye care behavior. This study identified the changes in DR awareness and eye care behavior due to a mHealth education intervention among Indigenous women with or at risk of diabetes.

METHODS

A pre-post study which adopted an embedded concurrent mixed methods approach guided by self-determination theory and the medicine wheel. Study participants were First Nations and Métis women living with or at risk of diabetes in Saskatoon, Canada. Data was collected via sharing circles and a DR knowledge, attitude, and practice survey. Pre-intervention participants' baseline information on DR knowledge and behavior were obtained from participants. After that, participants received daily text messages on diabetes-eye related information for 12 weeks. Post-intervention, the impact of the mHealth intervention on DR awareness and eye care behavior was assessed.

RESULTS

Following the intervention, the DR knowledge, attitude, and practice scores significantly improved. Individuals living with diabetes had increased DR attitude and practice post-scores compared to those at risk of diabetes. Older women had a lower pre-post change in practice scores compared to younger women. The mHealth intervention provided a holistic approach to support diabetes-eye care and empowered the study participants to eat healthily, take medication as prescribed, and have regular medical and eye check-ups.

CONCLUSIONS

The mHealth education intervention increased DR awareness and fostered a change in diabetes-eye care behavior. Health information via text messaging can motivate, provide support, and empower individuals as well as prevent and manage chronic conditions and reduce the risk of complications.

Psychosocial burden of localised cutaneous Leishmaniasis: a scoping review

Background

Cutaneous Leishmaniasis (CL) is a parasitic skin disease, linked to poverty, and belonging to the group of Neglected Tropical Diseases. Depending on the severity, the type of lesions or scars, and the context, CL can lead to self- and social stigma influencing the quality of life and psychological well-being of the patient. This dimension is, however, little documented for the most common, localized form of cutaneous leishmaniasis (LCL).

We aimed to describe the current knowledge on the psychological burden and the stigma related to LCL.

Methods

The population of interest for this scoping review are patients or their relatives with localized LCL or related scars.

We searched the electronic databases PubMed, Web of Knowledge, PsycINFO, POPLINE, Cochrane Library, Science Direct, Global Health, and LILACS, for articles written in Arabic, English, French, Dutch, Portuguese, or Spanish, and published until the end of August 2017.

Results

From 2485 initial records, 15 papers met our inclusion criteria. Dermatology life quality index was the most frequent used scale to assess LCL psychological impact in quantitative studies. Six qualitative studies used individual interviews and/or focus groups discussions to explore the psychological and/or the social burden of this disease. Quantitative assessments using standard scales as well as qualitative research asserts that LCL is a source of psychological suffering, stigmatization, and decreased quality of life (QoL).

Conclusion

Most studies showed that LCL has a significant negative effect on the QoL and mental health. However, the fact that the psychosocial burden generated by LCL is time-dependent makes it hard to measure. We recommend to develop a more specific and validated assessment scale to appreciate the full burden of this disease and enhance comparability of findings.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5260-9) contains supplementary material, which is available to authorized users.

Patients', caregivers', and providers' perceived strategies for diabetes care

OBJECTIVES

To explore strategies to improve type 2 diabetes mellitus (T2DM) self-management among low-income and minority groups.

METHODS

Focus groups centered on T2DM self-care behaviors were conducted using convenient sample of patients with T2DM (N = 17), caregivers (N = 5) and healthcare providers (N = 15).

RESULTS

Patients and caregivers perceived strategies included improving patient-provider communication, providers' accessibility and compassion, and flexible clinic hours. Strategies identified by providers were realistic patient's expectations, family support, and community resources.

CONCLUSIONS

To our knowledge, this study is the first to elicit strategies to improve T2DM self-management through a joint meeting of patients, caregivers, and healthcare providers. Study findings could help inform future efforts to assist patients better manage their T2DM.

Quantifying the physical and socio-economic burden of filarial lymphoedema in Chikwawa District, Malawi

BACKGROUND

Lymphatic filariasis (LF) is a disfiguring parasitic disease and one of the leading causes of disability in the world. This study aimed to assess the severity of lymphoedema, the physical restrictions and socio-economic impact on affected individuals living in an endemic community in Malawi.

METHODS

In a single health centre catchment area, a follow-up survey was conducted to assess 69 lymphoedema cases, and the impact of their condition in eight different areas of their lives. Differences were examined by sex, age and severity of disease. The overall level of disability was quantified and the impact of acute dermatolymphangioadenitis (ADLA) attacks was examined.

RESULTS

Lymphoedema cases were most affected by pain/discomfort and anxiety/depression, which also had an economic impact. Male and older (>60 years) individuals reported more problems. Higher disability levels based on a quantified score were significantly associated with decreased walking distance and working hours. ADLA significantly increased pain/discomfort and reduced cognition, and also affected the individuals' self-care, social participation and ability to work.

CONCLUSIONS

Filarial lymphoedema causes significant hardship, particularly in relation to ADLAs, and the scale of the problem needs to be better defined with new specific tools so that the best support and care can be provided to those in greatest need.

Identifying key domains of health-related quality of life for patients with chronic obstructive pulmonary disease: the patient perspective

Background

Numerous instruments are available to measure health-related quality of life (HRQoL) in patients with Chronic Obstructive Pulmonary Disease (COPD), covering a wide array of domains ranging from symptoms such as dyspnea, cough and wheezing, to social and emotional functioning. Currently no information or guide is available yet to aid the selection of domains for a particular study or disease population. The aim of this paper is to identify which domains of HRQoL are most important with respect to COPD, from the patient perspective.

Methods

Twenty-one Dutch patients with COPD were asked to describe important domains impacted by COPD freely; second, they were presented with cues (domains from the Patient-Reported Outcomes Measurement Information System (PROMIS) framework) and were asked to select the domains that were most relevant to them. During the interview, the patients were asked to indicate in which way the selected domains impact their lives. Both the answers to the open question, and the patient statements motivating nomination of PROMIS domains were coded into themes.

Results

The most relevant (sub)domains of HRQoL for patients with COPD were: physical health (fatigue, physical functioning), social health (instrumental support, ability to participate in social roles and activities, companionship, and emotional support), and coping with COPD.

Conclusion

We identified which domains of HRQoL are most important to patients with COPD. One of these (coping with COPD) is not explicitly covered by PROMIS, or by traditional questionnaires that are used to measure HRQoL in COPD.

Comparison of three quality of life instruments in lymphatic filariasis: DLQI, WHODAS 2.0, and LFSQQ

Background

The Global Program to Eliminate Lymphatic Filariasis aims to interrupt transmission of lymphatic filariasis and manage morbidity in people currently living with the disease. A component of morbidity management is improving health-related quality of life (HRQoL) in patients. Measurement of HRQoL in current management programs is varied because of the lack of a standard HRQoL tool for use in the lymphatic filariasis population.

Methodology/Principal Findings

In this study, the psychometric properties of three health status measures were compared when used in a group of lymphatic filariasis patients and healthy controls. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), the Dermatology Life Quality Index (DLQI), and the Lymphatic Filariasis Quality of Life Questionnaire (LFSQQ) were administered to 36 stage II and stage III lymphatic filariasis subjects and 36 age and sex matched controls in Kerala, India. All three tools yielded missing value rates lower than 10%, suggesting high feasibility. Highest internal consistency was seen in the LFSQQ (α = 0.97). Discriminant validity analysis demonstrated that HRQoL was significantly lower in the LF group than in controls for the WHODAS 2.0, DLQI, and LFSQQ, but total HRQoL scores did not differ between stage II and stage III lymphedema subjects. The LFSQQ total score correlated most strongly with the WHODAS 2.0 (r = 0.91, p<0.001) and DLQI (r = 0.81, p<0.001).

Conclusions/Significance

The WHODAS 2.0, DLQI, and LFSQQ demonstrate acceptable feasibility, internal consistency, discriminate validity, and construct validity. Based on our psychometric analyses, the LFSQQ performs the best and is recommended for use in the lymphatic filariasis population.

Lymphatic filariasis affects approximately 120 million people and is the second leading cause of life-long disability worldwide. Because lymphatic filariasis is one of the World Health Organization's six eradicable diseases, much effort has been placed into reducing transmission of the disease and managing morbidity. Novel interventions frequently use health-related quality of life as an outcome measure to monitor efficacy of the intervention. In an effort to delineate the strengths and weaknesses of health status measures and recommend use of a single tool in the lymphatic filariasis population, we compared the use of three health status tools (The World Health Organization Disability Assessment Schedule 2.0, the Dermatology Life Quality Index, and the Lymphatic Filariasis Quality of Life Questionnaire) in lymphatic filariasis subjects and healthy controls in Kerala, India. The Lymphatic Filariasis Quality of Life Questionnaire performed the best by discriminating well between subjects and controls, possessing significant content overlap with the other two tools, yielding a low missing value rate, and being internally consistent. This is the first study to compare health status measures in lymphatic filariasis subjects and provides insight into the use of the tools in quality of life analysis.