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Scarbrough H, Sanfilippo KRM, Ziemann A, Stavropoulou C. Mobilizing pilot-based evidence for the spread and sustainability of innovations in healthcare: The role of innovation intermediaries. Soc Sci Med 2024; 340:116394. [PMID: 38000177 DOI: 10.1016/j.socscimed.2023.116394] [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: 07/26/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
An endemic challenge facing healthcare systems around the world is how to spread innovation more widely and sustainably. A common response to this challenge involves conducting pilot implementation studies to generate evidence of the innovation's benefits. However, despite the key role that such studies play in the local adoption of innovation, their contribution to the wider spread and sustainability of innovation is relatively under-researched and under-theorized. In this paper we examine this contribution through an empirical examination of the experiences of an innovation intermediary organization in the English NHS (National Health Service). We find that their work in mobilizing pilot-based evidence involves three main strands; configuring to context; transitioning evidence; and managing the transition. Through this analysis we contribute to theory by showing how the agency afforded by intermediary roles can support the effective transitioning of pilot-based evidence across different phases in the innovation journey, and across different occupational groups, and can thus help to create a positive feedback loop from localized early implementers of an innovation to later more widespread adoption and sustainability. Based on these findings, we develop insights on the reasons for the unnecessary repetition of pilots - so-called 'pilotitis'- and offer policy recommendations on how to enhance the role of pilots in the wider spread and sustainability of innovation.
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Affiliation(s)
- Harry Scarbrough
- Centre for Healthcare Innovation Research (CHIR), Bayes Business School, City, University of London, 106 Bunhill Row, London, EC1Y 8TZ, UK.
| | - Katie Rose M Sanfilippo
- Centre for Healthcare Innovation Research (CHIR), School of Health and Psychological Sciences, City, University of London, UK
| | - Alexandra Ziemann
- Global Public Health, Department of Social & Policy Sciences, Bath University, UK
| | - Charitini Stavropoulou
- Centre for Healthcare Innovation Research (CHIR), School of Health and Psychological Sciences, City, University of London, UK
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2
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Mamuye A, Nigatu AM, Chanyalew MA, Amor LB, Loukil S, Moyo C, Quarshie S, Antypas K, Tilahun B. Facilitators and Barriers to the Sustainability of eHealth Solutions in Low- and Middle-Income Countries: Descriptive Exploratory Study. JMIR Form Res 2023; 7:e41487. [PMID: 37171865 DOI: 10.2196/41487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/15/2022] [Accepted: 01/31/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Despite the widely anticipated benefits of eHealth technologies in enhancing health care service delivery, the sustainable usage of eHealth in transitional countries remains low. There is limited evidence supporting the low sustainable adoption of eHealth in low- and middle-income countries. OBJECTIVE The aim of this study was to explore the facilitators and barriers to the sustainable use of eHealth solutions in low- and middle-income nations. METHODS A qualitative descriptive exploratory study was conducted in 4 African nations from September to December 2021. A semistructured interview guide was used to collect the data. Data were audio-recorded and transcribed from the local to the English language verbatim, and the audio data were transcribed. On the basis of the information gathered, we assigned codes to the data, searched for conceptual patterns, and created emerging themes. Data were analyzed thematically using OpenCode software. RESULTS A total of 49 key informant interviews (10 from Tunisia, 15 from Ethiopia, 13 from Ghana, and 11 from Malawi) were conducted. About 40.8% (20/49) of the study participants were between the ages of 26 and 35 years; 73.5% (36/49) of them were male participants; and 71.4% (35/49) of them had a master's degree or higher in their educational background. Additionally, the study participants' work experience ranged from 2 to 35 years. Based on the data we gathered, we identified 5 themes: organizational, technology and technological infrastructure, human factors, economy or funding, and policy and regulations. CONCLUSIONS This study explores potential facilitators and barriers to long-term eHealth solution implementation. Addressing barriers early in the implementation process can aid in the development of eHealth solutions that will better fulfill the demands of end users. Therefore, focusing on potential challenges would enhance the sustainability of eHealth solutions in low- and middle-income countries.
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Affiliation(s)
- Adane Mamuye
- College of Informatics, University of Gondar, Gondar, Ethiopia
| | - Araya Mesfin Nigatu
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | | | | | - Chris Moyo
- Health Information Systems Programme Malawi, Lilongwe, Malawi
| | | | | | - Binyam Tilahun
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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3
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Kaboré SS, Ngangue P, Soubeiga D, Barro A, Pilabré AH, Bationo N, Pafadnam Y, Drabo KM, Hien H, Savadogo GBL. Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: A systematic review. Front Digit Health 2022; 4:1014375. [PMID: 36518563 PMCID: PMC9742266 DOI: 10.3389/fdgth.2022.1014375] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/03/2022] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have increased exponentially all over the world. Furthermore, the interest in the sustainability of digital health interventions is growing significantly. However, a systematic synthesis of digital health intervention sustainability challenges is lacking. This systematic review aimed to identify the barriers and facilitators for the sustainability of digital health intervention in low and middle-income countries. METHODS Three electronic databases (PubMed, Embase and Web of Science) were searched. Two independent reviewers selected eligible publications based on inclusion and exclusion criteria. Data were extracted and quality assessed by four team members. Qualitative, quantitative or mixed studies conducted in low and middle-income countries and published from January 2000 to May 2022 were included. RESULTS The sustainability of digital health interventions is very complex and multidimensional. Successful sustainability of digital health interventions depends on interdependent complex factors that influence the implementation and scale-up level in the short, middle and long term. Barriers identified among others are associated with infrastructure, equipment, internet, electricity and the DHIs. As for the facilitators, they are more focused on the strong commitment and involvement of relevant stakeholders: Government, institutional, sectoral, stakeholders' support, collaborative networks with implementing partners, improved satisfaction, convenience, privacy, confidentiality and trust in clients, experience and confidence in using the system, motivation and competence of staff. All stakeholders play an essential role in the process of sustainability. Digital technology can have long term impacts on health workers, patients, and the health system, by improving data management for decision-making, the standard of healthcare service delivery and boosting attendance at health facilities and using services. Therefore, management changes with effective monitoring and evaluation before, during, and after DHIs are essential. CONCLUSION The sustainability of digital health interventions is crucial to maintain good quality healthcare, especially in low and middle-income countries. Considering potential barriers and facilitators for the sustainability of digital health interventions should inform all stakeholders, from their planning until their scaling up. Besides, it would be appropriate at the health facilities level to consolidate facilitators and efficiently manage barriers with the participation of all stakeholders.
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Affiliation(s)
- Soutongnoma Safiata Kaboré
- Centre D'excellence Africain, Université Nazi BONI, Bobo Dioulasso, Burkina Faso
- Direction Générale, Institut National de Santé Publique, Ouagadougou, Burkina Faso
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Patrice Ngangue
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département des Sciences de la Santé, Université du Québec en Abitibi Témiscamingue, Québec, Canada
| | - Dieudonné Soubeiga
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Abibata Barro
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Arzouma Hermann Pilabré
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département de Santé Publique, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Nestor Bationo
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département de Santé Publique, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Yacouba Pafadnam
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Koiné Maxime Drabo
- Institut de Recherche en Sciences de la Santé/Centre National Pour la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Hervé Hien
- Direction Générale, Institut National de Santé Publique, Ouagadougou, Burkina Faso
- Institut de Recherche en Sciences de la Santé/Centre National Pour la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
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Wong SS, Lim HM, Chin AJZ, Chang FWS, Yip KC, Teo CH, Abdullah A, Ng CJ. eHealth literacy of patients attending a primary care clinic in Malaysia and its associated factors: A cross-sectional study. Digit Health 2022; 8:20552076221135392. [PMID: 36420318 PMCID: PMC9677303 DOI: 10.1177/20552076221135392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND People are overloaded with online health information (OHI) of variable quality. eHealth literacy is important for people to acquire and appraise reliable information to make health-related decisions. While eHealth literacy is widely studied in developed countries, few studies have been conducted among patients in low- and middle-income countries (LMICs). OBJECTIVE We aimed to determine the level of eHealth literacy in patients attending a primary care clinic in Malaysia and its associated factors. METHODS A cross-sectional study using a self-administered questionnaire was conducted in an urban primary care clinic. We used a systematic random sampling method to select patients aged 18 years and above who attended the clinic. The eHealth literacy scale (eHEALS) was used to measure eHealth literacy. RESULTS A total of 381 participants were included. The mean eHEALS was 24.4 ± 7.6. The eHEALS statements related to skills in appraising OHI were scored lower than statements related to looking for online resources. Higher education level of attending upper secondary school (AOR 2.53, 95% CI 1.05-6.11), tertiary education (AOR 4.05, 95% CI 1.60-10.25), higher monthly household income of >US$470 (AOR 1.95, 95% CI 1.07-3.56), and those who had sought OHI in the past month (AOR 1.95, 95% CI 1.13-3.36) were associated with a higher eHealth literacy level. CONCLUSIONS This study found a low eHealth literacy level among primary care patients in Malaysia. While the patients were confident in searching for OHI, they lacked skills in appraising them. Our findings inform the interventions for improving eHealth literacy in LMICs, especially educating the public about OHI appraisal.
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Affiliation(s)
- Swee Shiuan Wong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adrian Jian Zhi Chin
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Felicia Wen Si Chang
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Chun Yip
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore
- Duke-NUS Medical School, Singapore
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5
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Ionescu A, de Jong PGM, Drop SLS, van Kampen SC. A scoping review of the use of e-learning and e-consultation for healthcare workers in low- and middle-income countries and their potential complementarity. J Am Med Inform Assoc 2021; 29:713-722. [PMID: 34966930 PMCID: PMC8922198 DOI: 10.1093/jamia/ocab271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Although the provision of e-learning (EL) training for healthcare workers (HCWs) and provider-to-HCW e-consultation (EC) is considered useful for health outcomes, research on their joint use is limited. This scoping review aimed to create an overview of what is currently known in the literature about the use and implementation of EC and EL by HCWs in LMICs and to answer the question of whether there is evidence of complementarity. MATERIALS AND METHODS Scientific databases were searched and peer-reviewed papers were reviewed systematically according to predefined inclusion/exclusion criteria. Data were extracted including the study focus (EC/EL), year of publication, geographical location, target population, target disease(s) under study, type(s) of study outcomes, and article type. RESULTS A total of 3051 articles were retrieved and screened for eligibility, of which 96 were kept for analysis. Of these, only 3 addressed both EL and EC; 54 studies addressed EL; and 39 addressed EC. Most studies looked at gain in knowledge/skills usability, efficiency, competence, and satisfaction of HCW, or barriers/challenges to implementation. Descriptive studies focused on the application of EL or EC for targeting specific health conditions. Factors contributing to the success of EC or EL networks were institutional anchoring, multiple partnership, and capacity building of local experts. CONCLUSIONS Our review found an important gap in the literature in relation to the complementary role of EL and EC for HCWs in LMICs evidenced by outcome measures. There is an important role for national and international academic institutions, learned medical societies, and networks to support regional experts in providing EL and EC for added value that will help the clinical performance of HCWs and improve health outcomes.
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Affiliation(s)
- Alma Ionescu
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter G M de Jong
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Stenvert L S Drop
- Division of Endocrinology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands,Corresponding Author: Stenvert L.S. Drop, MD, PhD, Division of Endocrinology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC, Sp2430, PO Box 2060, Rotterdam 3000 CB, The Netherlands;
| | - Sanne C van Kampen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Basholli A, Lagkas T, Bath PA, Eleftherakis G. Sensor-based platforms for remote management of chronic diseases in developing regions: A qualitative approach examining the perspectives of healthcare professionals. Health Informatics J 2021; 27:1460458220979350. [PMID: 33435815 DOI: 10.1177/1460458220979350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The continuous monitoring of chronic diseases serves as one of the cornerstones in the efforts to improve the quality of life of patients and maintain the healthcare services provided to them. This study aims to provide an in-depth understanding of the perspectives of healthcare professionals on using sensor-based networks (SBN) used for remote and continuous monitoring of patients with chronic illness in Kosovo, a developing country. A qualitative research method was used to interview 26 healthcare professionals. The study results demonstrate the positive attitudes of participants to using SBN, and considers their concerns on the impact of these platforms on the patient's life, the number of visits in the medical centre, data privacy concerning interactions between patients and their medical personnel and the costs of the platform. Further to that, the study makes an important contribution to knowledge by identifying the challenges and drawbacks of these platforms and provides recommendations for system designers.
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Affiliation(s)
| | | | | | - George Eleftherakis
- South-East European Research Centre (SEERC), Greece CITY College, International Faculty of the University of Sheffield, Greece
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7
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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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Meherali S, Hartling L, Scott SD. Cultural Adaptation of Digital Knowledge Translation Tools for Acute Otitis Media in Low- to Middle-Income Countries: Mixed Methods Usability Study. JMIR Form Res 2021; 5:e13908. [PMID: 33470942 PMCID: PMC7857946 DOI: 10.2196/13908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 11/14/2019] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute otitis media (AOM) is the most common pediatric bacterial ear infection. AOM presents challenges to parents who lack accurate information. Digital knowledge translation tools offer a promising approach to communicating complex health information. We developed AOM knowledge translation tools for Canadian parents and augmented them for Pakistani parent end users. OBJECTIVE This pilot study aimed to (1) develop AOM knowledge translation tools for Canadian parents, (2) adapt the knowledge translation tools across cultural contexts, and (3) evaluate the usability of the adapted knowledge translation tools. METHODS Parents' perceptions of the translated knowledge translation tools' usability were explored using a mixed-methods design. We recruited parent participants from a hospital in Pakistan to complete usability surveys (n=47) and focus group interviews (n=21). Descriptive statistics and content analysis were used to analyze data. RESULTS Usability results showed the usefulness and effectiveness of both adapted knowledge translation tools. Parents reported preferring a digital media narrative format in their own language. Findings revealed that culturally adapted knowledge translation tools are effective in transferring health information to parents. CONCLUSIONS Digital knowledge translation tools offer a promising approach to improving health literacy and communicating complex health information to parents of children with AOM. Culturally adapting the tools generated important knowledge that will contribute to knowledge translation advancements. Evaluation of the tool effectiveness is a critical next step to exploring the impact of knowledge translation tools on child health outcomes.
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Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Noreña I, Shah N, Ndenkeh J, Hernandez C, Sitoe N, Sillah A, Shin A, Han WW, Devaera Y, Mosoba M, Moonga G, Hendl T, Wernick A, Kiberu VM, Menke M, Guggenbuehl Noller JM, Pritsch M. Proceedings from the CIH LMU Symposium 2020 on "eHealth: Trends and innovations". BMC Proc 2020; 14:17. [PMID: 33292261 PMCID: PMC7720516 DOI: 10.1186/s12919-020-00202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Electronic Health (eHealth) is the use of information and communication technologies for health and plays a significant role in improving public health. The rapid expansion and development of eHealth initiatives allow researchers and healthcare providers to connect more effectively with patients. The aim of the CIHLMU Symposium 2020 was to discuss the current challenges facing the field, opportunities in eHealth implementation, to share the experiences from different healthcare systems, and to discuss future trends addressing the use of digital platforms in health. The symposium on eHealth explored how the health and technology sector must increase efforts to reduce the obstacles facing public and private investment, the efficacy in preventing diseases and improving patient quality of life, and the ethical and legal frameworks that influence the proper development of the different platforms and initiatives related to the field. This symposium furthered the sharing of knowledge, networking, and patient/user and practitioner experiences in low- and middle-income countries (LMIC) in both public and private sectors.
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Affiliation(s)
- Ivan Noreña
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany. .,Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Nairuti Shah
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Jackson Ndenkeh
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Cecilia Hernandez
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Nadia Sitoe
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany.,Instituto Nacional de Saúde, Maputo, Mozambique
| | - Abdou Sillah
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany.,Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Anna Shin
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Wai Wai Han
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany.,Department of Medical Research, Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Yoga Devaera
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Maureen Mosoba
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Given Moonga
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany.,Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | - Tereza Hendl
- Institute of Ethics, History, and Theory of Medicine LMU, Munich, Germany
| | - Alina Wernick
- Alexander von Humboldt Institute for Internet and Society, Berlin, Germany
| | | | | | | | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
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An internet of things-based intensity and time-resolved fluorescence reader for point-of-care testing. Biosens Bioelectron 2020; 154:112074. [PMID: 32056969 DOI: 10.1016/j.bios.2020.112074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/24/2022]
Abstract
A miniature internet of things (IoT)-based point-of-care testing (PoCT) fluorescence reader, able to perform both intensity and time-resolved measurements of different fluorescent tags, is presented. This low cost platform has been conceived for performing tests in low-resource and remote settings, displaying versatile performance and yet simple operation. It consists on an external case of 43 × 30 × 42 mm3 (built in a 3D-printer) where all the elements are fixed, including some basic optics (3 lenses and 2 filters), a laser diode and a custom designed Single-Photon Avalanche Diodes (SPADs) camera. Both, the laser and the camera are controlled by a Field Programmable Gate Array (FPGA) with IoT capabilities. The PoCT was validated by detecting Plasmodium antigen in a fluorescent enzyme-linked immunosorbent assay (ELISA) using a fluorescence substrate. The results were compared to those provided in parallel by two commercial fluorescent plate readers. As it will be shown, the PoCT fluorescent readout was more sensitive than its colorimetric counterpart. Furthermore, the PoCT displayed similar signal trends and levels of detection than the bulkier and more expensive commercial fluorescence plate readers. These results demonstrate that the PoCT platform developed could bring the performance of central laboratory assay techniques closer to the end-user level.
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11
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Zamora-Ilarionov A, Rodriguez L. The use of eHealth to design a regional health promotion program in the workplace: Institute of Costa Rican Electricity case series. Mhealth 2020; 6:44. [PMID: 33437840 PMCID: PMC7793017 DOI: 10.21037/mhealth-19-231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/03/2020] [Indexed: 11/06/2022] Open
Abstract
The development of sustainable health promotion programs in the workplace requires a coordinated systematic approach. Costs and resources often cause barriers to implement workplace programs in low-and middle-income countries. The objective of the case series is to evaluate the feasibility of health informatics to evaluate and monitor the physical activity and dietary habits of individuals in the workplace on a small scale as a preparation to implement the health promotion program across a company in Costa Rica. Participants were 25 employees where 17 participants had a body mass index (BMI) of 25.0 km/m2 or more. This case series assesses and evaluates patient data during an 8-week period using multiple tools of eHealth technologies such as an Electronic Health Record (EHR), a Personal Health Record (PHR), electronic surveys and fitness trackers with compatible mobile applications. Adherence to wearing Fitbit was high and stable with a mean of 97.5% over 30 days (n=16). The participants in the first week walked on average 8,239 steps but, at the end of the fourth week, the average steps decreased to 7,798. The dietary electronic survey was answered satisfactorily by 86.6% of the employees (n=25). The employees scored on average 35 out of 100 on a diet quality scale. The consumption of vegetables, beans, whole grains, nuts and seeds is lower than the recommended dietary guidelines of 60. The integration of eHealth technologies can provide a clearer understanding of the employees' health situation to more appropriately allocate efforts to promote behavior change where needed most.
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Affiliation(s)
- Anton Zamora-Ilarionov
- Translational Nutrition Research and Innovation Center (CIINT), San José, Costa Rica
- School of Medicine, Hispano-American University, San José, Costa Rica
| | - Laura Rodriguez
- Department of Occupational Health, Institute of Costa Rican Electricity, San José, Costa Rica
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12
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Liu C, Shao S, Liu C, Bennett GG, Prvu Bettger J, Yan LL. Academia-industry digital health collaborations: A cross-cultural analysis of barriers and facilitators. Digit Health 2019; 5:2055207619878627. [PMID: 31632684 PMCID: PMC6767742 DOI: 10.1177/2055207619878627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022] Open
Abstract
Background Development and uptake of digital health technologies benefit from
cross-sectoral efforts from academia and industry. Our study aims to
identify the barriers and facilitators associated with academia–industry
collaborations in digital health in middle- and high-income countries. Methods Trained personnel conducted semi-structured interviews with 23 stakeholders
who were active in industry, academia or both. Stakeholders were based in
middle-income countries (including China) and high-income countries
(including the United States) as defined by the World Bank. Interviews were
conducted in the stakeholder’s language of choice (Chinese,
n = 12; English, n = 11). Qualitative
interview questions elicited perspectives on stakeholders’ experience with
academia–industry collaboration, challenges faced, and factors that
facilitated the process. Interviews were audiotaped, transcribed verbatim,
thematically coded by bilingual coders and analyzed using inductive content
analysis. Results Stakeholders in both academia and industry identified complementary roles,
authentic communication between partners, and clearly outlined goals or
expectations prior to the collaboration as primary facilitators for success.
Misaligned goals or expectations, differences in timelines for productivity
and difficulties balancing expectations for business outcomes versus
generation of scientific evidence were identified as primary barriers.
Stakeholders in high-income countries reported inauthentic communication as
a significant barrier to collaboration, whereas those in middle-income
countries did not. Conclusion Outlining and communicating openly about goals and expectations for timeline
and priorities as well as establishing complementary roles will facilitate
fruitful academia–industry collaborations in the future. Best practices for
communication styles may be dependent on the cultural setting, and thus
should be adopted accordingly.
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Affiliation(s)
- Chelsea Liu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shuai Shao
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.,ACCESS Health International, Shanghai, China.,Duke Kunshan University, Kunshan, China
| | - Chang Liu
- ACCESS Health International, Shanghai, China.,Duke Kunshan University, Kunshan, China
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, USA
| | - Janet Prvu Bettger
- Duke University School of Medicine, Durham, USA.,Duke Global Health Institute, Durham, USA
| | - Lijing L Yan
- Duke Kunshan University, Kunshan, China.,Duke Global Health Institute, Durham, USA
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13
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López-Pelayo H, Caballeria E, Díaz E, Sánchez A, Segura L, Colom J, Wallace P, Gual A. Digital brief interventions for risky drinkers are not the panacea: A pilot study exploring barriers for its implementation according to professionals' perceptions. Health Informatics J 2019; 26:925-933. [PMID: 31213133 DOI: 10.1177/1460458219855177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Digital brief interventions have emerged as an instrument to improve the implementation of Screening, Brief Intervention and Referral to Treatment programs for risky drinkers. However, trials in Catalonia have been unsuccessful. This study was aimed at researching professionals' perceptions regarding the usefulness of digital brief interventions in overcoming traditional barriers of face-to-face Screening, Brief Intervention and Referral to Treatment and new barriers posed by the use of digital brief interventions. Professionals who participated in the Effectiveness of primary care based Facilitated Access to alcohol Reduction website (EFAR)digital brief intervention clinical trial were surveyed on April 2017 on the following areas: (1) satisfaction, (2) usefulness, (3) perceived ability of digital interventions on overcoming traditional barriers and (4) perceived new barriers of digital interventions. Sixty-eight professionals completed the survey. Univariate and multivariate analyses were performed using the level of professional engagement with the project as the dependent variable, barriers as independent variables and socio-demographic characteristics as covariables. Of all professionals, 79.4 percent were satisfied with their participation in the project, but only 26.5 percent perceived the website as useful. Low engagement was associated with the perceived lack of feedback (0.22; 95% confidence interval: 0.05 -0.88), perception that it was difficult to use among the elderly(0.22; 95 confidence interval: 0.05 -0.091) and among low socioeconomic population (0.14; 95% confidence interval: 0.03 -0.64). The majority of the participants indicated that digital brief intervention for risky drinkers succeeded in overcoming most of the traditional barriers. However, new barriers emerged as difficulties for implementing digital brief interventions in the Catalan Primary Health Care System. Usefulness perception is a key factor, which must be addressed in any proposed intervention in primary care.
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14
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Yau M, Timmerman V, Zwarenstein M, Mayers P, Cornick RV, Bateman E, Fairall L. e-PC101: an electronic clinical decision support tool developed in South Africa for primary care in low-income and middle-income countries. BMJ Glob Health 2019; 3:e001093. [PMID: 30899556 PMCID: PMC6407554 DOI: 10.1136/bmjgh-2018-001093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 11/03/2022] Open
Abstract
Health technology is increasingly recognised as a feasible method of addressing health needs in low and middle-income countries (LMICs). Primary Care 101, now known as PACK (Practical Approach to Care Kit), is a printed, algorithmic, checklist-based, comprehensive clinical decision support tool. It assists clinicians with delivering evidence-based medicine for common primary care presentations and conditions. These assessment and treatment guides have been adopted widely in primary care clinics across South Africa. This paper focuses on the process of designing, developing, and implementing a digital version of the clinical decision support tool for use on a tablet computer. Lessons learnt throughout its development and pilot implementation could apply to the creation of electronic health interventions and the digitisation of clinical tools in LMICs.
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Affiliation(s)
- Matthew Yau
- University of Toronto Medical School, Toronto, Ontario, Canada
| | - Venessa Timmerman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Pat Mayers
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ruth Vania Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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15
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Martinez B, Ixen EC, Hall-Clifford R, Juarez M, Miller AC, Francis A, Valderrama CE, Stroux L, Clifford GD, Rohloff P. mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial. Reprod Health 2018; 15:120. [PMID: 29973229 PMCID: PMC6033207 DOI: 10.1186/s12978-018-0554-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/13/2018] [Indexed: 11/22/2022] Open
Abstract
Background/objective Guatemala’s indigenous Maya population has one of the highest perinatal and maternal mortality rates in Latin America. In this population most births are delivered at home by traditional birth attendants (TBAs), who have limited support and linkages to public hospitals. The goal of this study was to characterize the detection of maternal and perinatal complications and rates of facility-level referral by TBAs, and to evaluate the impact of a mHealth decision support system on these rates. Methods A pragmatic one-year feasibility trial of an mHealth decisions support system was conducted in rural Maya communities in collaboration with TBAs. TBAs were individually randomized in an unblinded fashion to either early-access or later-access to the mHealth system. TBAs in the early-access arm used the mHealth system throughout the study. TBAs in the later-access arm provided usual care until crossing over uni-directionally to the mHealth system at the study midpoint. The primary study outcome was the monthly rate of referral to facility-level care, adjusted for birth volume. Results Forty-four TBAs were randomized, 23 to the early-access arm and 21 to the later-access arm. Outcomes were analyzed for 799 pregnancies (early-access 425, later-access 374). Monthly referral rates to facility-level care were significantly higher among the early-access arm (median 33 referrals per 100 births, IQR 22–58) compared to the later-access arm (median 20 per 100, IQR 0–30) (p = 0.03). At the study midpoint, the later-access arm began using the mHealth platform and its referral rates increased (median 34 referrals per 100 births, IQR 5–50) with no significant difference from the early-access arm (p = 0.58). Rates of complications were similar in both arms, except for hypertensive disorders of pregnancy, which were significantly higher among TBAs in the early-access arm (RR 3.3, 95% CI 1.10–9.86). Conclusions Referral rates were higher when TBAs had access to the mHealth platform. The introduction of mHealth supportive technologies for TBAs is feasible and can improve detection of complications and timely referral to facility-care within challenging healthcare delivery contexts. Trial registration Clinicaltrials.gov NCT02348840.
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Affiliation(s)
- Boris Martinez
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala.,Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Enma Coyote Ixen
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Rachel Hall-Clifford
- Departments of Sociology and Anthropology and Public Health, Agnes Scott College, Decatur, GA, USA
| | - Michel Juarez
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Aaron Francis
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | | | - Lisa Stroux
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
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