Using telehealth to support community health workers in Uganda during COVID-19: a mixed-method study

Background

At the onset of the COVID-19 pandemic, a local consortium in Uganda set up a telehealth approach that aimed to educate 3,500 Community Health Workers (CHW) in rural areas about COVID-19, help them identify, refer and care for potential COVID-19 cases, and support them in continuing their regular community health work. The aim of this study was to assess the functioning of the telehealth approach that was set up to support CHWs during the COVID-19 pandemic.

Methods

For this mixed-method study, we combined analysis of routine consultation data from the call-center, 24 interviews with key-informants and two surveys of 150 CHWs. Data were analyzed using constant comparative method of analysis.

Results

Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. According to the CHWs, there were no signs that people in their communities were suffering from severe health problems due to COVID-19. People compared the lack of visible symptoms to diseases such as Ebola and were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful for other purposes, such as supporting CHWs with their regular tasks and coordinating the supply of essential products. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients and adhering to infection prevention and control practices. The CHWs felt more informed and less isolated, saying the support from the call center helped them to provide better care and improved the supply of medicine and other essential health products.

Conclusions

The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities.

Determinants of Telehealth Continuance Intention: A Multi-Perspective Framework

Owing to the COVID-19 pandemic, many countries' physicians in the world have used telehealth to visit patients via telehealth. The study aimed to integrate the theory of planned behavior (TPB), the technology acceptance model (TAM), and self-determination theory (SDT) to explore the adoption behavior of a telehealth system. A convenient sample of residents was drawn from the population of Nantou County in Taiwan and analyzed via structural equation modeling. The findings revealed that attitude, perceived behavioral control, perceived usefulness, and perceived autonomy support jointly have significantly positive effects on continuance intention. Results also confirmed that perceived autonomy support, perceived ease of use, and perceived usefulness jointly have significantly positive effects on attitude. Furthermore, this study also showed that a crucial mediators' role is played by perceived ease of use, perceived usefulness, and attitude. The conclusions and practical implications of the research will hopefully provide health organizations and institutions with some innovative insights and foresights, which in turn will promote better practices and services of telehealth technology.

The Role of Digital Technology in Curbing COVID-19

Introduction: Using digital technology to provide support, medical consultations, healthcare services, and to track the spread of the coronavirus has been identified as an important solution to curb the transmission of the virus. This research paper aims to (1) summarize the digital technologies used during the COVID-19 pandemic to mitigate the transmission of the COVID-19; (2) establish the extent to which digital technology applications have facilitated mitigation of the spread of COVID-19; and (3) explore the facilitators and barriers that impact the usability of digital technologies throughout the pandemic. Methods: A rapid electronic search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted of available records up to June 2022 on the medical databases PubMed, Ovid, Embase, CINHAIL, the Cochrane Library, Web of Science, and Google Scholar. Results: An increasing number and variety of digital health applications have been available throughout the pandemic, such as telehealth, smartphone mobile health apps, machine learning, and artificial intelligence. Each technology has played a particular role in curbing COVID-19 transmission. Different users have gained benefits from using digital technology during the COVID-19 pandemic and different determinants have contributed to accelerating the wheel of digital technology implementation during the pandemic. Conclusion: Digital health during the COVID-19 pandemic has evolved very rapidly, with different applications and roles aimed at curbing the pandemic.

Brain barriers virtual: an interim solution or future opportunity?

BACKGROUND

Scientific conferences are vital communication events for scientists in academia, industry, and government agencies. In the brain barriers research field, several international conferences exist that allow researchers to present data, share knowledge, and discuss novel ideas and concepts. These meetings are critical platforms for researchers to connect and exchange breakthrough findings on a regular basis. Due to the worldwide COVID-19 pandemic, all in-person meetings were canceled in 2020. In response, we launched the Brain Barriers Virtual 2020 (BBV2020) seminar series, the first stand-in virtual event for the brain barriers field, to offer scientists a virtual platform to present their work. Here we report the aggregate attendance information on two in-person meetings compared with BBV2020 and comment on the utility of the virtual platform.

METHODS

The BBV2020 seminar series was hosted on a Zoom webinar platform and was free of cost for participants. Using registration- and Zoom-based data from the BBV2020 virtual seminar series and survey data collected from BBV2020 participants, we analyzed attendance trends, global reach, participation based on career stage, and engagement of BBV2020. We compared these data with those from two previous in-person conferences, a BBB meeting held in 2018 and CVB 2019.

RESULTS

We found that BBV2020 seminar participation steadily decreased over the course of the series. In contrast, live participation was consistently above 100 attendees and recording views were above 200 views per seminar. We also found that participants valued BBV2020 as a supplement during the COVID-19 pandemic in 2020. Based on one post-BBV2020 survey, the majority of participants indicated that they would prefer in-person meetings but would welcome a virtual component to future in-person meetings. Compared to in-person meetings, BBV2020 enabled participation from a broad range of career stages and was attended by scientists in academic, industry, and government agencies from a wide range of countries worldwide.

CONCLUSIONS

Our findings suggest that a virtual event such as the BBV2020 seminar series provides easy access to science for researchers across all career stages around the globe. However, we recognize that limitations exist. Regardless, such a virtual event could be a valuable tool for the brain barriers community to reach and engage scientists worldwide to further grow the brain barriers research field in the future.

Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems

Since the outbreak of COVID-19, the attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. Sub-Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems and COVID-19 emerging variants. Some developed countries integrated telemedicine to reduce the impacts of the shortage of healthcare professionals and potentially reduce the risk of exposure, ensuring easy delivery of quality health services while limiting regular physical contact and direct hospitalization. However, the adoption of telemedicine and telehealth is still nascent in many sub-Saharan Africa countries. Therefore, this study reflects on progress made towards the use of telemedicine, virtual health care services, challenges encountered, and proffers ways to address them. We conducted a systematic literature review to synthesise literature on telemedicine in sub-Saharan Africa. The study revealed that telemedicine provides unprecedented benefits such as improving efficiency, effective utilization of healthcare resources, forward triaging, prevention of medical personnel infection, aiding medical students' clinical observation and participation, and assurance of social support for patients. However, the absence of policy on virtual care and political will, cost of sustenance of virtual health care services, inadequate funding, technological and infrastructural barriers, patient and healthcare personnel bias on virtual care and cultural barriers are identified as limiting factors to the adoption of virtual health care in many African health systems. To alleviate some of these barriers, we recommend the development of robust policies and frameworks for virtual health care, the inclusion of virtual care in the medical school curriculum, supporting virtual care research and development, increasing health funding, removing monopolisation of telecommunication services, developing of virtual health solutions that address eccentricities of African health systems.

Utility of telemedicine in sub-Saharan Africa during the COVID-19 pandemic. A rapid review

Telemedicine is the use of technology to achieve remote care. This review looks at the utility of telemedicine during the pandemic, period March 2020 to February 2021. Eleven articles met inclusion criteria. There was moderate use of telemedicine in sub-Sahara Africa during the pandemic, however, there were also some limitations. Benefits of telemedicine include continuing medical service provision, connecting relatives with loved ones in quarantine, education, and awareness of mental health issues, and toxicovigilance and infection control. Challenges to the implementation of telemedicine on the continent were lack of supporting telemedicine framework and policies, digital barriers, and patient and healthcare personnel biases. To address these challenges, this article proposes the development of policy frameworks that fosters telemedicine use by all stakeholders, including medical insurance organizations, the introduction of telemedicine training of medical workers, educational awareness programs for the public, and improvement of digital platforms access and affordability.

Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.

Establishing and operating a 'virtual ward' system to provide care for patients with COVID-19 at home: experience from The Gambia

Health systems in sub-Saharan Africa have remained overstretched from dealing with endemic diseases, which limit their capacity to absorb additional stress from new and emerging infectious diseases. Against this backdrop, the rapidly evolving COVID-19 pandemic presented an additional challenge of insufficient hospital beds and human resource for health needed to deliver hospital-based COVID-19 care. Emerging evidence from high-income countries suggests that a 'virtual ward' (VW) system can provide adequate home-based care for selected patients with COVID-19, thereby reducing the need for admissions and mitigate additional stress on hospital beds. We established a VW at the Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, a biomedical research institution located in The Gambia, a low-income west African country, to care for members of staff and their families infected with COVID-19. In this practice paper, we share our experience focusing on the key components of the system, how it was set up and successfully operated to support patients with COVID-19 in non-hospital settings. We describe the composition of the multidisciplinary team operating the VW, how we developed clinical standard operating procedures, how clinical oversight is provided and the use of teleconsultation and data capture systems to successfully drive the process. We demonstrate that using a VW to provide an additional level of support for patients with COVID-19 at home is feasible in a low-income country in sub-Saharan Africa. We believe that other low-income or resource-constrained settings can adopt and contextualise the processes described in this practice paper to provide additional support for patients with COVID-19 in non-hospital settings.