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Kobashi Y, Haque SE, Sakisaka K, Amir I, Kaneko M, Mutahara M, Mubassara S, Kashem A, Tsubokura M. Community-based intervention for managing hypertension and diabetes in rural Bangladesh. Trop Med Health 2024; 52:13. [PMID: 38268002 PMCID: PMC10807096 DOI: 10.1186/s41182-023-00574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Approximately 80% of non-communicable diseases (NCDs) have been reported in low- and middle-income countries (LMICs). However, studies on the usefulness of educational interventions run by non-healthcare workers in combating NCDs in resource-limited areas in rural parts of LMICs are limited. This study aimed to identify the effectiveness of a community-based simple educational program run by non-healthcare trained staff for several outcomes associated with NCDs in a resource-limited area. METHODS Six villages in the Narail district in Bangladesh were selected, two each in the first and second intervention and the control groups, in the Narail district in Bangladesh were selected. Pre- and post-intervention survey data were collected. The first intervention group received the "strong" educational intervention that included a checklist poster on the wall, phone call messages, personalized advice papers, seminar videos, and face-to-face seminars. The second intervention group received a "weak" intervention that included only a checklist poster on the wall in their house. The outcome was the proportion of NCDs and changes in systolic blood pressure and blood sugar level. Confidential fixed-effects logistic regression and multiple linear regression were performed to identify the effectiveness of the intervention. RESULTS Overall, 600 participants completed the baseline survey and the follow-up survey. The mean systolic blood pressure reduced by 7.3 mm Hg (95% confidence interval [CI] 4.6-9.9) in the first intervention group, 1.9 mm Hg (95% CI - 0.5-4.2) in the second intervention group, and 4.7 mm Hg (95% CI 2.4-7.0) in the control group. Multiple linear regression analysis showed that the between-group differences in the decline in systolic blood pressure were significant for the first intervention versus control (p = 0.001), but not for the second intervention versus control (p = 0.21). The between-group differences in the reduction in blood glucose after the intervention, were not significant on multiple linear regression analysis. CONCLUSIONS Community-based educational interventions for NCDs provided by non-healthcare staff improved the outcomes of hypertension and risk behaviors. Well-designed community-based educational interventions should be frequently implemented to reduce NCDs in rural areas of low- and middle-income countries. Trial registration UMIN Clinical Trials Registry (UMIN-CTR; UMIN000050171) retrospectively registered on January 29, 2023.
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Affiliation(s)
- Yurie Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, 960-1295, Japan.
- Global Exchange Center, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.
- Health Equity Research Institute, Abiko City, Chiba, Japan.
| | | | - Kayako Sakisaka
- Faculty of International Liberal Arts, Kaichi International University, Kashiwa-Shi, Chiba, Japan
| | - Isamu Amir
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, 960-1295, Japan
| | - Megumi Kaneko
- Health Equity Research Institute, Abiko City, Chiba, Japan
| | | | - Sanzida Mubassara
- Department of Botany, Jahangirnagar University, Savar Union, 1342, Bangladesh
| | - Abul Kashem
- Bridge of Community Development Foundation, Narail, Bangladesh
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, 960-1295, Japan
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Daud MH, Yusoff FH, Abdul-Razak S, Baharudin N, Mohamed-Yassin MS, Badlishah-Sham SF, Nikmat AW, Isa MR, Jamil N, Nawawi H, Ramli AS. Design, development, utility and usability testing of the EMPOWER-SUSTAIN Self-Management Mobile App © among primary care physicians and patients with metabolic syndrome. Digit Health 2023; 9:20552076231176645. [PMID: 37312957 PMCID: PMC10259157 DOI: 10.1177/20552076231176645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/02/2023] [Indexed: 06/15/2023] Open
Abstract
Objective This study aimed to design, develop, assess and refine the EMPOWER-SUSTAIN Self-Management Mobile App© among primary care physicians (PCP) and patients with metabolic syndrome (MetS) in primary care. Methodology Using the software-development-life-cycle (SDLC) iterative model, storyboard and wireframe were drafted; and a mock prototype was designed to illustrate the content and function graphically. Subsequently, a working prototype was developed. Qualitative studies using the 'think-aloud' and cognitive-task-analysis methods were conducted for the utility and usability testing. Topic guide was based on the 10-Nielsen's-Heuristic-Principles. Utility testing was conducted among PCP in which they 'thought-aloud' while performing tasks using the mobile app. Usability testing was conducted among MetS patients after they were given the app for 3 weeks. They 'thought-aloud' while performing tasks using the app. Interviews were audio- and video-recorded, and transcribed verbatim. Thematic content analysis was performed. Result Seven PCP and nine patients participated in the utility and usability testing, respectively. Six themes (efficiency of use, user control and freedom, appearance and aesthetic features, clinical content, error prevention, and help and documentation) emerged. PCP found the mobile app attractive and relevant sections were easy to find. They suggested adding 'zoom/swipe' functions and some parts needed bigger fonts. Patients commented that the app was user-friendly, has nice interface, and straightforward language. It helped them understand their health better. Based on these findings, the mobile app was refined. Conclusion This app was produced using a robust SDLC method to increase users' satisfaction and sustainability of its use. It could potentially improve self-management behaviour among MetS patients in primary care.
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Affiliation(s)
- Maryam Hannah Daud
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | | | - Suraya Abdul-Razak
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Cardio Vascular and Lungs Research Institute (CaVaLRI), Hospital Al-Sultan Abdullah (HASA), Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Noorhida Baharudin
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Siti Fatimah Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Azlina Wati Nikmat
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Nursuriati Jamil
- Computing Centre of Studies, College of Computing, Informatics and Media, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Hapizah Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Anis Safura Ramli
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
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Sahar NH, Badlishah-Sham SF, Ramli AS. Adaptation and Psychometric Validation of the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) among Patients with Metabolic Syndrome in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179405. [PMID: 34502011 PMCID: PMC8431134 DOI: 10.3390/ijerph18179405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022]
Abstract
Self-management support is one of the most important components of the Chronic Care Model (CCM). The EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was developed for patients with Metabolic Syndrome (MetS), inspired by the CCM. Assessing usability of a self-management tool is important in chronic disease management. However, there was no available instrument to assess usability of a self-management booklet, as most instruments were developed to assess usability of mobile application. Therefore, this study aimed to adapt Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA) into the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) and to determine its validity and reliability in assessing usability of a self-management booklet. A cross-sectional validation study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. Content validation, adaptation and face validation of E-SUQ were performed according to recommended guidelines. It underwent two rounds of content validation as major revision was required for item 5. Subsequently, the revised E-SUQ was face-validated by 10 participants. Psychometric evaluation was conducted using principal component analysis with varimax rotation to determine the underlying structure of E-SUQ. Internal consistency reliability was assessed using Cronbach’s α coefficient and the test-retest reliability was assessed using intraclass correlation coefficient (ICC (2,k)). A total of 205 patients participated in the study. The item-level content-validity-index (I-CVI) for item 5 improved from 0.57 to 1.0 after the second round of content validation. The final S-CVI/Ave value for ESUQ was >0.90. The item-level face-validity-index (I-FVI) ranged between 0.9 and 1.0. Kaiser-Meyer-Olkin value of 0.871 and Bartlett’s test of sphericity p-value of <0.05 indicated good sample adequacy for factor analysis. Two factors with eigenvalues of >1 were extracted according to the Kaiser’s Criteria. The two extracted factors explained 60.6% of the cumulative percentage of variance. The elbow of the scree plot occurred between the second and third component, suggesting two factors to be retained. The two factors were consistent with “Positive” and “Negative” tone model. The overall Cronbach’s α coefficient was 0.77, indicating good internal reliability. The overall ICC was 0.85, indicating good reproducibility. The E-SUQ is shown to be valid, reliable and stable to measure the usability of a self-management booklet among patients with MetS in a university primary care clinic in Malaysia.
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Affiliation(s)
- Nurul Hidayatullaila Sahar
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Selangor, Malaysia; (N.H.S.); (S.F.B.-S.)
| | - Siti Fatimah Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Selangor, Malaysia; (N.H.S.); (S.F.B.-S.)
| | - Anis Safura Ramli
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Selangor, Malaysia; (N.H.S.); (S.F.B.-S.)
- Institute of Pathology, Laboratory & Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia
- Correspondence:
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Cohen O, Mahagna A, Shamia A, Slobodin O. Health-Care Services as a Platform for Building Community Resilience among Minority Communities: An Israeli Pilot Study during the COVID-19 Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207523. [PMID: 33081120 PMCID: PMC7602759 DOI: 10.3390/ijerph17207523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Background: Previous studies of minority groups in times of emergency have tended to focus on risk reduction or on individual resilience, overlooking the community factors that could be bolstered to promote better health and safety outcomes. The current study aimed to examine the role of health-care services in the perceived community resilience of urban and suburban Arab communities in Israel during the COVID-19 outbreak. Method: The study included 196 adults age 17–76 years, who filled out on-line questionnaires in May 2020; 112 participants lived in an urban community and 84 lived in a suburban community. Community resilience was evaluated using the Conjoint Community Resiliency Assessment Measure (CCRAM), a validated five-factor multidimensional instrument. Results: Residents of the suburban community reported higher community resilience than residents of the urban community. This difference was related to increased preparedness levels and strength of place attachment in the suburban community. Residents of suburban communities were also more satisfied and confident in health-care services than those of urban communities. Regression analysis showed that the satisfaction with primary health-care services, and not community type, significantly predicted community resilience. Conclusions: Our results support the pivotal role of primary health care in building community resilience of minority communities in times of emergency and routine.
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Affiliation(s)
- Odeya Cohen
- Nursing Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel or (A.M.); (A.S.)
- Correspondence: ; Tel.: +972-86477599
| | - Alaa Mahagna
- Nursing Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel or (A.M.); (A.S.)
| | - Asmaa Shamia
- Nursing Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel or (A.M.); (A.S.)
| | - Ortal Slobodin
- Education Department, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel;
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Haque M, Islam T, Rahman NAA, McKimm J, Abdullah A, Dhingra S. Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries. Risk Manag Healthc Policy 2020; 13:409-426. [PMID: 32547272 PMCID: PMC7244358 DOI: 10.2147/rmhp.s239074] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/24/2020] [Indexed: 12/31/2022] Open
Abstract
The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85–90% of premature deaths among 30–69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/33l6gK1RNFo
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Tariqul Islam
- UChicago Research Bangladesh, Dhaka 1230, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, 25200, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Adnan Abdullah
- Unit of Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Mount Hope, Trinidad & Tobago
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The EMPOWER-SUSTAIN e-Health Intervention to improve patient activation and self-management behaviours among individuals with Metabolic Syndrome in primary care: study protocol for a pilot randomised controlled trial. Trials 2020; 21:311. [PMID: 32248825 PMCID: PMC7130454 DOI: 10.1186/s13063-020-04237-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/09/2020] [Indexed: 01/26/2023] Open
Abstract
Background Epidemiological studies conducted in various parts of the world have clearly demonstrated that metabolic syndrome (MetS) is an increasing global health problem, not only in Western societies but also in Asian populations. Web-based and mobile phone-based self-management applications have been proven to be effective in improving self-management behaviour of patients with MetS components (i.e., diabetes or hypertension). However, evidence is lacking in terms of their effectiveness specifically for patients with MetS. The aim of this pilot study is to evaluate the feasibility and potential effectiveness of the EMPOWER-SUSTAIN Self-Management e-Health Intervention in improving activation and self-management behaviours among patients with MetS. This paper presents the study protocol. Methods A pilot randomised controlled trial will be conducted in a university primary care clinic. A total of 232 patients aged 18–60 years with MetS will be recruited; 116 will be randomised to receive the EMPOWER-SUSTAIN intervention for 6 months, and another 116 patients will continue with usual care. The EMPOWER-SUSTAIN intervention is a multifaceted chronic disease management strategy based on the Chronic Care Model and persuasive technology theory. It consists of training primary care physicians, nurses and patients to use the EMPOWER-SUSTAIN web-based self-management mobile app, strengthening the patient–physician relationship and reinforcing the use of relevant clinical practice guidelines to guide management and prescribing. The primary outcome is the mean change in patient activation score using the Patient Activation Measure short form Malay version (PAM-13-M) questionnaire. The secondary outcomes include the changes in waist circumference, body mass index, blood pressure, patient physical activity level, eating behaviour, perception of chronic illness care, satisfaction with patient–physician interaction, and perceived absolute 10-year cardiovascular disease risk. Feasibility of implementing the intervention will be evaluated. This includes acceptability of the intervention, estimating the likely rate of participant recruitment and retention, appropriateness of the outcome measures, calculation of sample size, and the intervention’s potential effectiveness. Conclusion To our knowledge, this is the first study in Malaysia that aims to determine the feasibility of a multifaceted e-health intervention, as well as to indicate more useful aspects of this intervention for further exploration in a larger trial. Trial registration ClinicalTrials.gov, NCT04120779. Registered on 9 October 2019, protocol version 1.
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Correia JC, Lachat S, Lagger G, Chappuis F, Golay A, Beran D. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review. BMC Public Health 2019; 19:1542. [PMID: 31752801 PMCID: PMC6873661 DOI: 10.1186/s12889-019-7842-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
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Affiliation(s)
- Jorge César Correia
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Sarah Lachat
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Grégoire Lagger
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Alain Golay
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
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Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC FAMILY PRACTICE 2018; 19:119. [PMID: 30025525 PMCID: PMC6053735 DOI: 10.1186/s12875-018-0807-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/26/2018] [Indexed: 11/29/2022]
Abstract
Background Majority of patients with chronic illnesses such as diabetes, receive care at primary care setting. Efforts have been made to restructure diabetes care in the Malaysian primary care setting in accordance with the Chronic Care Model (CCM). The Patient Assessment on Chronic Illness Care (PACIC) is a validated self-report tool to measure the extent to which patients with chronic illness receive care that aligns with the CCM. To date, no validated tool is available to evaluate healthcare delivery based on the CCM in the Malay language. Thus, the study aimed to translate the PACIC into the Malay language and validate the questionnaire among patients with diabetes in the Malaysian public primary care setting. Methods The English version of the PACIC questionnaire is a 20-item scale measuring five key components, which are patient activation, decision support, goal setting, problem solving and follow-up care. The PACIC underwent forward - backward translation and cross cultural adaptation process to produce the PACIC-Malay version (PACIC-M). Reliability was tested using internal consistencies and test-retest reliability analyses, while construct validity was tested using the exploratory factor analysis (EFA). Results The content of PACIC-M and the original version were conceptually equivalent. Overall, the internal consistency by Cronbach’s α was .94 and the intra-class correlation coefficient was .93. One item was deleted (item 1) when the factor loading was < 0.4. The factor analyses using promax identified three components (‘Goal Setting/Tailoring and Problem solving/Contextual’, ‘follow-up/coordination’ and ‘patient activation and delivery system design/ decision support’); explaining 61.2% of the variation. The Kaiser-Meyer-Olkin (KMO) was 0.93 and Bartlett’s test of sphericity was p = .000. Therefore, the final version of the PACIC-M consisted of 19 items, framed within three components. Conclusion The findings demonstrated that the PACIC-M measured different dimensions from the English version of PACIC. It is however; highly reliable and valid to be used in assessing three CCM model subscales. Further confirmatory factor analysis of PACIC-M should be conducted to confirm this new model.
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Effectiveness of a Behavioral Approach to Improve Healthcare Worker Compliance With Hospital Dress Code. Infect Control Hosp Epidemiol 2017; 38:1435-1440. [PMID: 29166973 DOI: 10.1017/ice.2017.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The VU University Medical Center, a tertiary-care hospital in the Netherlands, has adopted a dress code based on national guidelines. It includes uniforms provided by the hospital and a 'bare-below-the-elbow' policy for all healthcare workers (HCWs) in direct patient care. Because compliance was poor, we sought to improve adherence by interventions targeted at the main causes of noncompliance. OBJECTIVE To measure compliance with the dress code, to assess causes of noncompliance and to assess whether a behavioral approach (combing a nominal group technique with participatory action) is effective in improving compliance METHODS Between March 2014 and June 2016, a total of 1,920 HCWs were observed in hospital hallways for adherence to the policy, at baseline, and at follow-up measurements. Based on the outcome of the baseline measurement, a nominal group technique was applied to assess causes of noncompliance. The causes revealed served as input for interventions that were developed, prioritized, and tailored to specific groups of HCWs and specific departments through participatory action. RESULTS We identified lack of knowledge, lack of facilities, and negative attitudes as the main causes of noncompliance. The importance of each cause varied for different groups of HCWs. Tailored interventions targeted at these causes increased overall compliance by 39.6% (95% CI, 31.7-47.5). CONCLUSION The combination of a nominal group technique and participatory action approach is an effective method to increase and sustain compliance with hospital dress code. This combined approach may also be useful to improve adherence to other guidelines. Infect Control Hosp Epidemiol 2017;38:1435-1440.
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Ramli AS, Selvarajah S, Daud MH, Haniff J, Abdul-Razak S, Tg-Abu-Bakar-Sidik TMI, Bujang MA, Chew BH, Rahman T, Tong SF, Shafie AA, Lee VKM, Ng KK, Ariffin F, Abdul-Hamid H, Mazapuspavina MY, Mat-Nasir N, Chan CW, Yong-Rafidah AR, Ismail M, Lakshmanan S, Low WHH. Effectiveness of the EMPOWER-PAR Intervention in Improving Clinical Outcomes of Type 2 Diabetes Mellitus in Primary Care: A Pragmatic Cluster Randomised Controlled Trial. BMC FAMILY PRACTICE 2016; 17:157. [PMID: 27842495 PMCID: PMC5109682 DOI: 10.1186/s12875-016-0557-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/02/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The chronic care model was proven effective in improving clinical outcomes of diabetes in developed countries. However, evidence in developing countries is scarce. The objective of this study was to evaluate the effectiveness of EMPOWER-PAR intervention (based on the chronic care model) in improving clinical outcomes for type 2 diabetes mellitus using readily available resources in the Malaysian public primary care setting. METHODS This was a pragmatic, cluster-randomised, parallel, matched pair, controlled trial using participatory action research approach, conducted in 10 public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Patients who fulfilled the criteria were recruited over a 2-week period by each clinic. The obligatory intervention components were designed based on four elements of the chronic care model i.e. healthcare organisation, delivery system design, self-management support and decision support. The primary outcome was the change in the proportion of patients achieving HbA1c < 6.5%. Secondary outcomes were the change in proportion of patients achieving targets for blood pressure, lipid profile, body mass index and waist circumference. Intention to treat analysis was performed for all outcome measures. A generalised estimating equation method was used to account for baseline differences and clustering effect. RESULTS A total of 888 type 2 diabetes mellitus patients were recruited at baseline (intervention: 471 vs. CONTROL 417). At 1-year, 96.6 and 97.8% of patients in the intervention and control groups completed the study, respectively. The baseline demographic and clinical characteristics of both groups were comparable. The change in the proportion of patients achieving HbA1c target was significantly higher in the intervention compared to the control group (intervention: 3.0% vs. CONTROL -4.1%, P < 0.002). Patients who received the EMPOWER-PAR intervention were twice more likely to achieve HbA1c target compared to those in the control group (adjusted OR 2.16, 95% CI 1.34-3.50, P < 0.002). However, there was no significant improvement found in the secondary outcomes. CONCLUSIONS This study demonstrates that the EMPOWER-PAR intervention was effective in improving the primary outcome for type 2 diabetes in the Malaysian public primary care setting. TRIAL REGISTRATION Registered with: ClinicalTrials.gov.: NCT01545401 . Date of registration: 1st March 2012.
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Affiliation(s)
- Anis Safura Ramli
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | - Sharmini Selvarajah
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Maryam Hannah Daud
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | - Jamaiyah Haniff
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Suraya Abdul-Razak
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | | | - Mohamad Adam Bujang
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Malaysia
| | - Thuhairah Rahman
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Asrul Akmal Shafie
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Verna K. M. Lee
- Department of Family Medicine, School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Kien Keat Ng
- Faculty of Medicine & Defense Health, National Defense University of Malaysia, Sungai Besi Camp, Kuala Lumpur, Malaysia
| | - Farnaza Ariffin
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
| | - Hasidah Abdul-Hamid
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
| | - Md Yasin Mazapuspavina
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
| | - Nafiza Mat-Nasir
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
| | - Chun W. Chan
- Department of Family Medicine, School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Abdul Rahman Yong-Rafidah
- Discipline of Family Medicine, Faculty of Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya, Selangor Malaysia
| | - Mastura Ismail
- Klinik Kesihatan Seremban 2, Seremban, Negeri Sembilan Malaysia
| | - Sharmila Lakshmanan
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Wilson H. H. Low
- Monash Health, Monash Medical Centre, Clayton Campus, Clayton, VIC Australia
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