Digitization of the health sector in Pakistan: challenges and opportunities to online health communication: A case study of MARHAM social and mobile media

Mobile app for comprehensive management of orthodontic patients with fixed appliances : Design and use

OBJECTIVES

This study aimed to design and implement a mobile phone application (app) aiming to enhance the cooperation and oral hygiene of orthodontic patients.

METHODS

An orthodontic app named "Labkhand" was designed by a team of orthodontists and programmers according to the needs and scheduled interventions for patients. The aim of this app was to obviate the orthodontic needs of patients by providing educational content in the form of texts and videos, oral hygiene reminders, appointment reminders, and nutrition reminders. It also enabled instant messaging and chatting between patients and dental personnel. In this study, 61 patients were monitored during their orthodontic treatment procedure. All patients were evaluated using a questionnaire with 7 questions before and after a 6-month treatment period. A total of 31 patients were instructed to use the app, while the other 30 patients received treatment without the app. The collected data were analyzed using paired t‑test and analysis of covariance (ANCOVA) test.

RESULTS

While the control group's questionnaire score remained almost the same (P > 0.05), the mean questionnaire score of patients in the intervention group significantly increased after using the app compared to the baseline scores acquired before using the app (P < 0.001). The greatest improvement was noted in topics related to "reminding of appointments", "general information about orthodontic treatment", and "oral hygiene maintenance and instructions". "Quality of services" and "patient-orthodontist communication" showed the least improvement in patient satisfaction.

CONCLUSIONS

The Labkhand orthodontic app has multiple functions and can obviate the needs of orthodontic patients easily and at a low cost.

The impact of perceived value and affection on Chinese residents' continuous use intention of mobile health science information: An empirical study

Introduction

Disseminating health science information via the internet has become an essential means for improving Chinese residents' health literacy, which has received constant attention from the Chinese government. Therefore, it is important to explore Chinese residents' perceived value and emotional response to mobile health science information for determining Chinese residents' satisfaction and use intention.

Methods

This study applied the cognition-affect-conation model to evaluate the perceived value, arousal, pleasure, trust, satisfaction, and continuous use intention. A mobile device was used to obtain health science information from 236 Chinese residents via an online survey and the data were analyzed using partial least squares (PLS)-structural equation modeling.

Results

The results showed that Chinese residents' perceived value of health science information obtained using the mobile device directly affect the degree of arousal (β = 0.412, P < 0.001), pleasure (β = 0.215, P < 0.01), and trust (β = 0.339, P < 0.001). The degree of arousal (β = 0.121, P < 0.01), pleasure (β = 0.188, P < 0.01), and trust (β = 0.619, P < 0.001) directly affected Chinese residents' satisfaction, which further affected their continuous use intention (β = 0.513, P < 0.001). Similarly, trust directly affected Chinese residents' continuous use intention (β = 0.323, P < 0.001). The degree of arousal directly affected their degree of pleasure (β = 0.304, P < 0.001), and pleasure also imposed a direct effect on trust (β = 0.293, P < 0.001).

Discussion

The result of this study provided an academic and practical reference to improve mobile health science popularization information. Affective changes have imposed an important effect on Chinese residents' continuous use intention. High-quality, diversified and frequent use of health science information can significantly increase residents' continuous use intention, improving their health literacy as a consequence.

Feasibility of communication platforms to empower transgender cultural competence among human immunodeficiency virus screeners: A qualitative analysis

Background

Human immunodeficiency virus (HIV) screeners have limited experience of interacting with trans people. The application of communication platforms between them to empower HIV screeners' trans-related cultural competence remains unknown.

Objective

This study aims to qualitatively explore the follow-up interviews of HIV screeners regarding their opinions on the feasibility of an online platform group discussion and web page to enhance communication between them and trans people and to explore their perspectives on how these components enhanced their promotion of cultural competence.

Methods

This study was conducted between October 2020 and June 2021. Purposive and snowball sampling were applied to recruit 6 trans persons and 11 HIV screeners. Six online platform group discussions were held on weekday evenings, each group meeting for 60 min, 360 min in total within 3 months, via a video chat room of Google Meet; this was supplemented by a closed web page. The major results were presented through content analysis of the HIV screeners' follow-up interviews.

Results

The HIV screeners identified the facilitators of participating in the communication platforms, which included a reminder message, easy-to-use interface, visible-audible and readable interaction, recalled and reviewable content and group belonging; the barriers included time and space limitation, device restrictions and operation problem. Two categories of trans-related cultural competence - trans awareness and action taken - were revealed, from which five major themes emerged: provoked to ask questions, improved cognition, reflection, trans-sensitive communication and self-enhancement.

Conclusion

The results revealed that the communication platforms could facilitate the mutual and vivid discussion between HIV screeners and trans people and empower the trans-related cultural competence of HIV screeners. The highly feasible intervention design of this research can be applied to digital training courses related to gender diversity issues.

Role of Digital Media in Promoting Oral Health: A Systematic Review

Oral disease has affected almost half of the world’s population, causing an enormous economic burden. To overcome this huge problem, oral health promotion is one of the most cost-effective methods. Digital media can play a pivotal role in achieving the goal of reducing this burden by providing a wider platform to reach out to the population even in the areas of deficit oral health care service.

The aim of this systematic review is to assess the effectiveness of digital media in oral health promotion.

The combinations of terms in the following two broad categories were used to search the literature on PubMed, Cochrane Library articles, WHO guidelines on oral health promotion through digital media, and Google Scholar: Intervention (digital media, Mobile phones, Text messages, social media, Cell phones, MHealth application, Telemedicine, Television, Videos) and Outcome (Oral Health education, Oral health, Oral health promotion, Oral health literacy, Oral health knowledge, Oral health attitude, Oral health practice, Oral hygiene improvement). The review was conducted in two phases, using the standardized checklist applicable to studies. Initially, abstracts were retrieved, followed by the assessment of the full papers against the review criteria.

Among the selected studies, digital interventions helped in providing continuity of care and services in seven studies, eight addressed the increase in knowledge, attitude, and practice, and all the studies analyzed oral health needs.

The findings concluded that digital media-based interventions can enhance oral health literacy and help in tackling this problem among different age groups.

Challenges and opportunities for implementing digital health interventions in Nepal: A rapid review

Background

In recent times, digital technologies in health care have been well recognized in Nepal. It is crucial to understand what is works well and areas that need improvements in the digital health ecosystem. This rapid review was carried out to provide an overview of Nepal's challenges and opportunities for implementing digital health interventions.

Methods

This study is reported according to PRISMA guidelines and used telehealth, telemedicine, e-health, mobile health, digital health, implementation, opportunities, challenges and Nepal as key search terms to identify primary studies published between 1 January 2010 and 30 December 2021 in four databases, namely PubMed, Google Scholar, Scopus, and CINAHL. Initially, identified studies were screened against predetermined selection criteria, and data were extracted, and the findings were narratively synthesized.

Result

The review identified various challenges, opportunities, and benefits of implementing digital health initiatives in Nepal. The most expressed challenge was inadequate technical facilities (lack of electricity and internet) and rugged geographical distribution, which makes transportation difficult in hilly and mountain areas. Shortage of skilled workforce and supportive policies were also notable challenges documented. Meanwhile, major opportunities identified were education and training of the students and health practitioners and increasing awareness among the general population.

Conclusion

This review identified various factors associated with the successful implementation of digital health initiatives in Nepal. Our findings may guide the formulation of digital health policy and interventions to improve mass health outcomes using digital health services.

Cultivating Innovative Work Behavior of Nurses Through Diversity Climate: The Mediating Role of Job Crafting

Introduction

Innovative work behavior of nurses is essential to deliver affordable quality healthcare services. Diversity climate and job crafting are a few of the supportive managerial strategies that can be applied to cultivate the innovative capacity of nurses.

Objective

Aim for the current study is to: (a) examine the role of diversity climate in cultivating innovative work behavior of nurses directly; and (b) indirectly through job crafting.

Methods

For this study data was collected through cross-sectional design employing simple random sampling using structured questionnaires from 283 nurses. Data was analyzed using SPSS.Amos.21.

Results

Results revealed the positive influence of diversity climate on innovative work behavior directly (γ = 0.51, p < .001) and indirectly through job crafting (ρ = 0.235, p < .001).

Conclusion

The current study revealed that diversity climate significantly influences the innovative work behavior of employees directly and indirectly through Job crafting. Healthcare management can integrate diversity management policies and job crafting techniques in their strategies to foster innovative work behavior of nurses.

A Cross-Sectional Survey to Assess Biorisk Management System in Research and Diagnostic Laboratories in Khyber Pakhtunkhwa, Pakistan

Financial, cultural, and managerial hurdles have made biosafety and biosecurity measures difficult in resource-constrained countries like Pakistan. Because of increasing awareness of biorisk management, diagnostic and research laboratories have made major advances in biosafety and biosecurity in the recent decade. As a result, identifying and addressing gaps in biorisk management has never been more critical. The purpose of this study was to assess the current situation of personal protective equipment (PPE), biosafety behavior, waste management, biosafety and biosecurity measures, training and safety, and health services in diagnostic and research laboratories across Pakistan's Khyber Pakhtunkhwa (KP) province. We adapted the WHO Laboratory Assessment tool (2012) and CWA 15793 (Biorisk management guidelines) for conducting a cross-sectional survey, which was distributed among various laboratories in KP. The survey included 30 laboratories, including 11 diagnostic and 19 research laboratories. In comparison to diagnostic laboratories, biorisk management practices in research laboratories were better in terms of PPE, biosafety behavior, waste management, biosafety measures, biosecurity measures, trainings, and safety and health services. KP laboratories' biorisk management practices have improved over time, according to our findings. However, we were able to identify inadequacies that would require considerable improvements to the current setups based on the WHO and CWA 15793 recommendations. Organizations can tailor their biosafety measures and training to address identified gaps using the presented KP snapshot.

Can Digital Transformation Promote the Rapid Recovery of Cities from the COVID-19 Epidemic? An Empirical Analysis from Chinese Cities

Background: Digital transformation has become a key intervention strategy for the global response to the COVID-19 epidemic, and digital technology is helping cities recover from the COVID-19 epidemic. However, the effects of urban digital transformation on the recovery from the COVID-19 epidemic still lack mechanism analyses and empirical testing. This study aimed to explain the theoretical mechanism of urban digital transformation on the recovery from the COVID-19 epidemic and to test its effectiveness using an empirical analysis. Methods: This study, using a theoretical and literature-based analysis, summarizes the impact mechanisms of urban digital transformation on the recovery of cities from the COVID-19 epidemic. A total of 83 large- and medium-sized cities from China are included in the empirical research sample, covering most major cities in China. The ordinary least squares (OLS) method is adopted to estimate the effect of China’s urban digitalization level on population attraction in the second quarter of 2020. Results: The theoretical analysis found that urban digital transformation improves the ability of cities to recover from the COVID-19 epidemic by promoting social communication, collaborative governance, and resilience. The main findings of the empirical analysis show that the digital level of a city has a significant positive effect on urban population attraction (p < 0.001). Conclusions: A positive relationship was found between urban digital transformation and the rapid recovery of cities from the COVID-19 epidemic. Digital inventions for social communication, collaborative governance, and urban resilience are an effective way of fighting the COVID-19 emergency.

Social media use for health, cultural characteristics, and demographics: A survey of Pakistani millennials

Objective

Over the last 10 years, an extensive body of literature has been produced to investigate the role of social media in health. However, little is known about the impact of cultural characteristics (e.g. masculinity, collectivism, and uncertainty avoidance) on social media use regarding health-related information, especially in developing countries like Pakistan. The present study employed Hofstede’s cultural characteristics framework and uses and gratification theory to examine how Pakistani millennials’ demographic attributes and cultural characteristics are associated with their social media use for health-related information.

Method

An online survey of 722 people aged 18–35 living in Pakistan was conducted in spring 2020 to examine the intensity and frequency of social media use, health-related use of social media, cultural characteristics, and demographic attributes.

Results

Results showed that cultural characteristics—masculinity, collectivism, and uncertainty avoidance—are strongly related with their perceptions of social media importance, usefulness, and perceived ease of access for health-related information even when controlling for demographic characteristics. Age and gender are also significantly associated with their perspectives on social media for health.

Conclusions

We found that communicating and sharing information is the most important motivation for Pakistani millennials to use social media in the area of health with WhatsApp and YouTube being most preferred social media sites for health-related issues.

The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial

Background

Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration.

Objective

Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program’s effect on maternal and offspring health outcomes and assessment of its compliance and usability.

Methods

A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit.

Results

The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We expect the results to be published by the end of 2023.

Conclusions

This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries.

Trial Registration

ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446

International Registered Report Identifier (IRRID)

DERR1-10.2196/31611

Characteristics of mobile phone access and usage among caregivers in Pakistan - A mHealth survey of urban and rural population

INTRODUCTION

Globally mobile ownership and access is becoming very common, and breakthroughs in mobile technology have shaped digital communication, with 7 billion mobile phone users globally. Developing countries account for 80% of newly purchased mobile phone devices with majority of such countries having low Routine Immunization coverage and a high risk of vaccine preventable diseases. The use of mobile phones provides a tremendous potential for public health involvement.

OBJECTIVE

The aim of this study is to assess the acceptability and usability of mobile phones among infant caregivers in a LMIC setup and to explore the role of mHealth to improve immunization uptake and coverage.

METHODS

This is a cross-sectional survey exploring the regional differences in mobile phone ownership, usability and preferences, along with level of trust with others while sharing a mobile phone. The study was conducted with caregivers of infants in an urban and rural sites of Pakistan.

RESULTS

A total of 4472 households were approached, of which 3337 participants were eligible for the study (74.61 %). The reasons for not participating in the study (n = 1135) included (i) household locked or refusal to participate for 594 families (52%), (ii) child older than 14 days of life in 409 cases (36%), (iii) 80 (7%) families did not have access to a functional mobile phone, (iv) 36 (3%)families did not provide a mobile phone number, and (v) 14 (1%) could not stay within the HDSS for 6 months. Access to mobile phone with SMS features was considerably high at both sites: 99.1% in Matiari (rural site) and 96.7% in Karachi (urban). In Matiari 96.6% of the respondents reported having daily access to the phone, contrasting with only 51.4% in Karachi. In Karachi, the predominant spoken language was Urdu, whereas majority of the respondents in Matiari spoke Sindhi (34.6% vs. 70.9%).

CONCLUSION

Our study indicates high access to mobile phone in both urban and rural setup, However access to smart phone is still limited, urban and rural setup. Further, the acceptance of overall health- and barrier-based child immunization messages through mobile phone were quite high in both settings. Lastly automated calls were preferred over SMS due to literacy and local settings. This bears important implications for improving child immunization uptake through mobile phones in developing regions such as Pakistan.

Polio vaccine misinformation on social media: turning point in the fight against polio eradication in Pakistan

Pakistan's polio eradication program faces immense challenges, including misinformation on social media that resulted in an increased number of new polio cases in 2019, when viral misleading videos were shared online. In recent years, misinformation has played a critical role in shifting the public's attitude on polio vaccination acceptance in Pakistan. Vaccine misinformation on social media marked a turning point in information consumption habits of Pakistanis and the content moderation policies of social media platforms, as well as the relationship between the government of Pakistan and tech giants like Facebook, Google, and Twitter. This commentary suggests that instead of relying on national-level information, Pakistan's provincial and local health departments should engage with local users on social media to correct vaccine misinformation about polio. Further, vaccine communication must acknowledge the existing information gaps, and take into account readers' and viewers' concerns. To mitigate the amount and spread of visual content related to vaccine misinformation, monitoring visual misinformation more closely, perhaps using the AI capabilities of Google's DeepMind, would be helpful.