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Zhang P, Tao X, Ma Y, Zhang Y, Ma X, Song H, Liu Y, Patel A, Jan S, Peiris D. Improving the management of type 2 diabetes in China using a multifaceted digital health intervention in primary health care: the SMARTDiabetes cluster randomised controlled trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 49:101130. [PMID: 39056088 PMCID: PMC11269311 DOI: 10.1016/j.lanwpc.2024.101130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/23/2024] [Accepted: 06/16/2024] [Indexed: 07/28/2024]
Abstract
Background There is limited evidence, mainly from high-income countries, that digital health interventions improve type 2 diabetes (T2DM) care. Large-scale implementation studies are lacking. Methods A multifaceted digital health intervention comprising: (1) a self-management application ('app') for patients and lay 'family health promotors' (FHPs); and (2) clinical decision support for primary care doctors was evaluated in an open-label, parallel, cluster randomized controlled trial in 80 communities (serviced by a primary care facility for >1000 residents) in Hebei Province, China. People >40 years with T2DM and a glycated haemoglobin (HbA1c) ≥7% were recruited (∼25/community). After baseline assessment, community clusters were randomly assigned to intervention or control groups (1:1) via a web-based system, stratified by locality (rural/urban). Control arm clusters received usual care without access to the digital health application or family health promoters. The primary outcome was at the participant level defined as the proportion with ≥2 "ABC" risk factor targets achieved (HbA1c < 7.0%, blood pressure < 140/80 mmHg and LDL-cholesterol < 2.6 mmol/L) at 24 months. Findings A total of 2072 people were recruited from the 80 community clusters (40 urban and 40 rural), with 1872 (90.3%) assessed at 24 months. In the intervention arm, patients used FHPs for support more in rural than urban communities (252 (48.6%) rural vs 92 (21.5%) urban, p < 0.0001). The mean monthly proportion of active app users was 46.4% (SD 7.8%) with no significant difference between urban and rural usage rates. The intervention was associated with improved ABC control rates (339 [35.9%] intervention vs 276 [29.9%] usual care; RR 1.20, 95% CI 1.02-1.40; p = 0.025), with significant heterogeneity by geography (rural 220 [42.6%] vs 158 [31.0%]; urban 119 [27.9%] vs 118 [28.6%]; p = 0.022 for interaction). Risk factor reductions were mainly driven by improved glycaemic control (mean HbA1C difference -0.33%, 95% CI -0.48 to -0.17; p = 0.00025 and mean fasting plasma glucose difference -0.58 mmol, 95% CI -0.89 to -0.27; p = 0.00013). There were no changes in blood pressure and LDL-cholesterol levels. Interpretation A multifaceted digital health intervention improved T2DM risk factor control rates, particularly in rural communities where there may be stronger relationships between patients and doctors and greater family member support. Funding National Health and Medical Research CouncilGlobal Alliance for Chronic Diseases (ID 1094712).
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health China, UNSW, Sydney, Australia
| | - Xuanchen Tao
- The George Institute for Global Health China, UNSW, Sydney, Australia
| | - Yuxia Ma
- Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yaosen Zhang
- Luquan Center for Disease Control and Prevention, Shijiazhuang, Hebei Province, China
| | - Xinyan Ma
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Hongyi Song
- The George Institute for Global Health China, China
| | - Yu Liu
- Beihang University, Beijing, China
| | - Anushka Patel
- The George Institute for Global Health, UNSW Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Australia
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Vilafranca-Cartagena M, Bonet-Augè A, Colillas-Malet E, Puiggrós-Binefa A, Tort-Nasarre G. Physical Activity Interventions in People with Diabetes: A Systematic Review of The Qualitative Evidence. Healthcare (Basel) 2024; 12:1373. [PMID: 39057516 PMCID: PMC11275865 DOI: 10.3390/healthcare12141373] [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: 05/30/2024] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVES The aim of this systematic review is to summarize the results of qualitative research into people with type 2 diabetes mellitus (T2DM) and their propensity to engage in physical activity (PA), and to identify and analyse their experiences and opinions of interventions and programs designed to increase their adherence to PA recommendations. DESIGN Systematic review of qualitative studies extracted from databases using the SPIDER systematic search method. The review included studies that combined qualitative and mixed methods research and compiled the experiences and opinions of people with T2DM who had participated in interventions to increase their levels of PA. A thematic summary of qualitative data was performed. RESULTS The review comprised nine studies published between 2017 and 2021, which included 170 people. Four themes and ten subthemes were identified. The four themes include: (1) factors related to PA, (2) factors related to the program, (3) factors related to the support the participants received and (4) factors related to the person. CONCLUSION The support patients receive, both from family/friends and from health providers, is key to consolidating changes in habits and in promoting individualized health education. Future interventions and health policies should reinforce programs designed to promote PA that prioritize the experiences of people in order to increase their adherence to PA programs.
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Affiliation(s)
- Mireia Vilafranca-Cartagena
- Department of Nursing, Faculty of Health Sciences at Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (A.P.-B.)
- Epi4health Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
- Althaia Foundation, C/Dr Joan Soler 1-3, 08243 Manresa, Spain
| | - Aida Bonet-Augè
- Department of Nursing and Physiotherapy, University of Lleida, 25002 Lleida, Spain; (A.B.-A.); (G.T.-N.)
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, 25002 Lleida, Spain
| | - Ester Colillas-Malet
- Department of Nursing, Faculty of Health Sciences at Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (A.P.-B.)
- Epi4health Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
| | - Antònia Puiggrós-Binefa
- Department of Nursing, Faculty of Health Sciences at Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (A.P.-B.)
- Transformative Innovation and Simulation Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing and Physiotherapy, University of Lleida, 25002 Lleida, Spain; (A.B.-A.); (G.T.-N.)
- AFIN Research Group and Outreach Centre, Autonomous University of Barcelona, 08193 Bellaterra, Spain
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Yoon YJ. Depressive symptom trajectory of older adults with diabetes: exploring the role of physical activities using latent growth modeling. Aging Ment Health 2024; 28:1041-1049. [PMID: 38353514 DOI: 10.1080/13607863.2024.2313722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/25/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES The literature highlights the role of physical activities in reducing depression, primarily in clinical samples and international longitudinal studies on older adults with diabetes. Based on Andersen's Behavioral Model, this study aims to describe the trajectory of depressive symptoms in this population and examine whether physical activities are associated with this trajectory. METHODS This study used a longitudinal survey design, utilizing three waves of data from the Health and Retirement Study. The respondents were adults aged 50 or older (N = 4,278) with diabetes. After conducting descriptive analyses, latent growth modeling was performed including unconditional and conditional models. RESULTS The overall trajectory of depressive symptoms in adults with diabetes decreased over a 4-year period. Physical activities were significantly associated with the variance in the intercept of the trajectory (p < .05), but not associated with the variance in the slope (p > .05). Additionally, this study identified factors significantly associated with the variance in the intercept (e.g. age, gender, race, marriage, education, income, self-reported health) or the slope (e.g. race, marriage, education, self-reported health) of the depressive symptom trajectory (p < .05). CONCLUSION The findings underscore the importance of implementing targeted interventions to encourage and promote physical activities among older adults with diabetes, recognizing the potential benefits for managing their mental health.
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Affiliation(s)
- Young Ji Yoon
- Department of Social Work, Colorado State University Pueblo, Pueblo, USA
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Banu B, Khan MMH, Ali L, Barnighausen T, Sauerborn R, Souares A. Pattern and predictors of non-adherence to diabetes self-management recommendations among patients in peripheral district of Bangladesh. Trop Med Int Health 2024; 29:233-242. [PMID: 38221661 DOI: 10.1111/tmi.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVES This study was designed to determine the extent of non-adherence to the different dimensions of diabetes self-management and to identify the factors influencing non-adherence among peripheral patients in Bangladesh. METHODS A cross-sectional study was conducted among 990 adult diabetic patients residing in Thakurgaon district, Bangladesh. Data were collected through face-to-face interviews including socio-demographic information, disease and therapeutic, health services, knowledge and adherence to self-management components. RESULTS The proportion of non-adherence to drug prescription was 66.7%, dietary regimen (68.9%), physical exercise (58.0%), follow-up visit/blood glucose test (88.2%), stopping tobacco (50.6%), and regular foot care (93.9%). Significant predictors for non-adherence to drug were poorest socio-economic status (OR = 2.47), absence of diabetic complications (OR = 1.43), using non-clinical therapy (OR = 5.61), and moderate level of knowledge (OR = 1.87). Non-adherence to dietary recommendations was higher for women (OR = 1.72), poorest socio-economic status (OR = 3.17), and poor technical knowledge (OR = 4.68). Non-adherence to physical exercise was lower for women (OR = 0.62), combined family (OR = 0.63), middle socio-economic status (OR = 0.54), and moderate knowledge on physical exercise (OR = 0.55). Non-adherence to follow-up visits/blood glucose test was higher among patients who did not have diabetic complications (OR = 1.81) and with own transport (OR = 2.57), and respondents from high-income group (OR = 0.23) were less likely to be non-adherent. Non-adherence to stopping tobacco was higher for older individuals (OR = 1.86); but lower for women (OR = 0.48), individuals with higher education level (OR = 0.17) and patients sick for a longer time (OR = 0.52). Non-adherence to foot care was higher for patients who needed longer time to go to hospital (OR = 4.07) and had poor basic knowledge on diabetes (OR = 17.80). CONCLUSION An alarmingly high proportion of diabetic patients did not adhere to diabetes self-management. Major predictors for non-adherence were related to patient's demographic characteristics and their experience with disease, treatment and health care services.
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Affiliation(s)
- Bilkis Banu
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
| | | | - Liaquat Ali
- Pothikrit Institute of Health Studies, Dhaka, Bangladesh
| | - Till Barnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Aurélia Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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Dankoly US, Vissers D, El Mostafa SB, Ziyyat A, Van Rompaey B, Van Royen P, Maamri A. Perceived barriers, benefits, facilitators, and attitudes of health professionals towards type 2 diabetes management in Oujda, Morocco: a qualitative focus group study. Int J Equity Health 2023; 22:29. [PMID: 36750841 PMCID: PMC9903508 DOI: 10.1186/s12939-023-01826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/05/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND In Morocco, the treatment of type 2 diabetes (T2D) is mainly focused on medication and only 2% of patients are coached towards a healthier lifestyle. In Oujda, Eastern Morocco the prevalence of T2D is 10.2%, and the current trend is alarming, especially for women. Therefore, the aim of this study is to explore healthcare professionals (HCP) views on the perceived barriers and benefits of an integrated care approach in primary healthcare centers (PHCCs) to T2D management in Oujda. METHODS A qualitative descriptive study using focus groups in 8 PHCCs. This resulted in a sample of 5 doctors and 25 nurses caring for diabetes patients. The transcripts of all conversations were coded to allow for thematic analysis. RESULTS The participants mentioned different barriers to an integrated approach to DM management:: excessive workload; poor reimbursement policy; lack of staff and equipment; interrupted drug supply; poor working environment; limited referral; gap in the knowledge of general practitioners; health beliefs; poverty; advanced age; gender; the use of psychotropic drugs. An integrated approach could be facilitated by simplified electronic records and referrals; uninterrupted free care; staff recruitment; continuous professional development; internships. BENEFITS structured care; promotion of care in PHCCs; empowerment of self-management. CONCLUSION HCP views reflect the urge to strengthen the management of T2D in PHCCs. There is a need for HCP with expertise in physical activity and nutrition to solve the current gap in the multidisciplinary integrated care approach. The specific local context in this Eastern Moroccan region, with limited resources and remote hard-to-reach rural areas, can contribute to patients' reluctance to change their lifestyles, and is a challenge to provide care in an efficient and sustainable manner. More research is needed to see how a patient-centered multidisciplinary approach to T2D management can help motivate patients in Morocco to change to a healthier lifestyle.
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Affiliation(s)
- Usman Sani Dankoly
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Dirk Vissers
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. .,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Souad Ben El Mostafa
- grid.410890.40000 0004 1772 8348Faculty of Sciences, University Mohammed Premier, Oujda, Morocco
| | - Abderrahim Ziyyat
- grid.410890.40000 0004 1772 8348Faculty of Sciences, University Mohammed Premier, Oujda, Morocco
| | - Bart Van Rompaey
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Van Royen
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Abdellatif Maamri
- grid.410890.40000 0004 1772 8348Faculty of Sciences, University Mohammed Premier, Oujda, Morocco
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Kruse CS, Mileski M, Heinemann K, Huynh H, Leafblad A, Moreno E. Analyzing the Effectiveness of mHealth to Manage Diabetes Mellitus Among Adults Over 50: A Systematic Literature Review. J Multidiscip Healthc 2023; 16:101-117. [PMID: 36660039 PMCID: PMC9842522 DOI: 10.2147/jmdh.s392693] [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: 10/09/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
Purpose A total of 537 million suffered from diabetes mellitus in 2021, and the aging of the population will not abate this number in the future. Diabetes predisposes people to ailments and doubles the risk of COVID-19 mortality. mHealth has shown promise to help manage diabetes. The aim of this review is to objectively analyze research from the last 2.5 years to assess effectiveness where mHealth has been used as an intervention to help manage diabetes in older patients. We also analyzed patient satisfaction, quality, and barriers to adoption of mHealth to manage diabetes. Patients and Methods No human subjects were involved in this review. We queried four research databases for mHealth to manage diabetes in older adults. We conducted the review based on the Kruse Protocol for writing as systematic review and we reported our findings in accordance with PRISMA (2020). Results Thirty research articles from 11 countries were analyzed. Five interventions of mHealth were identified. Of these mHealth Short Message service (SMS) helped change behavior and encouraged self-care. mHealth SMS coupled with telemedicine for coaching showed positive effects on weight loss, BMI, diet, exercise, HbA1C, disease awareness, blood pressure, cholesterol, medication adherence, and foot care. Conclusion mHealth SMS coupled with telemedicine for coaching shows the greatest promise for educating, changing behavior, and realizing positive outcomes across a broad spectrum of health factors. The largest drawback is the cost of acquiring equipment and training users.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA,Correspondence: Michael Mileski, Texas State University, School of Health Administration, 601 University Drive, Encino Hall—250, San Marcos, TX, 78666, USA, Tel +1 512 245 3556, Email
| | - Katharine Heinemann
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Hung Huynh
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Abigail Leafblad
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Emmanuel Moreno
- School of Health Administration, Texas State University, San Marcos, TX, USA
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Kosowicz L, Tran K, Khanh TT, Dang TH, Pham VA, Ta Thi Kim H, Thi Bach Duong H, Nguyen TD, Phuong AT, Le TH, Ta VA, Wickramasinghe N, Schofield P, Zelcer J, Pham Le T, Nguyen TA. Lessons for Vietnam on the use of digital technologies to support patient-centred care in low- and middle-income countries in the Asia Pacific Region: A scoping review (Preprint). J Med Internet Res 2022; 25:e43224. [PMID: 37018013 PMCID: PMC10132046 DOI: 10.2196/43224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam's health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. OBJECTIVE This study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. METHODS A scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. RESULTS Of the 264 publications identified, 45 (17%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45%), followed by tier B (14/33, 42%) and tier A (4/33, 12%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users' individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. CONCLUSIONS The use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake.
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Affiliation(s)
- Leona Kosowicz
- Social Gerontology Division, National Ageing Research Institute, Parkville, Australia
| | - Kham Tran
- Social Gerontology Division, National Ageing Research Institute, Parkville, Australia
| | - Toan Tran Khanh
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Thu Ha Dang
- Social Gerontology Division, National Ageing Research Institute, Parkville, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | | | - Hue Ta Thi Kim
- New Horizon Palliative Care Company Limited, Hanoi, Vietnam
- Hanoi University of Science and Technology, Hanoi, Vietnam
| | | | | | | | | | - Van Anh Ta
- New Horizon Palliative Care Company Limited, Hanoi, Vietnam
| | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Penelope Schofield
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - John Zelcer
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Tuan Pham Le
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
- Military and Civil Medical Association of Vietnam, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Parkville, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
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Rezaee R, Asadi S, Yazdani A, Rezvani A, Kazeroon AM. Development, usability and quality evaluation of the resilient mobile application for women with breast cancer. Health Sci Rep 2022; 5:e708. [PMID: 35782301 PMCID: PMC9234476 DOI: 10.1002/hsr2.708] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Mental health problems as a consequence of cancer lower the quality of life of cancer patients. Despite increasing studies of breast cancer‐focused mobile health applications (m‐Health apps), there is less research on breast cancer patients' quality of life or well‐being. The purpose of this study is to develop and evaluate the usability and quality of an educational m‐Health app aimed at improving the resilience of breast cancer in women. Methods This study was conducted in four phases. It included extracting the requirements of the app through the nominal group technique. Based on these results, an m‐Health app was developed and evaluated in terms of usability and quality by two scales, System Usability Scale and Mobile App Rating Scale questionnaires, respectively. Finally, the role of patients' age and educational backgrounds in the use of the app was assessed. The relationship between learnability and usability of the app was measured by the T‐Test. Results The app was developed with three user interfaces. Its usability developed from the patient's point of view scored a remarkable score of 83.20 with a 95% confidence interval. This value was too indicative of high satisfaction with the usefulness and the possibility of recommending it to other cancer survivors. The results of the quality evaluation from an expert's point of view showed that this app had good functionality. Evaluation of the role of demographic information in the use of the app showed that it can be used for all age groups with different levels of education. The app did not differ significantly between learnability and usability. Conclusion The development of m‐Health apps, based on usability principles that are suitable for all age groups with different levels of education, is welcomed by cancer patients.
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Affiliation(s)
- Rita Rezaee
- Department of Health Information Management, Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences Shiraz University of Medical Sciences Shiraz Iran
| | - Sima Asadi
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | - Azita Yazdani
- Department of Health Information Management, Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences Shiraz University of Medical Sciences Shiraz Iran
| | - Alireza Rezvani
- Department of Internal Medicine, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
| | - Arash Mani Kazeroon
- Department of Psychiatry, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
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Aldosari N, Ahmed S, McDermott J, Stanmore E. Title: The use of digital health by South Asian communities: a scoping review (Preprint). J Med Internet Res 2022. [DOI: 10.2196/40425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Al-Sanaani EA, Ismail A, Abdul Manaf MR, Suddin LS, Mustafa N, Sukor N, Alabed AAA, Alkhodary AA, Aljunid SM. Health insurance status and its determinants among patients with type 2 diabetes mellitus in a tertiary teaching hospital in Malaysia. PLoS One 2022; 17:e0267897. [PMID: 35511889 PMCID: PMC9070921 DOI: 10.1371/journal.pone.0267897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Even in a country with a tax-based healthcare financing system, health insurance can play an important role, especially in the management of chronic diseases with high disease and economic burden such as Type 2 Diabetes Mellitus (T2DM). The insurance coverage among T2DM patients in Malaysia is currently unclear. The aim of this study was to determine the insurance status of T2DM patients in public and private healthcare facilities in Malaysia, and the association between this status and patients’ sociodemographic and economic factors.
Methods
A cross-sectional study among T2DM patients seeking inpatient or outpatient treatment at a public tertiary hospital (Hospital Canselor Tuanku Muhriz) and a private tertiary hospital (Universiti Kebangsaan Malaysia Specialist Centre) in Kuala Lumpur between August 2019 and March 2020. Patients were identified via convenience sampling using a self-administered questionnaire. Data collection focused on identifying insurance status as the dependent factor while the independent factors were the patients’ sociodemographic characteristics and economic factors.
Results
Of 400 T2DM patients, 313 responded (response rate, 78.3%) and 76.0% were uninsured. About 69.6% of the respondents had low monthly incomes of <RM5000. Two-thirds of participants (59.1%) spent RM100–500 for outpatient visits whilst 58.5% spent <RM100 on medicines per month (RM1 = USD0.244). Patients who visited a private facility had five times more likely to have insurance than patients who visited a public facility. Participants aged 18–49 years with higher education levels were 4.8 times more likely to be insured than participants aged ≥50 years with low education levels (2 times).
Conclusions
The majority of T2DM patients were uninsured. The main factors determining health insurance status were public facilities, age of ≥ 50 years, low education level, unemployment, and monthly expenditure on medicines.
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Affiliation(s)
- Essam Ali Al-Sanaani
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Ministry of Public Health and Population, Sana’a, Yemen
| | - Aniza Ismail
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Mohd Rizal Abdul Manaf
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Leny Suzana Suddin
- Faculty of Medicine, Department of Community Health, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Norlaila Mustafa
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Alabed Ali A. Alabed
- Faculty of Medicine, Department of Community Medicine, Lincoln University College, Kota Bharu, Malaysia
| | - Ahmed Abdelmajed Alkhodary
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Faculty of Medicine, International Centre for Casemix and Clinical Coding, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- Faculty of Medicine, International Centre for Casemix and Clinical Coding, National University of Malaysia, Kuala Lumpur, Malaysia
- Faculty of Public Health, Department of Health Policy and Management, Kuwait University, Kuwait, Kuwait
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Char A, Gaudel P, Kulathinal S, Kinnunen TI. Effects of technology-based interventions on dietary intake or anthropometrics among adolescents and adults in South Asia - A systematic review of intervention studies. Obes Res Clin Pract 2022; 16:181-196. [PMID: 35690586 DOI: 10.1016/j.orcp.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Mobile technology has been increasingly used as part of dietary interventions, but the effects of such interventions have not been systematically evaluated in the South Asian context. The systematic review aimed to determine the effects of technology-based interventions on dietary intake or anthropometrics among adolescents and adults in South Asia. METHODS Five electronic databases were searched (PubMed, Scopus, Web of Science, Global Health Library and Health Technology Assessment). Studies published in English between 1st January 2011 and 31st December 2021were included. Interventions that evaluated the effects of dietary interventions using technology on dietary outcomes and anthropometrics in adolescents or adults in the age group of 13-44 years (or a broader age group) from South Asia were eligible for inclusion. The risk of bias was assessed using the Cochrane Risk-of-bias 2 tool and ROBINS-I tool. A narrative synthesis was conducted. RESULTS Twenty-one studies met the inclusion criteria (20,667 participants). Eleven of the 17 randomised controlled trials (RCTs) had a high overall risk of bias. The four non-randomised intervention studies had a serious or critical overall risk of bias. When including studies with low risk or some concern for bias, the interventions had a beneficial effect on at least one dietary outcome in four of the six RCTs that measured changes in diet, and no effect on the anthropometric outcomes in the six RCTs that measured changes in anthropometric outcomes. DISCUSSION Technology-based dietary interventions have had some positive effects on dietary intake, but no effects on anthropometry in South Asia. More evidence is needed as the overall risk of bias was high in a majority of the studies.
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Affiliation(s)
- Arundhati Char
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pramila Gaudel
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sangita Kulathinal
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Tarja I Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.
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Sifat MS, Saperstein SL, Tasnim N, Green KM. Motivations Toward Using Digital Health and Exploring the Possibility of Using Digital Health for Mental Health in Bangladesh University Students: Cross-sectional Questionnaire Study. JMIR Form Res 2022; 6:e34901. [PMID: 35254267 PMCID: PMC8933805 DOI: 10.2196/34901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/26/2023] Open
Abstract
Background Digital health is efficacious for the management and prevention of mental health (MH) problems. It is particularly helpful for the young adult population, who appreciate the autonomy digital health provides, and in low-income countries, where the prevalence of MH problems is high but the supply of professionals trained in MH is low. Objective The objectives of this study are 2-fold: to determine whether university students in Bangladesh find using digital health for MH promotion acceptable and to examine motivational factors for using digital health for MH. Methods This study used a cross-sectional survey to examine the likelihood that university students in Bangladesh (n=311) would use different forms of digital health platforms for MH promotion and assessed drivers of intention to use and actual use of digital health generally and digital health for MH through the lens of the Technology Acceptance Model. The results provided evidence that the university student population in Bangladesh is likely to use digital health to promote their MH. Results Social influence (adjusted odds ratio [aOR] 1.68, 95% CI 1.40-2.01; P<.001), ease of use (aOR 1.85, 95% CI 1.35-2.53; P<.001), and perceived usefulness (aOR 4.12, 95% CI 1.79-9.51; P=.001) of digital health were found to be significant drivers of the intention to use general digital health, and having an intention to use digital health (aOR 2.10, 95% CI 1.17-3.78; P=.01) had the greatest influence on actual use of digital health. Social influence (aOR 1.71, 95% CI 1.43-2.04; P<.001), perceived usefulness (aOR 8.92, 95% CI 4.18-19.04; P<.001), and use of general digital health (aOR 2.16, 95% CI 1.18-3.97; P=.01) were associated with higher intention to use digital health for MH. The use of general digital health (aOR 4.19, 95% CI 2.37-7.41; P<.001) was associated with the actual use of digital health for MH, as were greater non–stigma-related barriers to using traditional clinical MH services (aOR 2.05, 95% CI 1.10-3.80; P=.02). Conclusions Overall, we see that the use of digital health for MH is acceptable in this population and can be helpful for students who perceive barriers to receiving traditional care. We also gain insight into how to promote the intention to use digital health, which in turn promotes the actual use of digital health.
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Affiliation(s)
- Munjireen S Sifat
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Sandra L Saperstein
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | | | - Kerry M Green
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
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McCool J, Dobson R, Whittaker R, Paton C. Mobile Health (mHealth) in Low- and Middle-Income Countries. Annu Rev Public Health 2021; 43:525-539. [PMID: 34648368 DOI: 10.1146/annurev-publhealth-052620-093850] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article reflects on current trends and proposes new considerations for the future of mobile technologies for health (mHealth). Our focus is predominantly on the value of and concerns with regard to the application of digital health within low- and middle-income countries (LMICs). It is in LMICs and marginalized communities that mHealth (within the wider scope of digital health) could be most useful and valuable. Peer-reviewed literature on mHealth in LMICs provides reassurance of this potential, often reflecting on the ubiquity of mobile phones and ever-increasing connectivity globally, reaching remote or otherwise disengaged populations. Efforts to adapt successful programs for LMIC contexts and populations are only just starting to reap rewards. Private-sector investment in mHealth offers value through enhanced capacity and advances in technology as well as the ability to meet increasing consumer demand for real-time, accessible, convenient, and choice-driven health care options. We examine some of the potential considerations associated with a private-sector investment, questioning whether a core of transparency, local ownership, equity, and safety are likely to be upheld in the current environment of health entrepreneurship. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Judith McCool
- School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand;
| | - Rosie Dobson
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand.,i3 Institute for Innovation and Improvement, Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand
| | - Chris Paton
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Department of Information Science, University of Otago, Dunedin, New Zealand
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A valid self-help tool to measure the role of spousal support in the care of persons with diabetes mellitus. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Harris B, Ajisola M, Alam RM, Watkins JA, Arvanitis TN, Bakibinga P, Chipwaza B, Choudhury NN, Kibe P, Fayehun O, Omigbodun A, Owoaje E, Pemba S, Potter R, Rizvi N, Sturt J, Cave J, Iqbal R, Kabaria C, Kalolo A, Kyobutungi C, Lilford RJ, Mashanya T, Ndegese S, Rahman O, Sayani S, Yusuf R, Griffiths F. Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study. Digit Health 2021; 7:20552076211033425. [PMID: 34777849 PMCID: PMC8580492 DOI: 10.1177/20552076211033425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. METHODS We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. RESULTS We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms (n = 5-17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. CONCLUSIONS There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.
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Affiliation(s)
| | - Motunrayo Ajisola
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Raisa Meher Alam
- Centre for Health, Population and Development, Independent University
Bangladesh, Bangladesh
| | | | | | | | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences,
Tanzania
| | | | - Peter Kibe
- African Population and Health Research
Center, Kenya
| | - Olufunke Fayehun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical
Sciences, College of Medicine, University of Ibadan, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College
of Medicine, University of Ibadan, Nigeria
| | - Senga Pemba
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Rachel Potter
- Clinical Trials Unit Warwick Medical School, University of Warwick, University of Warwick, UK
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Pakistan
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s
College London, UK
| | | | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Pakistan
| | | | - Albino Kalolo
- St Francis University College of Health and Allied Sciences,
Tanzania
| | | | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental
Sciences, University of Birmingham, UK
| | - Titus Mashanya
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Sylvester Ndegese
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Omar Rahman
- University of Liberal Arts
Bangladesh, Bangladesh
| | - Saleem Sayani
- Aga Khan Development Network Digital Health Resource Centre (Asia
and Africa), Aga Khan University, Pakistan
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University
Bangladesh, Bangladesh
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, UK
- Centre for Health Policy, University of the Witwatersrand, South
Africa
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