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Zimmermann K, Haen LS, Desloge A, Handler A. The Role of a Local Health Department in Advancing Health Equity: Universal Postpartum Home Visiting in a Large Urban Setting. Health Equity 2023; 7:703-712. [PMID: 37908403 PMCID: PMC10615061 DOI: 10.1089/heq.2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Racial and ethnic inequities persist among birthing families in urban U.S. communities, despite public health efforts to improve outcomes. To address these inequities, in 2020, the Chicago Department of Public Health (CDPH) launched Family Connects Chicago (FCC), an evidence-based, universal, postpartum home visiting program. We examine CDPH's transition from "high risk" to universal home visiting to determine whether and how this change represent an explicit commitment to advancing maternal and child health equity. Methods We conducted a secondary analysis of key informant interview data (n=45 interviews) collected from stakeholders involved in FCC's early implementation. Our analysis involved identifying processes used by CDPH in their planning and early implementation of FCC and examining the alignment of these processes with approaches for promoting health equity proposed by Calancie et al. Results The processes used by CDPH to plan and implement the FCC pilot are reflected in two major themes: (1) CDPH emphasized improving outcomes for all birthing families, and (2) CDPH prioritized engaging multiple stakeholders throughout planning and implementation. Alignment of these themes and their subthemes with the approaches proposed by Calancie et al. demonstrated that CDPH's implementation of FCC represents a commitment to advancing health equity. Discussion In their planning and implementation of FCC, CDPH appears to have exhibited a concerted effort to address Chicago's persistent health inequities. Institutional commitment, continued stakeholder engagement, ongoing data sharing, and sustainable funding will be crucial to implementing and expanding FCC. Health Equity Implications The implementation of FCC, a new service delivery approach for maternal and infant health, marks a new beginning in tackling inequities for Chicago's birthing families.
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Affiliation(s)
- Kristine Zimmermann
- Department of Family and Community Medicine, University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lisa S. Haen
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Allissa Desloge
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Arden Handler
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
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2
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Zhao Y, Zhang H, Liu X, Desloge A, Wang Q, Zhao S, Song L, Tzoulaki I. The prevalence of cardiometabolic multimorbidity and its associations with health outcomes among women in China. Front Cardiovasc Med 2023; 10:922932. [PMID: 36844741 PMCID: PMC9947472 DOI: 10.3389/fcvm.2023.922932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Objective In China, a limited number of studies focus on women and examine the effect of cardiometabolic multimorbidity (defined as the presence of two or more cardiometabolic diseases) on health outcomes. This research aims to investigate the epidemiology of cardiometabolic multimorbidity and the association of cardiometabolic multimorbidity with long-term mortality. Methods This study used data from the China Health and Retirement Longitudinal Study between 2011 and 2018, which includes 4,832 women aged 45 years and older in China. Poisson-distributed Generalized Linear Models (GLM) were applied to examine the association of cardiometabolic multimorbidity with all-cause mortality. Results Overall, the prevalence of cardiometabolic multimorbidity was 33.1% among the total sample of 4,832 Chinese women, and increased with age, ranging from 28.5% (22.1%) for those aged 45-54 years to 65.3% (38.2%) for those aged ≥75 years in urban (rural) areas. Compared with the group of none and single disease, cardiometabolic multimorbidity was positively associated with all-cause death (RR = 1.509, 95% CI = 1.130, 2.017), after adjusting socio-demographic and lifestyle behavioral covariates. Stratified analyses revealed that the association between cardiometabolic multimorbidity and all-cause death was only statistically significant (RR = 1.473, 95% CI = 1.040, 2.087) in rural residents, but not significant in urban residents. Conclusion Cardiometabolic multimorbidity is common among women in China and has been associated with excess mortality. Targeted strategies and people-centered integrated primary care models must be considered to more effectively manage the cardiometabolic multimorbidity shift from focusing on single-disease.
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Affiliation(s)
- Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,The George Institute for Global Health, Beijing, China
| | - Huan Zhang
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Qian Wang
- Yeda Hospital of Yantai, Yantai, Shandong, China
| | - Siqi Zhao
- Yantaishan Hospital of Yantai, Yantai, Shandong, China,Yantai Sino-French Friendship Hospital, Yantai, Shandong, China
| | - Lili Song
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,The George Institute for Global Health, Beijing, China,*Correspondence: Lili Song,
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom,Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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Johnson LCM, Haregu T, Sathish T, De Man J, Desloge A, Absetz P, Williams ED, Thankappan KR, Oldenburg B. Effects of a lifestyle intervention on depression and anxiety among adults at risk for diabetes in India: A secondary analysis of the Kerala Diabetes Prevention Program. Prev Med 2022; 162:107172. [PMID: 35868455 DOI: 10.1016/j.ypmed.2022.107172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 10/17/2022]
Abstract
The impact of lifestyle interventions on diabetes and mental health conditions have been documented among people with diabetes. However, the mental health benefits of lifestyle interventions designed for diabetes prevention have not been systematically investigated among people at high risk of diabetes, particularly in low- and middle-income countries. We examined the effects of a 12-month peer support lifestyle intervention designed for diabetes prevention on depression and anxiety symptomology in the sample population of the Kerala Diabetes Prevention Program. Mixed-effects linear regression models were used to examine the effect of the intervention on depression and anxiety scores at 12 and 24 months in the total sample of 1007 adults at risk for diabetes and among those with mild-severe depressive or anxiety symptoms at baseline (n = 326 for depression; n = 203 for anxiety). Among all participants, the intervention group had a significantly higher reduction of depressive symptoms as compared to the control group at 12 months (mean diff score = -0.51; 95% CI: -0.95, -0.07; P = 0.02). This effect was not sustained at 24 months. There were no significant intervention effects for anxiety. Among those with mild-severe symptoms at baseline, the intervention group had a significantly higher reduction of depressive symptoms (mean diff score = -1.55; 95% CI -2.50, -0.6; P = 0.001) and anxiety symptoms (mean diff score = -1.64; 95% CI -2.76, -0.52; P = 0.004) at 12 months. The effect was sustained at 24 months for depression, but not anxiety. Lifestyle interventions designed for prevention of diabetes might improve depressive and anxiety symptoms in the short-term, particularly among those with mild-severe symptoms.
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Affiliation(s)
- Leslie C M Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States of America.
| | - Tilahun Haregu
- Noncommunicable Disease Control Unit, Baker Heart & Diabetes Institute, Melbourne, Australia
| | | | - Jeroen De Man
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Allissa Desloge
- School of Population and Global Health, University of Melbourne, Melbourne, Australia; MacMillan Center for International and Area Studies, Yale University, New Haven, CT, United States of America
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Emily D Williams
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | | | - Brian Oldenburg
- Noncommunicable Disease Control Unit, Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Public Health, La Trobe University, Melbourne, Australia
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4
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Aziz Z, Haregu T, Kyobutungi C, Yan L, Irazola V, Absetz P, Bandurek I, Roberts M, Vedanthan R, Folkes S, Cao Y, Wen Y, Aung MN, Danhieux K, Desloge A, Oldenburg B. Strengthening Capacity for Implementation Research Amid COVID-19 Pandemic: Learnings From the Global Alliance for Chronic Diseases Implementation Science School. Int J Public Health 2022; 67:1604944. [PMID: 36016964 PMCID: PMC9395543 DOI: 10.3389/ijph.2022.1604944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: To describe the design, delivery and evaluation of the 3rd Global Alliance for Chronic Diseases (GACD) Implementation Science School (ISS), delivered virtually in 2020 for the first time. Methods: Since 2014, GACD has supported the delivery of more than ten Implementation Science Workshops for more than 500 international participants. It has also been conducting an annual ISS since 2018. In this study, we described the design, delivery and evaluation of the third ISS. Results: Forty-six participants from 23 countries in five WHO regions attended the program. The virtual delivery was well-received and found to be efficient in program delivery, networking and for providing collaborative opportunities for trainees from many different countries. The recently developed GACD Implementation Science e-Hub was found to be an instrumental platform to support the program by providing a stand-alone, comprehensive online learning space for knowledge and skill development in implementation research. Conclusion: The delivery of the virtual GACD ISS proved to be feasible, acceptable and effective and offers greater scalability and sustainability as part of a future strategy for capacity strengthening in implementation research globally.
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Affiliation(s)
- Zahra Aziz
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Tilahun Haregu
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- *Correspondence: Tilahun Haregu,
| | | | | | - Vilma Irazola
- Instituto de Efectividad Clinicay Sanitaria (IECS), Buenos Aires, Argentina
- Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Isobel Bandurek
- Global Alliance for Chronic Diseases, London, United Kingdom
| | - Morven Roberts
- Global Alliance for Chronic Diseases, London, United Kingdom
| | | | - Sheree Folkes
- Global Alliance for Chronic Diseases, London, United Kingdom
| | - Yingting Cao
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yu Wen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | | | | | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- La Trobe University, Melbourne, VIC, Australia
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Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 2022; 19:e1004055. [PMID: 35877677 PMCID: PMC9359585 DOI: 10.1371/journal.pmed.1004055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/08/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ting Wei
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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6
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Zhao L, Zhao Y, Du J, Desloge A, Hu Z, Cao G. Mapping the Research on Health Policy and Services in the Last Decade (2009-2018): A Bibliometric Analysis. Front Public Health 2022; 10:773668. [PMID: 35570893 PMCID: PMC9092023 DOI: 10.3389/fpubh.2022.773668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Health policy and services is a continuously evolving field of research that can inform prevention and control efforts for a variety of health conditions. The "Healthy China" strategy reflects the demand to formulate health policy that suits China's national needs and goals. Applying bibliometric analysis to grasp the general situation of health policy and services research globally will be conducive to informing China's designated health plans and initiatives. Method A bibliometric analysis of 58,065 articles on "Health Policy and Services" topics was conducted. The document type was restricted to journal articles that were published in the Web of Science database between the time parameter of January 1, 2009 to December 31, 2018. Data was collected on indicators such as the annual number of publications in the field of health policy and services, the country where the publication is issued, the publication organization, the source journal, the frequency of citations, research hotspots, and academic areas. Results The overall number of articles published in Web of Science on health policy and services research has increased over time. The United States has the largest number of articles in the field. The institution with the highest number of citations in the field is Harvard University and the journal with the most published articles in the field is Health Affairs. Research hotspots in the health policy and services field include topics such as "HIV Infections," "Primary Health Care," "Delivery of Health Care," and "Health Services Accessibility." Conclusion Experts in the field of health policy and services globally are dedicated to researching the most effective ways to improve people's health and living standards. There is a certain gap in the depth of health policy and services research between China and developed countries and regions such as Europe or America. China must learn from foreign experience to conduct meaningful and informative research that can aid in the formulation of multi-dimensional health policies in specific areas such as environmental infectious diseases, where attention is needed in areas beyond the medical and health system.
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Affiliation(s)
- Linyan Zhao
- School of Public Health and Management, Binzhou Medical University, Yantai, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Jian Du
- National Institute of Health Data Science, Peking University, Beijing, China.,Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Zhiyong Hu
- School of Public Health and Management, Binzhou Medical University, Yantai, China
| | - Gaofang Cao
- School of Public Health and Management, Binzhou Medical University, Yantai, China
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7
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Zhao Y, He L, Marthias T, Ishida M, Anindya K, Desloge A, D'Souza M, Cao G, Lee JT. Out-Of-Pocket Expenditure Associated with Physical Inactivity, Excessive Weight, and Obesity in China: Quantile Regression Approach. Obes Facts 2022; 15:416-427. [PMID: 35249040 PMCID: PMC9209956 DOI: 10.1159/000522433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous studies exploring associations of physical inactivity, obesity, and out-of-pocket expenditure (OOPE) mainly used traditional linear regression, and little is known about the effect of both physical inactivity and obesity on OOPE across the percentile distribution. This study aims to assess the effects of physical inactivity and obesity on OOPE in China using a quantile regression approach. METHODS Study participants included 10,687 respondents aged 45 years and older from the recent wave of the China Health and Retirement Longitudinal Study in 2015. Linear regression and quantile regression models were used to examine the association of physical activity, body weight with annual OOPE. RESULTS Overall, the proportion of overweight and obesity was 33.2% and 5.8%, respectively. The proportion of individuals performing high-level, moderate-level, and low-level physical activity was 55.2%, 12.7%, and 32.1%, respectively. The effects of low-level physical activity on annual OOPE were small at the bottom quantiles but more pronounced at higher quantiles. Respondents with low-level activity had an increased annual OOPE of 26.9 USD, 150.3 USD, and 1,534.4 USD, at the 10th, 50th, and 90th percentiles, respectively, compared with those with high-level activity. The effects of overweight and obesity on OOPE were also small at the bottom quantiles but more pronounced at higher quantiles. CONCLUSION Interventions that improve the lifestyles and unhealthy behaviors among people with obesity and physical inactivity are likely to yield substantial financial gains for the individual and health systems in China.
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Affiliation(s)
- Yang Zhao
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia,
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China,
| | - Li He
- College of Physical Education and Sport, Beijing Normal University, Beijing, China
| | - Tiara Marthias
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Melbourne, Victoria, Australia
- Department of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Marie Ishida
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Melbourne, Victoria, Australia
| | - Kanya Anindya
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Melbourne, Victoria, Australia
| | - Allissa Desloge
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Melbourne, Victoria, Australia
| | - Monique D'Souza
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Melbourne, Victoria, Australia
| | - Gaofang Cao
- College of Public Health and Management, Binzhou Medical University, Yantai, China
| | - John Tayu Lee
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Melbourne, Victoria, Australia
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Seneviratne S, Desloge A, Haregu T, Kwasnicka D, Kasturiratne A, Mandla A, Chambers J, Oldenburg B. Characteristics and Outcomes of Community Health Worker Training to Improve the Prevention and Control of Cardiometabolic Diseases in Low and Middle-Income Countries: A Systematic Review. INQUIRY 2022; 59:469580221112834. [PMID: 35916447 PMCID: PMC9350494 DOI: 10.1177/00469580221112834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Community health workers (CHWs) play an important role in controlling
non-communicable diseases in low- and middle-income countries. The aim of this
review was to describe the characteristics and outcomes of CHW training programs
that focused on the prevention and control of cardiometabolic diseases in low-
and middle-income countries (LMICs). Medline, CINAHL Complete, Academic Search
Complete, Directory of Open Access Journal, ScienceDirect, ERIC, Gale Academic,
and OneFile). Studies that described the training programs used to train CHWs
for prevention and control of cardiovascular diseases and type2 diabetes
mellitus in LMICs. Only studies that evaluated the outcomes of training programs
in at least one of the 4 levels of Kirkpatrick’s training evaluation model were
included in the review. CHWs who underwent training focused on the prevention
and control of cardiovascular disease and type 2 diabetes mellitus. We
summarized the resulting evidence using qualitative synthesis through a
narrative review. Training outcomes were assessed in relation to (1) CHW
reactions to training, their degree of learning, and their behaviors following
training, and (2) changes in biochemical and anthropometric indicators in target
populations following the CHW program implementation. PROSPERO (CRD42020162116).
Thirty-two studies were included. Methods used to train CHWs included:
face-to-face lectures, interactive group activities, and blended teaching with
online support. Training focused on identifying people with elevated risk of
cardiometabolic diseases and their risk factors as well as supporting people to
adopt healthy lifestyles. Many studies that utilized trained CHWs did not
publish CHW training methods and evaluations, and therefore could not be
included in this study. Training programs resulted in an increase in knowledge
and skills among CHWs demonstrating that there are certain activities that can
be shifted to CHWs following training.
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Affiliation(s)
- Shilanthi Seneviratne
- Ministry of Health, Colombo, Sri Lanka
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Dominika Kwasnicka
- University of Melbourne, Melbourne, VIC, Australia
- SWPS University of Social Sciences and Humanities, Poland
| | | | | | - John Chambers
- Nanyang Technological University (Singapore) and Imperial College London, London, UK
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Qian CX, Zhao Y, Anindya K, Tenneti N, Desloge A, Atun R, Qin VM, Mulcahy P, Lee JT. Non-communicable disease risk factors and management among internal migrant in China: systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003324. [PMID: 34593512 PMCID: PMC8487202 DOI: 10.1136/bmjgh-2020-003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 06/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background In 2019, there are more than 290 million people who have ever migrated from rural to urban areas in China. These rural-to-urban internal migrants account for more than one-fifth of China’s population and is the largest internal migrant group globally. We present the first systematic review that examines whether internal migrants are more likely to exhibit non-communicable diseases (NCDs) risk factors and have worse NCD management outcomes than non-migrant counterparts in China. Methods A systematic review was conducted via medical, public health, and economic databases including Scopus, MEDLINE, JSTOR, WHO Library Database and World Bank e-Library from 2000 to 2020. Study quality was assessed using the National Institute of Health Quality Assessment tool. We conducted a narrative review and synthesised differences for all studies included, stratified by different types of outcomes. We also conducted random-effects meta-analysis where we had a minimum of two studies with 95% CIs reported. The study protocol has been registered with PROSPERO: CRD42019139407. Results For most NCD risk factors and care cascade management, comparisons between internal migrants and other populations were either statistically insignificant or inconclusive. While most studies found migrants have a higher prevalence of tobacco use than urban residents, these differences were not statistically significant in the meta-analysis. Although three out four studies suggested that migrants may have worse access to NCD treatment and both studies suggested migrants have lower blood pressure control rates than non-migrants, these findings were not statistically significant. Conclusion Findings from this systematic review demonstrate that there is currently insufficient evidence on migrant and non-migrant differences in NCD risk factors and management in China. Further research is expected to investigate access to healthcare among internal and its effect on both their NCD outcomes and long-term healthcare costs in China.
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Affiliation(s)
- Cynthia Xinyi Qian
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA .,The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yang Zhao
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Kanya Anindya
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Naveen Tenneti
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Allissa Desloge
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Patrick Mulcahy
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Tayu Lee
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Johnson LCM, Desloge A, Sathish T, Williams ED, Absetz P, Haregu T, De Man J, Thankappan KR, Oldenburg B. The relationship between common mental disorders and incident diabetes among participants in the Kerala Diabetes Prevention Program (K-DPP). PLoS One 2021; 16:e0255217. [PMID: 34297780 PMCID: PMC8301665 DOI: 10.1371/journal.pone.0255217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
This study aims to describe the prevalence of depression and anxiety among a population sample of people at high risk for type 2 diabetes in Kerala, India, and examine the relationship between depressive symptoms, anxiety, and incident Type 2 Diabetes Mellitus (T2DM) over a two-year period. We used data from the Kerala Diabetes Prevention Program, a cluster-randomized controlled trial for diabetes prevention among 1007 high-risk individuals. The prevalence of depression and anxiety were estimated using the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder 7-item scale, respectively. We calculated proportions for depression and anxiety and performed generalized estimating equations (GEE) to examine the relationship between baseline mental health status and incident T2DM. The prevalence of depression and anxiety at baseline were 7.5% and 5.5%, respectively. Compared with those reporting none/low symptoms, the odds ratio for incident diabetes was 1.07 (95% CI 0.54–2.12) for participants with moderate to severe depression and 0.73 (95% CI 0.23–2.28) for participants with moderate to severe anxiety, after adjusting for potential confounders. Our findings suggest that the prevalence of depression and anxiety were higher than those previously reported in the general population in India. However, among this sample of community-based adults at high risk of developing T2DM, the presence of moderate to severe depression and/or anxiety symptoms was not significantly associated with the risk of developing T2DM. Trial registration: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909. Registered 10 March 2011.
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Affiliation(s)
- Leslie C. M. Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Allissa Desloge
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- MacMillan Center for International and Area Studies, Yale University, New Haven, Connecticut, United States of America
| | - Thirunavukkarasu Sathish
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Emily D. Williams
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Tampere University, Tampere, Finland
| | - Tilahun Haregu
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jeroen De Man
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | | | - Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
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De Man J, Absetz P, Sathish T, Desloge A, Haregu T, Oldenburg B, Johnson LCM, Thankappan KR, Williams ED. Are the PHQ-9 and GAD-7 Suitable for Use in India? A Psychometric Analysis. Front Psychol 2021; 12:676398. [PMID: 34054677 PMCID: PMC8155718 DOI: 10.3389/fpsyg.2021.676398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cross-cultural evidence on the factorial structure and invariance of the PHQ-9 and the GAD-7 is lacking for South Asia. Recommendations on the use of unit-weighted scores of these scales (the sum of items' scores) are not well-founded. This study aims to address these contextual and methodological gaps using data from a rural Indian population. METHODS The study surveyed 1,209 participants of the Kerala Diabetes Prevention Program aged 30-60 years (n at risk of diabetes = 1,007 and n with diabetes = 202). 1,007 participants were surveyed over 2 years using the PHQ-9 and the GAD-7. Bifactor-(S - 1) modeling and multigroup confirmatory factor analysis were used. RESULTS Factor analysis supported the existence of a somatic and cognitive/affective subcomponent for both scales, but less explicitly for the GAD-7. Hierarchical omega values were 0.72 for the PHQ-9 and 0.76 for the GAD-7. Both scales showed full scalar invariance and full or partial residual invariance across age, gender, education, status of diabetes and over time. Effect sizes between categories measured by unit-weighted scores versus latent means followed a similar trend but were systematically higher for the latent means. For both disorders, female gender and lower education were associated with higher symptom severity scores, which corresponds with regional and global trends. CONCLUSIONS For both scales, psychometric properties were comparable to studies in western settings. Distinct clinical profiles (somatic-cognitive) were supported for depression, and to a lesser extent for anxiety. Unit-weighted scores of the full scales should be used with caution, while scoring subscales is not recommended. The stability of these scales supports their use and allows for meaningful comparison across tested subgroups. CLINICAL TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336603&isReview=true.
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Affiliation(s)
- Jeroen De Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Tampere University, Tampere, Finland
- University of Eastern Finland, Kuopio, Finland
| | | | - Allissa Desloge
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tilahun Haregu
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Leslie C. M. Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Emily D. Williams
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
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Pan T, Mercer SW, Zhao Y, McPake B, Desloge A, Atun R, Hulse ESG, Lee JT. The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis. BMC Public Health 2021; 21:376. [PMID: 33602174 PMCID: PMC7890601 DOI: 10.1186/s12889-021-10414-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China. Methods Panel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes. Results After adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss. Conclusion Mental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10414-7.
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Affiliation(s)
- Tianxin Pan
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia.
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Yang Zhao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Victoria, Australia
| | - Barbara McPake
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia
| | - Allissa Desloge
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia
| | - Rifat Atun
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, USA
| | - Emily Susannah Grace Hulse
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia
| | - John Tayu Lee
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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