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Bukhari T, Gichuhi J, Mbare O, Ochwal VA, Fillinger U, Herren JK. Willingness to accept and participate in a Microsporidia MB-based mosquito release strategy: a community-based rapid assessment in western Kenya. Malar J 2024; 23:113. [PMID: 38643165 PMCID: PMC11031974 DOI: 10.1186/s12936-024-04941-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Microsporidia MB, an endosymbiont naturally found in Anopheles mosquitoes inhibits transmission of Plasmodium and is a promising candidate for a transmission-blocking strategy that may involve mosquito release. A rapid assessment was carried out to develop insight into sociodemographic factors, public health concerns, and malaria awareness, management, and prevention practices with the willingness to accept and participate in Microsporidia MB-based transmission-blocking strategy to develop an informed stakeholder engagement process. METHODS The assessment consisted of a survey conducted in two communities in western Kenya that involved administering a questionnaire consisting of structured, semi-structured, and open questions to 8108 household heads. RESULTS There was an overall high level of willingness to accept (81%) and participate in the implementation of the strategy (96%). Although the willingness to accept was similar in both communities, Ombeyi community was more willing to participate (OR 22, 95% CI 13-36). Women were less willing to accept (OR 0.8, 95% CI 0.7-0.9) compared to men due to fear of increased mosquito bites near homes. Household heads with incomplete primary education were more willing to accept (OR 1.6, 95% CI 01.2-2.2) compared to those educated to primary level or higher. Perceiving malaria as a moderate or low public health issue was also associated with a lower willingness to accept and participate. Experience of > 3 malaria cases in the family over the last six months and knowledge that malaria is transmitted by only mosquito bites, increased the willingness to accept but reduced the willingness to participate. Awareness of malaria control methods based on mosquitoes that cannot transmit malaria increases the willingness to participate. CONCLUSION The study showed a high level of willingness to accept and participate in a Microsporidia MB-based strategy in the community, which is influenced by several factors such as community, disease risk perception, gender, education level, knowledge, and experience of malaria. Further research will need to focus on understanding the concerns of women, educated, and employed community members, and factors that contribute to the lower disease risk perception. This improved understanding will lead to the development of an effective communication strategy.
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Affiliation(s)
- Tullu Bukhari
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya.
| | - Joseph Gichuhi
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Oscar Mbare
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Victoria A Ochwal
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Ulrike Fillinger
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
| | - Jeremy K Herren
- Human Health, International Centre of Insect Physiology and Ecology (Icipe), Nairobi, Kenya
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Albitres-Flores L, Perez-Leon S, Bernabe-Ortiz A, Tenorio-Mucha J, Cardenas MK, Vetter B, Safary E, Gamboa R, Cordova V, Gupta R, Moran A, Beran D, Lazo-Porras M. Co-creation process of an intervention to implement a multiparameter point-of-care testing device in a primary healthcare setting for non-communicable diseases in Peru. BMC Health Serv Res 2024; 24:401. [PMID: 38553724 PMCID: PMC10981306 DOI: 10.1186/s12913-024-10809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/29/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Point-of-care testing (POCT) devices are diagnostic tools that can provide quick and accurate results within minutes, making them suitable for diagnosing non-communicable diseases (NCDs). However, these devices are not widely implemented in healthcare systems and for this reason is relevant to understand the implementation process. AIM To describe the process and define a strategy to implement a multiparameter POCT device for diagnosing and managing NCDs in one region of Peru. METHODS A descriptive and non-experimental study, using the participatory methodologies of co-creation process. It was conducted in one region of Peru (Tumbes) to design an intervention for implementing a multiparameter POCT device. Two co-creation sessions were conducted involving five groups: community members, primary healthcare workers, these groups in both rural and urban settings, and regional decision-makers. These sessions included activities to understand patient journeys in receiving care for NCDs, identify facilitators and barriers to POCT devices usage, and define an implementation strategy for POCT devices in both rural and urban settings of Tumbes. The research team analysed the data and summarized key topics for discussion after each session. RESULTS A total of 78 participants were enrolled across the five groups. Among community members: 22.2% had only diabetes, 24.1% had only hypertension, and 18.5% had both diagnoses. In the patient journey, community members mentioned that it took at least three days to receive a diagnosis and treatment for an NCD. Most of the participants agreed that the POCT devices would be beneficial for their communities, but they also identified some concerns. The strategy for POCT devices implementation included healthcare workers training, POCT devices must be placed in the laboratory area and must be able to perform tests for glucose, glycated haemoglobin, cholesterol, and creatinine. Advertising about POCT devices should be displayed at the healthcare centres and the municipality using billboards and flyers. CONCLUSIONS The co-creation process was useful to develop strategies for the implementation of multiparameter POCT devices for NCDs, involving the participation of different groups of stakeholders guided by moderators in both, rural and urban, settings in Peru.
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Affiliation(s)
- Leonardo Albitres-Flores
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvana Perez-Leon
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Janeth Tenorio-Mucha
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Kathia Cardenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Ricardo Gamboa
- Global Health Center, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | | | - Reena Gupta
- Resolve to Save Lives, New York, NY, USA
- Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, USA
| | | | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland.
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Longworth GR, Erikowa-Orighoye O, Anieto EM, Agnello DM, Zapata-Restrepo JR, Masquillier C, Giné-Garriga M. Conducting co-creation for public health in low and middle-income countries: a systematic review and key informant perspectives on implementation barriers and facilitators. Global Health 2024; 20:9. [PMID: 38233942 PMCID: PMC10795424 DOI: 10.1186/s12992-024-01014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND There has been an increase in the use of co-creation for public health because of its claimed potential to increase an intervention's impact, spark change and co-create knowledge. Still, little is reported on its use in low-and-middle-income countries (LMICs). This study offers a comprehensive overview of co-creation used in public-health-related interventions, including the interventions' characteristics, and reported implementation barriers and facilitators. METHODS We conducted a systematic review within the Scopus and PubMed databases, a Google Scholar search, and a manual search in two grey literature databases related to participatory research. We further conducted eight interviews with first authors, randomly selected from included studies, to validate and enrich the systematic review findings. RESULTS Through our review, we identified a total of twenty-two studies conducted in twenty-four LMIC countries. Majority of the interventions were designed directly within the LMIC setting. Aside from one, all studies were published between 2019 and 2023. Most studies adopted a co-creation approach, while some reported on the use of co-production, co-design, and co-development, combined either with community-based participatory research, participatory action research or citizen science. Among the most reported implementation barriers, we found the challenge of understanding and accounting for systemic conditions, such as the individual's socioeconomic status and concerns related to funding constraints and length of the process. Several studies described the importance of creating a safe space, relying on local resources, and involving existing stakeholders in the process from the development stage throughout, including future and potential implementors. High relevance was also given to the performance of a contextual and/or needs assessment and careful tailoring of strategies and methods. CONCLUSION This study provides a systematic overview of previously conducted studies and of reported implementation barriers and facilitators. It identifies implementation barriers such as the setting's systemic conditions, the socioeconomic status and funding constrains along with facilitators such as the involvement of local stakeholders and future implementors throughout, the tailoring of the process to the population of interest and participants and contextual assessment. By incorporating review and interview findings, the study aims to provide practical insights and recommendations for guiding future research and policy.
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Affiliation(s)
| | | | - Ebuka Miracle Anieto
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
| | | | - Jorge Raul Zapata-Restrepo
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llul, Blanquerna, Barcelona, Spain
| | - Caroline Masquillier
- Family Medicine and Population Health'- FAMPOP, Faculty of Medical and Health Sciences & 'Centre for Family, Population and Health, Faculty of Social sciences, University of Antwerp, Belgium, Belgium
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llul, Blanquerna, Barcelona, Spain
- Faculty of Health Sciences, Universitat Ramon Llull, Blanquerna, Barcelona, Spain
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Lieneck C, Pacheco G, Cole M, Hipp L, Leal G, Matamoros K, Rojas-Trejo B, Stepp N, Torres C. Patient Co-Creation Initiatives in the Ambulatory Care Setting during COVID-19: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:111. [PMID: 38256372 PMCID: PMC10818531 DOI: 10.3390/medicina60010111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The COVID-19 pandemic has led to significant changes in ambulatory care to meet new healthcare demands. Materials and Methods: A review of 21 articles focusing on patient co-creation initiatives during the pandemic shows that integrating patient feedback was crucial in transforming care delivery. Results: Joint efforts between healthcare professionals and patients led to new patient-focused telemedicine platforms, more efficient appointment systems, and improved safety measures. These adaptations overcame care barriers and maintained continuity of care. Key themes identified include monitoring community health standards, combining technology with patient-provider communication, and enhancing patient participation in health research. Conclusions: These co-creation efforts not only boosted patient satisfaction and outcomes but also demonstrated the potential for long-term healthcare innovations beyond the pandemic. The review further illuminates that co-creation in healthcare, particularly in tracking community health trends, is a practical strategy that involves diverse stakeholders in shaping healthcare delivery. The widespread adoption of co-creation in outpatient care during the pandemic highlights its role in driving patient-centered behavioral changes through innovative methods like crowdsourcing and dialogue conferencing. The review also recognizes that co-creation has been instrumental in responding to demographic changes, enhancing resources, creativity, and problem-solving in municipal-volunteer collaborations. Additionally, the evolution of technology in patient-provider communication, from initial resistance in the 1990s to its current critical role, particularly during the COVID-19 pandemic, underscores its importance in enhancing healthcare service delivery and patient data communication. The review also emphasizes the need for ethically and accessibly designed technology, especially for vulnerable groups, and highlights the significance of patient involvement in healthcare research, advocating for user-centered design and shared decision-making to create truly patient-centric interventions.
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Affiliation(s)
- Cristian Lieneck
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA; (G.P.); (M.C.); (L.H.); (G.L.); (K.M.); (B.R.-T.); (N.S.); (C.T.)
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Vié C, Govindin-Ramassamy K, Thellier D, Labrosse D, Montagni I. Effectiveness of digital games promoting young people's mental health: A review of reviews. Digit Health 2024; 10:20552076231220814. [PMID: 38323239 PMCID: PMC10845979 DOI: 10.1177/20552076231220814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/28/2023] [Indexed: 02/08/2024] Open
Abstract
Objectives Digital games are a popular form of entertainment for youth. They are often used as a therapy for psychological problems, a mental health promotion intervention, and a preventative measure. Systematic reviews and meta-analyses have been conducted to assess the effectiveness of mental health-related digital games. However, a synthesis considering all evaluation results to inform their development is missing. Methods We performed a review of reviews to synthetize results of previous research to describe the impact of digital games on the mental health of young people aged <30 years old. We considered systematic reviews and meta-analyses published between 2012 and 2022. Searches were conducted in Scopus, Google Scholar, Pubmed, and Cochrane library systematic reviews (CENTRAL) during October 2023. Results Our final selection included 10 systematic reviews and meta-analyses on interventions targeting youth of both sexes aged 2-29 years old across the world. In total, 218 interventions were identified. Selected articles reported different types of games, e.g., active and non-active video games, virtual reality games, serious games. Not all digital games were conscientiously evaluated, but, in general, their impact on mental health was positive. Regarding the quality, 5 studies were of high quality, 3 of moderate quality and 2 of low quality. Conclusions Overall, elements of gamification were well-accepted, but they lacked assessment through rigorous experimental conditions. Digital games for mental health are promising, but in order to be consistently effective in promoting young people's mental health and prevent psychological diseases, they should present specific features.
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Affiliation(s)
- Clara Vié
- Bordeaux Population Health Research Center, University of Bordeaux, Inserm, Bordeaux, France
| | | | | | | | - Ilaria Montagni
- Bordeaux Population Health Research Center, University of Bordeaux, Inserm, Bordeaux, France
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Aya Pastrana N, Agudelo-Londoño S, Franco-Suarez O, Otero Machuca J, Guzman-Tordecilla DN, López Sánchez MC, Rodriguez-Patarroyo M, Rivera-Sánchez CA, Castro-Barbudo D, Trujillo AJ, Maniar V, Vecino-Ortiz AI. Improving COVID-19 vaccine uptake: a message co-design process for a national mHealth intervention in Colombia. Glob Health Action 2023; 16:2242670. [PMID: 37643136 PMCID: PMC10467523 DOI: 10.1080/16549716.2023.2242670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND COVID-19 vaccination is a global priority. Latin American countries have some of the highest COVID-19 death rates worldwide with vaccination hampered by a variety of reasons, including mis- and disinformation, vaccine hesitancy, and vaccine supply constraints. Addressing vaccine hesitancy through effective messages has been found to help increase vaccine uptake. Participatory processes could be used to co-design health messages for this purpose. OBJECTIVE This article describes the methodology used to co-design evidence-based audio messages to be deployed in a cohort of individuals through an interactive voice response (IVR) mobile phone survey intervention, aimed towards increasing vaccination uptake in an adult population in Colombia. METHODS Participants of the COVID-19 vaccination message co-design process included a sample of the general population of the country, representatives of the funder organisation, and research team members. The co-design process consisted of four phases: (1) formative quantitative and qualitative research, (2) message drafting based on the results of the formative research, (3) message content evaluation, and (4) evaluation of the voices to deliver the audio messages; and was informed by reflexive meetings. RESULTS Three categories of evidence-based audio messages were co-designed, each corresponding to an arm of the mHealth intervention: (1) factual messages, (2) narrative messages, and (3) mixed messages. An additional fourth arm with no message was proposed for control. The iterative co-design process ended with a total of 14 audio messages recorded to be deployed via the intervention. CONCLUSIONS Co-developing health messages in response to health emergencies is possible. Adopting more context-relevant, participatory, people-centred, and reflexive multidisciplinary approaches could help develop solutions that are more responsive to the needs of populations and public health priorities. Investing resources in message co-design is deemed to have a greater potential for influencing behaviours and improving health outcomes.
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Affiliation(s)
- Nathaly Aya Pastrana
- IMEK Centro de Investigación en Mercadeo & Desarrollo, Santiago de Cali, Colombia
- Instituto de Salud Pública, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Oscar Franco-Suarez
- Instituto de Salud Pública, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jessica Otero Machuca
- Instituto de Salud Pública, Pontificia Universidad Javeriana, Bogotá, Colombia
- Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | - Antonio J. Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vidhi Maniar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andres I. Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rousham E, Pareja RG, Creed-Kanashiro HM, Bartolini R, Pradeilles R, Ortega-Roman D, Holdsworth M, Griffiths P, Verdezoto N. Designing intervention prototypes to improve infant and young child nutrition in Peru: a participatory design study protocol. BMJ Open 2023; 13:e071280. [PMID: 38070935 PMCID: PMC10729018 DOI: 10.1136/bmjopen-2022-071280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Nutrition during the complementary feeding period (6-23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and middle-income countries, including Peru. This study aims to co-design and develop prototypes for interventions to address the multiple forms of malnutrition in IYC in urban Peru, using a participatory design approach. METHODS AND ANALYSIS The study will be based within peri-urban communities in two areas of Peru (Lima and Huánuco city). Following the identification of key nutritional challenges for IYC aged 6-23 months through formative research (phase I), we will conduct a series of workshops bringing together healthcare professionals from government health centres and caregivers of IYC aged 6-23 months. Workshops (on idea generation; creating future scenarios; storyboarding and early implementation and feedback) will take place in parallel in the two study areas. Through these workshops, we will engage with community participants to explore, experiment, co-design and iteratively validate new design ideas to address the challenges around IYC complementary feeding from phase I. Workshop outputs and transcripts will be analysed qualitatively using affinity diagramming and thematic analyses. The intervention prototypes will be evaluated qualitatively and piloted with the participating communities. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (388-2019/CIEI-IIN), Loughborough University (C19-87) and confirmed by Cardiff University. Findings of the participatory design process will be disseminated through a deliberative workshop in Lima, Peru with national and regional government stakeholders, as well as participants and researchers involved in the design process. Further dissemination will take place through policy briefs, conferences and academic publications.
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Snuggs S, Clot S, Lamport D, Sah A, Forrest J, Helme Guizon A, Kaur A, Iqbal Z, Caldara C, Wilhelm MC, Anin C, Vogt J. A mixed-methods approach to understanding barriers and facilitators to healthy eating and exercise from five European countries: highlighting the roles of enjoyment, emotion and social engagement. Psychol Health 2023:1-28. [PMID: 37933459 DOI: 10.1080/08870446.2023.2274045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
Healthy adults are consistently falling below national and international recommendations for physical activity and dietary intake across Europe. This study took a co-creative approach with adult samples from five European countries to qualitatively and quantitatively establish motivators, barriers and sustaining factors for positive health behaviour change. Stage 1 delivered a newly-designed online programme, creating a community who identified challenges, motivators and solutions to sustaining positive healthy eating and physical activity behaviours. Stage 2 administered an online survey (developed from Stage 1 findings) to a larger sample to quantify the relative importance of these motivators and barriers. Results from both stages indicated enjoyment, positive emotions, and reward as key motivators for both behaviours across all five countries. Barriers included habit-breaking difficulties, temptation and negative affective states. Those with a high BMI placed more importance on social pressure than those with healthy BMI. Participants' reports of motivators and barriers reflected relevant approaches from consumer science, behavioural economics, and psychology. Interventions supporting adults who are not chronically ill but would benefit from improved diet and/or physical activity should not focus exclusively on health as a motivating factor. Emphasis on enjoyable behaviours, social engagement and reward will likely improve engagement and sustained behaviour change.
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Affiliation(s)
- Sarah Snuggs
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Sophie Clot
- Department of Economics, University of Reading, Reading, UK
| | - Daniel Lamport
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Anumeha Sah
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Joseph Forrest
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Amanpreet Kaur
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Zara Iqbal
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Cindy Caldara
- Univ. Grenoble Alpes, Grenoble INP, CERAG, Grenoble, France
| | | | - Camille Anin
- Univ. Grenoble Alpes, Grenoble INP, CERAG, Grenoble, France
| | - Julia Vogt
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Gyawali R, Toomey M, Stapleton F, Keay L, Jalbert I. Enhancing the appropriateness of eyecare delivery: the iCaretrack approach. Clin Exp Optom 2023; 106:825-835. [PMID: 36813262 DOI: 10.1080/08164622.2023.2178286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023] Open
Abstract
Optometrists play an integral role in primary eyecare services, including prevention, diagnosis, and management of acute and chronic eye conditions. Therefore, it remains essential that the care they provide be timely and appropriate to ensure the best patient outcomes and optimal utilisation of resources. However, optometrists continuously face many challenges that can affect their ability to provide appropriate care (i.e., the care in line with evidence-based clinical practice guidelines). To address any resulting evidence-to-practice gaps, programs are needed that support and enable optometrists to adopt and utilise the best evidence in clinical practice. Implementation science is a field of research that can be applied to improving the adoption and maintenance of evidence-based practices in routine care, through systematic development and application of strategies or interventions to address barriers to evidence-based practice. This paper demonstrates an approach using implementation science to enhance optometric eyecare delivery. A brief overview of the methods used to identify existing gaps in appropriate eyecare delivery is presented. An outline of the process used to understand the behavioural barriers responsible for such gaps follows, involving theoretical models and frameworks. The resulting development of an online program for optometrists to enhance their capability, motivation, and opportunity to provide evidence-based eyecare is described, using the Behaviour Change Model and co-design methods. The importance of and methods used in evaluating such programs are also discussed. Finally, reflections on the experience and key learnings from the project are shared. While the paper focuses on experiences in improving glaucoma and diabetic eyecare in the Australian optometry context, this approach can be adapted to other conditions and contexts.
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Affiliation(s)
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW, Sydney, Australia
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Barakou I, Hackett KL, Finch T, Hettinga FJ. Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management. Ann Med 2023; 55:2270688. [PMID: 37871249 PMCID: PMC10595396 DOI: 10.1080/07853890.2023.2270688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE To propose a comprehensive multidimensional model of activity pacing that improves health-related quality of life and promotes sustained physical activity engagement among adults with chronic conditions. MATERIALS AND METHODS A narrative review was conducted to examine the existing literature on activity pacing, health-related quality of life, pain and fatigue management, and physical activity promotion in chronic conditions. RESULTS The literature revealed a lack of a cohesive approach towards a multidimensional model for using activity pacing to improve health-related quality of life. A comprehensive multidimensional model of activity pacing was proposed, emphasizing the importance of considering all aspects of pacing for sustained physical activity engagement and improved health-related quality of life. The model incorporates elements such as rest breaks, self-regulatory skills, environmental factors, and effective coping strategies for depression/anxiety. It takes into account physical, psychological, and environmental factors, all of which contribute significantly to the enhancement of health-related quality of life, physical function, and overall well-being, reflecting a holistic approach. CONCLUSIONS The model offers guidance to researchers and clinicians in effectively educating patients on activity pacing acquisition and in developing effective interventions to enhance physical activity engagement and health outcomes among adults with chronic conditions. Additionally, it serves as a tool towards facilitating discussions on sustained physical activity and a healthy lifestyle for patients, which can eventually lead to improved quality of life.
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Affiliation(s)
- Ioulia Barakou
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Katie L. Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- CRESTA Fatigue Clinic, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
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Francis-Oliviero F, Loubières C, Grové C, Marinucci A, Shankland R, Salamon R, Perez E, Garancher L, Galera C, Gaillard E, Orri M, González-Caballero JL, Montagni I. Improving Children's Mental Health Literacy Through the Cocreation of an Intervention and Scale Validation: Protocol for the CHILD-Mental Health Literacy Research Study. JMIR Res Protoc 2023; 12:e51096. [PMID: 37796588 PMCID: PMC10587813 DOI: 10.2196/51096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Children's mental health is a public health priority, with 1 in 5 European children younger than 12 years having a behavioral, developmental, or psychological disorder. Mental health literacy (MHL) is a modifiable determinant of mental health, promoting psychological well-being and reducing mental health problems. Despite its significance, no interventions or scales currently exist for increasing and measuring MHL in this population. OBJECTIVE This study has dual objectives: (1) cocreating and evaluating an intervention on children's MHL, and (2) developing and validating a scale that measures children's MHL. METHODS Our study focuses on children aged 9-11 years attending primary school classes in various settings, including urban and rural areas, and priority education zones within a French department. Using a participatory research approach, we will conduct workshops involving children, parents, teachers, and 1 artist to cocreate an intervention comprising multiple tools (eg, a pedagogical kit and videos). This intervention will undergo initial evaluation in 4 classes through observations, interviews, and satisfaction questionnaires to assess its viability. Concurrently, the artist will collaborate with children to create the initial version of the CHILD-MHL scale, which will then be administered to 300 children. Psychometric analyses will validate the scale. Subsequently, we will conduct a cluster randomized controlled trial involving a minimum of 20 classes, using the CHILD-MHL scale scores as the primary end point to evaluate the intervention's efficacy. Additional interviews will complement this mixed methods evaluation. Both the intervention and the scale are grounded in the Child-Focused MHL model. RESULTS The first tool of the intervention is the pedagogical kit Le Jardin du Dedans, supported by the public organization Psycom Santé Mentale Info and endorsed by UNICEF (United Nations Children's Fund) France. The second tool is a handbook by the Pan American Health Organization and the World Health Organization, which is addressed to teachers to sensitize them to children's mental health problems. The third is a 5-page supplementary leaflet produced by the nongovernmental organization The Ink Link, which teaches children the notion of MHL. Finally, we produced 56 items of the MHL Scale and listed existing education policies for children's mental health. CONCLUSIONS After its robust evaluation, the intervention could be extended to several schools in France. The scale will be the first in the world to measure children's MHL. It will be used not only to evaluate interventions but also to provide data for decision makers to include MHL in all educational policies. Both the intervention and the scale could be translated into other languages. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/51096.
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Affiliation(s)
- Florence Francis-Oliviero
- Bordeaux Population Health Research Center, Institut national de la santé et de la recherche médicale U1219, University of Bordeaux, Bordeaux, France
- Pôle de santé publique, Service d'Information Médicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Christine Grové
- School of Curriculum Teaching & Inclusive Education, Monash University, Clayton, Australia
- Fulbright Association, Science, Technology, Engineering and Mathematics College, Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Canberra, Australia
| | - Alexandra Marinucci
- School of Educational Psychology & Counselling, Monash University, Clayton, Australia
| | - Rebecca Shankland
- Laboratory Développement, Individu, Processus, Handicap, Éducation, Department of Psychology, Education and Vulnerabilities, Université Lumière Lyon 2, Lyon, France
| | - Réda Salamon
- Bordeaux Population Health Research Center, Institut national de la santé et de la recherche médicale U1219, University of Bordeaux, Bordeaux, France
| | | | | | - Cédric Galera
- Bordeaux Population Health Research Center, Institut national de la santé et de la recherche médicale U1219, University of Bordeaux, Bordeaux, France
- Charles Perrens Hospital, Bordeaux, France
| | - Elsa Gaillard
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | | | - Ilaria Montagni
- Bordeaux Population Health Research Center, Institut national de la santé et de la recherche médicale U1219, University of Bordeaux, Bordeaux, France
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Walker SC, Baquero B, Bekemeier B, Parnes M, Arora K. Strategies for enacting health policy codesign: a scoping review and direction for research. Implement Sci 2023; 18:44. [PMID: 37735397 PMCID: PMC10512571 DOI: 10.1186/s13012-023-01295-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Strategies for supporting evidence-informed health policy are a recognized but understudied area of policy dissemination and implementation science. Codesign describes a set of strategies potentially well suited to address the complexity presented by policy formation and implementation. We examine the health policy literature describing the use of codesign in initiatives intended to combine diverse sources of knowledge and evidence in policymaking. METHODS The search included PubMed, MEDLINE, PsychInfo, CINAHL, Web of Science, and Google Scholar in November 2022 and included papers published between 1996 and 2022. Terms included codesign, health, policy, and system terminology. Title and abstracts were reviewed in duplicate and included if efforts informed policy or system-level decision-making. Extracted data followed scoping review guidelines for location, evaluation method, health focus, codesign definition, description, level of health system user input, sectors involved, and reported benefits and challenges. RESULTS From 550 titles, 23 citations describing 32 policy codesign studies were included from multiple continents (Australia/New Zealand, 32%; UK/Europe, 32%; South America, 14%; Africa, 9%; USA/Canada 23%). Document type was primarily case study (77%). The area of health focus was widely distributed. Policy type was more commonly little p policy (47%), followed by big p policy (25%), and service innovations that included policy-enabled funding (25%). Models and frameworks originated from formal design (e.g., human-centered or participatory design (44%), political science (38%), or health service research (16%). Reported outcomes included community mobilization (50%), policy feasibility (41%), improved multisector alignment (31%), and introduction of novel ideas and critical thinking (47%). Studies engaging policy users in full decision-making roles self-reported higher levels of community mobilization and community needs than other types of engagement. DISCUSSION Policy codesign is theoretically promising and is gaining interest among diverse health sectors for addressing the complexity of policy formation and implementation. The maturity of the science is just emerging. We observed trends in the association of codesign strategies and outcomes that suggests a research agenda in this area could provide practical insights for tailoring policy codesign to respond to local contextual factors including values, needs, and resources.
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Affiliation(s)
- Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 356560, Seattle, USA.
| | - Barbara Baquero
- School of Public Health, University of Washington, 3980 15th Ave, Box 351621, Seattle, NE, USA
| | - Betty Bekemeier
- School of Nursing, University of Washington, Box 357263, Seattle, USA
| | - McKenna Parnes
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 356560, Seattle, USA
| | - Kashika Arora
- Seattle Children's Hospital, 6901 Sand Point Way NE, Seattle, WA, 98115, USA
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Gautier L, Di Ruggiero E, Jackson C, Bentayeb N, Blain MJ, Chowdhury F, Gueye STM, Haydary M, Maillet L, Mahmoudi L, Mondal S, Ouffouet Bessiranthy A, Pluye P, Ziam S, Touati N. Learning from intersectoral initiatives to respond to the needs of refugees, asylum seekers, and migrants without status in the context of COVID-19 in Quebec and Ontario: a qualitative multiple case study protocol. Health Res Policy Syst 2023; 21:59. [PMID: 37340475 DOI: 10.1186/s12961-023-00991-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/08/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Refugees, asylum seekers, and migrants without status experience precarious living and working conditions that disproportionately expose them to coronavirus disease 2019 (COVID-19). In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, and educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in the cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants. METHODS This theory-informed participatory research is co-created with socioculturally diverse research partners (refugees, asylum seekers and migrants without status, employees of community organizations, and employees of public organizations). We will utilize Mirzoev and Kane's framework on health systems' responsiveness to guide the four phases of a qualitative multiple case study (a case being an intersectoral initiative). These phases will include (1) building an inventory of intersectoral initiatives developed during the pandemic, (2) organizing a deliberative workshop with representatives of the study population, community, and public sector respondents to select and validate the intersectoral initiatives, (3) interviews (n = 80) with community and public sector frontline workers and managers, municipal/regional/provincial policymakers, and employees of philanthropic foundations, and (4) focus groups (n = 80) with refugees, asylum seekers, and migrants without status. Qualitative data will be analyzed using thematic analysis. The findings will be used to develop discussion forums to spur cross-learning among service providers. DISCUSSION This research will highlight the experiences of community and public organizations in their ability to offer responsive services for refugees, asylum seekers, and migrants without status in the context of a pandemic. We will draw lessons learnt from the promising practices developed in the context of COVID-19, to improve services beyond times of crisis. Lastly, we will reflect upon our participatory approach-particularly in relation to the engagement of refugees and asylum seekers in the governance of our research.
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Affiliation(s)
- Lara Gautier
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada.
- Centre de recherche en Santé Publique (CReSP), University of Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada.
- SHERPA University Institute, CIUSSS West Central Montreal, Montreal, Canada.
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carly Jackson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Naïma Bentayeb
- SHERPA University Institute, CIUSSS West Central Montreal, Montreal, Canada
- École Nationale d'Administration Publique, Montreal, Canada
- McGill University, Montreal, Canada
| | - Marie-Jeanne Blain
- Centre de recherche et de partage des savoirs InterActions, Université de Montréal, Montreal, Canada
| | - Fariha Chowdhury
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | | | | | - Lara Maillet
- École Nationale d'Administration Publique, Montreal, Canada
| | - Laila Mahmoudi
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | - Shinjini Mondal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Armel Ouffouet Bessiranthy
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | | | - Saliha Ziam
- École des Sciences de l'administration, Université TÉLUQ, Montreal, Canada
| | - Nassera Touati
- École Nationale d'Administration Publique, Montreal, Canada
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Duda-Sikuła M, Kurpas D. Barriers and Facilitators in the Implementation of Prevention Strategies for Chronic Disease Patients-Best Practice GuideLines and Policies' Systematic Review. J Pers Med 2023; 13:jpm13020288. [PMID: 36836522 PMCID: PMC9959826 DOI: 10.3390/jpm13020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Visits of chronically ill patients account for 80% of primary care consultations. Approximately 15-38% of patients have three or more chronic diseases, and 30% of hospitalisations result from the deteriorating clinical condition of these patients. The burden of chronic disease and multimorbidity is increasing in combination with the growing population of elderly people. However, many interventions found to be effective in health service studies fail to translate into meaningful patient care outcomes across multiple contexts. With the growing burden of chronic diseases, healthcare providers, health policymakers, and other healthcare system stakeholders are re-examining their strategies and opportunities for more effective prevention and clinical interventions. The study aimed to find the best practice guidelines and policies influencing effective intervention and making it possible to personalize prevention strategies. Apart from clinical treatment, it is essential to increase the effectiveness of non-clinical interventions that could empower chronic patients to increase their involvement in therapy. The review focuses on the best practice guidelines and policies in non-medical interventions and the barriers to and facilitators of their implementation into everyday practice. A systematic review of practice guidelines and policies was conducted to answer the research question. The authors screened databases and included 47 full-text recent studies in the qualitative synthesis.
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Affiliation(s)
- Marta Duda-Sikuła
- Clinical Trial Department, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence:
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
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Fasina FO, Nanyingi M, Wangila RS, Gikonyo S, Omani R, Nyariki T, Wahome LW, Kiplamai J, Tenge E, Kivaria F, Okuthe S, Nzietchueng S, Kimani T, Kimutai J, Mucheru G, Njagi O, Njogu G, Rono R, Maina GN, Mogaka D, Mathooko J, Sirdar MM, Mogoa EG, Makumi A, Bett B, Mwatondo A, Kimonye VK, Rwego IB, Adan A, Wakhusama S, Bastiaensen P, Bebay C. Co-creation and priority setting for applied and implementation research in One Health: Improving capacities in public and animal health systems in Kenya. One Health 2022; 15:100460. [PMID: 36532669 PMCID: PMC9754982 DOI: 10.1016/j.onehlt.2022.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background The Kenyan government has successfully been implementing sector specific and multisectoral projects aligned to the Global Health Security Agenda (GHSA). For operational readiness and to enhance the effective planning and implementation of Global Health Security Programs (GHSP) at national and subnational level, there is an urgent need for stakeholders' engagement process to seek input in identifying challenges, prioritise activities for field implementation, and identify applied research and development questions, that should be addressed in the next five years. Methods The modified Child Health and Nutrition Research Initiative (CHNRI) method was used to identify global health security related priorities for multisectoral implementation in Kenya. Subject matter experts from human, animal and environmental health sectors at national and subnational level contributed to predefined research questions from a number of sources and activities for consideration for implementation using a One Health approach. Sixty-two experts scored the 193 questions based on five pre-defined criteria: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Data resulting from this process was then analysed in a Microsoft Excel spreadsheet to determine the research priorities and experts' agreements. Results Among the priority activities identified for implementation research were; strengthening One Health governance and legal frameworks; integration of ecosystem health into One Health programming; strengthening disease reporting, integrated data collection, information sharing and joint outbreak response; socio-anthropological and gender-based approaches in improving risk and behavioural change communication and community engagement; and one health workforce development. In addition, the potentials to invest in collaborative predictive risk modelling to enhance epidemic intelligence systems, while strengthening the One Health approach in the food safety incident and emergency response plans are feasible. Interpretation Successful multisectoral implementation of global health security program in Kenya calls for a whole of society approach that will harness community and private sector knowledge to build preparedness and response capacities while targeting neglected and marginalised populations. This research provides a framework that is worth emulating for cost-effective planning and implementation of overarching One Health programs.
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Affiliation(s)
- Folorunso O. Fasina
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya,Corresponding author.
| | - Mark Nanyingi
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya,Faculty of Health and Life Sciences, Department of One Health, University of Liverpool, Liverpool, UK
| | - Rinah S. Wangila
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Stephen Gikonyo
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Ruth Omani
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Thomas Nyariki
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Lucy W. Wahome
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Joy Kiplamai
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Evans Tenge
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Fredrick Kivaria
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Sam Okuthe
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Serge Nzietchueng
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Tabitha Kimani
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Joshua Kimutai
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Gerald Mucheru
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Obadiah Njagi
- Directorate of Veterinary Services (DVS), Ministry of Agriculture, Livestock, Fisheries and Co-operatives, Nairobi, Kenya
| | - George Njogu
- Emergency Center for Transboundary Animal Diseases (ECTAD), Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Robert Rono
- Department of Health Services, Baringo County Government, Kabarnet, Kenya
| | - Grace N. Maina
- Directorate of Veterinary Services, Murang'a County Government, Murang'a, Kenya
| | - Dan Mogaka
- World Health Organization (WHO), World Health Emergencies (WHE), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Joseph Mathooko
- Inclusive Value Chain, Food and Agriculture Organization of the United Nations (FAO), United Nations Office in Nairobi (UNON), Gigiri, Nairobi, Kenya
| | - Mohammed M. Sirdar
- Sub-Regional Representation for Southern Africa, World Organization for Animal Health, Gaborone, Botswana
| | - Eddy G.M. Mogoa
- Africa One Health University Network (AFROHUN) Kenya, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Angela Makumi
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Bernard Bett
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Athman Mwatondo
- Zoonotic Disease Unit (ZDU), Ministry of Health, Nairobi, Kenya
| | | | - Innocent B. Rwego
- CORE Group Polio-Global Health Security Project, Kenya and Somalia, Nairobi, Kenya
| | - Abdirahman Adan
- CORE Group Polio-Global Health Security Project, Kenya and Somalia, Nairobi, Kenya
| | - Samuel Wakhusama
- Sub-Regional Representation for Eastern Africa, World Organization for Animal Health, Nairobi, Kenya
| | - Patrick Bastiaensen
- Sub-Regional Representation for Eastern Africa, World Organization for Animal Health, Nairobi, Kenya
| | - Charles Bebay
- Faculty of Health and Life Sciences, Department of One Health, University of Liverpool, Liverpool, UK
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Adnan NBB, Baldwin C, Dafny HA, Chamberlain D. What are the essential components to implement individual-focused interventions for well-being and burnout in critical care healthcare professionals? A realist expert opinion. Front Psychol 2022; 13:991946. [PMID: 36248564 PMCID: PMC9555236 DOI: 10.3389/fpsyg.2022.991946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study aimed to determine what, how, and under what circumstances individual-focused interventions improve well-being and decrease burnout for critical care healthcare professionals. Method This realist approach, expert opinion interview, was guided by the Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II) guidelines. Semi-structured interviews with critical care experts were conducted to ascertain current and nuanced information on a set of pre-defined individual interventions summarized from a previous umbrella review. The data were appraised, and relationships between context, mechanisms, and outcomes were extracted, which created theory prepositions that refined the initial program theory. Results A total of 21 critical care experts were individually interviewed. By understanding the complex interplay between organizational and personal factors that influenced intervention uptake, it was possible to decipher the most likely implementable intervention for critical care healthcare professionals. The expert recommendation suggested that interventions should be evidence-based, accessible, inclusive, and collaborative, and promote knowledge and skill development. Unique mechanisms were also required to achieve the positive effects of the intervention due to the presence of contextual factors within critical care settings. Mechanisms identified in this study included the facilitation of self-awareness, self-regulation, autonomy, collaboration, acceptance, and inclusion (to enable a larger reach to different social groups). Conclusion This validation of a theoretical understanding of intervention that addressed well-being and burnout in critical care healthcare professionals by expert opinion demonstrated essential mechanisms and contextual factors to consider when designing and implementing interventions. Future research would benefit by piloting individual interventions and integrating these new theoretical findings to understand better their effectiveness for future translation into the "real-world" setting.
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Affiliation(s)
- Nurul B. B. Adnan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
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Favas C, Ansbro É, Eweka E, Agarwal G, Lazo Porras M, Tsiligianni I, Vedanthan R, Webster R, Perel P, Murphy A. Factors Influencing the Implementation of Remote Delivery Strategies for Non-Communicable Disease Care in Low- and Middle-Income Countries: A Narrative Review. Public Health Rev 2022; 43:1604583. [PMID: 35832336 PMCID: PMC9272771 DOI: 10.3389/phrs.2022.1604583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives: The COVID-19 pandemic has disrupted health care for non-communicable diseases (NCDs) and necessitated strategies to minimize contact with facilities. We aimed to examine factors influencing implementation of remote (non-facility-based) delivery approaches for people with hypertension and/or diabetes in low- and middle-income countries (LMICs), to inform NCD care delivery during health service disruption, including humanitarian crises. Methods: Our narrative review used a hermeneutic and purposive approach, including primary studies conducted in LMICs, which assessed implementation factors influencing remote NCD care delivery. Results were analyzed using the Consolidated Framework for Implementation Research. Results: Twenty-eight included studies revealed the strong influence of both internal organizational and broader contextual factors, such as community health worker policies or technological environment. Addressing patients’ specific characteristics, needs and resources was important for implementation success. Conclusion: This review highlighted the multiple, complex, interdependent factors influencing implementation of remote NCD care in LMICs. Our findings may inform actors designing NCD care delivery in contexts where facility-based access is challenging. Implementation research is needed to evaluate context-adapted e-Health, community-based, and simplified clinical management strategies to facilitate remote NCD care.
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Affiliation(s)
- Caroline Favas
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Éimhín Ansbro
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Evette Eweka
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Maria Lazo Porras
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland.,CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethymno, Greece
| | - Rajesh Vedanthan
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Ruth Webster
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia.,George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Adrianna Murphy
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 181] [Impact Index Per Article: 90.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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19
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Zhang C, Zhang X, Zhang M. Exosomes Derived from Bone Marrow-Derived Mesenchymal Stem Cells (BM-MSC) Protect Submandibular Glands in Diabetic Rats. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Our study assess whether exosomes derived from bone marrow mesenchymal stem cells (BM-MSC) ameliorates diabetic salivary gland complications. 10 SD rats were assigned into diabetes group I and exosome treatment group II. Diabetic rats were induced by streptozotocin (STZ) and injected
with DMSO or exosomes through tail vein followed by collection of submandibular salivary gland samples for histological analysis and TGFβ, Smad2 and Smad3 level by PCR, saliva IgA and serum amylase level. Compared with control mice, exosome treatment mice showed less fibrosis of
the submandibular salivary glands and duct components with a more complete structure. Exosome treatment inhibited TGFβ, Smad2 and Smad3 level to reduce diabetic salivary gland complications, effectively decreased blood sugar level, improved salivary glands function with significantly
reduced serum amylase and salivary IgA levels. In conclusion, BM-MSC-derived exosomes may be a new therapeutic strategy for treating diabetic salivary gland complications.
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Affiliation(s)
- Cong Zhang
- Department of Endocrinology, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 311400, China
| | - Xiaohong Zhang
- Department of Endocrinology, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 311400, China
| | - Min Zhang
- Department of Traditional Chinese Medicine Nursing, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 311400, China
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20
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Assegaai T, Schneider H, Scott V. Developing a district level supportive supervision framework for community health workers through co-production in South Africa. BMC Health Serv Res 2021; 21:337. [PMID: 33853606 PMCID: PMC8045385 DOI: 10.1186/s12913-021-06350-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background One of the key challenges of community health worker (CHW) programmes across the globe is inadequate supervision. Evidence on effective approaches to CHW supervision is limited and intervention research has up to now focused primarily on outcomes and less on intervention development processes. This paper reports on participatory and iterative research on the supervision of CHWs, conducted in several phases and culminating in a co-produced district level supportive supervision framework for Ward Based Outreach Teams in a South African district. Methods Drawing on a conceptual framework of domains of co-production, the paper reflects on the implications of the research process adopted for participants, generation of research knowledge and recommendations for practice, as well as lessons for research on the supervision of CHWs. Results Through the research process, participants reflected and engaged meaningfully, honestly and productively across hierarchies, and were able to forge new, dialogic relationships. The iterative, back forth feedback, involving a core group of participants across phases, enabled additions and validations, and informed further data collection. The culmination of the process was consensus on the key issues facing the programme and the generation of a set of recommendations for a local, context-specific framework of supportive supervision. The process of engagement, relationships built and consensus forged proved to be more significant than the framework itself. Conclusion The co-production approach can enable local impact of research findings by providing a bottom-up collaborative platform of active participation, iterative feedback, knowledge generation and mutual learning that can complement guidance and frameworks from above. Although time consuming and not without its limitations, this approach to research has much to offer in advancing understanding of CHW supervision.
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Affiliation(s)
- Tumelo Assegaai
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
| | - Helen Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa
| | - Vera Scott
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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21
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Beran D, Pesantes MA, Berghusen MC, Hennig BJ, Jacobi J, Lazo-Porras M, Llanque A, Placella E, Robledo-Abad C, Bayona MT, Miranda JJ. Rethinking research processes to strengthen co-production in low and middle income countries. BMJ 2021; 372:m4785. [PMID: 33593804 PMCID: PMC7879271 DOI: 10.1136/bmj.m4785] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Maria Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Johanna Jacobi
- Centre for Development and Environment, University of Bern, Switzerland
- Institute of Geography, University of Bern, Switzerland
| | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Aymara Llanque
- University of Bern Switzerland Centre for Development and Environment, La Paz, Bolivia
| | - Enrichetta Placella
- Global Health Program, Swiss Agency for Development and Cooperation, Bern, Switzerland
| | | | | | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- George Institute for Global Health, University of New South Wales, Sydney, Australia
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22
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Turk E, Durrance-Bagale A, Han E, Bell S, Rajan S, Lota MMM, Ochu C, Porras ML, Mishra P, Frumence G, McKee M, Legido-Quigley H. International experiences with co-production and people centredness offer lessons for covid-19 responses. BMJ 2021; 372:m4752. [PMID: 33593813 PMCID: PMC7879267 DOI: 10.1136/bmj.m4752] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eva Turk
- Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
- University of Maribor, Faculty of Medicine, Maribor, Slovenia
| | | | - Emeline Han
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sadie Bell
- London School of Hygiene and Tropical Medicine, London, UK
| | - Selina Rajan
- London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Margarita M Lota
- Department of Medical Microbiology, College of Public Health, University of the Philippines, SEAMEO TROPMED Regional Center for PUBLIC Health, Hospital Administration, Environmental and Occupational Health, Manila, Philippines
| | - Chinwe Ochu
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - Gasto Frumence
- School of Public Health and Social Sciences, Department of Development Studies, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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23
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Cárdenas MK, Pérez-León S, Singh SB, Madede T, Munguambe S, Govo V, Jha N, Damasceno A, Miranda JJ, Beran D. Forty years after Alma-Ata: primary health-care preparedness for chronic diseases in Mozambique, Nepal and Peru. Glob Health Action 2021; 14:1975920. [PMID: 34569443 PMCID: PMC8477950 DOI: 10.1080/16549716.2021.1975920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Four decades after the Alma-Ata Declaration, strengthening primary health care (PHC) remains a priority for health systems, especially in low- and middle-income countries (LMICs). Given the prominence of chronic diseases as a global health issue, PHC must include a wide range of components in order to provide adequate care. Objective To assess PHC preparedness to provide chronic care in Mozambique, Nepal and Peru, we used, as ‘tracer conditions’, diabetes, hypertension and a country-specific neglected tropical disease with chronic sequelae in each country. Methods By implementing a health system assessment, we collected quantitative and qualitative data from primary and secondary sources, including interviews of key informants at three health-system levels (macro, meso and micro). The World Health Organization’s health-system building blocks provided the basis for content analysis. Results In total, we conducted 227 interviews. Our findings show that the ambitious policies targeting specific diseases lack the support of technical, administrative and financial resources. Data collection systems do not allow the monitoring of individual patients or provide the health system with the information it requires. Patients receive limited disease-specific information. Clinical guidelines and training are either non-existent or not adapted to local contexts. Availability of medicines and diagnostic tests at the PHC level is an issue. Although medicines available through the public health care system are affordable, some essential medicines suffer shortages or are not available to PHC providers. This need, along with a lack of clear referral procedures and available transportation, generates financial issues for individuals and affects access to health care. Conclusion PHC in these LMICs is not well prepared to provide adequate care for chronic diseases. Improving PHC to attain universal health coverage requires strengthening the identified weaknesses across health-system building blocks.
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Affiliation(s)
- Maria Kathia Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvana Pérez-León
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Tavares Madede
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Savaiva Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Valério Govo
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Nilambar Jha
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - 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
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva University Hospitals, Geneva, Switzerland
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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25
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Lau LL, Hung N, Dodd W, Lim K, Ferma JD, Cole DC. Social trust and health seeking behaviours: A longitudinal study of a community-based active tuberculosis case finding program in the Philippines. SSM Popul Health 2020; 12:100664. [PMID: 33015308 PMCID: PMC7522854 DOI: 10.1016/j.ssmph.2020.100664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Social trust is an important driver of health seeking behaviours and plays a particularly important role for diseases that have a high degree of stigma associated with them, such as tuberculosis (TB). Individuals experiencing poverty also face additional social and financial barriers in accessing care for TB. We examined an active case finding (ACF) initiative embedded in a program targeting those living in poverty (Transform) implemented by International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO), and analyzed how different forms of social trust may affect the initial uptake of ACF. Methods Program monitoring data and a cross-sectional survey conducted at the beginning of Transform included six dimensions of social trust: satisfaction with family life, satisfaction with friendships, and level of trust in relatives, neighbours, pastor or religious leader, and local government officials. Amongst individuals suspected of having TB who received referrals post-screening, multilevel modelling examined the effects of social trust on rural health unit (RHU) attendance. Results Among the subset of 3350 individuals who received TB screening in 51 communities, 889 (26.5%) were symptom positive and required referral to the RHU, but only 24.1% of those who received referrals successfully attended the RHU. Multilevel regression analysis showed that for each unit increase on the Likert scale in baseline level of family satisfaction and level of trust in relatives, the odds of attending an RHU was 1.03 times (95% CI: 0.99, 1.07) and 1.06 times greater (95% CI: 1.00, 1.11), respectively, independent of other factors. Conclusion These results suggest that social trust in family members could play a valuable role in addressing stigma and rejection, both cited as barriers to higher screening rates. It is recommended that ACF programs that target TB, or other diseases that are stigmatized, prioritize trust-building as an important component of their intervention. Role of social trust on health clinic attendance among extreme poor examined. Effect of five relationship types in supporting tuberculosis testing explored. Trust in family relationships predicted greater health clinic testing. Health interventions for stigmatized diseases should prioritize trust-building.
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Affiliation(s)
- Lincoln L.H. Lau
- Dalla Lana School of Public Health, University of Toronto, Canada
- International Care Ministries Foundation Inc, Philippines
- School of Public Health and Health Systems, University of Waterloo, Canada
- Corresponding author. Unit 2001 Antel Global Corporate Center Julia Vargas Ave Ortigas Center Pasig City NCR Philippines.
| | - Natalee Hung
- International Care Ministries Foundation Inc, Philippines
| | - Warren Dodd
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Krisha Lim
- International Care Ministries Foundation Inc, Philippines
| | | | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, Canada
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