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Haldane V, Zhang Z, Yin T, Zhang B, Li Y, Pan Q, Dainty KN, Rea E, Pasang P, Hu J, Wei X. Exploring opportunities to strengthen rural tuberculosis health service delivery: a qualitative study with health workers in Tibet autonomous region, China. BMJ Open 2024; 14:e079062. [PMID: 38740500 PMCID: PMC11097854 DOI: 10.1136/bmjopen-2023-079062] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES This qualitative study aimed to explore opportunities to strengthen tuberculosis (TB) health service delivery from the perspectives of health workers providing TB care in Shigatse prefecture of Tibet Autonomous Region, China. DESIGN Qualitative research, semi-structured in-depth interviews. SETTING The TB care ecosystem in Shigatse, including primary and community care. PARTICIPANTS Participants: 37 semi-structured interviews were conducted with village doctors (14), township doctors and nurses (14), county hospital doctors (7) and Shigatse Centre for Disease Control staff (2). RESULTS The three main themes reported include (1) the importance of training primary and community health workers to identify people with symptoms of TB, ensure TB is diagnosed and link people with TB to further care; (2) the need to engage community health workers to ensure retention in care and adherence to TB medications; and (3) the opportunity for innovative technologies to support coordinated care, retention in care and adherence to medication in Shigatse. CONCLUSIONS The quality of TB care could be improved across the care cascade in Tibet and other high-burden, remote settings by strengthening primary care through ongoing training, greater support and inclusion of community health workers and by leveraging technology to create a circle of care. Future formative and implementation research should include the perspectives of health workers at all levels to improve care organisation and delivery.
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Affiliation(s)
- Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tingting Yin
- Liangcheng No 3 Municipal Hospital, Liaocheng, Shandong, China
| | - Bei Zhang
- Weifang Medical College, Weifang, Shandong, China
| | - Yinlong Li
- Jining Medical University, Jining, Shandong, China
| | - Qiuyu Pan
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Katie N Dainty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Rea
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Public Health, Toronto, Ontario, Canada
| | - Pande Pasang
- Shigatse Centre for Disease Control and Prevention, Shigatse, Samzhubze, China
| | - Jun Hu
- Shigatse Centre for Disease Control and Prevention, Shigatse, Samzhubze, China
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wei X, Hicks JP, Zhang Z, Haldane V, Pasang P, Li L, Yin T, Zhang B, Li Y, Pan Q, Liu X, Walley J, Hu J. Effectiveness of a comprehensive package based on electronic medication monitors at improving treatment outcomes among tuberculosis patients in Tibet: a multicentre randomised controlled trial. Lancet 2024; 403:913-923. [PMID: 38309280 DOI: 10.1016/s0140-6736(23)02270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND WHO recommends that electronic medication monitors, a form of digital adherence technology, be used as a complement to directly observed treatment (DOT) for tuberculosis, as DOT is inconvenient and costly. However, existing evidence about the effectiveness of these monitors is inconclusive. Therefore, we evaluated the effectiveness of a comprehensive package based on electronic medication monitors among patients with tuberculosis in Tibet Autonomous Region (hereafter Tibet), China. METHODS This multicentre, randomised controlled trial recruited patients from six counties in Shigatse, Tibet. Eligible participants had drug-susceptible tuberculosis and were aged 15 years or older when starting standard tuberculosis treatment. Tuberculosis doctors recruited patients from the public tuberculosis dispensary in each county and the study statistician randomly assigned them to the intervention or control group based on the predetermined randomised allocation sequence. Intervention patients received an electronic medication monitor box. The box included audio medication-adherence reminders and recorded box-opening data, which were transmitted to a cloud-based server and were accessible to health-care providers to allow remote adherence monitoring. A linked smartphone app enabled text, audio, and video communication between patients and health-care providers. Patients were also provided with a free data plan. Patients selected a treatment supporter (often a family member) who was trained to support patients with using the electronic medication monitor and app. Patients in the control group received usual care plus a deactivated electronic medication monitor, which only recorded and transmitted box-opening data that was not made available to health-care providers. The control group also had no access to the app or trained treatment supporters. The primary outcome was a binary indicator of poor monthly adherence, defined as missing 20% or more of planned doses in the treatment month, measured using electronic medication monitor opening data, and verified by counting used medication blister packages during consultations. We recorded other secondary treatment outcomes based on national tuberculosis reporting data. We analysed the primary outcome based on the intention-to-treat population. This trial is registered at ISRCTN, 52132803. FINDINGS Between Nov 17, 2018, and April 5, 2021, 278 patients were enrolled into the study. 143 patients were randomly assigned to the intervention group and 135 patients to the control group. Follow-up ended when the final patient completed treatment on Oct 4, 2021. In the intervention group, 87 (10%) of the 854 treatment months showed poor adherence compared with 290 (37%) of the 795 months in the control group. The corresponding adjusted risk difference for the intervention versus control was -29·2 percentage points (95% CI -35·3 to -22·2; p<0·0001). Five of the six secondary treatment outcomes also showed clear improvements, including treatment success, which was found for 133 (94%) of the 142 individuals in the intervention arm and 98 (73%) of the 134 individuals in the control arm, with an adjusted risk difference of 21 percentage points (95% CI 12·4-29·4); p<0·0001. INTERPRETATION The interventions were effective at improving tuberculosis treatment adherence and outcomes, and the trial suggests that a comprehensive package involving electronic medication monitors might positively affect tuberculosis programmes in high-burden and low-resource settings. FUNDING TB REACH.
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Affiliation(s)
- Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Pande Pasang
- Shigatse Centre for Disease Control and Prevention, Shigatse, China
| | - Linhua Li
- Shigatse Centre for Disease Control and Prevention, Shigatse, China
| | | | - Bei Zhang
- Weifang Medical College, Weifang, China
| | - Yinlong Li
- Jining Medical University, Jining, China
| | - Qiuyu Pan
- North Sichuan Medical College, Nanchong, China
| | - Xiaoqiu Liu
- National Center for tuberculosis control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Jun Hu
- Shigatse Centre for Disease Control and Prevention, Shigatse, China; Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
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Ludolph R, Takahashi R, Shroff ZC, Kosinska M, Schmidt T, Anan HH, Arifi F, Yam A, Rasanathan K, Aseffa A, Nguyen PN, Kato M, Garg A, Dorji T, Villalobos A, Haldane V, Nguyen T, Briand S. A global research agenda on public health and social measures during emergencies. Bull World Health Organ 2023; 101:717-722. [PMID: 37961059 PMCID: PMC10630736 DOI: 10.2471/blt.23.289959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/02/2023] [Accepted: 09/10/2023] [Indexed: 11/15/2023] Open
Abstract
The importance of strong coordination for research on public health and social measures was highlighted at the Seventy-fourth World Health Assembly in 2021. This article describes efforts undertaken by the World Health Organization (WHO) to develop a global research agenda on the use of public health and social measures during health emergencies. This work includes a multistep process that started with a global technical consultation convened by WHO in September 2021. The consultation included experts from around the world and from a wide range of disciplines, such as public health, education, tourism, finance and social sciences, and aimed to identify research and implementation approaches based on lessons learnt during the coronavirus disease 2019 pandemic. To prepare for future epidemics and pandemics, it is essential to adopt a more robust, comparable and systematic research approach to public health and social measures. Such comprehensive approach will better inform agile, balanced and context-specific implementation decisions during future emergencies. This article describes the methods used to develop global research priorities for public health and social measures and the next steps needed.
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Affiliation(s)
- Ramona Ludolph
- Epidemic and Pandemic Preparedness and Prevention Department, WHO Health Emergencies Programme, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Ryoko Takahashi
- Epidemic and Pandemic Preparedness and Prevention Department, WHO Health Emergencies Programme, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Monika Kosinska
- Department of Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Tanja Schmidt
- WHO Health Emergencies Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Huda Haidar Anan
- WHO Health Emergencies Programme, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Fatima Arifi
- WHO Health Emergencies Programme, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Abdoulaye Yam
- Emergency Preparedness and Response Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Kumanan Rasanathan
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Abraham Aseffa
- The Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Phuong Nam Nguyen
- WHO Health Emergencies Programme, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Masaya Kato
- WHO Health Emergencies Programme, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Aarti Garg
- WHO Health Emergencies Programme, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Tshewang Dorji
- WHO Health Emergencies Programme, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Andrea Villalobos
- Public Health Emergencies, Pan American Health Organization, Washington, DC, United States of America
| | - Victoria Haldane
- Epidemic and Pandemic Preparedness and Prevention Department, WHO Health Emergencies Programme, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Tim Nguyen
- Epidemic and Pandemic Preparedness and Prevention Department, WHO Health Emergencies Programme, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Sylvie Briand
- Epidemic and Pandemic Preparedness and Prevention Department, WHO Health Emergencies Programme, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
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Wei X, Khan N, Durrani H, Muzaffar N, Haldane V, Walley JD, Thorpe K, Ge E, Ge S, Dodd W, Wallace J, Aslanyan G, Laporte A, Khan MA. Protocol for a pragmatic cluster randomised controlled trial to evaluate the effectiveness of digital health interventions in improving non-communicable disease management during the pandemic in rural Pakistan. PLoS One 2023; 18:e0282543. [PMID: 37816010 PMCID: PMC10564142 DOI: 10.1371/journal.pone.0282543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/07/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has revealed gaps in global health systems, especially in the low- and middle-income countries (LMICs). Evidence shows that patients with non-communicable diseases (NCDs) are at higher risk of contracting COVID-19 and suffering direct and indirect health consequences. Considering the future challenges such as environmental disasters and pandemics to the LMICs health systems, digital health interventions (DHI) are well poised to strengthen health care resilience. This study aims to implement and evaluate a comprehensive package of DHIs of integrated COVID-NCD care to manage NCDs in primary care facilities in rural Pakistan. METHODS The study is designed as a pragmatic, parallel two-arm, multi-centre, mix-methods cluster randomised controlled trial. We will randomise 30 primary care facilities in three districts of Punjab, where basic hypertension and diabetes diagnosis and treatment are provided, with a ratio of 1:1 between intervention and control. In each facility, we will recruit 50 patients who have uncontrolled hypertension. The intervention arm will receive training on an integrated COVID-NCD guideline, and will use a smartphone app-based telemedicine platform where patients can communicate with health providers and peer-supporters, along with a remote training and supervision system. Usual care will be provided in the control arm. Patients will be followed up for 10 months. Our primary indicator is systolic blood pressure measured at 10 months. A process evaluation guided by implementation science frameworks will be conducted to explore implementation questions. A cost-effectiveness evaluation will be conducted to inform future scale up in Pakistan and other LMICs. DISCUSSION Our study is one of the first randomised controlled trials to evaluate the effectiveness of DHIs to manage NCDs to strengthen health system resilience in LMICs. We will also evaluate the implementation process and cost-effectiveness to inform future scale-up in similar resource constrained settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier-NCT05699369.
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Affiliation(s)
- Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nida Khan
- Association for Social Development, Islamabad, Pakistan
| | - Hammad Durrani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - John D. Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erjia Ge
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shiliang Ge
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - James Wallace
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Garry Aslanyan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Lee-Foon NK, Haldane V, Brown A. Saying and doing are different things: a scoping review on how health equity is conceptualized when considering healthcare system performance. Int J Equity Health 2023; 22:133. [PMID: 37443086 DOI: 10.1186/s12939-023-01872-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/20/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Ensuring healthcare systems provide equitable, high quality care is critical to their users' overall health and wellbeing. Typically, systems use various performance frameworks and related indicators to monitor and improve healthcare. Although these frameworks usually include equity, the extent that equity is reflected in these measurements remains unclear. In order to create a system that meets patients' needs, addressing this uncertainty is important. This paper presents findings from a scoping review that sought to answer the question 'How is equity conceptualized in healthcare systems when assessing healthcare system performance?'. METHODS Levac's scoping review approach was used to locate relevant articles and create a protocol. Included, peer-reviewed articles were published between 2015 to 2020, written in English and did not discuss oral health and clinician training. These healthcare areas were excluded as they represent large, specialized bodies of literature beyond the scope of this review. Online databases (e.g., MEDLINE, CINAHL Plus) were used to locate articles. RESULTS Eight thousand six hundred fifty-five potentially relevant articles were identified. Fifty-four were selected for full review. The review yielded 16 relevant articles. Six articles emanated from North America, six from Europe and one each from Africa, Australia, China and India respectively. Most articles used quantitative methods and examined various aspects of healthcare. Studies centered on: indicators; equity policies; evaluating the equitability of healthcare systems; creating and/or testing equity tools; and using patients' sociodemographic characteristics to examine healthcare system performance. CONCLUSION Although equity is framed as an important component of most healthcare systems' performance frameworks, the scarcity of relevant articles indicate otherwise. This scarcity may point to challenges systems face when moving from conceptualizing to measuring equity. Additionally, it may indicate the limited attention systems place on effectively incorporating equity into performance frameworks. The disjointed and varied approaches to conceptualizing equity noted in relevant articles make it difficult to conduct comparative analyses of these frameworks. Further, these frameworks' strong focus on users' social determinants of health does not offer a robust view of performance. More work is needed to shift these narrow views of equity towards frameworks that analyze healthcare systems and not their users.
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Affiliation(s)
- Nakia K Lee-Foon
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Adalsteinn Brown
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
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Khalid A, Dong Q, Chuluunbaatar E, Haldane V, Durrani H, Wei X. Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review. J Med Internet Res 2023; 25:e42134. [PMID: 36917174 PMCID: PMC10131907 DOI: 10.2196/42134] [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: 08/24/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. OBJECTIVE We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. METHODS We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. RESULTS Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. CONCLUSIONS Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels.
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Affiliation(s)
- Ayisha Khalid
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Quanfang Dong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hammad Durrani
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Haldane V, Ariyarajah A, Berry I, Loutet M, Salamanca-Buentello F, Upshur REG. Global inequity creates local insufficiency: A qualitative study of COVID-19 vaccine implementation challenges in low-and-middle-income countries. PLoS One 2023; 18:e0281358. [PMID: 36780502 PMCID: PMC9925066 DOI: 10.1371/journal.pone.0281358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/22/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has amplified pre-existing challenges to health promotion and care across the world, and particularly in low- and middle-income countries (LMICs). This qualitative study draws on data from a panel of immunisation experts and uses a novel framework of vaccine delivery domains to explore perspectives from those who live and work in these settings on the challenges to implementing COVID-19 vaccine programs in LMICs. METHODS We conducted a thematic content analysis of 96 participant free text replies to questions from Round I of a three-round Delphi consensus study amongst global experts on COVID-19 vaccine implementation. RESULTS Participant responses highlighted challenges to vaccine program implementation including issues related to equity; governance, decision-making, and financing; regulatory structures, planning, and coordination; prioritisation, demand generation, and communication; vaccine, cold chain, logistics, and infrastructure; service delivery, human resources, and supplies; and surveillance, monitoring, and evaluation. CONCLUSION We reflect on our findings in light of global efforts to address vaccine inequity and emphasise three key areas salient to improving vaccination efforts during novel infectious disease outbreaks: 1) Ensuring safe and sustainable service delivery in communities and at points of care; 2) Strengthening systems for end-to-end delivery of vaccines, therapeutics, diagnostics, and essential supplies; 3) Transforming structural paradigms towards vaccine equity.
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Affiliation(s)
- Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Archchun Ariyarajah
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Miranda Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Ross E. G. Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- * E-mail:
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Luo OD, Razvi Y, Kaur G, Lim M, Smith K, Carson JJK, Petrin-Desrosiers C, Haldane V, Simms N, Miller FA. A qualitative study of what motivates and enables climate-engaged physicians in Canada to engage in health-care sustainability, advocacy, and action. Lancet Planet Health 2023; 7:e164-e171. [PMID: 36754472 DOI: 10.1016/s2542-5196(22)00311-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Increasing numbers of health-care professionals are aware of the need to deliver low-carbon sustainable health systems. We aimed to explore how physicians can be motivated and supported to pursue this ambition by conducting an exploratory qualitative descriptive study that involved individual in-depth interviews with climate-engaged Canadian physicians participating in health-care sustainability advocacy and action. Interview transcripts were analysed to identify themes related to the actions that physicians can take to promote sustainable health care, and the motivators and enablers of physician engagement in sustainable health care. Participants (n=19) engaged in a spectrum of health-care sustainability initiatives ranging from reducing health-care waste to lobbying and political action. They were motivated to advance health-care sustainability by their concern about the health implications of climate change, frustration with health-care waste, and recognition of their locus of influence as physicians. Participants articulated that policy and system, organisational and team, and knowledge generation and translation supports are required to strengthen their capacity to advance health-care sustainability. These findings can provide inspiration for engagement opportunities in health-care sustainability, guide service delivery and educational innovations to promote health-care professionals' interest in becoming sustainability champions, and extend the capacity of health-care professionals to reduce the climate impact of health care.
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Affiliation(s)
- Owen Dan Luo
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, QC, Canada
| | - Yasmeen Razvi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gurleen Kaur
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle Lim
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelti Smith
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacob Joel Kirsh Carson
- Department of Pediatrics, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Claudel Petrin-Desrosiers
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nicole Simms
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Sustainable Health Systems, University of Toronto, Toronto, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Sustainable Health Systems, University of Toronto, Toronto, ON, Canada.
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Haldane V, Morales-Vazquez M, Jamieson M, Veillard J, Marchildon GP, Allin S. Learning from the first wave of the COVID-19 pandemic: Comparing policy responses in Uruguay with 10 other Latin American and Caribbean countries. Health Policy Open 2022; 3:100081. [PMID: 36405237 PMCID: PMC9661545 DOI: 10.1016/j.hpopen.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during the first 6 months of the pandemic, with Uruguay effectively limiting transmission during this crucial phase. This review describes features of pandemic responses which may have contributed to Uruguay's early success relative to 10 other LAC countries - Argentina, Chile, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Panama, Paraguay, and Trinidad and Tobago. Uruguay differentiated its early response efforts from reviewed countries by foregoing strict border closures and restrictions on movement, and rapidly implementing a suite of economic and social measures. Our findings describe the importance of supporting adherence to public health interventions by ensuring that effective social and economic safety net measures are in place to permit compliance with public health measures.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Mariana Morales-Vazquez
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Jeremy Veillard
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada,World Bank, Health, Nutrition and Population, Washington, DC, USA
| | - Gregory P. Marchildon
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Sara Allin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada,Corresponding author at: Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
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10
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Haldane V, Dodd W, Kipp A, Ferrolino H, Wilson K, Servano D, Lau LL, Wei X. Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines. BMC Health Serv Res 2022; 22:1385. [PMID: 36411439 PMCID: PMC9677893 DOI: 10.1186/s12913-022-08734-4] [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: 03/25/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Amidst ongoing calls for increased health systems resilience, gaps remain in our understanding of how health systems can reach further into communities to ensure resilient service delivery. Indeed, public health emergencies caused by infectious hazards reveal both the value and vulnerability of the workforce delivering health services in communities. This study explores ways in which a non-governmental organization (NGO) in the Philippines protected their frontline workforce during the first year of the COVID-19 pandemic. METHODS Guided by a qualitative descriptive approach, 34 in-depth interviews were conducted with community-based health actors employed by the NGO between June 2020 and February 2021. Data analysis was guided by an iterative deductive and inductive approach. RESULTS We identified four key activities that enabled the NGO and their staff to provide health and social services in communities in a safe and consistent manner as part of the organization's pandemic response. These include (1) ensuring adequate personal protective equipment (PPE) and hygiene supplies; (2) providing contextualized and role-specific infection prevention and control (IPC) training; (3) ensuring access to testing for all staff; and (4) providing support during quarantine or isolation. CONCLUSION Learning from the implementation of these activities offers a way forward toward health emergency preparedness and response that is crucially needed for NGOs to safely leverage their workforce during pandemics. Further, we describe how community-based health actors employed by NGOs can contribute to broader health systems resilience in the context of health emergency preparedness and response.
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Affiliation(s)
- Victoria Haldane
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7 Toronto, ON Canada
| | - Warren Dodd
- grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1 Waterloo, ON Canada
| | - Amy Kipp
- grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1 Waterloo, ON Canada
| | - Hannah Ferrolino
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605 Pasig City, Philippines
| | - Kendall Wilson
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605 Pasig City, Philippines
| | - Danilo Servano
- grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1 Waterloo, ON Canada
| | - Lincoln L. Lau
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7 Toronto, ON Canada ,grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1 Waterloo, ON Canada ,International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605 Pasig City, Philippines
| | - Xiaolin Wei
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7 Toronto, ON Canada
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11
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Foo CD, Verma M, Tan SM, Haldane V, Reyes KA, Garcia F, Canila C, Orano J, Ballesteros AJ, Marthias T, Mahendradhata Y, Tuangratananon T, Rajatanavin N, Poungkantha W, Mai Oanh T, The Due O, Asgari-Jirhandeh N, Tangcharoensathien V, Legido-Quigley H. COVID-19 public health and social measures: a comprehensive picture of six Asian countries. BMJ Glob Health 2022; 7:bmjgh-2022-009863. [PMID: 36343969 PMCID: PMC9644075 DOI: 10.1136/bmjgh-2022-009863] [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: 06/14/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022] Open
Abstract
The COVID-19 pandemic will not be the last of its kind. As the world charts a way towards an equitable and resilient recovery, Public Health and Social Measures (PHSMs) that were implemented since the beginning of the pandemic need to be made a permanent feature of health systems that can be activated and readily deployed to tackle sudden surges in infections going forward. Although PHSMs aim to blunt the spread of the virus, and in turn protect lives and preserve health system capacity, there are also unintended consequences attributed to them. Importantly, the interactions between PHSMs and their accompanying key indicators that influence the strength and duration of PHSMs are elements that require in-depth exploration. This research employs case studies from six Asian countries, namely Indonesia, Singapore, South Korea, Thailand, the Philippines and Vietnam, to paint a comprehensive picture of PHSMs that protect the lives and livelihoods of populations. Nine typologies of PHSMs that emerged are as follows: (1) physical distancing, (2) border controls, (3) personal protective equipment requirements, (4) transmission monitoring, (5) surge health infrastructure capacity, (6) surge medical supplies, (7) surge human resources, (8) vaccine availability and roll-out and (9) social and economic support measures. The key indicators that influence the strength and duration of PHSMs are as follows: (1) size of community transmission, (2) number of severe cases and mortality, (3) health system capacity, (4) vaccine coverage, (5) fiscal space and (6) technology. Interactions between PHSMs can be synergistic or inhibiting, depending on various contextual factors. Fundamentally, PHSMs do not operate in silos, and a suite of PHSMs that are complementary is required to ensure that lives and livelihoods are safeguarded with an equity lens. For that to be achieved, strong governance structures and community engagement are also required at all levels of the health system.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - See Mieng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Victoria Haldane
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Katherine Ann Reyes
- School of Public Health, Pamantasan ng Lungsod ng Maynila, Manila, Philippines,Alliance for Improving Health Outcomes, Quezon, Philippines
| | - Fernando Garcia
- College of Public Health, University of the Philippines, Manila, Philippines
| | - Carmelita Canila
- College of Public Health, University of the Philippines, Manila, Philippines
| | | | | | - Tiara Marthias
- Department of Public Health, Gadjah Mada University Faculty of Medicine Public Health and Nursing, Yogyakarta, Indonesia,The University of Melbourne Nossal Institute for Global Health, Melbourne, Victoria, Australia
| | - Yodi Mahendradhata
- Department of Public Health, Gadjah Mada University Faculty of Medicine Public Health and Nursing, Yogyakarta, Indonesia
| | | | | | - Warapon Poungkantha
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Tran Mai Oanh
- Health Strategy and Policy Institute, Ministry of Health, Hanoi, Viet Nam
| | - Ong The Due
- Health Strategy and Policy Institute, Ministry of Health, Hanoi, Viet Nam
| | - Nima Asgari-Jirhandeh
- Asia-Pacific Observatory on Health Systems and Policies, World Health Organization, New Delhi, India
| | | | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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12
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Raymakers AJN, Sue-Chue-Lam C, Haldane V, Cooper-Reed A, Toccalino D. Climate change, sustainability, and health services research. Health Policy and Technology 2022. [DOI: 10.1016/j.hlpt.2022.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Haldane V, Jung AS, De Foo C, Shrestha P, Urdaneta E, Turk E, Gaviria JI, Boadas J, Buse K, Miranda JJ, Strathdee SA, Barratt A, Kazatchkine M, McKee M, Legido-Quigley H. Integrating HIV and substance misuse services: a person-centred approach grounded in human rights. Lancet Psychiatry 2022; 9:676-688. [PMID: 35750060 DOI: 10.1016/s2215-0366(22)00159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/13/2022]
Abstract
Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anne-Sophie Jung
- School of Politics and International Studies, University of Leeds, Leeds, UK.
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore
| | | | - Eva Turk
- Institute for Health and Society, University of Oslo, Oslo, Norway; Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Juan I Gaviria
- Coordinación de Vigilancia Epidemiologica e Infectologia, Hospital del Instituto Ecuatoriano del Seguro Social (IESS) Sur de Quito, Quito, Ecuador
| | - Jesus Boadas
- Centro de Rehabilitación Mental ANSALUD, Santo Domingo, Dominican Republic
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, London, UK
| | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | | | - Ashley Barratt
- Positive21, London, UK; ReShape/International HIV Partnerships-European Chemsex Forum, London, UK
| | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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14
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De Foo C, Haldane V, Jung AS, Grépin KA, Wu S, Singh S, Perera N, Miranda JJ, McKee M, Legido-Quigley H. Isolation facilities for covid-19: towards a person centred approach. BMJ 2022; 378:e069558. [PMID: 35882391 DOI: 10.1136/bmj-2021-069558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Victoria Haldane
- Institute of Health Policy Management and Education, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anne-Sophie Jung
- School of Politics and International Studies, University of Leeds, Leeds, UK
| | - Karen A Grépin
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sudhvir Singh
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | | | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, UK
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15
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Haldane V, Li BP, Ge S, Huang JZ, Huang H, Sadutshang L, Zhang Z, Pasang P, Hu J, Wei X. Exploring the translation process for multilingual implementation research studies: a collaborative autoethnography. BMJ Glob Health 2022; 7:bmjgh-2022-008674. [PMID: 35636804 PMCID: PMC9152927 DOI: 10.1136/bmjgh-2022-008674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/31/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction In an increasingly globalised and interconnected world, evidence to evaluate complex interventions may be generated in multiple languages. However, despite its influence in shaping the evidence base, there is little literature explicitly connecting the translation process to the goals and processes of implementation research. This study aims to explore the processes and experience of an international implementation research team conducting a process evaluation of a complex intervention in Tibet Autonomous Region, China. Methods This study uses a collaborative autoethnographic approach to explore the translation process from Chinese or Tibetan to English of key stakeholder interview transcripts. In this approach, multiple researchers and translators contributed their reflections, and conducted joint analysis through dialogue, reflection and with consideration of multiple perspectives. Seven researchers involved with the translation process contributed their perspectives through in-depth interviews or written reflections and jointly analysed the resulting data. Results We describe the translation process, synthesise key challenges including developing a ‘voice’ and tone as a translator, conveying the depth of idioms across languages, and distance from the study context. We further offer lessons learnt including the importance of word banks with unified translations of words and phrases created iteratively during the translation process, the need to collaborate between translators and the introspective work necessary for translators to explore their positionality and reflexivity during the work. We then offer a summary of these learnings for other implementation research teams. Conclusion Our findings emphasise that in order to ensure rigour in their work, implementation research teams using qualitative data should make concerted effort to consider both the translation process as well as its outcomes. Given the numerous multinational or multilingual implementation research studies using qualitative methods, there is a need for further consideration and reflection on the translation process.
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Affiliation(s)
- Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Betty Peiyi Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shiliang Ge
- Termerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Zekun Huang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hongyu Huang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Losang Sadutshang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pande Pasang
- Shigatse Centre for Disease Control and Prevention, Shigatse, Samzhubze District, China
| | - Jun Hu
- Shigatse Centre for Disease Control and Prevention, Shigatse, Samzhubze District, China.,Public Health Management, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Wu S, Tannous E, Haldane V, Ellen ME, Wei X. Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research. Implement Sci 2022; 17:30. [PMID: 35550169 PMCID: PMC9096759 DOI: 10.1186/s13012-022-01209-4] [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: 12/09/2021] [Accepted: 04/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Behavior change interventions that aim to improve rational antibiotic use in prescribers and users have been widely conducted in both high- and LMICs. However, currently, no review has systematically examined challenges unique to LMICs and offered insights into the underlying contextual factors that influence these interventions. We adopted an implementation research perspective to systematically synthesize the implementation barriers and facilitators in LMICs. Methods We conducted literature searches in five electronic databases and identified studies that involved the implementation of behavior change interventions to improve appropriate antibiotic use in prescribers and users in LMICs and reported implementation barriers and facilitators. Behavior change interventions were defined using the behavior change wheel, and the coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research (CFIR). Results We identified 52 eligible studies, with the majority targeting prescribers practicing at tertiary facilities (N=39, 75%). The most commonly reported factors influencing implementation were found in the inner setting domain of the CFIR framework, particularly related to constraints in resources and the infrastructure of the facilities where interventions were implemented. Barriers related to the external policy environment (e.g., lack of national initiatives and policies on antibiotic use), and individual characteristics of target populations (e.g., reluctance to change prescribing behaviors) were also common, as well as facilitators related to intervention characteristics (e.g., embedding interventions in routine practice) and process (e.g., stakeholder engagement). We also provided insights into the interrelationships between these factors and the underlying causes contributing to the implementation challenges in LMICs. Conclusion We presented a comprehensive overview of the barriers and facilitators of implementing behavior change interventions to promote rational antibiotic use in LMICs. Our findings suggest that facilitating the implementation of interventions to improve rational antibiotic use needs comprehensive efforts to address challenges at policy, organizational, and implementation levels. Specific strategies include (1) strengthening political commitment to prompt mobilization of domestic resources and formulation of a sustainable national strategy on AMR, (2) improving the infrastructure of health facilities that allow prescribers to make evidence-based clinical decisions, and (3) engaging local stakeholders to improve their buy-in and facilitate contextualizing interventions. Trial registration PROSPERO: CRD42021252715. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01209-4.
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Affiliation(s)
- Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elias Tannous
- Faculty of Health Sciences, Department of Clinical Biochemistry and Pharmacology, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Pharmacy services, Hillel Yaffe Medical Center, Hadera, Israel
| | - Victoria Haldane
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Moriah E Ellen
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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17
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Ariyarajah A, Berry I, Haldane V, Loutet M, Salamanca-Buentello F, Upshur REG. Identifying priority challenges and solutions for COVID-19 vaccine delivery in low- and middle-income countries: A modified Delphi study. PLOS Glob Public Health 2022; 2:e0000844. [PMID: 36962787 PMCID: PMC10021567 DOI: 10.1371/journal.pgph.0000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The rapid implementation of global COVID-19 vaccination programs has surfaced many challenges and inequities, particularly in low- and middle-income countries (LMICs). However, there continues to be a lack of consensus on which challenges are global priorities for action, and how to best respond to them. This study uses consensus-based methods to identify and rank the most important challenges and solutions for implementation of COVID-19 vaccination programs in LMICs. METHODS We conducted a three-round modified Delphi study with a global panel of vaccine delivery experts. In Round I, panelists identified broad topical challenges and solutions. Responses were collated and coded into distinct items. Through two further rounds of structured, iterative surveys panelists reviewed and ranked the identified items. Responses were analyzed qualitatively and quantitatively to achieve consensus on the most important COVID-19 vaccine delivery challenges and solutions. RESULTS Of the 426 invited panelists, 96 completed Round I, 56 completed Round II, and 39 completed Round III. Across all three rounds there was equal representation by gender, and panelists reported work experience in all World Bank regions and across a variety of content areas and organizations. Of the 64 initially identified items, the panel achieved consensus on three challenges and 10 solutions. Challenges fell under themes of structural factors and infrastructure and human and material resources, while solutions also included items within themes of communication, community engagement, and access and planning, processes, and operations. CONCLUSION COVID-19 vaccine delivery is challenged by long-standing and structural inequities that disadvantage health service delivery in LMICs. These findings can, and should, be used by global health organizations to efficiently and optimally direct resources to respond to these key challenges and solutions.
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Affiliation(s)
- Archchun Ariyarajah
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Miranda Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Ross E G Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
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18
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Jung AS, Haldane V, Neill R, Mei Jin Tan M, Abdalla SM, Bartos M, Shresha P, Chua AQ, Nordström A, Legido-Quigley H. From dichotomisation towards intersectionality in addressing covid-19. BMJ 2021; 375:e067500. [PMID: 34840132 PMCID: PMC8624761 DOI: 10.1136/bmj-2021-067500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Anne-Sophie Jung and colleagues argue that understanding mechanisms of response to the covid-19 pandemic as trade-offs reinforces false dichotomies and hamstrings attempts to create stronger and more equitable health systems
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Affiliation(s)
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Rachel Neill
- Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Salma M Abdalla
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | - Michael Bartos
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Pami Shresha
- Saw Swee Hock School of Public Health, Singapore
| | | | - Anders Nordström
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, UK
- Saw Swee Hock School of Public Health, Singapore
- The Independent Panel for Pandemic Preparedness and Response Secretariat
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19
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Haldane V, Jung AS, Neill R, Singh S, Wu S, Jamieson M, Verma M, Tan M, De Foo C, Abdalla SM, Shrestha P, Chua AQ, Nordström A, Legido-Quigley H. From response to transformation: how countries can strengthen national pandemic preparedness and response systems. BMJ 2021; 375:e067507. [PMID: 34840139 PMCID: PMC8624064 DOI: 10.1136/bmj-2021-067507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Haldane
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, UK
| | - Anne-Sophie Jung
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Rachel Neill
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Sudhvir Singh
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Melisa Tan
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Salma M Abdalla
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Alvin Qijia Chua
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Anders Nordström
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, UK
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
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20
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Abdalla SM, Koya SF, Jamieson M, Verma M, Haldane V, Jung AS, Singh S, Nordström A, Obaid T, Legido-Quigley H, McNab C. Investing in trust and community resilience: lessons from the early months of the first digital pandemic. BMJ 2021; 375:e067487. [PMID: 34840130 PMCID: PMC8624756 DOI: 10.1136/bmj-2021-067487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Salma M Abdalla and colleagues examine how an atmosphere of misinformation, disinformation, and erosion of trust shaped the early response to covid-19 on both global and national levels
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Affiliation(s)
- Salma M Abdalla
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
- School of Public Health, Boston University, USA
| | | | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Anne-Sophie Jung
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - Sudhvir Singh
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Anders Nordström
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
| | - Thoraya Obaid
- Independent Panel for Pandemic Preparedness and Response
| | - Helena Legido-Quigley
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - Christine McNab
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
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21
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Jung AS, Haldane V, Neill R, Wu S, Jamieson M, Verma M, Tan M, De Foo C, Abdalla SM, Shrestha P, Chua AQ, Bristol N, Singh S, Bartos M, Mabuchi S, Bonk M, McNab C, Werner GK, Panjabi R, Nordström A, Legido-Quigley H. National responses to covid-19: drivers, complexities, and uncertainties in the first year of the pandemic. BMJ 2021; 375:e068954. [PMID: 34840138 PMCID: PMC8624066 DOI: 10.1136/bmj-2021-068954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Anne-Sophie Jung
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Rachel Neill
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, Singapore
| | - Melisa Tan
- Saw Swee Hock School of Public Health, Singapore
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, Singapore
| | - Salma M Abdalla
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | | | | | - Nellie Bristol
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Sudhvir Singh
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Michael Bartos
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Shunsuke Mabuchi
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Mathias Bonk
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Christine McNab
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - George K Werner
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Raj Panjabi
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Anders Nordström
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
- Saw Swee Hock School of Public Health, Singapore
- The Independent Panel for Pandemic Preparedness and Response Secretariat
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22
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Tan MMJ, Neill R, Haldane V, Jung AS, De Foo C, Tan SM, Shrestha P, Verma M, Bonk M, Abdalla SM, Legido-Quigley H. Assessing the role of qualitative factors in pandemic responses. BMJ 2021; 375:e067512. [PMID: 34840137 PMCID: PMC8624757 DOI: 10.1136/bmj-2021-067512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Melisa Mei Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Rachel Neill
- Johns Hopkins University Bloomberg School of Public Health, US
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Anne-Sophie Jung
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - See Mieng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mathias Bonk
- Berlin Institute of Global Health
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Salma M Abdalla
- School of Public Health, Boston University, US
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
- Independent Panel for Pandemic Preparedness and Response Secretariat
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23
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Haldane V, Jung AS, De Foo C, Bonk M, Jamieson M, Wu S, Verma M, Abdalla SM, Singh S, Nordström A, Legido-Quigley H. Strengthening the basics: public health responses to prevent the next pandemic. BMJ 2021; 375:e067510. [PMID: 34840134 PMCID: PMC8624065 DOI: 10.1136/bmj-2021-067510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | | | - Chuan De Foo
- Saw Swee Hock School of Public Health, Singapore
| | - Mathias Bonk
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, Singapore
| | - Salma M Abdalla
- Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | - Sudhvir Singh
- Independent Panel for Pandemic Preparedness and Response Secretariat
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Anders Nordström
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, UK
- Saw Swee Hock School of Public Health, Singapore
- Independent Panel for Pandemic Preparedness and Response Secretariat
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24
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Wu S, Neill R, De Foo C, Chua AQ, Jung AS, Haldane V, Abdalla SM, Guan WJ, Singh S, Nordström A, Legido-Quigley H. Aggressive containment, suppression, and mitigation of covid-19: lessons learnt from eight countries. BMJ 2021; 375:e067508. [PMID: 34840136 PMCID: PMC8624062 DOI: 10.1136/bmj-2021-067508] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Rachel Neill
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Alvin Qijia Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Anne-Sophie Jung
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Victoria Haldane
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Salma M Abdalla
- Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, China
- Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Sudhvir Singh
- Independent Panel for Pandemic Preparedness and Response Secretariat
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Anders Nordström
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Independent Panel for Pandemic Preparedness and Response Secretariat
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25
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Toccalino D, Reed AC, Sue-Chue-Lam C, Cheung A, Haldane V. Building Environmentally Sustainable Health Systems in Canada: The Time Is Now for Emergent and Strategic Leadership. Healthc Q 2021; 24:76-81. [PMID: 34792453 DOI: 10.12927/hcq.2021.26614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Canada's healthcare sector produces the third highest healthcare-related emissions per capita globally. However, Canada has no national strategy toward environmentally sustainable healthcare. Transforming Canada's health systems to be environmentally sustainable requires leadership from many stakeholders and collaboration between trainees and health leaders. This article provides an overview of student and trainee leadership among health-related fields in response to the climate crisis and highlights the formation of a trainee-led organization focused on building capacity among emerging leaders in healthcare. We share key lessons learned by this group that are essential for all leaders seeking to leverage interdisciplinary action toward sustainable health systems in Canada.
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Affiliation(s)
- Danielle Toccalino
- A doctoral student at the Institute for Health Policy, Management and Evaluation (IHPME), University of Toronto in Toronto, ON. She is a founding member, the outgoing outreach director and incoming president of ELESH
| | - Anna Cooper Reed
- A social worker and doctoral student at IHPME, University of Toronto in Toronto, ON. She is a co-founder and outgoing co-president of ELESH and a junior fellow at the Centre for Sustainable Health Systems
| | - Colin Sue-Chue-Lam
- A resident physician and doctoral student at IHPME, University of Toronto in Toronto, ON. He is a founding member and outgoing strategy director of ELESH
| | - Anson Cheung
- A medical student at the Temerty Faculty of Medicine, University of Toronto in Toronto, ON. He is the outgoing finance director of ELESH
| | - Victoria Haldane
- A doctoral candidate at IHPME, University of Toronto in Toronto, ON. She is a co-founder and outgoing co-president of ELESH and a junior fellow at the Centre for Sustainable Health Systems. She can be contacted by e-mail at
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26
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Haldane V, Zhang Z, Ma Q, Yin T, Zhang B, Li Y, Pan Q, Dainty KN, Rea E, Pasang P, Wei X, Hu J. A qualitative study of perspectives on access to tuberculosis health services in Xigaze, China. Infect Dis Poverty 2021; 10:120. [PMID: 34544492 PMCID: PMC8451167 DOI: 10.1186/s40249-021-00906-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Tuberculosis (TB) is a major global health threat and the leading infectious disease cause of death worldwide. Access to and retention in TB care remains a challenge for patients, particularly those living in rural and remote settings. This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze (Shigatse) prefecture, Xizang Autonomous Region (Tibet Autonomous Region), China from the perspective of persons impacted by TB. Methods We conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture, Xizang Autonomous Region, China between April 2019 and November 2020. Interviews were conducted in Tibetan and Mandarin, transcribed in Mandarin and translated into English. Transcripts were checked against recordings by native Tibetan and Mandarin speakers. QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al. Results Overall patients reported low awareness of and an indifferent attitude towards TB, although all reported understanding the need to adhere to treatment. Participants reported complex pathways to care, often requiring visits to multiple healthcare facilities. Some participants reported visiting traditional Tibetan medicine (TTM) providers. Participants reported various barriers to accessing care including challenges physically reaching care, out-of-pocket payments for tests, diagnostics and transport. Barriers to maintaining care included medication side effects and worry about treatment effectiveness. Enablers to accessing care identified included knowledge or past experience with TB, integrated models of TTM and western care, supportive village doctors who conducted home visits, free TB treatment and other subsidies, as well as having family support with care and social support as barriers and facilitators to maintaining treatment. Conclusions We identified barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB. Challenges include complex pathways to care, travel distances, wait times and low awareness. Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness, partnerships with TTM providers, providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00906-4.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON, M5T 3M6, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Qi Ma
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON, M5T 3M6, Canada
| | - Tingting Yin
- Weifang Medical College, Weifang, Shandong, China
| | - Bei Zhang
- Weifang Medical College, Weifang, Shandong, China
| | - Yinlong Li
- Jining Medical University, Jining, Shandong, China
| | - Qiuyu Pan
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Katie N Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON, M5T 3M6, Canada
| | - Elizabeth Rea
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Pande Pasang
- Xigaze Centre for Disease Control and Prevention, 7 Keji Road, Sangzhuzi District, Xigaze, Xizang, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
| | - Jun Hu
- Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
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27
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Enria D, Feng Z, Fretheim A, Ihekweazu C, Ottersen T, Schuchat A, Ungchusak K, Briand S, Haldane V, Lamichhane J, Ludolph R, Mathis M, Nguyen T, Shindo N. Strengthening the evidence base for decisions on public health and social measures. Bull World Health Organ 2021; 99:610-610A. [PMID: 34475594 PMCID: PMC8381089 DOI: 10.2471/blt.21.287054] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Delia Enria
- Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui, Pergamino, Argentina
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | | | | | | | | | | | - Sylvie Briand
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Victoria Haldane
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Jaya Lamichhane
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ramona Ludolph
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Margaux Mathis
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Tim Nguyen
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Nahoko Shindo
- Global Infectious Hazard Preparedness Department, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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28
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Haldane V, Ratnapalan S, Perera N, Zhang Z, Ge S, Choi M, Lau LL, Samaraweera S, Dodd W, Walley J, Wei X. Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the 'SPRINT' principles. BMJ Glob Health 2021; 6:bmjgh-2021-006406. [PMID: 34452942 PMCID: PMC8406459 DOI: 10.1136/bmjgh-2021-006406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/26/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with fewer examples that can be implemented in resource-constrained settings. This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs). Methods We used a collaborative autoethnographic approach to explore the process of developing COVID-19 guidelines. In this approach, multiple researchers contributed their reflections, conducted joint analysis through dialogue, reflection and with consideration of experiential knowledge and multidisciplinary perspectives to identify and synthesise enablers, challenges and key lessons learnt. Results We describe the guideline development process in the Philippines and the adaptation process in Sri Lanka. We offer key enablers identified through this work, including flexible leadership that aimed to empower the team to bring their expertise to the process; shared responsibility through equitable ownership; an interdisciplinary team; and collaboration with local experts. We then elaborate on challenges including interpreting other guidelines to the country context; tensions between the ideal compared with the feasible and user-friendly; adapting and updating with evolving information; and coping with pandemic-related challenges. Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency. Conclusions Guideline development during a pandemic requires a robust and time sensitive paradigm. We summarise the learning in the ‘SPRINT principles’ for adapting guidelines in an epidemic context in LMICs. We emphasise that these principles must be grounded in a collaborative or codesign process and add value to existing national responses.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Savithiri Ratnapalan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Emergency Medicine, SickKids, Toronto, Ontario, Canada
| | - Niranjala Perera
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Emergency Medicine, SickKids, Toronto, Ontario, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shiliang Ge
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mia Choi
- International Care Ministries Inc, Manila, Philippines
| | - Lincoln L Lau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,International Care Ministries Inc, Manila, Philippines
| | | | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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29
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Haldane V, De Foo C, Abdalla SM, Jung AS, Tan M, Wu S, Chua A, Verma M, Shrestha P, Singh S, Perez T, Tan SM, Bartos M, Mabuchi S, Bonk M, McNab C, Werner GK, Panjabi R, Nordström A, Legido-Quigley H. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med 2021; 27:964-980. [PMID: 34002090 DOI: 10.1038/s41591-021-01381-y] [Citation(s) in RCA: 368] [Impact Index Per Article: 122.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/29/2021] [Indexed: 11/09/2022]
Abstract
Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Salma M Abdalla
- School of Public Health, Boston University, Boston, MA, USA.,The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland
| | | | - Melisa Tan
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Shishi Wu
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Alvin Chua
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Monica Verma
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Sudhvir Singh
- The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tristana Perez
- London School of Hygiene and Tropical Medicine, London, UK
| | - See Mieng Tan
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Michael Bartos
- The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland.,School of Sociology, Australian National University, Canberra, New South Wales, Australia
| | - Shunsuke Mabuchi
- The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland
| | - Mathias Bonk
- The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland.,Berlin Institute of Global Health, Berlin, Germany
| | - Christine McNab
- The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland
| | - George K Werner
- The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland
| | - Raj Panjabi
- The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland
| | - Anders Nordström
- The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, Singapore, Singapore. .,The Independent Panel for Pandemic Preparedness and Response Secretariat, Geneva, Switzerland. .,London School of Hygiene and Tropical Medicine, London, UK.
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30
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Haldane V, Morgan GT. From resilient to transilient health systems: the deep transformation of health systems in response to the COVID-19 pandemic. Health Policy Plan 2021; 36:134-135. [PMID: 33319220 PMCID: PMC7799054 DOI: 10.1093/heapol/czaa169] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6
| | - Garrett T Morgan
- Department of Geography and Planning, University of Toronto, Sidney Smith Hall 100 St. George Street, Room 5047 Toronto, ON M5S 3G3
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31
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Haldane V, Berry I. Equipping global health trainees for the climate crisis. Lancet Planet Health 2021; 5:e10. [PMID: 33421402 DOI: 10.1016/s2542-5196(20)30293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Victoria Haldane
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M7, Canada.
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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Haldane V, Zhang Z, Abbas RF, Dodd W, Lau LL, Kidd MR, Rouleau K, Zou G, Chao Z, Upshur REG, Walley J, Wei X. National primary care responses to COVID-19: a rapid review of the literature. BMJ Open 2020; 10:e041622. [PMID: 33293398 PMCID: PMC7725079 DOI: 10.1136/bmjopen-2020-041622] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this review, conducted in April 2020, is to examine available national primary care guidelines for COVID-19 and to explore the ways in which these guidelines support primary care facilities in responding to the demands of the COVID-19 pandemic. DESIGN Rapid review and narrative synthesis. DATA SOURCES PubMed, Embase and Google, as well as the websites of relevant national health departments, were searched from 1 January 2020 to 24 April 2020. ELIGIBILITY CRITERIA Documents included must be issued by a national health authority, must be specific to COVID-19 care, directed at healthcare workers or managers, and must refer to the role of primary care in the COVID-19 response. RESULTS We identified 17 documents from 14 countries. An adapted framework on primary care challenges and responses to pandemic influenza framed our analysis. Guidelines generally reported on COVID-19 service delivery and mostly made specific recommendations for ensuring continued delivery of essential primary care services through telehealth or other virtual care modalities. Few offered guidance to support surveillance as a public health function. All offered guidance on implementing outbreak control measures, largely through flexible and coordinated organisational models with partners from various sectors. There was a lack of guidance to support supply chain management and practice resilience in primary care, and lack of personal protective equipment represents a serious threat to the provision of quality care during the pandemic. CONCLUSIONS Current national primary care guidelines for COVID-19 provide guidance on infection control and minimising the risk of spread in primary care practices, while supporting the use of new technology and coordinated partnerships. However, to ensure primary care practice resilience and quality of care are upheld, guidelines must offer recommendations on supply chain management and operational continuity, supported by adequate resources.
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Affiliation(s)
- Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Raja Faisal Abbas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Warren Dodd
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lincoln L Lau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- International Care Ministries, Manila, Philippines
| | - Michael R Kidd
- Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Rouleau
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guanyang Zou
- School of Economics and Management, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhuo Chao
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Ross E G Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Walley
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wabnitz KJ, Guzman V, Haldane V, Ante-Testard PA, Shan Y, Blom IM. Planetary health: young academics ask universities to act. Lancet Planet Health 2020; 4:e257-e258. [PMID: 32681890 PMCID: PMC7363431 DOI: 10.1016/s2542-5196(20)30142-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 05/06/2023]
Affiliation(s)
- Katharina-Jaqueline Wabnitz
- Planetary Health Alliance Campus Ambassadors, Boston, MA, USA; London School of Hygiene and Tropical Medicine, London, UK
| | - Viveka Guzman
- Planetary Health Alliance Campus Ambassadors, Boston, MA, USA; Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Victoria Haldane
- Planetary Health Alliance Campus Ambassadors, Boston, MA, USA; University of Toronto, Toronto, ON, Canada
| | - Pearl Anne Ante-Testard
- Planetary Health Alliance Campus Ambassadors, Boston, MA, USA; Laboratoire MESuRS and Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - Yina Shan
- Planetary Health Alliance Campus Ambassadors, Boston, MA, USA; University of Toronto, Toronto, ON, Canada
| | - Iris Martine Blom
- Planetary Health Alliance Campus Ambassadors, Boston, MA, USA; University of Amsterdam, 10 12 WX Amsterdam, Netherlands.
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Zhuo C, Wei X, Zhang Z, Hicks JP, Zheng J, Chen Z, Haldane V, Walley J, Guan Y, Xu H, Zhong N. An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial. Trials 2020; 21:394. [PMID: 32398065 PMCID: PMC7216131 DOI: 10.1186/s13063-020-04303-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/19/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inappropriate prescribing of antibiotics for acute respiratory infections at the primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China's primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages. METHODS We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers. The family physician components include: (1) training using new operational guidelines, (2) improved management and peer-review of antibiotic prescribing, (3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key non-antibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months' post-trial long-term follow-up. DISCUSSION Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low- or middle-income country (LMIC). All interventional activities will be designed to be embedded into routine primary care with strong local ownership. Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription for primary care facilities in rural China and other LMICs. TRIAL REGISTRATION ISRCTN, ID: ISRCTN96892547. Registered on 18 August 2019.
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Affiliation(s)
- Chao Zhuo
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Jinkun Zheng
- Yuebei People’s Hospital, Shaoguan, Guangdong China
| | - Zhixu Chen
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
| | - Victoria Haldane
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Yubao Guan
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
| | - Hongyan Xu
- Yuebei People’s Hospital, Shaoguan, Guangdong China
| | - Nanshan Zhong
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
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Wei X, Deng S, Haldane V, Blacklock C, Zhang W, Zhang Z, Walley JD, King R, Hicks JP, Yin J, Zou G, Huang Y, Vergis M, Jun Z, Sun Q, Lin M. Understanding factors influencing antibiotic prescribing behaviour in rural China: a qualitative process evaluation of a cluster randomized controlled trial. J Health Serv Res Policy 2020; 25:94-103. [PMID: 31986910 DOI: 10.1177/1355819619896588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives We conducted a qualitative process evaluation embedded in a cluster randomized controlled trial in rural Guangxi China, which successfully reduced antibiotic use for children upper respiratory tract infections. This study aims to report on the factors that influenced behaviour change among providers and caregivers in the intervention arm, and to explore contextual considerations which may have influenced trial outcomes. Methods A total of 35 in-depth interviews were carried out with hospital directors, doctors, and caregivers of children. Participants were recruited from six purposively selected facilities, including two higher performing and two lower performing facilities per trial results. Interviews were conducted in Chinese and translated to English. We also observed guideline training sessions and prescription peer review meetings. Data were analysed using framework analysis. Results Intervention-arm doctors described that training sessions improved their knowledge, skills and confidence in appropriate prescribing. This was contrasted by control arm participants who did not receive training and reported less agency in reducing prescribing rates. Prescription peer review meetings were seen as an opportunity for further education, action planning and goal setting, particularly in high performing hospitals, where these meetings were led by senior doctors who were perceived to have relevant clinical experience. Caregiver participants reported that intervention educational materials were helpful but they identified information from doctors was more useful. Providers and caregivers also described contextual health system factors, including hospital competition, short consultation times, and antibiotic availability without prescription, which shaped care preferences. Conclusions This qualitative process evaluation identified a range of factors that may have influenced behaviour among providers and caregivers leading to observed changes in reducing inappropriate antibiotic prescribing in China. Future interventions to reduce antibiotic prescribing should consider system level and wider contextual factors to better understand behaviours and patient care preferences.
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Affiliation(s)
- Xiaolin Wei
- Dalla Lana Chair in Global Health Policy, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Simin Deng
- Research Associate, China Global Health Research and Development, China
| | - Victoria Haldane
- Doctoral student, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Claire Blacklock
- Research Fellow, Nuffield Centre for International Health and Development, University of Leeds, UK
| | - Wei Zhang
- Research Associate, China Global Health Research and Development, China
| | - Zhitong Zhang
- Research Fellow, Dalla Lana School of Public Health, University of Toronto, Canada
| | - John D Walley
- Professor of International Public Health, Nuffield Centre for International Health and Development, University of Leeds, UK
| | - Rebecca King
- Lecturer in International Health, Nuffield Centre for International Health and Development, University of Leeds, UK
| | - Joseph P Hicks
- Lecturer in Medical Statistics, Nuffield Centre for International Health and Development, University of Leeds, UK
| | - Jia Yin
- Associate Professor, School of Health Care Management, Shandong University, China
| | - Guanyang Zou
- Associate Professor, School of Economics and Management, Guangzhou University of Chinese Medicine, China
| | - Yunayuan Huang
- Research Associate, China Global Health Research and Development, China
| | - Mercy Vergis
- Research Fellow, Nuffield Centre for International Health and Development, University of Leeds, UK
| | - Zeng Jun
- Division Director, Guangxi Autonomous Region Centre for Disease Control and Prevention, China
| | - Qiang Sun
- Professor and Dean, School of Health Care Management, Shandong University, China
| | - Mei Lin
- Director in General, Guangxi Autonomous Region Centre for Disease Control and Prevention, China
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Haldane V, Singh SR, Srivastava A, Chuah FLH, Koh GCH, Chia KS, Perel P, Legido-Quigley H. Community involvement in the development and implementation of chronic condition programmes across the continuum of care in high- and upper-middle income countries: A systematic review. Health Policy 2019; 124:419-437. [PMID: 31837832 DOI: 10.1016/j.healthpol.2019.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/04/2018] [Revised: 11/10/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Community involvement is an important component of health programme development and implementation, including those focused on chronic condition treatment and management. Yet, few studies explore the manifestations of community involvement in chronic care programmes. Our review aims to examine the evidence on how communities are involved in planning and implementing chronic condition programmes in high and upper-middle income countries. METHODS Eligible studies included those that involved the community in the planning, implementation, monitoring and evaluation of health services, policy or health interventions. We searched Medline, Embase, Global Health, Scopus, and LILACs from 2000 to 2016, independently screened articles for inclusion, conducted data extraction, and assessed studies for risk of bias. RESULTS 27,232 records were identified and after screening, 32 met inclusion criteria. We conducted a narrative synthesis to report on the forms and processes of community involvement used across mental health programmes and contrast this with the paucity of evidence on comparable programmes addressing other chronic conditions. Challenges reported included user factors, organisational factors, and social challenges such as stigma. CONCLUSION Our review adds to the evidence supporting community involvement in chronic condition management and the processes that contribute to successful and sustainable involvement. We report on a model, derived from inductive analysis, that considers social and cultural components, organisational factors and stakeholder relationships as underpinning the development of community interventions across the care continuum.
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Affiliation(s)
- Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Aastha Srivastava
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Fiona L H Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK; World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore; London School of Hygiene and Tropical Medicine, WC1H 9SH, UK; Department of Nursing and Physiotherapy, University of Lleida, Spain.
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Han E, Haldane V, Koh JJK, Quek RYC, Ozdemir S, Finkelstein EA, Jafar TH, Choong HL, Gan S, Lim LWW, Shiraz F, Legido-Quigley H. Perspectives on decision making amongst older people with end-stage renal disease and caregivers in Singapore: A qualitative study. Health Expect 2019; 22:1100-1110. [PMID: 31418984 PMCID: PMC6803400 DOI: 10.1111/hex.12943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits. OBJECTIVE This study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis. DESIGN Qualitative study design using semi-structured interviews. SETTING AND PARTICIPANTS Twenty-three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers. RESULTS While some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision-making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden. DISCUSSION AND CONCLUSION This study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision-making factors as well as the relational dynamics between patients, caregivers and doctors.
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Affiliation(s)
- Emeline Han
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rina Yu Chin Quek
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | | | | | - Hui-Lin Choong
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Sheryl Gan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Lydia W W Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,London School of Hygiene and Tropical Medicine, London, UK
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Han E, Shiraz F, Haldane V, Koh JJK, Quek RYC, Ozdemir S, Finkelstein EA, Jafar TH, Choong HL, Gan S, Lim LWW, Legido-Quigley H. Biopsychosocial experiences and coping strategies of elderly ESRD patients: a qualitative study to inform the development of more holistic and person-centred health services in Singapore. BMC Public Health 2019; 19:1107. [PMID: 31412824 PMCID: PMC6694659 DOI: 10.1186/s12889-019-7433-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/31/2019] [Accepted: 08/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background As the incidence and prevalence rates of end stage renal disease (ESRD) rise globally, a disproportionate increase has been observed in the elderly population. Singapore has the fifth highest incidence of treated ESRD worldwide, with the upward trend of ESRD being most apparent among those aged 70 years and older. Although it is well-documented that ESRD patients suffer an impaired quality of life compared to the general population, there is limited research focusing on the unique experiences and needs of elderly ESRD patients in Asian populations. To address the knowledge gap, this study seeks to explore the impact of ESRD and dialysis on the quality of life of elderly (≥70 years old) ESRD patients in Singapore and examine the coping strategies utilised by these patients. Methods This qualitative study involved semi-structured, in-depth interviews with 7 peritoneal dialysis patients, 5 haemodialysis patients, 4 patients on non-dialysis supportive care and 7 caregivers in Singapore. Interviews were conducted in English, Chinese, and Malay and fully transcribed. QSR NVivo 11 software was used for analysis. Results Participants reported that ESRD and dialysis had an impact on three highly interconnected areas of their quality of life: (a) biological/physical (general symptoms, neuromuscular problems, skin problems and poor sleep quality); (b) psychological (depressive symptoms, anxiety and fears, stress and negative self-perceptions); and (c) social (increased dependence on family and loss of social life). There were four key strategies that participants used to cope with these biopsychosocial challenges: (a) family support (financial, practical and emotional support); (b) religious/spiritual support (experiencing gratitude/contentment, the power of prayer and belonging to a faith community); (c) avoidance (cognitive avoidance and distraction techniques); and (d) acceptance (positive thinking and problem solving). Conclusions This study has provided insights into the biopsychosocial impact of ESRD and dialysis, as well as cultural and religious factors that shape the experiences and coping mechanisms of elderly ESRD patients and caregivers in Singapore, which can be used to further the development and implementation of more holistic and person-centred services to help each patient achieve a better quality of life. Electronic supplementary material The online version of this article (10.1186/s12889-019-7433-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emeline Han
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore.
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Rina Yu Chin Quek
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Semra Ozdemir
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | | | | | - Hui-Lin Choong
- Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Sheryl Gan
- Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Lydia W W Lim
- Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore
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Su M, Haldane V, Upshur R, Sullivan F, Légaré F, Greiver M, Wei X. The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018. JMIR Res Protoc 2019; 8:e13571. [PMID: 31152529 PMCID: PMC6658229 DOI: 10.2196/13571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 01/02/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence. Objective This study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings. Methods We will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level. Results The project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019. Conclusions The findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities. International Registered Report Identifier (IRRID) DERR1-10.2196/13571
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Affiliation(s)
- Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frank Sullivan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,School of Medicine, University of St Andrews, North Haugh, United Kingdom
| | - France Légaré
- Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Haldane V, Koh JJK, Srivastava A, Teo KWQ, Tan YG, Cheng RX, Yap YC, Ong PS, Van Dam RM, Foo JM, Müller-Riemenschneider F, Koh GCH, Foong PS, Perel P, Legido-Quigley H. User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study. JMIR Mhealth Uhealth 2019; 7:e10465. [PMID: 31140445 PMCID: PMC6658252 DOI: 10.2196/10465] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 03/21/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/21/2022] Open
Abstract
Background The use of mobile health (mHealth) has gained popularity globally, including for its use in a variety of health interventions, particularly through short message service (SMS) text messaging. However, there are challenges to the use of mHealth, particularly among older users who have a large heterogeneity in usability and accessibility barriers when using technology. Objective In order to better understand and conceptualize the diversity of users and give insight into their particular needs, we turned to persona creation. Personas are user archetypes created through data generated from multi-method inquiry with actual target users. Personas are an appropriate yet largely underutilized component of current mHealth research. Methods Leveraging data from a multi-method study conducted in Singapore with an ethnically diverse population including Chinese, Malay, and Indian participants, we used a proforma to analyze data from the qualitative component (ie, 20 in-depth interviews) and quantitative component (ie, 100 interviewer-guided surveys). We then identified key characteristics, including technology use and preferences as well as adherence factors, to synthesize five personas reflective of persons over the age of 40 years in Singapore with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, such as hypertension. Results We present five personas typologized as (1) The Quiet Analog, (2) The Busy Grandparent, (3) The Socializer, (4) The Newly Diagnosed, and (5) The Hard-to-Reach. We report on four key characteristics: health care access, medication adherence, mobile phone technology usage (ie, ownership, access, and utilization), and interest in mHealth. Finally, we provide insights into how these personas may be used in the design and implementation of an mHealth intervention. Our work demonstrates how multi-method data can create biopsychosocial personas that can be used to explore and address the diversity in behaviors, preferences, and needs in user groups. Conclusions With wider adoption of mHealth, it is important that we consider user-centered design techniques and design thinking in order to create meaningful, patient-centered interventions for adherence to medications. Future research in this area should include greater exploration of how these five personas can be used to better understand how and when is best to deliver mHealth interventions in Singapore and beyond.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Aastha Srivastava
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Yao Guo Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Rui Xiang Cheng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Yi Cheng Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Pei-Shi Ong
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Rob M Van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jie Min Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pin Sym Foong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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Wei X, Hicks JP, Pasang P, Zhang Z, Haldane V, Liu X, Yin T, Wang L, Shi D, Ge S, Walley J, Upshur R, Hu J. Protocol for a randomised controlled trial to evaluate the effectiveness of improving tuberculosis patients' treatment adherence via electronic monitors and an app versus usual care in Tibet. Trials 2019; 20:273. [PMID: 31097023 PMCID: PMC6521492 DOI: 10.1186/s13063-019-3364-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/04/2019] [Accepted: 04/15/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment non-adherence is a serious challenge to effective tuberculosis (TB) control in Tibet. In this study we will pilot and evaluate the effectiveness of using new electronic monitors (e-monitors) and a smartphone app to improve treatment adherence among new pulmonary TB patients in Tibet. METHODS We will use a multicentre, parallel-group, individually randomised controlled, superiority trial with blinded outcome evaluation and unblinded treatment. We will randomise new pulmonary TB outpatients (aged ≥ 15 years old and free from communication impairment) from Shigatse, Tibet to either the intervention or control arm in a 1:1 ratio at the time of their diagnosis. All patients will be treated according to the World Health Organisation standard 6-month TB treatment regimen and the China National TB programme guidelines. Intervention arm patients will be given their medication via e-monitors that have automatic voice reminders, and record medication adherence data and share it with health staff via Cloud connection. Intervention patients will also be encouraged to receive smartphone-based video-observed treatment if their adherence is problematic. Control arm patients will receive their medication in e-monitors that will collect medication adherence history, but will have their reminder function deactivated and are not linked to the app. The primary outcome is the rate of poor adherence, measured monthly during treatment as a binary indicator where poor adherence means missing ≥ 20% of doses in a month. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and an analysis of the long-term effects of the intervention on TB control. DISCUSSION Our study is one of the first trials to evaluate the use of e-monitors and smartphone apps for customised treatment support in low- and middle-income countries (LMICs). All intervention activities are designed to be embedded into routine TB care with strong local ownership. Through the trial we intend to understand the feasibility of our intervention, its effectiveness, its cost-effectiveness and its long-term impacts to inform future scale-up in remote areas of China and other LMICs. TRIAL REGISTRATION Current Controlled Trials, ID: ISRCTN52132803 . Registered on 9 November 2018.
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Affiliation(s)
- Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Pande Pasang
- Shigatse Centre for Disease Control and Prevention, 7 Keji Road, Samzhubze District, Shigatse, Tibet China
| | - Zhitong Zhang
- Shigatse Centre for Disease Control and Prevention, 7 Keji Road, Samzhubze District, Shigatse, Tibet China
| | - Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Xiaoqiu Liu
- China National Centre for Tuberculosis Prevention and Control, China National Centre for Disease Control and Prevention, Beijing, China
| | - Tingting Yin
- Weifang Medical College, Weifang, Shandong China
| | - Lixia Wang
- China National Centre for Tuberculosis Prevention and Control, China National Centre for Disease Control and Prevention, Beijing, China
| | - Dachun Shi
- Shigatse Centre for Disease Control and Prevention, 7 Keji Road, Samzhubze District, Shigatse, Tibet China
| | - Shiliang Ge
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jun Hu
- Shigatse Centre for Disease Control and Prevention, 7 Keji Road, Samzhubze District, Shigatse, Tibet China
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Haldane V, Chuah FLH, Srivastava A, Singh SR, Koh GCH, Seng CK, Legido-Quigley H. Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PLoS One 2019; 14:e0216112. [PMID: 31075120 PMCID: PMC6510456 DOI: 10.1371/journal.pone.0216112] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Community participation is widely believed to be beneficial to the development, implementation and evaluation of health services. However, many challenges to successful and sustainable community involvement remain. Importantly, there is little evidence on the effect of community participation in terms of outcomes at both the community and individual level. Our systematic review seeks to examine the evidence on outcomes of community participation in high and upper-middle income countries. Methods and findings This review was developed according to PRISMA guidelines. Eligible studies included those that involved the community, service users, consumers, households, patients, public and their representatives in the development, implementation, and evaluation of health services, policy or interventions. We searched the following databases from January 2000 to September 2016: Medline, Embase, Global Health, Scopus, and LILACs. We independently screened articles for inclusion, conducted data extraction, and assessed studies for risk of bias. No language restrictions were made. 27,232 records were identified, with 23,468 after removal of duplicates. Following titles and abstracts screening, 49 met the inclusion criteria for this review. A narrative synthesis of the findings was conducted. Outcomes were categorised as process outcomes, community outcomes, health outcomes, empowerment and stakeholder perspectives. Our review reports a breadth of evidence that community involvement has a positive impact on health, particularly when substantiated by strong organisational and community processes. This is in line with the notion that participatory approaches and positive outcomes including community empowerment and health improvements do not occur in a linear progression, but instead consists of complex processes influenced by an array of social and cultural factors. Conclusion This review adds to the evidence base supporting the effectiveness of community participation in yielding positive outcomes at the organizational, community and individual level. Trial registration Prospero record number:CRD42016048244.
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Affiliation(s)
- Victoria Haldane
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Fiona L. H. Chuah
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Aastha Srivastava
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shweta R. Singh
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gerald C. H. Koh
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chia Kee Seng
- Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Helena Legido-Quigley
- Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Haldane V, Tan YG, Teo KWQ, Koh JJK, Srivastava A, Cheng RX, Yap YC, Ong PS, van Dam RM, Foo JM, Müller-Riemenschneider F, Koh GCH, Perel P, Legido-Quigley H. Perspectives on Acceptance and Use of a Mobile Health Intervention for the Prevention of Atherosclerotic Cardiovascular Disease in Singapore: Mixed-Methods Study. JMIR Mhealth Uhealth 2019; 7:e11108. [PMID: 30869651 PMCID: PMC6437612 DOI: 10.2196/11108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cardiovascular disease, including atherosclerotic cardiovascular disease (ASCVD), is a growing public health threat globally and many individuals remain undiagnosed, untreated, and uncontrolled. Simultaneously, mobile health (mHealth) interventions using short messaging service (SMS) have gained popularity globally. There is an opportunity for innovative approaches such as mHealth to encourage and enable adherence to medications for ASCVD and its risk factors. OBJECTIVE This study aimed to understand mobile technology acceptance, use, and facilitating conditions among the study population ahead of the design of an mHealth intervention. METHODS Using data from a mixed-methods study conducted in Singapore, we conducted a cross-sectional survey with 100 participants and in-depth, semistructured interviews with 20 patients. All participants were over the age of 40 years with ASCVD or its risk factors. Interviews were conducted in English and Mandarin and if needed translated to English. Nvivo 11 (QSR International) was used for analyses. RESULTS Participants reported their perspectives on technology use and preferences, including low or sporadic mobile phone use and usability concerns including small screen and text size, among others; the benefit of previous mHealth use in creating a favorable opinion of SMS for health information; trust in both the source of mHealth SMS, as well as in treatment; the formation of habits; and fear of sequelae or death for facilitating intention to use an mHealth intervention and adhere to medication. We also highlighted a case that underscored the importance of the period after diagnosis in habit forming as an opportunity for an mHealth intervention. CONCLUSIONS We explored both technology- and adherence-related factors that influence a patient's intention to use an mHealth intervention for adherence to ASCVD medication in Singapore. We highlighted the importance of identifying the right opportunity to engage with patients and promote an mHealth intervention for adherence, such as immediately following diagnosis when patients are establishing medication-taking habits.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yao Guo Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | | | - Joel Jun Kai Koh
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aastha Srivastava
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rui Xiang Cheng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Yi Cheng Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Pei-Shi Ong
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Rob M van Dam
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jie Min Foo
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Gerald Choon-Huat Koh
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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Khan MS, Lakha F, Tan MMJ, Singh SR, Quek RYC, Han E, Tan SM, Haldane V, Gea-Sánchez M, Legido-Quigley H. More talk than action: gender and ethnic diversity in leading public health universities. Lancet 2019; 393:594-600. [PMID: 30739695 DOI: 10.1016/s0140-6736(18)32609-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/05/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022]
Abstract
Improving the career progression of women and ethnic minorities in public health universities has been a longstanding challenge, which we believe might be addressed by including staff diversity data in university rankings. We present findings from a mixed methods investigation of gender-related and ethnicity-related differences in career progression at the 15 highest ranked social sciences and public health universities in the world, including an analysis of the intersection between sex and ethnicity. Our study revealed that clear gender and ethnic disparities remain at the most senior academic positions, despite numerous diversity policies and action plans reported. In all universities, representation of women declined between middle and senior academic levels, despite women outnumbering men at the junior level. Ethnic-minority women might have a magnified disadvantage because ethnic-minority academics constitute a small proportion of junior-level positions and the proportion of ethnic-minority women declines along the seniority pathway.
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Affiliation(s)
- Mishal Sameer Khan
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatim Lakha
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Melisa Mei Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - Emeline Han
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - See Mieng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, Health-Care Research Group (GRECS), Institute of Biomedical Research of Lleida (IRBLleida), Lleida, Spain; Grup d'Estudis Societat, Salut, Educació, Cultura (GESEC), Institut de Desenvolupament Social i Territorial (INDEST), University of Lleida, Lleida, Spain
| | - Helena Legido-Quigley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Legido-Quigley H, Naheed A, de Silva HA, Jehan I, Haldane V, Cobb B, Tavajoh S, Chakma N, Kasturiratne A, Siddiqui S, Jafar TH. Patients' experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study. PLoS One 2019; 14:e0211100. [PMID: 30682093 PMCID: PMC6347162 DOI: 10.1371/journal.pone.0211100] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/08/2019] [Indexed: 12/18/2022] Open
Abstract
Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertension disproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. Overall, patients' reported symptoms across the three countries were quite similar, although perceptions of hypertension were mixed. The majority of patients reported low knowledge on how to prevent or treat hypertension. The main barriers to accessing health services, as reported by participants, were inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached. Patients also mentioned that cost was a barrier to accessing services and adhering to medication. Many patients, when asked for areas of improvement, reported on the importance of the provider-patient relationship and mentioned valuing doctors who spent time with them, provided advice, and could be trusted. However, most patients reported that, especially at primary health care level and in government hospitals, the experience with their doctor did not meet their expectations. Patients in the three countries reported desire for good quality local medical services, the need for access to doctors, medicine and diagnostics and decreased cost for medication and medical services. Patients also described welcoming health care outreach activities near their homes. Areas of improvement could focus on reorienting community health workers' activities; involving family members in comprehensive counseling for medication adherence; providing appropriate training for health care staff to deliver effective information and services for controlling hypertension to patients; enhancing primary health care and specialist services; improving supplies of hypertensive medication in public facilities; taking into account patients' cultural and social background when providing services; and facilitating access and treatment to those who are most vulnerable.
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Affiliation(s)
| | - Aliya Naheed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Imtiaz Jehan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Cobb
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Saeideh Tavajoh
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Nantu Chakma
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anuradhani Kasturiratne
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Sahar Siddiqui
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Tazeen H Jafar
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Tan ST, Quek RYC, Haldane V, Koh JJK, Han EKL, Ong SE, Chuah FLH, Legido-Quigley H. The social determinants of chronic disease management: perspectives of elderly patients with hypertension from low socio-economic background in Singapore. Int J Equity Health 2019; 18:1. [PMID: 30606218 PMCID: PMC6318975 DOI: 10.1186/s12939-018-0897-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Singapore, the burden of hypertension disproportionately falls on the elderly population of low socio-economic status. Despite availability of effective treatment, studies have shown high prevalence of sub-optimal blood pressure control in this group. Poor hypertension management can be attributed to a number of personal factors including awareness, management skills and overall adherence to treatment. However, these factors are also closely linked to a broader range of community and policy factors. This paper explores the perceived social and physical environments of low socio-economic status and elderly patients with hypertension; and how the interplay of factors within these environments influences their ability to mobilise resources for hypertension management. Methods In-depth interviews were conducted in English, Chinese, Chinese dialects and Malay with 20 hypertensive patients of various ethnic backgrounds. Purposive sampling was adopted for recruitment of participants from a previous community health screening campaign. Interviews were translated into English and transcribed verbatim. We deductively analysed leveraging on the Social Model of Health to identify key themes, while inductive analysis was used simultaneously to allow sub-themes to emerge. Results and discussion Our finding shows that financing is an overarching topic embedded in most themes. Despite the availability of multiple safety nets, some patients were left out and lacked capital to navigate systems effectively, which resulted in delayed treatment or debt. The built environment played a significant role in enabling patients to access care easily and lead a more active lifestyle. A closer look is needed to enhance the capacity of patients with mobility challenges to enjoy equitable access. Furthermore, the establishment of community based elderly centres has enabled patients to engage in meaningful and healthy social activities. In contrast, participants’ descriptions showed that their communication with healthcare professionals remained brief, and that personalised and meaningful interactions that are context and culturally specific are essential to advocate for patients’ overall treatment adherence and lifestyle modification. Conclusion Elderly patients with hypertension from lower socio-economic background have various unmet needs in managing their hypertension and other comorbidities. These needs are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.
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Affiliation(s)
- Sok Teng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Rina Yu Chin Quek
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Emeline Kai Lin Han
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Fiona Leh Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore. .,London School of Hygiene and Tropical Medicine, WC1H 9SH, London, UK.
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Koh JJK, Cheng RX, Yap Y, Haldane V, Tan YG, Teo KWQ, Srivastava A, Ong PS, Perel P, Legido-Quigley H. Access and adherence to medications for the primary and secondary prevention of atherosclerotic cardiovascular disease in Singapore: a qualitative study. Patient Prefer Adherence 2018; 12:2481-2498. [PMID: 30538432 PMCID: PMC6255116 DOI: 10.2147/ppa.s176256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is a growing public health threat globally, and many individuals remain undiagnosed, untreated, and their condition remains uncontrolled. The key to effective ASCVD management is adherence to pharmacotherapy, and non-adherence has been associated with an increased risk of cardiovascular events and complications such as stroke, further impacting a patient's ability to be adherent. Our qualitative study aimed to explore factors influencing medication adherence in the primary and secondary prevention of ASCVD in Singapore. We propose a synthesized framework, which expands on current understandings of the factors of medication adherence, as a frame of analysis in this study. METHODS We conducted in-depth, semi-structured interviews with 20 patients over the age of 40 with ASCVD and/or its risk factors in Singapore. QSR Nvivo 11 was used to conduct thematic analysis using an inductive approach. RESULTS Using a synthesized framework, we reported that complex medication regimens, the lack of support received during regimen changes, and the perceived seriousness of a condition could impact a patient's medication adherence. Key findings suggest that the relationship between health care professionals and patients impacted patient acceptability of the medication regimen and consequently medication adherence. Different patient beliefs regarding diagnosis, medication, and adherence had some bearing on the ability to perceive the need to adhere to their medication. Patients also reported that they could afford medication, sometimes with the help of family members. Patients also largely reported not needing help managing their medication, considering it an individual responsibility. CONCLUSION We identified key factors which future interventions looking to improve medication adherence ought to consider. These include changing patient perceptions of health systems, diagnosis, medication, and adherence; patient-centeredness in developing interventions that facilitate adherence through building self-efficacy and stronger support networks via patient empowerment and engagement; decreasing patient co-payments on medication; and cultivating a trusting patient-provider relationship.
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Affiliation(s)
- Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Rui Xiang Cheng
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yicheng Yap
- Department of Pharmacy, National University of Singapore, Singapore
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Yao Guo Tan
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - Aastha Srivastava
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Pei Shi Ong
- Department of Pharmacy, National University of Singapore, Singapore
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, UK,
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
- London School of Hygiene and Tropical Medicine, London, UK,
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Naheed A, Haldane V, Jafar TH, Chakma N, Legido-Quigley H. Patient pathways and perceptions of hypertension treatment, management, and control in rural Bangladesh: a qualitative study. Patient Prefer Adherence 2018; 12:1437-1449. [PMID: 30147302 PMCID: PMC6097513 DOI: 10.2147/ppa.s163385] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Hypertension is an increasing threat to global public health, a leading cause of premature death, and an important modifiable risk factor for cardiovascular and cerebrovascular disease. Despite evidence on the efficacy of antihypertensive medication for blood-pressure control and mortality prevention, a large proportion of individuals are undiagnosed and untreated, especially in resource-constrained settings. This qualitative study explored patient pathways to care, as well as knowledge of and adherence to hypertension care. METHODS We conducted in-depth interviews with 20 hypertensive patients in two rural districts in Bangladesh. Interviews were conducted and transcribed in Bangla and translated to English. QSR NVivo 10 software was used for analyses. We mapped patient pathways and report here on patient experiences accessing care from local pharmacies, the government, and private clinics. RESULTS Overall, most patients reported hypertension awareness prior to diagnosis and were conscious about consequences of hypertension. However, patients had little knowledge about prevention and treatment strategies. Most patients considered hypertension an important disease, albeit reporting taking medication only when symptomatic. Patients were aware of dietary advice; however, they were largely sedentary. Qualified doctors in both private and government settings diagnosed hypertension in the majority of the patients, and some were diagnosed by an informal provider and a few reported self-care at home. Patients followed three pathways: specialized hospitals for acute care, private hospitals/local pharmacy for nonacute symptoms, and incidental hypertension identification while being treated for another condition. CONCLUSION We identify barriers to access to hypertension prevention and care that prevented patients from seeking and receiving treatment from government facilities. Challenges included a lack of support to enable community screening by government health workers, long waiting times, and inadequate supplies for hypertension treatment. Expanding community-health workers' scope in the dissemination of chronic-disease information may improve patient pathways to hypertension care in rural communities in Bangladesh.
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Affiliation(s)
- Aliya Naheed
- Initiative for Noncommunicable Diseases, International Centre for Diarrhoeal Disease Research (icddr), Dhaka, Bangladesh
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Tazeen H Jafar
- Program for Health Services and Systems Research, Duke NUS Medical School, Singapore,
- Duke Global Health Institute, Duke University, Durham, NC, USA,
| | - Nantu Chakma
- Initiative for Noncommunicable Diseases, International Centre for Diarrhoeal Disease Research (icddr), Dhaka, Bangladesh
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Haldane V, Cervero-Liceras F, Ong SE, Murphy G, Balabanova D, Buse K, McKee M, Ledigo-Quigley H, Chuah F. Interventions and approaches to integrating HIV and mental health services: a systematic review. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Haldane
- National University of Singapore, Singapore, Singapore
| | | | - SE Ong
- National University of Singapore, Singapore, Singapore
| | - G Murphy
- University of Oxford, Oxford, UK
| | - D Balabanova
- London School of Hygiene and Tropical Medicine, London, UK
| | - K Buse
- UNAIDS, Geneva, Switzerland
| | - M McKee
- National University of Singapore, Singapore, Singapore
| | | | - F Chuah
- National University of Singapore, Singapore, Singapore
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Singh SR, Srivastava A, Haldane V, Chuah FLH, Koh GCH, Seng Chia K, Legido-Quigley H. Community participation in health services development: A systematic review on outcomes. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- SR Singh
- National University of Singapore, Singapore
| | | | - V Haldane
- National University of Singapore, Singapore
| | - FLH Chuah
- National University of Singapore, Singapore
| | - GCH Koh
- National University of Singapore, Singapore
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