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Galavi Z, Khajouei R, Jahani Y. The role of e-health on the public knowledge and behavior in preventing COVID-19. INFORMATICS IN MEDICINE UNLOCKED 2023; 37:101193. [PMID: 36779178 PMCID: PMC9902341 DOI: 10.1016/j.imu.2023.101193] [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: 12/05/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023] Open
Abstract
Background Electronic health (e-health) technologies play an important role in improving public knowledge and behavior to control the COVID-19 pandemic. The present study aimed to investigate the role of e-health on the public knowledge and behavior in preventing COVID-19 in Kerman, a city in Iran. Methods The present descriptive cross-sectional study used an online survey in Kerman in November 2021. The research instrument was a tripartite questionnaire that included demographic information, the level of respondents' knowledge about COVID-19, the extent of change in respondents' behavior influenced by e-health. Negative binomial regression analysis was run to test the relationship between individual characteristics and the research variables with knowledge and behavior. Spearman correlation test was used to measure the correlation between the two main parts of the survey. Results As the negative binomial regression analysis results showed, the relationship between no demographic variable and the public knowledge and behavior was statistically significant (p < 0.001). The mean knowledge and behavior scores were 5.84 ± 2.55 and 11.95 ± 5.09, respectively, showing that people who used e-health had a high level of knowledge, and taking preventive measures was at a high level. The Spearman correlation coefficient test results showed a positive association between knowledge and behavior (r = 0.71). Conclusion E-health played a decisive role in increasing knowledge and improving behavior in preventing COVID-19. The results of our research can encourage the use of e-health to improve the public knowledge and behavior in pandemics such as COVID-19.
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Affiliation(s)
- Zahra Galavi
- Students Research Committee, Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran,Corresponding author
| | - Yones Jahani
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
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Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
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Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| | - Leah Morantz
- 1Centre for Trials Research, Cardiff University, Cardiff, UK
- 2The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
- 3School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- 4Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
- 5Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
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Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. The acceptability of asking women to delay removal of a long-acting reversible contraceptive to take part in a preconception weight loss programme: a mixed methods study using qualitative and routine data (Plan-it). BMC Pregnancy Childbirth 2022; 22:778. [PMID: 36258184 PMCID: PMC9580156 DOI: 10.1186/s12884-022-05077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Having a body mass index (BMI) which is classified as overweight (BMI ≥ 25) or obese (BMI ≥ 30) increases the risk of complications during pregnancy and labour. Weight-management interventions which target excess gestational weight gain during pregnancy have had limited success. Women who use long-acting reversible contraception (LARC) are in contact with services as part of their preparation for conception, creating a potential opportunity to offer a preconception weight-loss intervention. The aims of this mixed methods study were to assess the acceptability and practicability of a weight-loss intervention which asked people to delay LARC removal in order to lose weight before conceiving. Methods Routine UK NHS data were analysed to identify pathways from LARC removal to pregnancy. Qualitative surveys and advisory group discussions with service providers and LARC users with experience of being overweight were conducted and analysed thematically. Results Three hundred fifteen thousand seven hundred fifty-five UK women aged 16–48 years between 2009–2018 had at least one LARC-related event (e.g. insertion, removal) and 1.7% of those events were recorded as related to planning a pregnancy. BMI was included in 62% of women’s records, with 54% of those BMI being classified as overweight or obese. Online surveys were completed by 100 healthcare practitioners and 243 LARC users. Stakeholders identified facilitators and barriers associated with the proposed intervention including sensitivities of discussing weight, service-user past experiences, practitioner skills, the setting and ethical implications of the proposed intervention. Conclusions Although women and service providers recognised potential benefits, a preconception weight-loss intervention asking people to delay LARC removal posed many barriers, due mainly to the acceptability of such an intervention to women and healthcare practitioners. Weight-loss interventions that target the general population, together with a focus on improving public knowledge of preconception health, may be more acceptable than interventions which solely focus on LARC users. Many of the barriers identified, including communication, understanding and beliefs about weight and risk, appointment systems and the limitations of routine datasets also have relevance for any preconception weight-loss intervention. Work to improve routine datasets and reducing communication barriers to discussing weight are priorities. Trial registration ISRCTN14733020 registered 10.05.2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05077-0.
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Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Josie Henley
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Fiona Lugg-Widger
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Heather Strange
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, 8th floor, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Ty Dewi Sant, Cardiff, CF14 4XN, UK
| | - Caroline Scherf
- Department of Sexual Health, Cardiff and Vale University Health Board, Cardiff Royal Infirmary, Newport Road, Cardiff, CF24 0SZ, UK
| | - Zoe Couzens
- Health Protection, Public Health Wales NHS Trust, Public Health Wales, 4th Floor Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
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Hanafiah AN, Aagaard-Hansen J, Ch Cheah J, Norris SA, Karim ZB, Skau JK, Ali ZM, Biesma R, Matzen P, Sulaiman LH, Hanson M. Effectiveness of a complex, pre-conception intervention to reduce the risk of diabetes by reducing adiposity in young adults in Malaysia: The Jom Mama project - A randomised controlled trial. J Glob Health 2022; 12:04053. [PMID: 35972832 PMCID: PMC9380849 DOI: 10.7189/jogh.12.04053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Pre-conception interventions have the potential to lower non-communicable disease risk in prospective parents and reduce transmission of risk factors such as obesity to the next generation. The Jom Mama project in Malaysia investigated the effectiveness of a combined behaviour change communication and e-health intervention in young married couples prior to first pregnancy. This paper reports the evaluation of the effectiveness of this trial. Methods Jom Mama was a non-blinded, randomised controlled trial (RCT) conducted in Seremban, Malaysia, over a period of 33 weeks, covering six contact points between trained community health workers and newly married couples before the conception of a first child. Out of 2075 eligible nulliparous women, 549 participated and 305 completed the intervention, with 145 women in the intervention and 160 in the control group. The intervention group received a complex behavioural change intervention, combining behaviour change communication provided by community health promoters and access to a habit formation mobile application, while the control group received the standard care provided by public health clinics in Malaysia. The primary outcome was a change in the woman’s waist circumference. Secondary outcomes were anthropometric and metabolic measures, dietary intake (Food Frequency Questionnaire, FFQ), physical activity (International Physical Activity Questionnaire, IPAQ) and mental health (Depression Anxiety Stress Scale, DASS 21). An extensive process evaluation was conducted alongside the trial in order to aid the interpretation of the main findings. Results There were no significant differences of change in the woman’s waist circumference between intervention and control groups at the start and end of the intervention. While the weight, waist circumference and Body Mass Index (BMI) of women in both groups increased, there was a significantly lower increase in the intervention vs the control group over the period of the trial among women who are obese (0.1 kg vs 1.7 kg; P = 0.023, in the intervention and control group respectively). In terms of BMI, the obese intervention subgroup showed a slight reduction (0.01) compared to the obese control subgroup whose BMI increased by 0.7 (P = 0.015). There were no changes in the other secondary outcomes. Conclusions The Jom Mama pre-conception intervention did not lead to a reduction in waist circumference or significant changes in other secondary outcomes over the eight months prior to conception. However, there was a significantly smaller weight gain in the intervention vs the control group, predominantly in women with pre-existing obesity.
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Affiliation(s)
- Ainul Nm Hanafiah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.,SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Julius Ch Cheah
- School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Shane A Norris
- SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zulkarnain Ba Karim
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jutta Kh Skau
- SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zainudin M Ali
- Negeri Sembilan State Health Department, Seremban, Negeri Sembilan, Malaysia.,Universiti Teknologi Malaysia Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Priya Matzen
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lokman H Sulaiman
- Office of the Deputy Director General of Health (Public Health), Ministry of Health, Putrajaya, Malaysia.,Institute for Research, Development and Innovation, International Medical University Malaysia, Kuala Lumpur, Malaysia
| | - Mark Hanson
- Institute of Developmental Sciences, British Heart Foundation Professor of Cardiovascular Sciences, Faculty of Medicine and NIHR Biomedical Research Centre, University of Southampton, Southampton, UK
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Sharif SM, Hanson M, Chong DW, Hanafiah ANM, Zulkepli MZ, Zulbahari SF, Skau J, Ho JCC, Matzen P, Biesma R, Norris SA, Aagaard-Hansen J. Learning from the process evaluation of a complex, pre-conception randomised controlled trial in Malaysia: the Jom Mama project. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.34228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Seen from a life-course perspective, pre-conception interventions are essential to reduce transmission to the next generation of obesity as a risk factor for later non-communicable diseases. The Malaysian Jom Mama project investigated the effectiveness of a combined behaviour change communication and e-health intervention in young married couples prior to first pregnancy. This paper reports on the extensive process evaluation (PE) that accompanied the Jom Mama trial. Methods In accordance with the realistic evaluation approach, a programme theory was developed for the Jom Mama project, based on key functions selected for six PE sub-studies, namely: recruitment; attrition; behaviour change communication (BCC); e-health (the Jom app); peer-support for community health promoters (CHPs); and contextual factors. The results of the first four sub-studies are reported here. Three cycles of data collection were conducted based on triangulation and a mixed-methods approach. Results The findings permitted distinguishing between theory and implementation challenges in interpreting the outcome of the Jom Mama trial.1 Recruitment and attrition proved to be challenges, and although the PE allowed Jom Mama investigators to improve procedures in order to achieve a sufficient sample size, it also has implications for engaging this age group in future pre-conception interventions. PE sub-studies showed that there were challenges in applying the BCC, and that the uptake of the Jom app varied. In one way this can be seen as an indication of limited fidelity, but it also leads to questions about how best to change the communication culture within the Malaysian health care system. Conclusions The Jom Mama PE highlighted the challenges of recruiting newly-wed couples for a pre-conception intervention. Despite thorough intervention development preparations, the PE revealed the difficulty of lifestyle behaviour change through Malaysian community health wokers who were trained on new communication strategies combined with e-health solutions, and that six intervention sessions of eight months do not constitute a sufficient dose to affect change. <div style=“page-break-after: always;”></div>
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Affiliation(s)
- Shakirah Md. Sharif
- National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Mark Hanson
- British Heart Foundation Professor of Cardiovascular Sciences, Faculty of Medicine and NIHR Biomedical Research Centre, University of Southampton, UK
| | - Diane W. Chong
- National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | | | - Mohamad Z. Zulkepli
- National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | | | - Jutta Skau
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | - Priya Matzen
- Faculty of Medicine, University of Southampton, UK
| | - Regien Biesma
- Faculty of Medical Sciences, University Medical Center, Groningen, the Netherlands
| | - Shane A. Norris
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark; SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Chen S, Yue W, Liu N, Han X, Yang M. The progression on the measurement instruments of maternal health literacy: a scoping review. Midwifery 2022; 109:103308. [DOI: 10.1016/j.midw.2022.103308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
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Hardy I, Lloyd A, Morisset AS, Camirand Lemyre F, Baillargeon JP, Fraser WD. Healthy for My Baby Research Protocol- a Randomized Controlled Trial Assessing a Preconception Intervention to Improve the Lifestyle of Overweight Women and Their Partners. Front Public Health 2021; 9:670304. [PMID: 34414154 PMCID: PMC8369366 DOI: 10.3389/fpubh.2021.670304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/05/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Preconception lifestyle interventions appear promising to reduce pregnancy complications, prevent adult cardiometabolic diseases, and prevent childhood obesity. These interventions have almost exclusively been studied in populations of obese infertile women. The development of preconception lifestyle interventions targeting a broader population of overweight and obese women without a history infertility and their partners is needed. Methods: This study is a multicenter open label parallel group randomized controlled trial. Sixty-eight non-infertile women with overweight or obesity in the preconception period and their partners will be recruited from the Sherbrooke and Quebec City regions. The couples will be randomized in a 1:1 ratio to receive the Healthy for my Baby intervention or standard care in the preconception period and pregnancy. Women and their partners will be invited to take part in this lifestyle intervention which includes motivational interviews and daily self-monitoring of lifestyle goals through a mobile phone application. The primary endpoint of this study is the diet quality of women during the preconception period, which will be evaluated using the C-HEI 2007 score at baseline, 2, 4- and 6-months following study enrolment. Women's dietary quality will also be evaluated through the measure of urinary biomarkers of habitual dietary intake at baseline and 2 months in preconception, and 24–26 weeks in pregnancy. Additional indicators of women's lifestyle as well as anthropometric measures will be documented in preconception and pregnancy. For the pregnancy period, the main secondary endpoint is the pattern of gestational weight gain. Pregnancy and neonatal complications will also be evaluated. For partners, diet quality, other lifestyle habits, and anthropometric measures will be documented in the preconception and pregnancy periods. Discussion: This study will evaluate the effectiveness of a low-cost intervention designed to improve diet and other lifestyle characteristics of women in the preconception period who are overweight or obese. If the Healthy for my Baby intervention is efficacious regarding dietary measures, larger trials will be needed to evaluate the impact of this intervention on the rates of pregnancy complications, childhood obesity, and adult cardiometabolic disease. Clinical Trial Registration:clinicaltrials.gov (NCT04242069).
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Affiliation(s)
- Isabelle Hardy
- Department of Obstetrics and Gynecology, University of Sherbrooke and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Amanda Lloyd
- Institute of Biological, Environmental, and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Anne-Sophie Morisset
- School of Nutrition, Faculty of Agricultural and Food Science, Laval University, Laval, QC, Canada
| | - Felix Camirand Lemyre
- Department of Mathematics, University of Sherbrooke and CRCHUS, Sherbrooke, QC, Canada
| | - Jean-Patrice Baillargeon
- Endocrine Division, Department of Medicine, University of Sherbrooke and CRCHUS, Sherbrooke, QC, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, University of Sherbrooke and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
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Draper CE, Prioreschi A, Ware LJ, Lye S, Norris SA. Pilot implementation of Bukhali: A preconception health trial in South Africa. SAGE Open Med 2020; 8:2050312120940542. [PMID: 32685150 PMCID: PMC7346699 DOI: 10.1177/2050312120940542] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives This article describes the learnings from the pilot phase of the Healthy Life Trajectories Initiative, a preconception health trial for 18- to 25-year-old women in Soweto, South Africa. Methods The study compares two arms focussed on either physical and mental health (intervention; delivered by community health workers - 'Health Helpers') or standard of care plus (control; standard access to healthcare plus additional telephonic input on 'life skills'; delivered by call centre assistants). These are collectively referred to as Bukhali. Data on the pilot implementation of the Bukhali trial (n = 1655) were collected from (1) weekly team meetings, (2) two focus groups (one with the intervention team Health Helpers, n = 7; one with intervention participants, n = 8) and one paired interview with control call centre assistants (n = 2), (3) notes from eight debrief sessions with Health Helpers and (4) quantitative trial monitoring data. Qualitative data were thematically analysed. Results The findings clustered within three themes: (1) challenges for young women in Soweto, (2) priorities for young women in Soweto and (3) implementation challenges and perceptions of the intervention. Challenges were mostly related to tough socioeconomic circumstances and less prioritisation of living a healthier life. The priorities of employment and educational opportunities reflected the socioeconomic challenges, where health was not recognised as priority. The main challenge to participation and compliance with the trial was that young women in Soweto generally wanted a tangible and preferably financial and immediate benefit. Community peer sessions, despite being recommended by young women as part of the intervention development, were not successful. Many women also moved between multiple households within Soweto, which flagged concerns for a cluster trial and risk of contamination. Conclusion Preconception health trials should consider socioeconomic challenges present in urban poor contexts. Learnings from the pilot phase significantly affected the design and implementation of the main Bukhali trial.
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Affiliation(s)
- C E Draper
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Prioreschi
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L J Ware
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Lye
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Departments of Obstetrics and Gynaecology, Physiology and Medicine, University of Toronto, ON, Canada
| | - S A Norris
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Watson HA, Tribe RM, Shennan AH. The role of medical smartphone apps in clinical decision-support: A literature review. Artif Intell Med 2019; 100:101707. [PMID: 31607347 DOI: 10.1016/j.artmed.2019.101707] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/26/2019] [Accepted: 08/18/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The now ubiquitous smartphone has huge potential to assist clinical decision-making across the globe. However, the rapid pace of digitalisation contrasts starkly with the slower rate of medical research and publication. This review explores the evidence base that exists to validate and evaluate the use of medical decision-support apps. The resultant findings will inform appropriate and pragmatic evaluation strategies for future clinical app developers and provide a scientific and cultural context for research priorities in this field. METHOD Medline, Embase and Cochrane databases were searched for clinical trials concerning decision support and smart phones from 2007 (introduction of first smartphone iPhone) until January 2019. RESULTS Following exclusions, 48 trials and one Cochrane review were included for final analysis. Whilst diagnostic accuracy studies are plentiful, clinical trials are scarce. App research methodology was further interrogated according to setting and decision-support modality: e.g. camera-based, guideline-based, predictive models. Description of app development pathways and regulation were highly varied. Global health emerged as an early adopter of decision-support apps and this field is leading implementation and evaluation. CONCLUSION Clinical decision-support apps have considerable potential to enhance access to care and quality of care, but the medical community must rise to the challenge of modernising its approach if it is truly committed to capitalising on the opportunities of digitalisation.
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Affiliation(s)
- Helena A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
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Draper CE, Bosire E, Prioreschi A, Ware LJ, Cohen E, Lye SJ, Norris SA. Urban young women's preferences for intervention strategies to promote physical and mental health preconception: A Healthy Life Trajectories Initiative (HeLTI). Prev Med Rep 2019; 14:100846. [PMID: 31008026 PMCID: PMC6458479 DOI: 10.1016/j.pmedr.2019.100846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/24/2019] [Accepted: 03/14/2019] [Indexed: 01/15/2023] Open
Abstract
This study aimed to qualitatively investigate young women's preferences for preconception intervention strategies to promote physical and mental health in a rapidly transitioning, urban setting. Four semi-structured focus group discussions were conducted with young women (n = 29, 18–24 years old) from Soweto, South Africa. Qualitative data were thematically analysed. Two main themes were identified: 1) challenges and needs of intervention beneficiaries; and 2) preferences for intervention strategies (content and delivery). The challenges participants mentioned could be classified as those relating to social pressure, identity, and socioeconomic circumstances. Mental health support appeared to be a greater need than physical health, and this featured in their preferences for intervention content, although a number of physical health topics were also mentioned (healthy eating and contraception). Participants had mixed preferences for intervention materials, ranging from printed to electronic and mobile resources. Their preferences for intervention activities ranged from educational sessions, to fun and interactive practical activities, and activities they could take home. Community health workers (CHWs) were the preferred agent of delivery for interventions, though participants emphasised the importance of CHWs having appropriate interpersonal skills and own life experience. Some women preferred one-on-one sessions with a CHW, while others preferred group sessions. While recognising the value of family sessions, young women were less enthusiastic about this approach. These findings provide valuable formative data for developing effective interventions to optimise young women's preconception health in urban Africa. These contextual realities should be acknowledged when addressing key physical and mental health issues facing young women. Social pressure is a major challenge for young women in urban South Africa. Mental health should be a key feature of preconception interventions. Community health workers are the preferred agent of delivery in this context.
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Affiliation(s)
- C E Draper
- South African Medical Research Council Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - E Bosire
- South African Medical Research Council Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Prioreschi
- South African Medical Research Council Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L J Ware
- South African Medical Research Council Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - E Cohen
- South African Medical Research Council Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S J Lye
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Department of Obstetrics and Gynecology, Department of Physiology and Medicine, University of Toronto, Toronto, ON, Canada
| | - S A Norris
- South African Medical Research Council Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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11
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Abstract
The field of Developmental Origins of Health and Disease (DOHaD) has grown considerably in recent decades and is receiving increasing recognition from health policymakers. Today, DOHaD research aims to offer a comprehensive perspective on health and disease that traces how different life experiences shape health and disease risks over the entire life course. This integrative perspective opens up distinct possibilities for improving health. At the same time, it raises questions regarding the specific social responsibilities of DOHaD as a field and about possible pathways to a socially just and scientifically robust implementation of DOHaD knowledge in society. In this article, we review the history and key characteristics of DOHaD as a field of scientific knowledge production. We argue that based on its key assumptions - that life circumstances, health and disease are closely linked on a molecular scale - DOHaD is an inherently political research field. When tracing how life environments affect health and disease, it is of utmost social and political importance to specify how DOHaD understands and frames these life environments, which aspects of life worlds are included and which excluded, and how research results are interpreted and translated into health recommendations at individual, societal and policy levels. We suggest a number of ways by which the DOHaD community can constructively and responsibly meet the demands that these inherent characteristics place on knowledge production and dissemination in the field.
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Rivera-Romero O, Olmo A, Muñoz R, Stiefel P, Miranda ML, Beltrán LM. Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review. JMIR Mhealth Uhealth 2018; 6:e130. [PMID: 29848473 PMCID: PMC6000483 DOI: 10.2196/mhealth.9671] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 02/07/2023] Open
Abstract
Background Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC.
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Affiliation(s)
| | - Alberto Olmo
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
| | - Rocío Muñoz
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain
| | - Pablo Stiefel
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María Luisa Miranda
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis M Beltrán
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
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13
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Lawrie TA, Betrán AP, Singata-Madliki M, Ciganda A, Hofmeyr GJ, Belizán JM, Purnat TD, Manyame S, Parker C, Cormick G. Participant recruitment and retention in longitudinal preconception randomized trials: lessons learnt from the Calcium And Pre-eclampsia (CAP) trial. Trials 2017; 18:500. [PMID: 29073916 PMCID: PMC5658921 DOI: 10.1186/s13063-017-2220-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/02/2017] [Indexed: 11/26/2022] Open
Abstract
Background The preconception period has the potential to influence pregnancy outcomes and randomized controlled trials (RCTs) are needed to evaluate a variety of potentially beneficial preconception interventions. However, RCTs commencing before pregnancy have significant participant recruitment and retention challenges. The Calcium And Pre-eclampsia trial (CAP trial) is a World Health Organization multi-country RCT of calcium supplementation commenced before pregnancy to prevent recurrent pre-eclampsia in which non-pregnant participants are recruited and followed up until childbirth. This sub-study explores recruitment methods and preconception retention of participants of the CAP trial to inform future trials. Methods Recruiters at the study sites in Argentina, South Africa and Zimbabwe completed post-recruitment phase questionnaires on recruitment methods used. Qualitative data from these questionnaires and quantitative data on pre-pregnancy trial visit attendance and pregnancy rates up to September 2016 are reported in this paper. RStudio (Version 0.99.903 https://www.rstudio.org) statistical software was used for summary statistics. Results Between July 2011 and 8 September 2016, 1354 women with previous pre-eclampsia were recruited. Recruitment took 2 years longer than expected and was facilitated mainly through medical record/register and maternity ward/clinic-based strategies. Recruiters highlighted difficulties associated with inadequate medical records, redundant patient contact details, and follow-up of temporarily ineligible women as some of the challenges faced. Whilst the attendance rates at pre-pregnancy visits were high (78% or more), visits often occurred later than scheduled. Forty-five percent of participants became pregnant (614/1354), 33.5% (454/1354) within 1 year of randomization. Conclusions In preconception trials, both retrospective and prospective methods are useful for recruiting eligible women with certain conditions. However, these are time-consuming in low-resource settings with suboptimal medical records and other challenges. Trial planners should ensure that trial budgets cover sufficient on-site researchers with pre-trial training, and should consider using mobile phone and web-based electronic tools to optimize recruitment and retention. This should lead to greater efficiency and shorter trial durations. Trial registration Pan-African Clinical Trials Registry, Registration Number: PACTR201105000267371. The trial was registered on 6 December 2016.
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Affiliation(s)
- Theresa A Lawrie
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, East London, South Africa. .,HRP - UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Ana Pilar Betrán
- HRP - UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, East London, South Africa
| | - Alvaro Ciganda
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024, Buenos Aires, Argentina
| | - G Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, East London, South Africa
| | - José M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Tina Dannemann Purnat
- Division of Information, Evidence, Research and Innovation, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Sarah Manyame
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Catherine Parker
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, East London, South Africa
| | - Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024, Buenos Aires, Argentina
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14
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Chen Q, Carbone ET. Functionality, Implementation, Impact, and the Role of Health Literacy in Mobile Phone Apps for Gestational Diabetes: Scoping Review. JMIR Diabetes 2017; 2:e25. [PMID: 30291088 PMCID: PMC6238859 DOI: 10.2196/diabetes.8045] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/24/2017] [Accepted: 09/08/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The increasing ownership of mobile phones and advances in hardware and software position these devices as cost-effective personalized tools for health promotion and management among women with gestational diabetes mellitus (GDM). Numerous mobile phone apps are available online; however, to our knowledge, no review has documented how these apps are developed and evaluated in relation to GDM. OBJECTIVE The objective of our review was to answer the following 2 research questions: (1) What is known from the existing literature about the availability, functionality, and effectiveness of mobile phone apps on GDM prevention and management? (2) What is the role of health literacy in these apps? METHODS We searched 7 relevant electronic databases for original research documents using terms related to mobile phone apps, GDM, and health literacy. We thematically categorized selected articles using a framework adapted from Arksey and O'Malley. RESULTS We included 12 articles related to 7 apps or systems in the final analysis. We classified articles around 2 themes: (1) description of the development, feasibility, or usability of the apps or systems, and (2) trial protocols. The degree of personalization varied among the apps for GDM, and decision support systems can be used to generate time-efficient personalized feedback for both patients and health care providers. Health literacy was considered during the development or measured as an outcome by some apps. CONCLUSIONS There is a limited body of research on mobile phone apps in relation to GDM prevention and management. Mobile phone apps can provide time- and cost-efficient personalized interventions for GDM. Several randomized controlled trials have been launched recently to evaluate the effectiveness of the apps. Consideration of health literacy should be improved when developing features of the apps.
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Affiliation(s)
- Qiong Chen
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts/Amherst, Amherst, MA, United States
| | - Elena T Carbone
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts/Amherst, Amherst, MA, United States
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15
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Bhutta ZA, Lassi ZS, Bergeron G, Koletzko B, Salam R, Diaz A, McLean M, Black RE, De-Regil LM, Christian P, Prentice AM, Klein JD, Keenan W, Hanson M. Delivering an action agenda for nutrition interventions addressing adolescent girls and young women: priorities for implementation and research. Ann N Y Acad Sci 2017; 1393:61-71. [PMID: 28436103 DOI: 10.1111/nyas.13352] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/17/2017] [Indexed: 12/29/2022]
Abstract
Adolescent nutritional behaviors are assuming considerable importance in nutrition interventions given their important relationships with medium- and long-term outcomes. This is the period when young people undergo major anatomical and physiological maturational changes in preparation for adulthood. Nutritional requirements during puberty are higher during adolescence than during the prepubertal stage and during adulthood. A significant proportion of adolescents also become parents, and hence the importance of their health and nutritional status before as well as during pregnancy has its impact on their own health, fetal well-being, and newborn health. In this paper, we describe the evidence-based nutrition recommendations and the current global guidance for nutrition actions for adolescents. Despite the limitations of available information, we believe that a range of interventions are feasible to address outcomes in this age group, although some would need to start earlier in childhood. We propose packages of preventive care and management comprising nutrition-specific and nutrition-sensitive interventions to address adolescent undernutrition, overnutrition, and micronutrient deficiencies. We discuss potential delivery platforms and strategies relevant to low- and middle-income countries. Beyond the evidence synthesis, there is a clear need to translate evidence into policy and for implementation of key recommendations and addressing knowledge gaps through prioritized research.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, the Hospital for Sick Children, Toronto, Canada.,Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Gilles Bergeron
- The Sackler Institute for Nutrition Science, New York, New York
| | | | - Rehana Salam
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Angela Diaz
- Departments of Pediatrics and Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Robert E Black
- Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Parul Christian
- Women's Nutrition, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Andrew M Prentice
- MRC Unit, Serrekunda, the Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jonathan D Klein
- Global Health, Research and Policy, American Academy of Pediatrics, Washington, DC
| | - William Keenan
- Division of Neonatal-Perinatal Medicine, Saint Louis University, St. Louis, Missouri
| | - Mark Hanson
- Institute of Developmental Sciences and NIHR Biomedical Research Centre, University of Southampton and Southampton University Hospital, Southampton, United Kingdom
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16
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Tonkin E, Brimblecombe J, Wycherley TP. Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review. Adv Nutr 2017; 8:308-322. [PMID: 28298274 PMCID: PMC5347100 DOI: 10.3945/an.116.013748] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Smartphone applications are increasingly being used to support nutrition improvement in community settings. However, there is a scarcity of practical literature to support researchers and practitioners in choosing or developing health applications. This work maps the features, key content, theoretical approaches, and methods of consumer testing of applications intended for nutrition improvement in community settings. A systematic, scoping review methodology was used to map published, peer-reviewed literature reporting on applications with a specific nutrition-improvement focus intended for use in the community setting. After screening, articles were grouped into 4 categories: dietary self-monitoring trials, nutrition improvement trials, application description articles, and qualitative application development studies. For mapping, studies were also grouped into categories based on the target population and aim of the application or program. Of the 4818 titles identified from the database search, 64 articles were included. The broad categories of features found to be included in applications generally corresponded to different behavior change support strategies common to many classic behavioral change models. Key content of applications generally focused on food composition, with tailored feedback most commonly used to deliver educational content. Consumer testing before application deployment was reported in just over half of the studies. Collaboration between practitioners and application developers promotes an appropriate balance of evidence-based content and functionality. This work provides a unique resource for program development teams and practitioners seeking to use an application for nutrition improvement in community settings.
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Affiliation(s)
- Emma Tonkin
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; and .,Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Julie Brimblecombe
- Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Thomas Philip Wycherley
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; and,Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, Australia
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17
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Norris SA, Ho JCC, Rashed AA, Vinding V, Skau JKH, Biesma R, Aagaard-Hansen J, Hanson M, Matzen P. Pre-pregnancy community-based intervention for couples in Malaysia: application of intervention mapping. BMC Public Health 2016; 16:1167. [PMID: 27855663 PMCID: PMC5114777 DOI: 10.1186/s12889-016-3827-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaysia is experiencing a nutrition transition with burgeoning obesity, particularly in women, and a growing prevalence of non-communicable disease. These health burdens have severe implications not only for adult health but also across generations. Pre-conception health promotion could address the intergenerational risk of metabolic disease. This paper describes the development of the "Jom Mama" intervention using Intervention Mapping (IM). The Jom Mama intervention aims to improve the health of young adult couples in Malaysia prior to conception. METHODS IM comprises of five steps prior to the last one, which involves the evaluation of the intervention. We used the five steps to develop the Jom Mama intervention. RESULTS Both the process and evidence is documented providing the rationale to the selection of the key objectives of the intervention: (i) increasing healthy dietary practice; (ii) increasing physical activity levels, (iii) reducing sedentary activity; and (iv) improving social support to offset stressful lifestyles. From the IM process, Jom Mama will be health-system centred approach that uniquely combines both community health promoters and an electronic-health platform to deliver the complex intervention. CONCLUSION IM is an iterative process that systematically gathers "best" evidence, selects appropriate theories of behaviour change, and facilitates formative research so as to develop a complex intervention. Though the IM process is time consuming, complex, and costly, it has enriched the Jom Mama intervention with a number of notable advantages: (i) intervention fashioned on formative work with stakeholders and in the target group; (ii) intervention combines research evidence with theory; (iii) intervention acknowledges multiple dynamics of influence; and (iv) intervention is embedded within health service priorities in Malaysia for greater scale-up possibility.
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Affiliation(s)
- Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Julius Cheah Chee Ho
- School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor, Malaysia
| | - Aswir Abd Rashed
- Nutrition Unit, Cardiovascular, Diabetes and Nutrition Research Center, Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - Vibeke Vinding
- IT University of Copenhagen, Rued Langgaards Vej 7, 2300, Copenhagen, Denmark
| | - Jutta K H Skau
- MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Regien Biesma
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, 123 Saint Stephen's Green, Dublin 2, Ireland.,Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jens Aagaard-Hansen
- MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Promotion Research, Steno Diabetes Center, Niels Steensens Vej 6, 2820, Gentofte, Copenhagen, Denmark
| | - Mark Hanson
- Institute of Developmental Sciences, British Heart Foundation, Cardiovascular Sciences Faculty of Medicine, University of Southampton Mailpoint 887, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Priya Matzen
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
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