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Nie J, Zhu Y, Wang C, Lin Q, Tayier R, Cai Z, Ma P, Zhang L. Relationship between iodine knowledge and dietary iodine intake in pregnant and lactating women: a cross-sectional study. Public Health Nutr 2023; 26:1436-1450. [PMID: 36946300 PMCID: PMC10346033 DOI: 10.1017/s1368980023000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/04/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study assessed the iodine knowledge of pregnant and lactating women and the relationship to dietary iodine intake and iodine status. The factors influencing iodine intake were analysed. DESIGN Basic information and iodine knowledge were collected via a questionnaire. A FFQ assessed dietary iodine intake. The urinary iodine concentration (UIC) was measured using the arsenic-cerium catalytic spectrophotometric determination of iodine in urine (WS/T 107 -2016). SETTING A cross-sectional study involving pregnant and lactating women in Xinjiang, China was conducted. PARTICIPANTS A total of 1181 pregnant women and 504 lactating women were enrolled in the study. RESULTS The median UIC for pregnant and lactating women was 179·27 and 192·81 µg/l, respectively, and the dietary iodine intake was 407·16 and 356·89 µg/d, respectively. Of the pregnant and lactating women, 73·4 % and 82·5 % had medium iodine knowledge, respectively. In pregnant women, iodine knowledge and dietary iodine intake were positively correlated. High iodine knowledge and iodine education were shown to be protective factors for excessive iodine intake in pregnant women. CONCLUSION This study demonstrated that the iodine nutritional status of women in Xinjiang was appropriate, and iodine knowledge was at a medium level, but there was confusion about iodine nutrition. Public education is needed to improve iodine knowledge and active iodine supplementation awareness among these populations of women.
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Affiliation(s)
- Jiaoyang Nie
- School of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Yuming Zhu
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Chenchen Wang
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Qin Lin
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Rishalaiti Tayier
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Zhuoxuan Cai
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Pinjiang Ma
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Ling Zhang
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
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Fjeldsoe BS, Goode AD, Job J, Eakin EG, Spilsbury KL, Winkler E. Dose and engagement during an extended contact physical activity and dietary behavior change intervention delivered via tailored text messaging: exploring relationships with behavioral outcomes. Int J Behav Nutr Phys Act 2021; 18:119. [PMID: 34493307 PMCID: PMC8425069 DOI: 10.1186/s12966-021-01179-8] [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: 01/13/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background Extended contact interventions delivered via text messaging are a low-cost option for promoting the long-term continuation of behavior change. This secondary analysis of a text message–delivered extended contact intervention (‘Get Healthy, Stay Healthy’ (GHSH)) explores the extent to which changes in physical activity, dietary behaviors and body weight were associated with the frequency of text messages (dose) and contact between the health coach and participant (engagement). Methods Following a telephone coaching program, participants were randomised to receive extended contact via tailored text messages (GHSH, n = 114) or no additional contact (n = 114) over a 6-month period. Message dose, timing, and content were based on participant preferences, ascertained during two tailoring telephone calls. All incoming and outgoing messages were recorded. At baseline and 6 months, participants self-reported body weight and dietary behaviors (fruit and vegetable servings/day). Moderate-vigorous physical activity (MVPA) was assessed via accelerometry. Results Median dose (25th, 75th percentile) was 53 (33, 72) text messages in total across six months. Mean fortnightly dose in weeks 1–2 was 5.5 (95 % CI: 4.3, 6.6) text messages, and remained stable (with the exception of planned decreases in weeks involving additional intervention contacts). Offset against the average fortnightly dose of goal checks (1.6, 95 % CI: 1.3, 2.0 and 1.5, 95 % CI: 1.2, 1.8, for physical activity and diet respectively), mean replies to goal checks were highest in weeks 1–2 (1.4, 95 % CI: 1.4, 1.5 and 1.3, 95 % CI: 1.2, 1.4, respectively) and tended to become lower in most weeks thereafter. Greater weight loss was positively associated with text message dose (P = 0.022), with a difference of 1.9 kg between participants receiving the most and fewest texts. There was no association between engagement and changes in outcome measures. Conclusions A fixed dose of texts does not seem suitable to meet participants’ individual preferences. Higher self-selected text doses predicted better weight outcomes. However, greater participant engagement through text replies does not predict more favourable outcomes, despite being a suggested facilitator of successful behavior change maintenance. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12613000949785. Date registered: 27 August 2013. Retrospectively registered. http://www.anzctr.org.au/. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01179-8.
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Affiliation(s)
- Brianna S Fjeldsoe
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia
| | - Ana D Goode
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia.
| | - Jennifer Job
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia.,Centre for Health System Reform and Integration, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Elizabeth G Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia
| | - Kate L Spilsbury
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia.,Queensland Academy of Sport, Nathan, Australia
| | - Elisabeth Winkler
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia
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Asfaw A, Belachew T, Gari T. Effect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial. BMC Womens Health 2020; 20:255. [PMID: 33198715 PMCID: PMC7670725 DOI: 10.1186/s12905-020-01126-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although iodine nutrition status is improving globally, the progress is not uniform throughout the world due to several factors. Among these, poor knowledge, negative attitude and improper practice of iodized salt are the main risk factors for poor iodine nutrition in Ethiopia. This study was aimed to assess the effect of nutrition education intervention on knowledge, attitude and practice (KAP) of iodine deficiency and iodized salt utilization. METHODS A cluster randomized controlled trial was carried out among 652 women of reproductive age group in southwest Ethiopia. A total of 24 clusters were selected and randomized in to an intervention and control villages. Women in the intervention village received iodine nutrition related education for 6 months; while those in the control village did not receive any education. Baseline and endline data were collected from both groups. Generalized Estimating Equations (GEE) was used to determine the effect of intervention. RESULTS A total of 647 (99.2%) participants were successfully involved in the study. In the intervention group the median attendance was 10 out of 12 sessions. Women in the intervention group had shown statistically significant change in knowledge, attitude and practice scores as compared to control one. In multivariable GEE linear model, after adjusting for other background characteristics, the mean difference (95% CI) scores were 8.81 (8.46, 9.16) for knowledge, 3.35 (3.17, 3.54) for attitude and 2.90 (2.74, 3.05) for practice in the intervention arm. CONCLUSIONS Well designed and community-based iodine nutrition education is an effective strategy to improve the KAP of iodine deficiency disorders and iodized salt utilization. Trial registration PACTR201809544276357 (Retrospectively registered on 14, Sept. 2018). https://www.pactr.org .
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Affiliation(s)
- Agize Asfaw
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, P.O. Box 07, Gubre, Ethiopia.
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Taye Gari
- Department of Public Health and Environmental Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Iodine Content of Salt in Retail Shops and Retailers’ Knowledge on Iodized Salt in Wa East District, Upper West Region, Ghana. J FOOD QUALITY 2020. [DOI: 10.1155/2020/6053863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. There are laws to enforce the universal iodization of salt to check the consequences of iodine deficiency in Ghana. These laws are to ensure that there are production and sales of iodized salt in the country. Yet, the availability of iodized salt in the county's households is still not encouraging, with data indicating that 93.8% of children have urine iodine <100 μg/dl. Hence, the study investigated the iodine content of salt in retail shops and knowledge of iodized salt among retailers in the Wa East District. The study will help the informed decision on strengthening and enforcing laws to achieve the universal salt iodization and the consumption of adequate iodized salt. Method. The study was a descriptive cross-sectional survey. We used a questionnaire to collect quantitative data from participants and a rapid field test kits to determine the iodine content of salt. STATA version 14.2 was used to analyse data. Chi-squared and logistic regression models were used to examine the association between the dependent and independent variables and considered p value <0.05 as statistically significant. Findings. The retailers’ primary source of information about iodized salt was health workers (46.2%), with the majority (52.8%) of them having low knowledge of iodized salt. Notwithstanding the high knowledge of iodized salt, as high as 53.8% of the salts do not have adequate iodine (<15 ppm). Retailer’s sex (p=0.014), educational level (p=0.006), primary source of information about iodized salt (p=0.012), texture of salt being sold (p=0.023), and mode of displaying salt in the shop (p=0.003) were associated with knowledge of iodised salt. Again, retailer’s educational level (p=0.036), knowledge of iodized salt (p=0.034), texture of salt being sold (p=0.021), and method of displaying the salt being sold (p=0.004) were associated with an iodine content of the salt in the shop. Conclusions. Though policies have been implemented to promote production and consumption of iodized salt, the iodine content of salt in retail shops in the Wa East are not encouraging. We recommend the establishment of checkpoints along the production and distribution chain to ensure salt with adequate iodine reaches the consumer. Again, traders of iodized salt should have regular training on ways to preserve salt to maintain its iodine content.
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Walsh JL, Aridi H, Fathallah J, Al-Shaar L, Alam S, Nasreddine L, Isma'eel H. Impact of a hospital-based educational intervention on dietary salt-related knowledge and behaviour in a cardiac care unit population in Lebanon. Cardiovasc Diagn Ther 2018; 8:146-155. [PMID: 29850405 DOI: 10.21037/cdt.2017.12.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiovascular disease is the most common cause of morbidity and mortality worldwide. Numerous strategies have been effective in reducing cardiovascular disease risk, from pharmacological approaches to lifestyle modification interventions. One of these strategies includes the reduction in dietary sodium which in turn reduces cardiovascular risk by reducing high blood pressure, perhaps the most important cardiovascular risk factor. Methods We evaluated an educational dietary salt reduction intervention in a cardiac care unit population in Lebanon, assessing salt related knowledge and behaviours before and after administering an evidence-based educational leaflet to patients. Results Salt-related knowledge improved significantly immediately post-intervention and subsequently fell on 4-week follow-up, but remained above baseline. Three of the four salt-related behaviours measured improved on 4-week follow-up: trying to buy low-salt foods increased from 54% to 74% (P=0.007), adding salt at the table reduced from 44% to 34% (P=0.03) and trying to buy food with no added salt increased from 24% to 52% (P=0.02) of the cohort. Adding salt during cooking did not differ significantly. A trend towards improved behavioural risk category in the cohort overall was observed on follow-up (P=0.07), 32% of participants were categorised as high behavioural risk pre-intervention, reducing to 17% on follow-up. Multi-ordered regression modelling identified being in the high-risk behavioural category at baseline as a predictor of being in the high-risk or moderate-risk category on follow-up. Conclusions This hospital-based educational intervention had a modestly positive impact on salt-related knowledge and behaviour, with participants in the highest behavioural risk category at baseline being most resistant to behavioural improvement.
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Affiliation(s)
- Jason L Walsh
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Hussam Aridi
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Jihan Fathallah
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Laila Al-Shaar
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Samir Alam
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
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Watutantrige-Fernando S, Barollo S, Bertazza L, Cavedon E, Censi S, Manso J, Vianello F, Mian C. Efficacy of educational intervention to improve awareness of the importance of iodine, use of iodized salt, and dietary iodine intake in northeastern Italian schoolchildren. Nutrition 2018; 53:134-139. [PMID: 29778950 DOI: 10.1016/j.nut.2018.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE An educational program was conducted among school-aged children to improve their knowledge about iodine prophylaxis, their iodine status, and their dietary habits. METHODS At the baseline (T0) and after 6 mo (T1), participants (970 at T0 and 949 at T1) answered questionnaires testing their knowledge about iodine prophylaxis and their eating habits. Urine samples were collected from a randomly selected subgroup of participants (313 at T0 and 312 at T1). RESULTS From T0 to T1 there was a significant improvement in respondents' knowledge about iodine prophylaxis (from 44% to 70%), iodized salt consumption (from 78% to 84%), and median urine iodine concentrations (from 70 µg/L to 91 µg/L). Milk and iodized salt intakes were associated with a better iodine status per se, and more so when used simultaneously. Girls drank milk less often than boys did (daily in 52% and 59% of cases, respectively). Children of foreign origin ate sodium-rich food more often than Italians did. CONCLUSION Educational intervention improved the children's knowledge about iodine prophylaxis and use of iodized salt. Consuming salt in addition to milk improves iodine status. Children of foreign origin have different eating habits.
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Affiliation(s)
- Sara Watutantrige-Fernando
- Endocrinology Unit, Department of Medicine, University of Padua, via Ospedale Civile 105, 35128, Padua, Italy
| | - Susi Barollo
- Endocrinology Unit, Department of Medicine, University of Padua, via Ospedale Civile 105, 35128, Padua, Italy
| | - Loris Bertazza
- Endocrinology Unit, Department of Medicine, University of Padua, via Ospedale Civile 105, 35128, Padua, Italy
| | - Elisabetta Cavedon
- Endocrinology Unit, Department of Medicine, University of Padua, via Ospedale Civile 105, 35128, Padua, Italy
| | - Simona Censi
- Endocrinology Unit, Department of Medicine, University of Padua, via Ospedale Civile 105, 35128, Padua, Italy
| | - Jacopo Manso
- Endocrinology Unit, Department of Medicine, University of Padua, via Ospedale Civile 105, 35128, Padua, Italy
| | - Federica Vianello
- Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, via Giustiniani 2, 35128 Padua, Italy
| | | | - Caterina Mian
- Endocrinology Unit, Department of Medicine, University of Padua, via Ospedale Civile 105, 35128, Padua, Italy.
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Can existing mobile apps support healthier food purchasing behaviour? Content analysis of nutrition content, behaviour change theory and user quality integration. Public Health Nutr 2017; 21:288-298. [PMID: 29081322 DOI: 10.1017/s1368980017002889] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the quality of nutrition content and the integration of user quality components and behaviour change theory relevant to food purchasing behaviour in a sample of existing mobile apps. DESIGN Descriptive comparative analysis of eleven mobile apps comprising an assessment of their alignment with existing evidence on nutrition, behaviour change and user quality, and their potential ability to support healthier food purchasing behaviour. SETTING Mobile apps freely available for public use in GoogePlay were assessed and scored according to agreed criteria to assess nutrition content quality and integration of behaviour change theory and user quality components. SUBJECTS A sample of eleven mobile apps that met predefined inclusion criteria to ensure relevance and good quality. RESULTS The quality of the nutrition content varied. Improvements to the accuracy and appropriateness of nutrition content are needed to ensure mobile apps support a healthy behaviour change process and are accessible to a wider population. There appears to be a narrow focus towards behaviour change with an overemphasis on behavioural outcomes and a small number of behaviour change techniques, which may limit effectiveness. A significant effort from the user was required to use the mobile apps appropriately which may negatively influence user acceptability and subsequent utilisation. CONCLUSIONS Existing mobile apps may offer a potentially effective approach to supporting healthier food purchasing behaviour but improvements in mobile app design are required to maximise their potential effectiveness. Engagement of mobile app users and nutrition professionals is recommended to support effective design.
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Ampt FH, Mudogo C, Gichangi P, Lim MSC, Manguro G, Chersich M, Jaoko W, Temmerman M, Laini M, Comrie-Thomson L, Stoové M, Agius PA, Hellard M, L’Engle K, Luchters S. WHISPER or SHOUT study: protocol of a cluster-randomised controlled trial assessing mHealth sexual reproductive health and nutrition interventions among female sex workers in Mombasa, Kenya. BMJ Open 2017; 7:e017388. [PMID: 28821530 PMCID: PMC5724193 DOI: 10.1136/bmjopen-2017-017388] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION New interventions are required to reduce unintended pregnancies among female sex workers (FSWs) in low- and middle-income countries and to improve their nutritional health. Given sex workers' high mobile phone usage, repeated exposure to short messaging service (SMS) messages could address individual and interpersonal barriers to contraceptive uptake and better nutrition. METHODS In this two-arm cluster randomised trial, each arm constitutes an equal-attention control group for the other. SMS messages were developed systematically, participatory and theory-driven and cover either sexual and reproductive health (WHISPER) or nutrition (SHOUT). Messages are sent to participants 2-3 times/week for 12 months and include fact-based and motivational content as well as role model stories. Participants can send reply texts to obtain additional information. Sex work venues (clusters) in Mombasa, Kenya, were randomly sampled with a probability proportionate to venue size. Up to 10 women were recruited from each venue to enrol 860 women. FSWs aged 16-35 years, who owned a mobile phone and were not pregnant at enrolment were eligible. Structured questionnaires, pregnancy tests, HIV and syphilis rapid tests and full blood counts were performed at enrolment, with subsequent visits at 6 and 12 months. ANALYSIS The primary outcomes of WHISPER and SHOUT are unintended pregnancy incidence and prevalence of anaemia at 12 months, respectively. Each will be compared between study groups using discrete-time survival analysis. POTENTIAL LIMITATIONS Contamination may occur if participants discuss their intervention with those in the other trial arm. This is mitigated by cluster recruitment and only sampling a small proportion of sex work venues from the sampling frame. CONCLUSIONS The design allows for the simultaneous testing of two independent mHealth interventions for which messaging frequency and study procedures are identical. This trial may guide future mHealth initiatives and provide methodological insights into use of reciprocal control groups. TRIAL REGISTRATION NUMBER ACTRN12616000852459; Pre-results.
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Affiliation(s)
- Frances H Ampt
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Collins Mudogo
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
- University of Nairobi, Mombasa, Kenya
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | - Megan S C Lim
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Griffins Manguro
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Marleen Temmerman
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
- Aga Khan University, Nairobi, Kenya
| | - Marilyn Laini
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
| | | | | | - Paul A Agius
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | | | - Kelly L’Engle
- University of San Francisco, San Francisco, California, USA
| | - Stanley Luchters
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
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Abaza H, Marschollek M. mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries. Methods Inf Med 2017; 56:e105-e122. [PMID: 28925418 PMCID: PMC6291822 DOI: 10.3414/me17-05-0003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/25/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the continuous and enormous spread of mobile technologies, mHealth has evolved as a new subfield of eHealth. While eHealth is broadly focused on information and communication technologies, mHealth seeks to explore more into mobile devices and wireless communication. Since mobile phone penetration has exceeded other infrastructure in low and middle-income countries (LMICs), mHealth is seen as a promising component to provide pervasive and patient-centered care. OBJECTIVES The aim of our research work for this paper is to examine the mHealth literature to identify application areas, target diseases, and mHealth service and technology types that are most appropriate for LMICs. METHODS Based on the 2011 WHO mHealth report, a combination of search terms, all including the word "mHealth", was identified. A literature review was conducted by searching the PubMed and IEEE Xplore databases. Articles were included if they were published in English, covered an mHealth solution/ intervention, involved the use of a mobile communication device, and included a pilot evaluation study. Articles were excluded if they did not provide sufficient detail on the solution covered or did not focus on clinical efficacy/effectiveness. Cross-referencing was also performed on included articles. RESULTS 842 articles were retrieved and analyzed, 255 of which met the inclusion criteria. North America had the highest number of applications (n=74) followed by Europe (n=50), Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America (n=3) had the least number of studies. The majority of solutions addressed diabetes (n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors (n=16), and maternal and child's health (MCH) (n=11). Fewer solutions addressed asthma (n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2). Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu, ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each). The remainder of solutions (n=14) did not focus on a certain disease. Most applications fell in the areas of health monitoring and surveillance (n=93) and health promotion and raising awareness (n=88). Fewer solutions addressed the areas of communication and reporting (n=11), data collection (n=6), telemedicine (n=5), emergency medical care (n=3), point of care support (n=2), and decision support (n=2). The majority of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video (n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering from small sample sizes and short study durations. Problems addressed by solutions included travel distance for reporting, self-management and disease monitoring, and treatment/medication adherence. CONCLUSIONS SMS and app solutions are the most common forms of mHealth applications. SMS solutions are prevalent in both high and LMICs while app solutions are mostly used in high income countries. Common application areas include health promotion and raising awareness using SMS and health monitoring and surveillance using mobile apps. Remaining application areas are rarely addressed. Diabetes is the most commonly targeted medical condition, yet remains deficient in LMICs.
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Affiliation(s)
- Haitham Abaza
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
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Walsh JL, Fathallah J, Al-Shaar L, Alam S, Nasreddine L, Isma’eel H. Knowledge, attitudes, motivators and salt-related behaviour in a cardiac care unit population: A cross-sectional study in Lebanon. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2017. [DOI: 10.3233/mnm-16129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jason Leo Walsh
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Jihan Fathallah
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Laila Al-Shaar
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Samir Alam
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma’eel
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
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Armanasco AA, Miller YD, Fjeldsoe BS, Marshall AL. Preventive Health Behavior Change Text Message Interventions: A Meta-analysis. Am J Prev Med 2017; 52:391-402. [PMID: 28073656 DOI: 10.1016/j.amepre.2016.10.042] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 10/13/2016] [Accepted: 10/30/2016] [Indexed: 12/31/2022]
Abstract
CONTEXT Existing evidence shows that text message interventions can produce short-term health behavior change. However, understanding is limited regarding intervention characteristics moderating this effect or the long-term effectiveness of text message interventions on behavior change after contact stops. EVIDENCE ACQUISITION MEDLINE, PubMed Central, ERIC, PsycINFO, and Web of Science were searched for articles published between April 2008 and December 2014 that evaluated an intervention targeting preventive health behaviors, delivered primarily by text message. EVIDENCE SYNTHESIS Intervention development and design characteristics and research outcomes were evaluated for 51 studies. Thirty-five studies were included in a meta-analysis (conducted in 2015) examining overall effect size and moderators of effect size. The overall pooled effect of interventions was d=0.24 (95% CI=0.16, 0.32, p<0.001) using outcome data collected most proximal to intervention cessation. Seven studies collected data following a no-intervention maintenance period and showed a small but significant pooled maintenance effect (d=0.17, 95% CI=0.03, 0.31, p=0.017, k=7). Few variables significantly moderated intervention efficacy. Interventions that did not use a theoretic basis, used supplementary intervention components, and had a duration of 6-12 months were most effective. The specific behavior being targeted was not associated with differences in efficacy nor was tailoring, targeting, or personalization of text message content. CONCLUSIONS Text message interventions are capable of producing positive change in preventive health behaviors. Preliminary evidence indicates that these effects can be maintained after the intervention stops. The moderator analysis findings are at odds with previous research, suggesting a need to examine moderators at the behavior-specific level.
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Affiliation(s)
- Ashleigh A Armanasco
- Queensland University of Technology, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Brisbane, Australia.
| | - Yvette D Miller
- Queensland University of Technology, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Brisbane, Australia
| | - Brianna S Fjeldsoe
- The University of Queensland, Cancer Prevention Research Centre, School of Public Health, BrisbaneAustralia
| | - Alison L Marshall
- Queensland University of Technology, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Brisbane, Australia
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Amiri P, Hamzavi Zarghani N, Nazeri P, Ghofranipour F, Karimi M, Amouzegar A, Mirmiran P, Azizi F. Can an Educational Intervention Improve Iodine Nutrition Status in Pregnant Women? A Randomized Controlled Trial. Thyroid 2017; 27:418-425. [PMID: 27809707 DOI: 10.1089/thy.2016.0185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Because of their increased need for iodine, pregnant women are among the high-risk groups for iodine deficiency. The purpose of this study was to evaluate the effectiveness of an educational program on the iodine nutrition status of pregnant women. METHODS In this randomized controlled trial, 100 pregnant women were randomly selected from five healthcare centers in the southern region of Tehran, the capital of Iran. In the intervention group, pregnant women received a four-month educational program, which included two face-to-face educational sessions, using a researcher-designed educational pamphlet in the second and third trimesters, and two follow-up telephone calls. Knowledge, attitude, and practice (KAP) scores, urinary iodine concentration (UIC), and salt iodine content were assessed at baseline and four months after the intervention. RESULTS At baseline, there were significant associations between knowledge and attitude (r = 0.38, p = 0.03) between practice and UIC (r = 0.28, p = 0.01) and between UIC and iodine content of salt (r = 0.24, p = 0.009). Although a significant difference was found in mean KAP scores between the two groups after the educational intervention, scores were significantly higher in the intervention group compared with controls (p < 0.01). There were no significant differences in UIC and iodine content of salt between the two groups at follow-up. CONCLUSIONS Despite educational intervention increasing KAP among women regarding the importance of iodine and iodized salt consumption during pregnancy, their iodine status did not improve. Considering the main socio-environmental determinants of iodine deficiency, in particular, the monitoring of salt fortification, prescribing iodine containing supplements as well as improving health literacy in pregnant women seem essential strategies.
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Affiliation(s)
- Parisa Amiri
- 1 Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Najmeh Hamzavi Zarghani
- 1 Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
- 2 Department of Health Education and Health Promotion, Tarbiat Modares University , Tehran, Iran
| | - Pantea Nazeri
- 3 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Fazlollah Ghofranipour
- 2 Department of Health Education and Health Promotion, Tarbiat Modares University , Tehran, Iran
| | - Mehrdad Karimi
- 1 Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
- 4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran
| | - Atieh Amouzegar
- 5 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Parvin Mirmiran
- 3 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Fereidoun Azizi
- 5 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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Iodine knowledge is positively associated with dietary iodine intake among women of childbearing age in the UK and Ireland. Br J Nutr 2016; 116:1728-1735. [PMID: 27855727 DOI: 10.1017/s0007114516003925] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Adequate I intake is important before conception and during pregnancy for optimal infant neurodevelopment. Recent studies have highlighted the prevalence of I deficiency in the UK and Ireland. It is possible that optimal I intake may be impeded by a poor knowledge of I nutrition. This study aimed to investigate I knowledge among women of childbearing age in the UK and Ireland and to determine whether a relationship exists between I knowledge and dietary I intake. Females (aged 18-45 years) were invited to complete an online questionnaire, which assessed knowledge of I and estimated dietary I intake using a FFQ. A total of 520 females of childbearing age completed the study. I knowledge was poor; only one-third (32 %) of the participants correctly identified pregnancy as the most important stage of the lifecycle for I, and 41 % of participants could not correctly identify any health problem related to I deficiency. The median daily I intake was estimated as 152 µg/d. Almost half (46 %) of the participants failed to meet dietary recommendations (140 µg/d) for I. A higher dietary I intake was positively associated with greater I knowledge (r 0·107; P=0·016). This study suggests that knowledge of I nutrition is low among women of childbearing age, and those with a greater knowledge of I nutrition had a higher dietary I intake. Initiatives to educate women of childbearing age on the importance of I nutrition should be considered as part of a larger public health strategy to address I deficiency.
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Gilliland J, Sadler R, Clark A, O'Connor C, Milczarek M, Doherty S. Using a Smartphone Application to Promote Healthy Dietary Behaviours and Local Food Consumption. BIOMED RESEARCH INTERNATIONAL 2015; 2015:841368. [PMID: 26380298 PMCID: PMC4561980 DOI: 10.1155/2015/841368] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/26/2015] [Accepted: 02/23/2015] [Indexed: 11/17/2022]
Abstract
Smartphone "apps" are a powerful tool for public health promotion, but unidimensional interventions have been ineffective at sustaining behavioural change. Various logistical issues exist in successful app development for health intervention programs and for sustaining behavioural change. This study reports on a smartphone application and messaging service, called "SmartAPPetite," which uses validated behaviour change techniques and a behavioural economic approach to "nudge" users into healthy dietary behaviours. To help gauge participation in and influence of the program, data were collected using an upfront food survey, message uptake tracking, experience sampling interviews, and a follow-up survey. Logistical and content-based issues in the deployment of the messaging service were subsequently addressed to strengthen the effectiveness of the app in changing dietary behaviours. Challenges included creating relevant food goal categories for participants, providing messaging appropriate to self-reported food literacy and ensuring continued participation in the program. SmartAPPetite was effective at creating a sense of improved awareness and consumption of healthy foods, as well as drawing people to local food vendors with greater frequency. This work serves as a storehouse of methods and best practices for multidimensional local food-based smartphone interventions aimed at improving the "triple bottom line" of health, economy, and environment.
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Affiliation(s)
- Jason Gilliland
- Department of Geography, School of Health Studies, Department of Paediatrics Social Science Centre, The University of Western Ontario, 1151 Richmond Street, London, ON, Canada N6A 5C2
| | - Richard Sadler
- Department of Family Medicine, Michigan State University, 200 E 1st Street, Flint, MI 48502, USA
| | - Andrew Clark
- Department of Geography, Social Science Centre, The University of Western Ontario, 1151 Richmond Street, London, ON, Canada N6A 5C2
| | - Colleen O'Connor
- Division of Food and Nutritional Sciences, Brescia University College, 1285 Western Road, London, ON, Canada N6G 1H2
| | - Malgorzata Milczarek
- Department of Geography, Social Science Centre, The University of Western Ontario, 1151 Richmond Street, London, ON, Canada N6A 5C2
| | - Sean Doherty
- Department of Geography, Wilfrid Laurier University, 75 University AW, Waterloo, ON, Canada N2L 3C5
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Hartzler A, Wetter T. Engaging Patients through Mobile Phones: Demonstrator Services, Success Factors, and Future Opportunities in Low and Middle-income Countries. Yearb Med Inform 2014; 9:182-94. [PMID: 25123741 DOI: 10.15265/iy-2014-0022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Evolving technology and infrastructure can benefit patients even in the poorest countries through mobile health (mHealth). Yet, what makes mobile-phone-based services succeed in low and middle-income countries (LMIC) and what opportunities does the future hold that still need to be studied. We showcase demonstrator services that leverage mobile phones in the hands of patients to promote health and facilitate health care. METHODS We surveyed the recent biomedical literature for demonstrator services that illustrate well-considered examples of mobile phone interventions for consumer health. We draw upon those examples to discuss enabling factors, scalability, reach, and potential of mHealth as well as obstacles in LMIC. RESULTS Among the 227 articles returned by a PubMed search, we identified 55 articles that describe services targeting health consumers equipped with mobile phones. From those articles, we showcase 19 as demonstrator services across clinical care, prevention, infectious diseases, and population health. Services range from education, reminders, reporting, and peer support, to epidemiologic reporting, and care management with phone communication and messages. Key achievements include timely adherence to treatment and appointments, clinical effectiveness of treatment reminders, increased vaccination coverage and uptake of screening, and capacity for efficient disease surveillance. We discuss methodologies of delivery and evaluation of mobile-phone-based mHealth in LMIC, including service design, social context, and environmental factors to success. CONCLUSION Demonstrated promises using mobile phones in the poorest countries encourage a future in which IMIA takes a lead role in leveraging mHealth for citizen empowerment through Consumer Health Informatics.
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Affiliation(s)
- A Hartzler
- Dr. Thomas Wetter, Institute of Medical Biometry and Informatics, Heidelberg University, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany, Tel: +49 6221 56 7490, Fax: +49 6221 56 4997, E-mail:
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De Leon E, Fuentes LW, Cohen JE. Characterizing periodic messaging interventions across health behaviors and media: systematic review. J Med Internet Res 2014; 16:e93. [PMID: 24667840 PMCID: PMC3978550 DOI: 10.2196/jmir.2837] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/01/2013] [Accepted: 01/23/2014] [Indexed: 12/12/2022] Open
Abstract
Background Periodic prompts serve as tools for health behavior interventions to encourage and maintain behavior changes. Past literature reviews have examined periodic messages targeting specific behaviors (smoking, physical activity, diet, etc) or media (telephone, email, face-to-face, newsletter, etc) and have found them to be effective in impacting health behavior in the short term. Objective Our goal was to review the literature related to periodic messaging and prompts in order to explore typical characteristics, assess the role of prompt timing, identify common theoretical models used, and identify characteristics associated with the effectiveness of periodic prompts. Methods Electronic searches of PubMed, PsycINFO, CINAHL, and Web of Science were conducted in October 2012 and May 2013. Database search terms included variant terms for periods, prompts, interventions, media, and health behaviors. Results Forty-two of the 55 included research articles found that prompts resulted in significant positive behavioral outcomes for participants. Prompts were delivered via text messages, email, mailed communications, and in a few instances via phone. Generally, the provision of feedback and specific strategies to accomplish behavior change appears to be important for the success of periodic prompts. Rationale for prompt timing was rarely provided, although some studies did organize message content around days of the week or times perceived to be high risk for particular behaviors. Smoking cessation interventions tended to be organized around quit date. Among studies using theoretical models to inform their interventions, the transtheoretical model was most common. Conclusions Periodic messaging interventions yield positive results for short-term health behavior changes. Interventions including feedback and prompts that included strategies were more likely to report significantly positive outcomes. Work remains to better understand elements that make periodic prompts successful and whether they are effective in producing long-term outcomes.
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Affiliation(s)
- Elaine De Leon
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Smartphone Medical Applications for Women's Health: What Is the Evidence-Base and Feedback? Int J Telemed Appl 2013; 2013:782074. [PMID: 24454354 PMCID: PMC3880694 DOI: 10.1155/2013/782074] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/02/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Smartphone medical applications have a major role to play in women's health with their roles being very broad, ranging from improving health behaviours to undertaking personalised tests. Objective(s). Using Medline, Web of Knowledge, and the PRISMA guidelines 15 randomized controlled trials (RCTs) were identified, with mobile interventions being tested on 1603 females, in relation to key aspects of health. Using a similar systematic approach an iPhone database search identified 47 applications (apps) developed to improve women's health. Findings. Ten RCTs used text messaging or app interventions to support weight loss, with significant improvements being observed in eight studies. For other aspects of women's health RCTs are needed to determine possible health benefits. iPhone store data analysis identified that a substantial number of women's health apps did not have star ratings or feedback comments (68 and 49 per cent, resp.), raising concerns about their validity. Conclusion. Peer-review systems, supporting statements of evidence, or certification standards would be beneficial in maintaining the quality and credibility of future health-focused apps. Patient groups should also ideally be involved in the development and testing of mobile medical apps.
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McInnes DK, Li AE, Hogan TP. Opportunities for engaging low-income, vulnerable populations in health care: a systematic review of homeless persons' access to and use of information technologies. Am J Public Health 2013; 103 Suppl 2:e11-24. [PMID: 24148036 PMCID: PMC3969124 DOI: 10.2105/ajph.2013.301623] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2013] [Indexed: 01/05/2023]
Abstract
We systematically reviewed the health and social science literature on access to and use of information technologies by homeless persons by searching 5 bibliographic databases. Articles were included if they were in English, represented original research, appeared in peer-reviewed publications, and addressed our research questions. Sixteen articles met our inclusion criteria. We found that mobile phone ownership ranged from 44% to 62%; computer ownership, from 24% to 40%; computer access and use, from 47% to 55%; and Internet use, from 19% to 84%. Homeless persons used technologies for a range of purposes, some of which were health related. Many homeless persons had access to information technologies, suggesting possible health benefits to developing programs that link homeless persons to health care through mobile phones and the Internet.
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Affiliation(s)
- D Keith McInnes
- D. Keith McInnes and Timothy P. Hogan are with the Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA. D. Keith McInnes is also with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Timothy P. Hogan is also with the eHealth Quality Enhancement Research Initiative (QUERI), National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial VA Medical Center, and the Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Alice E. Li is with Amherst College, Amherst, MA
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Mirmiran P, Nazeri P, Amiri P, Mehran L, Shakeri N, Azizi F. Iodine nutrition status and knowledge, attitude, and behavior in Tehranian women following 2 decades without public education. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:412-419. [PMID: 23726893 DOI: 10.1016/j.jneb.2013.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 02/05/2013] [Accepted: 02/10/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the association of iodine nutrition status and knowledge, attitude, and behavior in Tehranian women after 2 decades without updating public education. DESIGN Cross-sectional study. SETTING Eight health care centers from 4 district areas of Tehran. PARTICIPANTS A total of 383 women aged ≥ 19 years, randomly selected. MAIN OUTCOME MEASURES Iodine concentration of 24-hour urine samples, iodine content of household salts, and knowledge, attitude, and practice scores regarding iodine nutrition and iodized salt. ANALYSIS Multiple logistic regression was used to identify the association of knowledge, attitude, and practice scores with urinary iodine concentration (UIC) < 100 μg/L. RESULTS The percentages of Tehranian women with high knowledge, attitude, and practice scores were 26%, 26%, and 14%, respectively. Practice score was significantly different between females with UIC < 100 and > 100 μg/L (P = .001). Risk of UIC < 100 μg/L in women of childbearing age (19-45 years) after adjustment of education level, region of residence, and iodine content of salt was significantly associated with intermediate practice score (odds ratio = 2.6; 95% confidence interval, 1.3-13.2). CONCLUSIONS AND IMPLICATIONS Marginally suboptimal iodine status in women of childbearing age can be attributed to inappropriate practices, but not to knowledge and attitude.
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Affiliation(s)
- Parvin Mirmiran
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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