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Pedersen K, Schlichter BR. Improving Predictability and Effectiveness in Preventive Digital Health Interventions: Scoping Review. Interact J Med Res 2023; 12:e40205. [PMID: 37471129 PMCID: PMC10401197 DOI: 10.2196/40205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/01/2022] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Lifestyle-related diseases caused by inadequate diet and physical activity cause premature death, loss of healthy life years, and increased health care costs. Randomized controlled trial (RCT) studies indicate that preventive digital health interventions (P-DHIs) can be effective in preventing these health problems, but the results of these studies are mixed. Adoption studies have identified multiple factors related to individuals and the context in which they live that complicate the transfer of positive results from RCT studies to practical use. Implementation studies have revealed barriers to the large-scale implementation of mobile health (mHealth) solutions in general. Consequently, there is no clear path to delivering predictable outcomes from P-DHIs and achieving effectiveness when scaling up interventions to reduce health problems in society. OBJECTIVE This research aimed to expand our understanding of how to increase the outcome predictability of P-DHIs by focusing on physical activity and diet behaviors and amplify our understanding of how to improve effectiveness in large-scale implementations. METHODS The research objective was pursued through a multidisciplinary scoping review. This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) as a guide. A comprehensive search of Web of Science and PubMed limited to English-language journal articles published before January 2022 was conducted. Google Scholar was used for hand searches. Information systems theory was used to identify key constructs influencing outcomes of IT in general. Public health and mHealth literature were used to identify factors influencing the adoption of, outcomes from, and implementation of P-DHIs. Finally, the P-DHI investment model was developed based on information systems constructs and factors from the public health and mHealth literature. RESULTS In total, 203 articles met the eligibility criteria. The included studies used a variety of methodologies, including literature reviews, interviews, surveys, and RCT studies. The P-DHI investment model suggests which constructs and related factors should be emphasized to increase the predictability of P-DHI outcomes and improve the effectiveness of large-scale implementations. CONCLUSIONS The research suggests that outcome predictability could be improved by including descriptions of the constructs and factors in the P-DHI investment model when reporting from empirical studies. Doing so would increase our understanding of when and why P-DHIs succeed or fail. The effectiveness of large-scale implementations may be improved by using the P-DHI investment model to evaluate potential difficulties and possibilities in implementing P-DHIs to create better environments for their use before investing in them and when designing and implementing them. The cost-effectiveness of large-scale implementations is unknown; implementations are far more complicated than just downloading and using apps, and there is uncertainty accompanying implementations given the lack of coordinated control over the constructs and factors that influence the outcome.
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Affiliation(s)
- Keld Pedersen
- Information Systems, Department of Management, Aarhus University, Aarhus C, Denmark
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Ajmera P, Miraj M, Kalra S, Goyal RK, Chorsiya V, Shaik RA, Alzhrani M, Alanazi A, Alqahtani M, Miraj SA, Pawaria S, Mehta V. Impact of telehealth interventions on physiological and psychological outcomes in breast cancer survivors: A meta-analysis of randomised controlled trials. Front Oncol 2023; 12:1017343. [PMID: 36686741 PMCID: PMC9850160 DOI: 10.3389/fonc.2022.1017343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/15/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction The use of telehealth interventions has been evaluated in different perspectives in women and also supported with various clinical trials, but its overall efficacy is still ascertained. The objective of the present review is to identify, appraise and analyze randomized controlled trials on breast cancer survivors who have participated in technology-based intervention programs incorporating a wide range of physical and psychological outcome measures. Material and methods We conducted electronic search of the literature during last twenty years i.e., from 2001 till August 10, 2021 through four databases. Standardized mean difference with 95% confidence interval was used. Results A total of 56 records were included in the qualitative and 28 in quantitative analysis. Pooled results show that telehealth interventions were associated with improved quality of life (SMD 0.48, 95% CI 0.03 to 0.92, p=0.04), reduced depression (SMD -1.27, 95% CI =-2.43 to -0.10 p=0.03), low distress and less perceived stress (SMD -0.40, 95% CI =-0.68 to -0.12, p=0.005). However, no significant differences were observed on weight change (SMD -0.27, 95% CI =-2.39 to 1.86, p=0.81) and anxiety scores (SMD -0.09, 95% CI =-0.20 to 0.02, p=0.10) between the two groups. Improvement in health care competence and fitness among participants was also reported. Conclusion Study concludes that telehealth care is a quick, convenient and assuring approach to breast cancer care in women that can reduce treatment burden and subsequent disturbance to the lives of breast cancer survivors.
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Affiliation(s)
- Puneeta Ajmera
- Department of Public Health, School of Allied Health Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Mohammad Miraj
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AlMajmaah, Saudi Arabia,*Correspondence: Mohammad Miraj,
| | - Sheetal Kalra
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Ramesh K. Goyal
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Varsha Chorsiya
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Riyaz Ahamed Shaik
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AlMajmaah, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AlMajmaah, Saudi Arabia
| | - Mazen Alqahtani
- College of Applied Medical Sciences, AlMaarefa University, Dariyah, Riyadh, Saudi Arabia
| | - Shaima Ali Miraj
- Department of Public Health, College of Health Science, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Sonia Pawaria
- Faculty of Physiotherapy, SGT University, Gurugram, India
| | - Vini Mehta
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
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Schnall R, Liu J, Alvarez G, Porras T, Ganzhorn S, Boerner S, Huang MC, Trujillo P, Cioe P. A Smoking Cessation Mobile App for Persons Living With HIV: Preliminary Efficacy and Feasibility Study. JMIR Form Res 2022; 6:e28626. [PMID: 35980739 PMCID: PMC9437787 DOI: 10.2196/28626] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/07/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of smoking in the United States general population has gradually declined to the lowest rate ever recorded; however, this has not been true for persons with HIV. OBJECTIVE We conducted a pilot test to assess the feasibility and efficacy of the Lumme Quit Smoking mobile app and smartwatch combination with sensing capabilities to improve smoking cessation in persons with HIV. METHODS A total of 40 participants were enrolled in the study and randomly assigned 1:1 to the control arm, which received an 8-week supply of nicotine replacement therapy, a 30-minute smoking cessation counseling session, and weekly check-in calls with study staff, or to the intervention arm, which additionally received the Lumme Quit Smoking app and smartwatch. RESULTS Of the 40 participants enrolled, 37 completed the follow-up study assessments and 16 used the app every day during the 56-day period. During the 6-month recruitment and enrollment period, 122 people were screened for eligibility, with 67.2% (82/122) deemed ineligible. Smoking criteria and incompatible tech were the major reasons for ineligibility. There was no difference in the proportion of 7-day point prevalence abstinence by study arm and no significant decrease in exhaled carbon monoxide for the intervention and control arms separately. However, the average exhaled carbon monoxide decreased over time when analyzing both arms together (P=.02). CONCLUSIONS Results suggest excellent feasibility and acceptability of using a smoking sensor app among this smoking population. The knowledge gained from this research will enable the scientific community, clinicians, and community stakeholders to improve tobacco cessation outcomes for persons with HIV. TRIAL REGISTRATION ClinicalTrials.gov NCT04808609; https://clinicaltrials.gov/ct2/show/NCT04808609.
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Affiliation(s)
- Rebecca Schnall
- Columbia University School of Nursing, New York, NY, United States
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, United States
| | | | - Tiffany Porras
- Zucker School of Medicine, Hofstra University, Hempstead, NY, United States
| | - Sarah Ganzhorn
- Columbia University School of Nursing, New York, NY, United States
| | - Samantha Boerner
- Center for Psychedelic Medicine, Department of Psychiatry, NYU Langone Health, New York, NY, United States
- New York University Grossman School of Medicine, New York, NY, United States
- Bellevue Hospital Center, New York, NY, United States
| | - Ming-Chun Huang
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Paul Trujillo
- Columbia University School of Nursing, New York, NY, United States
| | - Patricia Cioe
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
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Sibuyi IN, de la Harpe R, Nyasulu P. A Stakeholder-Centered mHealth Implementation Inquiry Within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case. JMIR Mhealth Uhealth 2022; 10:e18188. [PMID: 35708756 PMCID: PMC9247812 DOI: 10.2196/18188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/02/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background
The internet is a useful web-based multimedia platform for accessing and disseminating information unconstrained by time, distance, and place. To the health care sector’s benefit, the advent and proliferation of mobile devices have provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalized people and their communities, particularly in developing societies.
Objective
This study aimed to report on the perspectives of the different stakeholders involved in the study and to review an existing government mobile health (mHealth) program. It forms part of a study to design a re-engineered strategy based on the best demonstrated practices (considerations and methods) and learned experiences from the perspectives of multiple stakeholders within the digital health innovation ecosystem in South Africa.
Methods
This study used an ethnographic approach involving document review, stakeholder mapping, semistructured individual interviews, focus group discussions, and participant observations to explore, describe, and analyze the perspectives of its heterogeneous participant categories representing purposively sampled but different constituencies.
Results
Overall, 80 participants were involved in the study, in addition to the 6 meetings the researcher attended with members of a government-appointed task team. In addition, 46 archived records and reports were consulted and reviewed as part of gathering data relating to the government’s MomConnect project. Among the consulted stakeholders, there was general consensus that the existing government-sponsored MomConnect program should be implemented beyond mere piloting, to as best as possible capacity within the available resources and time. It was further intimated that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem was hamstrung by challenges that included stakeholder mismanagement, impact assessment inadequacies, management of data, lack of effective leadership and political support, inappropriate technology choices, eHealth and mHealth funding, integration of mHealth to existing health programs in tandem with Goal 3 of the Sustainable Development Goals, integration of lessons learned from other mHealth initiatives to avoid resource wastage and duplication of efforts, proactive evaluation of both mHealth and eHealth strategies, and change management and developing human resources for eHealth.
Conclusions
This study has only laid a foundation for the re-engineering of mHealth services within the digital health innovation ecosystem. This study articulated the need for stakeholder collaboration, such as continuous engagement among academics, technologists, and mHealth fieldwork professionals. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer-reviewed or systematic research documents from which South African professionals, research experts, and practitioners could learn. Further research is needed for the retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa.
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Affiliation(s)
- Idon-Nkhenso Sibuyi
- Faculty of Informatics and Design, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Retha de la Harpe
- Faculty of Informatics and Design, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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Lynch KA, Atkinson TM, Omisore AD, Famurewa O, Olasehinde O, Odujoko O, Alatise OI, Egberongbe A, Kingham TP, Morris EA, Sutton E. Developing a Technology Acceptability and Usage Survey (TAUS) for mHealth Intervention Planning and Evaluation in Nigeria: Pilot Study. JMIR Form Res 2022; 6:e34035. [PMID: 35442204 PMCID: PMC9069275 DOI: 10.2196/34035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/10/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Technology acceptability and usage surveys (TAUS) are brief questionnaires that measure technology comfort, typical daily use, and access in a population. However, current measures are not adapted to low- and middle-income country (LMIC) contexts. OBJECTIVE The objective of this pilot study was to develop a TAUS that could be used to inform the implementation of a mobile health (mHealth) intervention in Nigeria. METHODS A literature review of validated technology comfort and usage scales was conducted to identify candidate items. The draft measure was reviewed for face validity by an expert panel comprised of clinicians and researchers with cultural, methodological, and clinical expertise. The measure was piloted by radiologists at an oncology symposium in Nigeria. RESULTS After expert review, the final measure included 18 items organized into 3 domains: (1) comfort with using mobile applications, (2) reliability of internet or electricity, and (3) attitudes toward using computers or mobile applications in clinical practice. The pilot sample (n=16) reported high levels of comfort and acceptability toward using mHealth applications in the clinical setting but faced numerous infrastructure challenges. CONCLUSIONS Pilot results indicate that the TAUS may be a feasible and appropriate measure for assessing technology usage and acceptability in LMIC clinical contexts. Dedicating a domain to technology infrastructure and access yielded valuable insights for program implementation.
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Affiliation(s)
- Kathleen A Lynch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Thomas M Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Adeleye D Omisore
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusola Famurewa
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Oluwole Odujoko
- Department of Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth Sutton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Ben Charif A, Zomahoun HTV, Gogovor A, Abdoulaye Samri M, Massougbodji J, Wolfenden L, Ploeg J, Zwarenstein M, Milat AJ, Rheault N, Ousseine YM, Salerno J, Markle-Reid M, Légaré F. Tools for assessing the scalability of innovations in health: a systematic review. Health Res Policy Syst 2022; 20:34. [PMID: 35331260 PMCID: PMC8943495 DOI: 10.1186/s12961-022-00830-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/16/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The last decade has seen growing interest in scaling up of innovations to strengthen healthcare systems. However, the lack of appropriate methods for determining their potential for scale-up is an unfortunate global handicap. Thus, we aimed to review tools proposed for assessing the scalability of innovations in health. METHODS We conducted a systematic review following the COSMIN methodology. We included any empirical research which aimed to investigate the creation, validation or interpretability of a scalability assessment tool in health. We searched Embase, MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library and ERIC from their inception to 20 March 2019. We also searched relevant websites, screened the reference lists of relevant reports and consulted experts in the field. Two reviewers independently selected and extracted eligible reports and assessed the methodological quality of tools. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. RESULTS We identified 31 reports describing 21 tools. Types of tools included criteria (47.6%), scales (33.3%) and checklists (19.0%). Most tools were published from 2010 onwards (90.5%), in open-access sources (85.7%) and funded by governmental or nongovernmental organizations (76.2%). All tools were in English; four were translated into French or Spanish (19.0%). Tool creation involved single (23.8%) or multiple (19.0%) types of stakeholders, or stakeholder involvement was not reported (57.1%). No studies reported involving patients or the public, or reported the sex of tool creators. Tools were created for use in high-income countries (28.6%), low- or middle-income countries (19.0%), or both (9.5%), or for transferring innovations from low- or middle-income countries to high-income countries (4.8%). Healthcare levels included public or population health (47.6%), primary healthcare (33.3%) and home care (4.8%). Most tools provided limited information on content validity (85.7%), and none reported on other measurement properties. The methodological quality of tools was deemed inadequate (61.9%) or doubtful (38.1%). CONCLUSIONS We inventoried tools for assessing the scalability of innovations in health. Existing tools are as yet of limited utility for assessing scalability in health. More work needs to be done to establish key psychometric properties of these tools. Trial registration We registered this review with PROSPERO (identifier: CRD42019107095).
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Affiliation(s)
| | - Hervé Tchala Vignon Zomahoun
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada.,Faculty of Medicine and Health Science, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Institut national d'excellence en santé et en services sociaux (INESSS), Quebec City, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada
| | - Mamane Abdoulaye Samri
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - José Massougbodji
- Institut national de santé publique du Québec (INSPQ), Quebec City, QC, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Andrew J Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada
| | | | - Jennifer Salerno
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Canada Research Chair in Person Centred Interventions for Older Adults with Multimorbidity and their Caregivers, McMaster University, Hamilton, ON, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada. .,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec City, QC, Canada.
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Naggirinya AB, Kyomugisha EL, Nabaggala MS, Nasasira B, Akirana J, Oseku E, Kiragga A, Castelnuovo B, King RL, Katabira E, Byonanebye DM, Lamorde M, Parkes-Ratanshi R. Willingness to pay for an mHealth anti-retroviral therapy adherence and information tool: Transitioning to sustainability, Call for life randomised study experience in Uganda. BMC Med Inform Decis Mak 2022; 22:52. [PMID: 35219309 PMCID: PMC8882291 DOI: 10.1186/s12911-022-01782-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Evidence shows benefit of digital technology for people living with human immunodeficiency virus on antiretroviral therapy adherence and retention in care, however, scalability and sustainability have scarcely been evaluated. We assessed participants’ willingness to pay a fee for mHealth “Call for life Uganda” support, a mobile-phone based tool with the objective to assess sustainability and scalability. Methods “Call for Life study”, approved by Makerere University, School of Public Health research & ethics committee, at 2 sites in Uganda, evaluated a MoTech based software “CONNECT FOR LIFE™” mHealth tool termed “Call for life Uganda”. It provides short messages service or Interactive Voice Response functionalities, with a web-based interface, allows a computer to interact with humans through use of voice and tones input via keypad. Participants were randomized at 1:1 ratio to Standard of Care or standard of care plus Call for life Uganda. This sends pill reminders, visit reminders, voice messages and self-reported symptom support. At study visits 18 and 24 months, through mixed method approach we assessed mHealth sustainability and scalability. Participants were interviewed on desire to have or continue adherence support and willingness to pay a nominal fee for tool. We computed proportions willing to pay (± 95% confidence interval), stratified by study arm and predictors of willingness to continue and to pay using multivariate logistic regression model backed up by themes from qualitative interviews. Results 95% of participants were willing to continue using C4LU with 77.8% willing to pay for the service. Persons receiving care at the peri-urban clinic (OR 3.12, 95% CI 1.43–9.11.86) and those with exposure to the C4LU intervention (OR 4.2, 95% CI 1.55–11.84) were more likely to continue and pay for the service. Qualitative interviews revealed mixed feelings regarding amounts to pay, those willing to pay, argued that since they have been paying for personal phone calls/messages, they should not fail to pay for Call for life.
Conclusions Payment for the service offers opportunities to scale up and sustain mHealth interventions which may not be priorities for government funding. A co-pay model could be acceptable to PLHIV to access mHealth services in low resource settings.
Clinical Trial Number NCT 02953080. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01782-0.
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Yoon S, Ng JH, Kwan YH, Low LL. Healthcare Professionals' Views of Factors Influencing Diabetes Self-Management and the Utility of a mHealth Application and Its Features to Support Self-Care. Front Endocrinol (Lausanne) 2022; 13:793473. [PMID: 35282452 PMCID: PMC8907617 DOI: 10.3389/fendo.2022.793473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The perspectives of healthcare professionals (HCPs) are pivotal to co-development of self-management strategies for patients with diabetes. However, literature has been largely limited to perspectives of patients within the context of a Western healthcare setting. This study aims to explore factors influencing diabetes self-management in adult patients with diabetes from the perspectives of HCPs and their views of the value of mHealth application for diabetes self-management. MATERIALS AND METHODS We conducted focus group discussions (FGD) with purposively selected HCPs in Singapore. All FGDs were audio-recorded and transcribed verbatim. Thematic analysis was conducted using NVivo 12. RESULTS A total of 56 HCPs participated in the study. Barriers to self-management included limited patient commitment to lifestyle changes, suboptimal adherence to medication and treatment, patient resistance to insulin initiation and insufficient rapport between patients and HCPs. Patients' perceived susceptibility to complications, social support from family and community, multidisciplinary team care and patient's understanding of the benefits of self-care were viewed as facilitating self-management. HCPs saw mHealth apps as a vital opportunity to engage patients in the self-management of conditions and empower them to foster behavior changes. Yet, there were concerns regarding patient's limited digital literacy, lack of integration into routine electronic system and reluctance. DISCUSSION We identified a set of factors influencing self-management in adult patients with diabetes and useful app features that can empower patients to manage their conditions. Findings will inform the development of a mHealth application, and its features designed to improve self-care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Jun Hao Ng
- Duke-NUS Medical School, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Internal Medicine Residency Programme, SingHealth Residency, Singapore, Singapore
| | - Lian Leng Low
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- *Correspondence: Lian Leng Low,
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Enablers and Challenges for E-health Services- A Systematic Literature Review. INTERNATIONAL JOURNAL OF ELECTRONIC GOVERNMENT RESEARCH 2022. [DOI: 10.4018/ijegr.298626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of the paper is to systematically review the literature of enablers and challenges for implementation and adoption e-health service. The review aims to identify the most critical success factors and barriers related with the development and growth of the e-health services under different circumstances. A total 68 relevant publications related to enablers and challenges of e-health services were selected from a total 694 research papers. These publications were thoroughly reviewed to find out the critical factors influencing the e-health services. The findings indicate that there are five broad factors viz. technological, environmental, organizational, social and economical along with four major stakeholders’ viz. citizens, patients, caregivers and service providers which influence the e-health services. These factors act as enablers as well as challenges for proper implementation and adoption of e-health services in different situations. On the basis of the findings of the review, a conceptual diamond model of e-health services adoption has been proposed.
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Rokicki S, Mwesigwa B, Waiswa P, Cohen J. Impact of Solar Light and Electricity on the Quality and Timeliness of Maternity Care: A Stepped-Wedge Cluster-Randomized Trial in Uganda. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:777-792. [PMID: 34933975 PMCID: PMC8691890 DOI: 10.9745/ghsp-d-21-00205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023]
Abstract
Lack of access to reliable energy is a major neglected health system challenge to maternal and child health. We found that installing a solar energy system intervention in rural Ugandan maternity facilities led to modest increases in the quality of maternity care and reductions in delays in care. Background: We evaluated the impact of solar light installation in Ugandan maternity facilities on implementation processes, reliability of light, and quality of intrapartum care. Methods: We conducted a stepped-wedge cluster-randomized trial of the We Care Solar Suitcase, a complete solar electric system providing lighting and power for charging phones and small medical devices, in 30 rural Ugandan maternity facilities with unreliable lighting. Facilities were randomly assigned to receive the intervention in the first or second sequence in a 1:1 ratio. We collected data from June 2018 to April 2019. The intervention was installed in September 2018 (first sequence) and in December 2018 (second sequence). The primary effectiveness outcomes were a 20-item and a 36-item index of quality of intrapartum care, a 6-item index of delays in care provision, and the percentage of deliveries with bright light, satisfactory light, and adequate light. Results: We observed 1,118 births across 30 facilities. The intervention was successfully installed in 100% of facilities. After installation, the intervention was used in 83% of nighttime deliveries. Before the intervention, providers on average performed 42% of essential care actions and accumulated 76 minutes of delays during nighttime deliveries. After installation, quality increased by 4 percentage points (95% confidence interval [CI]=1,8) and delays in care decreased by 10 minutes (95% CI=−16,−3), with the largest impacts on infection control, prevention of postpartum hemorrhage, and newborn care practices. One year after the end of the trial, 90% of facilities had LED lights in operation and 60% of facilities had all components in operation. Conclusions: Reliable light is an important driver of timely and adequate health care. Policy makers should invest in renewable energy systems for health facilities; however, even when reliable lighting is present, quality of care may remain low without a broader approach to quality improvements.
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Affiliation(s)
- Slawa Rokicki
- Rutgers School of Public Health, Piscataway, NJ, USA. .,University College Dublin, Dublin, Ireland
| | | | - Peter Waiswa
- Maternal, Newborn and Child Health Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda.,Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Busoga Health Forum, Jinja, Uganda
| | - Jessica Cohen
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Krasuska M, Williams R, Sheikh A, Franklin B, Hinder S, TheNguyen H, Lane W, Mozaffar H, Mason K, Eason S, Potts H, Cresswell K. Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme. BMJ Health Care Inform 2021; 28:e100429. [PMID: 34921060 PMCID: PMC8685936 DOI: 10.1136/bmjhci-2021-100429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale national health information technology change programme aiming to promote digitally-enabled transformation in secondary healthcare provider organisations by supporting relatively digitally mature provider organisations to become international centres of excellence. AIM To qualitatively evaluate the impact of the GDE programme in promoting digital transformation in provider organisations that took part in the programme. METHODS We conducted a series of in-depth case studies in 12 purposively selected provider organisations and a further 24 wider case studies of the remaining organisations participating in the GDE programme. Data collected included 628 interviews, non-participant observations of 190 meetings and workshops and analysis of 9 documents. We used thematic analysis aided by NVivo software and drew on sociotechnical theory to analyse the data. RESULTS We found the GDE programme accelerated digital transformation within participating provider organisations. This acceleration was triggered by: (1) dedicated funding and the associated requirement for matched internal funding, which in turn helped to prioritise digital transformation locally; (2) governance requirements put in place by the programme that helped strengthen existing local governance and project management structures and supported the emergence of a cadre of clinical health informatics leaders locally; and (3) reputational benefits associated with being recognised as a centre of digital excellence, which facilitated organisational buy-in for digital transformation and increased negotiating power with vendors. CONCLUSION The GDE programme has been successful in accelerating digital transformation in participating provider organisations. Large-scale digital transformation programmes in healthcare can stimulate local progress through protected funding, putting in place governance structures and leveraging reputational benefits for participating provider organisations, around a coherent vision of transformation.
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Affiliation(s)
- Marta Krasuska
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | - Hung TheNguyen
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | | | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, UK
| | | | | | - Henry Potts
- Institute of Health Informatics, University College London, London, UK
| | - Kathrin Cresswell
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
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Assessment of RHIS Quality Assurance Practices in Tarkwa Submunicipal Health Directorate, Ghana. ADVANCES IN PUBLIC HEALTH 2021. [DOI: 10.1155/2021/5561943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Routine health information system (RHIS) quality assurance has become an important issue, not only because of its significance in promoting high standard of patient care, but also because of its impact on government budgets for the maintenance of health services. Routine health information system comprises healthcare data collection, compilation, storage, analysis, report generation, and dissemination on routine basis at the various healthcare settings. The data from RHIS give a representation of health status, health services, and health resources. The sources of RHIS data are normally individual health records, records of services delivered, and records of health resources. Using reliable information from routine health information systems is fundamental in the healthcare delivery system. Quality assurance practices are measures that are put in places to ensure the health data that are collected meet required quality standards. Routine health information system quality assurance practices ensure that data that are generated from the system are fit for use. This study considered quality assurance practices in the RHIS processes. Methods. A cross-sectional study was conducted in eight health facilities in Tarkwa Submunicipal health service in the western region of Ghana. The study involved routine quality assurance practices among the 90-health staff and management selected from facilities in Tarkwa Submunicipal who collect or use data routinely from 24th December, 2019, to 20th January, 2020. Results. Generally, Tarkwa Submunicipal health service appears to practice quality assurance during data collection, compilation, storage, analysis, and dissemination. The results show some achievement in quality control performance in report dissemination (77.6%), data analysis (68.0%), data compilation (67.4%), report compilation (66.3%), data storage (66.3%), and collection (61.1%). Conclusions. Even though Tarkwa Submunicipal health directorate engages some control measures to ensure data quality, there is the need to strengthen the process to achieve the targeted percentage of performance (90.0%). There was significant shortfall in quality assurance practices performance especially during data collection, with respect to the expected performance.
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Singh NS, Scott K, George A, LeFevre AE, Ved R. A tale of 'politics and stars aligning': analysing the sustainability of scaled up digital tools for front-line health workers in India. BMJ Glob Health 2021; 6:bmjgh-2021-005041. [PMID: 34312147 PMCID: PMC8728367 DOI: 10.1136/bmjgh-2021-005041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION India has become a lighthouse for large-scale digital innovation in the health sector, particularly for front-line health workers (FLHWs). However, among scaled digital health solutions, ensuring sustainability remains elusive. This study explores the factors underpinning scale-up of digital health solutions for FLHWs in India, and the potential implications of these factors for sustainability. METHODS We assessed five FLHW digital tools scaled at the national and/or state level in India. We conducted in-depth interviews with implementers, technology and technical partners (n=11); senior government stakeholders (n=5); funders (n=1) and evaluators/academics (n=3). Emergent themes were grouped according to a broader framework that considered the (1) digital solution; (2) actors; (3) processes and (4) context. RESULTS The scale-up of digital solutions was facilitated by their perceived value, bounded adaptability, support from government champions, cultivation of networks, sustained leadership and formative research to support fit with the context and population. However, once scaled, embedding digital health solutions into the fabric of the health system was hampered by challenges related to transitioning management and ownership to government partners; overcoming government procurement hurdles; and establishing committed funding streams in government budgets. Strong data governance, continued engagement with FLHWs and building a robust evidence base, while identified in the literature as critical for sustainability, did not feature strongly among respondents. Sustainability may be less elusive once there is more consensus around the roles played between national and state government actors, implementing and technical partners and donors. CONCLUSION The use of digital tools by FLHWs offers much promise for improving service delivery and health outcomes in India. However, the pathway to sustainability is bespoke to each programme and should be planned from the outset by investing in people, relationships and service delivery adjustments to navigate the challenges involved given the dynamic nature of digital tools in complex health systems.
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Affiliation(s)
- Neha S Singh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerry Scott
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Asha George
- School of Public Health, University of the Western Cape, Faculty of Community and Health Sciences, Cape Town, Western Province, South Africa
| | - Amnesty Elizabeth LeFevre
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, Delhi, India
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Swartz A, LeFevre AE, Perera S, Kinney MV, George AS. Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa. Global Health 2021; 17:77. [PMID: 34229699 PMCID: PMC8259085 DOI: 10.1186/s12992-021-00716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND With the aim to support further understanding of scaling up and sustaining digital health, we explore digital health solutions that have or are anticipated to reach national scale in South Africa: the Perinatal Problem Identification Programme (PPIP) and Child Healthcare Problem Identification Programme (Child PIP) (mortality audit reporting and visualisation tools), MomConnect (a direct to consumer maternal messaging and feedback service) and CommCare (a community health worker data capture and decision-support application). RESULTS A framework integrating complexity and scaling up processes was used to conceptually orient the study. Findings are presented by case in four domains: value proposition, actors, technology and organisational context. The scale and use of PPIP and Child PIP were driven by 'champions'; clinicians who developed technically simple tools to digitise clinical audit data. Top-down political will at the national level drove the scaling of MomConnect, supported by ongoing financial and technical support from donors and technical partners. Donor preferences played a significant role in the selection of CommCare as the platform to digitise community health worker service information, with a focus on HIV and TB. A key driver of scale across cases is leadership that recognises and advocates for the value of the digital health solution. The technology need not be complex but must navigate the complexity of operating within an overburdened and fragmented South African health system. Inadequate and unsustained investment from donors and government, particularly in human resource capacity and robust monitioring and evaluation, continue to threaten the sustainability of digital health solutions. CONCLUSIONS There is no single pathway to achieving scale up or sustainability, and there will be successes and challenges regardless of the configuration of the domains of value proposition, technology, actors and organisational context. While scaling and sustaining digital solutions has its technological challenges, perhaps more complex are the idiosyncratic factors and nature of the relationships between actors involved. Scaling up and sustaining digital solutions need to account for the interplay of the various technical and social dimensions involved in supporting digital solutions to succeed, particularly in health systems that are themselves social and political dynamic systems.
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Affiliation(s)
- Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
- Department of Epidemiology, School of Public Health, Brown University, Providence, USA.
| | - Amnesty E LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Shehani Perera
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mary V Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Asha S George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Stephani V, Opoku D, Otupiri E. Determining the potential of mobilephone-based health interventions in Kumasi, Ghana. Ghana Med J 2021; 54:88-92. [PMID: 33536678 PMCID: PMC7829046 DOI: 10.4314/gmj.v54i2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Numerous reviews have reported generally positive outcomes of mobile phone-based health (mHealth) interventions in the sub-Saharan African countries, especially for people with non-communicable diseases. At the same time, the mHealth landscape is burdened by a lack of sustainability. A recently published review has identified several context factors that influence the successful implementation of mHealth. Therefore, the aim is to use these contextual factors to assess the potential for mHealth in a particular clinical setting. Design The study used a cross-sectional, descriptive design. Setting The clinical setting of the study was the ‘Komfo Anokye Teaching Hospital’ in Kumasi, Ghana. Participants 150 patients attending the diabetes clinic were surveyed. Main outcome measures Context factors that influence the perceived usefulness and ease of use of mHealth. Results The survey revealed that patients at the diabetes centre had a positive attitude towards mobile phones, but also a low familiarity. Whereas patients faced several access barriers to care, most enabling resources for the successful and sustainable implementation of mHealth interventions such as access to mobile phones and electricity were available. Conclusions There is a high potential for mHealth in the setting of the diabetes clinic in Kumasi, Ghana. Funding None Declared
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Affiliation(s)
- Victor Stephani
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
| | - Daniel Opoku
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
| | - Easmon Otupiri
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Sarfo FS, Akpalu A, Bockarie A, Appiah L, Nguah SB, Ayisi-Boateng NK, Adamu S, Neizer C, Arthur A, Nyamekye R, Agyenim-Boateng K, Tagge R, Adusei-Mensah N, Ampofo M, Laryea R, Singh A, Amuasi JH, Ovbiagele B. Phone-Based Intervention under Nurse Guidance after Stroke (PINGS II) Study: Protocol for a Phase III Randomized Clinical Trial. J Stroke Cerebrovasc Dis 2021; 30:105888. [PMID: 34102553 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105888] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/24/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The Sub-Saharan African (SSA) region now has the highest estimated effect size of hypertension for stroke causation worldwide. An urgent priority for countries in SSA is to develop and test self-management interventions to control hypertension among those at highest risk of adverse outcomes. Thus the overall objective of the Phone-based Intervention under Nurse Guidance after Stroke II study (PINGS-2) is to deploy a hybrid study design to assess the efficacy of a theoretical-model-based, mHealth technology-centered, nurse-led, multi-level integrated approach to improve longer term blood pressure (BP) control among stroke survivors. MATERIALS AND METHODS A phase III randomized controlled trial involving 500 recent stroke survivors to be enrolled across 10 Ghanaian hospitals. Using a computer-generated sequence, patients will be randomly assigned 1:1 into the intervention or usual care arms. The intervention comprises of (i) home BP monitoring at least once weekly with nurse navigation for high domiciliary BP readings; (2) medication reminders using mobile phone alerts and (3) education on hypertension and stroke delivered once weekly via audio messages in preferred local dialects. The intervention will last for 12 months. The control group will receive usual care as determined by local guidelines. The primary outcome is the proportion of patients with systolic BP <140 mm Hg at 12 months. Secondary outcomes will include medication adherence, self-management of hypertension, major adverse cardiovascular events, health related quality of life and implementation outcomes. CONCLUSION An effective PINGS intervention can potentially be scaled up and disseminated across healthcare systems in low-and-middle income countries challenged with resource constraints to reduce poor outcomes among stroke survivors.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | - Lambert Appiah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Samuel Blay Nguah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | - Agnes Arthur
- Ankaase Methodist Faith Hospital, Ankaase, Ghana
| | | | | | - Raelle Tagge
- Northern California Institute of Research and Education, USA
| | | | | | | | - Arti Singh
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Nsaghurwe A, Dwivedi V, Ndesanjo W, Bamsi H, Busiga M, Nyella E, Massawe JV, Smith D, Onyejekwe K, Metzger J, Taylor P. One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange. BMC Med Inform Decis Mak 2021; 21:139. [PMID: 33926428 PMCID: PMC8086308 DOI: 10.1186/s12911-021-01499-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country's vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. METHODS From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the "Mind the GAPS" (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented "use case scenarios" addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates. RESULTS Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials. CONCLUSION Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania's experience may interest countries that are developing their HIS programs.
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Affiliation(s)
- Alpha Nsaghurwe
- USAID's Maternal and Child Survival Program/John Snow Inc., Dar es Salam, Tanzania
| | - Vikas Dwivedi
- USAID's Maternal and Child Survival Program/John Snow Inc., Arlington, USA.
| | - Walter Ndesanjo
- Information, Communication and Technology (ICT) Unit, Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), Dar es Salam, Tanzania
| | - Haji Bamsi
- Information, Communication and Technology (ICT) Unit, Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), Dar es Salam, Tanzania
| | - Moses Busiga
- USAID, Health System Strengthening, Dar es Salam, Tanzania
| | - Edwin Nyella
- USAID's Maternal and Child Survival Program/John Snow Inc., Dar es Salam, Tanzania
| | | | - Dasha Smith
- USAID's Maternal and Child Survival Program/John Snow Inc., Arlington, USA
| | - Kate Onyejekwe
- USAID's Maternal and Child Survival Program/John Snow Inc., Arlington, USA
| | | | - Patricia Taylor
- USAID's Maternal and Child Survival Program/John Snow Inc., Arlington, USA
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Greve M, Brendel AB, van Osten N, Kolbe LM. Overcoming the barriers of mobile health that hamper sustainability in low-resource environments. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Aim
This research aims to identify response strategies that non-profit organizations (NPOs) can apply to overcome the barriers that hamper the sustainable use of mobile health (mHealth) interventions in low-resource environments (LREs), such as in Sub-Saharan Africa (SSA).
Subject and method
A qualitative study on mHealth initiatives in SSA is conducted through semi-structured interviews with 15 key informants of NPOs that operate and manage mHealth interventions in this region. The interviews focus on identifying existing barriers and response strategies that NPOs apply to enable sustainable and long-term running interventions.
Results
Building on grounded theory techniques, the collected data guided us towards a process model that identifies four aggregated categories of challenging areas that require response strategies (economy, environment, technology, and user acceptance).
Conclusion
This study provides contributions from and implications for NPOs and researchers. Health practitioners are provided with a knowledge base of what barriers to expect and how to overcome them, to strive for sustainable implementation from the very beginning of an intervention. A process model is identified that structures the response strategies in a time-based agenda of mHealth initiatives and thus makes a theoretical contribution. Overall, this study addresses the need for a theoretical consideration of the “pilotitis” phenomenon, which currently hampers the sustainable implementation and scaling up of mHealth initiatives. While the focus is specifically on mHealth initiatives, the overall findings help prevent discontinuance of projects in the future after the pilot, and help facilitate LREs on their way to sustainable health interventions and universal health coverage.
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Tokosi TO, Twum-Darko M. Mobile Health Crowdsensing (MHCS) Intervention on Chronic Disease Awareness: Protocol for a Systematic Review. JMIR Res Protoc 2021; 10:e24589. [PMID: 33739288 PMCID: PMC8088872 DOI: 10.2196/24589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health crowdsensing (MHCS) involves the use of mobile communication technologies to promote health by supporting health care practices (eg, health data collection, delivery of health care information, or patient observation and provision of care). MHCS technologies (eg, smartphones) have sensory capabilities, such as GPS, voice, light, and camera, to collect, analyze, and share user-centered data (explicit and implicit). The current literature indicates no scientific study related to MHCS interventions for chronic diseases. The proposed systematic review will examine the impact of MHCS interventions on chronic disease awareness. OBJECTIVE The objectives of this study are to identify and describe various MHCS intervention strategies applied to chronic disease awareness. METHODS Literature from various databases, such as MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials, will be examined. Trial registers, reports, grey literature, and unpublished academic theses will also be included. All mobile technologies, such as cell phones, personal digital assistants, and tablets that have short message service, multimedia message service, video, and audio capabilities, will be included. MHCS will be the primary intervention strategy. The search strategy will include keywords such as mHealth, crowdsensing, and awareness among other medical subject heading terms. Articles published from January 1, 1945, to December 31, 2019, will be eligible for inclusion. The authors will independently screen and select studies, extract data, and assess the risk of bias, with discrepancies resolved by an independent party not involved in the study. The authors will assess statistical heterogeneity by examining the types of participants, interventions, study designs, and outcomes in each study, and pool studies judged to be statistically homogeneous. In the assessment of heterogeneity, a sensitivity analysis will be considered to explore statistical heterogeneity. Statistical heterogeneity will be investigated using the chi-square test of homogeneity on Cochrane Q test, and quantified using the I2 statistic. RESULTS The preliminary search query found 1 paper. Further literature search commenced in mid-March 2021 and is to be concluded in April 2021. The proposed systematic review protocol has been registered in PROSPERO (The International Prospective Register of Systematic Reviews; no. CRD42020161435). Furthermore, the use of search data extraction and capturing in Review Manager version 5.3 (Cochrane) commenced in January 2021 and ended in February 2021. Further literature search will begin in mid-March 2021 and will be concluded in April 2021. The final stages will include analyses and writing, which are anticipated to start and be completed in May 2021. CONCLUSIONS The knowledge derived from this study will inform health care stakeholders-including researchers, policy makers, investors, health professionals, technologists, and engineers-of the impact of MHCS interventions on chronic disease awareness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/24589.
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Affiliation(s)
- Temitope Oluwaseyi Tokosi
- Graduate Centre for Management, Faculty of Business and Management Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Michael Twum-Darko
- Graduate Centre for Management, Faculty of Business and Management Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
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Mncwabe N, Hlongwana KW, Ginindza TG. An ethnographic study exploring the experiences of patients living with cancer illness in support group settings in KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e8. [PMID: 33764135 PMCID: PMC8008000 DOI: 10.4102/phcfm.v13i1.2303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 09/11/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background The major strength of support groups stems from their ability to help patients manage their health within and outside the traditional hospital settings. Despite the known benefits of support groups for people living with cancer, ethnographic studies documenting the cancer patients’ experiences of living with cancer within the support group contexts in KwaZulu-Natal are scarce. Aim The aim of this study was to examine the experiences of patients living with cancer within a support group setting. Setting The study setting was support groups in KwaZulu- Natal, South Africa. Materials and Methods This study was conducted using, participant observation, focus group discussions and in-depth interviews. Data were generated over a 3-month period. Purposive sampling was used to identify the information-rich participants. Thematic data analysis was performed in order to obtain insights into the collective meaning of data generated. Results Participants viewed the support group settings as creating an environment with a unique sense of community. This was in contrast with the sense of isolation, rejection and lack of empowering knowledge on cancer, often experienced outside these contexts. Moreover, the support groups were lauded for facilitating positive relationships with family and friends and providing a safe space for members to freely express their emotions. Conclusion Psychosocial support provided by support groups can help to ameliorate the distress caused by cancer diagnosis and its treatment; however, these support groups are still few and far in between. Therefore, there should be a greater investment in establishing support groups.
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Affiliation(s)
- Nkosinathi Mncwabe
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
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Mekonnen ZA, Gelaye KA, Were MC, Tilahun B. Acceptability, Barriers and Facilitators of Mobile Text Message Reminder System Implementation in Improving Child Vaccination: A Qualitative Study in Northwest Ethiopia. J Multidiscip Healthc 2021; 14:605-616. [PMID: 33727823 PMCID: PMC7955748 DOI: 10.2147/jmdh.s298167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/23/2021] [Indexed: 12/31/2022] Open
Abstract
Background Mobile phone text message-based mHealth interventions have shown promise in improving health service delivery. Despite the promising findings at a small scale and few contexts, implementing new technologies as part of changes to health care services is inherently challenging. Though there is a potential to introduce mHealth initiatives to health systems of developing countries, existing evidence on the barriers and facilitators of implementation in different contexts is not adequate. Therefore, this study aimed to explore the acceptability, barriers and facilitators of implementing mobile text message reminder system for child vaccination in Ethiopia. Methods This study applied a phenomenological study design. The study was conducted in north-west, Ethiopia between July 28 and August 19, 2020. A total of 23 participants were purposively selected for the in-depth and key informant interviews. We used an interview guide to collect data and audio-records of interviews were transcribed verbatim. Coding was done to identify patterns and thematic analysis was conducted using ATLAS ti7 software. Results The findings indicated that mothers were receptive to mobile text message reminders for their child’s vaccination. Low mobile phone ownership, access to mobile network, access to electricity and illiteracy among the target population were identified as barriers that would affect implementation. Confidentiality and security-related issues are not barriers to implementation of text message reminders for child vaccination service. Facilitators for implementation include stakeholder collaboration, providing orientation/training to users, and willingness to pay by clients. Conclusion In this study, using mobile phone text message reminders for child vaccination services are acceptable by clients. Barriers identified were related to inadequate ICT infrastructure and other technical issues. Addressing the potential barriers and leveraging the existing opportunities could optimize the implementation in resource-limited settings. Before actual implementation, program implementers should also consider providing orientation to users on the proposed mHealth program.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Health System Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Martin C Were
- Department of Biomedical Informatics, Vanderbilt Medical Center, Nashville, TN, 37232, USA
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Rajvanshi H, Jain Y, Kaintura N, Soni C, Chandramohan R, Srinivasan R, Telasey V, Bharti PK, Jain D, Surve M, Saxena S, Gangamwar V, Anand MS, Lal AA. A comprehensive mobile application tool for disease surveillance, workforce management and supply chain management for Malaria Elimination Demonstration Project. Malar J 2021; 20:91. [PMID: 33593359 PMCID: PMC7885520 DOI: 10.1186/s12936-021-03623-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care technologies are now offering accountability, quality, robustness, and accuracy in disease surveillance and health care delivery programmes. With the advent of mobile hand-held devices, these technologies have become more accessible and adaptable for use by field staff working in remote areas. The Malaria Elimination Demonstration Project started collection of data and conduct of routine operations using paper-based reporting systems. Observing the need for a robust and quality digital mobile application, a comprehensive mobile application tool was developed that allowed the project to conduct disease surveillance, workforce management and supply chain management. METHODS In June 2017, the project conceptualized a comprehensive mobile application tool in the local language (Hindi) for disease surveillance, human resources management, and supply chain management. The tool is also available in English. Solution for Community Health-workers (SOCH) mobile app is an android native application developed using android SDK and web-based tool using MVC.net framework. Construction of the application started in November 2017 and rolled out its pilot in April 2018, followed by pan-district roll out in July 2018. The application uses self-validation tools to ensure high level of data quality and integrity. RESULTS The software is available in android based hand-held devices and web-screens with built-in data analytical capabilities. Using SOCH, the project has now successfully digitized its routine surveillance, attendance, tour plans, supply chain management components. The project has documented a reduction in 91% indigenous cases in the district, 60% improvement in stock accountability, and 99.6% accuracy in data collected through the mobile application. CONCLUSION SOCH is an excellent and user-friendly tool, which can be customized for any public health management programme. The system ensures accountability and data robustness, which is needed for malaria elimination efforts throughout the country. The mobile application can be adapted for English or any other Indian or international language for use for malaria or any other disease surveillance and control programme. Another expansion feature of this mobile application is incorporation of indicators for Indoor Residual Spraying (IRS), Long-Lasting Insecticidal Nets (LLINs), and minor engineering by the residents of community under surveillance. The authors believe that it would be highly desirable and appropriate for an international organization, such as the World Health Organization (WHO), to conduct an independent comparison of all available mobile e-surveillance tools, so that a high-performing and globally suitable system can be selected for use in malaria elimination programmes. The Foundation of Disease Elimination and Controlof India has decided to make the SOCH mobile application available to anyone who would like to use it for disease surveillance and health care programmes.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.
| | | | | | - Chaitanya Soni
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | | | | | - Vinay Telasey
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Deepak Jain
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | - Mangeshi Surve
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | | | - Vilas Gangamwar
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | - M S Anand
- Swaas Systems Pvt Ltd, Chennai, Tamil Nadu, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Mbuthia F, Reid M, Fichardt A. Development and validation of a mobile health communication framework for postnatal care in rural Kenya. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Salmani H, Ahmadi M, Shahrokhi N. The Impact of Mobile Health on Cancer Screening: A Systematic Review. Cancer Inform 2020; 19:1176935120954191. [PMID: 33116352 PMCID: PMC7573752 DOI: 10.1177/1176935120954191] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction: Mobile health is an emerging technology around the world that can be effective in cancer screening. This study aimed to examine the effectiveness of mobile health applications on cancer screening. Methods: We conducted a systematic literature review of studies related to the use of mobile health applications in cancer screening. We also conducted a comprehensive search of articles on cancer screening related to the use of mobile health applications in journals published between January 1, 2008, and January 31, 2019, using 5 databases: IEEE, Scopus, Web of Science, Science Direct and PubMed. Results: A total of 23 articles met the inclusion criteria and were included in the present review. All studies have identified positive effects of applications on cancer screening and clinical health outcomes. Furthermore, more than half of mobile applications had multiple functions such as providing information, planning and education. Moreover, most of the studies, which examined the satisfaction of patients and quality improvement, showed healthcare application users have significantly higher satisfaction of living and it leads to improving quality. Conclusion: This study found that the use of mobile health applications has a positive impact on health-related behaviours and outcomes. Application users were more satisfied with applying mobile health applications to manage their health condition in comparison with users who received conventional care.
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Affiliation(s)
- Hosna Salmani
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ahmadi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Shahrokhi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Osei E, Kuupiel D, Mashamba-Thompson TP. Availability and use of mHealth for disease diagnosis and treatment support by health workers in sub-Saharan Africa: a scoping review protocol. BMJ Open 2020; 10:e036641. [PMID: 33082180 PMCID: PMC7577031 DOI: 10.1136/bmjopen-2019-036641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Improving healthcare for all is one of the global health priorities, particularly in disease burdened settings such as sub-Saharan Africa (SSA). Considering the high penetration rate of mobile phones in SSA, mobile health (mHealth) could be used to achieve universal health coverage. The proposed study will map evidence on the availability and use of mHealth for disease diagnosis and treatment support by health workers in SSA. METHODS AND ANALYSIS This review will be guided by Arksey and O'Malley's scoping review framework and Levac et al's recommendations and guidelines from the Joanna Briggs Institute. A scoping review will be conducted to explore what is known about mHealth for disease diagnosis and treatment support by health workers in SSA and to identify areas for future research. In addition to searching the grey literature, the following databases will be explored from PubMed, MEDLINE and CINAHL with full text via EBSCOhost and ScienceDirect databases. A search in Google Scholar will be considered as an additional information source. The literature search will involve published studies from 2000 to 2020 in any language. This review will cover mHealth for disease diagnosis and treatment support by health workers in SSA. The primary investigator will conduct the title screening, and subsequently, two reviewers will independently conduct abstract and full article screening and data extraction. The results of this proposed review will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-analysis: Extension for Scoping Review guidelines. ETHICS AND DISSEMINATION Ethical approval is not required for the scoping review, which is the first stage in a PhD study in public health on accessing mHealth for disease diagnosis and treatment support by health workers in Ghana. The final review will be submitted for publications to a scientific journal, and our results will be presented at appropriate conferences.
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Affiliation(s)
- Ernest Osei
- Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Desmond Kuupiel
- Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Research for Sustainable Development Consult, Sunyani, Bono Region, Ghana
| | - Tivani Phosa Mashamba-Thompson
- Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Public Health, University of Limpopo, Polokwane, Limpopo Province, South Africa
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Sam S. Informal mobile phone use by marginalised groups in a plural health system to bridge healthcare gaps in Sierra Leone. INFORMATION DEVELOPMENT 2020. [DOI: 10.1177/0266666920932992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The possibility to use mobile phones to provide affordable, effective and accessible healthcare solutions has continued to attract significant investments in the application of formal m-health schemes in Africa. However, while the formal m-health schemes in Africa are limited and benefited only a handful of people, a majority of individuals are using their own phones to create an informal m-health ecosystem in an attempt to bridge primary healthcare access gaps. This paper draws on qualitative data from a four-year (2012-2016) anthropological study involving marginalised groups in Sierra Leone to document these health-seeking practices along with the benefits and challenges they create in a complex plural health system. It argues that the informal integration of mobile phones into the plural health system offers opportunities for marginalised individuals to search and secure primary healthcare of their choices, but poor network connectivity, high out of pocket maintenance costs, low digital literacy skills, and the lack of policy to streamline and regulate the practices can promise the effectiveness of the informal m-health system. It concludes by offering suggestions for addressing these challenges in the Sierra Leone context.
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Kynge L. Finding the Best Way to Deliver Online Educational Content in Low-Resource Settings: Qualitative Survey Study. JMIR MEDICAL EDUCATION 2020; 6:e16946. [PMID: 32452810 PMCID: PMC7284481 DOI: 10.2196/16946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/29/2020] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The reach of internet and mobile phone coverage has grown rapidly in low- and middle-income countries (LMICs). The potential for sharing knowledge with health care workers in low-resource settings to improve working practice is real, but barriers exist that limit access to online information. Burns affect more than 11 million people each year, but health care workers in low-resource settings receive little or no training in treating burn patients. Interburns' training programs are tailor-made to improve the quality of burn care in Asia, Africa, and the Middle East; the challenge is to understand the best way of delivering these resources digitally toward improved treatment and care of burn patients. OBJECTIVE The aim of the study, funded by the National Institute for Health Research (NIHR), was to understand issues and barriers that affect health care worker access to online learning in low-resource settings in order to broaden access to Interburns' training materials and improve burn-patient care. METHODS A total of 546 participants of Interburns' Essential Burn Care (EBC) course held in Bangladesh, Nepal, Ethiopia, and the West Bank, the occupied Palestinian Territories, between January 2016 and June 2018 were sent an online survey. EBC participants represent the wide range of health care professionals involved with the burn-injured patient. A literature review was carried out as well as research into online platforms. RESULTS A total of 207 of 546 (37.9%) participants of the EBC course did not provide an email address. Of the 339 email addresses provided, 81 (23.9%) "bounced" back. Surgeons and doctors were more likely to provide an email address than nurses, intern doctors, or auxiliary health care workers. A total of 258 participants received the survey and 70 responded, giving a response rate of 27.1%. Poor internet connection, lack of time, and limited access to computers were the main reasons for not engaging with online learning, along with lack of relevant materials. Computers were seen as more useful for holding information, while mobile phones were better for communicating and sharing knowledge. Health care workers in LMICs use mobile phones professionally on a daily basis. A total of 80% (56/70) felt that educational content on burns should be available through mobile apps. CONCLUSIONS Health care workers in low-resource settings face a variety of barriers to accessing educational content online. The reliance on email for sign-up to learning management systems is a significant barrier. Materials need to be relevant, localized, and easy to consume offline if necessary, to avoid costs of mobile phone data. Smartphones are increasingly used professionally every day for communication and searching for information, pointing toward the need for tailored educational content to be more available through mobile- and web-based apps.
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Affiliation(s)
- Lucy Kynge
- Interburns, Swansea University, Swansea, United Kingdom
- The Centre for Global Burn Injury, Policy and Research, Swansea University, Swansea, United Kingdom
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Electronic Health Information Systems to Improve Disease Diagnosis and Management at Point-of-Care in Low and Middle Income Countries: A Narrative Review. Diagnostics (Basel) 2020; 10:diagnostics10050327. [PMID: 32443856 PMCID: PMC7277945 DOI: 10.3390/diagnostics10050327] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of an electronic health information system (EHIS) is to support health care workers in providing health care services to an individual client and to enable data exchange among service providers. The demand to explore the use of EHIS for diagnosis and management of communicable and non-communicable diseases has increased dramatically due to the volume of patient data and the need to retain patients in care. In addition, the advent of Coronavirus disease 2019 (COVID-19) pandemic in high disease burdened low and middle income countries (LMICs) has increased the need for robust EHIS to enable efficient surveillance of the pandemic. EHIS has potential to enable efficient delivery of disease diagnostics services at point-of-care (POC) and reduce medical errors. This review provides an overview of literature on EHIS's with a focus on describing the key components of EHIS and presenting evidence on enablers and barriers to implementation of EHISs in LMICs. With guidance from the presented evidence, we proposed EHIS key stakeholders' roles and responsibilities to ensure efficient utility of EHIS for disease diagnosis and management at POC in LMICs.
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Yusif S, Hafeez-Baig A, Soar J. A model for evaluating eHealth preparedness – a case study approach. TRANSFORMING GOVERNMENT- PEOPLE PROCESS AND POLICY 2020. [DOI: 10.1108/tg-07-2019-0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to validate an initially developed e-Health readiness assessment model.
Design/methodology/approach
The authors thematically analysed an initial qualitative data collected and used the outcome to develop survey instruments for this study. To collect the quantitative data, the authors used the drop and collect survey approach given the research setting. The quantitative data was analysed using factor and regression analyses of SPSS 23 in which hypotheses formulated were tested.
Findings
The results suggest that the model [R2 = 0.971; F (5, 214) = 1414.303], which is made up of readiness assessment factors (constructs) and measuring tools explain about 97% of the variance of the overall health information technology/e-Health adoption readiness at Komfo Anokye Teaching Hospital. The measuring tools were reliable for assessing the composite variables (constructs): technology readiness; operational resource readiness; organizational and cultural readiness; regulatory and policy readiness; and core readiness, which have significant influence on eHealth adoption readiness assessment..
Originality/value
This study has successfully validated empirically developed eHealth readiness assessment model with complete reliable indicators given that existing eHealth readiness assessment models have not been effective due to a general lack of standard indicators for measuring assessment factors. The study also contributes to the growing research on the adoption of information technology/systems in health-care environment using the Technology–Organization–Environment framework.
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Dolan SB, Alao ME, Mwansa FD, Lymo DC, Bulula N, Carnahan E, Beylerian E, Werner L, Shearer JC. Perceptions of factors influencing the introduction and adoption of electronic immunization registries in Tanzania and Zambia: a mixed methods study. Implement Sci Commun 2020; 1:38. [PMID: 32885195 PMCID: PMC7427960 DOI: 10.1186/s43058-020-00022-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As technology has become cheaper and more accessible, health programs are adopting digital health interventions (DHI) to improve the provision of and demand for health services. These interventions are complex and require strong coordination and support across different health system levels and government departments, and they need significant capacities in technology and information to be properly implemented. Electronic immunization registries (EIRs) are types of DHI used to capture, store, access, and share individual-level, longitudinal health information in digitized records. The BID Initiative worked in partnership with the governments of Tanzania and Zambia to introduce an EIR at the sub-national level in both countries within 5 years as part of a multi-component complex intervention package focusing on data use capacity-building. METHODS We aimed to gather and describe learnings from the BID experience by conducting a framework-based mixed methods study to describe perceptions of factors that influenced scale-up of the EIR. Data were collected through key informant interviews, a desk review, EIRs, and health management information systems. We described how implementation of the EIRs fulfilled domains described in our conceptual framework and used cases to illustrate the relationships and relative influence of domains for scale-up and adoption of the EIR. RESULTS We found that there was no single factor that seemed to influence the introduction or sustained adoption of the EIR as many of the factors were interrelated. For EIR introduction, strong strategic engagement among partners was important, while EIR adoption was influenced by adequate staffing at facilities, training, use of data for supervision, internet and electricity connectivity, and community sensitization. CONCLUSIONS Organizations deploying DHIs in the future should consider how best to adapt their intervention to the existing ecosystem, including human resources and organizational capacity, as well as the changing technological landscape during planning and implementation.
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Affiliation(s)
- Samantha B. Dolan
- Dolan Consulting LLC, PATH, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Mary E. Alao
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | | | - Dafrossa C. Lymo
- Immunisation and Vaccines Development, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Ngwegwe Bulula
- Immunisation and Vaccines Development, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, Daniels K. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 3:CD011942. [PMID: 32216074 PMCID: PMC7098082 DOI: 10.1002/14651858.cd011942.pub2] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mobile health (mHealth), refers to healthcare practices supported by mobile devices, such as mobile phones and tablets. Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mHealth, can help in its implementation. OBJECTIVES To synthesise qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, Science Citation Index and Social Sciences Citation Index in January 2018. We searched Global Health in December 2015. We screened the reference lists of included studies and key references and searched seven sources for grey literature (16 February to 5 March 2018). We re-ran the search strategies in February 2020. We screened these records and any studies that we identified as potentially relevant are awaiting classification. SELECTION CRITERIA We included studies that used qualitative data collection and analysis methods. We included studies of mHealth programmes that were part of primary healthcare services. These services could be implemented in public or private primary healthcare facilities, community and workplace, or the homes of clients. We included all categories of health workers, as well as those persons who supported the delivery and management of the mHealth programmes. We excluded participants identified as technical staff who developed and maintained the mHealth technology, without otherwise being involved in the programme delivery. We included studies conducted in any country. DATA COLLECTION AND ANALYSIS We assessed abstracts, titles and full-text papers according to the inclusion criteria. We found 53 studies that met the inclusion criteria and sampled 43 of these for our analysis. For the 43 sampled studies, we extracted information, such as country, health worker category, and the mHealth technology. We used a thematic analysis process. We used GRADE-CERQual to assess our confidence in the findings. MAIN RESULTS Most of the 43 included sample studies were from low- or middle-income countries. In many of the studies, the mobile devices had decision support software loaded onto them, which showed the steps the health workers had to follow when they provided health care. Other uses included in-person and/or text message communication, and recording clients' health information. Almost half of the studies looked at health workers' use of mobile devices for mother, child, and newborn health. We have moderate or high confidence in the following findings. mHealth changed how health workers worked with each other: health workers appreciated being more connected to colleagues, and thought that this improved co-ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face-to-face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching". mHealth changed how health workers delivered care: health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult-to-reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but some preferred paper. Some health workers saw mHealth as creating more work. mHealth led to new forms of engagement and relationships with clients and communities: health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face-to-face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones. Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity: some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user-friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges. AUTHORS' CONCLUSIONS Our findings propose a nuanced view about mHealth programmes. The complexities of healthcare delivery and human interactions defy simplistic conclusions on how health workers will perceive and experience their use of mHealth. Perceptions reflect the interplay between the technology, contexts, and human attributes. Detailed descriptions of the programme, implementation processes and contexts, alongside effectiveness studies, will help to unravel this interplay to formulate hypotheses regarding the effectiveness of mHealth.
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Affiliation(s)
- Willem A Odendaal
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Stellenbosch UniversityDepartment of PsychiatryCape TownSouth Africa
| | | | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Brown UniversitySchool of Public HealthProvidenceRhode IslandUSA
| | - Jane Goudge
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Frances Griffiths
- University of WarwickWarwick Medical SchoolCoventryUK
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Mark Tomlinson
- Stellenbosch UniversityInstitute for Life Course Health Research, Department of Global HealthCape TownSouth Africa
- Queens UniversitySchool of Nursing and MidwiferyBelfastUK
| | - Karen Daniels
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- University of Cape TownHealth Policy and Systems Division, School of Public Health and Family MedicineCape TownWestern CapeSouth Africa7925
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Comulada WS, Wynn A, van Rooyen H, Barnabas RV, Eashwari R, van Heerden A. Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:126-136. [PMID: 30259235 DOI: 10.1007/s11121-018-0950-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Community-based HIV testing and counseling (HTC) programs have become an important part of the healthcare system in South Africa and other low- and middle-income countries with a high HIV prevalence and strained primary healthcare system. Current HTC programs excel at identifying people living with HIV (PLH) but leave gaps in linkage to care and antiretroviral therapy (ART) as most HTC programs do not have the capacity to ensure that linkage has occurred. This article presents the protocol for an mHealth study, that is, pilot testing a mobile platform in KwaZulu-Natal (KZN), South Africa, to improve linkage to care and ART adherence after home-based HTC. Testing data are shared with designated clinics. PLH are identified using fingerprint scans, mobile numbers, or South African IDs. If PLH do not present at a designated clinic after testing HIV positive, study field staff are sent SMS alerts to prompt follow-up visits. Similarly, if PLH do not refill ART prescriptions after their initial 1-month dose runs out, SMS alerts that are sent to field staff. This paper presents the mHealth study protocol and baseline sample characteristics (N = 101 PLH). Analyses will summarize rates of linkage to care and ART prescription refills. Cost-effectiveness analyses will examine the costs and benefits of linkage and ART adherence using our mHealth system. Linkage to care rates will be compared between our study and a historical control, that is, provided by a prior HTC program that was conducted in KZN without our mHealth system (n = 615).
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Affiliation(s)
- W Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd. Suite 350, Los Angeles, CA, 90024, USA.
| | - Adriane Wynn
- Department of Health Policy Management, University of California, Los Angeles, CA, USA
| | - Heidi van Rooyen
- Human and Social Development Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Ruanne V Barnabas
- Global Health and Medicine, University of Washington, Seattle, WA, USA
| | - Rajeev Eashwari
- eHealth Directorate, KwaZulu-Natal Provincial Department of Health, Durban, South Africa
| | - Alastair van Heerden
- Human and Social Development Research Programme, Human Sciences Research Council, Pretoria, South Africa.,Developmental Pathways to Health Research Unit, School of Community Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Shamu S, Chasela C, Slabbert J, Farirai T, Guloba G, Nkhwashu N. Social franchising of community-based HIV counselling and testing services to increase HIV testing and linkage to care in Tshwane, South Africa: study protocol for a non-randomised implementation trial. BMC Public Health 2020; 20:118. [PMID: 31996189 PMCID: PMC6988328 DOI: 10.1186/s12889-020-8231-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/16/2020] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Meeting the ambitious UN 90-90-90 HIV testing, treatment and viral load suppression targets requires innovative strategies and approaches in Sub-Saharan Africa. To date no known interventions have been tested with community health workers (counsellors) as social franchisees or owner-managed businesses in Community-based HIV counselling and testing (CBCT) work. The aim of this methods paper is to describe a Social franchise (SF) CBCT implementation trial to increase HIV testing and linkage to care for individuals at community levels in comparison with an existing CBCT programme methods. METHODS/DESIGN This is a two arm non-randomised community implementation trial with a once off round of post-test follow-up per HIV positive participant to assess linkage to care in low income communities. The intervention arm is a social franchise CBCT in which unemployed, self-employed or employed community members are recruited, contracted and incentivised to test at least 100 people per month, identifying at least 5 HIV positive tests and linking to care at least 4 of them. Social franchisees receive approximately $3.20 per HIV test and $8 per client linked to care. In the control arm, full-time employed HIV counsellors conduct CBCT on a fixed monthly salary. Primary study outcomes are HIV testing uptake rate, HIV positivity, Linkage to care and treatment rate and average counsellors' remuneration cost. Data collection will be conducted using both paper-based and electronic data applications by CBCT or SF counsellors. Data analysis will compare proportions of HIV testing, positivity, linkage to HIV care and treatment rates and counsellors' cost in the two study arms. DISCUSSION The study will provide important insight into whether the SF-delivered CBCT programme increases testing coverage and linkage to care as well as reducing CBCT cost per HIV test and per HIV positive person linked to care. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR201809873079121. The trial was retrospectively registered on 11 September 2018.
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Affiliation(s)
- Simukai Shamu
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa. .,University of the Witwatersrand, School of Public Health, Johannesburg, South Africa.
| | - Charles Chasela
- University of the Witwatersrand, Department of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa.,Right to Care, EQUIP, Pretoria, South Africa
| | - Jean Slabbert
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Thato Farirai
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Geoffrey Guloba
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Nkhensani Nkhwashu
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
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Dick S, O'Connor Y, Thompson MJ, O'Donoghue J, Hardy V, Wu TSJ, O'Sullivan T, Chirambo GB, Heavin C. Considerations for Improved Mobile Health Evaluation: Retrospective Qualitative Investigation. JMIR Mhealth Uhealth 2020; 8:e12424. [PMID: 32012085 PMCID: PMC7003121 DOI: 10.2196/12424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 07/12/2019] [Accepted: 08/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile phone use and, consequently, mobile health (mHealth) interventions have seen an exponential increase in the last decade. There is an excess of 318,000 health-related apps available free of cost for consumers to download. However, many of these interventions are not evaluated and are lacking appropriate regulations. Randomized controlled trials are often considered the gold standard study design in determining the effectiveness of interventions, but recent literature has identified limitations in the methodology when used to evaluate mHealth. OBJECTIVE The objective of this study was to investigate the system developers' experiences of evaluating mHealth interventions in the context of a developing country. METHODS We employed a qualitative exploratory approach, conducting semistructured interviews with multidisciplinary members of an mHealth project consortium. A conventional content analysis approach was used to allow codes and themes to be identified directly from the data. RESULTS The findings from this study identified the system developers' perceptions of mHealth evaluation, providing an insight into the requirements of an effective mHealth evaluation. This study identified social and technical factors which should be taken into account when evaluating an mHealth intervention. CONCLUSIONS Contextual issues represented one of the most recurrent challenges of mHealth evaluation in the context of a developing country, highlighting the importance of a mixed method evaluation. There is a myriad of social, technical, and regulatory variables, which may impact the effectiveness of an mHealth intervention. Failure to account for these variables in an evaluation may limit the ability of the intervention to achieve long-term implementation and scale.
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Affiliation(s)
- Samantha Dick
- Health Information Systems Research Centre, Cork University Business School, Cork, Ireland
| | - Yvonne O'Connor
- Health Information Systems Research Centre, Cork University Business School, Cork, Ireland
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - John O'Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Victoria Hardy
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | | | - Timothy O'Sullivan
- Health Information Systems Research Centre, Cork University Business School, Cork, Ireland
| | | | - Ciara Heavin
- Health Information Systems Research Centre, Cork University Business School, Cork, Ireland
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Watat JK, Madina M. Towards an Integrated Theoretical Model for Assessing Mobile Banking Acceptance Among Consumers in Low Income African Economies. INFORM SYST 2020. [DOI: 10.1007/978-3-030-44322-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dick S, O’Connor Y, Heavin C. Approaches to Mobile Health Evaluation: A Comparative Study. INFORMATION SYSTEMS MANAGEMENT 2019. [DOI: 10.1080/10580530.2020.1696550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Samantha Dick
- Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Yvonne O’Connor
- Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Ciara Heavin
- Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
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Eysenbach G, Bendixsen C, Patrick T. A Model for Assessing Necessary Conditions for Rural Health Care's Mobile Health Readiness: Qualitative Assessment of Clinician-Perceived Barriers. JMIR Mhealth Uhealth 2019; 7:e11915. [PMID: 31702564 PMCID: PMC6874803 DOI: 10.2196/11915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 06/06/2019] [Accepted: 09/04/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) technology dissemination has penetrated rural and urban areas alike. Yet, health care organization oversight and clinician adoption have not kept pace with patient use. mHealth could have a unique impact on health and quality of life for rural populations. If organizations are prepared to manage mHealth, clinicians may improve the quality of care for their patients, both rural and urban. However, many organizations are not yet prepared to prescribe or prohibit third-party mHealth technologies. OBJECTIVE This study explored organizational readiness for rural mHealth adoption, the use of patient-reported data by clinical care teams, and potential impact on improving rural health care delivery. METHODS Semistructured, open-ended interviews were used to investigate clinicians' current practices, motivators, and perceived barriers to their use of mHealth technologies in rural settings. RESULTS A total of 13 clinicians were interviewed, and 53.8% (7/13) reported encouraging use of mHealth apps or wearable devices with rural patients. Perceived barriers to adoption were categorized into three primary themes: (1) personal (clinician), (2) patient, and (3) organizational. Organizational was most prominent, with subcodes of time, uniformity, and policy or direction. Thematic analysis revealed code-category linkages that identify the complex nature of a rural health care organization's current climate from a clinician's perspective. A thematic map was developed to visualize the flow from category to code. Identified linkages guided the development of a refined rural mHealth readiness model. CONCLUSIONS Clinicians (including physicians) have limited time for continuing education, research, or exploration of emerging technologies. Clinicians are motivated to learn more, but they need guidance through organization-led directives. Rural health care institutions should consider investing in mHealth analysis, tool development, and formal recommendations of sanctioned tools for clinicians to use with patients.
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Affiliation(s)
| | - Casper Bendixsen
- Marshfield Clinic Research Institute, National Farm Medicine Center, Marshfield, WI, United States
| | - Timothy Patrick
- University of Wisconsin-Milwaukee, Health Informatics, Milwaukee, WI, United States
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Birur NP, Gurushanth K, Patrick S, Sunny SP, Raghavan SA, Gurudath S, Hegde U, Tiwari V, Jain V, Imran M, Rao P, Kuriakose MA. Role of community health worker in a mobile health program for early detection of oral cancer. Indian J Cancer 2019; 56:107-113. [PMID: 31062727 DOI: 10.4103/ijc.ijc_232_18] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The global incidence of oral cancer occurs in low-resource settings. Community-based oral screening is a strategic step toward downstaging oral cancer by early diagnosis. The mobile health (mHealth) program is a technology-based platform, steered with the aim to assess the use of mHealth by community health workers (CHWs) in the identification of oral mucosal lesions. MATERIALS AND METHODS mHealth is a mobile phone-based oral cancer-screening program in a workplace setting. The participants were screened by two CHWs, followed by an assessment by an oral medicine specialist. A mobile phone-based questionnaire that included the risk assessment was distributed among participants. On specialist recommendation an oral surgeon performed biopsy on participants. The diagnosis by onsite specialist that was confirmed by histopathology was considered as gold standard. All individuals received the standard treatment protocol. A remote oral medicine specialist reviewed the uploaded data in Open Medical Record System. Sensitivity, specificity, positive and negative predictive values were calculated. Inter-rater agreement was analyzed with Cohen's kappa coefficient (κ) test, and the diagnostic ability of CHWs, onsite specialist, and remote specialist was illustrated using receiver operating characteristic curve. RESULTS CHWs identified oral lesions in 405 (11.8%) individuals; the onsite specialist identified oral lesions in 394 (11.4%) individuals; and the remote specialist diagnosed oral lesions in 444 (13%). The inter-rater agreement between the CHW and the onsite specialist showed almost perfect agreement with the κ score of 0.92, and a substantial agreement between CHW and remote specialist showed a score of 0.62. The sensitivity, specificity, positive and negative predictive values of CHWs in the identification of oral lesion were 84.7, 97.6, 84.8, and 97.7%, respectively. CONCLUSION The trained CHWs can aid in identifying oral potentially malignant disorders and they can be utilized in oral cancer-screening program mHealth effectively.
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Affiliation(s)
- N Praveen Birur
- KLE Society's Institute of Dental Sciences; Oral Cancer Screening Program, Biocon Foundation, Bengaluru, India
| | | | - Sanjana Patrick
- Oral Cancer Screening Program, Biocon Foundation, Bengaluru, India
| | - Sumsum P Sunny
- Head and Neck Oncology, Mazumdar Shaw Cancer Center, Bengaluru, India
| | | | - Shubha Gurudath
- KLE Society's Institute of Dental Sciences, Bengaluru, India
| | - Usha Hegde
- JSS Dental College, Mysore, Karnataka, India
| | - Vidya Tiwari
- Oral Medicine Specialist, KLE Society's Institute of Dental Sciences, Bengaluru, India
| | - Vipin Jain
- Department of Public Health Dentistry, KLE Society's Institute of Dental Sciences, Bengaluru, India
| | - Mohammed Imran
- Oral Cancer Screening Program, Biocon Foundation, Bengaluru, India
| | - Pratima Rao
- Oral Cancer Screening Program, Biocon Foundation, Bengaluru, India
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Kim EH, Gellis ZD, Bradway CK, Kenaley B. Depression care services and telehealth technology use for homebound elderly in the United States. Aging Ment Health 2019; 23:1164-1173. [PMID: 30472881 DOI: 10.1080/13607863.2018.1481925] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: Despite the increasing evidence for the effectiveness of telehealth technology in screening and treating depression in older adults, they have been slowly adopted by Home Health Care (HHC) agencies. Therefore, this study was conducted to determine how HHC agencies perceive and use telehealth technology for depression care among homebound older adult patients. Methods: Five-hundred-and-sixteen staff from the National Association for Homecare & Hospice (NAHC) member home health care agencies completed the online survey. Questions were asked of HHC staff regarding performance expectancy, effort expectancy, social influences, facilitating conditions, telehealth use and intention to use/continue to use telehealth. Results: The majority had a neutral or positive perception towards telehealth. However, participants from agencies that have yet to use telehealth (mean: 3.25, SD: 1.56) reported a less intention to use the technology for depression care versus those from agencies that did (mean: 4.64, SD: 1.37). This may be partially explained by the finding that only 32% perceived themselves as having the knowledge and 25% as having resources to use telehealth. Additionally, facilitating conditions and social influences were significant predictors of intention to use/continue to use telehealth for depression care (p-values < .01). Conclusion: Overall, staff had a neutral or positive perception towards telehealth. Factors such as fewer years of experience in using telehealth and a small annual budget may explain a negative perception towards telehealth. Therefore, further education and resources are needed to support telehealth use. Future studies may consider comparing telehealth programs and identifying supporting policies.
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Affiliation(s)
- Eun Hae Kim
- a School of Social Work , Texas State University , San Marcos , TX , USA
| | - Zvi D Gellis
- b School of Social Policy & Practice , University of Pennsylvania , Philadelphia , PA , USA
| | | | - Bonnie Kenaley
- d School of Social Work , Boise State University , Boise , ID , USA
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George A, LeFevre AE, Jacobs T, Kinney M, Buse K, Chopra M, Daelmans B, Haakenstad A, Huicho L, Khosla R, Rasanathan K, Sanders D, Singh NS, Tiffin N, Ved R, Zaidi SA, Schneider H. Lenses and levels: the why, what and how of measuring health system drivers of women's, children's and adolescents' health with a governance focus. BMJ Glob Health 2019; 4:e001316. [PMID: 31297255 PMCID: PMC6590975 DOI: 10.1136/bmjgh-2018-001316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/16/2019] [Accepted: 02/15/2019] [Indexed: 11/18/2022] Open
Abstract
Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users’ rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the why, what and how of measuring health system drivers across micro, meso and macro health systems levels, through three examples (digital health, maternal and perinatal death surveillance and review, and multisectoral action for adolescent health). Appreciating these underpinnings of measuring health systems and governance drivers of the health of women, children and adolescents is essential for a holistic learning and action agenda that engages a wider range of stakeholders, which includes, but also goes beyond, indicator-based measurement. Without a broadening of approaches to measurement and the types of research partnerships involved, continued investments in the health of women, children and adolescents will fall short.
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Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Tanya Jacobs
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Mary Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Kent Buse
- Political Affairs and Strategy, UNAIDS, Geneva, Switzerland
| | | | | | - Annie Haakenstad
- School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Luis Huicho
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rajat Khosla
- United Nations High Commission for Human Rights, Geneva, Switzerland
| | | | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicki Tiffin
- Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa.,Computational Biology, University of Cape Town, Cape Town, South Africa
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, India
| | - Shehla Abbas Zaidi
- Community Health Sciences, Aga Khan University Faculty of Health Sciences, Karachi, Pakistan
| | - Helen Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Early J, Gonzalez C, Gordon-Dseagu V, Robles-Calderon L. Use of Mobile Health (mHealth) Technologies and Interventions Among Community Health Workers Globally: A Scoping Review. Health Promot Pract 2019; 20:805-817. [PMID: 31179777 DOI: 10.1177/1524839919855391] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is mounting evidence to show that community health workers (CHWs) play a positive role in improving population health by connecting people to information, resources, and services. However, barriers faced by CHWs include not being able to access information quickly and in a language tailored to the communities they serve. Mobile health (mHealth) shows promise of bridging this gap. Although there are a number of studies published on mHealth interventions, there is a need to synthesize the literature specific to mHealth and CHWs globally. Therefore, the primary goals of this review are to identify and describe over ten years of studies on the use, effectiveness, and potential of mHealth involving CHWs. Findings provide evidence-based strategies for designing and implementing mHealth tools for and with CHWs. We used criteria and methodology for scoping reviews established by the Joanna Briggs Institute as well as PRISMA protocols. We searched scholarly databases for peer-reviewed articles published between 2007 and 2018. The initial search yielded 207 published articles; after applying inclusion criteria, the sample totaled 64. While research about mHealth use among CHWs is still emerging, we found out that large-scale, longitudinal, and clinical studies are lacking. The existing evidence indicates that interventions, which include both CHWs and mHealth tools, are effective. Challenges include the scarcity of culturally relevant mHealth interventions, lack of a consistent methodology to assess mHealth outcomes, the need for effective training for CHWs to adopt mHealth tools, and improved communication within health care teams working with CHWs.
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Affiliation(s)
- Jody Early
- University of Washington Bothell, Bothell, WA, USA
| | | | - Vanessa Gordon-Dseagu
- University of Washington, Seattle, WA, USA.,National Cancer Institute, Bethesda, MD, USA
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Bervell B, Al-Samarraie H. A comparative review of mobile health and electronic health utilization in sub-Saharan African countries. Soc Sci Med 2019; 232:1-16. [PMID: 31035241 DOI: 10.1016/j.socscimed.2019.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/15/2019] [Accepted: 04/19/2019] [Indexed: 12/12/2022]
Abstract
This study distinguished between the application of e-health and m-health technologies in sub-Saharan African (SSA) countries based on the dimensions of use, targeted diseases or health conditions, locations of use, and beneficiaries (types of patients or health workers) in a country specific context. It further characterized the main opportunities and challenges associated with these dimensions across the sub-region. A systematic review of the literature was conducted on 66 published peer reviewed articles. The review followed the scientific process of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of identification, selection, assessment, synthesis and interpretation of findings. The results of the study showed that m-health was prevalent in usage for promoting information for treatment and prevention of diseases as well as serving as an effective technology for reminders towards adherence. For e-health, the uniqueness lay in data acquisition and patients' records management; diagnosis; training and recruitment. While m-health was never used for monitoring or training and recruitment, e-health on the other hand could not serve the purpose of reminders or for reporting cases from the field. Both technologies were however useful for adherence, diagnosis, disease control mechanisms, information provision, and decision-making/referrals. HIV/AIDS, malaria, and maternal (postnatal and antenatal) healthcare were important in both m-health and e-health interventions mostly concentrated in the rural settings of South Africa and Kenya. ICT infrastructure, trained personnel, illiteracy, lack of multilingual text and voice messages were major challenges hindering the effective usage of both m-health and e-health technologies.
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Affiliation(s)
- Brandford Bervell
- E-learning & Technology Unit, College of Distance Education, University of Cape Coast, Cape Coast, Ghana
| | - Hosam Al-Samarraie
- Centre for Instructional Technology & Multimedia, Universiti Sains Malaysia, Penang, Malaysia.
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Tiffin N, George A, LeFevre AE. How to use relevant data for maximal benefit with minimal risk: digital health data governance to protect vulnerable populations in low-income and middle-income countries. BMJ Glob Health 2019; 4:e001395. [PMID: 31139457 PMCID: PMC6509603 DOI: 10.1136/bmjgh-2019-001395] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 11/30/2022] Open
Abstract
Globally, the volume of private and personal digital data has massively increased, accompanied by rapid expansion in the generation and use of digital health data. These technological advances promise increased opportunity for data-driven and evidence-based health programme design, management and assessment; but also increased risk to individuals of data misuse or data breach of their sensitive personal data, especially given how easily digital data can be accessed, copied and transferred on electronic platforms if the appropriate controls are not implemented. This is particularly pertinent in low-income and middle-income countries (LMICs), where vulnerable populations are more likely to be at a disadvantage in negotiating digital privacy and confidentiality given the intersectional nature of the digital divide. The potential benefits of strengthening health systems and improving health outcomes through the digital health environment thus come with a concomitant need to implement strong data governance structures and ensure the ethical use and reuse of individuals’ data collected through digital health programmes. We present a framework for data governance to reduce the risks of health data breach or misuse in digital health programmes in LMICS. We define and describe four key domains for data governance and appropriate data stewardship, covering ethical oversight and informed consent processes, data protection through data access controls, sustainability of ethical data use and application of relevant legislation. We discuss key components of each domain with a focus on their relevance to vulnerable populations in LMICs and examples of data governance issues arising within the LMIC context.
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Affiliation(s)
- Nicki Tiffin
- Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa.,Computational Biology Division, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Asha George
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Amnesty Elizabeth LeFevre
- Division of Epidemiology and Biostatistics, Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa.,Department of International Health, JohnsHopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Sadegh SS, Khakshour Saadat P, Sepehri MM, Assadi V. A framework for m-health service development and success evaluation. Int J Med Inform 2019; 112:123-130. [PMID: 29500009 DOI: 10.1016/j.ijmedinf.2018.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 12/29/2017] [Accepted: 01/06/2018] [Indexed: 11/17/2022]
Abstract
The emergence of mobile technology has influenced many service industries including health care. Mobile health (m-Health) applications have been used widely, and many services have been developed that have changed delivery systems and have improved effectiveness of health care services. Stakeholders of m-Health services have various resources and rights that lends to a complexity in service delivery. In addition, abundance of different m-Health services makes it difficult to choose an appropriate service for these stakeholders that include customers, patients, users or even providers. Moreover, a comprehensive framework is not yet provided in the literature that would help manage and evaluate m-health services, considering various stakeholder's benefits. In this paper, a comprehensive literature review has been done on famous frameworks and models in the field of Information Technology and electronic health with the aim of finding different aspects of developing and managing m-health services. Using the results of literature review and conducting a stakeholder analysis, we have proposed an m-health evaluation framework which evaluates the success of a given m-health service through a three-stage life cycle: (1) Service Requirement Analysis, (2) Service Development, and (3) Service Delivery. Key factors of m-health evaluation in each step are introduced in the proposed framework considering m-health key stakeholder's benefits. The proposed framework is validated via expert interviews, and key factors in each evaluation step is validated using PLS model. Results show that path coefficients are higher than their threshold which supports the validity of proposed framework.
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Affiliation(s)
- S Saeedeh Sadegh
- Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran.
| | | | - Mohammad Mehdi Sepehri
- Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran.
| | - Vahid Assadi
- Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
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Kohrt BA, Rai S, Vilakazi K, Thapa K, Bhardwaj A, van Heerden A. Procedures to Select Digital Sensing Technologies for Passive Data Collection With Children and Their Caregivers: Qualitative Cultural Assessment in South Africa and Nepal. JMIR Pediatr Parent 2019; 2:e12366. [PMID: 31518316 PMCID: PMC6716492 DOI: 10.2196/12366] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/02/2018] [Accepted: 12/31/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Populations in low-resource settings with high childhood morbidity and mortality increasingly are being selected as beneficiaries for interventions using passive sensing data collection through digital technologies. However, these populations often have limited familiarity with the processes and implications of passive data collection. Therefore, methods are needed to identify cultural norms and family preferences influencing the uptake of new technologies. OBJECTIVE Before introducing a new device or a passive data collection approach, it is important to determine what will be culturally acceptable and feasible. The objective of this study was to develop a systematic approach to determine acceptability and perceived utility of potential passive data collection technologies to inform selection and piloting of a device. To achieve this, we developed the Qualitative Cultural Assessment of Passive Data collection Technology (QualCAPDT). This approach is built upon structured elicitation tasks used in cultural anthropology. METHODS We piloted QualCAPDT using focus group discussions (FGDs), video demonstrations of simulated technology use, attribute rating with anchoring vignettes, and card ranking procedures. The procedure was used to select passive sensing technologies to evaluate child development and caregiver mental health in KwaZulu-Natal, South Africa, and Kathmandu, Nepal. Videos were produced in South Africa and Nepal to demonstrate the technologies and their potential local application. Structured elicitation tasks were administered in FGDs after showing the videos. Using QualCAPDT, we evaluated the following 5 technologies: home-based video recording, mobile device capture of audio, a wearable time-lapse camera attached to the child, proximity detection through a wearable passive Bluetooth beacon attached to the child, and an indoor environmental sensor measuring air quality. RESULTS In South Africa, 38 community health workers, health organization leaders, and caregivers participated in interviews and FGDs with structured elicitation tasks. We refined the procedure after South Africa to make the process more accessible for low-literacy populations in Nepal. In addition, the refined procedure reduced misconceptions about the tools being evaluated. In Nepal, 69 community health workers and caregivers participated in a refined QualCAPDT. In both countries, the child's wearable time-lapse camera achieved many of the target attributes. Participants in Nepal also highly ranked a home-based environmental sensor and a proximity beacon worn by the child. CONCLUSIONS The QualCAPDT procedure can be used to identify community norms and preferences to facilitate the selection of potential passive data collection strategies and devices. QualCAPDT is an important first step before selecting devices and piloting passive data collection in a community. It is especially important for work with caregivers and young children for whom cultural beliefs and shared family environments strongly determine behavior and potential uptake of new technology.
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Affiliation(s)
- Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States.,Department of Global Health, Milken School of Public Health, George Washington University, Washington, DC, United States.,Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Sauharda Rai
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.,Jackson School of International Studies, University of Washington, Seattle, WA, United States
| | - Khanya Vilakazi
- Research Department, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Kiran Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, United States
| | - Anvita Bhardwaj
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States.,Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Alastair van Heerden
- Human and Social Development, Human Sciences Research Council, Pietermaritzburg, South Africa.,Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
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Afrizal SH, Handayani PW, Hidayanto AN, Eryando T, Budiharsana M, Martha E. Barriers and challenges to Primary Health Care Information System (PHCIS) adoption from health management perspective: A qualitative study. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Enam A, Torres-Bonilla J, Eriksson H. Evidence-Based Evaluation of eHealth Interventions: Systematic Literature Review. J Med Internet Res 2018; 20:e10971. [PMID: 30470678 PMCID: PMC6286426 DOI: 10.2196/10971] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022] Open
Abstract
Background Until now, the use of technology in health care was driven mostly by the assumptions about the benefits of electronic health (eHealth) rather than its evidence. It is noticeable that the magnitude of evidence of effectiveness and efficiency of eHealth is not proportionate to the number of interventions that are regularly conducted. Reliable evidence generated through comprehensive evaluation of eHealth interventions may accelerate the growth of eHealth for long-term successful implementation and help to experience eHealth benefits in an enhanced way. Objective This study aimed to understand how the evidence of effectiveness and efficiency of eHealth can be generated through evaluation. Hence, we aim to discern (1) how evaluation is conducted in distinct eHealth intervention phases, (2) the aspects of effectiveness and efficiency that are typically evaluated during eHealth interventions, and (3) how eHealth interventions are evaluated in practice. Methods A systematic literature review was conducted to explore the evaluation methods for eHealth interventions. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. We searched Google Scholar and Scopus for the published papers that addressed the evaluation of eHealth or described an eHealth intervention study. A qualitative analysis of the selected papers was conducted in several steps. Results We intended to see how the process of evaluation unfolds in distinct phases of an eHealth intervention. We revealed that in practice and in several conceptual papers, evaluation is performed at the end of the intervention. There are some studies that discuss the importance of conducting evaluation throughout the intervention; however, in practice, we found no case study that followed this. For our second research question, we discovered aspects of efficiency and effectiveness that are proposed to be assessed during interventions. The aspects that were recurrent in the conceptual papers include clinical, human and social, organizational, technological, cost, ethical and legal, and transferability. However, the case studies reviewed only evaluate the clinical and human and social aspects. At the end of the paper, we discussed a novel approach to look into the evaluation. Our intention was to stir up a discussion around this approach with the hope that it might be able to gather evidence in a comprehensive and credible way. Conclusions The importance of evidence in eHealth has not been discussed as rigorously as have the diverse evaluation approaches and evaluation frameworks. Further research directed toward evidence-based evaluation can not only improve the quality of intervention studies but also facilitate successful long-term implementation of eHealth in general. We conclude that the development of more robust and comprehensive evaluation of eHealth studies or an improved validation of evaluation methods could ease the transferability of results among similar studies. Thus, the resources can be used for supplementary research in eHealth.
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Affiliation(s)
- Amia Enam
- Centre for Healthcare Improvement, Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Johanna Torres-Bonilla
- Centre for Healthcare Improvement, Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Henrik Eriksson
- Centre for Healthcare Improvement, Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
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Shiferaw S, Workneh A, Yirgu R, Dinant GJ, Spigt M. Designing mHealth for maternity services in primary health facilities in a low-income setting - lessons from a partially successful implementation. BMC Med Inform Decis Mak 2018; 18:96. [PMID: 30419891 PMCID: PMC6233283 DOI: 10.1186/s12911-018-0704-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing mobile phone ownership, functionality and access to mobile-broad band internet services has triggered growing interest to harness the potential of mobile phone technology to improve health services in low-income settings. The present project aimed at designing an mHealth system that assists midlevel health workers to provide better maternal health care services by automating the data collection and decision-making process. This paper describes the development process and technical aspects of the system considered critical for possible replication. It also highlights key lessons learned and challenges during implementation. METHODS The mHealth system had front-end and back-end components. The front-end component was implemented as a mobile based application while the back-end component was implemented as a web-based application that ran on a central server for data aggregation and report generation. The current mHealth system had four applications; namely, data collection/reporting, electronic health records, decision support, and provider education along the continuum of care including antenatal, delivery and postnatal care. The system was pilot-tested and deployed in selected health centers of North Shewa Zone, Amhara region, Ethiopia. RESULTS The system was used in 5 health centers since Jan 2014 and later expanded to additional 10 health centers in June 2016 with a total of 5927 electronic forms submitted to the back-end system. The submissions through the mHealth system were slightly lower compared to the actual number of clients who visited those facilities as verified by record reviews. Regarding timeliness, only 11% of the electronic forms were submitted on the day of the client visit, while an additional 17% of the forms were submitted within 10 days of clients' visit. On average forms were submitted 39 days after the day of clients visit with a range of 0 to 150 days. CONCLUSIONS In conclusion, the study illustrated that an effective mHealth intervention can be developed using an open source platform and local resources. The system impacted key health outcomes and contributed to timely and complete data submission. Lessons learned through the process including success factors and challenges are discussed.
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Affiliation(s)
- Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | | | - Robel Yirgu
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Geert-Jan Dinant
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Mark Spigt
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.,General Practice Research Unit, Department of Community Medicine, the Arctic University of Norway, Tromsø, Norway
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Wallis L, Blessing P, Dalwai M, Shin SD. Integrating mHealth at point of care in low- and middle-income settings: the system perspective. Glob Health Action 2018; 10:1327686. [PMID: 28838302 PMCID: PMC5645717 DOI: 10.1080/16549716.2017.1327686] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
While the field represents a wide spectrum of products and services, many aspects of mHealth have great promise within resource-poor settings: there is an extensive range of cheap, widely available tools which can be used at the point of care delivery. However, there are a number of conditions which need to be met if such solutions are to be adequately integrated into existing health systems; we consider these from regulatory, technological and user perspectives. We explore the need for an appropriate legislative and regulatory framework, to avoid ‘work around’ solutions, which threaten patient confidentiality (such as the extensive use of instant messaging services to deliver sensitive clinical information and seek diagnostic and management advice). In addition, we will look at other confidentiality issues such as the need for applications to remove identifiable information (such as photos) from users’ devices. Integration is dependent upon multiple technological factors, and we illustrate these using examples such as products made available specifically for adoption in low- and middle-income countries. Issues such as usability of the application, signal loss, data volume utilization, need to enter passwords, and the availability of automated or in-app context-relevant clinical advice will be discussed. From a user perspective, there are three groups to consider: experts, front-line clinicians, and patients. Each will accept, to different degrees, the use of technology in care – often with cultural or regional variation – and this is central to integration and uptake. For clinicians, ease of integration into daily work flow is critical, as are familiarity and acceptability of other technology in the workplace. Front-line staff tend to work in areas with more challenges around cell phone signal coverage and data availability than ‘back-end’ experts, and the effect of this is discussed.
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Affiliation(s)
- Lee Wallis
- a Division of Emergency Medicine, Faculty of Medicine and Health Sciences , Stellenbosch University , Bellville , South Africa.,b Division of Emergency Medicine, Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
| | - Paul Blessing
- c College of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - Mohammed Dalwai
- b Division of Emergency Medicine, Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
| | - Sang Do Shin
- d Laboratory of Emergency Medical Services , Seoul National University Hospital Biomedical Research Institute , Seoul , South Korea
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Higman S, Dwivedi V, Nsaghurwe A, Busiga M, Sotter Rulagirwa H, Smith D, Wright C, Nyinondi S, Nyella E. Designing interoperable health information systems using Enterprise Architecture approach in resource-limited countries: A literature review. Int J Health Plann Manage 2018; 34:e85-e99. [PMID: 30182517 DOI: 10.1002/hpm.2634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Enterprise Architecture (EA) integrates business and technical processes in health information systems (HIS). Low-income and middle-income countries (LMIC) use EA to combine management components with disease tracking and health care service monitoring. Using an EA approach differs by country, addressing specific needs. METHODS Articles in this review referenced EA, were peer-reviewed or gray literature reports published in 2010 to 2016 in English, and were identified using PubMed, Scopus, Web of Science, and Google Scholar. RESULTS Fourteen articles described EA use in LMICs. India, Sierra Leone, South Africa, Mozambique, and Rwanda reported building the system to meet country needs and implement a cohesive HIS framework. Jordan and Taiwan focused on specific HIS aspects, ie, disease surveillance and electronic medical records. Five studies informed the context. The Millennium Villages Project employed a "uniform but contextualized" approach to guide systems in 10 countries; Malaysia, Indonesia, and Tanzania used interviews and mapping of existing components to improve HIS, and Namibia used of Activity Theory to identify technology-associated activities to better understand EA frameworks. South Africa, Burundi, Kenya, and Democratic Republic of Congo used EA to move from paper-based to electronic systems. CONCLUSIONS Four themes emerged: the importance of multiple sectors and data sources, the need for interoperability, the ability to incorporate system flexibility, and the desirability of open group models, data standards, and software. Themes mapped to EA frameworks and operational components and to health system building blocks and goals. Most articles focused on processes rather than outcomes, as countries are engaged in implementation.
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Affiliation(s)
| | - Vikas Dwivedi
- John Snow Inc, Arlington, Virginia, USA.,Maternal and Child Survival Program, John Snow, Inc. Arlington, Virginia, USA
| | - Alpha Nsaghurwe
- John Snow Inc, Arlington, Virginia, USA.,Maternal and Child Survival Program, John Snow, Inc. Dar es Salaam, Tanzania
| | - Moses Busiga
- USAID, Health System Strengthening, Dar es Salaam, Tanzania
| | | | - Dasha Smith
- John Snow Inc, Arlington, Virginia, USA.,Maternal and Child Survival Program, John Snow, Inc. Arlington, Virginia, USA
| | - Chris Wright
- John Snow Inc, Arlington, Virginia, USA.,Maternal and Child Survival Program, John Snow, Inc. Arlington, Virginia, USA
| | - Ssanyu Nyinondi
- John Snow Inc, Arlington, Virginia, USA.,Maternal and Child Survival Program, John Snow, Inc. Dar es Salaam, Tanzania
| | - Edwin Nyella
- John Snow Inc, Arlington, Virginia, USA.,Maternal and Child Survival Program, John Snow, Inc. Dar es Salaam, Tanzania
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