The potential of mobile health clinics in chronic disease prevention and health promotion in universal healthcare systems. An on-field experiment

Patients' experiences in the use of mobile health clinics in KwaMachi rural area of KwaZulu-Natal, South Africa

Background

A study was conducted to evaluate the role of mobile health clinics (MHCs) in providing healthcare services in rural areas, focusing on the population of KwaMachi in KwaZulu Natal, South Africa. The objective of the study was to explore the level of health promotion and health-seeking behaviour in KwaMachi, understand the services provided by the MHCs, and assess the experiences of individuals accessing healthcare through these clinics.

Methods

The study used qualitative research methods, including face-to-face interviews and focused group discussions. A sample of 20 patients, with equal representation of males and females across different age groups, was selected using purposive and convenience sampling methods. Two themes were developed: positive experiences and negative experiences. The collected data was analyzed using manual thematic analysis.

Findings

The findings of the study revealed that MHCs serve as the main entry point to the national healthcare system in rural areas, but they offer limited services, which contributes to the ongoing struggle of rural communities to access primary healthcare. While respondents generally had positive experiences with MHCs, some negative aspects need to be addressed. These included concerns about privacy during consultations, the unavailability of essential medications, limited services offered, lack of doctors, and inadequate management of clinical records leading to diagnostic inaccuracies.

Conclusion

The study highlights the challenges faced by rural communities in accessing healthcare services and the role of MHCs in addressing these challenges Based on these findings, the study concludes that there is a need for sustainable MHC programs that address the specific needs and preferences of the local population.

Recommendations

These insights are of value to policymakers seeking to enhance the impact of MHCs in improving healthcare access and outcomes in rural areas. By looking at areas of improvement in the services provided by MHCs, including addressing privacy concerns, ensuring the availability of essential medications, and improving the management of clinical records. The study provides valuable insights for policymakers to enhance the effectiveness of MHC programs in rural areas.

Do we protect ourselves against West Nile Virus? A systematic review on knowledge, attitudes, and practices and their determinants

BACKGROUND

West Nile virus (WNV) is a mosquito-borne flavivirus. In humans, 80% of infections are asymptomatic, while approximately 20% experience influenza-like symptoms. Fewer than 1% develop the neuroinvasive form which can lead to encephalitis, meningitis, acute flaccid paralysis, and even death. The global spread of the virus to areas where it was not previously present has become a growing concern. Since the 2000 s, there have been numerous outbreaks affecting local and travelling populations worldwide. Given the lack of a vaccine, preventative measures are primarily focused on surveillance, vector control, and the use of personal protective behaviours (PPBs). The importance of PPBs is central to public health recommendations. However, translating these messages into coherent action by the public can prove challenging, as the uptake of such measures is inevitably influenced by socio-economic factors, awareness, knowledge, and risk perception.

METHODS

A PRISMA-based systematic research was conducted on EMBASE, PubMed/MEDLINE, and Web of Science databases. PROSPERO registration number CRD42023459714. Quality of studies included in the final stage was evaluated using the Critical Appraisal Checklist for Cross-Sectional Study (CEBMa).

RESULTS

2963 articles were screened, and 17 studies were included in the final round. Out of these, six were deemed of high quality, ten were of medium quality, and one was of low quality. In almost all studies considered, both awareness and knowledge of WNV transmission were above 90%, while concern about WNV ranged from 50% to 80%. Concern about the safety of repellents, either with or without DEET, ranged from 27% to 70%. The percentage of people actually using repellents ranged from 30% to 75%, with the lowest usage reported among individuals over 60 years old (29%) and pregnant women (33%), and the highest among students aged 9-11 (75%). Concern for West Nile Virus (WNV) was consistently linked to an increase in taking preventative measures, including the use of repellents, by two to four times across studies. The school-based intervention was effective in increasing the practice of removing standing water (AOR=4.6; 2.7-8.0) and wearing long clothing (AOR=2.4; 95%CI: 1.3-4.3), but did not have a significant impact on the use of repellents.

CONCLUSIONS

The present systematic review provides an overview of the knowledge, attitudes, and practices (KAP) of WNV and their determinants. While concern about West Nile Virus (WNV) and its effects can be a significant motivator, it is important to promote evidence-based personal protective behaviours (PPBs) to counter unwarranted fears. For example, the use of repellents among the most vulnerable age groups. Given the geographical expansion of WNV, it is necessary to target the entire population preventively, including those who are difficult to reach and areas not yet endemic. The findings of this investigation could have significant implications for public health and support well-informed and effective communication strategies and interventions.

Reshaping the equitable and inclusive access to healthcare: A qualitative study

Background

Improving equitable access to healthcare requires innovative interventions and strengthening a service innovation operational model to achieve transformative change and bring sustainability to public health interventions. The current study aims to identify the components of the Mobile Medical Units (MMUs) operational model as an innovative intervention to provide equitable and inclusive access to healthcare.

Methods

The study used qualitative research to identify the components of the operational model of MMUs for primary healthcare in future. Data has been collected via semi-structured in-depth interviews with 103 healthcare professionals from six states representing India's Tier I, Tier II, and Tier III regions. A thematic analysis was performed to examine emergent salient themes.

Results

The study identified and examined scalability, affordability, replicability, and sustainability as the four critical components of the operational model of MMUs. The findings of the study indicated that MMUs with these four components played a vital role in COVID-19 immunization, especially in resource-limited settings. The study found that MMUs are a cost-effective and scalable healthcare delivery model that can be easily replicated in primary healthcare service delivery.

Conclusion

The findings underscore the significant role of MMUs in addressing healthcare disparities, particularly in resource-limited settings. The adaptability and cost-effectiveness of MMUs make them an ideal solution for primary healthcare delivery, especially in Tier I, II, and III regions of India. It lays a foundation for future research and policy-making, emphasizing the need for innovative, equitable, and sustainable healthcare delivery models like MMUs to transform and strengthen healthcare systems globally.

Pop-up screening nested within routine community activities unmasks an addressed cardiovascular risk: A pilot study (Gippsland Healthy Heart Study)

OBJECTIVE

To evaluate the benefits of a pop-up health screening for cardiovascular risk factors (CVRF) in the Gippsland region, and to assess the acceptability of the screening and to determine whether such a process results in attendance at a general practitioner (GP).

PARTICIPANTS

Overall, 454 participants over the age of 18 who were residents of the Gippsland region were enrolled.

METHODS

This is a community-based, observational, prospective cohort study using pop-up screening sites at six retail locations or workplaces, where participants' blood pressure, body weight and lipid profile were measured. The primary outcome was to assess the proportion of participants with at least one unaddressed CVRF (hypertension [blood pressure >140/90 mmHg], overweight and obesity [body mass index >25 kg/m2 ] or hypercholesterolaemia [low-density lipoprotein cholesterol >2.5 mmol/L]). Email surveys were performed after 4 weeks of follow-up.

RESULTS

Overall, 85.8% (95% confidence interval [CI], 82.1%-88.8%) of participants had at least one unaddressed CVRF. Among the 54 participants who responded to the email survey, 50 participants (92.6% [95% CI, 81.3%-97.6%]) found the screening approach acceptable, and 31 (57.4% [95% CI, 43.3%-70.5%]) considered a discussion with the GP.

CONCLUSIONS

This study supported the feasibility and effectiveness of pop-up screening to detect CVRF in rural communities.

Identifying, Understanding, and Addressing Disparities in Glaucoma Care in the United States

Glaucoma is the leading cause of irreversible blindness worldwide, currently affecting around 80 million people. Glaucoma prevalence is rapidly rising in the United States due to an aging population. Despite recent advances in the diagnosis and treatment of glaucoma, significant disparities persist in disease detection, management, and outcomes among the diverse patient populations of the United States. Research on disparities is critical to identifying, understanding, and addressing societal and healthcare inequalities. Disparities research is especially important and impactful in the context of irreversible diseases such as glaucoma, where earlier detection and intervention are the primary approach to improving patient outcomes. In this article, we first review recent studies identifying disparities in glaucoma care that affect patient populations based on race, age, and gender. We then review studies elucidating and furthering our understanding of modifiable factors that contribute to these inequities, including socioeconomic status (particularly age and education), insurance product, and geographic region. Finally, we present work proposing potential strategies addressing disparities in glaucoma care, including teleophthalmology and artificial intelligence. We also discuss the presence of non-modifiable factors that contribute to differences in glaucoma burden and can confound the detection of glaucoma disparities.

Translational Relevance

By recognizing underlying causes and proposing potential solutions, healthcare providers, policymakers, and other stakeholders can work collaboratively to reduce the burden of glaucoma and improve visual health and clinical outcomes in vulnerable patient populations.

Strategies to tackle non-communicable diseases in Afghanistan: A scoping review

Non-communicable diseases (NCDs) and their risk factors are the leading cause of death worldwide and contribute to 74.3% of deaths globally in 2019. The burden of NCDs is escalating in Afghanistan. Currently, every seconds, people in Afghanistan are dying of NCDs. Addressing this challenge in Afghanistan needs effective and practical interventions. This study aimed to identify the strategies developed and implemented in countries with low non-communicable premature death. To conduct a scoping review, we followed the six-step Arksey and O'Malley protocol and searched for eligible articles on eight international databases and the gray literature. The study followed the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were English documents and evidence produced up to 30 November 2021 for the control of NCDs. We excluded incomplete texts, duplicates, and dissertations due to lack of access. We used EndNote X9 and MaxQDA software for data management and analysis. We conducted content analysis for this study. A total of 122 documents developed between 1984 and 2021 met the inclusion criteria. We identified 35 strategies from which the most used strategies were related to unhealthy diets and smoking cessation programs. Canada (26.4%), Korea (19.8%), and the United Kingdom (19%) have the most publications on the control and prevention of NCDs among the countries included in the study. Most strategies were implemented over 2 years (41%). This study recommends specific interventions to control and prevent NCDs for the main risk factors of tobacco use, unhealthy diet, physical inactivity, and the main non-communicable diseases such as heart diseases, cancers, diabetes, and chronic obstructive pulmonary diseases. Afghanistan Ministry of Public Health, the WHO country office, and other involved stakeholders can use the findings of this review to design and implement strategies for controlling and preventing NCDs in Afghanistan. International organizations such as the World Health Organization, United Nations Agencies, the World Bank, and other involving communities should invest in strengthening good health governance in Afghanistan. The Afghan Government should focus on promoting and funding health literacy among the public and self-care to control and prevent NCDs.

Uptake of Non-Mandatory Vaccinations in Future Physicians in Italy

In 2017 in Italy, a number of vaccinations became mandatory or started to be recommended and offered free of charge. In this study, we aimed at assessing the coverage rates for those vaccinations in the pre-mandatory era among students at the School of Medicine of Padua University studying the degree course in medicine and surgery (future physicians) on the basis of the vaccination certificates presented during health surveillance. The vaccinations considered were those against pertussis, rubella, mumps, measles, varicella, Haemophilus influenzae type b (which became mandatory in 2017), pneumococcus, meningococcus C and meningococcus B (only suggested and offered for free since 2017). The study enrolled 4706 students of medicine and surgery. High vaccine uptake was observed, especially in younger students (born after 1990), with vaccines against pertussis, rubella, mumps and measles. Good completion for Haemophilus influenzae type b and meningococcus C was also observed. Very low coverage rates (all under 10%) for vaccination against varicella, pneumococcus and meningococcus B were observed. In conclusion, uptake for some non-mandatory vaccines was below the recommended threshold, although younger generations showed a higher uptake, possibly as a results of policy implemented at the national level. Our findings support the idea to consider health surveillance visits also as an additional opportunity to overcome confidence and convenience barriers and offer vaccine administration.

Digital Interventions for Psychological Comorbidities in Chronic Diseases-A Systematic Review

Chronic diseases represent one of the main causes of death worldwide. The integration of digital solutions in clinical interventions is broadly diffused today; however, evidence on their efficacy in addressing psychological comorbidities of chronic diseases is sparse. This systematic review analyzes and synthesizes the evidence about the efficacy of digital interventions on psychological comorbidities outcomes of specific chronic diseases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of PubMed, PsycInfo, Scopus and Web of Science databases was conducted. Only Randomized Controlled Trials (RCTs) were considered and either depression or anxiety had to be assessed to match the selection criteria. Of the 7636 identified records, 17 matched the inclusion criteria: 9 digital interventions on diabetes, 4 on cardiovascular diseases, 3 on Chronic Obstructive Pulmonary Disease (COPD) and one on stroke. Of the 17 studies reviewed, 14 found digital interventions to be effective. Quantitative synthesis highlighted a moderate and significant overall effect of interventions on depression, while the effect on anxiety was small and non-significant. Design elements making digital interventions effective for psychological comorbidities of chronic diseases were singled out: (a) implementing a communication loop with patients and (b) providing disease-specific digital contents. This focus on “how” to design technologies can facilitate the translation of evidence into practice.

Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review

BACKGROUND

Mobile clinics have been used to deliver primary health care to populations that otherwise experience difficulty in accessing services. Indigenous populations in Australia, Canada, New Zealand, and the United States experience greater health inequities than non-Indigenous populations. There is increasing support for Indigenous-governed and culturally accessible primary health care services which meet the needs of Indigenous populations. There is some support for primary health care mobile clinics implemented specifically for Indigenous populations to improve health service accessibility. The purpose of this review is to scope the literature for evidence of mobile primary health care clinics implemented specifically for Indigenous populations in Australia, Canada, New Zealand, and the United States.

METHODS

This review was undertaken using the Joanna Brigg Institute (JBI) scoping review methodology. Review objectives, inclusion criteria and methods were specified in advance and documented in a published protocol. The search included five academic databases and an extensive search of the grey literature.

RESULTS

The search resulted in 1350 unique citations, with 91 of these citations retrieved from the grey literature and targeted organisational websites. Title, abstract and full-text screening was conducted independently by two reviewers, with 123 citations undergoing full text review. Of these, 39 citations discussing 25 mobile clinics, met the inclusion criteria. An additional 14 citations were snowballed from a review of the reference lists of included citations. Of these 25 mobile clinics, the majority were implemented in Australia (n = 14), followed by United States (n = 6) and Canada (n = 5). No primary health mobile clinics specifically for Indigenous people in New Zealand were retrieved. There was a pattern of declining locations serviced by mobile clinics with an increasing population. Furthermore, only 13 mobile clinics had some form of evaluation.

CONCLUSIONS

This review identifies geographical gaps in the implementation of primary health care mobile clinics for Indigenous populations in Australia, Canada, New Zealand, and the United States. There is a paucity of evaluations supporting the use of mobile clinics for Indigenous populations and a need for organisations implementing mobile clinics specifically for Indigenous populations to share their experiences. Engaging with the perspectives of Indigenous people accessing mobile clinic services is imperative to future evaluations.

REGISTRATION

The protocol for this review has been peer-reviewed and published in JBI Evidence Synthesis (doi: 10.11124/JBISRIR-D-19-00057).