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Rodríguez‐Ortega M, Ortega‐Latorre Y, Montano‐Navarro E, Casado‐Collado AJ, Nguepy FR, Damou F. Telemedicine as a counselling tool for nurses in Central Africa. J Adv Nurs 2025; 81:2477-2486. [PMID: 39154349 PMCID: PMC11967317 DOI: 10.1111/jan.16406] [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: 02/20/2024] [Revised: 07/12/2024] [Accepted: 08/08/2024] [Indexed: 08/20/2024]
Abstract
AIM Compare the use and trend of a telemedicine tool for clinical advice among nurses and other Cameroonian healthcare providers and explore its feasibility and accessibility. DESIGN A comparative observational descriptive study. METHODS The sample includes all telemedicine users who request advice from volunteer medical specialists in Spain on clinical cases through the telemedicine tool "diagnosis assistance" (DA). It consisted of a total of 296 Cameroonian health professionals (59% women), of whom 77 were nurses. The variables in which the trend was explored (2013-2022) were DAs entered by nurses versus other healthcare professionals, compared by primary specialty, comments and documents attached. Feasibility and accessibility were explored through an anonymous survey. RESULTS There were 2527 DAs between 2013 and 2022, of which nurses introduced 68%. There is an increasing trend in the nurse/other healthcare providers ratio, with significant differences in the chi-square of the linear trend between 2015 and 2022 (χ 2 = 395.05; df = 7; p < .001). The probability that a DA was requested by nurses (PR >1) was observed in all years except for 2014, 2018 and 2019. The most tele-counselling requested by nurses was in the specialties of internal medicine, obstetrics and gynaecology, and dermatology. The exchange of comments and attachments was mainly conducted among nurses (74.9% and 50.4%, respectively). The users surveyed considered the tool valuable for diagnosis, applicable, with limitations due to cost, Internet quality or lack of time and effective at reducing hospital referrals. CONCLUSIONS Telemedicine for clinical advice has been used mostly and with increasing tendency by nurses, mainly in internal medicine, gynaecology and dermatology, being a useful and feasible resource that can contribute to improving clinical decision-making by African nurses. IMPACT The study addressed the problem of the shortage of health professionals in Central Africa and the search for alternatives that facilitate decision-making in this context. Tele-counselling tools through digital platforms that put Spanish specialists in contact with health professionals in Central Africa are mostly used by nurses working in rural health centres with a growing trend in their use. The research allows us to determine that tele-counselling tools constitute a well-accepted resource, which has a positive impact in environments with a shortage of human health resources, favouring the safety of both the nursing professional, through support in decision-making, and the populations to whom they provide care, who benefit from a multidisciplinary approach to their processes. REPORTING METHOD The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- María Rodríguez‐Ortega
- San Juan de Dios FoundationMadridSpain
- Health Sciences, Department of San Juan de Dios School of Nursing and Physical TherapyComillas Pontifical UniversityMadridSpain
| | - Yolanda Ortega‐Latorre
- San Juan de Dios FoundationMadridSpain
- Health Sciences, Department of San Juan de Dios School of Nursing and Physical TherapyComillas Pontifical UniversityMadridSpain
| | | | | | | | - Fleur Damou
- Centre de Santé Mère Nazaria Ignacia de OyackOyackDoualaCameroon
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Sanya RE, Karugu CH, Binyaruka P, Mohamed SF, Kisia L, Kibe P, Mashasi I, Mhalu G, Bunn C, Deidda M, Mair FS, Grieve E, Gray CM, Mtenga S, Asiki G. Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania. Glob Health Action 2024; 17:2345970. [PMID: 38774927 PMCID: PMC11123500 DOI: 10.1080/16549716.2024.2345970] [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: 01/22/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services. OBJECTIVES We investigated the pandemic's impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania. METHODS A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February-April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access. RESULTS We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p < 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05-2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22-0.58]; p < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33-0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14-2.88]; p = 0.011). CONCLUSIONS COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.
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Affiliation(s)
- Richard E. Sanya
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline H. Karugu
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Peter Binyaruka
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Shukri F. Mohamed
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Lyagamula Kisia
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Peter Kibe
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Irene Mashasi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Mhalu
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Manuela Deidda
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S. Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cindy M. Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Sally Mtenga
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Gershim Asiki
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
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Verma N, Buch B, Taralekar R, Acharya S. Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial. JMIR Form Res 2023; 7:e42775. [PMID: 37130015 PMCID: PMC10337309 DOI: 10.2196/42775] [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] [Received: 09/17/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards. OBJECTIVE This study aims to compare the diagnosis and treatment decisions from teleconsultations to those of in-person care in teleclinics in rural Gujarat. METHODS We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at 10 telemedicine primary care clinics. Patients reporting to 10 telemedicine primary care clinics were randomly assigned to first receive an in-person doctor consultation (59/104, 56.7%) or to first receive a health worker-assisted telemedicine consultation (45/104, 43.3%). The 2 groups were then switched, with the first group undergoing a telemedicine consultation following the in-person consultation and the second group receiving an in-person consultation after the teleconsultation. The in-person doctor and remote doctor were blinded to the diagnosis and management plan of the other. The diagnosis and treatment plan of in-person doctors was considered the gold standard. RESULTS We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74% (77/104) diagnostic concordance and 79.8% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker-doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95% concordance; Cohen kappa=0.93) and diabetes (14/15, 93% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33%) and patients presenting with nonspecific symptoms (3/10, 30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols. CONCLUSIONS The findings reflect that telemedicine can be a safe and acceptable alternative mode of care especially in remote rural settings when in-person care is not accessible. Telemedicine has advantages. for the potential gains for improved health care-seeking behavior for patients, reduced costs for the patient, and improved health system efficiency by reducing overcrowding at tertiary health facilities.
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Affiliation(s)
- Neha Verma
- Intelehealth, Baltimore, MD, United States
| | - Bimal Buch
- Intelehealth, Baltimore, MD, United States
| | | | - Soumyadipta Acharya
- Center for Bioengineering Innovation & Design, Johns Hopkins University, Baltimore, MD, United States
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Dougherty K, Hobensack M, Bakken S. Scoping review of health information technology usability methods leveraged in Africa. J Am Med Inform Assoc 2023; 30:726-737. [PMID: 36458941 PMCID: PMC10018268 DOI: 10.1093/jamia/ocac236] [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: 05/30/2022] [Revised: 09/14/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the state of health information technology (HIT) usability evaluation in Africa. MATERIALS AND METHODS We searched three electronic databases: PubMed, Embase, and Association for Computing Machinery. We categorized the stage of evaluations, the type of interactions assessed, and methods applied using Stead's System Development Life Cycle (SDLC) and Bennett and Shackel's usability models. RESULTS Analysis of 73 of 1002 articles that met inclusion criteria reveals that HIT usability evaluations in Africa have increased in recent years and mainly focused on later SDLC stage (stages 4 and 5) evaluations in sub-Saharan Africa. Forty percent of the articles examined system-user-task-environment (type 4) interactions. Most articles used mixed methods to measure usability. Interviews and surveys were often used at each development stage, while other methods, such as quality-adjusted life year analysis, were only found at stage 5. Sixty percent of articles did not include a theoretical model or framework. DISCUSSION The use of multistage evaluation and mixed methods approaches to obtain a comprehensive understanding HIT usability is critical to ensure that HIT meets user needs. CONCLUSIONS Developing and enhancing usable HIT is critical to promoting equitable health service delivery and high-quality care in Africa. Early-stage evaluations (stages 1 and 2) and interactions (types 0 and 1) should receive special attention to ensure HIT usability prior to implementing HIT in the field.
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Affiliation(s)
- Kylie Dougherty
- School of Nursing, Columbia University, New York, New York, USA
| | | | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA
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Onsongo S, Kamotho C, Rinke de Wit TF, Lowrie K. Experiences on the Utility and Barriers of Telemedicine in Healthcare Delivery in Kenya. Int J Telemed Appl 2023; 2023:1487245. [PMID: 37180825 PMCID: PMC10171985 DOI: 10.1155/2023/1487245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/19/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Telemedicine is the provision of health services over a distance using information communication technology devices. Telemedicine is emerging as a promising component of healthcare care delivery worldwide, accelerated by the COVID-19 pandemic. This study assessed the factors promoting uptake, barriers, and opportunities for telemedicine among doctors in Kenya. Methodology. A semiquantitative, cross-sectional online survey was conducted among doctors in Kenya. During a month, between February and March 2021, 1,200 doctors were approached by email and WhatsApp, of whom 13% responded. Findings. A total of 157 interviewees participated in the study. The general usage of telemedicine was 50%. Seventy-three percent of doctors reported using a mix of in-person care and telemedicine. Fifty percent reported using telemedicine to support physician-to-physician consultations. Telemedicine had limited utility as a standalone clinical service. The inadequate information communication technology infrastructure was the most reported barrier to telemedicine, followed by a cultural resistance to using technology to deliver healthcare services. Other notable barriers were the high cost of initial setup limited skills among patients, limited skills among doctors, inadequate funding to support telemedicine services, weak legislative/policy framework, and lack of dedicated time for telemedicine services. The COVID-19 pandemic increased the uptake of telemedicine in Kenya. Conclusion The most extensive use of telemedicine in Kenya supports physician-to-physician consultations. There is limited single use of telemedicine in providing direct clinical services to patients. However, telemedicine is regularly used in combination with in-person clinical services, allowing for continuity of clinical services beyond the physical hospital infrastructure. With the widespread adoption of digital technologies in Kenya, especially mobile telephone technologies, the growth opportunities for telemedicine services are immense. Numerous mobile applications will improve access capabilities for both service providers and users and bridge the gaps in care.
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Affiliation(s)
- Simon Onsongo
- Aga Khan Hospital, Kisumu, Box 530-40100, Kisumu, Kenya
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Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11532. [PMID: 36141806 PMCID: PMC9517420 DOI: 10.3390/ijerph191811532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Teleconsultation has become one of the most important and sometimes the only possible forms of communication between healthcare professionals (HCPs) and their patients during the COVID-19 pandemic. The perceptions and attitudes of HCPs to teleconsultations may affect the quality of the therapeutic process provided using them. Therefore, this study aimed to understand the attitudes to and perceptions of medical teleconsultation among various HCPs during the COVID-19 pandemic. We analyzed data from a dedicated questionnaire on preferences, attitudes, and opinions about teleconsultation, which was filled by 780 Polish HCPs. Most of the HCPs were doctors and nurses (69% and 19%, respectively); most of the doctors were family physicians (50.1%). During the pandemic, teleconsultation and face-to-face contact were reported as the preferred methods of providing medical services with similar frequency. Doctors and nurses displayed the most positive attitude toward teleconsultation while the paramedics and physiotherapists took the least positive view of it. The most frequently indicated ratio of the optimal number of teleconsultations to in-person visits in primary health facilities care was 20%:80%. Most HCPs appreciate the value of teleconsultation, and more than half of them are willing to continue this form of communication with the patient when necessary or desirable.
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Affiliation(s)
| | - Mateusz Sobieski
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
| | - Jarosław Drobnik
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
- Department of Epidemiology and Health Education, Wroclaw Medical University, 50-372 Wroclaw, Poland
| | - Ewa Fabich
- Jan Mikulicz-Radecki University Teaching Hospital, 50-556 Wroclaw, Poland
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Mbunge E, Muchemwa B, Batani J. Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems. SENSORS INTERNATIONAL 2021; 3:100152. [PMID: 34901894 PMCID: PMC8648577 DOI: 10.1016/j.sintl.2021.100152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/14/2023] Open
Abstract
Since the outbreak of COVID-19, the attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. Sub-Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems and COVID-19 emerging variants. Some developed countries integrated telemedicine to reduce the impacts of the shortage of healthcare professionals and potentially reduce the risk of exposure, ensuring easy delivery of quality health services while limiting regular physical contact and direct hospitalization. However, the adoption of telemedicine and telehealth is still nascent in many sub-Saharan Africa countries. Therefore, this study reflects on progress made towards the use of telemedicine, virtual health care services, challenges encountered, and proffers ways to address them. We conducted a systematic literature review to synthesise literature on telemedicine in sub-Saharan Africa. The study revealed that telemedicine provides unprecedented benefits such as improving efficiency, effective utilization of healthcare resources, forward triaging, prevention of medical personnel infection, aiding medical students' clinical observation and participation, and assurance of social support for patients. However, the absence of policy on virtual care and political will, cost of sustenance of virtual health care services, inadequate funding, technological and infrastructural barriers, patient and healthcare personnel bias on virtual care and cultural barriers are identified as limiting factors to the adoption of virtual health care in many African health systems. To alleviate some of these barriers, we recommend the development of robust policies and frameworks for virtual health care, the inclusion of virtual care in the medical school curriculum, supporting virtual care research and development, increasing health funding, removing monopolisation of telecommunication services, developing of virtual health solutions that address eccentricities of African health systems.
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Affiliation(s)
- Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Private Bag 4, Kwaluseni, Eswatini
| | - Benhildah Muchemwa
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Private Bag 4, Kwaluseni, Eswatini
| | - John Batani
- Faculty of Engineering and Technology, Botho University, Maseru, Lesotho
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Dodoo JE, Al-Samarraie H, Alsswey A. The development of telemedicine programs in Sub-Saharan Africa: Progress and associated challenges. HEALTH AND TECHNOLOGY 2021; 12:33-46. [PMID: 34849325 PMCID: PMC8613515 DOI: 10.1007/s12553-021-00626-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/18/2021] [Indexed: 12/30/2022]
Abstract
Monitoring the progress of telemedicine use in Sub-Saharan Africa (SSA) countries has received a considerable attention from many health organizations and governmental agencies. This study reviewed the current progress and challenges in relation to the development of telemedicine programs in SSA. The results from reviewing 66 empirical studies revealed an unbalanced progress across SSA countries. Further, technological, organisational, legal and regulatory, individual, financial, and cultural aspects were identified as the major barriers to the success of telemedicine development in SSA. This study reported the current trends in telemedicine application, as well as highlighting critical barriers for consideration by healthcare decision makers. The outcomes from this study offer a number of recommendations to support wider implementation and sustainable usage of telemedicine in SSA.
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Affiliation(s)
- Joana Eva Dodoo
- College of Distance Education, Department of Business Studies, University of Cape Coast, Cape Coast, Ghana
| | - Hosam Al-Samarraie
- School of Design, University of Leeds, Leeds, UK
- Centre for Instructional Technology & Multimedia, Universiti Sains Malaysia, Penang, Malaysia
| | - Ahmed Alsswey
- Department of Multimedia Technology, AL-Zaytoonah University of Jordan, Amman, Jordan
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Opoku D, Busse R, Quentin W. Achieving Sustainability and Scale-Up of Mobile Health Noncommunicable Disease Interventions in Sub-Saharan Africa: Views of Policy Makers in Ghana. JMIR Mhealth Uhealth 2019; 7:e11497. [PMID: 31066706 PMCID: PMC6524449 DOI: 10.2196/11497] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/04/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022] Open
Abstract
Background A growing body of evidence shows that mobile health (mHealth) interventions may improve treatment and care for the rapidly rising number of patients with noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA). A recent realist review developed a framework highlighting the influence of context factors, including predisposing characteristics, needs, and enabling resources (PNE), for the long-term success of mHealth interventions. The views of policy makers will ultimately determine implementation and scale-up of mHealth interventions in SSA. However, their views about necessary conditions for sustainability and scale-up remain unexplored. Objective This study aimed to understand the views of policy makers in Ghana with regard to the most important factors for successful implementation, sustainability, and scale-up of mHealth NCD interventions. Methods Members of the technical working group responsible for Ghana’s national NCD policy were interviewed about their knowledge of and attitude toward mHealth and about the most important factors contributing to long-term intervention success. Using qualitative methods and applying a qualitative content analysis approach, answers were categorized according to the PNE framework. Results A total of 19 policy makers were contacted and 13 were interviewed. Interviewees had long-standing work experience of an average of 26 years and were actively involved in health policy making in Ghana. They were well-informed about the potential of mHealth, and they strongly supported mHealth expansion in the country. Guided by the PNE framework’s categories, the policy makers ascertained which critical factors would support the successful implementation of mHealth interventions in Ghana. The policy makers mentioned many factors described in the literature as important for mHealth implementation, sustainability, and scale-up, but they focused more on enabling resources than on predisposing characteristics and need. Furthermore, they mentioned several factors that have been rather unexplored in the literature. Conclusions The study shows that the PNE framework is useful to guide policy makers toward a more systematic assessment of context factors that support intervention implementation, sustainability, and scale-up. Furthermore, the framework was refined by adding additional factors. Policy makers may benefit from using the PNE framework at the various stages of mHealth implementation. Researchers may (and should) use the framework when investigating reasons for success (or failure) of interventions.
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Affiliation(s)
- Daniel Opoku
- Faculty VII Economics and Management, Institute of Technology and Management, Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Reinhard Busse
- Faculty VII Economics and Management, Institute of Technology and Management, Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Wilm Quentin
- Faculty VII Economics and Management, Institute of Technology and Management, Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
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Taype-Rondán Á, Vidal-Torres MI, Chung-Delgado K, Maticorena-Quevedo J, Mayta-Tristán P. Problems perceived and experienced by health professionals rendering social service in Ancash, Peru. 2015. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n3.59055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. En Perú, durante el servicio social en salud se han reportado problemas como condiciones laborales riesgosas, mortalidad asociada a accidentes de tránsito y déficit de cobertura de aseguramiento.Objetivo. Describir los problemas percibidos y experimentados por los profesionales de salud que realizan el Servicio Rural y Urbano Marginal de Salud (SERUMS) en Ancash, Perú, y evaluar su asociación con la práctica de los profesionales y la categoría del establecimiento donde se realiza el SERUMS.Materiales y métodos. Durante abril del 2015, se realizó un estudio transversal analítico con profesionales de salud que realizaban el SERUMS en establecimientos del Ministerio de Salud de Ancash. Se aplicaron encuestas para recolectar datos generales, características y problemas del SERUMS.Resultados. Se analizaron 364 encuestas. El 79.3% de los participantes fue de sexo femenino, la edad promedio fue de 27.4±5.0 años, 80.0% percibió carencia de insumos, 54.4% percibió carga laboral excesiva, y 14.7% sufrió algún accidente de tránsito durante el SERUMS. Ser médico y laborar en establecimientos I-1 fueron factores asociados a haber sufrido accidentes de tránsito y otros imprevistos.Conclusiones. Los encuestados reportan carga laboral excesiva, carencia de insumos y accidentes. Los accidentes son más frecuentes en médicos y en establecimientos de categoría I-1.
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Njoroge M, Zurovac D, Ogara EAA, Chuma J, Kirigia D. Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya. BMC Res Notes 2017; 10:90. [PMID: 28183341 PMCID: PMC5301342 DOI: 10.1186/s13104-017-2416-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/02/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. RESULTS A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. CONCLUSION This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.
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Affiliation(s)
- Martin Njoroge
- Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya
| | - Dejan Zurovac
- Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ UK
- Center for Global Health and Development, Boston University School of Public Health, 85 East Concord Street, Boston, MA 02118 USA
| | | | - Jane Chuma
- Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya
| | - Doris Kirigia
- Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya
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Opoku D, Stephani V, Quentin W. A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa. BMC Med 2017; 15:24. [PMID: 28162090 PMCID: PMC5292812 DOI: 10.1186/s12916-017-0782-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The prevalence of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa. At the same time, the use of mobile phones is rising, expanding the opportunities for the implementation of mobile phone-based health (mHealth) interventions. This review aims to understand how, why, for whom, and in what circumstances mHealth interventions against NCDs improve treatment and care in sub-Saharan Africa. METHODS Four main databases (PubMed, Cochrane Library, Web of Science, and Google Scholar) and references of included articles were searched for studies reporting effects of mHealth interventions on patients with NCDs in sub-Saharan Africa. All studies published up until May 2015 were included in the review. Following a realist review approach, middle-range theories were identified and integrated into a Framework for Understanding the Contribution of mHealth Interventions to Improved Access to Care for patients with NCDs in sub-Saharan Africa. The main indicators of the framework consist of predisposing characteristics, needs, enabling resources, perceived usefulness, and perceived ease of use. Studies were analyzed in depth to populate the framework. RESULTS The search identified 6137 titles for screening, of which 20 were retained for the realist synthesis. The contribution of mHealth interventions to improved treatment and care is that they facilitate (remote) access to previously unavailable (specialized) services. Three contextual factors (predisposing characteristics, needs, and enabling resources) influence if patients and providers believe that mHealth interventions are useful and easy to use. Only if they believe mHealth to be useful and easy to use, will mHealth ultimately contribute to improved access to care. The analysis of included studies showed that the most important predisposing characteristics are a positive attitude and a common language of communication. The most relevant needs are a high burden of disease and a lack of capacity of first-contact providers. Essential enabling resources are the availability of a stable communications network, accessible maintenance services, and regulatory policies. CONCLUSIONS Policy makers and program managers should consider predisposing characteristics and needs of patients and providers as well as the necessary enabling resources prior to the introduction of an mHealth intervention. Researchers would benefit from placing greater attention on the context in which mHealth interventions are being implemented instead of focusing (too strongly) on the technical aspects of these interventions.
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Affiliation(s)
- Daniel Opoku
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, Sekretariat H80, 10623, Berlin, Germany.
| | - Victor Stephani
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, Sekretariat H80, 10623, Berlin, Germany
| | - Wilm Quentin
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, Sekretariat H80, 10623, Berlin, Germany
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Anticona Huaynate CF, Pajuelo Travezaño MJ, Correa M, Mayta Malpartida H, Oberhelman R, Murphy LL, Paz-Soldan VA. Diagnostics barriers and innovations in rural areas: insights from junior medical doctors on the frontlines of rural care in Peru. BMC Health Serv Res 2015; 15:454. [PMID: 26438342 PMCID: PMC4595324 DOI: 10.1186/s12913-015-1114-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/24/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Worldwide, rural communities face barriers when accessing health services. In response, numerous initiatives have focused on fostering technological innovations, new management approaches and health policies. Research suggests that the most successful innovations are those involving stakeholders at all levels. However, there is little evidence exploring the opinions of local health providers that could contribute with further innovation development and research. The aims of this study were to explore the perspectives of medical doctors (MDs) working in rural areas of Peru, regarding the barriers impacting the diagnostic process, and ideas for diagnostic innovations that could assist them. METHODS Data gathered through three focus group discussions (FGG) and 18 individual semi-structured interviews (SSI) with MDs who had completed their medical service in rural areas of Peru in the last two years were analyzed using thematic analysis. RESULTS Three types of barriers emerged. The first barrier was the limited access to point of care (POC) diagnostic tools. Tests were needed for: i) the differential diagnosis of malaria vs. pneumonia, ii) dengue vs. leptospirosis, iii) tuberculosis, iv) vaginal infections and cervical cancer, v) neurocysticercosis, and vi) heavy metal toxicity. Ultrasound was needed for the diagnosis of obstetric and intra-abdominal conditions. There were also health system-related barriers such as limited funding for diagnostic services, shortage of specialists, limited laboratory services and access to telecommunications, and lack of institutional support. Finally, the third type of barriers included patient related-barriers to follow through with diagnostic referrals. Ideas for innovations proposed included POC equipment and tests, and telemedicine. CONCLUSIONS MDs at primary health facilities in rural Peru face diagnostic challenges that are difficult to overcome due to a limited access to diagnostic tools. Referrals to specialized facilities are constrained by deficiencies in the organization of health services and by barriers that impede the patients' travel to distant health facilities. Technological innovations suggested by the participants such as POC diagnostic tools and mobile-health (m-health) applications could help address part of the problem. However, other types of innovation to address social, adaptation and policy issues should not be dismissed.
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Affiliation(s)
- Cynthia Fiorella Anticona Huaynate
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Monica Jehnny Pajuelo Travezaño
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Malena Correa
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Holger Mayta Malpartida
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Richard Oberhelman
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
| | - Laura L Murphy
- Department of Global Health Systems & Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
| | - Valerie A Paz-Soldan
- Department of Global Health Systems & Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
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Ranslow A, Crompton D, Mehta K, Butler P, Adair J. Empowering Community Health Workers with Inkjet-printed Diagnostic Test Strips. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.proeng.2015.06.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brinkel J, Krämer A, Krumkamp R, May J, Fobil J. Mobile phone-based mHealth approaches for public health surveillance in sub-Saharan Africa: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11559-82. [PMID: 25396767 PMCID: PMC4245630 DOI: 10.3390/ijerph111111559] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/24/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM), BioMed Central, PubMed Central (PMC), the Public Library of Science (PLoS) and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3), tuberculosis (n = 1) and influenza-like illnesses (n = 1) as well as on non-infectious disease surveillance of child malnutrition (n = 2), maternal health (n = 1) and routine surveillance of various diseases and symptoms (n = 1). Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region.
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Affiliation(s)
- Johanna Brinkel
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany.
| | - Alexander Krämer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany.
| | - Ralf Krumkamp
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht-Str. 74, D-20359 Hamburg, Germany.
| | - Jürgen May
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht-Str. 74, D-20359 Hamburg, Germany.
| | - Julius Fobil
- Department of Biological, Environmental, Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Legon, Ghana.
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Abstract
OBJECTIVES To discuss how current research in the area of smart homes and ambient assisted living will be influenced by the use of big data. METHODS A scoping review of literature published in scientific journals and conference proceedings was performed, focusing on smart homes, ambient assisted living and big data over the years 2011-2014. RESULTS The health and social care market has lagged behind other markets when it comes to the introduction of innovative IT solutions and the market faces a number of challenges as the use of big data will increase. First, there is a need for a sustainable and trustful information chain where the needed information can be transferred from all producers to all consumers in a structured way. Second, there is a need for big data strategies and policies to manage the new situation where information is handled and transferred independently of the place of the expertise. Finally, there is a possibility to develop new and innovative business models for a market that supports cloud computing, social media, crowdsourcing etc. CONCLUSIONS The interdisciplinary area of big data, smart homes and ambient assisted living is no longer only of interest for IT developers, it is also of interest for decision makers as customers make more informed choices among today's services. In the future it will be of importance to make information usable for managers and improve decision making, tailor smart home services based on big data, develop new business models, increase competition and identify policies to ensure privacy, security and liability.
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Affiliation(s)
- V Vimarlund
- Vivian Vimarlund, Jönköping International Business School, PO Box 1026, 551 11 Jönköping, Sweden, Tel: +46 (0)36 101775, Fax: +46 (0)36 165069, E-mail:
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Trause D, Peterson S, Doty N, Liguori A, Holmes K, Kanzleiter L, Mehta K. The Diverse Roles of Community Health Workers: Cues for Technology Innovations. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.proeng.2014.07.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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