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O'Connor S, Tilston G, Jones O, Sharma A, Ormesher L, Quinn B, Wilson A, Myers J, Peek N, Palin V. Acceptability of data linkage to identify women at risk of postnatal complication for the development of digital risk prediction tools and interventions to better optimise postnatal care, a qualitative descriptive study design. BMC Med 2024; 22:276. [PMID: 38956666 PMCID: PMC11220952 DOI: 10.1186/s12916-024-03489-7] [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: 02/06/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Pregnancy acts as a cardiovascular stress test. Although many complications resolve following birth, women with hypertensive disorder of pregnancy have an increased risk of developing cardiovascular disease (CVD) long-term. Monitoring postnatal health can reduce this risk but requires better methods to identity high-risk women for timely interventions. METHODS Employing a qualitative descriptive study design, focus groups and/or interviews were conducted, separately engaging public contributors and clinical professionals. Diverse participants were recruited through social media convenience sampling. Semi-structured, facilitator-led discussions explored perspectives of current postnatal assessment and attitudes towards linking patient electronic healthcare data to develop digital tools for identifying postpartum women at risk of CVD. Participant perspectives were gathered using post-it notes or a facilitator scribe and analysed thematically. RESULTS From 27 public and seven clinical contributors, five themes regarding postnatal check expectations versus reality were developed, including 'limited resources', 'low maternal health priority', 'lack of knowledge', 'ineffective systems' and 'new mum syndrome'. Despite some concerns, all supported data linkage to identify women postnatally, targeting intervention to those at greater risk of CVD. Participants outlined potential benefits of digitalisation and risk prediction, highlighting design and communication needs for diverse communities. CONCLUSIONS Current health system constraints in England contribute to suboptimal postnatal care. Integrating data linkage and improving education on data and digital tools for maternal healthcare shows promise for enhanced monitoring and improved future health. Recognised for streamlining processes and risk prediction, digital tools may enable more person-centred care plans, addressing the gaps in current postnatal care practice.
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Affiliation(s)
- Siobhán O'Connor
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - George Tilston
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Olivia Jones
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, The University of Manchester, Manchester, M13 9WL, UK
| | | | - Laura Ormesher
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, The University of Manchester, Manchester, M13 9WL, UK
| | - Bradley Quinn
- Health Innovation Manchester, Manchester, M13 9NQ, UK
| | - Anthony Wilson
- Clinical Data Science Unit, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Jenny Myers
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, The University of Manchester, Manchester, M13 9WL, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, M13 9PL, UK
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Victoria Palin
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, M13 9PL, UK.
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, The University of Manchester, Manchester, M13 9WL, UK.
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Jia H. Impact of digital infrastructure construction on the migrants' utilization of basic public health services in China. BMC Health Serv Res 2024; 24:761. [PMID: 38910262 PMCID: PMC11194986 DOI: 10.1186/s12913-024-11221-7] [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: 04/30/2024] [Accepted: 06/19/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Global digitalization significantly impacts public health by improving healthcare access for marginalized populations. In China, socioeconomic disparities and the Hukou system create significant barriers for the migrant population to access basic public health services (BPHS). This study aimed to assess how digital infrastructure construction (DIC) affects BPHS utilization among China's migrant populations, filling a gap in the literature regarding the relationship between digital advancements and health service accessibility. METHODS This research used micro-level data from the 2018 China Migrants Dynamic Survey and incorporated variables aligned with the Broadband China policy to employ a comprehensive empirical strategy. It included baseline regressions, robustness checks through propensity score matching and machine learning techniques, and heterogeneity analysis to explore the differential impacts of DIC based on gender, age, education level, and Hukou status. RESULTS The findings revealed that DIC significantly enhances the likelihood of migrants establishing health records and registering with family doctors, demonstrating quantifiable improvements in health service utilization. Heterogeneity analysis further indicated that the beneficial impacts of DIC were more pronounced among female migrants, those with higher education levels, younger populations, and urban Hukou holders. CONCLUSIONS DIC plays a crucial role in bridging the accessibility gap to BPHS for migrant populations in China, contributing to narrowing health disparities and advancing social equity. These results emphasize the significance of digital infrastructure in public health strategies and offer valuable insights for policymakers, healthcare providers, and researchers. Future research should prioritize longitudinal studies on the sustained effects of DIC and tailor digital health initiatives to meet the unique needs of migrant populations, promoting inclusive health policy planning and implementation.
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Affiliation(s)
- Haowen Jia
- School of Economics, Shandong Technology and Business University, Yantai, Shandong, China.
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3
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Shi Y, Stanmore E, McGarrigle L, Todd C. Social-media based Health Education plus Exercise Programme (SHEEP) to improve muscle function among community-dwelling young-old adults with possible sarcopenia in China: A study protocol for intervention development. PLoS One 2024; 19:e0286490. [PMID: 38547178 PMCID: PMC10977808 DOI: 10.1371/journal.pone.0286490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024] Open
Abstract
Possible sarcopenia refers to low muscle strength. Prevalence of possible sarcopenia is estimated to be significantly higher in community-dwelling older adults than that of confirmed or severe sarcopenia. However, there are currently far fewer non-pharmacological intervention strategies for possible sarcopenia than for sarcopenia in the community. Meanwhile, one type of non-pharmacological intervention in sarcopenic area, health education, is under-researched, and older people's awareness about sarcopenia is extremely low, necessitating an immediate dissemination tool for prevention. Social media may be a potential, scalable, low-cost tool for this. This study protocol outlines how a social media-based multicomponent intervention will be co-designed with stakeholders to address this evidence gap. Guided by the Medical Research Council's framework, the proposed research covers two phases that employ a co-design approach to develop a theory-based multicomponent intervention to increase sarcopenia prevention in the community. The participants will be recruited from young-old adults (60~69) with possible sarcopenia in the community of Changsha, China. Maximum sample size will be 45 participants in total, with 18~25 participants in the development phase and 15~20 participants in the pre-test phase. During two rounds of focus groups with older adults, a social-media based intervention strategy will be developed from a theory-based conceptual model and an initial intervention plan formulated by the research group. After this, there will be a three-week pre-test phase, followed by a semi-structured interview to further modify the theory-based conceptual model and the social-media based intervention strategy. The focus of the data analysis will be on thematic analysis of qualitative data primarily derived from the group interview and the semi-structured interview with key stakeholders.
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Affiliation(s)
- Ya Shi
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- School of Nursing & School of Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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4
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Popa V, Geissler J, Vermeulen R, Priest E, Capperella K, Susuzlu G, Terry SF, Brooke N. Delivering Digital Health Solutions that Patients Need: A Call to Action. Ther Innov Regul Sci 2024; 58:236-241. [PMID: 38082118 PMCID: PMC10850017 DOI: 10.1007/s43441-023-00592-4] [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] [Received: 05/09/2023] [Accepted: 10/27/2023] [Indexed: 02/09/2024]
Abstract
Digital health solutions have the potential to complement traditional healthcare approaches and deliver improved health outcomes, but there are system-wide challenges that need to be addressed. These include fragmentation of the digital health landscape, regulatory processes that lack the agility to accommodate the fast pace of digital health advances, and inadequate transparency around data sharing and data governance. All of these challenges have led to mistrust, limited understanding and sharing of best practices, a lack of digital education and awareness, and insufficient patient and public engagement and involvement. In this paper, we argue that for digital health solutions to fulfil their potential, there needs to be a significant increase in early, meaningful, and sustained engagement with the people they intend to benefit. The uptake as well as the impact of digital solutions created in partnership with patients for patients are greater and more relevant to the communities they address.
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5
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Sidek NN, Tengku Ismail TA, Kamalakannan S, Chen XW, Romli MH, Mat Said MZ, Papachristou Nadal I, Ibrahim KA, Musa KI. A mixed-methods study on the implementation of a mobile health application (mHealth app) for stroke caregivers in Malaysia: healthcare providers' perspective. Front Neurol 2023; 14:1222260. [PMID: 37905189 PMCID: PMC10613485 DOI: 10.3389/fneur.2023.1222260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/12/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Recognizing the burden experienced by caregivers of stroke survivors, an intervention using mobile health applications (mHealth apps) has been proposed to support and empower stroke caregivers. This study aimed to assess the acceptability and expectations of healthcare providers, who play a vital role as gatekeepers in the healthcare system, to ensure the effectiveness and sustainability of the intervention. Methods This was a concurrent mixed-method study design, with healthcare providers involved in stroke care management in the northeast regions of Malaysia as study participants. The qualitative component of the study was conducted using a phenomenological approach that involved in-depth interviews to explore the acceptability and expectations of healthcare providers regarding the adoption of mHealth apps in the context of stroke caregiving. The study was complemented by quantitative data collected through an online survey using an adjusted version of the technology acceptance model tool. Results In total, 239 participants from diverse backgrounds and professions were enrolled in the study, with 12 in the qualitative component and 227 in the quantitative component. The findings from the quantitative survey showed that over 80% of the participants expressed their intention to use mHealth apps. The qualitative component generated two themes related to the acceptability and expectations of mHealth apps, which were integrated with the quantitative findings. Additionally, in-depth interviews revealed a new theme, namely the key features of mHealth, with three sub-themes: availability of services for caregivers, provision of knowledge skills, and supporting caregivers in managing stroke patients. Conclusion Healthcare providers demonstrated excellent acceptability of this mHealth intervention as part of caregiving assistance, particularly with the inclusion of essential key features. However, future investigations are necessary to establish the feasibility of integrating the mHealth app into the healthcare system and to ensure its long-term sustainability.
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Affiliation(s)
- Norsima Nazifah Sidek
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Sureshkumar Kamalakannan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Social Work, Education, and Community Well-being, Northumbria University, Coach Lane Campus, Newcastle upon Tyne, United Kingdom
| | - Xin Wee Chen
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, UPM Teaching Hospital, Faculty of Medicine and Health Sciences, Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | | | | | - Khairul Azmi Ibrahim
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
- Department of Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Huffman JC, Feig EH, Zambrano J, Celano CM. Positive Psychology Interventions in Medical Populations: Critical Issues in Intervention Development, Testing, and Implementation. AFFECTIVE SCIENCE 2023; 4:59-71. [PMID: 37070006 PMCID: PMC10105001 DOI: 10.1007/s42761-022-00137-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022]
Abstract
Positive psychological well-being is prospectively associated with superior health outcomes. Positive psychology interventions have promise as a potentially feasible and effective means of increasing well-being and health in those with medical illness, and several initial studies have shown the potential of such programs in medical populations. At the same time, numerous key issues in the existing positive psychology literature must be addressed to ensure that these interventions are optimally effective. These include (1) assessing the nature and scope of PPWB as part of intervention development and application; (2) identifying and utilizing theoretical models that can clearly outline potential mechanisms by which positive psychology interventions may affect health outcomes; (3) determining consistent, realistic targets for positive psychology interventions; (4) developing consistent approaches to the promotion of positive psychological well-being; (5) emphasizing the inclusion of diverse samples in treatment development and testing; and (6) considering implementation and scalability from the start of intervention development to ensure effective real-world application. Attention to these six domains could greatly facilitate the generation of effective, replicable, and easily adopted positive psychology programs for medical populations with the potential to have an important impact on public health.
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Affiliation(s)
- Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, MB Boston, USA
| | - Emily H. Feig
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, MB Boston, USA
| | - Juliana Zambrano
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, MB Boston, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, MB Boston, USA
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7
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Liu SH, Wu YR, Chen W, Su CH, Chin CL. Using Ballistocardiogram and Impedance Plethysmogram for Minimal Contact Measurement of Blood Pressure Based on a Body Weight-Fat Scale. SENSORS (BASEL, SWITZERLAND) 2023; 23:2318. [PMID: 36850917 PMCID: PMC9966183 DOI: 10.3390/s23042318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Electronic health (eHealth) is a strategy to improve the physical and mental condition of a human, collecting daily physiological data and information from digital apparatuses. Body weight and blood pressure (BP) are the most popular and important physiological data. The goal of this study is to develop a minimal contact BP measurement method based on a commercial body weight-fat scale, capturing biometrics when users stand on it. The pulse transit time (PTT) is extracted from the ballistocardiogram (BCG) and impedance plethysmogram (IPG), measured by four strain gauges and four footpads of a commercial body weight-fat scale. Cuffless BP measurement using the electrocardiogram (ECG) and photoplethysmogram (PPG) serves as the reference method. The BP measured by a commercial BP monitor is considered the ground truth. Twenty subjects participated in this study. By the proposed model, the root-mean-square errors and correlation coefficients (r2s) of estimated systolic blood pressure and diastolic blood pressure are 7.3 ± 2.1 mmHg and 4.5 ± 1.8 mmHg, and 0.570 ± 0.205 and 0.284 ± 0.166, respectively. This accuracy level achieves the C grade of the corresponding IEEE standard. Thus, the proposed method has the potential benefit for eHealth monitoring in daily application.
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Affiliation(s)
- Shing-Hong Liu
- Department of Computer Science and Information Engineering, Chaoyang University of Technology, Taichung City 41349, Taiwan
| | - Yan-Rong Wu
- Department of Computer Science and Information Engineering, Chaoyang University of Technology, Taichung City 41349, Taiwan
| | - Wenxi Chen
- Biomedical Information Engineering Laboratory, The University of Aizu, Aizu-Wakamatsu City 965-8580, Japan
| | - Chun-Hung Su
- Institute of Medicine, School of Medicine, Chung-Shan Medical University, Taichung City 40201, Taiwan
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung City 40201, Taiwan
| | - Chiun-Li Chin
- Department of Medical Informatics, Chung-Shan Medical University, Taichung City 40201, Taiwan
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8
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Baniya M, Rana C, Dhakal R, Makower SG, Halpin SJ, Hariharan R, Sivan M, Allsop MJ. The Experience of Limited Access to Care for Community-Based Patients With Spinal Cord Injury and Stroke in Nepal and the Potential of Telerehabilitation: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580221146830. [PMID: 36799352 PMCID: PMC9940166 DOI: 10.1177/00469580221146830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This study explores the experiences of care received and management of disability for individuals with spinal cord injury and stroke following discharge from a specialty rehabilitation center, alongside perspectives on the potential role of telerehabilitation. We employed qualitative in-depth face-to-face interviews with patients who had accessed and been discharged from a specialist rehabilitation center in Nepal were used. Interviews sought perspectives of adjusting to, living with, and managing disability alongside the potential role of telerehabilitation in the community setting. Inductive thematic analysis was used to derive themes. A total of 17 participants with spinal cord injuries or stroke were interviewed. Four generated themes included: (i) Difficulties accessing support and perceived mismanagement following initial neurological injury; (ii) Realizing the magnitude and impact of an injury in the absence of clear routes to support; (iii) A multi-faceted symptom burden and its impact; and (iv) The nature and types of interaction with health professionals post-discharge and the potential role of telerehabilitation. We detail accounts of suspended periods with minimal or no support provided from healthcare providers for people with spinal cord injury and stroke following initial acute management. Telerehabilitation could be a worthwhile approach to enhance access to rehabilitation in the community setting but must accompany national efforts to enhance the provision of specialist rehabilitation.
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Affiliation(s)
| | - Chanda Rana
- Spinal Injury Rehabilitation Center, Kavre, Nepal
| | - Raju Dhakal
- Spinal Injury Rehabilitation Center, Kavre, Nepal
| | | | - Stephen J Halpin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK,University of Leeds, Leeds, UK
| | - Ram Hariharan
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Manoj Sivan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK,University of Leeds, Leeds, UK
| | - Matthew J Allsop
- University of Leeds, Leeds, UK,Matthew Allsop, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds LS2 9JT, UK.
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Ridde V, Kane B, Mbow NB, Senghor I, Faye A. The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal. BMJ Glob Health 2022; 7:bmjgh-2022-010062. [PMID: 36526299 PMCID: PMC9764624 DOI: 10.1136/bmjgh-2022-010062] [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: 07/05/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In its pursuit of solutions for universal health coverage (UHC), Senegal has set up two departmental health insurance units (UDAMs) since 2014. Few studies on the resilience of health systems in Africa have examined health insurance organisations. This article aims to understand how these two UDAMs have been resilient during the COVID-19 pandemic and the restrictive measures imposed by the State to maintain services to their members and reimbursements to healthcare providers. METHODS This study was a multicase study with multiple levels of analysis using a conceptual framework of resilience and analysis of organisational configurations. Empirical data are derived from document analysis, observations for 6 months and 17 qualitative in-depth interviews. RESULTS The results identified three main configurations concerning (1) safety and hygiene, (2) organisation and planning and (3) communication for sustainable payment. The UDAM faced the pandemic with resilience processes to absorb the shock and maintain service to their members. The UDAM learnt positive lessons from crisis management, such as remote work or the ability to support members in their care in hospitals away from their headquarters. They have innovated (transformative resilience) with the organisation of electronic payment and the use of social networks to raise funds and communicate with members. Strengthening their effectiveness after the shock of the departure of the donors in 2017 contributed to the adaptation and even transformation from the pandemic shock of 2020 and 2021. The study shows that leadership, team dynamics and adaptation to contexts are drivers of resilience processes. CONCLUSION Both UDAMs adapted to the shocks of the pandemic and government measures to maintain the services of their members and their organisational routine. This resilience confirms that UDAMs are one of the possible solutions for UHC in the Sahel.
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Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Ceped, Paris, France,Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
| | - Babacar Kane
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
| | - Ndeye Bineta Mbow
- Foundiougne, Sénégal, Departmental Health Insurance Unit, Foundiougne, Senegal
| | - Ibrahima Senghor
- Koungheul, Sénégal, Departmental Health Insurance Unit, Koungheul, Senegal
| | - Adama Faye
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
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Kwasnicka D, Keller J, Perski O, Potthoff S, Ten Hoor GA, Ainsworth B, Crutzen R, Dohle S, van Dongen A, Heino M, Henrich JF, Knox L, König LM, Maltinsky W, McCallum C, Nalukwago J, Neter E, Nurmi J, Spitschan M, Van Beurden SB, Van der Laan LN, Wunsch K, Levink JJJ, Sanderman R. White Paper: Open Digital Health - accelerating transparent and scalable health promotion and treatment. Health Psychol Rev 2022; 16:475-491. [PMID: 35240931 DOI: 10.1080/17437199.2022.2046482] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In this White Paper, we outline recommendations from the perspective of health psychology and behavioural science, addressing three research gaps: (1) What methods in the health psychology research toolkit can be best used for developing and evaluating digital health tools? (2) What are the most feasible strategies to reuse digital health tools across populations and settings? (3) What are the main advantages and challenges of sharing (openly publishing) data, code, intervention content and design features of digital health tools? We provide actionable suggestions for researchers joining the continuously growing Open Digital Health movement, poised to revolutionise health psychology research and practice in the coming years. This White Paper is positioned in the current context of the COVID-19 pandemic, exploring how digital health tools have rapidly gained popularity in 2020-2022, when world-wide health promotion and treatment efforts rapidly shifted from face-to-face to remote delivery. This statement is written by the Directors of the not-for-profit Open Digital Health initiative (n = 6), Experts attending the European Health Psychology Society Synergy Expert Meeting (n = 17), and the initiative consultant, following a two-day meeting (19-20th August 2021).
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Affiliation(s)
- Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - Jan Keller
- Department of Education and Psychology; Freie Universität Berlin, Berlin, Germany
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Gill A Ten Hoor
- Department of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Ben Ainsworth
- Department of Psychology, University of Bath, Bath, UK
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, the Netherlands
| | - Simone Dohle
- Department of Psychology, University of Cologne, Cologne, Germany and Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Anne van Dongen
- Department of Psychology, Health, and Technology, University of Twente, Enschede, the Netherlands
| | - Matti Heino
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Julia F Henrich
- Faculty of Social and Behavioural Sciences, Leiden University, Institute of Psychology, Unit of Health-, Medical- and Neuropsychology, Leiden, The Netherlands
| | - Liam Knox
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, UK
| | - Laura M König
- Faculty of Life Sciences, University of Bayreuth, Bayreuth, Germany
| | - Wendy Maltinsky
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, UK
| | - Claire McCallum
- Centre for Digital Health and Care, Faculty of Engineering, University of Bristol, Bristol, UK
| | - Judith Nalukwago
- Center for Communication Programs, USAID-Social and Behavior Change Activity, Johns Hopkins University Bloomberg School of Public Health, Kampala, Uganda
| | - Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Johanna Nurmi
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,University of Cambridge, Behavioural Science Group, Primary Care Unit, Institute of Public Health, Forvie Site, Cambridge, UK
| | - Manuel Spitschan
- TUM Department of Sport and Health Sciences (TUM SG), Technical University of Munich, Munich, Germany and Translational Sensory and Circadian Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | | | - L Nynke Van der Laan
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
| | - Kathrin Wunsch
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Karlsruhe, Germany
| | - Jasper J J Levink
- Levink Life Sciences BV & Stichting Feniks Ontwikkelingsbegeleiding, Utrecht, The Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health, and Technology, University of Twente, Enschede, the Netherlands.,Department of Health Psychology, University Medical Center Groningen University of Groningen, Groningen, The Netherlands
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Kalinga A, Munga M, Ngenya A, John W, Kisoka W, Oriyo N, Mutalemwa P, Mandara W, Masagati L, Ogondiek J, Korir P, Klarmann-Schulz U, Horn S, Kroidl I, Debrah A, Hoerauf A, Mwingira U. The viability of utilising phone-based text messages in data capture and reporting morbidities due to lymphatic Filariasis by community health workers: a qualitative study in Kilwa district, Tanzania. BMC Health Serv Res 2022; 22:924. [PMID: 35854308 PMCID: PMC9295502 DOI: 10.1186/s12913-022-08256-z] [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: 11/12/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Globally, there is recognition of the value of using mobile phones among health providers in improving health systems performance. However, in many Low- and Middle-income countries where there is shortage of health providers, Community Health Workers have assumed some responsibilities especially relating to identifying and reporting on health problems within their communities. Despite the known benefits of using mobile phone technology to deliver health services, there is limited information on the extent to which Community Health Workers are able to effectively use the technology in data collection and reporting. The aim of this study was to determine the feasibility of utilizing phone-based text messages on Lymphatic Filariasis morbidity surveillance by Community Health Workers. Methods This was a cross sectional study whose data was collected through key informant interviews and focused group discussions among community health workers, health providers and staff of neglected tropical diseases control program. Collected transcripts were analysed through Thematic content analysis as it allowed for the identification of data codes through inductive reasoning. Results The use of mobile phone-based text messages in data collection and reporting lymphatic filariasis morbidity cases by Community Health Workers was perceived by study participants to be a relevant tool and feasible due to the ease of use of the technology. The tool was reported by end-users to significantly increase their performance and efficiency was gained in terms of reduced paper work, increased the number of patients accessing health care services and the ability to report in real-time. All respondents were confident that Community Health Workers were the right persons to interact with communities in tracking and reporting morbidity cases using mobile technology. Conclusion Mobile phone-based text messages have proven to be effective in routine workflows such as, data collection and reporting on Lymphatic Filariasis morbidity cases, patient to provider communication, decision making and supportive supervision. Mobile phones have also improved efficiency and general performance of end users in terms of increased number of cases identified and efficiency gained in terms of reduced paper work and the ability to collect and report in real-time.
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Affiliation(s)
- Akili Kalinga
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania.
| | - Michael Munga
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Abdallah Ngenya
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Winfrida John
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - William Kisoka
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Ndekya Oriyo
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Prince Mutalemwa
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Wilfred Mandara
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Leonard Masagati
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - John Ogondiek
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Patricia Korir
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), Bonn, Germany
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), Bonn, Germany
| | - Sacha Horn
- Division of Infectious Diseases and Tropical Medicine, University Hospital Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,German Centre for Infection Research (DZIF), Neglected Tropical Diseases, Partner Site, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,German Centre for Infection Research (DZIF), Neglected Tropical Diseases, Partner Site, Munich, Germany
| | - Alex Debrah
- Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), Bonn, Germany
| | - Upendo Mwingira
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania.,Research Triangle Institute (RTI), International, Washington DC, USA
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Sorg H, Ehlers JP, Sorg CGG. Digitalization in Medicine: Are German Medical Students Well Prepared for the Future? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8308. [PMID: 35886156 PMCID: PMC9317432 DOI: 10.3390/ijerph19148308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022]
Abstract
The German healthcare system is facing a major transformation towards digitalized medicine. The aim was to find out the attitude and the degree of preparation of upcoming medical professionals for digital medicine. By means of an online survey, medical students from 38 German faculties were asked about different topics concerning digitalization. Most students (70.0%) indicated that they had not had any university courses on digital topics. Thus, only 22.2% feel prepared for the technical reality of digitalized medicine. Most fear losing patient contact because of digitalized medicine and assume that the medical profession will not be endangered by digitalization. Security systems, data protection, infrastructure and inadequate training are cited as the top problems of digitalization in medicine. Medical students have major concerns about incorrect decisions and the consecutive medicolegal aspects of using digital support as part their treatment plans. Digitalization in medicine is progressing faster than it can currently be implemented in the practical work. The generations involved have different understandings of technology, and there is a lack of curricular training in medical schools. There must be a significant improvement in training in digital medical skills so that the current and future healthcare professionals are better prepared for digitalized medicine.
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Affiliation(s)
- Heiko Sorg
- Didactics and Education Research in the Health Sector, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany;
- Department of Plastic and Reconstructive Surgery, Marien Hospital Witten, 58452 Witten, Germany
| | - Jan P. Ehlers
- Didactics and Education Research in the Health Sector, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany;
| | - Christian G. G. Sorg
- Department of Management and Entrepreneurship, Faculty of Management, Economics and Society, University of Witten/Herdecke, 58455 Witten, Germany;
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13
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Reid HW, Proeschold-Bell RJ, Makarushka C, Melgar Vega KD, Huchko M, Jeronimo J, Vasudevan L. Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspección Visual con Ácido Acético System: Mixed Methods Case Study. JMIR Form Res 2022; 6:e32577. [PMID: 35737455 PMCID: PMC9264128 DOI: 10.2196/32577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/03/2022] [Accepted: 05/02/2022] [Indexed: 12/03/2022] Open
Abstract
Background There is growing evidence supporting the use of mobile health (mHealth) interventions in low- and middle-income countries to address resource limitations in the delivery of health information and services to vulnerable populations. In parallel, there is an increasing emphasis on the use of implementation science tools and frameworks for the early identification of implementation barriers and to improve the acceptability, appropriateness, and adoption of mHealth interventions in resource-limited settings. However, there are limited examples of the application of implementation science tools and frameworks to the formative phase of mHealth design for resource-limited settings despite the potential benefits of this work for enhancing subsequent implementation, scale-up, and sustainability. Objective We presented a case study on the use of an implementation science framework in mHealth design. In particular, we illustrated the usability of the Consolidated Framework for Implementation Research (CFIR) for organizing and interpreting formative research findings during the design of the mobile Inspección Visual con Ácido Acético (mIVAA) system in Lima, Peru. Methods We collected formative data from prospective users of the mIVAA intervention using multiple research methodologies, including structured observations, surveys, group and individual interviews, and discussions with local stakeholders at the partnering organization in Peru. These activities enabled the documentation of clinical workflows, perceived barriers to and facilitators of mIVAA, overarching barriers to cervical cancer screening in community-based settings, and related local policies and guidelines in health care. Using a convergent mixed methods analytic approach and the CFIR as an organizing framework, we mapped formative research findings to identify key implementation barriers and inform iterations of the mIVAA system design. Results In the setting of our case study, most implementation barriers were identified in the CFIR domains of intervention characteristics and inner setting. All but one barrier were addressed before mIVAA deployment by modifying the system design and adding supportive resources. Solutions involved improvements to infrastructure, including cellular data plans to avoid disruption from internet failure; improved process and flow, including an updated software interface; and better user role definition for image capture to be consistent with local health care laws. Conclusions The CFIR can serve as a comprehensive framework for organizing formative research data and identifying key implementation barriers during mHealth intervention design. In our case study of the mIVAA system in Peru, formative research contributing to the CFIR domains of intervention characteristics and inner setting elicited the most key barriers to implementation. The early identification of barriers enabled design iterations before system deployment. Future efforts to develop mHealth interventions for low- and middle-income countries may benefit from using the approach presented in this case study as well as prioritizing the CFIR domains of intervention characteristics and inner setting.
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Affiliation(s)
| | - Rae Jean Proeschold-Bell
- Duke Global Health Institute, Durham, NC, United States
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States
| | - Christina Makarushka
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
| | | | - Megan Huchko
- Duke University School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States
| | | | - Lavanya Vasudevan
- Duke University School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
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14
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Ojo A, Tolentino H, Yoon SS. Strengthening eHealth Systems to Support Universal Health Coverage in sub-Saharan Africa. Online J Public Health Inform 2021; 13:E17. [PMID: 35079321 PMCID: PMC8769196 DOI: 10.5210/ojphi.v13i3.11550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of universal health coverage (UHC) is to ensure that all individuals in a country have access to quality healthcare services and do not suffer financial hardship in using these services. However, progress toward attaining UHC has been slow, particularly in sub-Saharan Africa. The use of information and communication technologies for healthcare, known as eHealth, can facilitate access to quality healthcare at minimal cost. eHealth systems also provide the information needed to monitor progress toward UHC. However, in most countries, eHealth systems are sometimes non-functional and do not serve programmatic purposes. Therefore, it is crucial to implement strategies to strengthen eHealth systems to support UHC. This perspective piece proposes a conceptual framework for strengthening eHealth systems to attain UHC goals and to help guide UHC and eHealth strategy development.
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Affiliation(s)
- Adebowale Ojo
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA
- Public Health Informatics Fellowship Program, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
| | - Herman Tolentino
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Steven S. Yoon
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA
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15
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Flott K, Maguire J, Phillips N. Digital safety: the next frontier for patient safety. Future Healthc J 2021; 8:e598-e601. [PMID: 34888448 DOI: 10.7861/fhj.2021-0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Healthcare safety is the product of many interrelated parts of the health system that change over time, so efforts to improve safety also need to evolve and modernise to pre-empt emerging risks. One major shift is that the records and data infrastructure necessary to support safety improvements and evaluation are increasingly facilitated by, or dependent on, digital technologies. Continuing to reduce harm and save lives requires taking a closer look at digital technologies, both in the risks they present and the solutions they offer. The priorities for digital clinical safety can be considered in two parts: first, the intrinsic safety of technologies, and second, the extrinsic ability of technologies to drive safety. Embracing these two components requires digital clinical safety to become part of the healthcare culture, with everyone understanding their role in digital clinical safety. It must include processes being easy to follow with clear, accessible guidance, accompanied by targeted standards. Patients and staff must be equipped and empowered via digital clinical safety training. Finally, the vision for digital safety includes safety solutions that should be digitally enabled, with digital technologies appropriately applied to tackle major patient safety issues.
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16
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Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, Sayed S, Adam P, Aguilar B, Andronikou S, Boehme C, Cherniak W, Cheung AN, Dahn B, Donoso-Bach L, Douglas T, Garcia P, Hussain S, Iyer HS, Kohli M, Labrique AB, Looi LM, Meara JG, Nkengasong J, Pai M, Pool KL, Ramaiya K, Schroeder L, Shah D, Sullivan R, Tan BS, Walia K. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; 398:1997-2050. [PMID: 34626542 PMCID: PMC8494468 DOI: 10.1016/s0140-6736(21)00673-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Affiliation(s)
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | - Bertha Aguilar
- Médicos e Investigadores de la Lucha Contra el Cáncer de Mama, Mexico City, Mexico
| | - Savvas Andronikou
- Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | | | - William Cherniak
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie Ny Cheung
- The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Sarwat Hussain
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Hari S Iyer
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alain B Labrique
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Lee Schroeder
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Devanshi Shah
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Kamini Walia
- Indian Council of Medical Research, Delhi, India
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17
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Kickbusch I, Piselli D, Agrawal A, Balicer R, Banner O, Adelhardt M, Capobianco E, Fabian C, Singh Gill A, Lupton D, Medhora RP, Ndili N, Ryś A, Sambuli N, Settle D, Swaminathan S, Morales JV, Wolpert M, Wyckoff AW, Xue L. The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world. Lancet 2021; 398:1727-1776. [PMID: 34706260 DOI: 10.1016/s0140-6736(21)01824-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/09/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Ilona Kickbusch
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Dario Piselli
- Centre for International Environmental Studies, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Anurag Agrawal
- CSIR Institute of Genomics and Integrative Biology, Delhi, India; Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Ran Balicer
- Clalit Research Institute, Tel Aviv, Israel; Clalit Health Services, Tel Aviv, Israel
| | - Olivia Banner
- School of Arts, Technology and Emerging Communication, The University of Texas at Dallas, Richardson, TX, USA
| | - Michael Adelhardt
- Competence Centre Health and Social Protection, Deutsche Gesellschaft für Internationale Zusammenarbeit, Bonn, Germany
| | - Emanuele Capobianco
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Amandeep Singh Gill
- International Digital Health & AI Research Collaborative, Geneva, Switzerland
| | - Deborah Lupton
- Centre for Social Research in Health, Social Policy Research Centre, Australian Research Council for Automated Decision-Making and Society, University of New South Wales, Sydney, NSW, Australia
| | | | - Njide Ndili
- PharmAccess Foundation Nigeria, Lagos, Nigeria
| | - Andrzej Ryś
- Health Systems, Medical Products and Innovation, European Commission, Brussels, Belgium
| | | | | | | | | | | | - Andrew W Wyckoff
- Directorate for Science, Technology and Innovation, Organisation for Economic Co-operation and Development, Paris, France
| | - Lan Xue
- The Schwarzman College, Tsinghua University, China
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18
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Hicks JP, Allsop MJ, Akaba GO, Yalma RM, Dirisu O, Okusanya B, Tukur J, Okunade K, Akeju D, Ajepe A, Okuzu O, Mirzoev T, Ebenso B. Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study. JMIR Mhealth Uhealth 2021; 9:e24182. [PMID: 34528891 PMCID: PMC8485189 DOI: 10.2196/24182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/12/2020] [Accepted: 08/01/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. OBJECTIVE This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. METHODS A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers' knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders' experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention's acceptability and usability in the work environment. RESULTS In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. CONCLUSIONS This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs' workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. TRIAL REGISTRATION ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372.
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Affiliation(s)
- Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Matthew John Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Godwin O Akaba
- Department of Obstetrics and Gynaecology, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Ramsey M Yalma
- Department of Community Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
| | | | - Babasola Okusanya
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Kehinde Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - David Akeju
- Department of Sociology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adegbenga Ajepe
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Okey Okuzu
- Instrat Global Health Solutions, Abuja, Nigeria
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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19
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Bartlett L, Avery L, Ponnappan P, Chelangat J, Cheruiyot J, Matthews R, Rocheleau M, Tikkanen M, Allen M, Amendola P, Labrique A. Insights into the design, development and implementation of a novel digital health tool for skilled birth attendants to support quality maternity care in Kenya. Fam Med Community Health 2021; 9:fmch-2020-000845. [PMID: 34344764 PMCID: PMC8336131 DOI: 10.1136/fmch-2020-000845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Linda Bartlett
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Avery
- Centre for Global Public Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | | | | | | | | | | | | | - Mark Allen
- Strategic Partnerships, Merck for Mothers, Kenilworth, New Jersey, USA
| | | | - Alain Labrique
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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20
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Troncoso EL, Breads J. Best of both worlds: digital health and nursing together for healthier communities. Int Nurs Rev 2021; 68:504-511. [PMID: 34133028 DOI: 10.1111/inr.12685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
AIM This manuscript offers a set of practical recommendations to the nursing and digital health communities in order to achieve a common vision of nurses fully engaged with and leading digital health solutions for universal health coverage. BACKGROUND Nurses comprise the largest occupation of health workers in the world and play a central role in efforts to achieve Sustainable Development Goals. Nevertheless, though they are essential to delivering health care, nursing voices are too often absent in the design and implementation of new technology and digital health advances. The World Health Organization recognizes digital health as a critical catalyst for advancing universal health coverage and the aims of the Sustainable Development Goals. Therefore, the use of digital health by nurses is globally recommended as a channel of practice to strengthen nursing services and allow practitioners to significantly improve health outcomes. SOURCES OF EVIDENCE Websites of the World Health Organization, United Nations, peer-reviewed research search engines, as well as the experiences of both authors. DISCUSSION Digital health is transforming the entirety of the healthcare provision system and these systemic changes require engagement, leadership and championing from nurses. CONCLUSION AND IMPLICATIONS FOR NURSING PRACTICE AND POLICY Both the nursing and digital health communities have much to gain from each other and can be stronger together. The authors offer a set of practical recommendations for both the nursing and digital health communities to implement to optimize mutual efforts towards achieving universal health coverage.
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21
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Sant Fruchtman C, Mbuyita S, Mwanyika-Sando M, Braun M, de Savigny D, Cobos Muñoz D. The complexity of scaling up an mHealth intervention: the case of SMS for Life in Tanzania from a health systems integration perspective. BMC Health Serv Res 2021; 21:343. [PMID: 33853601 PMCID: PMC8048333 DOI: 10.1186/s12913-021-06285-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. METHODS A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. RESULTS SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme's failure to adapt to the continuous changes in Tanzania's health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. CONCLUSION This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.
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Affiliation(s)
- Carmen Sant Fruchtman
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | | | | | | | - Don de Savigny
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Mistry SK, Akter F, Yadav UN, Hossain MB, Sichel A, Labrique AB, Storisteanu DML. Factors associated with mobile phone usage to access maternal and child healthcare among women of urban slums in Dhaka, Bangladesh: a cross-sectional study. BMJ Open 2021; 11:e043933. [PMID: 33837099 PMCID: PMC8043001 DOI: 10.1136/bmjopen-2020-043933] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION With the acute shortage of human resources and infrastructure, mobile phones can be a critical tool for accessing health services and strengthening health systems in Bangladesh. Yet, there is a scarcity of evidence on the use of mobile phones in this context for accessing health services. In this study, we sought to explore the current use of mobile phones for accessing maternal and child healthcare and its determinants among recently delivered women in urban slums of Bangladesh. METHODS The data were collected through interviewing 800 recently delivered women from eight slums of Dhaka city of Bangladesh during May and June 2018. The study followed a cross-sectional design and a two-stage cluster random sampling procedure was followed. A pretested structured questionnaire was employed to collect information. Chi square tests were performed for descriptive analyses and a multilevel binary logistic regression model was executed to explore the determinants of mobile phone usage for accessing maternal and childcare among the participants. RESULTS Overall, 73.8% of study participants used mobile phones for accessing maternal and child healthcare. After adjusting for potential confounders, participants' age, husband's occupation, sex of household head, women's ownership of mobile phones and household wealth status were found to be significantly associated with higher odds of using mobile phones to access maternal and child healthcare. CONCLUSION The study highlighted the possibility of implementing large-scale mobile health (mHealth) interventions in slum settlements for accessing maternal and child healthcare and is a sustainable mitigation strategy for the acute health worker crisis in Bangladesh. The findings of this study are particularly crucial for policymakers and practitioners while they revise the health policy to incorporate mHealth interventions as highlighted in the recently initiated Digital Health Strategy of Bangladesh.
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Affiliation(s)
- Sabuj Kanti Mistry
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Fahmida Akter
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Center for Research Policy and Implementation, Biratnagar, Nepal
| | - Md Belal Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Alain B Labrique
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Dietzel N, Kürten L, Karrer L, Reichold M, Köhler L, Nagel A, Chmelirsch C, Seebahn K, Hladik M, Meuer S, Kirchner A, Holm K, Selau M, Wendel M, Trinkwalter J, Prokosch HU, Graessel E, Kolominsky-Rabas PL. Digital Dementia Registry Bavaria-digiDEM Bayern: study protocol for a multicentre, prospective, longitudinal register study. BMJ Open 2021; 11:e043473. [PMID: 33558357 PMCID: PMC7871684 DOI: 10.1136/bmjopen-2020-043473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Dementia is one of the most relevant widespread diseases, with a prevalence of currently 50 million people with dementia worldwide. The care of people with dementia will be one of the major challenges for healthcare systems worldwide. Digitalisation offers new possibilities to improve both dementia healthcare and health outcomes research as a fundament for national healthcare planning. The 'Digital Dementia Registry Bavaria-digiDEM Bayern' aims to improve the understanding of the complexity and long-term progression of dementia and the current care situation in Bavaria. Moreover, by offering digital services, digiDEM will actively contribute to improving the care situation in Bavaria. METHODS AND ANALYSIS: digiDEM will recruit people with dementia and their family caregivers in all administrative regions of Bavaria. All participants will undergo dementia screening prior to study inclusion in order to identify people with mild cognitive impairment and mild-to-moderate dementia. Participants will be followed up over a period of three years. Sociodemographic data, type of dementia, symptoms, diagnosis, cognitive trajectories, activities of daily living, behavioural and psychological symptoms, falls, resource utilisation, caregiver burden, quality of life, needs of people with dementia and their caregivers, mobility, use of media and sources of information will be assessed. The project will implement a digital web-based platform for data collection. Data will be collected by means of standardised online or face-to-face interviews. ETHICS AND DISSEMINATION The study obtained ethical approval from the Ethics Committee of the Medical Faculty of Friedrich-Alexander-University Erlangen-Nürnberg (FAU) (application number: 253_20 B). Findings will be used for evidence-based decision-making for health decision-makers in order to optimise dementia healthcare in the state of Bavaria. Specific analyses will be conducted for the participating research partners. Results of the study will be published in peer-reviewed journals.
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Affiliation(s)
- Nikolas Dietzel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Lara Kürten
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Linda Karrer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Reichold
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Laura Köhler
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Andreas Nagel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christina Chmelirsch
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kathrin Seebahn
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Markus Hladik
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Meuer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna Kirchner
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kristina Holm
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marina Selau
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marco Wendel
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Jörg Trinkwalter
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Bent B, Sim I, Dunn JP. Digital Medicine Community Perspectives and Challenges: Survey Study. JMIR Mhealth Uhealth 2021; 9:e24570. [PMID: 33533721 PMCID: PMC7889423 DOI: 10.2196/24570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/17/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The field of digital medicine has seen rapid growth over the past decade. With this unfettered growth, challenges surrounding interoperability have emerged as a critical barrier to translating digital medicine into practice. In order to understand how to mitigate challenges in digital medicine research and practice, this community must understand the landscape of digital medicine professionals, which digital medicine tools are being used and how, and user perspectives on current challenges in the field of digital medicine. OBJECTIVE The primary objective of this study is to provide information to the digital medicine community that is working to establish frameworks and best practices for interoperability in digital medicine. We sought to learn about the background of digital medicine professionals and determine which sensors and file types are being used most commonly in digital medicine research. We also sought to understand perspectives on digital medicine interoperability. METHODS We used a web-based survey to query a total of 56 digital medicine professionals from May 1, 2020, to July 10, 2020, on their educational and work experience, the sensors, file types, and toolkits they use professionally, and their perspectives on interoperability in digital medicine. RESULTS We determined that the digital medicine community comes from diverse educational backgrounds and uses a variety of sensors and file types. Sensors measuring physical activity and the cardiovascular system are the most frequently used, and smartphones continue to be the dominant source of digital health information collection in the digital medicine community. We show that there is not a general consensus on file types in digital medicine, and data are currently handled in multiple ways. There is consensus that interoperability is a critical impediment in digital medicine, with 93% (52) of survey respondents in agreement. However, only 36% (20) of respondents currently use tools for interoperability in digital medicine. We identified three key interoperability needs to be met: integration with electronic health records, implementation of standard data schemas, and standard and verifiable methods for digital medicine research. We show that digital medicine professionals are eager to adopt new tools to solve interoperability problems, and we suggest tools to support digital medicine interoperability. CONCLUSIONS Understanding the digital medicine community, the sensors and file types they use, and their perspectives on interoperability will enable the development and implementation of solutions that fill critical interoperability gaps in digital medicine. The challenges to interoperability outlined by this study will drive the next steps in creating an interoperable digital medicine community. Establishing best practices to address these challenges and employing platforms for digital medicine interoperability will be essential to furthering the field of digital medicine.
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Affiliation(s)
- Brinnae Bent
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Ida Sim
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jessilyn P Dunn
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, United States
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Berg CJ, Harutyunyan A, Paichadze N, Hyder AA, Petrosyan V. Addressing cancer prevention and control in Armenia: tobacco control and mHealth as key strategies. Int J Equity Health 2021; 20:4. [PMID: 33407461 PMCID: PMC7789615 DOI: 10.1186/s12939-020-01344-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
This paper focuses on the particular challenges in cancer prevention and control (CPC) in low- and middle-income countries (LMICs). In particular, this paper extrapolates challenges and opportunities in Armenia, which has the 2nd highest rate of cancer-related deaths in the world, the 11th highest smoking prevalence among men globally, and an evolving health system infrastructure for non-communicable disease (NCD) prevention and control, including CPC. Despite significant progress in enhancing research capacity in Armenia over the past decade, additional efforts are needed, particularly in CPC-related research. Key opportunities are to advance tobacco control and utilization of mHealth. Public health training programs remain insufficient in the area of CPC, and in-country research expertise regarding CPC and related areas (e.g., tobacco control, mHealth, policy) is limited, particularly given the need to address the diverse and complex determinants of onset, prevention, and management of cancer. Moreover, critical gaps in research dissemination and knowledge translation from evidence to policy and practice continue to exist. Thus, public health infrastructure must be enhanced, in-country CPC leaders across various relevant disciplines must be further developed and supported, and medical and public health training must more fully integrate CPC and research dissemination and translation to inform policy and practice.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA.
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Nino Paichadze
- Center on Commercial Determinants of Health and Department of Global Health, Milken Institute School of Public Health, Washington, DC, USA
| | - Adnan A Hyder
- Center on Commercial Determinants of Health and Department of Global Health, Milken Institute School of Public Health, Washington, DC, USA
| | - Varduhi Petrosyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Himes BE, Leszinsky L, Walsh R, Hepner H, Wu AC. Mobile Health and Inhaler-Based Monitoring Devices for Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2535-2543. [PMID: 31706485 DOI: 10.1016/j.jaip.2019.08.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/16/2022]
Abstract
Mobile health and web applications (apps), wearables, and other personal monitoring devices have tremendous potential to improve the management of asthma. More than 500 asthma-related apps, whether standalone or paired with sensors on inhalers, are currently available for health education, symptom recording, tracking of inhaler use, displaying environmental alerts, and providing medication reminders. Benefits of these tools include the ability to longitudinally collect symptom, trigger, and inhaler usage data, allowing the detection of significant changes over time to help patients and their caregivers determine whether symptoms are worsening. In addition, data from external information sources, including weather, allergen, and air quality reports, can be integrated with user-specific data to enhance predictions on when patients may experience symptoms and/or need to avoid triggers. Barriers to adoption of asthma-related apps and inhaler-based devices include uncertain efficacy and effectiveness, potential high cost, sustained user engagement, and concerns about privacy. Moreover, ensuring the acceptability and utility of asthma management apps for individuals of all races/ethnicities, socioeconomic groups, ages, genders, and literacy levels is necessary. Based on studies thus far, mobile health apps and inhaler-based devices have great potential to serve as useful tools in the patient-doctor relationship and revolutionize asthma care.
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Affiliation(s)
- Blanca E Himes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Lena Leszinsky
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Ryan Walsh
- Center for Healthcare Research in Pediatrics (CHeRP) and PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Hannah Hepner
- Center for Healthcare Research in Pediatrics (CHeRP) and PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics (CHeRP) and PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
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Mahoney MF. Telehealth, Telemedicine, and Related Technologic Platforms: Current Practice and Response to the COVID-19 Pandemic. J Wound Ostomy Continence Nurs 2020; 47:439-444. [PMID: 32970029 PMCID: PMC7722284 DOI: 10.1097/won.0000000000000694] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Providing health care at a distance has evolved over the past decades, resulting in a myriad of terms and styles of care delivery. Telehealth is defined as any health care service delivered at a distance. Nursing services have been delivered by a wide range of specialty nurses for many years using various technological formats. Clinical experience suggests that few WOC nurses had extensively adopted these technologies and principles into their practice as recently as 2019. However, the COVID-19 pandemic of 2020 has forced both administrators and clinicians to rapidly adapt or introduce telemedicine technologies to deliver specialty care including WOC nurse services. CASES Three WOC nurses were chosen to describe the use of telehealth technologies to illustrate opportunities for WOC nurses to integrate telehealth nursing into a health care setting. Two adapted telehealth technology into their practice before the pandemic, and one started telehealth practice as a means to provide care after the onset of the pandemic. Disadvantages and advantages are discussed to provide further information regarding WOC patient care using these technologies. CONCLUSION The pandemic crisis has accelerated the need for health care to reimagine the delivery of care to patients. Telehealth technologies and principles have emerged as essential for WOC nurses to deliver safe and effective care.
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Affiliation(s)
- Mary F. Mahoney
- Mary F. Mahoney, MSN, RN, CWOCN, CFCN, UnityPoint at Home, West Des Moines, Iowa; WEB WOC Nursing Education Programs, Adjunct Faculty
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Abstract
Depression is one of the most common comorbidities of many chronic medical diseases including cancer and cardiovascular, metabolic, inflammatory and neurological disorders. Indeed, the prevalence of depression in these patient groups is often substantially higher than in the general population, and depression accounts for a substantial part of the psychosocial burden of these disorders. Many factors can contribute to the occurrence of comorbid depression, such as shared genetic factors, converging biological pathways, social factors, health behaviours and psychological factors. Diagnosis of depression in patients with a medical disorder can be particularly challenging owing to symptomatic overlap. Although pharmacological and psychological treatments can be effective, adjustments may need to be made for patients with a comorbid medical disorder. In addition, symptoms or treatments of medical disorders may interfere with the treatment of depression. Conversely, symptoms of depression may decrease adherence to treatment of both disorders. Thus, comprehensive treatment plans are necessary to optimize care.
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Scherr TF, Moore CP, Thuma P, Wright DW. Evaluating Network Readiness for mHealth Interventions Using the Beacon Mobile Phone App: Application Development and Validation Study. JMIR Mhealth Uhealth 2020; 8:e18413. [PMID: 32720909 PMCID: PMC7420690 DOI: 10.2196/18413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions have the potential to transform the global health care landscape. The processing power of mobile devices continues to increase, and growth of mobile phone use has been observed worldwide. Uncertainty remains among key stakeholders and decision makers as to whether global health interventions can successfully tap into this trend. However, when correctly implemented, mHealth can reduce geographic, financial, and social barriers to quality health care. OBJECTIVE The aim of this study was to design and test Beacon, a mobile phone-based tool for evaluating mHealth readiness in global health interventions. Here, we present the results of an application validation study designed to understand the mobile network landscape in and around Macha, Zambia, in 2019. METHODS Beacon was developed as an automated mobile phone app that continually collects spatiotemporal data and measures indicators of network performance. Beacon was used in and around Macha, Zambia, in 2019. Results were collected, even in the absence of network connectivity, and asynchronously uploaded to a database for further analysis. RESULTS Beacon was used to evaluate three mobile phone networks around Macha. Carriers A and B completed 6820/7034 (97.0%) and 6701/7034 (95.3%) downloads and 1349/1608 (83.9%) and 1431/1608 (89.0%) uploads, respectively, while Carrier C completed only 62/1373 (4.5%) file downloads and 0/1373 (0.0%) file uploads. File downloads generally occurred within 4 to 12 seconds, and their maximum download speeds occurred between 2 AM and 5 AM. A decrease in network performance, demonstrated by increases in upload and download durations, was observed beginning at 5 PM and continued throughout the evening. CONCLUSIONS Beacon was able to compare the performance of different cellular networks, show times of day when cellular networks experience heavy loads and slow down, and identify geographic "dead zones" with limited or no cellular service. Beacon is a ready-to-use tool that could be used by organizations that are considering implementing mHealth interventions in low- and middle-income countries but are questioning the feasibility of the interventions, including infrastructure and cost. It could also be used by organizations that are looking to optimize the delivery of an existing mHealth intervention with improved logistics management.
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Affiliation(s)
| | - Carson Paige Moore
- Department of Chemistry, Vanderbilt University, Nashville, TN, United States
| | | | - David Wilson Wright
- Department of Chemistry, Vanderbilt University, Nashville, TN, United States
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Wu AC. There's an App for That, But Does It Work? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2592-2593. [PMID: 31706488 DOI: 10.1016/j.jaip.2019.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ann Chen Wu
- Center for Healthcare Research in Pediatrics (CHeRP) and PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
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Winters N, Venkatapuram S, Geniets A, Wynne-Bannister E. Prioritarian principles for digital health in low resource settings. JOURNAL OF MEDICAL ETHICS 2020; 46:259-264. [PMID: 31949027 PMCID: PMC7231431 DOI: 10.1136/medethics-2019-105468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/28/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
This theoretical paper argues for prioritarianism as an ethical underpinning for digital health in contexts of extreme disadvantage. In support of this claim, the paper develops three prioritarian principles for making ethical decisions for digital health programme design, grounded in the normative position that the greater the need (of the marginalised), the stronger the moral claim. The principles are positioned as an alternative view to the prevailing utilitarian approach to digital health, which the paper argues is not sufficient to address the needs of the worst off. As researchers of digital health, we must ensure that the most globally marginalised are not overlooked by overtly technocentric implementation practices. Consequently, the paper concludes by advocating for use of the three principles to support stronger critical reflection on the ethics involved in the design and implementation of digital health programmes.
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Affiliation(s)
- Niall Winters
- Department of Education, University of Oxford, Oxford, UK
| | - Sridhar Venkatapuram
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Anne Geniets
- Department of Education, University of Oxford, Oxford, UK
| | - Emma Wynne-Bannister
- Department of Global Health and Social Medicine, King's College London, London, UK
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Khan FA, Mullany LC, Wu LFS, Ali H, Shaikh S, Alland K, West Jr KP, Labrique AB. Predictors of neonatal mortality: development and validation of prognostic models using prospective data from rural Bangladesh. BMJ Glob Health 2020; 5:e001983. [PMID: 32133171 PMCID: PMC7042570 DOI: 10.1136/bmjgh-2019-001983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/10/2019] [Accepted: 12/10/2019] [Indexed: 12/23/2022] Open
Abstract
Objective To assess the extent to which maternal histories of newborn danger signs independently or combined with birth weight and/or gestational age (GA) can capture and/or predict postsecond day (age>48 hours) neonatal death. Methods Data from a cluster-randomised trial conducted in rural Bangladesh were split into development and validation sets. The prompted recall of danger signs and birth weight measurements were collected within 48 hours postchildbirth. Maternally recalled danger signs included cyanosis (any part of the infant's body was blue at birth), non-cephalic presentation (part other than head came out first at birth), lethargy (weak or no arm/leg movement and/or cry at birth), trouble suckling (infant unable to suckle/feed normally in the 2 days after birth or before death, collected 1-month postpartum or from verbal autopsy). Last menstrual period was collected at maternal enrolment early in pregnancy. Singleton newborns surviving 2 days past childbirth were eligible for analysis. Prognostic multivariable models were developed and internally validated. Results Recalling ≥1 sign of lethargy, cyanosis, non-cephalic presentation or trouble suckling identified postsecond day neonatal death with 65.3% sensitivity, 60.8% specificity, 2.1% positive predictive value (PPV) and 99.3% negative predictive value (NPV) in the development set. Requiring either lethargy or weight <2.5 kg identified 89.1% of deaths (at 39.7% specificity, 1.9% PPV and 99.6% NPV) while lethargy or preterm birth (<37 weeks) captured 81.0% of deaths (at 53.6% specificity, 2.3% PPV and 99.5% NPV). A simplified model (birth weight, GA, lethargy, cyanosis, non-cephalic presentation and trouble suckling) predicted death with good discrimination (validation area under the receiver-operator characteristic curve (AUC) 0.80, 95% CI 0.73 to 0.87). A further simplified model (GA, non-cephalic presentation, lethargy, trouble suckling) predicted death with moderate discrimination (validation AUC 0.74, 95% CI 0.66 to 0.81). Conclusion Maternally recalled danger signs, coupled to either birth weight or GA, can predict and capture postsecond day neonatal death with high discrimination and sensitivity.
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Affiliation(s)
- Farhad A Khan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee F-S Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saijuddin Shaikh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelsey Alland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West Jr
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Curioso WH. Building Capacity and Training for Digital Health: Challenges and Opportunities in Latin America. J Med Internet Res 2019; 21:e16513. [PMID: 31850849 PMCID: PMC6939247 DOI: 10.2196/16513] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/22/2019] [Accepted: 12/09/2019] [Indexed: 12/23/2022] Open
Abstract
Tackling global health challenges demands the appropriate use of available technologies. Although digital health could significantly improve health care access, use, quality, and outcomes, realizing this possibility requires personnel trained in digital health. There is growing evidence of the benefits of digital health for improving the performance of health systems and outcomes in developed countries. However, significant gaps remain in resource-constrained settings. Technological and socio-cultural disparities between different regions or between provinces within the same country are prevalent. Rural areas, where the promise and need are highest, are particularly deprived. In Latin America, there is an unmet need for training and building the capacity of professionals in digital health. This viewpoint paper aims to present a selection of experiences in building digital health capacity in Latin America to illustrate a series of challenges and opportunities for strengthening digital health training programs in resource-constrained environments. These describe how a successful digital health ecosystem for Latin America requires culturally relevant and collaborative research and training programs in digital health. These programs should be responsive to the needs of all relevant regional stakeholders, including government agencies, non–governmental organizations, industry, academic or research entities, professional societies, and communities. This paper highlights the role that collaborative partnerships can play in sharing resources, experiences, and lessons learned between countries to optimize training and research opportunities in Latin America.
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Affiliation(s)
- Walter H Curioso
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
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Dickman Portz J, Ford K, Bekelman DB, Boxer RS, Kutner JS, Czaja S, Elsbernd K, Bull S. "We're Taking Something So Human and Trying to Digitize": Provider Recommendations for mHealth in Palliative Care. J Palliat Med 2019; 23:240-247. [PMID: 31526220 DOI: 10.1089/jpm.2019.0216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Mobile health (mHealth) is a promising tool for improving health outcomes. However, the benefits of using mHealth in palliative care are under studied. Objective: As a first step to designing meaningful palliative care-specific mobile applications, this research explored provider perspectives regarding the utility of mHealth in palliative care. Design: A qualitative phenomenological study with semistructured interviews. Setting/Subjects: Providers from multiple disciplines working in palliative care settings at an academic medical center. Results: Thematic analysis resulted in five provider recommendations regarding the utility and design of palliative care-specific mHealth, including (i) thoughtfulness to language, context, and delivery when assessing palliative care needs; (ii) include tools for prognosis and advance care planning; (iii) tailor health and quality-of-life goals; (iv) emphasize supports for family and caregivers; and (v) consider technology abilities of older adults. Conclusions: Palliative care providers are enthusiastic about the use of mHealth to improve care coordination, facilitate communication, enhance symptom monitoring, and improve patient-family support. However, providers have reservations about mobile functionality and depersonalized assessment and care. Providers stress the utility of mHealth to facilitate palliative care rather than replace important multidisciplinary services.
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Affiliation(s)
- Jennifer Dickman Portz
- Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado.,mHealth Impact Lab, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kelsey Ford
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David B Bekelman
- Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado.,Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, Colorado
| | - Rebecca S Boxer
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Jean S Kutner
- Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado
| | - Sara Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - Kira Elsbernd
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sheana Bull
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Sundstrom B, DeMaria AL, Ferrara M, Smith E, McInnis S. “People are struggling in this area:” a qualitative study of women’s perspectives of telehealth in rural South Carolina. Women Health 2019; 60:352-365. [DOI: 10.1080/03630242.2019.1643814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Beth Sundstrom
- Department of Communication, College of Charleston, Charleston, SC, USA
| | - Andrea L. DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Merissa Ferrara
- Department of Communication, College of Charleston, Charleston, SC, USA
| | - Ellie Smith
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Stephanie McInnis
- Department of Communication, The College of Charleston, Charleston, SC, USA
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