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Faria BSFD, Carvalho C, Triches MI, Vieira LMSMDA, Sato TDO. Mobile health technologies for workers' health and wellbeing: A systematic search of mHealth applications in Brazil. J Bodyw Mov Ther 2024; 38:54-59. [PMID: 38763605 DOI: 10.1016/j.jbmt.2024.01.023] [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: 05/19/2023] [Accepted: 01/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Inadequate working conditions and sedentary work can exert a negative impact on workers' health and wellbeing, leading to musculoskeletal disorders and disability. Mobile health (mHealth) applications (apps) have high potential for the self-management of workers' health. OBJECTIVE To identify mHealth apps aimed at promoting workers' health and wellbeing available in Brazilian online stores and assess these apps in terms of engagement, functionality, aesthetics and information quality. METHODS A systematic search for apps was conducted in the Brazilian online App Store and Play Store in December 2022. Only smartphone apps in Brazilian Portuguese directed at workers' health were assessed. The appraisal of the quality of the applications was performed using the Mobile App Rating Scale (MARS). RESULTS Among the 3449 mHealth apps found, ten were eligible for inclusion. The mean overall score was 3.15 ± 0.91 on a scale of 1-5. The lowest score was found for the "credibility" item. Exercises and breaks were the most frequent strategies. Most apps provided low-quality information from questionable sources and therefore received a mean score of 2.1 ± 1.5 on the MARS information subscale. CONCLUSION Ten relevant mHealth apps were eligible for inclusion. The mHealth apps for the promotion of workers' health and wellbeing currently available in Brazil exhibited moderate quality and limited functionality.
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Affiliation(s)
| | - Cristiano Carvalho
- Biosciences Department, Universidade Federal de São Paulo, Baixada Santista Campus, Santos, Brazil
| | - Maria Isabel Triches
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, Brazil
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Joubert A, Reid M. Knowledge, skills, and training of community health workers to contribute to interprofessional education: a scoping review. J Interprof Care 2024; 38:308-318. [PMID: 36821383 DOI: 10.1080/13561820.2023.2176472] [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: 02/10/2022] [Revised: 10/12/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
A scoping review of 32 publications was conducted with the aim of mapping literature to determine what is known about the knowledge, skills, and training of community health workers that could contribute to interprofessional education. Interprofessional education, as a pedagogical approach, prepares health professions students to serve patients in collaboration with other health professionals to improve patient outcomes. All over the world, the role of community health workers is vital for its support of community service and community health outcomes. However, no evidence could be found on the knowledge, skills, and training of community health workers that contribute to interprofessional education. The knowledge that community health workers need to contribute to interprofessional education, as reported by the literature, relates to case management, communication, health education, recordkeeping and referrals. Skills, such as critical thinking, interprofessional collaboration, and various clinical procedures, were noted. Training approaches reported included the use of technology such as mobile phones and web-based learning. The scoping review improved our understanding of the knowledge, skills, and training of community health workers that could contribute to interprofessional education. Applying a fit-for-purpose approach, and building on existing knowledge, skills, and training, could fast-track the contribution of community health workers to interprofessional education.
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Affiliation(s)
- Annemarie Joubert
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Marianne Reid
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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Desrosiers A, Carrol B, Ritsema H, Higgins W, Momoh F, Betancourt TS. Advancing sustainable implementation of an evidence-based mental health intervention in Sierra Leone's schools: protocol for a hybrid type 3 implementation-effectiveness trial. BMC Public Health 2024; 24:362. [PMID: 38310232 PMCID: PMC10837990 DOI: 10.1186/s12889-024-17928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Mental health disorders among youth contribute substantially to the global burden of disease, which is exacerbated in low- and middle-income countries (LMICs) due to large mental health treatment gaps. In Sierra Leone, a West African country with a long history of complex adversity, the mental health treatment gap is estimated at 98%. Implementing innovative mental health interventions that can be sustained at scale is a priority. The Youth Readiness Intervention (YRI) is an evidence-based mental health intervention for youth that can be delivered feasibly by lay health workers/nonspecialists. Using mobile-based technologies to assist implementation could improve the reach and sustainability of the YRI in Sierra Leone. This study aims to train teachers to deliver the YRI in Sierra Leone's secondary schools and test the feasibility, acceptability, cost, and fidelity to the YRI of a mobile-based supervision model compared with standard, in-person supervision. METHODS We will conduct a hybrid type 3 implementation-effectiveness cluster randomized trial to assess the feasibility, acceptability, costs and fidelity to the YRI implemented by teachers receiving mobile-based supervision vs. standard supervision. Enrolled schools (N = 50) will be randomized to YRI + mobile supervision (N = 20), YRI + standard supervision (N = 20) or waitlist control (N = 10). We will recruit and enroll four teachers per intervention-condition school (N = 160) and 1200 youth. We will collect data on implementation outcomes among teachers, principals and youth via a mixed methods approach at baseline and post-intervention. We will also collect quantitative data on youth mental health and functioning as secondary outcomes at baseline and post-intervention, as well as cost-effectiveness data at 12-month follow-up. DISCUSSION Study findings have the potential to expand the reach of mental health services among youth in low-resource settings via a teacher workforce. The use of mobile tools, if successful, could support further scale out and sustainment of the YRI to other regions of Sierra Leone and West Africa more broadly, which could help address the mental health treatment gap. TRIAL REGISTRATION Clinical Trial Network: NCT05737667.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA.
| | - Bidemi Carrol
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Haley Ritsema
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA
| | - Walker Higgins
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Fatoma Momoh
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02496, USA
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Ramkumar V, Neethi J, Kumar S. Needs and readiness to use tele-practice for identification and rehabilitation of children with hearing and speech-language disorders: perceptions of public sector care providers in South India. EARLY CHILD DEVELOPMENT AND CARE 2024; 194:39-57. [PMID: 38681940 PMCID: PMC7615870 DOI: 10.1080/03004430.2023.2276660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/24/2023] [Indexed: 05/01/2024]
Abstract
The current study was a first step towards planning the implementation of tele-practice in a South Indian state's public-sector services for childhood hearing and speech, language disorders. The aim was to understand the perceptions of public-sector health care providers (HCPs) regarding their need and readiness to accept and implement tele-practice-based diagnostics and rehabilitation services. A cross-sectional study design was used, which included focus group discussions (FGDs), semi-structured interviews (SSIs) and geo-spatial analysis. Participants in the qualitative component included various cadres of health HCPs in public-sector services. Theoretical saturation and cross-case variance were used to assess the data's sufficiency. A hybrid deductive-inductive thematic analytical approach was used to analyse the data. Geo-tags and geo-locations of addresses of all children with disabilities and all the public-sector service providers were used to generate geospatial maps. The HCPs considered the currently available services for childhood hearing and speech-language disorders to be insufficient and reported shortage of professionals to meet current demands. There was inconsistent availability of suitable equipment and professionals in the existing district-level facilities. HCPs were comfortable using technology, and were willing to investigate tele-practice, but they required training in tele-practice [Q2].
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Affiliation(s)
- Vidya Ramkumar
- Department of Audiology, Sri Ramachandra, Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India
| | - J Neethi
- Department of Audiology, Sri Ramachandra, Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India
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Kachimanga C, Mulwafu M, Ndambo MK, Harare J, Murkherjee J, Kulinkina AV, Mbae S, Ndarama E, van den Akker T, Abejirinde IOO. Experiences of community health workers on adopting mHealth in rural Malawi: A qualitative study. Digit Health 2024; 10:20552076241253994. [PMID: 38757088 PMCID: PMC11097726 DOI: 10.1177/20552076241253994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background The use of mobile health technology (mHealth) by community health workers (CHWs) can strengthen community-based service delivery and improve access to and quality of healthcare. Objective This qualitative study sought to explore experiences and identify factors influencing the use of an integrated smartphone-based mHealth called YendaNafe by CHWs in rural Malawi. Methods Using pre-tested interview guides, between August and October 2022, we conducted eight focus group discussions with CHWs (n = 69), four in-depth interviews with CHW supervisors, and eight key informant interviews in Neno District, Malawi. We audio-recorded and transcribed the interviews verbatim and organized them for analysis in Dedoose V9.0.62. We used an inductive analysis technique to analyze the data. We further applied the six domains of the socio-technical system (STS) framework to map factors influencing the use of YendaNafe. Results User experiences and facilitators and barriers were the two main themes that emerged. mHealth was reported to improve the task efficiency, competence, trust, and perceived professionalism of CHWs. CHWs less frequently referred to cultural factors influencing app uptake. However, for other social systems, they identified relationships and trust with stakeholders, availability of training and programmatic support, and performance monitoring and feedback as influencing the use of YendaNafe. From the STS technical domain, the availability and adequacy of hardware such as phones, mobile connectivity, and usability influenced the use of YendaNafe. Conclusions Despite the initial discomfort, CHWs found mHealth helpful in supporting their service delivery tasks. Identifying and addressing social and technical factors during mHealth implementation may help improve end users' attitudes and uptake.
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Affiliation(s)
- Chiyembekezo Kachimanga
- Partners In Health, Neno, Malawi
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | | | - Alexandra V Kulinkina
- Partners In Health, Neno, Malawi
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - Ibukun- Oluwa Omolade Abejirinde
- Women College Hospital Institute for Health System Solutions and Virtual Care, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontorio, Canada
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Obasanjo I, Scott A, Griffin M, Agyemang-Duah A, Westhoff C, Toney S, Shelton P. Understanding the Public Health Role, Motivations, and Perceptions of Community Health Workers Deployed to Low-Income Housing in Richmond, Virginia. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:219-227. [PMID: 36716267 DOI: 10.1177/2752535x231154051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For the US health indicators to improve to the level of other developed countries, the use of Community Health Workers (CHWs) in vulnerable populations has been indicated as a possible long-term intervention. There are few models of long-term deployment of CHWs as part of the district level public health system in the US. METHOD In this study we interviewed CHWs who served as neighborhood-integrated health district staff assigned to low-income housing in Richmond, Virginia for 10 years. Qualitative analyses of their taped and transcribed interviews resulted in 5 themes from the interviews. The themes were Activities, Satisfaction, Strengths, Facilitation/Resources and Challenges. We highlighted quotes from the CHWs interviews for themes and summarized the findings from each theme. RESULTS CHWs carried out a variety of activities daily and these were described. The CHWs were generally satisfied with their job because it enabled them to assist others. The strength of their communities was resilience, and the resources they needed more included physical resources, human resources, political support, and more comprehensive programming. Their client's challenges include transportation, mental health, and physical safety and the CHWs challenge to effectively carrying out their work with clients was trust by community members. CONCLUSION The information garnered from the CHWs would be useful in designing CHW programs at other health districts.
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Affiliation(s)
- Iyabo Obasanjo
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Alison Scott
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Monica Griffin
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Amma Agyemang-Duah
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Charlie Westhoff
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Stephanie Toney
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
| | - Patrice Shelton
- Department of Kinesiology, College of William and Mary, Williamsburg, VA, USA
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Rogers I, Grice-Jackson T, Ford E, Howat J, Salimkumar R, Frere-Smith K, O’Connor N, Bastiaens H, van Marwijk H. The Healthy Hearts Project: Development and evaluation of a website for cardiovascular risk assessment and visualisation and self-management through healthy lifestyle goal-setting. PLOS DIGITAL HEALTH 2023; 2:e0000395. [PMID: 38019808 PMCID: PMC10686463 DOI: 10.1371/journal.pdig.0000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
Materially deprived communities in the UK have excess morbidity and mortality from cardiovascular disease (CVD) but are less likely to engage with formal care pathways. Community engagement and e-health may be more effective ways to promote risk-reducing lifestyle change. The "Healthy Hearts Project" website was designed for use by community health workers (CHWs) for cardiovascular risk assessment and lifestyle goal setting, or for independent use by community members. This paper describes the website's development and evaluation. The website was developed using interactive wire frame prototypes in a user-led approach. Qualitative evaluation of the completed website's usability and acceptability was conducted using the "Thinking Aloud" method in a purposive sample of 10 participants (one voluntary sector employee, three CHWs, two community members and four healthcare professionals). Thinking Aloud interview transcripts were thematically analysed using an inductive approach. A separate quantitative evaluation of usability and the effect of using the website on CVD knowledge and beliefs was conducted. A random sample of 134 participants, recruited using the online platform Prolific, completed the "Attitudes and Beliefs About Cardiovascular Disease" (ABCD) questionnaire before and after using the website, along with the System Usability Scale (SUS). Qualitative evaluation-Four key themes were identified: 1) Website functionality and design-participants generally found the website easy to use and understood the risk communication graphics and the feedback and goal-setting features,; 2) Inclusivity and representation-most participants considered the website inclusive of a range of users/cultures; 3) Language and comprehension-participants found the language used easy to understand but suggested reducing the amount of text; 4) Motivation and barriers to change-participants liked the personalized feedback and empowerment offered by goal-setting but commented on the need for self-motivation. Quantitative evaluation-The mean score across all domains of the ABCD questionnaire (from 2.99 to 3.11, p<0.001) and in the sub-domains relating to attitudes and beliefs around healthy eating and exercise increased after using the website. The mean(sd) score on the SUS was 77.5 (13.5). The website's usability was generally rated well by both quantitative and qualitative measures, and measures of CVD knowledge improved after use. A number of general recommendations for the design of eHealth behaviour change tools are made based on participants' suggestions to improve the website.
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Affiliation(s)
- Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Tom Grice-Jackson
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - John Howat
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Kat Frere-Smith
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | | | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Universiteit Antwerpen, Antwerp, Belgium
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
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Bucher SL, Young A, Dolan M, Padmanaban GP, Chandnani K, Purkayastha S. The NeoRoo mobile app: Initial design and prototyping of an Android-based digital health tool to support Kangaroo Mother Care in low/middle-income countries (LMICs). PLOS DIGITAL HEALTH 2023; 2:e0000216. [PMID: 37878575 PMCID: PMC10599536 DOI: 10.1371/journal.pdig.0000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/12/2023] [Indexed: 10/27/2023]
Abstract
Premature birth and neonatal mortality are significant global health challenges, with 15 million premature births annually and an estimated 2.5 million neonatal deaths. Approximately 90% of preterm births occur in low/middle income countries, particularly within the global regions of sub-Saharan Africa and South Asia. Neonatal hypothermia is a common and significant cause of morbidity and mortality among premature and low birth weight infants, particularly in low/middle-income countries where rates of premature delivery are high, and access to health workers, medical commodities, and other resources is limited. Kangaroo Mother Care/Skin-to-Skin care has been shown to significantly reduce the incidence of neonatal hypothermia and improve survival rates among premature infants, but there are significant barriers to its implementation, especially in low/middle-income countries (LMICs). The paper proposes the use of a multidisciplinary approach to develop an integrated mHealth solution to overcome the barriers and challenges to the implementation of Kangaroo Mother Care/Skin-to-skin care (KMC/STS) in LMICs. The innovation is an integrated mHealth platform that features a wearable biomedical device (NeoWarm) and an Android-based mobile application (NeoRoo) with customized user interfaces that are targeted specifically to parents/family stakeholders and healthcare providers, respectively. This publication describes the iterative, human-centered design and participatory development of a high-fidelity prototype of the NeoRoo mobile application. The aim of this study was to design and develop an initial ("A") version of the Android-based NeoRoo mobile app specifically to support the use case of KMC/STS in health facilities in Kenya. Key functions and features are highlighted. The proposed solution leverages the promise of digital health to overcome identified barriers and challenges to the implementation of KMC/STS in LMICs and aims to equip parents and healthcare providers of prematurely born infants with the tools and resources needed to improve the care provided to premature and low birthweight babies. It is hoped that, when implemented and scaled as part of a thoughtful, strategic, cross-disciplinary approach to reduction of global rates of neonatal mortality, NeoRoo will prove to be a useful tool within the toolkit of parents, health workers, and program implementors.
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Affiliation(s)
- Sherri Lynn Bucher
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Allison Young
- Scholarly Concentration in Public Health Certificate Program, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Madison Dolan
- Scholarly Concentration in Public Health Certificate Program, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Geetha Priya Padmanaban
- Department of Human Centered Computing, Human-Computer Interaction, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Khushboo Chandnani
- Department of Human Centered Computing, Human-Computer Interaction, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Data Science and Health Informatics, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
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Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med 2023; 6:161. [PMID: 37723240 PMCID: PMC10507089 DOI: 10.1038/s41746-023-00899-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/01/2023] [Indexed: 09/20/2023] Open
Abstract
Digital technologies change the healthcare environment, with several studies suggesting barriers and facilitators to using digital interventions by healthcare professionals (HPs). We consolidated the evidence from existing systematic reviews mentioning barriers and facilitators for the use of digital health technologies by HP. Electronic searches were performed in five databases (Cochrane Database of Systematic Reviews, Embase®, Epistemonikos, MEDLINE®, and Scopus) from inception to March 2023. We included reviews that reported barriers or facilitators factors to use technology solutions among HP. We performed data abstraction, methodological assessment, and certainty of the evidence appraisal by at least two authors. Overall, we included 108 reviews involving physicians, pharmacists, and nurses were included. High-quality evidence suggested that infrastructure and technical barriers (Relative Frequency Occurrence [RFO] 6.4% [95% CI 2.9-14.1]), psychological and personal issues (RFO 5.3% [95% CI 2.2-12.7]), and concerns of increasing working hours or workload (RFO 3.9% [95% CI 1.5-10.1]) were common concerns reported by HPs. Likewise, high-quality evidence supports that training/educational programs, multisector incentives, and the perception of technology effectiveness facilitate the adoption of digital technologies by HPs (RFO 3.8% [95% CI 1.8-7.9]). Our findings showed that infrastructure and technical issues, psychological barriers, and workload-related concerns are relevant barriers to comprehensively and holistically adopting digital health technologies by HPs. Conversely, deploying training, evaluating HP's perception of usefulness and willingness to use, and multi-stakeholders incentives are vital enablers to enhance the HP adoption of digital interventions.
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Affiliation(s)
- Israel Júnior Borges do Nascimento
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226-3522, USA
| | - Hebatullah Abdulazeem
- Department of Sport and Health Science, Techanische Universität München, Munich, 80333, Germany
| | - Lenny Thinagaran Vasanthan
- Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Edson Zangiacomi Martinez
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Miriane Lucindo Zucoloto
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University Library of Southern Denmark, Odense, 5230, Denmark
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Tomas Zapata
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark.
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Borges do Nascimento IJ, Abdulazeem HM, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. The global effect of digital health technologies on health workers' competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis. Lancet Digit Health 2023; 5:e534-e544. [PMID: 37507197 PMCID: PMC10397356 DOI: 10.1016/s2589-7500(23)00092-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/31/2023] [Accepted: 04/29/2023] [Indexed: 07/30/2023]
Abstract
Systematic reviews have quantified the effectiveness, feasibility, acceptability, and cost-effectiveness of digital health technologies (DHTs) used by health-care workers. We aimed to collate available evidence on technologies' effect on health-care workers' competencies and performance. We searched the Cochrane Database of Systematic Reviews, Embase, MEDLINE, Epistemonikos, and Scopus for reviews published from database inception to March 1, 2023. Studies assessing the effects of DHTs on the organisational, socioeconomic, clinical, and epidemiological levels within the workplace, and on health-care workers' performance parameters, were included. Data were extracted and clustered into 25 domains using vote counting based on the direction of effect. The relative frequency of occurrence (RFO) of each domain was estimated using R software. AMSTAR-2 tool was used to appraise the quality of reporting, and the Confidence in the Evidence from Reviews of Qualitative research approach developed by Grading of Recommendations Assessment, Development and Evaluation was used to analyse the certainty of evidence among included studies. The 12 794 screened reviews generated 132 eligible records for assessment. Top-ranked RFO identifiers showed associations of DHT with the enhancement of health-care workers' performance (10·9% [95% CI 5·3-22·5]), improvement of clinical practice and management (9·8% [3·9-24·2]), and improvement of care delivery and access to care (9·2% [4·1-20·9]). Our overview found that DHTs positively influence the daily practice of health-care workers in various medical specialties. However, poor reporting in crucial domains is widely prevalent in reviews of DHT, hindering our findings' generalisability and interpretation. Likewise, most of the included reviews reported substantially more data from high-income countries. Improving the reporting of future studies and focusing on low-income and middle-income countries might elucidate and answer current knowledge gaps.
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Affiliation(s)
- Israel Júnior Borges do Nascimento
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; School of Medicine and University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil; Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | | | - Edson Zangiacomi Martinez
- Department of Social Medicine-Biostatistics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Miriane Lucindo Zucoloto
- Department of Social Medicine-Biostatistics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; University Library of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Tomas Zapata
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
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Pedersen K, Schlichter BR. Improving Predictability and Effectiveness in Preventive Digital Health Interventions: Scoping Review. Interact J Med Res 2023; 12:e40205. [PMID: 37471129 PMCID: PMC10401197 DOI: 10.2196/40205] [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: 06/10/2022] [Revised: 11/01/2022] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Lifestyle-related diseases caused by inadequate diet and physical activity cause premature death, loss of healthy life years, and increased health care costs. Randomized controlled trial (RCT) studies indicate that preventive digital health interventions (P-DHIs) can be effective in preventing these health problems, but the results of these studies are mixed. Adoption studies have identified multiple factors related to individuals and the context in which they live that complicate the transfer of positive results from RCT studies to practical use. Implementation studies have revealed barriers to the large-scale implementation of mobile health (mHealth) solutions in general. Consequently, there is no clear path to delivering predictable outcomes from P-DHIs and achieving effectiveness when scaling up interventions to reduce health problems in society. OBJECTIVE This research aimed to expand our understanding of how to increase the outcome predictability of P-DHIs by focusing on physical activity and diet behaviors and amplify our understanding of how to improve effectiveness in large-scale implementations. METHODS The research objective was pursued through a multidisciplinary scoping review. This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) as a guide. A comprehensive search of Web of Science and PubMed limited to English-language journal articles published before January 2022 was conducted. Google Scholar was used for hand searches. Information systems theory was used to identify key constructs influencing outcomes of IT in general. Public health and mHealth literature were used to identify factors influencing the adoption of, outcomes from, and implementation of P-DHIs. Finally, the P-DHI investment model was developed based on information systems constructs and factors from the public health and mHealth literature. RESULTS In total, 203 articles met the eligibility criteria. The included studies used a variety of methodologies, including literature reviews, interviews, surveys, and RCT studies. The P-DHI investment model suggests which constructs and related factors should be emphasized to increase the predictability of P-DHI outcomes and improve the effectiveness of large-scale implementations. CONCLUSIONS The research suggests that outcome predictability could be improved by including descriptions of the constructs and factors in the P-DHI investment model when reporting from empirical studies. Doing so would increase our understanding of when and why P-DHIs succeed or fail. The effectiveness of large-scale implementations may be improved by using the P-DHI investment model to evaluate potential difficulties and possibilities in implementing P-DHIs to create better environments for their use before investing in them and when designing and implementing them. The cost-effectiveness of large-scale implementations is unknown; implementations are far more complicated than just downloading and using apps, and there is uncertainty accompanying implementations given the lack of coordinated control over the constructs and factors that influence the outcome.
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Affiliation(s)
- Keld Pedersen
- Information Systems, Department of Management, Aarhus University, Aarhus C, Denmark
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12
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Tsai YT, Fulcher IR, Li T, Sukums F, Hedt-Gauthier B. Predicting facility-based delivery in Zanzibar: The vulnerability of machine learning algorithms to adversarial attacks. Heliyon 2023; 9:e16244. [PMID: 37234636 PMCID: PMC10205516 DOI: 10.1016/j.heliyon.2023.e16244] [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] [Received: 10/04/2022] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Background Community health worker (CHW)-led maternal health programs have contributed to increased facility-based deliveries and decreased maternal mortality in sub-Saharan Africa. The recent adoption of mobile devices in these programs provides an opportunity for real-time implementation of machine learning predictive models to identify women most at risk for home-based delivery. However, it is possible that falsified data could be entered into the model to get a specific prediction result - known as an "adversarial attack". The goal of this paper is to evaluate the algorithm's vulnerability to adversarial attacks. Methods The dataset used in this research is from the Uzazi Salama ("Safer Deliveries") program, which operated between 2016 and 2019 in Zanzibar. We used LASSO regularized logistic regression to develop the prediction model. We used "One-At-a-Time (OAT)" adversarial attacks across four different types of input variables: binary - access to electricity at home, categorical - previous delivery location, ordinal - educational level, and continuous - gestational age. We evaluated the percent of predicted classifications that change due to these adversarial attacks. Results Manipulating input variables affected prediction results. The variable with the greatest vulnerability was previous delivery location, with 55.65% of predicted classifications changing when applying adversarial attacks from previously delivered at a facility to previously delivered at home, and 37.63% of predicted classifications changing when applying adversarial attacks from previously delivered at home to previously delivered at a facility. Conclusion This paper investigates the vulnerability of an algorithm to predict facility-based delivery when facing adversarial attacks. By understanding the effect of adversarial attacks, programs can implement data monitoring strategies to assess for and deter these manipulations. Ensuring fidelity in algorithm deployment secures that CHWs target those women who are actually at high risk of delivering at home.
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Affiliation(s)
- Yi-Ting Tsai
- Department of Biostatistics, Harvard Chan School of Public Health, Boston, USA
| | - Isabel R. Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Harvard Data Science Initiative, Harvard University, Cambridge, USA
| | - Tracey Li
- D-tree International, Zanzibar, Tanzania
| | - Felix Sukums
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bethany Hedt-Gauthier
- Department of Biostatistics, Harvard Chan School of Public Health, Boston, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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13
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Chasiotis G, Stoyanov SR, Karatzas A, Gravas S. Greek validation of the user version of the Mobile Application Rating Scale (uMARS). J Int Med Res 2023; 51:3000605231161213. [PMID: 36924222 PMCID: PMC10026115 DOI: 10.1177/03000605231161213] [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] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE The original user version of the Mobile Application Rating Scale (uMARS) is an English-language questionnaire that was designed to allow non-expert app users to assess the quality of health apps. We aimed to translate into the Greek language and validate the uMARS. METHODS This was a qualitative prospective study. The World Health Organization translation process was followed and a readily available and free-of-charge app was used for the validation process. Internal consistency and reliability were tested twice within one month by 91 Greek medical students. RESULTS The total uMARS score showed excellent internal consistency (Cronbach's alpha = 0.86). The internal consistencies of its subscales were also very high (engagement alpha = 0.71; functionality alpha = 0.71; aesthetics alpha = 0.67; information alpha = 0.63), with the notable exception of the satisfaction alpha, which was 0.61. The uMARS total score demonstrated almost perfect agreement levels in most of the subscales according to the rWG index from baseline to 1 month. CONCLUSIONS The Greek uMARS is a reliable and valid tool for assessing the quality of mobile apps.
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Affiliation(s)
- Georgios Chasiotis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Anastasios Karatzas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Medical School, University of Cyprus, Nicosia, Cyprus
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14
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Kalmbach DA, Cheng P, Reffi AN, Seymour GM, Ruprich MK, Bazan LF, Pitts DS, Walch O, Drake CL. Racial disparities in treatment engagement and outcomes in digital cognitive behavioral therapy for insomnia among pregnant women. Sleep Health 2023; 9:18-25. [PMID: 36456448 PMCID: PMC9992066 DOI: 10.1016/j.sleh.2022.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In the United States, Black women are disproportionately afflicted with prenatal insomnia. Although cognitive-behavioral therapy for insomnia (CBTI) may represent a strategy to reduce disparities in insomnia, racial minorities attend fewer healthcare appointments and have poorer outcomes from prenatal care and mental health treatment relative to white patients. The present study examined differences in treatment engagement and patient-reported outcomes in non-Hispanic Black and white pregnant women receiving digital CBTI. METHODS Secondary analysis of 39 pregnant women with clinical insomnia who received digital CBTI. Treatment engagement was operationalized as the number of sessions completed (≥4 considered an adequate dose). Treatment outcomes were assessed using the Insomnia Severity Index (ISI; insomnia) and Pittsburgh Sleep Quality Index (PSQI; global sleep disturbance). RESULTS Black women were 4 times more likely than white women to discontinue CBTI before receiving an adequate dose (8.3% vs. 33.3%). Regarding treatment outcomes, white women reported a mean reduction of 5.75 points on the ISI and a reduction of 3.33 points on the PSQI (Cohen's dz = 1.10-1.19). By comparison, Black women reported reductions of 2.13 points on the ISI and 1.53 points on the PSQI, which were statistically non-significant. Differences in treatment engagement did not account for the disparities in patient-reported outcomes. CONCLUSIONS During pregnancy, Black women completed fewer CBTI sessions and experienced poorer treatment outcomes in response to digital CBTI relative to white women. Enhancements to insomnia therapy and its digital delivery may improve adherence and outcomes in Black pregnant women.
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Affiliation(s)
- David A Kalmbach
- Division of Sleep Medicine, Henry Ford Health, Detroit, Michigan, USA.
| | - Philip Cheng
- Division of Sleep Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - Anthony N Reffi
- Division of Sleep Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - Grace M Seymour
- Division of Sleep Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - Melissa K Ruprich
- Division of Sleep Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - Luisa F Bazan
- Division of Sleep Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - D'Angela S Pitts
- Departments of Obstetrics & Gynecology and Maternal-Fetal Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - Olivia Walch
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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15
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Pandey P, Zheng Y. Social positioning matters: A socialized affordance perspective of
mHealth
in India. INFORMATION SYSTEMS JOURNAL 2023. [DOI: 10.1111/isj.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Priyanka Pandey
- School of Management and Marketing University of Westminster London UK
| | - Yingqin Zheng
- School of Business and Management, Department of Digital Innovation Management Royal Holloway, University of London Egham, Surrey UK
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16
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Ebbs D, Benson O, Jasicki S, McCollum S, Cappello M. The Laro Kwo Project: A train the trainer model combined with mobile health technology for community health workers in Northern Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001290. [PMID: 37195969 DOI: 10.1371/journal.pgph.0001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
Community Health Workers (CHWs) in low and middle income countries (LMICs) provide invaluable health resources to their community members. Best practices for developing and sustaining CHW training programs in LMICs have yet to be defined using rigorous standards and measures of effectiveness. With the expansion of digital health to LMICs, few studies have evaluated the role of participatory methodologies combined with the use of mobile health (mHealth) for CHW training program development. We completed a three-year prospective observational study aligned with the development of a community-based participatory CHW training program in Northern Uganda. Twenty-five CHWs were initially trained using a community participatory training methodology combined with mHealth and a train-the-trainer model. Medical skill competency exams were evaluated after the initial training and annually thereafter to assess retention with use of mHealth. After three years, CHWs who advanced to trainer status redeveloped all program materials using a mHealth application and trained a new cohort of 25 CHWs. Implementation of this methodology coupled with longitudinal mHealth training demonstrated an improvement in medical skills over three years among the original cohort of CHWs. Further, we found that the train-the-trainer model with mHealth was highly effective, as the new cohort of 25 CHWs trained by the original CHWs exhibited higher scores when tested on medical skill competencies. The combination of mHealth and participatory methodologies can facilitate the sustainability of CHW training programs in LMIC. Further investigations should focus on comparing specific mHealth modalities for training and clinical outcomes using similar combined methodologies.
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Affiliation(s)
- Daniel Ebbs
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Oyoo Benson
- Pader District Health Office, Pader District, Uganda
| | - Stanton Jasicki
- Emergency Medical Associates, El Segundo, California, United States of America
| | - Sarah McCollum
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Michael Cappello
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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du Plessis D, Mahomed-Asmail F, le Roux T, Graham MA, de Kock T, van der Linde J, Swanepoel DW. mHealth-Supported Hearing Health Training for Early Childhood Development Practitioners: An Intervention Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14228. [PMID: 36361108 PMCID: PMC9658621 DOI: 10.3390/ijerph192114228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
(1) Hearing health training and promotion is a priority for early childhood development (ECD) practitioners, but training opportunities are limited, especially in low- and middle-income countries (LMIC). mHealth (mobile health) has the potential to deliver scalable ear and hearing training to ECD practitioners. (2) This study investigated the effect of an mHealth training intervention program for ECD practitioners to improve knowledge and perceptions of hearing health in young children. An experimental one-group, pre-post-test study included ECD practitioners working with children between birth and 6 years old across 31 neighbouring communities in the Western Cape Province, South Africa. Hearing health training was provided using WhatsApp messages that encompassed infographics and voice notes. Knowledge and perceptions regarding hearing and hearing-related problems in children were surveyed pre-training, directly post training, and 6 months post training. (3) ECD practitioners (N = 1012) between 17 and 71 years of age received the mHealth training program and completed both the pre-and post-training surveys. Overall, knowledge scores indicated a significant improvement from pre- to post training (Z = -22.49; p < 0.001). Six-month post-training knowledge scores were sustained. Content analysis of ECD practitioners' application of the training information 6 months post training indicated improved awareness, practical application, better assistance for hearing problems, and widespread advocacy. (4) The mHealth training program supports improved knowledge and perceptions of ECD practitioners regarding hearing health for young children. With improved knowledge scores maintained 6 months post training, mHealth hearing health training is an effective intervention. An mHealth training program for ECD practitioners provides a scalable, low-cost intervention for primary and secondary prevention in childhood hearing loss, especially in LMICs.
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Affiliation(s)
- Divan du Plessis
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria 0028, South Africa
| | - Faheema Mahomed-Asmail
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria 0028, South Africa
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado and the University of Pretoria, Aurora, CO 80309, USA
| | - Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria 0028, South Africa
| | - Marien Alet Graham
- Department of Science, Mathematics and Technology Education, University of Pretoria, Pretoria 0028, South Africa
| | | | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria 0028, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria 0028, South Africa
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado and the University of Pretoria, Aurora, CO 80309, USA
- Ear Science Institute Australia, Subiaco 6008, Australia
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Laar AS, Harris ML, Shifti DM, Loxton D. Perspectives of health care professionals’ on delivering mHealth sexual and reproductive health services in rural settings in low-and-middle-income countries: a qualitative systematic review. BMC Health Serv Res 2022; 22:1141. [PMID: 36085027 PMCID: PMC9461099 DOI: 10.1186/s12913-022-08512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In low to middle income countries (LMICs) with limited health care providers (HCPs) and health infrastructure, digital technologies are rapidly being adopted to help augment service delivery. In this sphere, sexual and reproductive health (SRH) services are increasingly leveraging mobile health (mHealth) technologies to improve service and information provision in rural areas. This systematic review aimed to identify HCPs perspectives on barriers to, and facilitators of, mobile phone based SRH services and information in rural areas of LMICs from current literature.
Methods
Searches were conducted using the following databases: Medline, Scopus, PsychINFO, CINAHL and Cochrane Library. Based on the inclusion and exclusion criteria, twelve full text qualitative studies published in English between January 2000 and December 2020 were included. The methodological quality of papers was assessed by two authors using the critical skills appraisal programme and synthesized using the narrative thematic analysis approach.
Results
Positive HCPs experiences surrounding the provision of mHealth based SRH services in LMICs included saving consultation time, ability to shift tasks, reduction in travel costs, easy referrals and follow up on clients, convenience in communicating health information confidentially, and the ability to consult groups of clients remotely rather than face-to-face. Barriers to the provision of mHealth reported by HCPs included lack of technological infrastructure, unreliable networks, limited power, the cost of mobile airtime/data and mobile phones and limited technological literacy or skills.
Conclusions
Implementing innovative mHealth based SRH services could bridge a service provision and access gap of SRH information and services in rural areas of LMICs. Despite the advantages of this technology, several challenges associated with delivering mHealth SRH services need to be urgently addressed to enable scale-up and integration of sexual and reproductive mHealth into rural health systems.
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Kim MT, Heitkemper EM, Hébert ET, Hecht J, Crawford A, Nnaka T, Hutson TS, Rhee H, Radhakrishnan K. Redesigning culturally tailored intervention in the precision health era: Self-management science context. Nurs Outlook 2022; 70:710-724. [PMID: 35933178 PMCID: PMC9722518 DOI: 10.1016/j.outlook.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nurse scientists have significantly contributed to health equity and ensuring cultural tailoring of interventions to meet unique needs of individuals. Methodologies for cultural tailoring of self-mangament interventions among marginalized populations have limitedly accommodated intersectionality and group heterogeneity when addressing health needs. PURPOSE Identify methodological limitations in cultural tailoring of interventions among priority populations and issue recommendations on cultural elements that researchers can target to ensure valid cultural tailoring approaches. METHODS Synthesis of literature on health equity, self-management, and implementation and dissemination research. FINDINGS Among priority populations, intersectionality and group heterogeneity has made group-based cultural tailoring approaches less effective in eliciting desirable health outcomes. Precision health methodology could be useful for cultural tailoring of interventions due to the methodology's focus on individual-level tailoring approaches. DISCUSSION We offer ways to advance health equity research using precision health approaches in cultural tailoring through targeting unique elements of culture and relevant psychosocial phenotypes.
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Affiliation(s)
- Miyong T Kim
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX.
| | - Elizabeth M Heitkemper
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Emily T Hébert
- The Center for Health Equity Research, Health Science Center at Houston, School of Publics Health Austin, The University of Texas, Austin, TX
| | - Jacklyn Hecht
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Alison Crawford
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Tonychris Nnaka
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Tara S Hutson
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Hyekyun Rhee
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Kavita Radhakrishnan
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
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20
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Savai S, Kamano J, Misoi L, Wakholi P, Hasan MK, Were MC. Leveraging mHealth usage logs to inform health worker performance in a Resource-Limited setting: Case example of mUzima use for a chronic disease program in Western Kenya. PLOS DIGITAL HEALTH 2022; 1:e0000096. [PMID: 36812583 PMCID: PMC9931325 DOI: 10.1371/journal.pdig.0000096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health systems in low- and middle-income countries (LMICs) can be strengthened when quality information on health worker performance is readily available. With increasing adoption of mobile health (mHealth) technologies in LMICs, there is an opportunity to improve work-performance and supportive supervision of workers. The objective of this study was to evaluate usefulness of mHealth usage logs (paradata) to inform health worker performance. METHODOLOGY This study was conducted at a chronic disease program in Kenya. It involved 23 health providers serving 89 facilities and 24 community-based groups. Study participants, who already used an mHealth application (mUzima) during clinical care, were consented and equipped with an enhanced version of the application that captured usage logs. Three months of log data were used to determine work performance metrics, including: (a) number of patients seen; (b) days worked; (c) work hours; and (d) length of patient encounters. PRINCIPAL FINDINGS Pearson correlation coefficient for days worked per participant as derived from logs as well as from records in the Electronic Medical Record system showed a strong positive correlation between the two data sources (r(11) = .92, p < .0005), indicating mUzima logs could be relied upon for analyses. Over the study period, only 13 (56.3%) participants used mUzima in 2,497 clinical encounters. 563 (22.5%) of encounters were entered outside of regular work hours, with five health providers working on weekends. On average, 14.5 (range 1-53) patients were seen per day by providers. CONCLUSIONS / SIGNIFICANCE mHealth-derived usage logs can reliably inform work patterns and augment supervision mechanisms made particularly challenging during the COVID-19 pandemic. Derived metrics highlight variabilities in work performance between providers. Log data also highlight areas of suboptimal use, of the application, such as for retrospective data entry for an application meant for use during the patient encounter to best leverage built-in clinical decision support functionality.
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Affiliation(s)
- Simon Savai
- Institute of Biomedical Informatics, Moi University, Eldoret, Kenya
- * E-mail: (SS); (MCV)
| | - Jemimah Kamano
- School of Medicine, Moi University, Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Peter Wakholi
- School of Computing and Informatics Technology, Makerere University, Kampala, Uganda
| | - Md Kamrul Hasan
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Martin C. Were
- Department of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail: (SS); (MCV)
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Mantell JE, Masvawure TB, Zech JM, Reidy W, Msukwa M, Glenshaw M, Grund J, Williams D, Pitt B, Rabkin M. "They are our eyes outside there in the community": Implementing enhanced training, management and monitoring of South Africa’s ward-based primary healthcare outreach teams. PLoS One 2022; 17:e0266445. [PMID: 36018854 PMCID: PMC9417004 DOI: 10.1371/journal.pone.0266445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
In 2018, South Africa’s National Department of Health provided additional resources for ward-based primary healthcare outreach teams (OT) with support from the U.S. President’s Emergency Plan for AIDS Relief. The intervention package included a new training curriculum, enhanced staffing, revised management and supervisory structures, and more intensive monitoring and evaluation (M&E). The goal was to strengthen OT and their impact on both primary healthcare and HIV-specific services. We conducted a process evaluation of this intervention package during its second year and examined implementation successes and challenges.
Methods
We conducted a mixed-methods evaluation at 20 purposively selected facilities in Bojanala and City of Tshwane districts, including surveys with 222 community health workers (CHWs) and outreach team leaders (OTLs); key informant interviews and online surveys with 28 policy and program stakeholders; 70 in-depth interviews with health facility staff; 20 focus group discussions with 194 CHWs; 20 structured health facility assessments; directly-observed time-motion studies; and review of program documents.
Results
Most participants highlighted the hiring and training of CHWs and OTLs as a key implementation success because this had partially alleviated staffing shortages and helped clarify CHWs’ and OTLs’ responsibilities and supervisory structures. The new monitoring tools were welcomed for their potential to improve data collection and program tracking. However, participants highlighted many program challenges: short-lived gains in CHWs’ knowledge and skills due to lack of ongoing training and mentoring; insufficient integration of OT into health facility management structures; persistent shortages of equipment, supplies, transportation, and workspace for CHWs; and insufficient remuneration for staff.
Conclusion
Strengthening and expanding CHW programs, such as OT, requires intensive support and continuous investments. To sustain improvements in training, supervision, and job satisfaction, CHWs must be equipped with needed resources, provided with ongoing supportive supervision, and strengthened by optimized program management, monitoring and processes.
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Affiliation(s)
- Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
- * E-mail:
| | - Tsitsi B. Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Jennifer M. Zech
- ICAP at Columbia University, New York, New York, United States of America
| | - William Reidy
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Mary Glenshaw
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Center for Global Health, Pretoria, South Africa
| | - Jonathan Grund
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Center for Global Health, Pretoria, South Africa
| | - Daniel Williams
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Center for Global Health, Pretoria, South Africa
| | - Blanche Pitt
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Miriam Rabkin
- ICAP at Columbia University, New York, New York, United States of America
- Departments of Medicine and Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
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22
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Fredriksson A, Fulcher IR, Russell AL, Li T, Tsai YT, Seif SS, Mpembeni RN, Hedt-Gauthier B. Machine learning for maternal health: Predicting delivery location in a community health worker program in Zanzibar. Front Digit Health 2022; 4:855236. [PMID: 36060544 PMCID: PMC9428344 DOI: 10.3389/fdgth.2022.855236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Maternal and neonatal health outcomes in low- and middle-income countries (LMICs) have improved over the last two decades. However, many pregnant women still deliver at home, which increases the health risks for both the mother and the child. Community health worker programs have been broadly employed in LMICs to connect women to antenatal care and delivery locations. More recently, employment of digital tools in maternal health programs have resulted in better care delivery and served as a routine mode of data collection. Despite the availability of rich, patient-level data within these digital tools, there has been limited utilization of this type of data to inform program delivery in LMICs. Methods We use program data from 38,787 women enrolled in Safer Deliveries, a community health worker program in Zanzibar, to build a generalizable prediction model that accurately predicts whether a newly enrolled pregnant woman will deliver in a health facility. We use information collected during the enrollment visit, including demographic data, health characteristics and current pregnancy information. We apply four machine learning methods: logistic regression, LASSO regularized logistic regression, random forest and an artificial neural network; and three sampling techniques to address the imbalanced data: undersampling of facility deliveries, oversampling of home deliveries and addition of synthetic home deliveries using SMOTE. Results Our models correctly predicted the delivery location for 68%–77% of the women in the test set, with slightly higher accuracy when predicting facility delivery versus home delivery. A random forest model with a balanced training set created using undersampling of existing facility deliveries accurately identified 74.4% of women delivering at home. Conclusions This model can provide a “real-time” prediction of the delivery location for new maternal health program enrollees and may enable early provision of extra support for individuals at risk of not delivering in a health facility, which has potential to improve health outcomes for both mothers and their newborns. The framework presented here is applicable in other contexts and the selection of input features can easily be adapted to match data availability and other outcomes, both within and beyond maternal health.
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Affiliation(s)
- Alma Fredriksson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Correspondence: Alma Fredriksson
| | - Isabel R. Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Harvard Data Science Initiative, Cambridge, MA, United States
| | | | - Tracey Li
- D-tree International, Dar es Salaam, Tanzania
| | - Yi-Ting Tsai
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Rose N. Mpembeni
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bethany Hedt-Gauthier
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Conceptualising the Factors Influencing Community Health Workers’ Preparedness for ICT Implementation: A Systematised Scoping Review. SUSTAINABILITY 2022. [DOI: 10.3390/su14148930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background: Globally, community health workers (CHW) are increasingly viewed as an integral part of the health system as opposed to simply being an extension of it. Given this view, most low- or middle-income countries (LMICs) have refocused their efforts on reorganising CHW initiatives to maximise their impact. The ongoing endeavours to augment the practice of community health workers using technological solutions are characterised by as many challenges as opportunities. In low- and middle-income countries, including South Africa, information and communication technology (ICT) has become a promising development in the enhancement of the equitable coverage of health services by community health workers. However, there has not been a wide-scale implementation and adoption of ICT; most technology initiatives fail to scale up during the implementation stage, which is attributable to human and context-related factors. Although there has been an effort to develop solutions to address ICT infrastructure and technical barriers, conceptualising an evidence-based understanding of the contextual and user-related factors that influence the efficacy of technology adoption by CHWs within their multidimensional system remains critical. Objective: The purpose of the study is to conceptualise the social factors to consider when implementing a bespoke ICT solution suited to the specific demands of CHWs in primary healthcare in developing contexts, with a particular focus on the South African context. Methodology: The methodology involves synthesizing, extracting, and consolidating the findings of a systematised scoping review into concepts and factors. The review adapts Arksey and O’Malley’s scoping review approach to the study and incorporates 59 relevant articles. Results: Although the knowledge base on CHWs is extensive, there is a considerable gap in addressing structural challenges within the community system, which contributes significantly to the overall performance of CHW programs. Factors promoting policy adaptations, common practice within the health system, CHW competencies, a community’s development in terms of knowledge and economic advancement, safety and security, the environment, and the socio-cultural context all play a significant role in facilitating or impeding the success of health interventions from the individual to the national level. Conclusions: Within several practical limitations, the study shows that despite the efforts of various developing countries to promote technology adoption, the barriers to ICT adoption outweigh the benefits gained in developing countries. The paper argues that addressing these challenges before and during implementation is critical. The authors conclude with some essential concerns about assisting CHWs towards realising the desired health outcomes through ICT.
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Kusyanti T, Wirakusumah FF, Rinawan FR, Muhith A, Purbasari A, Mawardi F, Puspitasari IW, Faza A, Stellata AG. Technology-Based (Mhealth) and Standard/Traditional Maternal Care for Pregnant Woman: A Systematic Literature Review. Healthcare (Basel) 2022; 10:healthcare10071287. [PMID: 35885813 PMCID: PMC9322765 DOI: 10.3390/healthcare10071287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
The world of health has changed significantly since the advent of smartphones. Smartphones have been widely known to facilitate the search for health information in the mobile Health (mHealth) system, which is used to improve the quality of life for patients, such as communication between doctors and patients. This systematic literature review aims to identify the use of mHealth as a digital communication tool for pregnant women by comparing technology-based and standard-based pregnancy care. The method used is a systematic review of articles related to pregnancy care that utilize mHealth for pregnant women. The articles were obtained from the database based on the PICO framework; we searched articles using seven databases. The selection was adjusted to the inclusion criteria, data extraction, study quality evaluation, and results from synthesis. From the disbursement, 543 articles were obtained and 10 results were obtained after the screening. After a critical appraisal was carried out, four articles were obtained. Advantages can be in the form of increasing knowledge of pregnant women who use mHealth due to the availability of information needed by pregnant women in the mHealth application. mHealth also provides information about their babies, so the impact of mHealth is not only for mothers. mHealth is a promising solution in pregnancy care compared to the standard of maternal care.
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Affiliation(s)
- Tatik Kusyanti
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia
- Department of Midwifery, Bandung Health Polytechnic, Jl. Sederhana No. 2, Bandung 40161, Indonesia
- Center of Excellence, Bandung Health Polytechnic, Jl. Pajajaran 56, Bandung 40171, Indonesia
- Correspondence:
| | - Firman Fuad Wirakusumah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia;
- Department of Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung 40161, Indonesia
| | - Fedri Ruluwedrata Rinawan
- Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia;
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Ir. Soekarno KM. 21, Jatinangor, Sumedang 45363, Indonesia
- Indonesian Society for Remote Sensing Branch, Gedung Labtek IX-C lt.3 Jalan Ganesha 10, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Abdul Muhith
- Department of Nursing Science, Universitas Nahdlatul Ulama, Surabaya 60237, Indonesia;
| | - Ayi Purbasari
- Informatics Engineering Study Program, Faculty of Engineering, Universitas Pasundan, Jl. Dr. Setiabudi No. 193, Bandung 40153, Indonesia;
| | - Fitriana Mawardi
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia;
| | - Indriana Widya Puspitasari
- Master of Midwifery Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia; (I.W.P.); (A.G.S.)
| | - Afina Faza
- Master of Public Health Study Program, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No. 38 Gedung RSP Unpad Lantai 4, Bandung 40161, Indonesia;
- School of Economic and Business, Telkom University, Bandung 40257, Indonesia
| | - Alyxia Gita Stellata
- Master of Midwifery Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia; (I.W.P.); (A.G.S.)
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Cardiovascular Disease Risk in Rural Adults. J Cardiovasc Nurs 2022; 38:262-271. [PMID: 37027131 DOI: 10.1097/jcn.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) risk reduction programs led by a nurse/community health worker team are effective in urban settings. This strategy has not been adequately tested in rural settings. OBJECTIVE A pilot study was conducted to examine the feasibility of implementing an evidence-based CVD risk reduction intervention adapted to a rural setting and evaluate the potential impact on CVD risk factors and health behaviors. METHODS A 2-group, experimental, repeated-measures design was used; participants were randomized to a standard primary care group (n = 30) or an intervention group (n = 30) where a registered nurse/community health worker team delivered self-management strategies in person, by phone, or by videoconferencing. Outcomes were measured at baseline and at 3 and 6 months. A sample of 60 participants was recruited and retained in the study. RESULTS In-person (46.3%) and telephone (42.3%) meetings were used more than the videoconferencing application (9%). Mean change at 3 months differed significantly between the intervention and control groups for CVD risk (-1.0 [95% confidence interval (CI), -3.1 to 1.1] vs +1.4 [95% CI, -0.4 to 3.3], respectively), total cholesterol (-13.2 [95% CI, -32.1 to 5.7.] vs +21.0 [95% CI, 4.1-38.1], respectively), and low-density lipoprotein (-11.5 [95% CI, -30.8 to 7.7] vs +19.6 [95% CI, 1.9-37.2], respectively). No between-group differences were seen in high-density lipoprotein, blood pressure, or triglycerides. CONCLUSIONS Participants receiving the nurse/community health worker-delivered intervention improved their risk CVD profiles, total cholesterol, and low-density lipoprotein levels at 3 months. A larger study to explore the intervention impact on CVD risk factor disparities experienced by rural populations is warranted.
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Adam M, Job N, Mabaso B, Bärnighausen T, Kuhnert KL, Johnston J, Mqungwana N, Le Roux I, Mbewu N, Gates J, Scott K, Vandormael A, Greuel M, Prober C, McMahon SA. "The Videos Gave Weight to Our Work": Animated mHealth Videos and Tablet Technology Boost Community Health Workers' Perceived Credibility in Khayelitsha, South Africa. QUALITATIVE HEALTH RESEARCH 2022; 32:1273-1284. [PMID: 35674176 DOI: 10.1177/10497323221091504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Mobile health (mHealth) interventions are increasingly used to support community health workers (CHWs) in low-and middle-income countries. As near-peers within their communities, the credibility of CHWs is sometimes questioned-a recognized barrier to their efficacy. Nested within a large, randomized-controlled trial, this qualitative study captured the experiences of South African CHWs, called "Mentor-Mothers," using tablets and animated videos to promote exclusive breastfeeding. We conducted in-depth telephone interviews with 26 tablet-carrying Mentor-Mothers. We analyzed interview transcripts using a Grounded Theory approach, then developed a theoretical framework, based on an emerging theme, for understanding how tablet technology boosts the perceived credibility of CHWs. Tablet-carrying Mentor-Mothers described an increase in their perceived credibility, which they attributed to overt and signaling effects related to enhanced credibility of (1) their messages, (2) themselves as messengers, and (3) the program employing them. Mobile technology investments in CHWs could enhance their credibility, translating into meaningful investments in the health of under-served communities.
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Affiliation(s)
- Maya Adam
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Heidelberg University Institute of Global Health, Heidelberg, Germany
| | - Nophiwe Job
- Digital Medic South Africa, Cape Town, South Africa
| | - Bongekile Mabaso
- School of Management Studies, University of Cape Town, Cape Town, South Africa
| | - Till Bärnighausen
- Heidelberg University Institute of Global Health, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Wellcome Trust's Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | | | | | | | - Ingrid Le Roux
- The Philani Maternal Child Health and Nutrition Trust, Khayelitsha, South Africa
| | - Nokwanele Mbewu
- The Philani Maternal Child Health and Nutrition Trust, Khayelitsha, South Africa
| | - Jennifer Gates
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kerry Scott
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain Vandormael
- Heidelberg University Institute of Global Health, Heidelberg, Germany
| | - Merlin Greuel
- Heidelberg University Institute of Global Health, Heidelberg, Germany
| | - Charles Prober
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Center for Health Education, Stanford, CA, USA
| | - Shannon A McMahon
- Heidelberg University Institute of Global Health, Heidelberg, Germany
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rodrigues SM, Kanduri A, Nyamathi A, Dutt N, Khargonekar P, Rahmani AM. Digital Health-Enabled Community-Centered Care: Scalable Model to Empower Future Community Health Workers Using Human-in-the-Loop Artificial Intelligence. JMIR Form Res 2022; 6:e29535. [PMID: 35384853 PMCID: PMC9021941 DOI: 10.2196/29535] [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: 04/11/2021] [Revised: 01/29/2022] [Accepted: 02/19/2022] [Indexed: 11/13/2022] Open
Abstract
Digital health-enabled community-centered care (D-CCC) represents a pioneering vision for the future of community-centered care. D-CCC aims to support and amplify the digital footprint of community health workers through a novel artificial intelligence-enabled closed-loop digital health platform designed for, and with, community health workers. By focusing digitalization at the level of the community health worker, D-CCC enables more timely, supported, and individualized community health worker-delivered interventions. D-CCC has the potential to move community-centered care into an expanded, digitally interconnected, and collaborative community-centered health and social care ecosystem of the future, grounded within a robust and digitally empowered community health workforce.
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Affiliation(s)
- Sarah M Rodrigues
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
| | - Anil Kanduri
- Department of Computing, University of Turku, Turku, Finland
| | - Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
| | - Nikil Dutt
- Department of Computer Science, University of California, Irvine, CA, United States
| | - Pramod Khargonekar
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA, United States
| | - Amir M Rahmani
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
- Department of Computer Science, University of California, Irvine, CA, United States
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA, United States
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28
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Uwizeye CB, Zomahoun HTV, Bussières A, Thomas A, Kairy D, Massougbodji J, Rheault N, Tchoubi S, Philibert L, Abib Gaye S, Khadraoui L, Ben Charif A, Diendéré E, Langlois L, Dugas M, Légaré F. Implementation strategies for knowledge products in primary healthcare: a systematic review of systematic reviews (Preprint). Interact J Med Res 2022; 11:e38419. [PMID: 35635786 PMCID: PMC9315889 DOI: 10.2196/38419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception. Objective This study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. Methods We performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis. Results Of the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level. Conclusions Clinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes.
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Affiliation(s)
- Claude Bernard Uwizeye
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
| | - Dahlia Kairy
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montreal, QC, Canada
| | - José Massougbodji
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
- Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Nathalie Rheault
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Sébastien Tchoubi
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
| | - Leonel Philibert
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- Faculty of Nursing, Laval University, Québec, QC, Canada
| | - Serigne Abib Gaye
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
| | - Lobna Khadraoui
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Ali Ben Charif
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada
- CubecXpert, Québec, QC, Canada
| | - Ella Diendéré
- Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Léa Langlois
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - France Légaré
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada
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Huang Y, Emery J, Naughton F, Cooper S, McDaid L, Dickinson A, Clark M, Kinahan-Goodwin D, Thomson R, Phillips L, Lewis S, Orton S, Coleman T. The development and acceptability testing of an app-based smart survey system to record smoking behaviour, use of nicotine replacement therapy (NRT) and e-cigarettes. BMC Res Notes 2022; 15:100. [PMID: 35272684 PMCID: PMC8908557 DOI: 10.1186/s13104-022-05983-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/22/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Nicotine replacement therapy (NRT) helps people stop smoking. Monitoring treatment adherence is important as poor adherence to NRT limits its effectiveness. As e-cigarettes contain nicotine, their use (‘vaping’) is likely to affect both NRT use and smoking. We wished to measure adherence to NRT, and to investigate relationships between NRT, vaping and smoking so we developed ‘NicUse’, a smartphone App linked to a cloud database for collecting data relevant to NRT adherence. We report user-acceptability and investigate data validity among pregnant people by comparing heaviness of smoking reported to NicUse surveys with contemporaneous exhaled carbon monoxide readings. Results Thirty five pregnant women participating in a pilot study were asked to install and use NicUse on their smartphones. 32/35 (91%) logged into NicUse, 31 (89%) completed one or more surveys, and 22 (63%) completed these on ≥ 20 of 28 study days. Twenty-four gave end-of-study user acceptability ratings; 23 (96%) agreed or strongly agreed NicUse was ‘Easy to use’ and ‘Instructions were clear’. There was a strong correlation between the number of daily cigarettes reported on NicUse and exhaled CO readings taken on study Day 7 (Pearson’s r = 0.95, p < 0.001). NicUse appears highly acceptable, and smoking data reported to it shows validity. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05983-8.
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Affiliation(s)
- Yue Huang
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Joanne Emery
- School of Health Sciences, University of East Anglia, Norwich, NR4 7UL, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, NR4 7UL, UK
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Lisa McDaid
- School of Health Sciences, University of East Anglia, Norwich, NR4 7UL, UK
| | - Anne Dickinson
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Miranda Clark
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | | | - Ross Thomson
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Lucy Phillips
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
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Li S, Yin Z, Lesser J, Li C, Choi BY, Parra-Medina D, Flores B, Dennis B, Wang J. A Community Health Worker-Led mHealth-Enabled Diabetes Self-Management Education and Support Intervention in Rural Latino Adults: Single-Arm Feasibility Trial (Preprint). JMIR Diabetes 2022; 7:e37534. [PMID: 35635752 PMCID: PMC9153909 DOI: 10.2196/37534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/19/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Latinos living in rural South Texas have a higher prevalence of diabetes, but their access to diabetes self-management education and support (DSMES) is limited. Objective We aimed to test the feasibility of a community health worker-led, mobile health (mHealth)-based DSMES intervention to reduce disparities in accessing DSMES in underserved rural Latino residents in South Texas. Methods This 12-week, single-arm, pre-post trial was delivered by trained community health workers to 15 adults with type 2 diabetes. The intervention consisted of digital diabetes education, self-monitoring, a cloud-based connected platform, and community health worker support. Feasibility was evaluated as retention, actual intervention use, program satisfaction, and barriers to implementation. We also explored the intervention’s effect on weight loss and hemoglobin A1c (HbA1c). Results All 15 participants were Latino (mean age 61.87 years, SD 10.67; 9/15 female, 60%). The retention rate at posttest was 14 of 15 (93%). On average, the participants completed 37 of 42 (88%) digital diabetes education lessons with 8 participants completing all lessons. Participants spent 81/91 days (89%) step tracking, 71/91 days (78%) food logging, 43/91 days (47%) blood glucose self-monitoring, and 74/91 days (81%) weight self-monitoring. The level of program satisfaction was high. On average, participants lost 3.5 (SD 3.2) kg of body weight (P=.001), while HbA1c level remained unchanged from baseline (6.91%, SD 1.28%) to posttest (7.04%, SD 1.66%; P=.668). Conclusions A community health worker-led mHealth-based intervention was feasible and acceptable to improve access to DSMES services for Latino adults living in rural communities. Future randomized controlled trials are needed to test intervention efficacy on weight loss and glycemic control.
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Affiliation(s)
- Shiyu Li
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Zenong Yin
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Janna Lesser
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Chengdong Li
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Deborah Parra-Medina
- Latino Research Institute, The University of Texas at Austin, Austin, TX, United States
| | - Belinda Flores
- South Coastal Area Health Education Center, Corpus Christi, TX, United States
| | - Brittany Dennis
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, FL, United States
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Effects of Out-of-Hospital Continuous Nursing on Postoperative Breast Cancer Patients by Medical Big Data. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9506915. [PMID: 35035864 PMCID: PMC8758290 DOI: 10.1155/2022/9506915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022]
Abstract
This study aimed to explore the application value of the intelligent medical communication system based on the Apriori algorithm and cloud follow-up platform in out-of-hospital continuous nursing of breast cancer patients. In this study, the Apriori algorithm is optimized by Amazon Web Services (AWS) and graphics processing unit (GPU) to improve its data mining speed. At the same time, a cloud follow-up platform-based intelligent mobile medical communication system is established, which includes the log-in, my workstation, patient records, follow-up center, satisfaction management, propaganda and education center, SMS platform, and appointment management module. The subjects are divided into the control group (routine telephone follow-up, 163) and the intervention group (continuous nursing intervention, 216) according to different nursing methods. The cloud follow-up platform-based intelligent medical communication system is used to analyze patients' compliance, quality of life before and after nursing, function limitation of affected limb, and nursing satisfaction under different nursing methods. The running time of Apriori algorithm is proportional to the data amount and inversely proportional to the number of nodes in the cluster. Compared with the control group, there are statistical differences in the proportion of complete compliance data, the proportion of poor compliance data, and the proportion of total compliance in the intervention group (P < 0.05). After the intervention, the scores of the quality of life in the two groups are statistically different from those before treatment (P < 0.05), and the scores of the quality of life in the intervention group were higher than those in the control group (P < 0.05). The proportion of patients with limited and severely limited functional activity of the affected limb in the intervention group is significantly lower than that in the control group (P < 0.05). The satisfaction rate of postoperative nursing in the intervention group is significantly higher than that in the control group (P < 0.001), and the proportion of basically satisfied and dissatisfied patients in the control group was higher than that in the intervention group (P < 0.05).
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Dinakrisma AA, Laksmi PW, Abdiel T, Fernandez JP, Indahwati N, Susanto AP, Indrajaya Lukmana AA, Yusuf PA. The role of digital mobile technology in elderly health management among health care workers in Indonesia: Analysis of knowledge, attitudes, and practice. Digit Health 2022; 8:20552076221102771. [PMID: 35646377 PMCID: PMC9131384 DOI: 10.1177/20552076221102771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Technology, including information and communication technology (ICT), plays a significant role in the quality of health services. However, its application in elderly health services is still lacking. The aim of this study was to determine the knowledge of, attitudes toward, and practices of cell phone and mobile application use for elderly health care among Indonesian health care workers. Methods This was a cross-sectional study conducted with health care workers in Jakarta, Indonesia. The potential subjects were contacted through instant messenger application and/or through conventional short message service or telephone calls from August through November 2020. Results There were 134 subjects. All the subjects had used various health applications to assist with their daily work, including telemedicine (64.2%), guidelines (60.4%), and medical calculators (46.3%). However, 96.3% of the subjects were not aware of the existence of a health application for geriatric assessment. Furthermore, 98.5% of subjects thought that it is important to use ICT to manage geriatric patients, and 94.8% felt that comprehensive geriatric assessment (CGA) in digital form would help them manage geriatric patients better. Nevertheless, 35.10% of subjects had never applied CGA to their geriatric patients. Conclusions The current health care system has begun to enter a period of using ICT in performing health services for geriatric patients. Nevertheless, only a few Indonesian health care workers were aware of or were using the geriatric mobile application. It is essential to improve the dissemination of geriatric health care and e-health literacy among them to improve the quality of elderly health care.
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Affiliation(s)
- Anastasia A. Dinakrisma
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Purwita Wijaya Laksmi
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Teofilus Abdiel
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Johannes P. Fernandez
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nuri Indahwati
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anindya Pradipta Susanto
- Department of Medical Physics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Prasandhya Astagiri Yusuf
- Department of Medical Physics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Perez H, Neubauer N, Marshall S, Philip S, Miguel-Cruz A, Liu L. Barriers and Benefits of Information Communication Technologies Used by Health Care Aides. Appl Clin Inform 2022; 13:270-286. [PMID: 35263800 PMCID: PMC8906996 DOI: 10.1055/s-0042-1743238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although information and communication technologies (ICT) are becoming more common among health care providers, there is little evidence on how ICT can support health care aides. Health care aides, also known as personal care workers, are unlicensed service providers who encompass the second largest workforce, next to nurses, that provide care to older adults in Canada. OBJECTIVE The purpose of this literature review is to examine the range and extent of barriers and benefits of ICT used by health care workers to manage and coordinate the care-delivery workflow for their clients. METHODS We conducted a literature review to examine the range and extent of ICT used by health care aides to manage and coordinate their care delivery, workflow, and activities. We identified 8,958 studies of which 40 were included for descriptive analyses. RESULTS We distinguished the following five different purposes for the use and implementation of ICT by health care aides: (1) improve everyday work, (2) access electronic health records for home care, (3) facilitate client assessment and care planning, (4) enhance communication, and (5) provide care remotely. We identified 128 barriers and 130 benefits related to adopting ICT. Most of the barriers referred to incomplete hardware and software features, time-consuming ICT adoption, heavy or increased workloads, perceived lack of usefulness of ICT, cost or budget restrictions, security and privacy concerns, and lack of integration with technologies. The benefits for health care aides' adoption of ICT were improvements in communication, support to workflows and processes, improvements in resource planning and health care aides' services, and improvements in access to information and documentation. CONCLUSION Health care aides are an essential part of the health care system. They provide one-on-one care to their clients in everyday tasks. Despite the scarce information related to health care aides, we identified many benefits of ICT adoption.
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Affiliation(s)
- Hector Perez
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Noelannah Neubauer
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Samantha Marshall
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Serrina Philip
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Antonio Miguel-Cruz
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada.,Glenrose Rehabilitation Hospital, Edmonton (AB), Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton (AB), Canada
| | - Lili Liu
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
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Gandhi P A, Kathirvel S, Chakraborty S. Rural community health workers’ readiness for mobile-phone based telemedicine uptake in India. J Rural Med 2022; 17:166-170. [PMID: 35847763 PMCID: PMC9263958 DOI: 10.2185/jrm.2021-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 04/18/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Aravind Gandhi P
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, India
| | - Soundappan Kathirvel
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, India
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Patel V, Chesmore A, Legner CM, Pandey S. Trends in Workplace Wearable Technologies and Connected‐Worker Solutions for Next‐Generation Occupational Safety, Health, and Productivity. ADVANCED INTELLIGENT SYSTEMS 2021. [DOI: 10.1002/aisy.202100099] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Vishal Patel
- Department of Electrical & Computer Engineering Iowa State University 2126 Coover Hall Ames IA 50011 USA
| | - Austin Chesmore
- Department of Electrical & Computer Engineering Iowa State University 2126 Coover Hall Ames IA 50011 USA
| | - Christopher M. Legner
- Department of Electrical & Computer Engineering Iowa State University 2126 Coover Hall Ames IA 50011 USA
| | - Santosh Pandey
- Department of Electrical & Computer Engineering Iowa State University 2126 Coover Hall Ames IA 50011 USA
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“Through their eyes, I can work” – rural physicians' perceptions about mobile phone use among community health workers – a qualitative analysis. HEALTH EDUCATION 2021. [DOI: 10.1108/he-12-2020-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Physicians who are primary care providers in rural communities form an essential stakeholder group in rural mobile health (mHealth) delivery. This study was exploratory in nature and was conducted in Udupi district of Karnataka, India. The purpose of this study is to examine the perceptions of rural medical officers (MOs) (rural physicians) regarding the benefits and challenges of mobile phone use by community health workers (CHWs).
Design/methodology/approach
In-depth interviews were conducted among 15 MOs belonging to different primary health centers of the district. Only MOs with a minimum five years of experience were recruited in the study using purposive and snowball sampling. This was followed by thematic analysis of the data collected.
Findings
The perceptions of MOs regarding the CHWs' use of mobile phones were largely positive. However, they reported the existence of some challenges that limits the potential of its full use. The findings were categorized under four themes namely, benefits of mobile phone use to CHWs, benefits of mobile phone-equipped CHWs, current mobile phone use by CHWs and barriers to CHWs' mobile phone use. The significant barriers reported in the CHWs' mobile phone use were poor mobile network coverage, technical illiteracy, lack of consistent technical training and call and data expense of the CHWs. The participants recommend an increased number of mobile towers, frequent training in mobile phone use and basic English language for the CHWs as possible solutions to the barriers.
Originality/value
Studies examining the perceptions of doctors who are a primary stakeholder group in mHealth as well as in the public health system scenario are limited. To the authors’ knowledge, this is one of the first studies to examine the perception of rural doctors regarding CHWs' mobile phone use for work in India.
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Wattanapisit A, Amaek W, Wattanapisit S, Tuangratananon T, Wongsiri S, Pengkaew P. Challenges of Implementing an mHealth Application for Personalized Physical Activity Counselling in Primary Health Care: A Qualitative Study. Int J Gen Med 2021; 14:3821-3831. [PMID: 34335048 PMCID: PMC8318008 DOI: 10.2147/ijgm.s317241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/09/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction A mobile health (mHealth) technology has the potential to facilitate personalized physical activity (PA) counselling. We aimed to explore the feasibility and challenges of implementing a newly developed mHealth application (PAC app) for personalized PA counselling. Material and Methods A qualitative design employed a descriptive phenomenology approach. Data were collected through focus group discussions (FGDs) with primary health care (PHC) providers and were analyzed using a deductive thematic approach. Results A total of 16 participants participated in four FGDs. Four major themes were found: application for personalized PA counselling, barriers to the use of the application by providers, patient involvement, and impact on PHC services. Discussion The results showed that the new mHealth application can potentially facilitate PA counselling. However, its use in PHC settings requires an understanding of the context of service delivery; the challenges faced by providers and patients and effects on services must be considered. Conclusion Future research should focus on the long-term use of PAC app and its impact on behavioral and health outcomes.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.,Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Waluka Amaek
- College of Graduate Studies, Walailak University, Nakhon Si Thammarat, Thailand
| | | | | | - Sunton Wongsiri
- Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Prasert Pengkaew
- School of Informatics, Walailak University, Nakhon Si Thammarat, Thailand
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Rinawan FR, Susanti AI, Amelia I, Ardisasmita MN, Widarti, Dewi RK, Ferdian D, Purnama WG, Purbasari A. Understanding mobile application development and implementation for monitoring Posyandu data in Indonesia: a 3-year hybrid action study to build "a bridge" from the community to the national scale. BMC Public Health 2021; 21:1024. [PMID: 34059029 PMCID: PMC8165997 DOI: 10.1186/s12889-021-11035-w] [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: 02/04/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu (Posyandu/Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia. METHODS A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition. RESULTS (1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs' knowledge (p = 0.000) and skills (p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia. CONCLUSIONS The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs' book. Hence, its implementation is promising for use at the national level.
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Affiliation(s)
- Fedri Ruluwedrata Rinawan
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia. .,Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.
| | - Ari Indra Susanti
- Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Mother and Child Health Division, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia
| | - Indah Amelia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia
| | - Mulya Nurmansyah Ardisasmita
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Biostatistics and Epidemiology Division, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia
| | - Widarti
- Midwifery Master Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Puskesmas Sungai Durian, Jl. MT Haryono Gg. Wiyata 2, Kelurahan Kapuas Kanan Hulu, Kecamatan Sintang, Kab. Sintang, West Kalimantan, 78614, Indonesia
| | - Rima Kusumah Dewi
- Midwifery Master Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Makassar Regional General Hospital, Jl. Perintis Kemerdekaan No.KM.14, Daya, Kec. Biringkanaya, Kota Makassar, South Sulawesi, 90243, Indonesia
| | - Dani Ferdian
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia.,Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung, West Java, 40161, Indonesia
| | - Wanda Gusdya Purnama
- Informatics Engineering Study Program, Faculty of Engineering, Universitas Pasundan, Jl. Dr. Setiabudi No.193, Bandung, West Java, 40153, Indonesia
| | - Ayi Purbasari
- Informatics Engineering Study Program, Faculty of Engineering, Universitas Pasundan, Jl. Dr. Setiabudi No.193, Bandung, West Java, 40153, Indonesia
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Naranjo-Rojas A, Perula-de-Torres LÁ, Cruz-Mosquera FE, Molina-Recio G. Mobile application for monitoring patients under home oxygen therapy: a protocol for a randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:104. [PMID: 34039277 PMCID: PMC8157712 DOI: 10.1186/s12875-021-01450-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/04/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mobile technologies have become capable of changing the paradigm of healthcare services. A clear example is that, nowadays, these technologies are an important instrument for data collection processes, epidemiologic surveillance, health promotion and disease prevention. Therefore, technological tools should be exploited to optimize the monitoring of patients with chronic diseases, including patients who require home oxygen therapy. PURPOSE The purpose of this study is to determine the efficacy of a mobile application in the clinical monitoring of patients under home oxygen therapy. METHODS This is a randomized controlled trial includes subjects of 18 years or older diagnosed with Chronic Obstructive Pulmonary Disease (COPD) who are under home oxygen therapy. Subjects will be divided into two arms: the intervention group will include patients who will be monitored with a mobile application, and the control group will include patients monitored by conventional follow-up methods (periodic visits of a respiratory therapist). The following outcome variables will be considered to measure the effect of the intervention: identification of dyspnea self-management, number of acute exacerbations associated with oxygen therapy, and the occurrence of oxygen supply underuse. DISCUSSION This study is expected to assess the efficacy of a mobile application in the follow up of patients under home oxygen therapy. It will also determine whether the monitoring of a six-month intervention by a team comprising a physician, a nurse and respiratory therapists can decrease acute exacerbations, determine the most appropriate oxygen dose, and identify the underuse of oxygen systems and supplies. TRIAL REGISTRATION The study has been registered at ClinicalTrials.gov ( NCT04820790 ; date of registration: March 29, 2021).
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Affiliation(s)
- Anisbed Naranjo-Rojas
- School of Medicine, GINEYSA - GISI. USC Research Groups, Universidad Santiago de Cali, Cali, Colombia.
| | - Luis Ángel Perula-de-Torres
- Multiprofessional teaching unit for Family and Community Care of the Córdoba and Guadalquivir District. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofia, Universidad de Córdoba, Cordoba, Spain
| | | | - Guillermo Molina-Recio
- Nursing, Pharmacology and Physiotherapy Department, University of Cordoba. Lifestyles, Innovation and Health (GA-16). Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
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MORSELLI SIMONE, SEBASTIANELLI ARCANGELO, DOMNICH ALEXANDER, BUCCHI CHIARA, SPATAFORA PIETRO, LIACI ANDREA, GEMMA LUCA, GRAVAS STAVROS, PANATTO DONATELLA, STOYANOV STOYAN, SERNI SERGIO, GACCI MAURO. Translation and validation of the Italian version of the user version of the Mobile Application Rating Scale (uMARS). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E243-E248. [PMID: 34322643 PMCID: PMC8283658 DOI: 10.15167/2421-4248/jpmh2021.62.1.1894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Background Health sciences are steadily developing apps to help people to adopt correct lifestyles and to help physicians to monitor patients with chronic diseases. However, a properly validated tool that can evaluate patients' perception of apps is still lacking in many languages. In English, a validated questionnaire, called User Version of the Mobile Application Rating Scale (uMARS), is currently available. We translated the uMARS into Italian and validated our version. Methods The uMARS questionnaire was translated from English to Italian by an official translator, and then administered to 100 smartphone users in order to evaluate the same app at times 1 and 2 (after 2 weeks). Paired t-test, Pearson Correlation Coefficient, Intraclass Correlation Coefficient (ICCs) and Cronbach's Alpha were used to evaluate the reliability and validity of the Italian uMARS. Results We recruited 100 subjects, 52 males (52%) and 48 females (48%), with a mean age of 22.8 (SD: 3.4). All subjects answered all questions both at time 1 and at time 2. Paired t-test showed no statistically significant difference in each answer or group of answers between times 1 and 2 (P > 0.05). Cronbach's alpha was 0.945, as all subjects answered all questions. Each question was further assessed through the Pearson correlation coefficient, which demonstrated high reliability, with significant P (< 0.05) and Pearson Coefficients higher than 0.7. Similarly, ICCs were always higher than 0.750. Conclusions Our results validated the Italian version of uMARS, which may become a reliable and useful tool for evaluating health apps.
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Affiliation(s)
- SIMONE MORSELLI
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Florence, Italy
- Correspondence: Simone Morselli, Department of Minimally Invasive and Robotic Urologic Surgery, University of Florence, largo Brambilla 3, 50134 Florence, Italy - Tel.: +39 347 3050852 - E-mail:
| | - ARCANGELO SEBASTIANELLI
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Florence, Italy
| | - ALEXANDER DOMNICH
- Hygiene Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - CHIARA BUCCHI
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - PIETRO SPATAFORA
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Florence, Italy
| | - ANDREA LIACI
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Florence, Italy
| | - LUCA GEMMA
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Florence, Italy
| | - STAVROS GRAVAS
- Department of Urology, University of Thessaly, Larissa, Greece
| | | | - STOYAN STOYANOV
- School of Design, Creative Industries Faculty, Queensland University of Technology, Brisbane, QLD, Australia
| | - SERGIO SERNI
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Florence, Italy
| | - MAURO GACCI
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Florence, Italy
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Quintiliani LM, Whiteley JA, Murillo J, Lara R, Jean C, Quinn EK, Kane J, Crouter SE, Heeren TC, Bowen DJ. Community health worker-delivered weight management intervention among public housing residents: A feasibility study. Prev Med Rep 2021; 22:101360. [PMID: 33816090 PMCID: PMC8008178 DOI: 10.1016/j.pmedr.2021.101360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023] Open
Abstract
Community health worker-led interventions may be an optimal approach to promote behavior change among populations with low incomes due to the community health workers’ unique insights into participants’ social and environmental contexts and potential ability to deliver interventions widely. The objective was to determine the feasibility (implementation, acceptability, preliminary efficacy) of a weight management intervention for adults living in public housing developments. In 2016–2018, in Boston Massachusetts, we conducted a 3-month, two-group randomized trial comparing participants who received a tailored feedback report (control group) to participants who received the same report plus behavioral counseling. Community health workers provided up to 12 motivational interviewing-based counseling sessions in English or Spanish for diet and physical activity behaviors using a website designed to guide standardized content delivery. 102 participants enrolled; 8 (7.8%) were lost at 3-month follow up. Mean age was 46.5 (SD = 11.9) years; the majority were women (88%), Hispanic (67%), with ≤ high school degree (62%). For implementation, among intervention group participants (n = 50), 5 completed 0 sessions and 45 completed a mean of 4.6 (SD = 3.1) sessions. For acceptability, most indicated they would be very likely (79%) to participate again. For preliminary efficacy, adjusted linear regression models showed mean changes in weight (-0.94 kg, p = 0.31), moderate-to-vigorous physical activity (+11.7 min/day, p = 0.14), and fruit/vegetable intake (+2.30 servings/day, p < 0.0001) in the intervention vs. control group. Findings indicate a low-income public housing population was reached through a community health worker-led intervention with sufficient implementation and acceptability and promising beneficial changes in weight, nutrition, and physical activity outcomes.
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Affiliation(s)
- Lisa M Quintiliani
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston Medical Center, United States
| | - Jessica A Whiteley
- University of Massachusetts Boston, College of Nursing and Health Sciences, Department of Exercise and Health Sciences, United States
| | - Jennifer Murillo
- Section of General Internal Medicine, Boston Medical Center, United States
| | - Ramona Lara
- Section of General Internal Medicine, Boston Medical Center, United States
| | - Cheryl Jean
- Section of General Internal Medicine, Boston Medical Center, United States
| | - Emily K Quinn
- Boston University, School of Public Health, Biostatics and Epidemiology Data Analytics Center, United States
| | - John Kane
- Boston Housing Authority, United States
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, United States
| | - Timothy C Heeren
- Department of Biostatistics, Boston University, School of Public Health, United States
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, United States
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Desrosiers A, Schafer C, Esliker R, Jambai M, Betancourt T. mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25443. [PMID: 33528371 PMCID: PMC7946434 DOI: 10.2196/25443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background Past trauma and exposure to violence have been related to poor emotion regulation and household violence, which can have persistent mental health effects across generations. The Family Strengthening Intervention for Early Childhood Development (FSI-ECD/called Sugira Muryango in Rwanda) is an evidence-based behavioral home-visiting intervention to promote caregiver mental health, positive parenting practices, and early childhood development among families facing adversity. In Sierra Leone and other lower- and middle-income countries, mobile health (mHealth) technology has the potential to improve health care delivery and health outcomes. Objective This study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the FSI-ECD and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care. Methods We will recruit and enroll CHWs, supervisors, and families with a child aged 6-36 months from community health clinics in Sierra Leone. CHWs and supervisors will participate in 1 problem analysis focus group and 2 user interface/user experience cycles to provide feedback on mHealth tool prototypes. Families will be randomized to mHealth-supported FSI-ECD or standard maternal and child health services. We will collect quantitative data on caregiver mental health, emotion regulation, caregiving behaviors, and family functioning at baseline, postintervention, and 3-month follow up. We will use a mixed methods approach to explore feasibility and acceptability of mHealth tools and the FSI-ECD. Mixed effects linear modeling will assess FSI-ECD effects on caregiver outcomes. Cost-effectiveness analysis will estimate costs across FSI-ECD versus standard care. Results Funding for this study was received from the National Institutes of Mental Health on August 17, 2020. Institutional Review Board approval was received on September 4, 2020. Data collection is projected to begin on December 15, 2020. Conclusions This study will provide important data on the feasibility, acceptability, and preliminary efficacy of mHealth-supported delivery of an evidence-based family home-visiting intervention in a postconflict LMIC. Trial Registration ClinicalTrials.gov NCT04481399; https://clinicaltrials.gov/ct2/show/NCT04481399. International Registered Report Identifier (IRRID) PRR1-10.2196/25443
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Affiliation(s)
| | - Carolyn Schafer
- Boston College, School of Social Work, Chestnut Hill, MA, United States
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Mahmood H, Mckinstry B, Luz S, Fairhurst K, Nasim S, Hazir T. Community health worker-based mobile health (mHealth) approaches for improving management and caregiver knowledge of common childhood infections: A systematic review. J Glob Health 2020; 10:020438. [PMID: 33437462 PMCID: PMC7774026 DOI: 10.7189/jogh.10.020438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Children in lower middle-income countries (LMICs) are more at risk of dying, than those in High Income Countries (HICs), due to highly prevalent deadly yet preventable childhood infections. Alongside concerns about the incidence of these infections, there has been a renewed interest in involving community health workers (CHWs) in various public health programs. However, as CHWs are increasingly asked to take on different tasks there is a risk that their workload may become unmanageable. One solution to help reduce this burden is the use of mobile health (mHealth) technology in the community through behaviour change. Considering there are various CHWs based mHealth approaches on illness management and education, therefore, we aimed to appraise the available literature on effectiveness of these mHealth approaches for caregivers to improve knowledge and management about common under-five childhood infections with respect to behaviour change. Methods We searched six databases between October to December 2019 using subject heading (Mesh) and free text terms in title or abstract in US English. We included multiple study types of children under-five or their caregivers who have been counselled, educated, or provided any health care service by CHWs for any common paediatric infectious diseases using mHealth. We excluded articles published prior to 1990 and those including mHealth technology not coming under the WHO definition. A data extraction sheet was developed and titles, abstracts, and selected full text were reviewed by two reviewers. Quality assessment was done using JBI tools. Results We included 23 articles involving around 300 000 individuals with eight types of study designs. 20 studies were conducted in Africa, two in Asia, and one in Latin America mainly on pneumonia or respiratory tract infections followed by malaria and diarrhoea in children. The most common types of Health approaches were mobile applications for decision support, text message reminders and use of electronic health record systems. None of the studies employed the use of any behaviour change model or any theoretical framework for selection of models in their studies. Conclusions Coupling mhealth with CHWs has the potential to benefit communities in improving management of illnesses in children under-five. High quality evidence on impact of such interventions on behaviour is relatively sparse and further studies should be conducted using theoretically informed behaviour change frameworks/models. Registration PROPSERO Registration number: CRD42018117679
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Affiliation(s)
- Hana Mahmood
- Maternal, Neonatal and Child Health Research Network (MNCHRN), Pakistan.,NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Brian Mckinstry
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Saturnino Luz
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Karen Fairhurst
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Sumaira Nasim
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Tabish Hazir
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
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Intelligent Rehabilitation Assistance Tools for Distal Radius Fracture: A Systematic Review Based on Literatures and Mobile Application Stores. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:7613569. [PMID: 33062041 PMCID: PMC7542482 DOI: 10.1155/2020/7613569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022]
Abstract
Objective To systematically analyze the existing intelligent rehabilitation mobile applications (APPs) related to distal radius fracture (DRF) and evaluate their features and characteristics, so as to help doctors and patients to make evidence-based choice for appropriate intelligent-assisted rehabilitation. Methods Literatures which in regard to the intelligent rehabilitation tools of DRF were systematic retrieved from the PubMed, the Cochrane library, Wan Fang, and VIP Data. The effective APPs were systematically screened out through the APP markets of iOS and Android mobile platform, and the functional characteristics of different APPs were evaluated and analyzed. Results A total of 8 literatures and 31 APPs were included, which were divided into four categories: intelligent intervention, angle measurement, intelligent monitoring, and auxiliary rehabilitation games. These APPs provide support for the patients' home rehabilitation guidance and training and make up for the high cost and space limitations of traditional rehabilitation methods. The intelligent intervention category has the largest download ratio in the APP market. Angle measurement tools help DRF patients to measure the joint angle autonomously to judge the degree of rehabilitation, which is the most concentrated type of literature research. Some of the APPs and tools have obtained good clinical verification. However, due to the restrictions of cost, geographic authority, and applicable population, a large number of APPs still lack effective evidence to support popularization. Conclusion Patients with DRF could draw support from different kinds of APPs in order to fulfill personal need and promote self-management. Intelligent rehabilitation APPs play a positive role in the rehabilitation of patients, but the acceptance of the utilization for intelligent rehabilitation APPs is relatively low, which might need follow-up research to address the conundrum.
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Bucher SL, Cardellichio P, Muinga N, Patterson JK, Thukral A, Deorari AK, Data S, Umoren R, Purkayastha S. Digital Health Innovations, Tools, and Resources to Support Helping Babies Survive Programs. Pediatrics 2020; 146:S165-S182. [PMID: 33004639 DOI: 10.1542/peds.2020-016915i] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.
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Affiliation(s)
- Sherri L Bucher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana; .,Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | | | - Naomi Muinga
- Kenya Medical Research Institute Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, School of Medicine, Seattle, Washington.,Department of Global Health, School of Medicine, University of Washington, Seattle, Washington; and
| | - Saptarshi Purkayastha
- Department of Data Science and Health Informatics, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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Zaidi S, Kazi AM, Riaz A, Ali A, Najmi R, Jabeen R, Khudadad U, Sayani S. Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study. J Med Internet Res 2020; 22:e18414. [PMID: 32940612 PMCID: PMC7530697 DOI: 10.2196/18414] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/06/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. OBJECTIVE Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. METHODS The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. RESULTS Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. CONCLUSIONS The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology.
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Affiliation(s)
- Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Atif Riaz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ammarah Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rabia Najmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rawshan Jabeen
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Umerdad Khudadad
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Saleem Sayani
- Digital Health Resource Centre, Aga Khan Development Network, Karachi, Pakistan
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Acceptability and usability of a mobile application for management and surveillance of vector-borne diseases in Colombia: An implementation study. PLoS One 2020; 15:e0233269. [PMID: 32469894 PMCID: PMC7259752 DOI: 10.1371/journal.pone.0233269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/01/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Vector-borne diseases are a public health problem in Colombia, where dengue virus infection is hyperendemic. The introduction of other arboviruses, such as chikungunya and Zika in the last three years, has aggravated the situation. Mobile health (mHealth) offers new strategies for strengthening health care and surveillance systems promoting the collection, delivery, and access of health information to professionals, researchers, and patients. Assessing mobile application performance has been a challenge in low- and middle-income countries due to the difficulty of implementing these technologies in different clinical settings. In this study, we evaluate the usability and acceptability of a mobile application, FeverDX, as a support tool in the management of patients with febrile syndrome and suspected arboviruses infection by general practitioners from Colombia. METHODS A pilot implementation study was conducted to evaluate the usability and acceptability of FeverDX using the modified version of the Mobile Application Rating Scale (uMARS). The evaluation form included 25 questions regarding quantity and quality of information, engagement, functionality, aesthetics, impact, and acceptability by healthcare workers. Each item uses a 5-point scale (1-Inadequate, 2-Poor, 3-Acceptable, 4-Good, 5-Excellent). A global score was obtained for the evaluation form test by determining the median scores of each subsection. A descriptive statistical analysis of the data obtained was performed. RESULTS Between December 2016 and January 2017, a total of 20 general practitioners from the Emergency room and hospitalization areas evaluated FeverDX. Less than half (9/20) of the evaluators had a comprehensive knowledge of the Colombian Ministry of Health's guidelines for the diagnosis and management of arboviruses, and evaluators partially (4/9) or completely (5/9) agreed that the content of the application follows the management guidelines. On uMARS scale, FeverDX excelled regarding impact (median 5; IQR = 5-5), functionality (median 5; IQR = 4.8-5), and information and scientific basis (median 4; IQR = 4-4). FeverDX scored well regarding user feedback (median 4; IQR = 4-4.5), design and aesthetics (median 4; IQR = 4-4.3), and subjective assessment of quality (median 4.5; IQR = 4.3-4.8). CONCLUSIONS FeverDX, a mobile application, is a novel mHealth strategy to strengthen care processes and facilitate the detection and reporting of notifiable surveillance diseases. It could improve adherence to clinical practice guidelines for the management and prevention of prevalent diseases as arboviruses in healthcare settings. Although this pilot study used a small sample size, FeverDx performed adequately in a simulated emergency consultation. Further implementation studies are needed to increase the reliability of mHealth technologies in different scenarios.
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Hattingh M, Matthee M, Smuts H, Pappas I, Dwivedi YK, Mäntymäki M. Categorization of Factors Influencing Community Health Workers from a Socio-Technical Systems Perspective. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7134222 DOI: 10.1007/978-3-030-45002-1_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In low-and-middle-income countries (LMICs), community health workers (CHWs) are often seen as a connecting bridge between two dynamic and overlapping systems- the community and formal health systems. Although the importance of CHWs is acknowledged, there is minimal aggregated evidence contributing towards understanding their position, technological capabilities, barriers and facilitators of their effectiveness in the South African context. Despite the widespread enthusiasm around the potential that mobile health (mHealth) technology holds in extending healthcare through CHW to underserved communities, an understanding of mHealth’s various implications in a developing world context is imperative to appreciate both the community and health systems context. The CHWs within this context need to assume multiple roles as they work and live amongst and in the community. The study argues that by examining their multiple roles as part of the healthcare continuum and from within the community setting, appropriating technological solutions can be conceptualized to facilitate and enhance their impact and visibility. This research article then aims to articulate the key conceptual factors which should be considered when implementing technological solutions for CHWs within the South African context. The aim is operationalized by means of the best-fit framework synthesis method to explore the body of knowledge towards presenting a conceptual understanding through a categorization of Factors Influencing Community Health Workers from a Socio-Technical Systems Perspective.
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