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Ranjit YS, Basnyat I, Joshi O, Khoshnood K, Fisher CB. Sharing Culture and Management of Sex Work Information on Mobile Phones by Female Sex Workers in Nepal: Implications for mHealth Practice and Research. HEALTH COMMUNICATION 2024:1-11. [PMID: 38836353 DOI: 10.1080/10410236.2024.2363617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Female sex workers (FSWs) in Nepal continue to be disproportionately at risk for Sexually Transmitted Infections (STIs), including HIV. Due to stigma related to sex work and HIV, FSWs keep their sex work information hidden, which poses a barrier to seeking health services. Emerging research indicates a high uptake of mobile phones among FSWs in Nepal. Mobile health (mHealth) interventions can provide health information and linkage to care. However, largely missing from the literature is FSWs' experience of managing the information about their involvement in sex work in a culture where sharing personal information and belongings is a part of the social norm, and maintaining privacy could have negative social repercussions. The current study aims to understand how FSWs perceive and manage privacy when they share their mobile phones. Using the Communication Privacy Management theory, we explore FSWs' perception of the threat to their privacy posed by mobile phones. We conducted 30 in-depth interviews among FSWs in Kathmandu, Nepal. Results showed that all participants owned mobile phones, and sharing devices was common. Mobile phones pose a considerable challenge in keeping sex work information private, and FSWs use various communication strategies to circumvent privacy threats. The findings highlight the mental and emotional burden FSWs face trying to conceal their private information in a sharing culture. The study discusses the importance of theorizing privacy in the cultural context of the Global South and the practical implications for developing mHealth interventions for this population.
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Affiliation(s)
| | - Iccha Basnyat
- Global Affairs Program & Department of Communication, George Mason University
| | | | | | - Celia B Fisher
- Research Ethics and Training Institute, Fordham University
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Saif-Ur-Rahman KM, Islam MS, Alaboson J, Ola O, Hasan I, Islam N, Mainali S, Martina T, Silenga E, Muyangana M, Joarder T. Artificial intelligence and digital health in improving primary health care service delivery in LMICs: A systematic review. J Evid Based Med 2023; 16:303-320. [PMID: 37691394 DOI: 10.1111/jebm.12547] [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: 08/11/2022] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
AIM Technology including artificial intelligence (AI) may play a key role to strengthen primary health care services in resource-poor settings. This systematic review aims to explore the evidence on the use of AI and digital health in improving primary health care service delivery. METHODS Three electronic databases were searched using a comprehensive search strategy without providing any restriction in June 2023. Retrieved articles were screened independently using the "Rayyan" software. Data extraction and quality assessment were conducted independently by two review authors. A narrative synthesis of the included interventions was conducted. RESULTS A total of 4596 articles were screened, and finally, 48 articles were included from 21 different countries published between 2013 and 2021. The main focus of the included studies was noncommunicable diseases (n = 15), maternal and child health care (n = 11), primary care (n = 8), infectious diseases including tuberculosis, leprosy, and HIV (n = 7), and mental health (n = 6). Included studies considered interventions using AI, and digital health of which mobile-phone-based interventions were prominent. m-health interventions were well adopted and easy to use and improved the record-keeping, service deliver, and patient satisfaction. CONCLUSION AI and the application of digital technologies improve primary health care service delivery in resource-poor settings in various ways. However, in most of the cases, the application of AI and digital health is implemented through m-health. There is a great scope to conduct further research exploring the interventions on a large scale.
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Affiliation(s)
- K M Saif-Ur-Rahman
- College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Shariful Islam
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Joan Alaboson
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Oluwadara Ola
- Sacred Heart Hospital, Abeokuta, Ogun State, Nigeria
| | - Imran Hasan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nazmul Islam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shristi Mainali
- Department of Operations, Marie Stopes International, Kathmandu, Nepal
| | - Tina Martina
- General Hospital of Haji Padjonga, South Sulawesi, Indonesia
| | - Eva Silenga
- Department of Mother and Child Health, Ministry of Health, Lusaka, Zambia
| | - Mubita Muyangana
- Lewanika School of Nursing and Midwifery, Ministry of Health, Mongu, Zambia
| | - Taufique Joarder
- SingHealth Duke-NUS Global Health Institute, National University of Singapore, Singapore
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Bhattarai P, Shrestha A, Xiong S, Peoples N, Ramakrishnan C, Shrestha S, Yin R, Karmacharya B, Yan LL, Jafar TH. Strengthening urban primary healthcare service delivery using electronic health technologies: A qualitative study in urban Nepal. Digit Health 2022; 8:20552076221114182. [PMID: 35898291 PMCID: PMC9309786 DOI: 10.1177/20552076221114182] [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: 01/17/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nepal is a South Asian country with a high burden of non-communicable diseases. Electronic health technologies are a promising strategy to mitigate the rising burden of non-communicable diseases by strengthening primary healthcare center service delivery. However, electronic health implementation in Nepal is limited. Furthermore, electronic health use at the primary healthcare center level is chronically understudied. This qualitative study seeks to understand the perceived awareness, benefits, and determinants of electronic health uptake in Nepal, focusing on primary healthcare center-level non-communicable disease management. Methods We conducted in-depth interviews with 27 participants including policymakers, health experts, facility administrators, providers, and non-communicable diseases patients in 2019. We selected six urban primary healthcare center facilities via cluster convenience sampling for recruiting facility administrators, providers, and patients, and used convenience sampling to recruit policymakers and experts. We conducted thematic data analysis inductively and deductively using the electronic health readiness assessment framework to understand perceived barriers and facilitators of electronic health implementation. Results While there was general awareness and acceptance of electronic health, multiple barriers impede readiness for implementation. These include policy making gaps, language barriers, low user technical literacy, concerns of overreliance on technology, and inadequate training for administrators and providers. Stakeholder suggestions include creating electronic health interfaces that meet the needs of end users (providers and patients), providing training to enable end users to effectively use electronic health technologies, and strong policy support at the national level. Conclusion We identify several determinants for effectively promoting the use of electronic health for non-communicable diseases service delivery at the primary healthcare center level in Nepal.
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Affiliation(s)
- Prayog Bhattarai
- Yale-NUS College, Singapore,Biraj Karmacharya, Department of Community
Programs, Kathmandu University School of Medical Sciences (KUSMS), Nepal.
Lijing L. Yan, Global Health Research
Center, Duke Kunshan University, China.
| | - Abha Shrestha
- Kathmandu University School of Medical
Sciences (KUSMS), Nepal
| | - Shangzhi Xiong
- Duke Kunshan University, ChinaThe George Institute for Global Health, University
of New South Wales, Australia
| | | | | | | | - Ruoyu Yin
- Department of Family Medicine and Primary Care, Nanyang Technological
University, Singapore
| | - Biraj Karmacharya
- Department of Community Programs, Kathmandu University School of
Medical Sciences (KUSMS), Nepal
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, China
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Basnet B, Yadav JK, Gajurel BP, Shing YK, Kandel B, Nepal G. Role of female community health volunteers in ischemic stroke prevention, identification, referral and rehabilitation in Nepal. Ann Med Surg (Lond) 2021; 72:102893. [PMID: 34992775 PMCID: PMC8712991 DOI: 10.1016/j.amsu.2021.102893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 01/01/2023] Open
Abstract
For the past three decades, female community health volunteers (FCHVs) have been at the forefront of Nepal's health map and have contributed significantly to its improving health indicators such as maternal mortality rate and infant mortality rate. Given the changing epidemiology of Nepal and the shift of burden from communicable to non-communicable diseases (NCDs), it is important to revitalize their role with the changing times. The prevalence of ischemic stroke in Nepal is on the rise. However, very few people make it to the hospital within the time frame for thrombolysis and the patient's knowledge about ischemic stroke seems to play a major part. FCHVs can play a significant role in improving ischemic stroke care by raising awareness about the condition, its risk factors, and informing the public about the need for timely treatment. They can help screen for common risk factors such as obesity, hypertension and diabetes as well as monitor for treatment in previously diagnosed individuals. Randomized controlled trials have shown to yield favorable results in NCDs with engagement of FCHVs. With proper training and support, they can play an important role in improving ischemic stroke care in low- and middle-income countries like Nepal.
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Affiliation(s)
- Babin Basnet
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Jayant Kumar Yadav
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Yow Ka Shing
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bipin Kandel
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Gaurav Nepal
- Rani Primary Health Care Center, Biratnagar 56613, Morang, Nepal
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Bhandari B, Schutte AE, Jayasuriya R, Vaidya A, Subedi M, Narasimhan P. Acceptability of a mHealth strategy for hypertension management in a low-income and middle-income country setting: a formative qualitative study among patients and healthcare providers. BMJ Open 2021; 11:e052986. [PMID: 34824118 PMCID: PMC8627401 DOI: 10.1136/bmjopen-2021-052986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Understanding contextual needs and preferences is important for a successful design and effective outcome of a mHealth strategy. OBJECTIVES This formative study aimed to explore the perspectives of patients and providers on the acceptability of a mHealth (text message) strategy and elicit preferred features of a mHealth strategy for hypertension management. DESIGN A qualitative study was conducted using in-depth interviews and focus group discussions guided by the technology acceptance model. SETTING The study was conducted at primary healthcare facilities and at a tertiary level referral hospital in Kathmandu, Nepal. PARTICIPANTS A total of 61 participants, patients with hypertension (n=41), their family members (n=5), healthcare workers (n=11) and key informants (n=4) were included. We purposively recruited patients with hypertension aged 30-70 who attended the selected healthcare facilities to obtain maximum variation based on their age, sex and literacy. RESULTS The respondents perceived the mHealth strategy to be useful as it would reinforce medication compliance and behaviour change. Participants valued the trustworthiness of information from health authorities that could be delivered privately. Some implementation challenges were identified including a lack of technical manpower, resources for software development, gaps in recording a patient's essential information and digital illiteracy. Solutions proposed were having system-level preparedness for recording the patient's details, establishing a separate technical department in the hospital and involving a family member to assist illiterate/elderly patients. In addition, participants preferred text messages in the local language, containing comprehensive contextual content (disease, treatment, cultural foods and misconceptions) delivered at regular intervals (2-3 times/week) preferably in the morning or evening. CONCLUSIONS We found that a simple text messaging strategy was acceptable for hypertension management in this low/middle-income country setting. However, meticulous planning must address the needs of a diverse range of participants to ensure the mHealth strategy is acceptable to wider groups.
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Affiliation(s)
- Buna Bhandari
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Central Department of Public Health, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Rohan Jayasuriya
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Abhinav Vaidya
- Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Madhusudan Subedi
- School of Public Health, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Padmanesan Narasimhan
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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6
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Peoples N, Gong E, Gautam K, Khanal SN, Kohrt BA, Koirala S, Amatya A, Xiong S, Østbye T, Moe J, Long Q, Yan LL. Perception and Use of Primary Healthcare Services Among People With Cardiometabolic Diseases in Two Resource-Limited Areas in Nepal: A Mixed Methods Study. Front Public Health 2021; 9:698030. [PMID: 34631643 PMCID: PMC8494788 DOI: 10.3389/fpubh.2021.698030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Nepal is a country in south Asia with a high burden of cardiometabolic diseases (CMDs). Strengthening primary healthcare (PHC) is a key strategy to mitigate this increasing burden and achieve universal health coverage. While previous studies in Nepal have assessed PHC use among the elderly, none have specifically explored PHC use among people with CMDs. Therefore, this mixed-methods study aimed to assess the use and perception of PHC services in Nepal among people living with CMDs for primary and secondary prevention of cardiovascular disease. We used a quantitative survey followed-up by semi-structured qualitative interviews. The sampling frame comprised five PHC facilities in Sindhuli district (rural; eastern Nepal) and five in Kailali district (urban; western Nepal), with participants selected from each facility via convenience sampling. 114 people (mean age: 54.5 ± 14.7, sex ratio 1.04) with CMDs participated in the survey. Survey data showed general dissatisfaction with PHC services. Medicine cost was rated "too expensive" by 52 and 63% of rural and urban participants, respectively. Interview data showed that perceived poor bedside manner was tied to negative perceptions of PHC quality, and vice versa. Lack of resources and excessive barriers to care was mentioned by every interviewee. In conclusion, PHC use was high but overall satisfaction relatively low. Our results suggest that bedside manner is a practical target for future research. Additionally, we identified several barriers to care, and, based on existing literature, we suggest electronic-health interventions may have potential to mitigate these challenges.
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Affiliation(s)
- Nicholas Peoples
- Baylor College of Medicine, Houston, TX, United States
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Enying Gong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Shree N. Khanal
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- George Washington University, Department of Psychiatry and Behavioral Science, Washington, DC, United States
| | - Suraj Koirala
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Archana Amatya
- Institute of Medicine, Department of Community Medicine and Public Health, Tribhuvan University, Kathmandu, Nepal
| | - Shangzhi Xiong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Truls Østbye
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Jeffrey Moe
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Health Sciences, Wuhan University, Wuhan, China
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7
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Yan LL, Gong E, Gu W, Turner EL, Gallis JA, Zhou Y, Li Z, McCormack KE, Xu LQ, Bettger JP, Tang S, Wang Y, Oldenburg B. Effectiveness of a primary care-based integrated mobile health intervention for stroke management in rural China (SINEMA): A cluster-randomized controlled trial. PLoS Med 2021; 18:e1003582. [PMID: 33909607 PMCID: PMC8115798 DOI: 10.1371/journal.pmed.1003582] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/12/2021] [Accepted: 03/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Managing noncommunicable diseases through primary healthcare has been identified as the key strategy to achieve universal health coverage but is challenging in most low- and middle-income countries. Stroke is the leading cause of death and disability in rural China. This study aims to determine whether a primary care-based integrated mobile health intervention (SINEMA intervention) could improve stroke management in rural China. METHODS AND FINDINGS Based on extensive barrier analyses, contextual research, and feasibility studies, we conducted a community-based, two-arm cluster-randomized controlled trial with blinded outcome assessment in Hebei Province, rural Northern China including 1,299 stroke patients (mean age: 65.7 [SD:8.2], 42.6% females, 71.2% received education below primary school) recruited from 50 villages between June 23 and July 21, 2017. Villages were randomly assigned (1:1) to either the intervention or control arm (usual care). In the intervention arm, village doctors who were government-sponsored primary healthcare providers received training, conducted monthly follow-up visits supported by an Android-based mobile application, and received performance-based payments. Participants received monthly doctor visits and automatically dispatched daily voice messages. The primary outcome was the 12-month change in systolic blood pressure (BP). Secondary outcomes were predefined, including diastolic BP, health-related quality of life, physical activity level, self-reported medication adherence (antiplatelet, statin, and antihypertensive), and performance in "timed up and go" test. Analyses were conducted in the intention-to-treat framework at the individual level with clusters and stratified design accounted for by following the prepublished statistical analysis plan. All villages completed the 12-month follow-up, and 611 (intervention) and 615 (control) patients were successfully followed (3.4% lost to follow-up among survivors). The program was implemented with high fidelity, and the annual program delivery cost per capita was US$24.3. There was a significant reduction in systolic BP in the intervention as compared with the control group with an adjusted mean difference: -2.8 mm Hg (95% CI -4.8, -0.9; p = 0.005). The intervention was significantly associated with improvements in 6 out of 7 secondary outcomes in diastolic BP reduction (p < 0.001), health-related quality of life (p = 0.008), physical activity level (p < 0.001), adherence in statin (p = 0.003) and antihypertensive medicines (p = 0.039), and performance in "timed up and go" test (p = 0.022). We observed reductions in all exploratory outcomes, including stroke recurrence (4.4% versus 9.3%; risk ratio [RR] = 0.46, 95% CI 0.32, 0.66; risk difference [RD] = 4.9 percentage points [pp]), hospitalization (4.4% versus 9.3%; RR = 0.45, 95% CI 0.32, 0.62; RD = 4.9 pp), disability (20.9% versus 30.2%; RR = 0.65, 95% CI 0.53, 0.79; RD = 9.3 pp), and death (1.8% versus 3.1%; RR = 0.52, 95% CI 0.28, 0.96; RD = 1.3 pp). Limitations include the relatively short study duration of only 1 year and the generalizability of our findings beyond the study setting. CONCLUSIONS In this study, a primary care-based mobile health intervention integrating provider-centered and patient-facing technology was effective in reducing BP and improving stroke secondary prevention in a resource-limited rural setting in China. TRIAL REGISTRATION ClinicalTrials.gov NCT03185858.
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Affiliation(s)
- Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- The George Institute for Global Health, Beijing, China
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
- Peking University School of Global Health and Development, Beijing, China
- * E-mail:
| | - Enying Gong
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Wanbing Gu
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- Vital Strategies, Jinan Representative Office, Beijing, China
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics & Bioinformatics, Duke University, Durham North Carolina, United States
| | - John A. Gallis
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics & Bioinformatics, Duke University, Durham North Carolina, United States
| | - Yun Zhou
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kara E. McCormack
- Department of Biostatistics & Bioinformatics, Duke University, Durham North Carolina, United States
| | - Li-Qun Xu
- China Mobile Industry Institute, Chengdu, China
| | - Janet P. Bettger
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Orthopedic Surgery, Duke University, Durham North Carolina, United States of America
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Yilong Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
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Pham TV, Kaiser BN, Koirala R, Maharjan SM, Upadhaya N, Franz L, Kohrt BA. Traditional Healers and Mental Health in Nepal: A Scoping Review. Cult Med Psychiatry 2021; 45:97-140. [PMID: 32444961 PMCID: PMC7680349 DOI: 10.1007/s11013-020-09676-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Despite extensive ethnographic and qualitative research on traditional healers in Nepal, the role of traditional healers in relation to mental health has not been synthesized. We focused on the following clinically based research question, "What are the processes by which Nepali traditional healers address mental well-being?" We adopted a scoping review methodology to maximize the available literature base and conducted a modified thematic analysis rooted in grounded theory, ethnography, and phenomenology. We searched five databases using terms related to traditional healers and mental health. We contacted key authors and reviewed references for additional literature. Our scoping review yielded 86 eligible studies, 65 of which relied solely on classical qualitative study designs. The reviewed literature suggests that traditional healers use a wide range of interventions that utilize magico-religious explanatory models to invoke symbolic transference, manipulation of local illness narratives, roles, and relationships, cognitive restructuring, meaning-making, and catharsis. Traditional healers' perceived impact appears greatest for mild to moderate forms of psychological distress. However, the methodological and sample heterogeneity preclude uniform conclusions about traditional healing. Further research should employ methods which are both empirically sound and culturally adapted to explore the role of traditional healers in mental health.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry and Behavioral Sciences, Duke University, 2301 Erwin Road, Durham, NC, 27701, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | - Bonnie N Kaiser
- Duke Global Health Institute, Durham, NC, USA
- Department of Anthropology and Global Health Program, University of California San Diego, La Jolla, CA, USA
| | - Rishav Koirala
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- University of Oslo, Oslo, Norway
- Brain and Neuroscience Center Nepal, Kathmandu, Nepal
| | | | | | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke University, 2301 Erwin Road, Durham, NC, 27701, USA
- Duke Global Health Institute, Durham, NC, USA
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, Duke University, 2301 Erwin Road, Durham, NC, 27701, USA
- Duke Global Health Institute, Durham, NC, USA
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Department of Psychiatry and Behavioral Sciences, George Washington, Washington, DC, USA
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9
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Ni Z, Lebowitz ER, Zou Z, Wang H, Liu H, Shrestha R, Zhang Q, Hu J, Yang S, Xu L, Wu J, Altice FL. Response to the COVID-19 Outbreak in Urban Settings in China. J Urban Health 2021; 98:41-52. [PMID: 33258088 PMCID: PMC7703725 DOI: 10.1007/s11524-020-00498-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 02/05/2023]
Abstract
The COVID-19 outbreak in China was devastating and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2-11, 2020, 4607 individuals were recruited from 11 provinces with varying numbers of COVID-19 cases using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, the recommended public health practices significantly (p < 0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR = 1.58, p < 0.01), living in regions with a higher density of COVID-19 cases (aOR = 2.13, p < 0.01), having completed college (aOR = 1.38, p = 0.03), meeting screening criteria for depression (aOR = 6.03, p < 0.01), and poorer perceived health status (aOR = 1.54, p < 0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.
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Affiliation(s)
- Zhao Ni
- School of Medicine, Yale University, New Haven, Connecticut, USA.
| | - Eli R Lebowitz
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Zhijie Zou
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Huaping Liu
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Roman Shrestha
- School of Medicine, Yale University, New Haven, Connecticut, USA.,Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Qing Zhang
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Jianwei Hu
- College of Nursing, Xi'an Medical University, Xi'an, Shaanxi, China
| | - Shuying Yang
- Hohhot Vocational College, Hohhot, Inner Mongolia, China
| | - Lei Xu
- School of Nursing, Fudan University, Shanghai, China
| | - Jianjun Wu
- Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Frederick L Altice
- School of Medicine, Yale University, New Haven, Connecticut, USA.,West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.,School of Public Health, Yale University, New Haven, Connecticut, USA
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Ni Z, Lebowitz ER, Zou Z, Wang H, Liu H, Shrestha R, Zhang Q, Hu J, Yang S, Xu L, Wu J, Altice FL. Response to the COVID-19 Outbreak in Urban Settings in China. RESEARCH SQUARE 2020. [PMID: 32935093 PMCID: PMC7491581 DOI: 10.21203/rs.3.rs-71833/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The COVID-19 outbreak in China was devastating, and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2-11, 2020, 4,607 individuals were recruited from 11 provinces with varying numbers of COVID-19 casers using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2,551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, recommended public health practices significantly (p <0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR=1.58, p <0.01), living in regions with a higher density of COVID-19 cases (aOR=2.13, p <0.01), having completed college (aOR=1.38, p =0.03), meeting screening criteria for depression (aOR=6.03, p <0.01) and poorer perceived health status (aOR=1.54, p <0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.
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Affiliation(s)
- Zhao Ni
- School of Medicine, Yale University, New Haven, CT, USA
| | | | - Zhijie Zou
- School of Health Sciences, Wuhan University, Hubei, China
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Hunan, China
| | - Huaping Liu
- School of Nursing, Peking Union Medical College, Beijing, China
| | | | - Qing Zhang
- School of Health Sciences, Wuhan University, Hubei, China
| | - Jianwei Hu
- College of Nursing, Xi'an Medical University, Xi'an, China
| | | | - Lei Xu
- School of Nursing, Fudan University, Shanghai, China
| | - Jianjun Wu
- Gansu University of Chinese Medicine, Lanzhou, China
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