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Wang Y, Wong ELY, Nilsen P, Chung VCH, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci 2023; 18:43. [PMID: 37726779 PMCID: PMC10507824 DOI: 10.1186/s13012-023-01296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way. METHODS A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability. RESULTS A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability. CONCLUSIONS Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.
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Affiliation(s)
- Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Vincent Chi-Ho Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Sy F, Berner-Rodoreda A, Asnake T, Getnet M, Amogne W, Bussmann H, Abera H, Bärnighausen T, Deckert A. Exploring computer-aided health decision-making on cervical cancer interventions through deliberative interviews in Ethiopia. NPJ Digit Med 2023; 6:68. [PMID: 37069432 PMCID: PMC10106317 DOI: 10.1038/s41746-023-00808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Abstract
Cervical cancer is a significant disease burden in Ethiopia. Mathematical models and computer simulations on disease dynamics can support effective resource allocation. The objectives of this work are (i) to explore the perspectives of health decision-makers on computer-aided predictions supporting cervical cancer interventions, (ii) to identify their information needs from these predictions, and (iii) their willingness to apply the results in their work. We conducted deliberative interviews with 15 health decision-makers and advisors in Ethiopia in autumn 2019. We analyze the data using a five steps framework approach drawing on thematic analysis and find that Ethiopian health decision-makers are willing to use computer-aided predictions in their decisions. Data on HPV prevalence and the cervical cancer burden are scarce but valued highly and decision-makers are particularly interested in the identification of local HPV hotspots. Data-driven mathematical models and computer simulations may increasingly influence health decision-making in Ethiopia.
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Affiliation(s)
- Frithjof Sy
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| | | | | | - Misrak Getnet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Infectious Disease Department (TASH) Addis Ababa University, Addis Ababa, Ethiopia
| | - Hermann Bussmann
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Helen Abera
- Infectious Disease Department (TASH) Addis Ababa University, Addis Ababa, Ethiopia
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Harvard Center for Population & Development Studies, Harvard University, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Andreas Deckert
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
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Haregu T, Lim SC, Miranda M, Pham CT, Nguyen N, Suya I, Ilagan R, Poowanasatien A, Kowal P, Oldenburg B. Practical Strategies for Improving Sustainability and Scale-up of Noncommunicable Disease-related Public Health Interventions: Lessons from the Better Health Program in Southeast Asia. WHO South East Asia J Public Health 2023; 12:15-37. [PMID: 37843178 DOI: 10.4103/who-seajph.who-seajph_140_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Introduction The Better Health Program has been addressing key health system issues in the prevention and control of noncommunicable diseases (NCDs) in Malaysia, Thailand, Vietnam, and the Philippines. As the program comes to an end, the sustainability and scaling-up of issues have assumed importance. Objectives The objective is to assess how well sustainability and scale-up strategies have been integrated into the design and implementation of a 3-year multicountry technical program; to explore enablers and barriers of sustainability and scaling up; and to identify practical strategies that can improve sustainability and scale-up of Better Health Program interventions. Methods We applied a staged approach to explore barriers and enablers and to identify practical strategies to improve sustainability and scale-up of four NCD interventions: community-based obesity prevention, front-of-pack labeling, local learning networks (LLNs), and NCD surveillance. We extracted evidence from peer-reviewed literature and local documents. We also conducted in-depth interviews with the implementation teams and key stakeholders. We conducted a thematic synthesis of the resulting information to identify practical strategies that improve sustainability and scale-up of the four interventions. Results Strong engagement of stakeholders at higher levels of the health system was identified as the main enabler, while limited funding and commitment from local governments were identified as a key barrier to sustainability and scale-up. Strengthening the social and institutional anchors of community health volunteers, enhancing evidence-based advocacy for front-of-pack labeling, trailblazing the LLN innovation, and securing the commitment of local governments in the implementation of NCD surveillance were among the key strategies for improving sustainability and scale-up of Better Health Program interventions in Malaysia, Thailand, Philippines, and Vietnam, respectively. Conclusions This study identified practical strategies for improving sustainability and scale-up of NCD-related interventions. Implementation of the strategies that had high priority and feasibility will improve the sustainability of critical elements of the program in the respective countries.
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Affiliation(s)
- Tilahun Haregu
- Noncommunicable Disease and Implementation Science Lab, Baker Heart and Diabetes Institute; Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | | | | | - Inthira Suya
- FHI 360 Asia Pacific Regional Office, Bangkok, Thailand
| | | | | | - Paul Kowal
- Australian National University and Better Health Programme Southeast Asia, Yangon, Myanmar
| | - Brian Oldenburg
- Noncommunicable Disease and Implementation Science Lab, Baker Heart and Diabetes Institute; Baker Department of Cardiovascular Research, Translation and Implementation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Udenigwe O, Okonofua FE, Ntoimo LF, Yaya S. Enablers and barriers to the acceptability of mHealth for maternal healthcare in rural Edo, Nigeria. DIALOGUES IN HEALTH 2022; 1:100067. [PMID: 38515913 PMCID: PMC10953930 DOI: 10.1016/j.dialog.2022.100067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 03/23/2024]
Abstract
Objective Acceptability has become a key consideration in designing, implementing and evaluating digital health interventions. Current evidence points to acceptability as a crucial factor in sustaining mobile health programs for maternal health across sub-Saharan Africa particularly in Nigeria where the burden of maternal mortality is high. This paper describes the enablers and barriers to the acceptance of Text4Life, a mobile phone-based health intervention that extends maternal healthcare services to rural areas of Edo State Nigeria. Method This is a cross-sectional qualitative study of women who used Text4Life, their spouses who were all men and Ward Development Committee chairpersons who oversaw the implementation of Text4Life. This study was set in Etsako East and Esan Central Local Government Areas of Edo State, Nigeria. Between September 2021 and January 2022, eight focus groups were conducted with 64 participants: 39 women and 25 men. Two in-depth interviews were conducted with Ward Development Committee chairpersons. Data collection was conducted in English and Pidgin English. Discussions and interviews were digitally recorded and translated to English from Pidgin English where necessary. Data analysis followed a mainly deductive approach to thematic analysis, however, emergent information from the data was also considered and reported. Results The results show that participants' positive attitudes towards the intervention, the involvement of the community, participants' understanding of the intervention, and perceived effectiveness of the Text4Life program were enablers to women's acceptance of Text4Life and enablers to Ward Development Committee chairpersons' assistance with the program. On the other hand, limited resources and a clash with the community's value system presented barriers to the acceptability of the Text4Life program. Conclusion Our findings demonstrate the importance of alleviating the burdens associated with participating in mobile health interventions while noting that the risk of obstructing the gains from mobile health interventions is high if plans for sustaining it are not incorporated early enough in the design phase.
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Affiliation(s)
- Ogochukwu Udenigwe
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Friday E. Okonofua
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Lorretta F.C. Ntoimo
- Federal University Oye-Ekiti, P. M. B. 373, Km 3 Oye-Are Road, Oye-Ekiti, Ekiti State, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Kaboré SS, Ngangue P, Soubeiga D, Barro A, Pilabré AH, Bationo N, Pafadnam Y, Drabo KM, Hien H, Savadogo GBL. Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: A systematic review. Front Digit Health 2022; 4:1014375. [PMID: 36518563 PMCID: PMC9742266 DOI: 10.3389/fdgth.2022.1014375] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/03/2022] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have increased exponentially all over the world. Furthermore, the interest in the sustainability of digital health interventions is growing significantly. However, a systematic synthesis of digital health intervention sustainability challenges is lacking. This systematic review aimed to identify the barriers and facilitators for the sustainability of digital health intervention in low and middle-income countries. METHODS Three electronic databases (PubMed, Embase and Web of Science) were searched. Two independent reviewers selected eligible publications based on inclusion and exclusion criteria. Data were extracted and quality assessed by four team members. Qualitative, quantitative or mixed studies conducted in low and middle-income countries and published from January 2000 to May 2022 were included. RESULTS The sustainability of digital health interventions is very complex and multidimensional. Successful sustainability of digital health interventions depends on interdependent complex factors that influence the implementation and scale-up level in the short, middle and long term. Barriers identified among others are associated with infrastructure, equipment, internet, electricity and the DHIs. As for the facilitators, they are more focused on the strong commitment and involvement of relevant stakeholders: Government, institutional, sectoral, stakeholders' support, collaborative networks with implementing partners, improved satisfaction, convenience, privacy, confidentiality and trust in clients, experience and confidence in using the system, motivation and competence of staff. All stakeholders play an essential role in the process of sustainability. Digital technology can have long term impacts on health workers, patients, and the health system, by improving data management for decision-making, the standard of healthcare service delivery and boosting attendance at health facilities and using services. Therefore, management changes with effective monitoring and evaluation before, during, and after DHIs are essential. CONCLUSION The sustainability of digital health interventions is crucial to maintain good quality healthcare, especially in low and middle-income countries. Considering potential barriers and facilitators for the sustainability of digital health interventions should inform all stakeholders, from their planning until their scaling up. Besides, it would be appropriate at the health facilities level to consolidate facilitators and efficiently manage barriers with the participation of all stakeholders.
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Affiliation(s)
- Soutongnoma Safiata Kaboré
- Centre D'excellence Africain, Université Nazi BONI, Bobo Dioulasso, Burkina Faso
- Direction Générale, Institut National de Santé Publique, Ouagadougou, Burkina Faso
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Patrice Ngangue
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département des Sciences de la Santé, Université du Québec en Abitibi Témiscamingue, Québec, Canada
| | - Dieudonné Soubeiga
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Abibata Barro
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Arzouma Hermann Pilabré
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département de Santé Publique, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Nestor Bationo
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département de Santé Publique, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Yacouba Pafadnam
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Koiné Maxime Drabo
- Institut de Recherche en Sciences de la Santé/Centre National Pour la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Hervé Hien
- Direction Générale, Institut National de Santé Publique, Ouagadougou, Burkina Faso
- Institut de Recherche en Sciences de la Santé/Centre National Pour la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
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Ekman B, Thulesius H, Wilkens J, Arvidsson E. Digitalization of health care: findings from key informant interviews in Sweden on technical, regulatory, and patient safety aspects (Preprint). J Med Internet Res 2022; 24:e38746. [PMID: 36048503 PMCID: PMC9478815 DOI: 10.2196/38746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/15/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Björn Ekman
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jens Wilkens
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Osei EA, Ninon AP, Gaogli JE, Boadi EO. "I Just Went for the Screening, But I Did Not Go for the Results". Utilization of Cervical Cancer Screening and Vaccination among Females at Oyibi Community. Asian Pac J Cancer Prev 2021; 22:1789-1797. [PMID: 34181335 PMCID: PMC8418834 DOI: 10.31557/apjcp.2021.22.6.1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Cervical cancer screening and vaccination practices is reported to have low coverage in most developing countries. It has been reported that most women are aware of cervical cancer screening and vaccination worldwide. Nevertheless, the rate at which women participate in cervical cancer screening and vaccination was found to be low both locally and internationally. Consequently, in sub-Saharan Africa, cervical cancer screening programs have poor coverage. The aim of this study was to explore the practices of cervical cancer screening and vaccination among females at Oyibi community. Methods: The researchers employed a qualitative exploratory design to recruit 35 participants put into five Focus Group Discussions (FGDs). Five FGDs were formed with seven (7) members in each group. The members were purposely recruited. The sample size was based on data saturation. Data was retrieved using a semi-structured interview guide. The researchers served as moderators in the group. Results: Two (2) main themes with Eight (8) subthemes were generated from the data analysis. The themes were; (cervical cancer screening and vaccination practices), and (perceived benefits of cervical cancer screening and vaccination). The subthemes that emerged were as follows: types of cervical screening and vaccination done by participants, experiences during cervical cancer screening, experiences during cervical cancer vaccination, decision to go for cervical cancer screening and vaccination, willingness to recommend cervical cancer screening and vaccination to other women, early detection of cervical cancer through early screening, benefits of cervical cancer vaccination, and willingness to receive cervical cancer vaccine. The study also revealed that most of the women who had done the screening and vaccination were young (19-29 years). Conclusion: The results from the study indicated that the participants’ utilization of cervical cancer screening and vaccination were poor although they were conscious of the benefits of cervical cancer screening and vaccination and were willing to recommend it to their relatives and their loved ones.
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Affiliation(s)
- Evans Appiah Osei
- School of Nursing and Midwifery, Department of Nursing, Valley View University, Ghana
| | - Amertil P Ninon
- School of Nursing and Midwifery, Department of Nursing, Valley View University, Ghana
| | - Judith E Gaogli
- School of Nursing and Midwifery, Department of Nursing, Valley View University, Ghana
| | - Ezekiel Oti Boadi
- School of Nursing and Midwifery, Department of Nursing, Valley View University, Ghana
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Lederle M, Tempes J, Bitzer EM. Application of Andersen's behavioural model of health services use: a scoping review with a focus on qualitative health services research. BMJ Open 2021; 11:e045018. [PMID: 33952550 PMCID: PMC8103375 DOI: 10.1136/bmjopen-2020-045018] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Qualitative methods have become integral in health services research, and Andersen's behavioural model of health services use (BMHSU) is one of the most commonly employed models of health service utilisation. The model focuses on three core factors to explain healthcare utilisation: predisposing, enabling and need factors. A recent overview of the application of the BMHSU is lacking, particularly regarding its application in qualitative research. Therefore, we provide (1) a descriptive overview of the application of the BMHSU in health services research in general and (2) a qualitative synthesis on the (un)suitability of the model in qualitative health services research. METHODS We searched five databases from March to April 2019, and in April 2020. For inclusion, each study had to focus on individuals ≥18 years of age and to cite the BMHSU, a modified version of the model, or the three core factors that constitute the model, regardless of study design, or publication type. We used MS Excel to perform descriptive statistics, and applied MAXQDA 2020 as part of a qualitative content analysis. RESULTS From a total of 6319 results, we identified 1879 publications dealing with the BMSHU. The main methodological approach was quantitative (89%). More than half of the studies are based on the BMHSU from 1995. 77 studies employed a qualitative design, the BMHSU was applied to justify the theoretical background (62%), structure the data collection (40%) and perform data coding (78%). Various publications highlight the usefulness of the BMHSU for qualitative data, while others criticise the model for several reasons (eg, its lack of cultural or psychosocial factors). CONCLUSIONS The application of different and older models of healthcare utilisation hinders comparative health services research. Future research should consider quantitative or qualitative study designs and account for the most current and comprehensive model of the BMHSU.
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Affiliation(s)
- Mareike Lederle
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
| | - Jana Tempes
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
| | - Eva M Bitzer
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
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Greve M, Brendel AB, van Osten N, Kolbe LM. Overcoming the barriers of mobile health that hamper sustainability in low-resource environments. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Aim
This research aims to identify response strategies that non-profit organizations (NPOs) can apply to overcome the barriers that hamper the sustainable use of mobile health (mHealth) interventions in low-resource environments (LREs), such as in Sub-Saharan Africa (SSA).
Subject and method
A qualitative study on mHealth initiatives in SSA is conducted through semi-structured interviews with 15 key informants of NPOs that operate and manage mHealth interventions in this region. The interviews focus on identifying existing barriers and response strategies that NPOs apply to enable sustainable and long-term running interventions.
Results
Building on grounded theory techniques, the collected data guided us towards a process model that identifies four aggregated categories of challenging areas that require response strategies (economy, environment, technology, and user acceptance).
Conclusion
This study provides contributions from and implications for NPOs and researchers. Health practitioners are provided with a knowledge base of what barriers to expect and how to overcome them, to strive for sustainable implementation from the very beginning of an intervention. A process model is identified that structures the response strategies in a time-based agenda of mHealth initiatives and thus makes a theoretical contribution. Overall, this study addresses the need for a theoretical consideration of the “pilotitis” phenomenon, which currently hampers the sustainable implementation and scaling up of mHealth initiatives. While the focus is specifically on mHealth initiatives, the overall findings help prevent discontinuance of projects in the future after the pilot, and help facilitate LREs on their way to sustainable health interventions and universal health coverage.
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Paul ME, Castillo M, Emmanuel P, Bauermeister JA, Mena LA, Sullivan PS, Hightow-Weidman LB. Scale up mHealth HIV interventions: site and public health perspectives and lessons learned from P3. Mhealth 2021; 7:38. [PMID: 33898607 PMCID: PMC8063006 DOI: 10.21037/mhealth-20-65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/24/2020] [Indexed: 11/06/2022] Open
Abstract
A number of mobile health (mHealth) interventions have been shown to be effective and highly acceptable tools for improving human immunodeficiency virus (HIV) prevention and care for youth. Scale-up of efficacious technology-based interventions is challenging and best practices for scale-up have not been clearly established. Developers of mHealth interventions should have plans in mind for wide scale implementation throughout all stages of development including planning, during trials and during analysis and dissemination. We discuss an approach of focus on researchers, funders and potential implementers including members of the community, public health practitioners and policymakers during initial planning, trials, analysis and dissemination, and planning for scale-up. Development of the P3 (Prepared, Protected, emPowered) mobile application (app), an intervention built to encourage and increase pre-exposure prophylaxis (PrEP) adherence among young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWSM), is discussed in terms of designing for scale-up and lessons learned.
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Affiliation(s)
- Mary E. Paul
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
| | - Marné Castillo
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jose A. Bauermeister
- University of Pennsylvania School of Nursing, Claire M. Fagin Hall, Philadelphia, PA, USA
| | | | | | - Lisa B. Hightow-Weidman
- Institute for Global Health & Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
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Steinman L, Heang H, van Pelt M, Ide N, Cui H, Rao M, LoGerfo J, Fitzpatrick A. Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e13536. [PMID: 32329737 PMCID: PMC7210501 DOI: 10.2196/13536] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/04/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022] Open
Abstract
Background In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo’s database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. Objective This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. Methods We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. Results We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor’s consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. Conclusions These mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management.
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Affiliation(s)
- Lesley Steinman
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Hen Heang
- MoPoTsyo Patient Information Centre, Phnom Penh, Cambodia
| | | | - Nicole Ide
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States
| | - Haixia Cui
- MoPoTsyo Patient Information Centre, Phnom Penh, Cambodia
| | - Mayuree Rao
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States.,General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, United States
| | - James LoGerfo
- Department of Medicine, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Annette Fitzpatrick
- Department of Global Health, University of Washington, Seattle, WA, United States.,Departments of Family Medicine, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States
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12
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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