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van Zyl C, Mokkink LB, Derman W, Hanekom S, Heine M. Patient-Reported Outcome Measures in Key Sub-Saharan African Languages to Promote Diversity: A Scoping Review. Value Health Reg Issues 2023; 34:86-99. [PMID: 36621214 DOI: 10.1016/j.vhri.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/12/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Sub-Saharan Africa is a world region rich and diverse in cultures and languages; yet, it is also challenged with regard to resources that may facilitate the cultural adaptation or development of patient-reported outcome measures (PROMs). Systematic exclusion of patients' "voices," because of gaps in the availability of PROMs, may perpetuate health inequity. Hence, the objective is to describe the availability of PROMs in the non-English, sub-Saharan African languages. METHODS A scoping review was conducted to identify PROMs that had been translated, validated, or developed for use in 32 selected, non-English, sub-Saharan African languages pertaining to health outcomes. Four databases were searched (May 7, 2021), and additional articles were identified through reference screening and via corresponding authors. Data were extracted in terms of country, language, population, construct, and PROM characteristics (eg, number of items). RESULTS A total of 220 unique articles were included from 7451 records, leading to the identification of 126 unique PROMs. Most studies were conducted in either Ethiopia, Nigeria, or South Africa. As such, prevalent languages included Amharic, Yoruba, and non-English languages common to South Africa (eg, Setswana, Xhosa, and Zulu). No PROMs were identified in any of the languages for 27 sub-Saharan African countries or 10 of the 32 included languages. CONCLUSIONS There are significant gaps in the availability of PROMs across the non-English African languages included. Nevertheless, the PROMs that were identified largely align with core outcome sets relevant to the prevalent disease burden in this world region. Consensus-based priority setting may inform the most pertinent gaps to be addressed.
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Affiliation(s)
- Chanel van Zyl
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lidwine B Mokkink
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; IOC Research Center, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Heine M, Badenhorst M, van Zyl C, de Melo Ghisi GL, Babu AS, Buckley J, Serón P, Turk-Adawi K, Derman W. Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries-A Qualitative Systematic Review with Meta-Synthesis. Int J Environ Res Public Health 2021; 18:11977. [PMID: 34831732 PMCID: PMC8619369 DOI: 10.3390/ijerph182211977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/17/2022]
Abstract
Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context.
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Affiliation(s)
- Martin Heine
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa; (C.v.Z.); (W.D.)
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, Auckland 1010, New Zealand;
| | - Chanel van Zyl
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa; (C.v.Z.); (W.D.)
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, ON M4G 2R6, Canada;
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - John Buckley
- The School of Allied Health Professions, Keele University, Staffordshire ST5 5AZ, UK;
| | - Pamela Serón
- Department of Internal Medicine and Center of Excellence CIGES, Facultad de Medicina, Universidad de La Frontera, Temuco 4781176, Chile;
| | - Karam Turk-Adawi
- Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa; (C.v.Z.); (W.D.)
- IOC Research Centre, Cape Town 8000, South Africa
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Heine M, Mokkink LB, van Zyl C, Derman W, Hanekom S. Patient-Reported OUtcome measures in key African languages to promote Diversity in research and clinical practice (PROUD)-protocol for a systematic review of measurement properties. Trials 2021; 22:380. [PMID: 34090493 PMCID: PMC8180136 DOI: 10.1186/s13063-021-05328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Sub-Saharan Africa is a subcontinent with a proud cultural richness and diversity, yet inexplicably also a region with severe health care challenges and inequity. To challenge this health equity gap and reduce the burden of disease, the patient’s voice in monitoring and evaluation of health and health care interventions is paramount. The aim of this two-phased review is to map the availability of patient-reported outcome measures (PROMs) in a selection of non-English, African Languages, and systematically evaluate the measurement properties of the PROMs that were identified. Methods This systematic review will be conducted in two phases. In phase 1, we will scope the literature for patient-reported outcome measures (PROMs), either developed from scratch or through translation and validation in a sub-Saharan African country and a selection of non-English, African languages (n = 31; spoken in > 10 million people and/or a national language). The availability of PROMs will be mapped against the previously reported burden of disease in the respective countries included. Subsequently, in phase 2, we systematically evaluate the measurement properties of these PROMs using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for systematic reviews on PROMs. To ensure rigour, secondary searches will be developed to specifically locate articles that report on the measurement properties of the PROMs identified during phase 1. The evidence will be graded using the modified GRADE approach. Discussion This review will provide a comprehensive overview and quality appraisal of PROMs developed in non-English, African languages. Consequently, this review when concluded may be an important first step in promoting access to these PROMs for use in clinical practice and research, as well as facilitate identification and prioritization of key knowledge gaps. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05328-z.
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Affiliation(s)
- Martin Heine
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zyl drive, Cape Town, 8000, South Africa.
| | - Lidwine B Mokkink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Chanel van Zyl
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zyl drive, Cape Town, 8000, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zyl drive, Cape Town, 8000, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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van Zyl C, Badenhorst M, Hanekom S, Heine M. Unravelling 'low-resource settings': a systematic scoping review with qualitative content analysis. BMJ Glob Health 2021; 6:e005190. [PMID: 34083239 PMCID: PMC8183220 DOI: 10.1136/bmjgh-2021-005190] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as 'low-to-middle-income countries' or 'developing countries', are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings. METHODS A systematic scoping review was undertaken to start unravelling the term 'low-resource setting'. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to 'low-resource setting' and 'rehabilitation'. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used. RESULTS A total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term 'low-resource setting'. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices. CONCLUSION The emerging themes may assist with (1) the groundwork needed to unravel 'low-resource settings' in health-related research, (2) moving away from assumptive umbrella terms like 'low-to-middle-income countries' or 'low/middle-income countries' and (3) promoting effective knowledge transfer between settings.
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Affiliation(s)
- Chanel van Zyl
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Marelise Badenhorst
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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