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Guarchaj M, Tschida S, Milian Chew JP, Aguilar A, Flood D, Fort MP, Morales LC, Mendoza Montano C, Rodríguez Serrano SN, Rohloff P. Impact of COVID-19 on diabetes care: mixed methods study in an Indigenous area of Guatemala. BMJ Open 2024; 14:e079130. [PMID: 38167279 PMCID: PMC10773399 DOI: 10.1136/bmjopen-2023-079130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION SARS-CoV-2 has impacted globally the care of chronic diseases. However, direct evidence from certain vulnerable communities, such as Indigenous communities in Latin America, is missing. We use observational data from a health district that primarily serves people of Maya K'iche' ethnicity to examine the care of type 2 diabetes in Guatemala during the pandemic. METHODS We used a parallel convergent mixed methods design. Quantitative data (n=142 individuals with diabetes) included glycated haemoglobin (HbA1c), blood pressure, body mass index and questionnaires on diabetes knowledge, self-care and diabetes distress. Quantitative data was collected at two points, at baseline and after COVID restrictions were lifted. For quantitative outcomes, we constructed multilevel mixed effects models with multiple imputation for missing data. Qualitative data included interviews with providers, supervisors and individuals living with diabetes (n=20). We conducted thematic framework analysis using an inductive approach. RESULTS Quantitative data was collected between June 2019 and February 2021, with a median of 487 days between data collection points. HbA1c worsened +0.54% (95% CI, 0.14 to 0.94) and knowledge about diabetes decreased -3.54 points (95% CI, -4.56 to -2.51). Qualitatively, the most important impact of the pandemic was interruption of the regular timing of home visits and peer group meetings which were the standard of care. CONCLUSIONS The deterioration of diabetes care was primarily attributed to the loss of regular contact with healthcare workers. The results emphasize the vulnerability of rural and Indigenous populations in Latin America to the suspension of chronic disease care.
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Affiliation(s)
- Magdalena Guarchaj
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
| | - Scott Tschida
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
| | | | - Andrea Aguilar
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
- Colectiva Guatemala Menstruante, Guatemala City, Guatemala
| | - David Flood
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Meredith P Fort
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Carlos Mendoza Montano
- Centro de Investigación para la Prevención de las Enfermedades Crónicas, Instituto deNutrición de Centro América y Panamá, Guatemala City, Guatemala
| | | | - Peter Rohloff
- Center for Research in Indigenous Health, Maya Health Alliance | Wuqu' Kawoq, Tecpan, Chimaltenango, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Molina R, Enriquez M. Enhancing Diabetes Health Outcomes Among Haitian Migrants Living in Dominican Bateyes. Sci Diabetes Self Manag Care 2023; 49:281-290. [PMID: 37313730 DOI: 10.1177/26350106231178838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to better understand the factors that influence the ability of batey adults to self-manage their type 2 diabetes mellitus (T2DM). METHODS A qualitative descriptive approach was used to conduct in-depth, individual interviews in Spanish. Participants (n = 12) were health care workers and members of a nongovernmental organization (NGO) that provides direct diabetes care to batey residents via free, pop-up, mobile medical clinics. Conventional content analysis was used to identify categories and common themes in the data. RESULTS Participants described daily existence in the bateyes as a constant "scarcity of resources." Additionally, four themes and one subtheme emerged that participants felt impacted diabetes health outcomes and the ability of NGO health care workers to provide diabetes care. CONCLUSIONS NGO members, while committed to serve and improve health outcomes for the batey population, often felt overwhelmed. Findings from this qualitative descriptive study may be used to inform novel interventions, which are needed, to enhance the diabetes outcomes of the batey residents who are living with T2DM. In addition, strategies are needed to build diabetes care infrastructure in the batey community.
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Affiliation(s)
- Rosalia Molina
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Maithe Enriquez
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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Rimawi A, Shah A, Louis H, Scales D, Kheiran JA, Jawabreh N, Yunez S, Horino M, Seita A, Wispelwey B. Community Health Worker Program Outcomes for Diabetes and Hypertension Control in West Bank Refugee Camps: A Retrospective Matched Cohort Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200168. [PMID: 36316145 PMCID: PMC9622278 DOI: 10.9745/ghsp-d-22-00168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Community health worker (CHW) programs have proven effective in improving diabetes control in many locations and settings, but data on feasibility and efficacy are lacking in the Middle East and settings of chronic violence. A Palestinian CHW program, Health for Palestine (H4P), addresses chronic diseases in West Bank refugee camps. Our study assesses the feasibility and effectiveness of the program's diabetes and hypertension interventions. METHODS Data on home visits, patient retention, and blood pressure were extracted from the CHW records and analyzed. To assess diabetic patient progress, we conducted a retrospective matched cohort study using data obtained from a United Nations (UN) clinical database to analyze the trajectory of hemoglobin A1c (A1c) values. Thirty of the 47 diabetic patients in the H4P CHW program met study inclusion criteria and were each matched with 3 patients from the Bethlehem UN clinic (n=120). We tested for significance using multivariable linear regression with robust standard errors. RESULTS The average number of home visits per patient per month was 7.3 (standard deviation=4.1), and the patient retention rate was 100% over an average of 11.2 months. For hypertension patients in the CHW program (n=33), mean systolic blood pressure decreased by 7.3 mmHg (95% confidence interval [CI]=1.93, 12.25; P=.009) and mean diastolic blood pressure by 4.3 mmHg (95% CI=0.80, 7.91; P=.018) from March 2018 to November 2019. On average, diabetic patients within the CHW group experienced a 1.4 point greater decline in A1c per year compared to those in the non-CHW group, after adjusting for potential confounders (95% CI=-0.66, -2.1; P<.001). DISCUSSION The results suggest that CHW accompaniment may be an effective model for improving diabetes and hypertension control in refugee camps experiencing direct violence and extreme adversity. A low exclusion cut-off for A1c (≤6.4%) may underestimate the program's impact.
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Affiliation(s)
- Asmaa Rimawi
- Harvard T.H. Chan School of Public Health; Harvard Medical School, Boston, MA, USA
| | - Adarsh Shah
- Harvard Kennedy School, Harvard University, Cambridge, MA, USA
| | - Henry Louis
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - David Scales
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jawad Abu Kheiran
- United Nations Relief and Works Agency, Arroub refugee camp, occupied Palestinian territory
| | - Nashat Jawabreh
- Makassad Hospital, East Jerusalem, occupied Palestinian territory
| | - Sofia Yunez
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Masako Horino
- United Nations Relief and Works Agency, Amman, Jordan
| | - Akihiro Seita
- United Nations Relief and Works Agency, Amman, Jordan
| | - Bram Wispelwey
- Brigham and Women's Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Lamptey R, Robben MP, Amoakoh‐Coleman M, Boateng D, Grobbee DE, Davies MJ, Klipstein‐Grobusch K. Structured diabetes self-management education and glycaemic control in low- and middle-income countries: A systematic review. Diabet Med 2022; 39:e14812. [PMID: 35179792 PMCID: PMC9539947 DOI: 10.1111/dme.14812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
Abstract
AIM To determine the association between structured diabetes self-management education (DSME) and glycaemic control in persons living with diabetes (PLD) in low- and middle-income countries (LMICs). METHODS PubMed, Embase and Cochrane databases were searched up to June 2020 for intervention studies on the effect of structured DSME on glycaemic control in PLD in LMICs (PROSPERO registration CRD42020164857). The primary outcome was reduction in glycated haemoglobin. Included studies were assessed for risk of bias (RoB) with the Cochrane RoB tool for randomised trials. Findings were summarized in a narrative synthesis. RESULTS Out of 154 abstracts retrieved and screened for eligibility, nine studies with a total of 1389 participants were included in the review. The structured DSME interventions were culturally tailored and were delivered in-person. They were associated with reductions in glycated haemoglobin in all studies: mean/median reduction ranged between 0.5% and 2.6% relative to baseline. CONCLUSIONS There is a dearth of literature on the association between structured DSME and glycaemic control among PLD in LMICs. The evidence available suggests that in LMICs; particularly in sub-Saharan Africa, structured DSME is associated with reduction in glycated haemoglobin. We recommend further intervention studies on the effects of structured DSME in LMICs.
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Affiliation(s)
- Roberta Lamptey
- Department of Family MedicineKorle Bu Teaching HospitalAccraGhana
- Department of Community HealthUniversity of Ghana Medical SchoolAccraGhana
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Maud P. Robben
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Mary Amoakoh‐Coleman
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Noguchi Memorial Institute for Medical ResearchUniversity of GhanaAccraGhana
| | - Daniel Boateng
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Diederick E. Grobbee
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | | | - Kerstin Klipstein‐Grobusch
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Division of Epidemiology and BiostatisticsFaculty of Health SciencesSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
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Tschida S, Flood D, Guarchaj M, Milian J, Aguilar A, Fort MP, Guetterman T, Montano CM, Miller A, Morales L, Rohloff P. Implementation of a Diabetes Self-Management Education and Support Intervention in Rural Guatemala: A Mixed-Methods Evaluation Using the RE-AIM Framework. Prev Chronic Dis 2021; 18:E100. [PMID: 34882536 PMCID: PMC8673946 DOI: 10.5888/pcd18.210259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION To address the global diabetes epidemic, lifestyle counseling on diet, physical activity, and weight loss is essential. This study assessed the implementation of a diabetes self-management education and support (DSMES) intervention using a mixed-methods evaluation framework. METHODS We implemented a culturally adapted, home-based DSMES intervention in rural Indigenous Maya towns in Guatemala from 2018 through 2020. We used a pretest-posttest design and a mixed-methods evaluation approach guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative data included baseline characteristics, implementation metrics, effectiveness outcomes, and costs. Qualitative data consisted of semistructured interviews with 3 groups of stakeholders. RESULTS Of 738 participants screened, 627 participants were enrolled, and 478 participants completed the study. Adjusted mean change in glycated hemoglobin A1c was -0.4% (95% CI, -0.6% to -0.3%; P < .001), change in systolic blood pressure was -5.0 mm Hg (95% CI, -6.4 to -3.7 mm Hg; P < .001), change in diastolic blood pressure was -2.6 mm Hg (95% CI, -3.4 to -1.9 mm Hg; P < .001), and change in body mass index was 0.5 (95% CI, 0.3 to 0.6; P < .001). We observed improvements in diabetes knowledge, distress, and most self-care activities. Key implementation factors included 1) recruitment barriers for men, 2) importance of patient-centered care, 3) role of research staff in catalyzing health worker involvement, 4) tradeoffs between home and telephone visits, and 5) sustainability challenges. CONCLUSION A community health worker-led DSMES intervention was successfully implemented in the public health system in rural Guatemala and resulted in significant improvements in most clinical and psychometric outcomes. Scaling up sustainable DSMES in health systems in rural settings requires careful consideration of local barriers and facilitators.
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Affiliation(s)
- Scott Tschida
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
- Wuqu' Kawoq, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala.
| | - David Flood
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
- Department of Internal Medicine, National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan
| | - Magdalena Guarchaj
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
| | - Juanita Milian
- Instituto de Salud Incluyente, San Lucas Sacatepéquez, Sacatepéquez, Guatemala
| | - Andrea Aguilar
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
| | - Meredith P Fort
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Timothy Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Carlos Mendoza Montano
- Centro de Investigación para la Prevención de las Enfermedades Crónicas, Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Ann Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lidia Morales
- Instituto de Salud Incluyente, San Lucas Sacatepéquez, Sacatepéquez, Guatemala
| | - Peter Rohloff
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
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van Zyl C, Badenhorst M, Hanekom S, Heine M. Unravelling 'low-resource settings': a systematic scoping review with qualitative content analysis. BMJ Glob Health 2021; 6:e005190. [PMID: 34083239 PMCID: PMC8183220 DOI: 10.1136/bmjgh-2021-005190] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as 'low-to-middle-income countries' or 'developing countries', are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings. METHODS A systematic scoping review was undertaken to start unravelling the term 'low-resource setting'. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to 'low-resource setting' and 'rehabilitation'. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used. RESULTS A total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term 'low-resource setting'. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices. CONCLUSION The emerging themes may assist with (1) the groundwork needed to unravel 'low-resource settings' in health-related research, (2) moving away from assumptive umbrella terms like 'low-to-middle-income countries' or 'low/middle-income countries' and (3) promoting effective knowledge transfer between settings.
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Affiliation(s)
- Chanel van Zyl
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Marelise Badenhorst
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Leyns CC, Couvreur N, Willems S, Van Hecke A. Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: a people-centred perspective. Int J Equity Health 2021; 20:104. [PMID: 33879174 PMCID: PMC8056633 DOI: 10.1186/s12939-021-01442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The rising prevalence of type 2 diabetes results in a worldwide public healthcare crisis, especially in low- and middle-income countries (LMICs) with unprepared and overburdened health systems mainly focused on infectious diseases and maternal and child health. Studies regarding type 2 diabetes in LMICs describe specific interventions ignoring a comprehensive analysis of the local factors people see influential to their health. This study aims to meet this research gap by exploring what people with type 2 diabetes in Bolivia need to maintain or improve their health, how important they perceive those identified needs and to what extent these needs are met. METHODS From March until May 2019, 33 persons with type 2 diabetes from three periurban municipalities of the department of Cochabamba participated in this study. The concept mapping methodology by Trochim, a highly structured qualitative brainstorming method, was used to generate and structure a broad range of perspectives on what the participants considered instrumental for their health. RESULTS The brainstorming resulted in 156 original statements condensed into 72 conceptually different needs and resources, structured under nine conceptual clusters and four action domains. These domains illustrated with vital needs were: (1) self-management with use of plants and the possibility to measure sugar levels periodically; (2) healthcare providers with the need to trust and receive a uniform diagnosis and treatment plan; (3) health system with opportune access to care and (4) community with community participation in health and safety, including removal of stray dogs. CONCLUSIONS This study identifies mostly contextual factors like low literacy levels, linguistic problems in care, the need to articulate people's worldview including traditional use of natural remedies with the Bolivian health system and the lack of expertise on type 2 diabetes by primary health care providers. Understanding the needs and structuring them in different areas wherein action is required serves as a foundation for the planning and evaluation of an integrated people centred care program for people with type 2 diabetes. This participative method serves as a tool to implement the often theoretical concept of integrated people centred health care in health policy and program development.
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Affiliation(s)
- Christine Cécile Leyns
- Fundación Vida Plena, Juan Capriles 346, Cochabamba, Bolivia
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Niek Couvreur
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- University Center for Nursing and Midwifery, Ghent University Hospital, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- University Center for Nursing and Midwifery, Ghent University Hospital, Ghent, Belgium
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Duffy S, Norton D, Kelly M, Chavez A, Tun R, Ramírez MNDG, Chen G, Wise P, Svenson J. Using Community Health Workers and a Smartphone Application to Improve Diabetes Control in Rural Guatemala. GLOBAL HEALTH, SCIENCE AND PRACTICE 2020; 8:699-720. [PMID: 33361237 PMCID: PMC7784066 DOI: 10.9745/ghsp-d-20-00076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The global prevalence of diabetes has nearly doubled since 1980. Seventy-five percent of patients with diabetes live in low- and middle-income countries, such as Guatemala, where health care systems are often poorly equipped for chronic disease management. Community health workers (CHWs) and mobile health technology have increasingly been applied to the diabetes epidemic in these settings, although mostly in supportive rather than primary roles in diabetes management. We sought to improve diabetes care in rural Guatemala through the development of a CHW-led diabetes program and a smartphone application to provide CHWs with clinical decision support. METHODS We worked with our local partners to develop a program model and the smartphone application (using the CommCare platform) and to train CHWs. We recruited patients with type 2 diabetes living in rural communities. Program evaluation used a single-group, pre-post design. Primary outcomes were hemoglobin A1c and the percentage of patients meeting A1c goals compared with baseline. We also followed a variety of process metrics, including application reliability. RESULTS Eighty-nine patients enrolled during the study period. The hemoglobin A1c percentage decreased significantly at 3 months (-1.0; 95% CI=-1.7, -0.6), 6 months (-1.5; 95% CI=-2.2, -0.8), 9 months (-1.3; 95% CI=-2.0, -0.6), and 12 months (-1.0; 95% CI=-1.7, -0.4). The percentage of patients with A1c ≤ 8% increased significantly at 3 months (23.6% to 44.4%, P=.007), 6 months (22.0% to 44.0%, P=.015), and 9 months (23.9% to 45.7%, P=.03). CHWs and supervising physicians agreed with application medication recommendations >90% of the time. CONCLUSION Our results suggest that CHWs can safely and effectively manage diabetes with the assistance of a smartphone application and remote physician supervision. This model should be evaluated versus other standards of care and could be adapted to other low-resource settings and chronic diseases.
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Affiliation(s)
- Sean Duffy
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA.
| | - Derek Norton
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Mark Kelly
- University of California-Los Angeles David Geffen School of Medicine, Internal Medicine Residency Program, Los Angeles, CA, USA
| | | | - Rafael Tun
- Hospital Obras Sociales Monseñor Gregorio Schaffer, San Lucas Tolimán, Guatemala
| | - Mariana Niño de Guzmán Ramírez
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | - Guanhua Chen
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Paul Wise
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jim Svenson
- University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, WI, USA
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Zare S, Ostovarfar J, Kaveh MH, Vali M. Effectiveness of theory-based diabetes self-care training interventions; a systematic review. Diabetes Metab Syndr 2020; 14:423-433. [PMID: 32361532 DOI: 10.1016/j.dsx.2020.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Permanent compliance of self-care behaviors is a challenging issue in managing chronic diseases like diabetes. The evidence supports theory-based intervention in promoting self-care behaviors. However, no systematic review was done to monitor these interventions and compare more effective constructs. This study was conducted to investigate the studies using self-care theories and introducing the most effective theories. METHODS This is a systematic review study during which some scientific databases including Scopus, Elsevier, Google scholar and PubMed were searched by using some key words like self-care or self-management, diabetes, theory or model. English articles from the start of 2013 up to the end of November 2020 were monitored. RESULTS 20 articles were selected and studied based on eight theories which they used. These theories were: Social support theory, Health Belief Model, Heath Belief Model and Empowerment Theory, Empowerment Theory, Self-efficacy Theory, precede-proceed model, Self-regulation Theory, behavioral theory and Social Cognitive Theory. CONCLUSION Four theories appeared to be more effective for the target behavior of present research: Social Support Theory and the combination of Empowerment Theory and Health Belief Model, Social Cognitive Theory and Self Efficacy Theory. Taken together, the findings of this systematic review suggest that interventions that go beyond individual determinants (such as changing knowledge and attitudes) to determinants of upper cognitive, motor, and social levels (such as the development of skills and competencies) they have led to raised self-care outcomes.
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Affiliation(s)
- Somayeh Zare
- Department of Health Promotion, Faculty of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jeyran Ostovarfar
- Department of Health Promotion, Faculty of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Kaveh
- Department of Health Promotion, Faculty of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohebat Vali
- Department of Epidemiology, Faculty of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Guadalupe Vargas M, Pazmiño Gomez BJ, Vera Lorenti FE, Álvarez Condo GM, Rodas Neira EI, Veron D, Fernández Veron M, Cercado AG, Bahar B, Tufro A, Veron D. Assessment of two glycated hemoglobin immunoassays. ACTA ACUST UNITED AC 2019; 67:297-303. [PMID: 31859182 DOI: 10.1016/j.endinu.2019.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/12/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Glycated hemoglobin (HbA1c) level reflects chronic glycemic status if reliable tests are used, however, in some regions worldwide high performing assays might not be readily available. This study aimed to asses two HbA1c immunoassays, comparing them with high-performance liquid chromatography (HPLC) assay, three methods available in Ecuador. MATERIAL AND METHODS HbA1c were measured in 114 fresh whole blood-samples by DCA-Vantage point-of-care analyzer, I-Chroma portable fluorescent scanner immunoassay and BioRad Variant II Turbo HPLC. Normal and pathological HbA1c ranges were included. Blood samples with variants of hemoglobin were excluded. HbA1c values were expressed in National Glycohemoglobin Standardization Program percentages and mmol/mol, as mean±standard deviation. RESULTS HbA1c results by HPLC and DCA-Vantage were similar: 6.3±1.7% (45±18.6mmol/mol) vs. 6.3±1.8% (45±19.7mmol/mol), respectively, P=0.057; while HbA1c values by I-Chroma were lower than HPLC, 5.8±1.9% (40±20.8mmol/mol), P<0.001. The coefficient of variation was below 2% for high and low HbA1c levels, in all methods studied. HbA1c values by HPLC and DCA-Vantage were highly correlated (Spearman's Rank Correlation [SRC]: 0.916), while the correlation among HPLC and I-Chroma was weak (SRC: 0.368). The mean bias between DCA-Vantage and HPLC was -0.02±0.29% (-0.2±3.2mmol/mol), while for I-Chroma and HPLC mean bias was -0.50±1.62% (-5.5±17.7mmol/mol). CONCLUSION HbA1c immunoassays DCA-Vantage was comparable to HPLC assay, showing good correlation, appropriate precision and low bias, whereas I-Chroma assay was precise but inaccurate. Therefore, DCA-Vantage has better performance than I-Chroma. These findings suggest that is convenient to assess the HbA1c immunoassays commercially available in our country, Ecuador.
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Affiliation(s)
- M Guadalupe Vargas
- Facultad de Ciencias de la Salud, Universidad Estatal de Milagro, Milagro, Guayas, Ecuador
| | - B J Pazmiño Gomez
- Facultad de Ciencias de la Salud, Universidad Estatal de Milagro, Milagro, Guayas, Ecuador
| | - F E Vera Lorenti
- Facultad de Ciencias de la Salud, Universidad Estatal de Milagro, Milagro, Guayas, Ecuador
| | - G M Álvarez Condo
- Facultad de Ciencias de la Salud, Universidad Estatal de Milagro, Milagro, Guayas, Ecuador
| | - E I Rodas Neira
- Laboratorio Clínico y Microbiológico Pazmiño, Milagro, Guayas, Ecuador
| | - D Veron
- Facultad de Ciencias Sociales, Escuela de Trabajo Social, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - M Fernández Veron
- Escuela de Diseño Industrial, Facultad de Arquitectura, Diseño y Urbanismo, Universidad de Buenos Aires, Argentina
| | - A G Cercado
- Facultad de Ciencias de la Salud, Universidad Estatal de Milagro, Milagro, Guayas, Ecuador
| | - B Bahar
- Department of Laboratory Medicine and Department of Pediatrics and Cell and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
| | - A Tufro
- Department of Laboratory Medicine and Department of Pediatrics and Cell and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
| | - D Veron
- Facultad de Ciencias de la Salud, Universidad Estatal de Milagro, Milagro, Guayas, Ecuador.
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Hearn J, Ssinabulya I, Schwartz JI, Akiteng AR, Ross HJ, Cafazzo JA. Self-management of non-communicable diseases in low- and middle-income countries: A scoping review. PLoS One 2019; 14:e0219141. [PMID: 31269070 PMCID: PMC6608949 DOI: 10.1371/journal.pone.0219141] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/17/2019] [Indexed: 12/30/2022] Open
Abstract
Background The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries (LMICs). Self-management, which enables patients to better manage their health, presents a potentially-scalable means of mitigating the growing burden of NCDs in LMICs. Though the effectiveness of self-management interventions in high-income countries is well-documented, the use of these strategies in LMICs has yet to be thoroughly summarized. Objective The purpose of this scoping review is to summarize the nature and effectiveness of past interventions that have enabled the self-management of NCDs in LMICs. Methods Using the scoping review methodology proposed by Arksey and O’Malley, PubMed was searched for relevant articles published between January 2007 and December 2018. The implemented search strategy comprised three major themes: self-management, NCDs and LMICs. Results Thirty-six original research articles were selected for inclusion. The selected studies largely focused on the self-management of diabetes (N = 21), hypertension (N = 7) and heart failure (N = 5). Most interventions involved the use of short message service (SMS, N = 17) or phone calls (N = 12), while others incorporated educational sessions (N = 10) or the deployment of medical devices (N = 4). The interventions were generally effective and often led to improvements in physiologic indicators, patient self-care and/or patient quality of life. However, the studies emphasized results in small populations, with little indication of future scaling of the intervention. Furthermore, the results indicate a need for further research into the self-management of cardiovascular diseases, as well as for the co-management of diabetes and cardiovascular disease. Conclusions Self-management appears to be an effective means of improving health outcomes in LMICs. Future strategies should include patients and clinicians in all stages of design and development, allowing for a focus on long-term sustainability, scalability and interoperability of the intervention in the target setting.
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Affiliation(s)
- Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Isaac Ssinabulya
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Heather J. Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
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13
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Anand TN, Joseph LM, Geetha AV, Prabhakaran D, Jeemon P. Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2019; 7:e761-e771. [PMID: 31097278 PMCID: PMC6527522 DOI: 10.1016/s2214-109x(19)30077-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/22/2019] [Accepted: 02/08/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries. METHODS We searched the Cochrane Library, PubMed, Embase, and CINAHL for studies published up to December 2018. We included intervention studies involving a task-sharing strategy for management of blood pressure and other cardiovascular risk factors. We extracted data on population, interventions, blood pressure, and task sharing groups. We did a meta-analysis of randomised controlled trials. FINDINGS We found 3012 references, of which 54 met the inclusion criteria initially. Another nine studies were included following an updated search. There were 43 trials and 20 before-and-after studies. We included 31 studies in our meta-analysis. Systolic blood pressure was decreased through task sharing in different groups of health-care workers: the mean difference was -5·34 mm Hg (95% CI -9·00 to -1·67, I2=84%) for task sharing with nurses, -8·12 mm Hg (-10·23 to -6·01, I2=57%) for pharmacists, -4·67 mm Hg (-7·09 to -2·24, I2=0%) for dietitians, -3·67 mm Hg (-4·58 to -2·77, I2=24%) for community health workers, and -4·85 mm Hg (-6·12 to -3·57, I2=76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference -2·92 mm Hg, -3·75 to -2·09, I2=80%). The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure, but low for diastolic blood pressure. INTERPRETATION Task-sharing interventions are effective in reducing blood pressure. Long-term studies are needed to understand their potential impact on cardiovascular outcomes and mortality. FUNDING Wellcome Trust/DBT India Alliance.
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Affiliation(s)
- T N Anand
- Centre for Chronic Disease Control, New Delhi, India
| | | | - A V Geetha
- Public Health Foundation of India, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene & Tropical Medicine, London, UK
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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14
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Mao L, Lu J, Zhang Q, Zhao Y, Chen G, Sun M, Chang F, Li X. Family-based intervention for patients with type 2 diabetes via WeChat in China: protocol for a randomized controlled trial. BMC Public Health 2019; 19:381. [PMID: 30953483 PMCID: PMC6451245 DOI: 10.1186/s12889-019-6702-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/26/2019] [Indexed: 01/03/2023] Open
Abstract
Background China has the largest number of cases of diabetes with a high rate of uncontrolled blood sugar. Many studies show that family members’ involvement is related to better glycemic control. However, there is a significant problem with low participation of family members. The widespread use of WeChat provides an opportunity for family members to support their diabetic loved ones in their type 2 diabetes self-management practices. The main aim of this study is to examine the effectiveness of a family-based intervention via WeChat. Methods A parallel, two-group, randomized controlled trial will be conducted in the central urban area of Jiading district in Shanghai, China. A total of 222 type 2 diabetics will be randomly divided into an intervention group or a control group using a 1:1 ratio. Patients in the intervention group will receive the usual care, and their family will get education in diabetes control and the importance of family support by subscribing to the WeChat public account. Both the patients and the family members will be followed up at 12 months after the intervention commences. Data collection is scheduled at baseline, 6-months, and 12-months. Discussion Family involvement based on WeChat may generate ongoing support for type 2 diabetic patients and improve these patients’ health outcomes. A successful outcome of this study may also provide inspiration for other efforts to provide health education via WeChat. Trial registration ChiCTR1900020736. Registered 15 January 2019. Electronic supplementary material The online version of this article (10.1186/s12889-019-6702-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linqi Mao
- Department of Health Policy and Management, School of Public Health, Fudan University, P.O. Box 177, 130 Dong'an Road, Shanghai, 200032, China.,China Research on Disability at Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Jun Lu
- Department of Health Policy and Management, School of Public Health, Fudan University, P.O. Box 177, 130 Dong'an Road, Shanghai, 200032, China.,China Research on Disability at Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia, USA
| | - Yuxi Zhao
- Department of Health Policy and Management, School of Public Health, Fudan University, P.O. Box 177, 130 Dong'an Road, Shanghai, 200032, China.,China Research on Disability at Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Gang Chen
- China Research on Disability at Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China.,Department of Health Law and Inspection, School of Public Health, Fudan University, Shanghai, China
| | - Mei Sun
- Department of Health Policy and Management, School of Public Health, Fudan University, P.O. Box 177, 130 Dong'an Road, Shanghai, 200032, China.,China Research on Disability at Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Fengshui Chang
- Department of Health Policy and Management, School of Public Health, Fudan University, P.O. Box 177, 130 Dong'an Road, Shanghai, 200032, China.,China Research on Disability at Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Xiaohong Li
- Department of Health Policy and Management, School of Public Health, Fudan University, P.O. Box 177, 130 Dong'an Road, Shanghai, 200032, China. .,China Research on Disability at Fudan University, Shanghai, 200032, People's Republic of China. .,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China.
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15
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Jarrín OF, Pouladi FA, Madigan EA. International priorities for home care education, research, practice, and management: Qualitative content analysis. NURSE EDUCATION TODAY 2019; 73:83-87. [PMID: 30550942 PMCID: PMC6713276 DOI: 10.1016/j.nedt.2018.11.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite growing demand for home care nursing, there is a growing home care workforce shortage, due in part to hospital-centric nursing curricula that lead students to undervalue of home care and community practice setting (Van Iersel et al., 2018a, 2018b). OBJECTIVES Articulate an international vision for the future of home care education, research, practice, and management shared by experienced home care nurses working in leadership roles. DESIGN Qualitative content analysis. SETTINGS AND PARTICIPANTS The sample included 50 home care professionals from 17 countries. METHODS Home care nurse leaders (in education, research, practice, and management roles) were recruited through professional international nursing networks to participate in a structured online survey about priorities for the future of home care in 2014. Responses were open coded by two independent researchers. Preliminary categories and sub-themes were developed by the research team and revised after a modified member-checking process that included presentation and discussion of preliminary findings at three international nursing meetings in 2015 and 2016. RESULTS Four major themes emerged reflecting international priorities for the future of home care education, research, practice, and management: 1) Build the evidence base for home care; 2) Design better systems of care; 3) Develop leaders at all levels; and 4) Address payment and policy issues. CONCLUSIONS Collectively, the findings provide a major call to action for nurse educators to re-design existing pre- and post-licensure educational programs to meet the growing demand for home care nurses. Innovations in education that focus on filling gaps in the evidence-base for community nursing practice, and improving access to continuing education and evidence-based resources for practicing home care nurses and nurse managers should be prioritized.
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Affiliation(s)
- Olga F Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, and Institute for Health, Health Care Policy, and Aging Research, 112 Paterson Street, New Brunswick, NJ 08901, United States of America.
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