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Oronti IB, Iadanza E, Pecchia L. Hypertension Diagnosis and Management in Africa Using Mobile Phones: A Scoping Review. IEEE Rev Biomed Eng 2024; 17:197-211. [PMID: 35763465 DOI: 10.1109/rbme.2022.3186828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Target 3.4 of the third Sustainable Development Goal (SDG) of the United Nations (UN) General Assembly proposes to reduce premature mortality from non-communicable diseases (NCDs) by one-third. Epidemiological data presented by the World Health Organization (WHO) in 2016 show that out of a total of 57 million deaths worldwide, approximately 41 million deaths occurred due to NCDs, with 78% of such deaths occurring in low-and-middle-income countries (LMICs). The majority of investigations on NCDs agree that the leading risk factor for mortality worldwide is hypertension. Over 75% of the world's mobile phone subscriptions reside in LMICs, hence making the mobile phone particularly relevant to mHealth deployment in Africa. This study is aimed at determining the scope of the literature available on hypertension diagnosis and management in Africa, with particular emphasis on determining the feasibility, acceptability and effectiveness of interventions based on the use of mobile phones. The bulk of the evidence considered overwhelmingly shows that SMS technology is yet the most used medium for executing interventions in Africa. Consequently, the need to define novel and superior ways of providing effective and low-cost monitoring, diagnosis, and management of hypertension-related NCDs delivered through artificial intelligence and machine learning techniques is clear.
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Oy S, Saing CH, Ung M, Zahari M, Nouhak I, Kim S, Nagashima-Hayashi M, Khuon D, Koy V, Mam S, Sayasone S, Saphonn V, Yi S. Developing an infection prevention and control intervention to reduce hospital-acquired infections in Cambodia and Lao People's Democratic Republic: the HAI-PC study protocol. Front Public Health 2023; 11:1239228. [PMID: 37799162 PMCID: PMC10548876 DOI: 10.3389/fpubh.2023.1239228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Background Hospital-acquired infections (HAIs) are significant public health issues, especially in low-and middle-income countries (LMICs). Hand hygiene and low-level disinfection of equipment practices among healthcare workers are some of the essential measures to reduce HAIs. Various infection prevention and control (IPC) interventions to reduce HAI incidence have been developed. However, effective interventions have not been well developed in the LMICs context. Therefore, this protocol aims to develop, pilot, and assess the feasibility and acceptability of an IPC intervention in Cambodia and the Lao People's Democratic Republic. Methods This study will consist of four phases guided by the Medical Research Council (MRC) Framework. Three hospitals will be purposely selected - each from the district, provincial, and national levels - in each country. The gap analysis will be conducted in Phase 1 to explore IPC practices among healthcare workers at each hospital through desk reviews, direct observation of hand hygiene and low-level disinfection of equipment practices, in-depth interviews with healthcare workers, and key informant interviews with stakeholders. In Phase 2, an IPC intervention will be developed based on the results of Phase 1 and interventions selected from a systematic literature review of IPC interventions in LMICs. In Phase 3, the developed intervention will be piloted in the hospitals chosen in Phase 1. In Phase 4, the feasibility and acceptability of the developed intervention will be assessed among healthcare workers and representatives at the selected hospitals. National consultative workshops in both countries will be conducted to validate the developed intervention with the national technical working groups. Discussion The MRC Framework will be employed to develop and evaluate an intervention to reduce HAIs in two LMICs. This theoretical framework will be used to explore the factors influencing hand hygiene compliance among healthcare workers. The gap analysis results will allow us to develop a comprehensive IPC intervention to reduce HAI incidence in Cambodia and Lao People's Democratic Republic. Findings from this protocol will feed into promising IPC interventions to reduce HAI incidence in other resource-limited settings. Clinical trial registration ClinicalTrial.Gov, identifier NCT05547373.
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Affiliation(s)
- Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Marina Zahari
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Inthavong Nouhak
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Sothea Kim
- University of Health Sciences, Phnom Penh, Cambodia
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Dyna Khuon
- University of Health Sciences, Phnom Penh, Cambodia
| | - Virya Koy
- Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia
| | - Sovatha Mam
- University of Health Sciences, Phnom Penh, Cambodia
| | - Somphou Sayasone
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | | | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, United States
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Kaur J, Kaur M, Chakrapani V, Kumar R. Theory-guided process evaluation of a multicomponent, technology-based 'SMART Eating' trial among Indian adults: an embedded mixed-methods study. HEALTH EDUCATION RESEARCH 2023; 38:469-489. [PMID: 37207678 DOI: 10.1093/her/cyad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/26/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023]
Abstract
We report process evaluation findings from the 'SMART Eating' intervention trial, which significantly improved fat, sugar and salt (FSS), and fruits and vegetables (FVs) intake among adults. Intervention used information technology [short message service (SMS), WhatsApp and website] and interpersonal communication (distribution of SMART Eating kit) and pamphlet for comparison group. Guided by UK Medical Research Council's framework, using embedded mixed-methods design, continuous process evaluation documented fidelity, dose, reach, acceptability and mechanisms. Intervention was implemented as intended, with high reach (91%) in both groups: 'comparison group' (n = 366): inadequate use of pamphlets (46%); 'intervention group' (n = 366): with timely remedial measures to remove implementation/usage barriers, dose of SMS (93%), WhatsApp (89%) and 'SMART Eating' kit (100%) was adequate, but website usage was low (50%); compliance was evident from participants' interactions with the implementor and observations on kit usage. All these might have improved attitude, social influence, self-efficacy and household behaviours, which, in turn, mediated intervention's effect on improving FSS and FV intake. Among poor performers, lack of effect on FV intake was perceived to be related to high cost/pesticides use and FSS intake was related to lack of family support. Low website usage, challenges with WhatsApp messaging and contextual factors (cost, pesticides abuse and family support) need to be considered while designing similar future interventions.
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Affiliation(s)
- Jasvir Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012 India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012 India
| | | | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012 India
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Isangula K, Pallangyo ES, Ndirangu-Mugo E. Interventions co-designed by healthcare providers and clients for improving therapeutic relationships in maternal and child healthcare: a pilot study using human centered design in rural Tanzania. BMC Nurs 2023; 22:314. [PMID: 37704982 PMCID: PMC10500767 DOI: 10.1186/s12912-023-01472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Research shows that poor provider-client interactions in maternity and child health (MCH) continue to affect health outcomes, service uptake, continuity of care, and trust in formal healthcare systems. OBJECTIVE The study's objective was to jointly create a prototype intervention package for enhancing nurse-client relationships using human centered design (HCD) approach. METHODS A five-step HCD methodology was used: (1) Community-driven discovery through qualitative descriptive research methods using 9 focus groups with nurses and clients and 12 key informant interviews with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough prototype model; (3) rough prototype validation through qualitative insight gathering using 6 FGDs with nurses and clients; (4) refinement and adaptation meetings with 14 nurses, 14 clients and 12 administrators; and (5) documentation and sharing of lessons learnt. RESULTS According to the community-driven research, poor service, a lack of concern, poor communication, a bad attitude, and unhappiness at work are the nurse factors that affect the relationships between nurses and their patients. Non-compliance with procedures, unfavorable attitudes, poor communication, low education, poverty, and faith in conventional healers were among the client-related factors. Inadequate funding, bad management techniques, improper policy execution, and a lack of an independent institution for handling complaints are the health system factors that affect nurse-client relationships. In response, three ideation and co-creating meetings resulted in 24 interventions. Seven (7) of these were rated as more acceptable and feasible in the local context and formed a rough prototype. During validation, there were some disagreements on the feasibility of curriculum and resource-related interventions. Refinement meetings resulted in a final prototype including four interventions: (i) promotion of patient-centred care; (ii) awards and recognition for nurses; (iii) strengthening complaints mechanisms and (iv) disciplinary measures for abusive nurses and clients. The lessons learnt have been shared through publications and institutional research meetings. CONCLUSIONS HCD approach provides a novel entry point for providers and clients to examine the problems and design interventions for strengthening their therapeutic relationships in MCH care. Researchers, practitioners, and policy developers are welcome to consider the emerging prototype as it was deemed acceptable and potentially feasible in rural African contexts.
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Affiliation(s)
- Kahabi Isangula
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania.
| | - Eunice S Pallangyo
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania
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Wang Z, Fan J, Chen L, Xie L, Huang L, Ruan Y, Xu X, Liang Z. Strategies to preventing pressure injuries among intensive care unit patients mechanically ventilated in prone position: a systematic review and a Delphi study. Front Med (Lausanne) 2023; 10:1131270. [PMID: 37644983 PMCID: PMC10461099 DOI: 10.3389/fmed.2023.1131270] [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: 12/24/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Background Although the incidence of pressure injury in the prone position is high for the mechanically ventilated patients in the intensive care unit, evidence-based strategies are still lacking. Propose To conduct a systematic review of current evidence, and to propose a series of strategies to prevent pressure injuries among mechanically ventilated patients with prone position in the intensive care unit. Methods The study was guided by the Medical Research Council framework. After a systematic review of current evidence of original articles, guidelines, expert consensus and theories, a strategy draft was developed. Then we invited 20 experts to modify and refine these strategies through two rounds of Delphi consensus method. Results After two rounds of Delphi process, the importance of coefficient of variation (Cv) and Kendall's coefficient of concordance in the strategies repository were 0.067 and 0.311, respectively. And the operability of Cv and Kendall's coefficient of concordance in the strategy draft was 0.055 and 0.294, respectively. Ultimately, we established 31 strategies for including 7 themes (assess risk factors, assess skin and tissue, body position management, skin care, nutrition, preventing medical device-related pressure injuries, education and supervision). In addition, we also developed a strategy framework to clarify our strategies. Conclusion According to the Medical Research Council framework, we developed 7 themes and 31 strategies to prevention prone-position pressure injuries among the intensive care unit mechanically ventilated patients. This study was considered to improve the clinical management of pressure injuries among prone position patients in the intensive care unit settings.
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Affiliation(s)
- Zonghua Wang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Jiangshan Fan
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Ling Chen
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Army Medical University, Chongqing, China
| | - Langlang Xie
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Lingfang Huang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Yang Ruan
- Department of Outpatient, The 79th Hospital of Group Army, Liaoning, China
| | - Xia Xu
- Department of Health Management and Geriatric Nursing, Daping Hospital, Chongqing, China
| | - Zeping Liang
- Department of Nursing, Daping Hospital, Chongqing, China
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Halvorsen U, Bjørnnes AK, Ljosaa TM. Nurse-Led Telephone Follow-Up Intervention for Titrating and Tapering Opioids in Chronic Pain Patients - A Feasibility Study. J Pain Res 2023; 16:1285-1300. [PMID: 37090765 PMCID: PMC10120593 DOI: 10.2147/jpr.s394878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/08/2023] [Indexed: 04/25/2023] Open
Abstract
Background and Purpose Opioids in chronic non-cancer pain are debated, but remain a part of the pain treatment for selected patients. Research is scarce on the relieving and adverse effects of opioids, and how to deliver opioid treatment in this patient group. This study's purpose was to assess the feasibility of a nurse-led telephone follow-up intervention for titrating or tapering opioids, including a pilot study of the intervention outcomes. Patients and Methods The feasibility assessment and process evaluation were performed according to the UK Medical Research Council (MRC) framework for evaluating complex interventions. A pilot study of the intervention outcomes was also performed. With a retrospective, descriptive, and longitudinal approach, we analyzed reports from 32 patients who titrated or tapered opioids. Information on demography, sleep satisfaction, health status, pain intensity/bothersomeness, opioid doses, and side effects was derived from the Oslo Pain Registry. Descriptive statistics, t-tests, and chi-square tests were used to analyze registry data. Results The study findings indicate that the intervention is feasible. Areas of impact were lack of a sound theory basis, unclear allocation criteria, and inconsistent and non-validated measurement tools. Mechanisms of change were interprofessional collaboration, nurses' knowledge and competencies, predictability, and availability. Statistical analyses showed no between-groups differences in demographical-, clinical-, and pain characteristics, except those who titrated opioids were significantly older than patients tapering opioids (P=0.010). All patients reported poor health and side effects at baseline. Those who tapered opioids had a significant reduction in opioid use (P=0.004). Titrating opioids was associated with a significant increase in side effects (P=0.038). Conclusion Considering the limitations and the strengths of the intervention, the present study indicates that the nurse-led telephone follow-up program is a feasible intervention. With the right adjustments and improvements, the intervention is eligible for a larger efficacy study.
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Affiliation(s)
- Unni Halvorsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Correspondence: Unni Halvorsen, Department of Pain Management and Research, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway, Tel + 47 23 02 61 61, Fax + 47 23 02 74 02, Email
| | - Ann Kristin Bjørnnes
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tone Marte Ljosaa
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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Dhinagaran DA, Martinengo L, Ho MHR, Joty S, Kowatsch T, Atun R, Tudor Car L. Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework. JMIR Mhealth Uhealth 2022; 10:e38740. [PMID: 36194462 PMCID: PMC9579935 DOI: 10.2196/38740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/02/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Conversational agents (CAs), also known as chatbots, are computer programs that simulate human conversations by using predetermined rule-based responses or artificial intelligence algorithms. They are increasingly used in health care, particularly via smartphones. There is, at present, no conceptual framework guiding the development of smartphone-based, rule-based CAs in health care. To fill this gap, we propose structured and tailored guidance for their design, development, evaluation, and implementation. OBJECTIVE The aim of this study was to develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for health care. METHODS We followed the approach by Jabareen, which was based on the grounded theory method, to develop this conceptual framework. We performed 2 literature reviews focusing on health care CAs and conceptual frameworks for the development of mobile health interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study. RESULTS The Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER) conceptual framework includes 8 iterative steps grouped into 3 stages, as follows: design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations-user-centered design and privacy and security-that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. CONCLUSIONS Drawing on published evidence, the DISCOVER conceptual framework provides a step-by-step guide for developing rule-based, smartphone-delivered CAs. Further evaluation of this framework in diverse health care areas and settings and for a variety of users is needed to demonstrate its validity. Future research should aim to explore the use of CAs to deliver health care interventions, including behavior change and potential privacy and safety concerns.
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Affiliation(s)
| | - Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Moon-Ho Ringo Ho
- School of Social Sciences, Nanyang Technological University Singapore, Singapore, Singapore
| | - Shafiq Joty
- School of Computer Sciences and Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St Gallen, St Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Rifat Atun
- Department of Global Health & Population, Department of Health Policy & Management, Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Cambridge, MA, United States
- Health Systems Innovation Lab, Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, United States
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Zang Y, Fu L, Zhang H, Hou R, Lu H. Practice Programme for Upright Positions in the Second Stage of Labour: the development of a complex intervention based on the Medical Research Council Framework. J Nurs Manag 2022; 30:3608-3617. [PMID: 36121431 DOI: 10.1111/jonm.13805] [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: 06/24/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to develop a Practice Programme for Upright Positions in the Second Stage of Labour to provide a reference for midwifery professionals in the standardized implementation of upright positions in clinical practice. BACKGROUND The adoption of upright positions in the second stage of labour is recommended by many international organizations, but upright positions have not been widely used and their implementation varies greatly across studies. METHODS The Practice Programme for Upright Positions in the Second Stage of Labour was developed under the guidance of the Medical Research Council framework for developing and evaluating complex interventions and the World Health Organization handbook for guideline development. Four stages were conducted: (1) establishing the intervention development group; (2) identifying a theoretical basis and forming a content framework; (3) evidence retrieval and synthesis; (4) refining and modelling the practice programme. RESULTS The content framework of the Practice Programme for Upright Positions in the Second Stage of Labour was formed based on the literature review, semi- structured interviews and expert consultation, including indications and contraindications, implementation methods, observations, potential risks and precautions. According to each item, we conducted a series of systematic reviews, and summarized the available best evidence from clinical guidelines, systematic reviews and original studies. Eventually, the Practice Programme for Upright Positions in the Second Stage of Labour was developed, integrating the findings of the iterative evidence reviews and revised by stakeholders. CONCLUSIONS This study firstly reported the development process of the Practice Programme for Upright Positions in the Second Stage of Labour, characterized by evidence-based, iteratively-processed, and highly-rigorous. The implications may guide researchers to embed the intervention normatively into clinical practice for improving maternal and infant outcomes. IMPLICATIONS FOR NURSING MANAGEMENT Facilitate systematic labour position management, and guide midwives in the successful implementation of upright positions.
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Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Li Fu
- School of Nursing, Peking University, Beijing, China
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology, the Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Hou
- School of Nursing, Peking University, Beijing, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
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Gabriel I, Creedy D, McGuire A, Coyne E. Improving the health-related quality of life of adult Nigerians living with cancer and their family caregivers: intervention development. Pilot Feasibility Stud 2022; 8:151. [PMID: 35859142 PMCID: PMC9297656 DOI: 10.1186/s40814-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Evidence for the effectiveness of interventions aimed at improving the health-related quality of life of people living with cancer and/or family members is compelling. However, most interventional research has been conducted in high-income countries, and no intervention had been tested in low-income countries such as Nigeria. It is critical to design a culturally theory-based intervention in a resource-poor setting to address the needs and support coping strategies of cancer patients and their family caregivers. Methods Theory, evidence, and practical issues were considered. The Medical Research Council framework for developing and evaluating complex interventions and Behaviour Change Wheel provided the framework for intervention design. Findings generated by a needs assessment of adult Nigerians with cancer and their family caregivers and relevant theories (the Spirituality and the Supportive Care Framework for Cancer) informed content development. Results A theory-based, culturally tailored socio-spiritual intervention was developed to address the specific needs of adult Nigerians with cancer and their family caregivers. A 4-week intervention included strategies designed to improve social and spiritual support, information and health literacy, and health-related quality of life. Conclusions A systemic approach was used to conceptualise an evidence-based and theory-informed intervention tailored to address previously identified shortfalls in support available to adults living with cancer and their family caregivers, in Nigeria. If implemented and effective, such an intervention has the potential to improve the health-related quality of life of people living with cancer and their families in Nigeria.
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Affiliation(s)
- Israel Gabriel
- School of Nursing and Midwifery, Griffith University, Logan Campus, Meadowbrook, Queensland, 4131, Australia.
| | - Debra Creedy
- Transforming Maternity Care Collaborative, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Amanda McGuire
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Elisabeth Coyne
- School of Nursing and Midwifery, Griffith University, Logan Campus, Meadowbrook, Queensland, 4131, Australia
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Isangula K, Shumba C, Pallangyo ES, Mbekenga C, Ndirangu-Mugo E. Using a human centered design (HCD) approach to strengthen interpersonal relationships in maternal and child health care in rural Tanzania: Study Design (Preprint). JMIR Res Protoc 2022; 11:e37947. [PMID: 35797107 PMCID: PMC9305451 DOI: 10.2196/37947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kahabi Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, United Republic of Tanzania
| | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | - Eunice S Pallangyo
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, United Republic of Tanzania
| | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, United Republic of Tanzania
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Appiah R, Wilson Fadiji A, Wissing MP, Schutte L. The Inspired Life Program: Development of a multicomponent positive psychology intervention for rural adults in Ghana. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:302-328. [PMID: 33821476 DOI: 10.1002/jcop.22566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Although several theories and studies have explored human strengths and mental well-being at the global level, these insights are rarely tested and translated into practice in sub-Saharan Africa. This study aims to describe the development of a 10-session multicomponent positive psychology intervention, the Inspired Life Program (ILP), designed to promote mental health and reduce symptoms of depression and negative affect in rural adults in Ghana. Guided by the Medical Research Council's framework for developing complex interventions, a seven-step iterative community-based participatory research approach was adopted to develop the ILP, based on constructs and principles of positive psychology and cognitive-behavioral model. The final intervention components included a 10-session, two-hourly, once-weekly manualized program designed to promote meaningful and purposeful living, self-acceptance, personal growth, goal-setting and problem-solving skills, and positive thinking through group discussion and activity sessions. We describe the program theory and implementation strategy of the final intervention, and reflect on the challenges and lessons learned from applying this framework in the study context. The development of strengths-based interventions and practicality of methods to promote positive mental health in rural adults are feasible, and have important policy implications for mental health and social care in sub-Saharan Africa.
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Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - Angelina Wilson Fadiji
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
- Department of Educational Psychology, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Marié P Wissing
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Lusilda Schutte
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
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O'Neill L, Guinan E, Brennan L, Doyle SL, O'Connor L, Sheill G, Smyth E, Fairman CM, Segurado R, Connolly D, O'Sullivan J, Reynolds JV, Hussey J. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol. HRB Open Res 2021; 3:86. [PMID: 34046552 PMCID: PMC8127012 DOI: 10.12688/hrbopenres.13185.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Louise Brennan
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Suzanne L. Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Ciaran M. Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Sciences,, University College Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Occupational Therapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - John V. Reynolds
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
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Dreischor F, Laan ETM, Apers S, Repping S, van Lunsen RHW, Lambalk CB, D' Hooghe TM, Goddijn M, Custers IM, Dancet EAF. The stepwise development of an interactive web-based sex education programme for subfertile couples: the Pleasure & Pregnancy programme. Hum Reprod 2021; 35:1839-1854. [PMID: 32649754 DOI: 10.1093/humrep/deaa106] [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: 07/15/2019] [Revised: 02/27/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Can we develop a web-based sex education programme (programme running in a web browser) that addresses the needs of subfertile couples who are advised expectant management for at least 6 months? SUMMARY ANSWER The 'Pleasure & Pregnancy' programme addresses couples' needs, is likely to improve couples' sexual functioning, and is subsequently hypothesised to improve the chance of natural pregnancy. WHAT IS KNOWN ALREADY According to professional guidelines (e.g. the Netherlands and UK) couples with unexplained subfertility and a good chance of natural pregnancy, should be advised at least 6 months of expectant management. Adherence to expectant management is challenging as couples and gynaecologist prefer a more active approach. Targeting sexuality may be useful as subfertility is a risk factor for decreased sexual functioning. STUDY DESIGN, SIZE, DURATION A novel programme was developed according to the three steps of the Medical Research Councils' (MRC) framework. First, relevant literature was explored. Second, an interdisciplinary expert panel developed a theory (based on a systematic literature review and patient interviews) on how the chance of natural conception can be improved. Third, the expected process and outcomes were modelled. PARTICIPANTS/MATERIALS, SETTING, METHODS Two licenced clinical sexologists, two gynaecologists, a clinical embryologist and two midwife-researchers, all from Belgium and the Netherlands, proposed components for the sex education programme. PubMed was searched systematically for randomised controlled trials (RCTs) evaluating the proposed components in different patient populations. The needs of 12 heterosexual Dutch or Belgian couples who were advised expectant management were explored with in-depth interviews. The content and delivery characteristics of the novel programme were described in detail with the aid of 'Intervention Taxonomy'. To model the outcomes, a protocol for an RCT was designed, registered and submitted for publication. MAIN RESULTS AND THE ROLE OF CHANCE To help maintain or improve sexual functioning, mainly pleasure, and hence increase pregnancy rates, the web-based Pleasure & Pregnancy programme contains a combination of psychosexual education and couple communication, mindfulness and sensate focus exercises. Information on the biology of conception and interaction with fertility clinic staff and peers were added based on couples' needs to increase potential acceptability. LIMITATIONS AND REASON FOR CAUTION This paper outlines the development phase of a sex education programme according to the MRC-framework. Whether the Pleasure & Pregnancy programme actually is acceptable, improves sexual functioning, increases pregnancy rates and is cost-effective remains to be determined. WIDER IMPLICATIONS OF THE FINDINGS No previous interactive web-based sex education programme has aimed to increase the natural pregnancy rate of subfertile couples by targeting their sexual pleasure. The Pleasure & Pregnancy programme addresses couples' needs and its effect on sexual functioning and pregnancy rate is plausible but remains to be demonstrated by an RCT which is currently ongoing. STUDY FUNDING/COMPETING INTEREST(S) Funding was provided by The Netherlands Organisation for Health Research and Development (ZonMw), Flanders Research Foundation and the University of Amsterdam. C.B.L. is editor-in-chief of Human Reproductionbut was blinded to all parts of the peer review process. The remaining authors have no conflict of interest to report. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- F Dreischor
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - E T M Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), 1105 AZ Amsterdam, The Netherlands
| | - S Apers
- Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium
| | - S Repping
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - R H W van Lunsen
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), 1105 AZ Amsterdam, The Netherlands
| | - C B Lambalk
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - T M D' Hooghe
- Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium
| | - M Goddijn
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - I M Custers
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - E A F Dancet
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium.,Research Foundation of Flanders, Belgium
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Austin EJ, Neukirch J, Ong TD, Simpson L, Berger GN, Keller CS, Flum DR, Giusti E, Azen J, Davidson GH. Development and Implementation of a Complex Health System Intervention Targeting Transitions of Care from Hospital to Post-acute Care. J Gen Intern Med 2021; 36:358-365. [PMID: 32869191 PMCID: PMC7878619 DOI: 10.1007/s11606-020-06140-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 08/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Failure of effective transitions of care following hospitalization can lead to excess days in the hospital, readmissions, and adverse events. Evidence identifies both patient and system factors that influence poor care transitions, yet health systems struggle to translate evidence into complex interventions that have a meaningful impact on care transitions. OBJECTIVE We report on our experience developing, pilot testing, and evaluating a complex intervention (Addressing Complex Transitions program, or ACT program) that aims to improve care transitions for complex patients. DESIGN Following the Medical Research Council (MRC) framework, we engaged in iterative, stakeholder-driven work to develop a complex care intervention, assess feasibility and pilot methods, evaluate the intervention in practice, and facilitate ongoing implementation monitoring and dissemination. PARTICIPANTS Patients receiving care from UW Medicine's health system including 4 hospitals and 20-site Post-Acute Care network. INTERVENTION Literature review and prospective data collection activities informed ACT program design. ACT program components include a tailored risk calculator that provides real-time scoring of transitions of care risk factors, a multidisciplinary team with the capacity to address complex barriers to safe transitions, and enhanced discharge workflows to improve care transitions for complex patients. KEY MEASURES Program evaluation metrics included estimated hospital days saved and program acceptance by care team members. KEY RESULTS During the 6-month pilot, 565 patients were screened and 97 enrolled in the ACT program. An estimated 664 hospital days were saved for the index admission of ACT program participants. Analysis of pre/post-hospital utilization for ACT program participants showed an estimated 3227 fewer hospital days after ACT program enrollment. CONCLUSIONS Health systems need to address increasingly difficult challenges in care delivery. The use of evidence-based frameworks, such as the MRC framework, can guide systems to design complex interventions that respond to their local context and stakeholder needs.
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Affiliation(s)
- Elizabeth J. Austin
- Surgical Outcomes Research Center, University of Washington , Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Jen Neukirch
- UW Medicine Post-Acute Care, University of Washington, Seattle, WA USA
| | - Thuan D. Ong
- UW Medicine Post-Acute Care, University of Washington, Seattle, WA USA
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA USA
| | - Louise Simpson
- UW Medicine Post-Acute Care, University of Washington, Seattle, WA USA
| | - Gabrielle N. Berger
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Carolyn Sy Keller
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - David R Flum
- Surgical Outcomes Research Center, University of Washington , Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Elaine Giusti
- Center for Clinical Excellence, University of Washington, Seattle, WA USA
| | - Jennifer Azen
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Giana H. Davidson
- Surgical Outcomes Research Center, University of Washington , Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
- UW Medicine Post-Acute Care, University of Washington, Seattle, WA USA
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15
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Leon N, Namadingo H, Bobrow K, Cooper S, Crampin A, Pauly B, Levitt N, Farmer A. Intervention development of a brief messaging intervention for a randomised controlled trial to improve diabetes treatment adherence in sub-Saharan Africa. BMC Public Health 2021; 21:147. [PMID: 33451308 PMCID: PMC7811237 DOI: 10.1186/s12889-020-10089-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/17/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brief messaging interventions, including Short Message Service (SMS) text-messages, delivered via mobile device platforms, show promise to support and improve treatment adherence. To understand how these interventions work, and to facilitate transparency, we need clear descriptions of the intervention development process. METHOD We describe and reflect on the process of designing and pretesting an evidence- and theory-informed brief messaging intervention, to improve diabetes treatment adherence in sub-Saharan Africa. We followed the stepwise approach recommended by the Medical Research Council, United Kingdom (MRC UK) Framework for Development and Evaluation of Complex Health Interventions and guidance for mobile health intervention development. RESULTS We used a four-phase, iterative approach that first generated primary and secondary evidence on the lived experience of diabetes, diabetes treatment services and mobile-phone use. Second, we designed a type 2 diabetes-specific, brief text-message library, building on our previous hypertension text-message library, as well as drawing on the primary and secondary data from phase one, and on expert opinion. We then mapped the brief text-messages onto behaviour change (COM-B) theoretical constructs. Third, we refined and finalised the newly developed brief text-message library through stakeholder consultation and translated it into three local languages. Finally, we piloted the intervention by pre-testing the automated delivery of the brief text-messages in the trial sites in Malawi and South Africa. The final SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention was tested in a randomised controlled trial in Malawi and South Africa (trial registration: ISRCTN70768808 ). CONCLUSION The complexity of public health interventions requires that we give more attention to intervention development work. Our documentation and reflection on the StAR2D intervention development process promotes transparency, replicability, assessment of intervention quality, and comparison with other studies.
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Affiliation(s)
- Natalie Leon
- South African Medical Research Council, Cape Town, South Africa.
| | - Hazel Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Kirsty Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Sara Cooper
- South African Medical Research Council, Cape Town, South Africa
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bruno Pauly
- Department of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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O'Neill L, Guinan E, Doyle SL, O'Connor L, Sheill G, Smyth E, Fairman CM, Segurado R, Connolly D, O'Sullivan J, Reynolds JV, Hussey J. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol. HRB Open Res 2020; 3:86. [PMID: 34046552 PMCID: PMC8127012 DOI: 10.12688/hrbopenres.13185.1] [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] [Accepted: 11/20/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Suzanne L Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Ciaran M Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Sciences,, University College Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Occupational Therapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - John V Reynolds
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
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Alamer A, Palm C, Almulhim AS, Te C, Pendergrass ML, Fazel MT. Impact of Non-Tailored One-Way Automated Short Messaging Service (OASMS) on Glycemic Control in Type 2 Diabetes: A Retrospective Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207590. [PMID: 33086524 PMCID: PMC7593936 DOI: 10.3390/ijerph17207590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/03/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022]
Abstract
Short message service (SMS) is easily accessible and potentially an ideal platform for delivering patient-targeted messages. However, an effective SMS dosing strategy is not well established. Our purpose was to evaluate the impact of diabetes self-care promoting messages via non-tailored one-way automated SMS (OASMS) on glycemic control in type 2 diabetes (T2DM). The change in hemoglobin A1c (HbA1c) was compared between patients who received the service and those who did not. This retrospective quasi-experimental pre-post feasibility study was conducted at an academic medical center endocrinology clinic. English-speaking adults (≥18 years) with uncontrolled T2DM (HbA1c ≥ 8%) were included. A total of 69 patients (intervention n = 34; control n = 35) met the inclusion criteria. The mean (±SD) baseline HbA1c values were 10.2% (±1.9%) and 9.9% (±1.7%) in the intervention and control arms, respectively. Median follow-up was 3.3 months (IQR = 3-4.2). An ANCOVA model adjusted for baseline HbA1c and age showed an estimated HbA1c reduction difference of -0.97% (95% CI, -1.73 to -0.20%, p = 0.014), favoring the intervention arm. Inverse propensity score weighting confirmed the ANCOVA results. Our study suggests that adding diabetes self-care promoting messages via non-tailored OASMS to usual care improves glycemic control in poorly controlled T2DM. Larger and longer studies are needed to evaluate different features of the non-tailored OASMS strategy.
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Affiliation(s)
- Ahmad Alamer
- Center for Health Outcomes and Pharmaco-Economic Research, University of Arizona College of Pharmacy, Tucson, AZ 85721, USA
- Department of Pharmacy Practice, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 16278, Saudi Arabia
- Correspondence:
| | - Charles Palm
- Banner—University Medicine Endocrinology and Diabetes Clinic, Tucson, AZ 85714, USA; (C.P.); (C.T.); (M.L.P.); (M.T.F.)
| | - Abdulaziz S. Almulhim
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
| | - Charisse Te
- Banner—University Medicine Endocrinology and Diabetes Clinic, Tucson, AZ 85714, USA; (C.P.); (C.T.); (M.L.P.); (M.T.F.)
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, College of Medicine, Tucson, AZ 85724, USA
| | - Merri L. Pendergrass
- Banner—University Medicine Endocrinology and Diabetes Clinic, Tucson, AZ 85714, USA; (C.P.); (C.T.); (M.L.P.); (M.T.F.)
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, College of Medicine, Tucson, AZ 85724, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, AZ 85721, USA
| | - Maryam T. Fazel
- Banner—University Medicine Endocrinology and Diabetes Clinic, Tucson, AZ 85714, USA; (C.P.); (C.T.); (M.L.P.); (M.T.F.)
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, College of Medicine, Tucson, AZ 85724, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, AZ 85721, USA
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Ferrua M, Minvielle E, Fourcade A, Lalloué B, Sicotte C, Di Palma M, Mir O. How to Design a Remote Patient Monitoring System? A French Case Study. BMC Health Serv Res 2020; 20:434. [PMID: 32429987 PMCID: PMC7236289 DOI: 10.1186/s12913-020-05293-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Remote Patient Monitoring Systems (RPMS) based on e-health, Nurse Navigators (NNs) and patient engagement can improve patient follow-up and have a positive impact on quality of care (by limiting adverse events) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted. This is partly due to the lack of attention paid to the RPMS design phase prior to implementation. The content of the RPMS can be carefully designed at this stage and various obstacles anticipated. Our aim was to report on an RPMS design case to provide insights into the methodology required in order to manage this phase. METHODS This study was carried out at Gustave Roussy, a comprehensive cancer centre, in France. A multidisciplinary team coordinated the CAPRI RPMS design process (2013-2015) that later produced positive outcomes. Data were collected during eight studies conducted according to the Medical Research Council (MRC) framework. This project was approved by the French National Data Protection Authorities. RESULTS Based on the study results, the multidisciplinary team defined strategies for resolving obstacles prior to the implementation of CAPRI. Consequently, the final CAPRI design includes a web app with two interfaces (patient and health care professionals) and two NNs. The NNs provide regular follow-up via telephone or email to manage patients' symptoms and toxicity, treatment compliance and care packages. Patients contact the NNs via a secure messaging system. Eighty clinical decision support tools enable NNs to prioritise and decide on the course of action to be taken. CONCLUSION In our experience, the RPMS design process and, more generally, that of any complex intervention programme, is an important phase that requires a sound methodological basis. This study is also consistent with the notion that an RPMS is more than a technological innovation. This is indeed an organizational innovation, and principles identified during the design phase can help in the effective use of a RPMS (e.g. locating NNs if possible within the care organization; recruiting NNs with clinical and managerial skills; defining algorithms for clinical decision support tools for assessment, but also for patient decision and orientation).
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Affiliation(s)
- Marie Ferrua
- Capri program, Research Division, Gustave Roussy, Villejuif, France.
| | - Etienne Minvielle
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- I3, CRG, Ecole Polytechnique, CNRS, Palaiseau, France
| | - Aude Fourcade
- Capri program, Research Division, Gustave Roussy, Villejuif, France
| | | | - Claude Sicotte
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- EHESP, Department of Health Care Management, Rennes, France
| | - Mario Di Palma
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- American Hospital, Neuilly-sur-Seine, France
| | - Olivier Mir
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- Outpatient Department, Gustave Roussy, Villejuif, France
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Shahsavari H, Matourypour P, Ghiyasvandian S, Nejad MRG. Medical Research Council framework for development and evaluation of complex interventions: A comprehensive guidance. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:88. [PMID: 32509896 PMCID: PMC7271909 DOI: 10.4103/jehp.jehp_649_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/13/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Hooman Shahsavari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Matourypour
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ghiyasvandian
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Kowatsch T, Otto L, Harperink S, Cotti A, Schlieter H. A design and evaluation framework for digital health interventions. IT - INFORMATION TECHNOLOGY 2019. [DOI: 10.1515/itit-2019-0019] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Digital health interventions (DHIs) have the potential to help the growing number of chronic disease patients better manage their everyday lives. However, guidelines for the systematic development of DHIs are still scarce. The current work has, therefore, the objective to propose a framework for the design and evaluation of DHIs (DEDHI). The DEDHI framework is meant to support both researchers and practitioners alike from early conceptual DHI models to large-scale implementations of DHIs in the healthcare market.
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Affiliation(s)
- Tobias Kowatsch
- Center for Digital Health Interventions, Institute of Technology Management , 27215 University of St. Gallen , Dufourstrasse 40a , St. Gallen , Switzerland
- Department of Management, Technology, and Economics , ETH Zurich , Weinbergstrasse 56/58 , Zurich , Switzerland
| | - Lena Otto
- Chair of Wirtschaftsinformatik, esp. Systems Development , Technische Universität Dresden , Dresden , Germany
| | - Samira Harperink
- Center for Digital Health Interventions, Institute of Technology Management , 27215 University of Saint Gallen (ITEM-HSG) , Dufourstrasse 40a , St. Gallen , Switzerland
| | - Amanda Cotti
- Center for Digital Health Interventions, Institute of Technology Management , 27215 University of Saint Gallen (ITEM-HSG) , Dufourstrasse 40a , St. Gallen , Switzerland
| | - Hannes Schlieter
- Chair of Wirtschaftsinformatik, esp. Systems Development , Technische Universität Dresden , Dresden , Germany
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Farmer A, Bobrow K, Leon N, Williams N, Phiri E, Namadingo H, Cooper S, Prince J, Crampin A, Besada D, Daviaud E, Yu LM, Ngoma J, Springer D, Pauly B, Norris S, Tarassenko L, Nyirenda M, Levitt N. Mobile Messaging Support Versus Usual Care for People With Type 2 Diabetes on Glycemic Control: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12377. [PMID: 31199346 PMCID: PMC6592392 DOI: 10.2196/12377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/09/2019] [Accepted: 03/25/2019] [Indexed: 01/29/2023] Open
Abstract
Background Health outcomes for people treated for type 2 diabetes could be substantially improved in sub-Saharan Africa. Failure to take medicine regularly to treat diabetes has been identified as a major problem. Resources to identify and support patients who are not making the best use of medicine in low- and middle-income settings are scarce. Mobile phones are widely available in these settings, including among people with diabetes; linked technologies, such as short message service (SMS) text messaging, have shown promise in delivering low-cost interventions efficiently. However, evidence showing that these interventions will work when carried out at a larger scale and measuring the extent to which they will improve health outcomes when added to usual care is limited. Objective The objective of this trial is to test the effectiveness of sending brief, automated SMS text messages for improving health outcomes and medication adherence in patients with type 2 diabetes compared to an active control. Methods We will carry out a randomized trial recruiting from clinics in two contrasting settings in sub-Saharan Africa: Cape Town, South Africa, and Lilongwe, Malawi. Intervention messages will advise people about the benefits of their diabetes treatment and offer motivation and encouragement around lifestyle and use of medication. We allocated patients, using randomization with a minimization algorithm, to receive either three to four intervention messages per week or non-health-related messages every 6 weeks. We will follow up with participants for 12 months, measuring important risk factors for poor health outcomes and complications in diabetes. This will enable us to estimate potential health benefits, including the primary outcome of hemoglobin A1c (HbA1c) levels as a marker for long-term blood glucose control and a secondary outcome of blood pressure control. We will record the costs of performing these activities and estimate cost-effectiveness. We will also use process evaluation to capture the collection of medication and assess the reception of the intervention by participants and health care workers. Results Recruitment to the trial began in September 2016 and follow-up of participants was completed in October 2018. Data collection from electronic health records and other routinely collected sources is continuing. The database lock is anticipated in June 2019, followed by analysis and disclosing of group allocation. Conclusions The knowledge gained from this study will have wide applications and advance the evidence base for effectiveness of mobile phone-based, brief text messaging on clinical outcomes and in large-scale, operational settings. It will provide evidence for cost-effectiveness and acceptability that will further inform policy development and decision making. We will work with a wide network that includes patients, clinicians, academics, industry, and policy makers to help us identify opportunities for informing people about the work and raise awareness of what is being developed and studied. Trial Registration ISRCTN Registry ISRCTN70768808; http://www.isrctn.com/ISRCTN70768808 (Archived by WebCite at http://www.webcitation.org/786316Zqk) International Registered Report Identifier (IRRID) DERR1-10.2196/12377
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Affiliation(s)
- Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Kirsty Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Natalie Leon
- South African Medical Research Council, Cape Town, South Africa
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Enita Phiri
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Hazel Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Sara Cooper
- South African Medical Research Council, Cape Town, South Africa
| | - John Prince
- Institute of Biomedical Engineering, Oxford, United Kingdom
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Donela Besada
- South African Medical Research Council, Cape Town, South Africa
| | | | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | | | - Bruno Pauly
- Department of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johanesburg, South Africa
| | - Shane Norris
- South African Medical Research Council, Developmental Pathways for Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | | | - Moffat Nyirenda
- Malawi Epidemiology and Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
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KIM M. Effects of Customized Long-Message Service and Phone-Based Health-Coaching on Elderly People with Hypertension. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:655-663. [PMID: 31110975 PMCID: PMC6500537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to develop long-message services (LMS) and phone-based health-coaching for community-dwelling seniors diagnosed with hypertension and assess the effects of the programs implemented both separately and together. These programs are easily applicable to seniors diagnosed with hypertension and will help control their blood pressure (BP) in a practical manner. METHODS We conducted a single-blinded, randomized, controlled pragmatic trial. Individuals aged 65 years or older with hypertension at two senior welfare centers in Seoul, South Korea, who were able to take phone calls and check text messages were enrolled. The study included 124 participants: 31 in the control group, 30 in the health-coaching group, 32 in the LMS group, and 31 in the health-coaching-with-LMS group. RESULTS Phone-based health-coaching with LMS was effective in improving medication adherence, hypertension self-efficacy, and self-management behavior and decreasing systolic BP as compared to LMS only. There were also improvements in medication adherence, hypertension-related knowledge, hypertension self-efficacy, self-management behavior, and systolic BP in the LMS group as compared to the control group. CONCLUSION Using phone-based health-coaching with LMS was effective for managing hypertension in community-dwelling seniors diagnosed with hypertension and could become a useful intervention method.
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Ben Charif A, Hassani K, Wong ST, Zomahoun HTV, Fortin M, Freitas A, Katz A, Kendall CE, Liddy C, Nicholson K, Petrovic B, Ploeg J, Légaré F. Assessment of scalability of evidence-based innovations in community-based primary health care: a cross-sectional study. CMAJ Open 2018; 6:E520-E527. [PMID: 30389751 PMCID: PMC6221806 DOI: 10.9778/cmajo.20180143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2013, the Canadian Institutes of Health Research funded 12 community-based primary health care research teams to develop evidence-based innovations. We aimed to explore the scalability of these innovations. METHODS In this cross-sectional study, we invited the 12 teams to rate their evidence-based innovations for scalability. Based on a systematic review, we developed a self-administered questionnaire with 16 scalability assessment criteria grouped into 5 dimensions (theory, impact, coverage, setting and cost). Teams completed a questionnaire for each of their innovations. We analyzed the data using simple frequency counts and hierarchical cluster analysis. We calculated the mean number and standard deviation (SD) of innovations that met criteria within each dimension that included more than 1 criterion. The analysis unit was the innovation. RESULTS The 11 responding teams evaluated 33 evidence-based innovations (median 3, range 1-8 per team). The innovations focused on access to care and chronic disease prevention and management, and varied from health interventions to methodological innovations. Most of the innovations were health interventions (n = 21), followed by analytical methods (n = 4), conceptual frameworks (n = 4), measures (n = 3) and strategies to build research capacity (n = 1). Most (29) met criteria in the theory dimension, followed by impact (mean 22.3 [SD 5.6] innovations per dimension), setting (mean 21.7 [SD 8.5]), cost (mean 17.5 [SD 2.1]) and coverage (mean 14.0 [SD 4.1]). On average, the innovations met 10 of the 16 criteria. Adoption was the least assessed criterion (n = 9). Most (20) of the innovations were highly ranked for scalability. INTERPRETATION Scalability varied among innovations, which suggests that readiness for scale up was suboptimal for some innovations. Coverage remained largely unaddressed; further investigation of this critical dimension is necessary.
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Affiliation(s)
- Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Kasra Hassani
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Sabrina T Wong
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Martin Fortin
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Alan Katz
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Claire E Kendall
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Clare Liddy
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Kathryn Nicholson
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Bojana Petrovic
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - Jenny Ploeg
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont.
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Anstey Watkins J, Goudge J, Gómez-Olivé FX, Huxley C, Dodd K, Griffiths F. mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review. BMJ Glob Health 2018. [PMID: 29527356 PMCID: PMC5841508 DOI: 10.1136/bmjgh-2017-000543] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Routine monitoring by patients and healthcare providers to manage chronic disease is vital, though this can be challenging in low-resourced health systems. Mobile health (mHealth) has been proposed as one way to improve management of chronic diseases. Past mHealth reviews have proposed the need for a greater understanding around how the theoretical constructs in mHealth interventions actually work. In response, we synthesised evidence from primary studies on monitoring of chronic diseases using two-way digital text or voice communication between a patient and health worker. We did this in order to understand the important considerations for the design of mHealth interventions. Method Articles retrieved were systematically screened and analysed to elicit explanations of mHealth monitoring interventions. These explanations were consolidated into programme theory and compared with existing theory and frameworks. We identified variation in outcomes to understand how context moderates the outcome. Results Four articles were identified—monitoring of hypertension and HIV/AIDS from: Kenya, Pakistan, Honduras and Mexico and South Africa. Six components were found in all four interventions: reminders, patient observation of health state, motivational education/advice, provision of support communication, targeted actions and praise and encouragement. Intervention components were mapped to existing frameworks and theory. Variation in outcome identified in subgroup analysis suggests greater impact is achieved with certain patient groups, such as those with low literacy, those with stressful life events or those early in the disease trajectory. There was no other evidence in the included studies of the effect of context on the intervention and outcome. Conclusion mHealth interventions for monitoring chronic disease in low-resource settings, based on existing frameworks and theory, can be effective. A match between what the intervention provides and the needs or social factors relevant to specific patient group increases the effect. It was not possible to understand the impact of context on intervention and outcome beyond these patient-level measures as no evidence was provided in the study reports.
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Affiliation(s)
- Jocelyn Anstey Watkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Huxley
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katherine Dodd
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.,Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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