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Baum E, Abdi S, van Eeuwijk P, Probst-Hensch N, Zinsstag J, Tschopp R, Vosseler B. "It is difficult for us to treat their pain". Health professionals' perceptions of Somali pastoralists in the context of pain management: a conceptual model. MEDICAL HUMANITIES 2023; 49:700-712. [PMID: 37468237 PMCID: PMC10803968 DOI: 10.1136/medhum-2022-012570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/21/2023]
Abstract
Pain is one of the most neglected areas of care in sub-Saharan Africa. Access to adequate pain management is important, especially in marginalised populations, such as pastoralists. Little is known about health professionals' perceptions of pain-related care for Somali pastoralists. This study seeks to understand health professionals' perceptions of Somali pastoralists in the context of pain management in Eastern Ethiopia. Within the scope of this qualitative multicentre study, we conducted semi-structured interviews with 17 health professionals (mainly nurses) experienced in treating Somali pastoralists with pain. Data analysis was based on the coding paradigm proposed by Strauss and Corbin within Grounded Theory methodology and resulted in a conceptual model of pastoralist-specific pain management. We gave voice to pastoralists in the study design, for example, through focus group discussions conducted prior to this study. Our study is part of a larger ongoing research project involving health professionals and pastoralist communities. The perspective of pastoralists is explored in a consecutive study. 'Patient-professional relationship' was the core category we identified within the conceptual model. This category was closely linked with issues of '(mis)trust' and 'communication (barriers)'. 'Patient-related conditions' (eg, (under)-reporting of pain, care preferences and beliefs) and 'health professional-related' conditions' (eg, insufficient training, (under)exposure to local culture) had an influence on the core category. Contextual factors proved to be relevant as well, such as age and gender. The study highlights the complexity of pain management among marginalised communities, such as pastoralists. Health professionals perceive Somali pastoralists to have distinct illness beliefs and pain concepts influencing their health-seeking behaviour. The study highlights the importance of reaching this patient group with culturally acceptable and comprehensive pain management strategies.
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Affiliation(s)
- Eleonore Baum
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences-Campus St Gallen, St Gallen, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sied Abdi
- School of Nursing and Midwifery, Jigjiga University, Jigjiga, Ethiopia
| | - Peter van Eeuwijk
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Institute of Social Anthropology, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jakob Zinsstag
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Rea Tschopp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
- One Health Division, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Birgit Vosseler
- School of Health Sciences, Eastern Switzerland University of Applied Sciences-Campus St Gallen, St Gallen, Switzerland
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Farmer N, Powell-Wiley TM, Middleton KR, Brooks AT, Mitchell V, Troncoso M, Ceasar J, Claudel SE, Andrews MR, Kazmi N, Johnson A, Wallen GR. Use of a focus group-based cognitive interview methodology to validate a cooking behavior survey among African-American adults. Front Nutr 2022; 9:1000258. [PMID: 36545469 PMCID: PMC9760831 DOI: 10.3389/fnut.2022.1000258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/21/2022] [Indexed: 12/08/2022] Open
Abstract
Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent's interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved African-American adults (n = 11) at risk for cardiovascular disease who were recruited from a community-based participatory research study in Washington, D.C., to participate in a focus group-based cognitive interview. Cognitive interview methodologies included the verbal think-aloud protocol and the use of retrospective probes. Thematic analysis and evaluation of verbalized cognitive processes were conducted using verbatim transcripts. Five thematic themes related to the survey were generated: (1) Clarity and relevancy of question items; (2) influence of participants' perspectives and gender roles; (3) participant social desirability response to questions; (4) concern regarding question intent. Eleven survey items were determined as difficult by participants. Cooking topics for these items were: cooking practices, cooking skills, cooking perception (how one defines cooking), food shopping skills, and socialization around cooking. Question comprehension and interpreting response selections were the most common problems identified. Cognitive interviews are useful for cooking research as they can evaluate survey questions to determine if the meaning of the question as intended by the researcher is communicated to the respondents-specific implications from the results that apply to cooking research include revising questions on cooking practice and skills. Focus-group-based cognitive interviews may provide a feasible method to develop culturally grounded survey instruments to help understand disparities in behavior for culturally relevant diet behaviors such as cooking.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States,*Correspondence: Nicole Farmer,
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States,Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Kimberly R. Middleton
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Alyssa T. Brooks
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Melissa Troncoso
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Joniqua Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Sophie E. Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marcus R. Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Allan Johnson
- Department of Nutritional Sciences, Division of Allied Health Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, United States
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
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Wenemark M, Ngwili N, Ndoboli D, Wieland B, Roesel K. “How Are My Age and Cows Related?” Cognitive Interviewing as a Tool to Pretest Survey Questions in Two Limited Resource Settings. Front Vet Sci 2022; 9:833748. [PMID: 35873686 PMCID: PMC9305482 DOI: 10.3389/fvets.2022.833748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance is a complex topic requiring interdisciplinary solutions embedded in One Health thinking. Currently, many surveys are underway in low- and middle-income countries to study how antimicrobial use in the livestock sector is driving resistance. In a survey, the respondents must understand and answer the questions correctly to produce accurate and valuable results. Pretesting survey questions is therefore important but sometimes not performed due to limited time and resources. Cognitive interviewing is a pretesting method to give insights into the respondent's way of interpreting and mentally processing the survey questions to identify problems and finding ways to improve the questions. It has previously been suggested that cognitive interviews may be difficult to use in some cultural settings. This study aimed to use cognitive interviews in a respondent-adjusted way to study how survey questions related to antimicrobial use are understood and answered by 12 small-scale farmers in Kenya and Uganda. The results show that even a small number of interviews and using interviewers with limited knowledge of cognitive interviewing can identify many problems in survey questions and the survey tool. Cognitive interviews may provide a feasible and affordable way of pretesting questionnaires in situations where time and resources are limited, for example, during a disease outbreak.
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Affiliation(s)
- Marika Wenemark
- Department of Health, Medicine and Caring Science, Faculty of Medicine, Linköping University, Linköping, Sweden
- Department of Health and Care Development, Region Östergötland, Linköping, Sweden
- *Correspondence: Marika Wenemark
| | - Nicholas Ngwili
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
| | - Dickson Ndoboli
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
- Central Diagnostic Laboratory, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Barbara Wieland
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
- Institute of Virology and Immunology, Mittelhäusern Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Kristina Roesel
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
- Department of Veterinary Medicine, Institute of Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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Matula ST, Irving SY, Deatrick JA, Steenhoff AP, Polomano RC. The perceptions and practices of parents and children on acute pain management among hospitalized children in two Botswana referral hospitals. J Pediatr Nurs 2022; 65:e35-e42. [PMID: 35190237 DOI: 10.1016/j.pedn.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perceptions and practices of parties in pediatric pain are critical in children's access to adequate acute pain management. The personal factors of the child and parents have been shown to be central to pediatric pain management by the Symptom Management Theory. AIM To describe children and parents/guardians' perceptions (knowledge, attitudes and beliefs) and practices regarding pediatric acute pain management and explain the influence of socio-cultural and environmental factors on those perceptions and practices. METHODS Descriptive cross-sectional survey using modified versions of the American Pain Society Patient Outcome Questionnaire-Revised among parents/guardians and children. RESULTS A convenience sample of 275 parents/guardians and 42 children aged 8 to 13 years admitted between date November 2018 and February 2019 to two Botswana tertiary hospitals completed the surveys. Forty-seven percent (n = 129) of parents/guardians reported the child to be in moderate-severe pain, while 38% (n = 16) of children reported pain as moderate-severe at the time of the survey. The children mean scores for cm-APS-POQ-R were 113(33) while parents/guardian's guardians for m-APS-POQ-R were 123(26). The subscales except for the parents/'guardians' pain interference (p = .96) were statistically significant (p = .000), showing adequate knowledge, positive attitudes and high pain intensity for both parents/guardians and children. CONCLUSION Parent/guardians and children reported a high incidence of acute pain, were content with pain management services, and showed adequate knowledge of pediatric pain and its management. The incongruence between the intensity of pain, satisfaction on the adequacy of pain management and knowledge and attitudes demonstrated in this study need further inquiry.
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Affiliation(s)
- Samuel T Matula
- Faculty of Health Sciences, School of Nursing, University of Botswana, Gaborone, Botswana; University of Botswana, Block 246/A106, 4775 Notwane Road, Gaborone, Botswana. P/bag UB, 00712, Gaborone, Botswana.
| | - Sharon Y Irving
- Pediatric Nursing, University of Pennsylvania, Nurse Practitioner, Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing. The Children's Hospital of Philadelphia.
| | | | - Andrew P Steenhoff
- Perelman School of Medicine, University of Pennsylvania; Medical Director, Global Health Center, The Children's Hospital of Philadelphia; & Adjunct Senior Lecturer, Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana.
| | - Rosemary C Polomano
- Professor of Pain Practice, School of Nursing, Professor of Anesthesiology and Critical Care, Perelman School of Medicine.
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Translation and Cultural Adaptation of NIH Toolbox Cognitive Tests into Swahili and Dholuo Languages for Use in Children in Western Kenya. J Int Neuropsychol Soc 2022; 28:414-423. [PMID: 34027848 PMCID: PMC8611114 DOI: 10.1017/s1355617721000497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Performing high-quality and reliable cognitive testing requires significant resources and training. As a result, large-scale studies involving cognitive testing are difficult to perform in low- and middle-income settings, limiting access to critical knowledge to improve academic achievement and economic production in these populations. The NIH Toolbox® is a collection of cognitive, motor, sensory, and emotional tests that can be administered and scored using an iPad® tablet, reducing the need for training and quality monitoring; and thus, it is a potential solution to this problem. METHODS We describe our process for translation and cultural adaptation of the existing NIH Toolbox tests of fluid cognition into the Swahili and Dholuo languages for use in children aged 3-14 years in western Kenya. Through serial forward and back translations, cognitive interviews, group consensus, outside feedback, and support from the NIH Toolbox team, we produced translated tests that have both face validity and linguistic validation. RESULTS During our cognitive interviews, we found that the five chosen tests (one each of attention, cognitive flexibility, working memory, episodic memory, and processing speed) were generally well understood by children aged 7-14 years in our chosen populations. The cognitive interviews informed alterations in translation as well as slight changes in some images to culturally adapt the tests. CONCLUSIONS This study describes the process by which we translated five fluid cognition tests from the NIH Toolbox into the Swahili and Dholuo languages. The finished testing application will be available for future studies, including a pilot study for assessment of psychometric properties.
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Matula ST, Irving SY, Deatrick JA, Steenhoff AP, Polomano RC. The Prevalence, Intensity, Assessment, and Management of Acute Pain in Hospitalized Children in Botswana. Pain Manag Nurs 2022; 23:548-558. [PMID: 34987004 DOI: 10.1016/j.pmn.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is very limited clinical and observational data on acute pain experienced by children in sub-Saharan Africa. AIMS To report the prevalence and intensity of acute pain, pain management practices, and describe associations between acute pain outcomes, children's and parents or guardian's demographics in hospitalized children aged 2 months to 13 years in Botswana. DESIGN A descriptive correlational prospective observational study using five repeated cross-sectional samples. SETTINGS Two referral hospitals in Botswana. PARTICIPANTS The sample size included 308 children and 226 parents or guardians. Data were collected between November 2018 and February 2019 from children, their parents or guardians (<7 years child), and the health record for pain documentation and treatment. MEASURES Pain was measured using Faces Pain Scale-Revised for children ≥7 years, revised Face, Legs, Activity, Cry, Consolability scale for children <7 years and numeric rating scale for parents or guardians. RESULTS There are 1,290 data points for children of which 1,000 were children <7 years and 999 data points for parents or guardians of children <7 years were used in analysis. Fifty percent of children <7 years were in pain using the revised Face, Legs, Activity, Cry, Consolability scale, whereas parents indicated 46% to be in pain. The pain prevalence for children ≥7 years was estimated at 54%. Pain was documentated at a rate of 54 % on the health records. Acetaminophen was most common analgesic across all age groups. Univariate associations of child <7 years pain intensity was statistically significant (p ≤ .05) for weight, diagnosis, residence, and parent relationship. Parents reported pain intensity was statistically significant (p ≤ .05) for child sex, weight, diagnosis, residence, surgery, parent or guardian age and education. Only age and surgery were significant for children ≥7 years. CONCLUSIONS Acute pain prevalence and intensity among hospitalized children in Botswana is low.
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Affiliation(s)
- Samuel T Matula
- Faculty of Health Sciences, School of Nursing, University of Botswana, Gaborone, Botswana.
| | - Sharon Y Irving
- Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing, University of Pennsylvania, Nurse Practitioner, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Andrew P Steenhoff
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana
| | - Rosemary C Polomano
- University of Pennsylvania, Philadelphia, Pennsylvania; School of Nursing, Professor of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania
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Mbazzi FB, Nimusiima C, Akellot D, Kawesa E, Abaasa A, Hodges S, Seeley J, Vervoort T. Use of Virtual Reality Distraction to Reduce Child Pain and Fear during Painful Medical Procedures in Children with Physical Disabilities in Uganda: A feasibility study. PAIN MEDICINE 2021; 23:642-654. [PMID: 34185091 DOI: 10.1093/pm/pnab206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study explored the acceptability and feasibility of the use of low-cost virtual reality (VR) glasses, and the Wong-Baker Faces Pain Scale and Children's Fear Scale scales, for pain and fear reduction in children admitted at the septic ward of CoRSU Rehabilitation Hospital in Uganda. METHODS In total 79 children aged 4 to 17 years of age were offered to watch cartoons using VR glasses while undergoing painful dressing procedures. Before and after the procedure children were asked to index current pain; children and their caregivers were asked to rate anticipated fear. Focus group discussions with 13 children, 10 caregivers and 9 nurses explored acceptability and feasibility. Quantitative data were analysed using STATA15, NVIVO12 was used for qualitative data analysis. RESULTS The VR glasses were accepted by 76 (96%) of the children. Children, caregivers, and nurses mentioned the glasses were helpful in distracting children from the medical procedure, and felt the use of the glasses helped reduce child fear and pain. Nurses felt it made their work easier. The Wong-Baker Faces Pain Scale was an acceptable and feasible method to measure pain, whilst the Children's Fear Scale was more difficult to interpret for our study population as they felt the faces on the scale were hard to read and identify with. CONCLUSIONS The use of VR glasses may offer an acceptable and effective pain and fear reduction method in resource-constrained settings and should be further explored in a randomized controlled trial.
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Affiliation(s)
- Femke Bannink Mbazzi
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.,London School of Hygiene & Tropical Medicine, Global Health & Development, London, United Kingdom
| | - Claire Nimusiima
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Elizabeth Kawesa
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,CoRSU Rehabilitation Hospital, Kisubi, Uganda
| | - Andrew Abaasa
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, Global Health & Development, London, United Kingdom
| | - Tine Vervoort
- Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Psychometric Properties of a Modified Version of the Faces Pain Scale-Revised (Modified FPS-R) to Evaluate Worst Pain in Children and Adolescents With Sickle Cell Anemia. J Pediatr Hematol Oncol 2018; 40:499-503. [PMID: 30044349 DOI: 10.1097/mph.0000000000001250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated psychometric properties (validity, reliability, and responsiveness) of a modified Faces Pain Scale-Revised (FPS-R) in 257 patients with sickle cell anemia (SCA) 7 to below 18 years old in a randomized, multinational clinical study. The modified FPS-R asks patients to report, by daily diary, their worst intraday SCA-related pain. Intraclass correlation coefficient assessed test-retest reliability between month 1 and month 2. Pearson correlations between monthly mean SCA-related pain intensity, activity interference score, analgesic use, and opioid use assessed convergent validity. Responsiveness was assessed with correlations of changes of monthly pain rate or intensity and changes in analgesic use or activity interference score from month 1 to month 9. Intraclass correlation coefficients for pain intensity and pain rate were 0.777 and 0.820, respectively, indicating agreement among stable patients. Moderate associations were shown between mean pain intensity and analgesic use (r=0.39) and opioid use (r=0.44), and between monthly pain rate and analgesic use (r=0.38). Moderate-to-large associations were observed between change in mean pain rate or intensity and changes in analgesic use (r=0.38 to 0.39, both P<0.001) and in activity interference scores (r=0.82 to 0.92, both P<0.001). These results support use of the modified FPS-R across cultures in children and adolescents aged 7 to below 18 years with SCA.
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Chang KT, Mullany LC, Khatry SK, LeClerq SC, Munos MK, Katz J. Why some mothers overestimate birth size and length of pregnancy in rural Nepal. J Glob Health 2018; 8:020801. [PMID: 30206478 PMCID: PMC6122007 DOI: 10.7189/jogh.08.020801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Quantitative validation studies alone may not be able to distinguish between instances when participants did not accurately report an event vs when participants did not understand a question. We used an explanatory qualitative study design to acquire an in-depth understanding of why some mothers in rural Nepal overestimate birth size of their newborn and their length of pregnancy. Methods We conducted two focus group discussions (FGDs) with study staff who administered a quantitative questionnaire and 12 in-depth interviews (IDIs) with mothers who had participated in a quantitative validation study. Transcripts were coded and analyzed for themes in patterns of meaning within and across FGDs and IDIs. Using this thematic map, we synthesized our data into common and divergent responses from participants to facilitate our interpretation of the quantitative findings. Results We identified five themes specific to this analysis: difficulties with the length of pregnancy question, challenges in administering the birth size question, the perceived effect of time since birth on mothers' ability to remember information, the language and style differences specific to this setting, and the study context shaping the relationship between study staff and mothers who participated and how this may have influenced mothers' responses. Visual aids may help to scale the question about birth size within a cultural frame of reference for maternal reports to be more interpretable. Among both study staff and mothers, a longer period of time since the birth of a child was thought to be associated with diminished accuracy of maternal reports, a perception not supported by our previously published quantitative findings. Conclusions Poor validity of low birth weight (LBW) and preterm birth indicators based on maternal reports may be partly attributed to challenges in maternal understanding of questions assessing birth size and length of pregnancy. Additional research is needed to confirm these findings regarding maternal comprehension and to further evaluate the utility of visual aids developed for this study.
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Affiliation(s)
- Karen T Chang
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
| | - Luke C Mullany
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
| | - Subarna K Khatry
- The Nepal Nutrition Intervention Project-Sarlahi, Lalitpur, Nepal
| | - Steven C LeClerq
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA.,The Nepal Nutrition Intervention Project-Sarlahi, Lalitpur, Nepal
| | - Melinda K Munos
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
| | - Joanne Katz
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
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Response scale selection in adult pain measures: results from a literature review. J Patient Rep Outcomes 2018; 2:40. [PMID: 30238085 PMCID: PMC6127068 DOI: 10.1186/s41687-018-0053-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/20/2018] [Indexed: 11/22/2022] Open
Abstract
Background The purpose of this literature review was to examine the existing patient-reported outcome measurement literature to understand the empirical evidence supporting response scale selection in pain measurement for the adult population. Methods The search strategy involved a comprehensive, structured, literature review with multiple search objectives and search terms. Results The searched yielded 6918 abstracts which were reviewed against study criteria for eligibility across the adult pain objective. The review included 42 review articles, consensus guidelines, expert opinion pieces, and primary research articles providing insights into optimal response scale selection for pain assessment in the adult population. Based on the extensive and varied literature on pain assessments, the adult pain studies typically use simple response scales with single-item measures of pain—a numeric rating scale, visual analog scale, or verbal rating scale. Across 42 review articles, consensus guidelines, expert opinion pieces, and primary research articles, the NRS response scale was most often recommended in these guidance documents. When reviewing the empirical basis for these recommendations, we found that the NRS had slightly superior measurement properties (e.g., reliability, validity, responsiveness) across a wide variety of contexts of use as compared to other response scales. Conclusions Both empirical studies and review articles provide evidence that the 11-point NRS is likely the optimal response scale to evaluate pain among adult patients without cognitive impairment.
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Young JR, Sih C, Hogg MM, Anderson-Montoya BL, Fasano HT. Qualitative Assessment of Face Validity and Cross-Cultural Acceptability of the Faces Pain Scale: "Revised" in Cameroon. QUALITATIVE HEALTH RESEARCH 2018; 28:832-843. [PMID: 29571279 DOI: 10.1177/1049732318757488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Faces Pain Scale-Revised (FPS-R) is a self-report pain scale validated in numerous countries, but not in Cameroon. We postulated that while cultural factors influence pain perception and expression, the FPS-R should remain culturally acceptable for pediatric use. A convenience sample of 36 pediatric patients, aged 4 to 16 years, representing three primary language groups, was enrolled at Mbingo Baptist Hospital (MBH). Pre- and postanalgesia FPS-R scores and vital signs were obtained. Audio-recorded cognitive interviews were performed with each participant. Written questionnaires were also provided to physicians, nurses, and caretakers to further explore cultural perceptions of pain. Four independent reviewers analyzed interview transcripts and questionnaires using inductive reasoning and identified common themes pertaining to gender differences, societal roles, and pain perception. Basic comprehension of the FPS-R was present across language groups, vital sign changes corresponded with FPS-R alterations, and the FPS-R appears intuitive for pediatric use.
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Affiliation(s)
- James R Young
- 1 Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Colette Sih
- 2 Mbingo Baptist Hospital, Cameroon, West Africa
| | - Melanie M Hogg
- 1 Carolinas Medical Center, Charlotte, North Carolina, USA
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Gupta N, Naegeli AN, Turner-Bowker DM, Flood EM, Heath LE, Mays SM, Dampier C. Cognitive Testing of an Electronic Version of the Faces Pain Scale-Revised with Pediatric and Adolescent Sickle Cell Patients. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 9:433-43. [PMID: 27026180 PMCID: PMC5021749 DOI: 10.1007/s40271-016-0166-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient diaries and pain scales can capture the course and complications of pain managed at home in children. The Faces Pain Scale-Revised (FPS-R) is a validated scale showing reliability in children, but it has not been validated in children with sickle cell disease (SCD). OBJECTIVE The purpose of this study was to evaluate comprehension and usability of an electronic modified version of the FPS-R among pediatric patients with SCD. METHODS This was a cross-sectional, qualitative study involving in-person interviews with children/adolescents from the USA and their parents/legal guardians. Interviews involved cognitive debriefing and usability testing of the FPS-R. RESULTS In total, 22 children with SCD aged 4-17 years participated. Children aged 4-6 were generally unable to demonstrate clear understanding of the FPS-R and its response scale. Overall, children aged ≥7 years understood the instrument and could complete it on the electronic device, although children aged 7-8 often needed assistance from the parent. Children aged 9-17 years were able to read and complete the instrument independently. Most participants considered the electronic device easy to use. CONCLUSIONS The FPS-R was shown to be a comprehensible and usable pain measure for children aged 7-17 with SCD and to be beneficial for future clinical studies.
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Affiliation(s)
- Neehar Gupta
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - April N Naegeli
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | - Emuella M Flood
- ICON plc, Clinical Outcomes Assessments, Gaithersburg, MD, 20878, USA
| | - Lori Ellen Heath
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Shelley M Mays
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA
| | - Carlton Dampier
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Young JR, Sawe HR, Mfinanga JA, Nshom E, Helm E, Moore CG, Runyon MS, Reynolds SL. Subdissociative intranasal ketamine plus standard pain therapy versus standard pain therapy in the treatment of paediatric sickle cell disease vaso-occlusive crises in resource-limited settings: study protocol for a randomised controlled trial. BMJ Open 2017; 7:e017190. [PMID: 28698351 PMCID: PMC5541700 DOI: 10.1136/bmjopen-2017-017190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Pediatric sickle cell disease, highly prevalent in sub-Saharan Africa, carries great morbidity and mortality risk. Limited resources and monitoring make management of acute vaso-occlusive crises challenging. This study aims to evaluate the efficacy and safety of subdissociative intranasal ketamine as a cheap, readily available and easily administered adjunct to standard pain therapy. We hypothesise that subdissociative, intranasal ketamine may significantly augment current approaches to pain management in resource-limited settings in a safe and cost-effective manner. METHODS AND ANALYSIS This is a multicentred, randomised, double-blind, placebo-controlled trial enrolling children 4-16 years of age with sickle cell disease and painful vaso-occlusive pain crises. Study sites include two sub-Saharan teaching and referral hospitals with acute intake areas. All patients receive standard analgesic therapy during evaluation. Patients randomised to the treatment arm receive 1 mg/kg intranasal ketamine at onset of therapy, while placebo arm participants receive volume-matched intranasal normal saline. All participants and clinical staff are blinded to the treatment allocation. Data will be analysed on an intention-to-treat basis. Primary endpoints are changes in self-report pain scales (Faces Pain Scale-Revised) at 30, 60 and 120 minutes and rates of adverse events. Secondary endpoints include hospital length of stay, total analgesia use and quality of life assessment 2-3 weeks postintervention. ETHICS AND DISSEMINATION The research methods for this study have been approved by the Cameroon Baptist Convention Health Board Institutional Review Board (IRB2015-07), the Tanzanian National Institute for Medical Research (NIMR/HQ/R.8a/Vol. IX/2299), Muhimbili National Hospital IRB (MNH/IRB/I/2015/14) and the Tanzanian Food and Drugs Authority (TFDA0015/CTR/0015/9). Data reports will be provided to the Data and Safety Monitoring Board (DSMB) periodically throughout the study as well as all reports of adverse events. All protocol amendments will also be reviewed by the DSMB. Study results, regardless of direction or amplitude, will be submitted for publication in relevant peer-reviewed journals. TRIAL REGISTRATION ClinicalTrials.Gov, NCT02573714. Date of registration: 8 October 2015. Pre-results.
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Affiliation(s)
- James R Young
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Hendry Robert Sawe
- Deparment of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Juma A Mfinanga
- Department of Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Ernest Nshom
- Department of Internal Medicine, CIMS, Mbingo Baptist Hospital, Cameroon Baptist Convention, Mbingo, Cameroon
| | - Ethan Helm
- Department of Pediatrics, Mbingo Baptist Hospital, Cameroon Baptist Convention, Mbingo, Cameroon
| | - Charity G Moore
- Center for Outcomes Research and Evaluation, Carolinas HealthCare System, Charlotte, North Carolina, USA
| | - Michael S Runyon
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Stacy L Reynolds
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
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14
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Wallen GR, Saygbe JN, Brooks AT, McClurkin M, Thomas S, Powell-Wiley TM. Engaging Community Leaders in the Development of a Cardiovascular Health Behavior Survey Using Focus Group-Based Cognitive Interviewing. Health Serv Insights 2017; 10:1178632917701123. [PMID: 28469458 PMCID: PMC5404898 DOI: 10.1177/1178632917701123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/01/2017] [Indexed: 12/26/2022] Open
Abstract
Establishing the validity of health behavior surveys used in community-based participatory research (CBPR) in diverse populations is often overlooked. A novel, group-based cognitive interviewing method was used to obtain qualitative data for tailoring a survey instrument designed to identify barriers to improved cardiovascular health in at-risk populations in Washington, DC. A focus group–based cognitive interview was conducted to assess item comprehension, recall, and interpretation and to establish the initial content validity of the survey. Thematic analysis of verbatim transcripts yielded 5 main themes for which participants (n = 8) suggested survey modifications, including survey item improvements, suggestions for additional items, community-specific issues, changes in the skip logic of the survey items, and the identification of typographical errors. Population-specific modifications were made, including the development of more culturally appropriate questions relevant to the community. Group-based cognitive interviewing provided an efficient and effective method for piloting a cardiovascular health survey instrument using CBPR.
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Affiliation(s)
- Gwenyth R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Johnetta N Saygbe
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | | | - Michael McClurkin
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Samantha Thomas
- NIH Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany M Powell-Wiley
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
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15
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Mandysová P, Kadlečková Z. The performance of three pain intensity scales and their preferences among Czech women with acute postoperative pain. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2015. [DOI: 10.15452/cejnm.2015.06.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Hill Z, Okyere E, Wickenden M, Tawiah-Agyemang C. What can we learn about postnatal care in Ghana if we ask the right questions? A qualitative study. Glob Health Action 2015; 8:28515. [PMID: 26350434 PMCID: PMC4563099 DOI: 10.3402/gha.v8.28515] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/10/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022] Open
Abstract
Background There are increasing efforts to monitor progress in maternal and neonatal care, with household surveys the main mode of data collection. Postnatal care (PNC) is considered a priority indicator yet few countries report on it, and the need to improve the construct validity associated with PNC questions is recognized. Objectives To determine women's knowledge of what happens to the baby after delivery, women's comprehension of terms and question phrasing related to PNC, and issues with recall periods. Design Forty qualitative interviews and four focus group discussions were conducted with mothers, and 10 interviews with health workers in rural Ghana. Data were collected on knowledge and recall of postnatal health checks and language used to describe these health checks. Results Mothers required specific probing using appropriate language to report postnatal checks. They only had adequate knowledge of postnatal checks, which were easily observed or required asking them a question. Respondents reported that health workers rarely communicated with mothers about what they were doing, and most women did not know the purpose of the equipment used during health checks, such as why a thermometer was being used. Knowledge of neonatal checks in the first hours after a facility delivery was low if the mother and child were separated, or if the mother was tired or weak. Many women reported that they could remember events clearly, but long recall periods affected reporting for some, especially those who had multiple checks or for those with no problems. Conclusions Direct questions about PNC or health checks are likely to underestimate coverage. Validity of inferences can be enhanced by using appropriate verbal probes during surveys on commonly performed checks that are clear and visible to the mother.
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Affiliation(s)
- Zelee Hill
- Institute for Global Health, University College London, London, UK;
| | | | - Mary Wickenden
- Institute for Global Health, University College London, London, UK
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Blum D, Selman LE, Agupio G, Mashao T, Mmoledi K, Moll T, Dinat N, Gwyther L, Sebuyira LM, Ikin B, Downing J, Kaasa S, Higginson IJ, Harding R. Self-report measurement of pain & symptoms in palliative care patients: a comparison of verbal, visual and hand scoring methods in Sub-Saharan Africa. Health Qual Life Outcomes 2014; 12:118. [PMID: 25085579 PMCID: PMC4243734 DOI: 10.1186/s12955-014-0118-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 07/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a high incidence of life-limiting disease, there is a deficit of palliative care outcome evidence in sub-Saharan Africa. Providers of end of life care call for appropriate measurement tools. The objective is to compare four approaches to self-report pain and symptom measurement among African palliative care patients completing the African Palliative Care Association African Palliative Outcome Scale (APCA African POS). METHODS Patients were recruited from five services (4 in South Africa and 1 in Uganda). Research nurses cross-sectionally administered POS pain and symptom items in local languages. Both questions were scored from 0 to 5 using 4 methods: verbal rating, demonstrating the score using the hand (H), selecting a face on a visual scale (F), and indicating a point on the Jerrycan visual scale (J). H, F and J scores were correlated with verbal scores as reference using Spearman's rank and weighted Kappa. A Receiver Operating Characteristic (ROC) analysis was performed. RESULTS 315 patients participated (mean age 43.5 years, 69.8% female), 71.1% were HIV positive and 35.6% had cancer, 49.2% lived in rural areas. Spearman's rank correlations for pain scores were: H: 0.879, F: 0.823, J: 0.728 (all p < 0.001); for symptoms H: 0.876, F: 0.808, J: 0.721 (all p < 0.001). Weighted Kappa for pain was H: 0.798, F: 0.719 J: 0.548 and for symptoms: H: 0.818, F: 0.718, J: 0.571. There was lower agreement between verbal and both hand and face scoring methods in the Ugandan sample. Compared to the verbal scale the accuracy of predicting high pain/symptoms was H > F > J (0.96-0.89) in ROC analysis. CONCLUSIONS Hands and faces scoring methods correlate highly with verbal scoring. The Jerrycan method had only moderate weighted Kappa. POS scores can be reliably measured using hand or face score.
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Huang KTL, Owino C, Gramelspacher GP, Monahan PO, Tabbey R, Hagembe M, Strother RM, Njuguna F, Vreeman RC. Prevalence and correlates of pain and pain treatment in a western Kenya referral hospital. J Palliat Med 2013; 16:1260-7. [PMID: 24032753 DOI: 10.1089/jpm.2013.0080] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pain is often inadequately evaluated and treated in sub-Saharan Africa (SSA). OBJECTIVE We sought to assess pain levels and pain treatment in 400 hospitalized patients at a national referral hospital in western Kenya, and to identify factors associated with pain and pain treatment. DESIGN Using face-validated Kiswahili versions of two single-item pain assessment tools, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), we determined patients' pain levels. Additional data collected included patient demographics, prescribed analgesics, and administered analgesics. We calculated mean pain ratings and pain management index (PMI) scores. RESULTS Averaged between the NRS and FPS-R, 80.5% of patients endorsed a nonzero level of pain and 30% of patients reported moderate to severe pain. Older patients, patients with HIV, and cancer patients had higher pain ratings. Sixty-six percent of patients had been prescribed analgesics at some point during their hospitalization, the majority of which were nonopioids. A majority of patients (66%) had undertreated pain (negative scores on the PMI). CONCLUSION This study shows that hospitalized patients in Kenya are experiencing pain and that this pain is often undertreated.
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Affiliation(s)
- Kristin T L Huang
- 1 USAID - Academic Model Providing Access to Healthcare (AMPATH) , Eldoret, Kenya
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