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Ataee E, Shirekhoda M, Nahvijou A, Shahmoradi L, Ramezanghorbani N. Determining the Content of a Melanoma Prevention and Care Mobile Application for Melanoma Patients: A Survey Study. Asian Pac J Cancer Prev 2024; 25:409-418. [PMID: 38415525 PMCID: PMC11077132 DOI: 10.31557/apjcp.2024.25.2.409] [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: 04/11/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTS Skin cancer is one of the most common cancers and melanoma is the deadliest type of skin cancer. Since the Mobile based health interventions have significant effects in the management of diseases. This study aimed to determining the content of melanoma prevention and care application. METHODS This is a descriptive study that was conducted in three stages. at first, in order to identify the features of the application, search was conducted based on PubMed, Google Scholar ، Scopus databases. In the second step, in order to determine the content of information, articles and guidelines related to melanoma were searched. In the third stage, in order to ensure the validity of researcher-made questionnaire, a survey was conducted by 51 experts based on targeted sampling. The collected data were analyzed. RESULTS demographic and clinical information and melanoma prevention training was common in 14 reviewed applications; The possibility of sending reminders for patients was less considered. Most of the articles have paid attention to the data elements: age, gender, history of sunburn, skin color and history of cancer, exposure to ultraviolet rays, how to care for the skin. The content of the melanoma prevention and care application consists of three general sections: 1- Demographic, clinical information and melanoma risk factors; 2- Educational needs; 3- Features and capabilities of the application for prevention and care were formed. The results of the expert survey showed that 81% of the section1, 80% of the section2, and 91% of the section3 were approved. CONCLUSIONS Mobile applications has an effective role in disease management and accelerating the provision of health services and reducing the costs of providing services. Melanoma prevention and care application can be an aid in patient education and ultimately better disease management in the field of prevention and care during the current crisis.
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Affiliation(s)
- Elham Ataee
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Shirekhoda
- Department of General Oncology, Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
| | - Leila Shahmoradi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nahid Ramezanghorbani
- Department of Development and Coordination Scientific Information and Publications, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.
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Bailey JE, Gurgol C, Pan E, Njie S, Emmett S, Gatwood J, Gauthier L, Rosas LG, Kearney SM, Robler SK, Lawrence RH, Margolis KL, Osunkwo I, Wilfley D, Shah VO. Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review. J Med Internet Res 2021; 23:e28503. [PMID: 34878986 PMCID: PMC8693194 DOI: 10.2196/28503] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. OBJECTIVE This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. METHODS A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. RESULTS PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. CONCLUSIONS Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
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Affiliation(s)
- James E Bailey
- Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cathy Gurgol
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Eric Pan
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Shirilyn Njie
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Susan Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lynne Gauthier
- Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
- Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Shannon M Kearney
- Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States
| | | | - Raymona H Lawrence
- Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | - Ifeyinwa Osunkwo
- Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Denise Wilfley
- Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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van Olmen J, Erwin E, García-Ulloa AC, Meessen B, Miranda JJ, Bobrow K, Iwelunmore J, Nwaozuru U, Obiezu Umeh C, Smith C, Harding C, Kumar P, Gonzales C, Hernández-Jiménez S, Yeates K. Implementation barriers for mHealth for non-communicable diseases management in low and middle income countries: a scoping review and field-based views from implementers. Wellcome Open Res 2020; 5:7. [PMID: 32399497 PMCID: PMC7194478 DOI: 10.12688/wellcomeopenres.15581.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Mobile health (mHealth) has been hailed as a potential gamechanger for non-communicable disease (NCD) management, especially in low- and middle-income countries (LMIC). Individual studies illustrate barriers to implementation and scale-up, but an overview of implementation issues for NCD mHealth interventions in LMIC is lacking. This paper explores implementation issues from two perspectives: information in published papers and field-based knowledge by people working in this field. Methods: Through a scoping review publications on mHealth interventions for NCDs in LMIC were identified and assessed with the WHO mHealth Evidence Reporting and Assessment (mERA) tool. A two-stage web-based survey on implementation barriers was performed within a NCD research network and through two online platforms on mHealth targeting researchers and implementors. Results: 16 studies were included in the scoping review. Short Message Service (SMS) messaging was the main implementation tool. Most studies focused on patient-centered outcomes. Most studies did not report on process measures and on contextual conditions influencing implementation decisions. Few publications reported on implementation barriers. The websurvey included twelve projects and the responses revealed additional information, especially on practical barriers related to the patients' characteristics, low demand, technical requirements, integration with health services and with the wider context. Many interventions used low-cost software and devices with limited capacity that not allowed linkage with routine data or patient records, which incurred fragmented delivery and increased workload. Conclusion: Text messaging is a dominant mHealth tool for patient-directed of quality improvement interventions in LMIC. Publications report little on implementation barriers, while a questionnaire among implementors reveals significant barriers and strategies to address them. This information is relevant for decisions on scale-up of mHealth in the domain of NCD. Further knowledge should be gathered on implementation issues, and the conditions that allow universal coverage.
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Affiliation(s)
- Josefien van Olmen
- Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, 1000, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, 1000, Belgium
| | - Erica Erwin
- Global Health Research Office, Queen’s University, Ontario, Canada
- Pamoja Tunaweza Research Center, Moshi, Tanzania
| | | | | | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kirsty Bobrow
- University of CapeTown, Capetown, South Africa
- Oxford University, Oxford, UK
| | - Juliet Iwelunmore
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | | | - Carter Smith
- Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | - Pratap Kumar
- Strathmore Business School, Institute of Healthcare Management, Nairobi, Kenya
| | - Clicerio Gonzales
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Karen Yeates
- College of Global Public Health, New York University, New York, USA
- Medicine, Queen's University, Ontario, Canada
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van Olmen J, Erwin E, García-Ulloa AC, Meessen B, Miranda JJ, Bobrow K, Iwelunmore J, Nwaozuru U, Obiezu Umeh C, Smith C, Harding C, Kumar P, Gonzales C, Hernández-Jiménez S, Yeates K. Implementation barriers for mHealth for non-communicable diseases prevention and management in low and middle income countries: a scoping review and field-based views from implementers. Wellcome Open Res 2020; 5:7. [PMID: 32399497 PMCID: PMC7194478 DOI: 10.12688/wellcomeopenres.15581.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 03/29/2024] Open
Abstract
Background: Mobile health (mHealth) has been hailed as a potential gamechanger for non-communicable disease (NCD) management, especially in low- and middle-income countries (LMICs). Individual studies illustrate barriers to implementation and scale-up, but an overview of implementation issues for NCD mHealth interventions in LMICs is lacking. This paper explores implementation issues from two perspectives: information in published papers and field-based knowledge by people working in this field. Methods: Through a scoping review publications on mHealth interventions for NCDs in LMICs were identified and assessed with the WHO mHealth Evidence Reporting and Assessment (mERA) tool. A two-stage web-based survey on implementation barriers was performed within a NCD research network and through two online platforms on mHealth targeting researchers and implementors. Results: 18 studies were included in the scoping review. Short Message Service (SMS) messaging was the main implementation tool. Most studies focused on patient-centered outcomes. Most studies do not report on process measures and on contextual conditions influencing implementation decisions. Few publications reported on implementation barriers. The websurvey included twelve projects and the responses revealed additional information, especially on practical barriers related to the patients' characteristics, low demand, technical requirements, integration with health services and with the wider context. Many interventions used low-cost software and devices with limited capacity that not allowing linkage with routine data or patient records, which incurred fragmented delivery and increased workload. Conclusion: Text messaging is a dominant mHealth tool for patient-directed of quality improvement interventions in LMICs. Publications report little on implementation barriers, while a questionnaire among implementors reveals significant barriers and strategies to address them. This information is relevant for decisions on scale-up of mHealth in the domain of NCD. Further knowledge should be gathered on implementation issues, and the conditions that allow universal coverage.
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Affiliation(s)
- Josefien van Olmen
- Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, 1000, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, 1000, Belgium
| | - Erica Erwin
- Global Health Research Office, Queen’s University, Ontario, Canada
- Pamoja Tunaweza Research Center, Moshi, Tanzania
| | | | | | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kirsty Bobrow
- University of CapeTown, Capetown, South Africa
- Oxford University, Oxford, UK
| | - Juliet Iwelunmore
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | | | - Carter Smith
- Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | - Pratap Kumar
- Strathmore Business School, Institute of Healthcare Management, Nairobi, Kenya
| | - Clicerio Gonzales
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Karen Yeates
- College of Global Public Health, New York University, New York, USA
- Medicine, Queen's University, Ontario, Canada
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Ong KKX, Ng JS, Om C, Chhoun P, Tuot S, Yi S. Perceived barriers and facilitators in using text and voice messaging for improving HIV and sexual and reproductive health of female entertainment workers in Cambodia: a qualitative study. Mhealth 2020; 6:38. [PMID: 33209915 PMCID: PMC7656103 DOI: 10.21037/mhealth.2020.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Female entertainment workers (FEWs) in Cambodia are one of the hard-to-reach populations at risk of human immunodeficiency virus (HIV) and poor sexual and reproductive health (SRH). Due to the stigmatizing nature of their work, it is difficult to reach them with prevention and treatment services. The Mobile Link project is a mobile health (mHealth) intervention that aims to deliver health messages to FEWs and link them up to health services. This study aims to explore the perspectives of stakeholders on the Mobile Link and identify barriers and facilitators to the project implementation, in order to determine areas for improvement of future mHealth interventions. METHODS This study was conducted between November to December 2018 in the capital city and other three provinces where the Mobile Link was implemented. We employed a qualitative research design using an interpretative approach. A purposive sampling method was used to recruit participants across four project sites. All participants were stakeholders involved directly or indirectly with the Mobile Link. Nine different groups of stakeholders at the national, non-governmental organizations, community, and individual levels were recruited. Seventeen semi-structured in-depth interviews (IDIs) and five focus group discussions (FGDs) were conducted and transcribed. Data were managed using NVivo 12 and analysed using thematic analysis with an inductive approach. RESULTS We derived four major themes: (I) perceived benefits, (II) attitudes, (III) access, and (IV) enabling environment. Different levels of stakeholders reported on the perceived benefits of the Mobile Link, including ease of use, knowledge gained, link to services, and cost-effectiveness. Perceived benefits and enabling environment were identified as facilitators to implementation of the project. Barriers included technological issues, operational challenges, poor rapport with entertainment establishment owners, and low motivation to participate in the Mobile Link among FEWs. CONCLUSIONS The Mobile Link has many advantages and is well-accepted by stakeholders from the national and community levels. We discussed the implications of the perceived facilitators and barriers identified on the project and mHealth interventions. Implications discussed should be taken into consideration by organizations implementing mHealth interventions for HIV key populations in Cambodia as well as in other resource-limited settings.
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Affiliation(s)
- Kiyoko Kai Xuan Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Janelle Shaina Ng
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Chhorvoin Om
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, CA, USA
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
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Agarwal G, Angeles RN, Dolovich L, Kaczorowski J, Gaber J, Guenter D, Arnuco FD, Lam HY, Thabane L, O'Reilly D, Agbulos RM, Arciaga RS, Barrera J, Gregorio E, Halili S, Jalani N, Cristobal F. The Community Health Assessment Program in the Philippines (CHAP-P) diabetes health promotion program for low- to middle-income countries: study protocol for a cluster randomized controlled trial. BMC Public Health 2019; 19:682. [PMID: 31159778 PMCID: PMC6547510 DOI: 10.1186/s12889-019-6974-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/14/2019] [Indexed: 11/17/2022] Open
Abstract
Background Type 2 diabetes is increasing globally, with the highest burden in low- to middle-income countries (LMICs) such as the Philippines. Developing effective interventions could improve detection, prevention, and treatment of diabetes. The Cardiovascular Health Awareness Program (CHAP), an evidence-based Canadian intervention, may be an appropriate model for LMICs due to its low cost, ease of implementation, and focus on health promotion and disease prevention. The primary aim of this study is to adapt the CHAP model to a Philippine context as the Community Health Assessment Program in the Philippines (CHAP-P) and evaluate the effect of CHAP-P on glycated hemoglobin (HbA1c) compared to a random sample of community residents in control communities. Methods Six-month, 26-community (13 intervention, 13 control) parallel cluster randomized controlled trial in Zamboanga Peninsula, an Administrative Region in the southern Philippines. Criteria for community selection include: adequate political stability, connection with local champions, travel feasibility, and refrigerated space for materials. The community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic condition assessment, blood pressure monitoring, and health education. Three participant groups will be involved: 1) Random sample of community participants aged 40 or older, 100 per community (1300 control, 1300 intervention participants total); 2) Community members aged 40 years or older who attended at least one CHAP-P session; 3) Community health workers and staff facilitating sessions. Primary outcome: mean difference in HbA1c at 6 months in intervention group individuals compared to control. Secondary outcomes: modifiable risk factors, health utilization and access (individual); diabetes detection and management (cluster). Evaluation also includes community process evaluation and cost-effectiveness analysis. Discussion CHAP has been shown to be effective in a Canadian setting. Individual components of CHAP-P have been piloted locally and shown to be acceptable and feasible. This study will improve understanding of how best to adapt this model to an LMIC setting, in order to maximize prevention, detection, and management of diabetes. Results may inform policy and practice in the Philippines and have the potential to be applied to other LMICs. Trial registration ClinicalTrials.gov (NCT03481335), registered March 29, 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-6974-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada.
| | - Ricardo N Angeles
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada.,School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal and CRCHUM, 850 Saint-Denis St, Montreal, Quebec, H2X 0A9, Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Dale Guenter
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Floro Dave Arnuco
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Hilton Y Lam
- Institute of Health Policy and Development Studies, University of the Philippines Manila, One Adriatico Place Tower One, Adriatico Street Corner Pedro Gill Street, 1000, Manila, Philippines
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Daria O'Reilly
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Rodelin M Agbulos
- Zamboanga City Health Office, Pettit Barracks, 7000, Zamboanga City, Philippines
| | - Rosemarie S Arciaga
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines.,Zamboanga Medical Research Foundation, Zamboanga City, Philippines
| | - Jerome Barrera
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Elgie Gregorio
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Servando Halili
- Graduate School, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Norvie Jalani
- Department of Health, Zamboanga Peninsula, 7000, Zamboanga City, Philippines
| | - Fortunato Cristobal
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
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Chhoun P, Kaplan KC, Wieten C, Jelveh I, Lienemann M, Tuot S, Yi S, Brody C. Using participatory methods to build an mHealth intervention for female entertainment workers in Cambodia: the development of the Mobile Link project. Mhealth 2019; 5:24. [PMID: 31559269 PMCID: PMC6737450 DOI: 10.21037/mhealth.2019.07.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/27/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The HIV epidemic in Cambodia is strongly and disproportionately concentrated among key populations. One important hard-to-reach key population is the expanding community of female entertainment workers (FEWs). HIV as well as other sexual and reproductive health (SRH) outcomes including sexually transmitted infections (STIs), contraception, and gynecologic health are also substandard among FEWs. To address these concerns, a mobile health intervention (mHealth) using short message service (SMS) and voice message (VM) services-the Mobile Link project-was constructed. This paper aims to describe the development of this mHealth intervention that used participatory methodologies and to illustrate how these findings can be useful in future mHealth projects. METHODS This intervention development process used an iterative, participatory approach. Twenty-seven focus group discussions (FGDs) covering SRH topics were designed and conducted and implemented across four provinces in Cambodia. Additionally, six in-depth interviews (IDIs) were conducted with FEWs living with HIV in Siem Reap and Phnom Penh. Data from the FGDs and IDIs were analyzed using content and matrix analysis methods to identify prioritized themes for messages. Two data validation workshops were organized to present the prioritized themes to FEWs and outreach workers (outreach workers) for validation. The workshops included activities stimulating participation such as listening to sample messages in order to determine health priorities as well as message tone and style. RESULTS The findings from the qualitative research provided guidance on how to tailor the intervention to the FEW community in terms of the tone, timing, content and delivery mode of the messages. Participants preferred a friendly, professional female voice for VM. Participants revealed that health priorities such as gynecologic issues (vaginal infections/irritation) and cervical and breast cancer, were emphasized more than HIV and family planning. Participants also reported a number of misconceptions about contraception, particularly around oral contraceptives and intrauterine devices, and STI transmission. Participants expressed the need to build trust in outreach workers and linkages, affirming the emphasis on the link within the Mobile Link project. Lastly, from the IDIs, FEWs living with HIV highlighted wanting supportive/messages to address depressive feelings that may stem from their perceived stigma. CONCLUSIONS Utilizing participatory methodologies was demonstrated to be useful in intervention content creation and program implementation. As a result of this intervention development process, the research team gleaned lessons that may be applicable to future mHealth projects including the idea of adding some layers of choice to mHealth interventions for further tailoring at the individual level and the importance of human contact and trusting relationship.
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Affiliation(s)
- Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Carlijn Wieten
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Ida Jelveh
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
| | - Mitchell Lienemann
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
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Brody C, Tuot S, Chhoun P, Swendenman D, Kaplan KC, Yi S. Mobile Link - a theory-based messaging intervention for improving sexual and reproductive health of female entertainment workers in Cambodia: study protocol of a randomized controlled trial. Trials 2018; 19:235. [PMID: 29673381 PMCID: PMC5907699 DOI: 10.1186/s13063-018-2614-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/28/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In Cambodia, HIV prevalence is concentrated in key populations including among female entertainment workers (FEWs) who may engage in direct or indirect sex work. Reaching FEWs with sexual and reproductive health (SRH) services has been difficult because of their hidden and stigmatized nature. Mobile-phone-based interventions may be an effective way to reach this population and connect them with the existing services. This article describes study design and implementation of a randomized controlled trial (RCT) of a mobile health intervention (the Mobile Link) aiming to improve SRH and related outcomes among FEWs in Cambodia. METHODS A two-arm RCT will be used to determine the effectiveness of a mobile-phone-based text/voice messaging intervention. The intervention will be developed through a participatory process. Focus group discussions and in-depth interviews have been conducted to inform and tailor behavior change theory-based text and voice messages. During the implementation phase, 600 FEWs will be recruited and randomly assigned into one of the two arms: (1) a control group and (2) a mobile phone message group (either text messages [SMS] or voice messages [VM], a delivery method chosen by participants). Participants in the control group will also receive a weekly monitoring survey, which will provide real-time information to implementing partners to streamline outreach efforts and be able to quickly identify geographic trends. The primary outcome measures will include self-reported HIV and sexually transmitted infections (STI) testing and treatment, condom use, contraceptive use, and gender-based violence (GBV). DISCUSSION If the Mobile Link trial is successful, participants will report an increase in condom use, linkages to screening and treatment for HIV and STI, and contraception use as well as a reduction in GBV. This trial is unique in a number of ways. First, the option of participation mode (SMS or VM) allows participants to choose the message medium that best links them to services. Second, this is the first RCT of a mobile-phone-based behavior change intervention using SMS/VMs to support linkage to SRH services in Cambodia. Lastly, we are working with a hidden, hard-to-reach, and dynamic population with which existing methods of outreach have not been fully successful. TRIAL REGISTRATION Clinical trials.gov, NCT03117842 . Registered on 31 March 2017.
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Affiliation(s)
- Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Dallas Swendenman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA USA
| | - Kathryn C. Kaplan
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Siyan Yi
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA USA
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
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Daniels J, Lane T, Struthers H, Maleke K, Moges W, McIntyre J, Coates T. Assessing the Feasibility of Smartphone Apps for HIV-Care Research with MSM and Transgender Individuals in Mpumalanga, South Africa. J Int Assoc Provid AIDS Care 2017; 16:433-439. [PMID: 28791915 DOI: 10.1177/2325957417724207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is an urgent need to develop the HIV treatment cascade for men who have sex with men (MSM) and transgender individuals in rural Mpumalanga, South Africa. Mhealth tools such as smartphone applications have the potential to support HIV self-care behaviors. We conducted an exploratory study with HIV-positive community leaders to understand their current uses of cell phones and smartphones and to assess their interest in an HIV research study that utilized a smartphone application for HIV care support. A total of 18 community leaders were recruited to complete a questionnaire and focus group. We found that a large proportion of participants had smartphone access and were interested in a research study that utilized a smartphone application with secure access measures. We conclude that smartphone applications for HIV care research are feasible based on access and interest by MSM and transgender individuals in this rural setting.
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Affiliation(s)
- Joseph Daniels
- 1 Department of Health Sciences, Lehman College, The City University of New York, USA
| | - Tim Lane
- 2 Center for AIDS Prevention Studies, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Kabelo Maleke
- 3 Anova Health Institute, Johannesburg, South Africa
| | - Winta Moges
- 4 Program in Public Health, University of California at Irvine, Irvine, USA
| | - James McIntyre
- 5 School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thomas Coates
- 6 Center for World Health, David Geffen School of Medicine, Los Angeles, USA
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Van Olmen J, Kegels G, Korachais C, de Man J, Van Acker K, Kalobu JC, van Pelt M, Ku GM, Hen H, Kanda D, Malombo B, Darras C, Schellevis F. The effect of text message support on diabetes self-management in developing countries - A randomised trial. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2017; 7:33-41. [PMID: 29067248 PMCID: PMC5651290 DOI: 10.1016/j.jcte.2016.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 01/05/2023]
Abstract
Report of a randomised trial on an mHealth intervention in 3 low income countries. There was no additional effect of the text message self-management support. Coverage, routine care and disease progression interfere with the potential impact.
Objective mHealth interventions have the potential to facilitate self-management. This TEXT4DSM study implemented a mobile phone intervention in existing diabetes programmes in three low- and middle-income countries (Democratic Republic of Congo, Cambodia, and the Philippines). Research design and methods Sub-studies with a similar randomised controlled trial design were conducted in three different countries. Each sub-study included 480 adults with diabetes. Subjects were randomised to receive either routine care or routine care plus text message self-management support. The primary outcome was the difference in the proportion of subjects with well-controlled diabetes after 2 years. Results Baseline and 2-year HbA1c measurements were available for 781 individuals. After 2 years, the proportion of subjects with controlled HbA1c was 2.8% higher in the intervention group than in the control group (difference not statistically significant). In the logistic regression model, the odds ratio for having controlled diabetes after the intervention was 1.1, after adjusting for baseline HbA1c level, sex, receiving insulin treatment, and participating in the routine programme. The HbA1c dynamics over time differed between programmes; the number of people with controlled diabetes tended to increase in DR Congo and decrease in Cambodia. Conclusion This study was the first to test the same mHealth intervention in different countries. The finding that text messages did not show an additional effect on diabetes control implied that expectations about mHealth should be cautious. The degree of coverage, the quality of the routine programme, and the progression of disease can interfere with the expected impact. Trial registration: ISRCTN registry (86247213).
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Affiliation(s)
- Josefien Van Olmen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
| | - Guy Kegels
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Catherine Korachais
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jeroen de Man
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Van Acker
- Algemeen ziekenhuis Heilige Familie Reet en Centre de Santé des Fagnes, Chimay, Belgium
| | | | | | - Grace Marie Ku
- Veterans Memorial Medical Center, Philippines.,Institute of Health Policy & Development Studies, National Institutes of Health, University of the Philippines Manila, Philippines
| | | | - Dominique Kanda
- Algemeen ziekenhuis Heilige Familie Reet en Centre de Santé des Fagnes, Chimay, Belgium
| | - Billy Malombo
- Algemeen ziekenhuis Heilige Familie Reet en Centre de Santé des Fagnes, Chimay, Belgium
| | | | - François Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands.,Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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Brody C, Tatomir B, Sovannary T, Pal K, Mengsrun S, Dionosio J, Luong MA, Yi S. Mobile phone use among female entertainment workers in Cambodia: an observation study. Mhealth 2017; 3:3. [PMID: 28293620 PMCID: PMC5344137 DOI: 10.21037/mhealth.2017.01.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/07/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Text or voice messages containing health behavior change content may be an inexpensive, discreet, sustainable and scalable way to reach populations at high risk for HIV. In Cambodia, one of the important high-risk populations is female entertainment workers (FEWs). This ethnographic study aims to explore typical phone use, examining patterns and behaviors that may influence the design of future mHealth interventions. METHODS The study consisted of one 8-hour non-participant observation session for 15 randomly sampled FEWs. Observations focused on capturing normal daily use of mobile devices. Observation checklists were populated by observers during the observations and a post-observation survey was conducted. Findings were discussed with Cambodian HIV outreach workers and HIV research fellows and their interpretations are summarized below. RESULTS In this ethnographic study, all 15 participants made calls, checked the time and received research-related texts. More than half (n=8) of the participants engaged in texting to a non-research recipient. About half (n=7) went on Facebook (FB) and some (n=5) listened to music and looked at their FB newsfeed. Fewer played a mobile game, posted a photo to FB, went on YouTube, used FB chat/messenger, watched a video on FB, played a game on FB, used FB call/voice chat, looked at their phone's background or used the LINE app. Fewer still shared their phones, left them unattended, added airtime or changed their SIM cards. When participants received a research text message, most did not share the text message with anyone, did not ask for help deciphering the message and did not receive help composing a response. Notable themes from observer notes, HIV outreach workers and researchers include reasons why phone calls were the most frequent mode of communication, examples of how cell phone company text messages are used as a form of behavior change, literacy as a persistent barrier for some FEWs, and FEWs' high interest in receiving health-related messages and less concern about privacy and phone-sharing issues than expected. CONCLUSIONS This study suggests texting is a part of normal phone use although not as frequently used as voice calls or Facebook. Despite the less frequent use, FEWs were able to send and receive messages, were interested in health messages and were not overly concerned about privacy issues. Texting and voice messaging may be useful tools for health behavior change within the FEW population in Cambodia.
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Affiliation(s)
- Carinne Brody
- Center for Global Health Research, School of Public Health, Touro University California, Vallejo, CA, USA
| | - Brent Tatomir
- Center for Global Health Research, School of Public Health, Touro University California, Vallejo, CA, USA
| | - Tuot Sovannary
- Khmer HIV/AIDS NGO Alliance (KHANA), Center for Population Health Research, Phnom Penh, Cambodia
| | - Khuondyla Pal
- Khmer HIV/AIDS NGO Alliance (KHANA), Center for Population Health Research, Phnom Penh, Cambodia
| | - Song Mengsrun
- Khmer HIV/AIDS NGO Alliance (KHANA), Center for Population Health Research, Phnom Penh, Cambodia
| | - Jennifer Dionosio
- Center for Global Health Research, School of Public Health, Touro University California, Vallejo, CA, USA
| | - Minh-Anh Luong
- Center for Global Health Research, School of Public Health, Touro University California, Vallejo, CA, USA
| | - Siyan Yi
- Khmer HIV/AIDS NGO Alliance (KHANA), Center for Population Health Research, Phnom Penh, Cambodia
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Process evaluation of a mobile health intervention for people with diabetes in low income countries – the implementation of the TEXT4DSM study. J Telemed Telecare 2016; 23:96-105. [DOI: 10.1177/1357633x15617885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Evidence about mobile health (mHealth) approaches to manage diabetes shows modest effects on outcomes, but little is known about implementation variability. This is a process evaluation of an mHealth intervention to improve diabetes self-management through Short Message Service (SMS) provision in three diabetes care programmes in the Democratic Republic of Congo (DRC), Cambodia and the Philippines. Methods The intervention involved Diabetes Self-Management Support via text messages. The content and process of the intervention is based upon the core principles of diabetes self-management and behaviour theory. In each country, messages were sent by project managers to 240 participants in each country, who were randomly assigned to the intervention group. Contracts were negotiated with national phone providers and open access software was used to send the messages. Participants received a mobile phone and SIM card. We analysed data about the implementation process over a one year period. Results The mean monthly number of messages delivered to recipients’ phones was 67.7% of the planned number in DRC, 92.3% in Cambodia and 83.9% in the Philippines. A telephone check revealed problems with one-third of the phones, including breakage, loss and cancelled subscriptions. The number of people reached at least once was 177 (70.0%) in DRC; 147 (60.7%) in Cambodia; five in the Philippines (2.0%). Those reached each time was 144 in DRC (56.9%), 28 (9.9%) in Cambodia, none in the Philippines. People used their phone more frequently than before the intervention. Discussion Implementation of the intervention meets constraints at every step in the process. Barriers relate to the technology, the context and the participants.
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Brody C, Dhaliwal S, Tuot S, Johnson M, Pal K, Yi S. Are Text Messages a Feasible and Acceptable Way to Reach Female Entertainment Workers in Cambodia with Health Messages? A Cross-Sectional Phone Survey. JMIR Mhealth Uhealth 2016; 4:e52. [PMID: 27207374 PMCID: PMC4909390 DOI: 10.2196/mhealth.5297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/13/2022] Open
Abstract
Background Despite great achievements in reducing the prevalence of HIV, eliminating new HIV infections remains a challenge in Cambodia. Entertainment venues such as restaurants, karaoke bars, beer gardens, cafes, pubs, and massage parlors are now considered important venues for HIV prevention efforts and other health outreach interventions. Objective The purpose of this study was to explore phone use and texting practices of female entertainment workers (FEWs) in order to determine if text messaging is a feasible and acceptable way to link FEWs to health services. Methods This cross-sectional phone survey was conducted in May 2015 with 97 FEWs aged 18–35 years and currently working at an entertainment venue in Phnom Penh. Results Of the 96 respondents, 51% reported sending text messages daily; of them, 47% used Khmer script and 45% used Romanized Khmer. Younger FEWs were more likely to report daily texting (P<.001). Most FEWs (98%) in this study reported feeling comfortable receiving private health messages despite the fact that 39% were sharing their phone with others. Younger FEWs were less likely to share their phone with others (P=.02). Of all of the FEWs, 47% reported owning a smartphone, and younger women were more likely to own a smartphone than were older women (P=.08). Conclusions The findings from this study support the development of mHealth interventions targeting high-risk groups in urban areas of Cambodia. Our data suggest that mHealth interventions using texting may be a feasible way of reaching FEWs in Phnom Penh.
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Affiliation(s)
- Carinne Brody
- Touro University California, Public Health Program, Center for Global Health Research, Vallejo, CA, United States.
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Fernando ME, Seneviratne RM, Tan YM, Lazzarini PA, Sangla KS, Cunningham M, Buttner PG, Golledge J. Intensive versus conventional glycaemic control for treating diabetic foot ulcers. Cochrane Database Syst Rev 2016; 2016:CD010764. [PMID: 26758576 PMCID: PMC8627701 DOI: 10.1002/14651858.cd010764.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The estimated likelihood of lower limb amputation is 10 to 30 times higher amongst people with diabetes compared to those without diabetes. Of all non-traumatic amputations in people with diabetes, 85% are preceded by a foot ulcer. Foot ulceration associated with diabetes (diabetic foot ulcers) is caused by the interplay of several factors, most notably diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD) and changes in foot structure. These factors have been linked to chronic hyperglycaemia (high levels of glucose in the blood) and the altered metabolic state of diabetes. Control of hyperglycaemia may be important in the healing of ulcers. OBJECTIVES To assess the effects of intensive glycaemic control compared to conventional control on the outcome of foot ulcers in people with type 1 and type 2 diabetes. SEARCH METHODS In December 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; EBSCO CINAHL; Elsevier SCOPUS; ISI Web of Knowledge Web of Science; BioMed Central and LILACS. We also searched clinical trial databases, pharmaceutical trial databases and current international and national clinical guidelines on diabetes foot management for relevant published, non-published, ongoing and terminated clinical trials. There were no restrictions based on language or date of publication or study setting. SELECTION CRITERIA Published, unpublished and ongoing randomised controlled trials (RCTs) were considered for inclusion where they investigated the effects of intensive glycaemic control on the outcome of active foot ulcers in people with diabetes. Non randomised and quasi-randomised trials were excluded. In order to be included the trial had to have: 1) attempted to maintain or control blood glucose levels and measured changes in markers of glycaemic control (HbA1c or fasting, random, mean, home capillary or urine glucose), and 2) documented the effect of these interventions on active foot ulcer outcomes. Glycaemic interventions included subcutaneous insulin administration, continuous insulin infusion, oral anti-diabetes agents, lifestyle interventions or a combination of these interventions. The definition of the interventional (intensive) group was that it should have a lower glycaemic target than the comparison (conventional) group. DATA COLLECTION AND ANALYSIS All review authors independently evaluated the papers identified by the search strategy against the inclusion criteria. Two review authors then independently reviewed all potential full-text articles and trials registry results for inclusion. MAIN RESULTS We only identified one trial that met the inclusion criteria but this trial did not have any results so we could not perform the planned subgroup and sensitivity analyses in the absence of data. Two ongoing trials were identified which may provide data for analyses in a later version of this review. The completion date of these trials is currently unknown. AUTHORS' CONCLUSIONS The current review failed to find any completed randomised clinical trials with results. Therefore we are unable to conclude whether intensive glycaemic control when compared to conventional glycaemic control has a positive or detrimental effect on the treatment of foot ulcers in people with diabetes. Previous evidence has however highlighted a reduction in risk of limb amputation (from various causes) in people with type 2 diabetes with intensive glycaemic control. Whether this applies to people with foot ulcers in particular is unknown. The exact role that intensive glycaemic control has in treating foot ulcers in multidisciplinary care (alongside other interventions targeted at treating foot ulcers) requires further investigation.
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Affiliation(s)
- Malindu E Fernando
- College of Medicine and Dentistry, James Cook UniversityVascular Biology Unit, Queensland Research Centre for Peripheral Vascular DiseaseTownsvilleQueenslandAustralia4814
- Kirwan Community Health CampusPodiatry ServiceTownsvilleQueenslandAustralia
| | - Ridmee M Seneviratne
- College of Medicine and Dentistry, James Cook UniversityVascular Biology Unit, Queensland Research Centre for Peripheral Vascular DiseaseTownsvilleQueenslandAustralia4814
| | - Yong Mong Tan
- The Townsville HospitalDepartment of Diabetes and Endocrinology100 Angus Smith DriveTownsvilleQueenslandAustralia4814
| | - Peter A Lazzarini
- Queensland HealthAllied Health Research CollaborativeLevel 315 Butterfield StreetHerston, BrisbaneQueenslandAustralia4029
- Queensland University of TechnologySchool of Clinical SciencesBrisbaneQueenslandAustralia
| | - Kunwarjit S Sangla
- The Townsville HospitalDepartment of Diabetes and Endocrinology100 Angus Smith DriveTownsvilleQueenslandAustralia4814
| | - Margaret Cunningham
- University of StirlingNursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU)StirlingStirlingshireUKFK9 4LA
| | - Petra G Buttner
- Tropical Health Solutions Pty Ltd72 Kokoda StTownsvilleQueenslandAustralia4811
| | - Jonathan Golledge
- College of Medicine and Dentistry, James Cook UniversityVascular Biology Unit, Queensland Research Centre for Peripheral Vascular DiseaseTownsvilleQueenslandAustralia4814
- The Townsville HospitalDepartment of Vascular and Endovascular SurgeryTownsvilleQueenslandAustralia4814
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Van Olmen J, Marie KG, Christian D, Clovis KJ, Emery B, Maurits VP, Heang H, Kristien VA, Natalie E, François S, Guy K. Content, participants and outcomes of three diabetes care programmes in three low and middle income countries. Prim Care Diabetes 2015; 9:196-202. [PMID: 25281167 DOI: 10.1016/j.pcd.2014.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 08/13/2014] [Accepted: 09/08/2014] [Indexed: 01/02/2023]
Abstract
AIMS To improve access and quality of diabetes care for people in low-income countries, it is important to understand which elements of diabetes care are effective. This paper analyses three diabetes care programmes in the DR Congo, Cambodia and the Philippines. METHODS Three programmes offering diabetes care and self-management were selected. Programme information was collected through document review and interviews. Data about participants' characteristics, health outcomes, care utilisation, expenditures, care perception and self-management were extracted from a study database. Comparative univariate analyses were performed. RESULTS Kin-réseau (DR Congo) is an urban primary care network with 8000 patients. MoPoTsyo (Cambodia) is a community-based peer educator network, covering 7000 patients. FiLDCare (Philippines) is a programme in which 1000 patients receive care in a health facility and self-management support from a community health worker. Content of care of the programmes is comparable, the focus on self-management largest in MoPoTsyo. On average, Kin-réseau patients have a higher age, longer diabetes history and more overweight. MoPoTsyo includes most female, most illiterate and most lean patients. Health outcomes (HbA1C level, systolic blood pressure, diabetes foot lesions) were most favourable for MoPoTsyo patients. Diabetes-related health care expenditure was highest for FiLDCare patients. CONCLUSIONS This study shows it possible to maintain a diabetes programme with minimal external resources, offering care and self-management support. It also illustrates that health outcomes of persons with diabetes are determined by their bio-psycho-social characteristics and behaviour, which are each subject to the content of care and the approach to chronic illness and self-management of the programme, in turn influenced by the larger context.
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Affiliation(s)
- Josefien Van Olmen
- Institute of Tropical Medicine, Department of Public Health Antwerp, Belgium; Department of General Practice & Elderly Medicine, EMGO, Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Ku Grace Marie
- Institute of Tropical Medicine, Department of Public Health Antwerp, Belgium
| | | | | | - Bewa Emery
- Memisa, Kinshasa, People's Republic of Congo
| | | | | | - Van Acker Kristien
- Algemeen Ziekenhuis Heilige Familie, Reet & Centre de Santé des Fagnes, Chimay, Belgium
| | | | - Schellevis François
- Department of General Practice & Elderly Medicine, EMGO, Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), The Netherlands
| | - Kegels Guy
- Institute of Tropical Medicine, Department of Public Health Antwerp, Belgium
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Humble JR, Tolley EA, Krukowski RA, Womack CR, Motley TS, Bailey JE. Use of and interest in mobile health for diabetes self-care in vulnerable populations. J Telemed Telecare 2015; 22:32-8. [DOI: 10.1177/1357633x15586641] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/21/2015] [Indexed: 12/17/2022]
Abstract
Objective We aimed to assess use of and interest in mobile health (mHealth) technology and in-person services for diabetes self-care in vulnerable populations. Methods We delivered a self-administered cross-sectional survey. Participants were recruited at two primary care practices (P1 and P2) with P1 located in a medically underserved area and P2 in an affluent suburb. Two-sample t-tests and chi-square tests were used with p < 0.05 significant. In addition, a secondary analysis was performed to analyse differences in use and interest in mHealth by age. Results Of 75 eligible patients, 60 completed the survey (80% response rate). P1 patients had significantly higher interest in three of five categories of in-person diabetes support services, one of four categories of health-related text messages (TM), and three of eight categories of mHealth applications ( p < 0.05). Smartphone users reported higher interest in TM ( p = 0.004) and mHealth applications for diabetes self-care ( p = 0.004). Younger patients were more likely to have a smartphone ( p < 0.006), use the Internet ( p < 0.0012), use smartphone applications ( p < 0.0004), and to be interested in using applications to manage their diabetes ( p < 0.004). Discussion This study shows substantial patient interest in TM and mHealth applications for diabetes self-care and suggests that patients in underserved areas may have particularly high interest in using mHealth solutions in primary care. Younger patients and smartphone users were more likely to be interested in using applications to manage their diabetes. As more patients use smartphones, interest in using mHealth to support patient self-care and strengthen primary care infrastructure will continue to grow.
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Affiliation(s)
- James R Humble
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Elizabeth A Tolley
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN,USA
| | - Rebecca A Krukowski
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN,USA
| | - Catherine R Womack
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN,USA
| | - Todd S Motley
- Motley Internal Medicine Group, 1264 Wesley Dr. Suite 606, Memphis, TN 38116, USA
| | - James E Bailey
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN,USA
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