Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the 'SPRINT' principles

Protocol for a pragmatic cluster randomised controlled trial to evaluate the effectiveness of digital health interventions in improving non-communicable disease management during the pandemic in rural Pakistan

BACKGROUND

The COVID-19 pandemic has revealed gaps in global health systems, especially in the low- and middle-income countries (LMICs). Evidence shows that patients with non-communicable diseases (NCDs) are at higher risk of contracting COVID-19 and suffering direct and indirect health consequences. Considering the future challenges such as environmental disasters and pandemics to the LMICs health systems, digital health interventions (DHI) are well poised to strengthen health care resilience. This study aims to implement and evaluate a comprehensive package of DHIs of integrated COVID-NCD care to manage NCDs in primary care facilities in rural Pakistan.

METHODS

The study is designed as a pragmatic, parallel two-arm, multi-centre, mix-methods cluster randomised controlled trial. We will randomise 30 primary care facilities in three districts of Punjab, where basic hypertension and diabetes diagnosis and treatment are provided, with a ratio of 1:1 between intervention and control. In each facility, we will recruit 50 patients who have uncontrolled hypertension. The intervention arm will receive training on an integrated COVID-NCD guideline, and will use a smartphone app-based telemedicine platform where patients can communicate with health providers and peer-supporters, along with a remote training and supervision system. Usual care will be provided in the control arm. Patients will be followed up for 10 months. Our primary indicator is systolic blood pressure measured at 10 months. A process evaluation guided by implementation science frameworks will be conducted to explore implementation questions. A cost-effectiveness evaluation will be conducted to inform future scale up in Pakistan and other LMICs.

DISCUSSION

Our study is one of the first randomised controlled trials to evaluate the effectiveness of DHIs to manage NCDs to strengthen health system resilience in LMICs. We will also evaluate the implementation process and cost-effectiveness to inform future scale-up in similar resource constrained settings.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier-NCT05699369.

Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines

BACKGROUND

Amidst ongoing calls for increased health systems resilience, gaps remain in our understanding of how health systems can reach further into communities to ensure resilient service delivery. Indeed, public health emergencies caused by infectious hazards reveal both the value and vulnerability of the workforce delivering health services in communities. This study explores ways in which a non-governmental organization (NGO) in the Philippines protected their frontline workforce during the first year of the COVID-19 pandemic.

METHODS

Guided by a qualitative descriptive approach, 34 in-depth interviews were conducted with community-based health actors employed by the NGO between June 2020 and February 2021. Data analysis was guided by an iterative deductive and inductive approach.

RESULTS

We identified four key activities that enabled the NGO and their staff to provide health and social services in communities in a safe and consistent manner as part of the organization's pandemic response. These include (1) ensuring adequate personal protective equipment (PPE) and hygiene supplies; (2) providing contextualized and role-specific infection prevention and control (IPC) training; (3) ensuring access to testing for all staff; and (4) providing support during quarantine or isolation.

CONCLUSION

Learning from the implementation of these activities offers a way forward toward health emergency preparedness and response that is crucially needed for NGOs to safely leverage their workforce during pandemics. Further, we describe how community-based health actors employed by NGOs can contribute to broader health systems resilience in the context of health emergency preparedness and response.

Sports Injury Risk Prevention and MRI Image Performance of Athletes in Physical Education

In order to effectively prevent athletes' injury during sports training in physical education, a method of risk prevention of sports injury based on MRI technology was proposed. This method solves the problem of injury prevention in sports training by studying the association analysis algorithm in data mining technology and the research of MRI technology. The experimental results show that the average prediction error of CT and US is about 5%, so it can be considered that the model can predict accurately. Conclusion. The method of risk prevention of sports injury based on MRI technology can effectively prevent the injury of athletes in the process of sports training and reduce the injury rate of athletes.

Implementation of a coronavirus disease 2019 infection prevention and control training program in a low-middle income country

INTRODUCTION AND AIMS

The COVID-19 pandemic poses an ongoing risk to health workers globally. This is particularly true in low- and middle-income countries (LMICs) where resource constraints, ongoing waves of infection, and limited access to vaccines disproportionately burden health systems. Thus, infection prevention and control (IPC) training for COVID-19 remains an important tool to safeguard health workers. We report on the implementation of evidence-based and role-specific COVID-19 IPC training for health workers in a hospital and public health field setting in Sri Lanka.

METHODS

We describe the development of training materials, which were contextualized to local needs and targeted to different staffing categories including support staff. We describe development of role- and context-specific IPC guidelines and accompanying training materials and videos during the first year of the COVID-19 pandemic. We describe in-person training activities and an overview of session leadership and participation.

RESULTS

Key to program implementation was the role of champions in facilitating the training, as well as delivery of training sessions featuring multi-media videos and role play to enhance the training experience. A total of 296 health workers participated in the training program sessions. Of these, 198 were hospital staff and 98 were from the public health workforce. Of the 296 health workers who participated in a training session, 277 completed a pre-test questionnaire and 256 completed post-test questionnaires. A significant increase in knowledge score was observed among all categories of staff who participated in training;however, support staff had the lowest pre-test knowledge on IPC practices at 71%, which improved to only 77% after the formal class.

CONCLUSION

Implementing an IPC training program during a complex health emergency is a challenging, yet necessary task. Leveraging champions, offering training through multiple modalities including the use of videos and role play, as well as inclusion of all staff categories, is crucial to making training accessible.

Navigating fear and care: The lived experiences of community-based health actors in the Philippines during the COVID-19 pandemic

The activities of community-based health actors are widely recognized as critical to pandemic response; yet, there exists a lack of clarity concerning who is included in this ecosystem of actors and how these actors experience the complexity of delivering community-level care in the context of a public health emergency. The objectives of this study were (1) to characterize the lived experiences of community-based health actors during the COVID-19 pandemic in the Philippines; and (2) to identify opportunities for further supporting these critical actors in the health workforce. Virtual semi-structured interviews were conducted (January–February 2021) with 28 workers employed by a Philippines-based non-governmental organization (NGO) to explore their lived experiences during the COVID-19 pandemic. Data were analyzed thematically using a hybrid inductive-deductive coding process, informed by Tronto's conceptualization of an ethic of care. Lived experiences among study participants were shaped by discourses of fear and care, and the interaction between these two affects. Participants reported everyday experiences of fear: NGO workers' fears of contracting and transmitting COVID-19 to others; perceived fear among community members where they worked; and fears around COVID-19 testing, recognizing the personal and social implications (e.g. stigma) of a positive test. Amid fear, participants had everyday experiences of care: care was a powerful motivator to continue their work; they felt supported by a caring organization that implemented safety protocols and provided material supports to those in quarantine; and they engaged in self-care practices. These findings contribute to understanding the ecosystem of actors involved in community-based health care and engagement efforts and the challenges they encounter in their work, particularly in a pandemic context. We highlight implications for civil society organizations charged with protecting the mental and physical well-being of their workers and describe how these actions can contribute to local health systems strengthening.

Exploring the translation process for multilingual implementation research studies: a collaborative autoethnography

Introduction

In an increasingly globalised and interconnected world, evidence to evaluate complex interventions may be generated in multiple languages. However, despite its influence in shaping the evidence base, there is little literature explicitly connecting the translation process to the goals and processes of implementation research. This study aims to explore the processes and experience of an international implementation research team conducting a process evaluation of a complex intervention in Tibet Autonomous Region, China.

Methods

This study uses a collaborative autoethnographic approach to explore the translation process from Chinese or Tibetan to English of key stakeholder interview transcripts. In this approach, multiple researchers and translators contributed their reflections, and conducted joint analysis through dialogue, reflection and with consideration of multiple perspectives. Seven researchers involved with the translation process contributed their perspectives through in-depth interviews or written reflections and jointly analysed the resulting data.

Results

We describe the translation process, synthesise key challenges including developing a ‘voice’ and tone as a translator, conveying the depth of idioms across languages, and distance from the study context. We further offer lessons learnt including the importance of word banks with unified translations of words and phrases created iteratively during the translation process, the need to collaborate between translators and the introspective work necessary for translators to explore their positionality and reflexivity during the work. We then offer a summary of these learnings for other implementation research teams.

Conclusion

Our findings emphasise that in order to ensure rigour in their work, implementation research teams using qualitative data should make concerted effort to consider both the translation process as well as its outcomes. Given the numerous multinational or multilingual implementation research studies using qualitative methods, there is a need for further consideration and reflection on the translation process.

We go farther together: practical steps towards conducting a collaborative autoethnographic study

ABSTRACT

Autoethnography is an underused qualitative research method in implementation science. Autoethnography can be used to reflect on and archive personal experiences, which can yield useful information to advance our knowledge. In particular, collaborative autoethnography is an important method towards providing greater insights on the experiences of multidisciplinary teams conducting research amidst complexity and intersectionality. In conducting a collaborative autoethnography, all authors are participants who narrate, analyze and theorize about their individual and or collective experiences. This article provides an overview of collaborative autoethnography for health research teams and implementation scientists embarking on autoethnographic studies.