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Saouadogo I, Massom DM, Kabore SS, Fomete Djatsa RK, Seu J, Ngangue P. Perceived Benefits and Disadvantages Associated with the Use of the Electronic Consultation Register by Health Providers in the Health District of Toma, Burkina Faso. Int J MCH AIDS 2024; 13:e002. [PMID: 38694895 PMCID: PMC11008583 DOI: 10.25259/ijma_650] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/28/2024] [Indexed: 05/04/2024] Open
Abstract
Background and Objective Most countries in sub-Saharan Africa need to catch up in integrating information and communication technologies (ICT) into their health systems. This is mainly because of the need for more infrastructure that allows for reasonable use of the technologies. To support the actions of the Ministry of Health of Burkina Faso, a Non-governmental Organization (NGO) has implemented the integrated electronic diagnostic approach (IeDA) Project. The project includes the deployment of an electronic consultation register (ECR). This article aims to explore the perceptions of healthcare providers on the benefits and disadvantages of using the ECR. Methods We conducted a qualitative, descriptive study through individual semi-structured interviews with healthcare providers. Data were collected in the Toma health district in December 2021. In addition, a thematic analysis was performed using NVivo software. Results Thirty-five healthcare workers were interviewed (19 nurses, 7 midwives, 6 mobile community health and hygiene workers, and 3 birth attendants). Two main themes emerged from our analyses, which are the advantages and disadvantages perceived by ECR users. Our data suggest that using the ECR had many benefits ranging from improving healthcare providers' knowledge and performance in terms of patients' care, assisting and helping in patient diagnosis and treatment and improving patient satisfaction. However, the participants also shared their negative perceptions about the ECR, mentioning that it increased their workload. They also reported lengthened consultation time and work duplication as the tool was still in its trial phase and was used along with the paper consultation register. Conclusion and Global Health Implications The ECR is an effective tool for diagnosis and management, which has several advantages and reasonably satisfies patients. However, disadvantages, including increased workload and lack of fluidity and stability of the system, must be considered to ensure better usability.
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Affiliation(s)
- Issaka Saouadogo
- Institute for Interdisciplinary Research Training in Health Sciences and Education, Ouagadougou, Burkina Faso
| | - Douglas Mbang Massom
- Epidemiology, Intervention and Training Department, Epicentre, Yaounde, Cameroon
| | - Soutongnoma Safiata Kabore
- Institute for Interdisciplinary Research Training in Health Sciences and Education, Ouagadougou, Burkina Faso
| | - Ronny Kevin Fomete Djatsa
- Laboratory for Research on Economic and Social Transformations, Research Laboratory on Economic and Social Transformations, Cheikh Anta Diop University of Dakar, Senegal
| | - Josiane Seu
- Faculty of Nursing, Laval University, Quebec, Canada
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Yopa DS, Massom DM, Kiki GM, Sophie RW, Fasine S, Thiam O, Zinaba L, Ngangue P. Barriers and enablers to the implementation of one health strategies in developing countries: a systematic review. Front Public Health 2023; 11:1252428. [PMID: 38074697 PMCID: PMC10701386 DOI: 10.3389/fpubh.2023.1252428] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction One Health is a concept that establishes the link between humans, animals and the environment in a collaborative approach. Since One Health's inception, several interventions have been developed in many regions and countries worldwide to tackle complex health problems, including epidemics and pandemics. In the developed world, many collaborative platforms have been created with an international strategy to address issues specific or not to their environment. Unfortunately, there is a lack of synthesis on the challenges and opportunities Low and Middle-Income Countries (LMICs) face. Methods Following The Preferred Reporting Elements for PRISMA Systematic Reviews and Meta-Analyses (PRISMA), we conducted a systematic review. We applied a search strategy to electronic bibliographic databases (PubMed, Embase, Global Health, Web of Science and CINAHL). We assessed the included articles' quality using the Mixed Methods Appraisal tool (MMAT). Results and discussion A total of 424 articles were initially identified through the electronic database search. After removing duplicates (n = 68), 356 articles were screened for title and abstract, and 16 were retained for full-text screening. The identified barriers were the lack of political will, weak governance and lack of human, financial and logistics resources. Concerning the enablers, we listed the existence of a reference framework document for One Health activities, good coordination between the different sectors at the various levels, the importance of joint and multisectoral meetings that advocated the One Health approach and the Availability of funds and adequate resources coupled with the support of Technical and Financial partners. Conclusion One Health strategy and interventions must be implemented widely to address the rising burden of emerging infectious diseases, zoonotic diseases, and antimicrobial resistance. Addressing those challenges and reinforcing the enablers to promote managing global health challenges is necessary. Systematic Review Registration https://www.crd.york.ac.uk/prospero/record_email.php, Unique Identifier: CRD42023393693.
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Affiliation(s)
- Daniele Sandra Yopa
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaoundé, Cameroon
| | - Douglas Mbang Massom
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Gbètogo Maxime Kiki
- Rehabilitation Department, Université Laval, Québec, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada
| | | | - Sylvie Fasine
- National Institute of Biomedical Research, Ministry of Public Health, Kinshasa, Democratic Republic of Congo
| | - Oumou Thiam
- Ministry of Health and Public Hygiene, Conakry, Guinea
| | - Lassane Zinaba
- Institute for Interdisciplinary Training and Research in Health Sciences and Education, Ouagadougou, Burkina Faso
| | - Patrice Ngangue
- Rehabilitation Department, Université Laval, Québec, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada
- Institute for Interdisciplinary Training and Research in Health Sciences and Education, Ouagadougou, Burkina Faso
- Faculty of Nursing Sciences, Université Laval, Québec, QC, Canada
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Philibert L, Ngangue P, Lapierre J, Bernardino E, Kiki GM, Ntanda GM. Vulnerability analysis of Haitian adolescent girls before pregnancy: a qualitative study. Int J Adolesc Med Health 2023; 35:403-410. [PMID: 37671939 DOI: 10.1515/ijamh-2022-0114] [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] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/26/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES This article aims to analyze the vulnerabilities experienced by Haitian adolescent girls before their pregnancy. METHODS A qualitative research design was developed from Dewey's social survey. From October 2020 to January 2021, semi-structured interviews were conducted with 33 pregnant adolescents living in Haiti's North and North-East departments. Thematic data analysis was performed using the qualitative data analysis software QDA miner, 6.0.5. RESULTS The adolescent girls interviewed were between 14 and 19. The study showed that adolescent girls experienced economic and social hardship, gender issues, and barriers to contraceptive use before pregnancy. These girls have experienced restrictive conditions that make them vulnerable to risky sexual practices and unwanted pregnancy. CONCLUSIONS The results have indicated that Haitian adolescent girls' vulnerabilities before their pregnancy result from economic, social, and cultural injustices to which they are exposed from early childhood. These adolescent girls are also highly vulnerable to sexual exploitation and rape, as well as pregnancy. It is essential to address these issues when implementing programs aimed at improving the living conditions of adolescents in Haiti, including the prevention of early and unwanted pregnancy.
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Affiliation(s)
- Léonel Philibert
- Université de l'Ontario français, Toronto, ON, Canada
- Faculty of Nursing, Université Laval, Québec, Québec, Canada
| | - Patrice Ngangue
- Faculty of Nursing, Université Laval, Québec, Québec, Canada
| | - Judith Lapierre
- Faculty of Nursing, Université Laval, Québec, Québec, Canada
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Ossomba JPBE, Ngangue P, Ekani ASO, Kamgain ET. De-medicalized and decentralized HIV testing: a strategy to test hard-to-reach men who have sex with men in Cameroon. Front Public Health 2023; 11:1180813. [PMID: 37564422 PMCID: PMC10410143 DOI: 10.3389/fpubh.2023.1180813] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Conventional HIV testing performed by a health professional has shown its limitations in targeting marginalized and vulnerable populations. Indeed, men who have sex with men (MSM) due to social discrimination are often uncomfortable using this service at the health facilities level. In this perspective, new differentiated approaches have been thought through de-medicalized and decentralized HIV testing (DDHT). This HIV testing strategy enables overcoming the structural, legal, and social barriers that prevent these populations from quickly accessing HIV services. This article discusses the prerequisites and added value of implementing this strategy for MSM living in a criminalized context and its implication in decentralizing health services toward the community level.
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Ngangue P, Robert K, Ly BA, Traoré F, Philibert L, Vezina M, Bationo N. Evaluating the effects of an intervention to improve the health environment for mothers and children in health centres (BECEYA) in Mali: a qualitative study. Pan Afr Med J 2023. [DOI: 10.11604/pamj.2023.44.138.36736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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Kaboré SS, Ngangue P, Soubeiga D, Barro A, Pilabré AH, Bationo N, Pafadnam Y, Drabo KM, Hien H, Savadogo GBL. Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: A systematic review. Front Digit Health 2022; 4:1014375. [PMID: 36518563 PMCID: PMC9742266 DOI: 10.3389/fdgth.2022.1014375] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/03/2022] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have increased exponentially all over the world. Furthermore, the interest in the sustainability of digital health interventions is growing significantly. However, a systematic synthesis of digital health intervention sustainability challenges is lacking. This systematic review aimed to identify the barriers and facilitators for the sustainability of digital health intervention in low and middle-income countries. METHODS Three electronic databases (PubMed, Embase and Web of Science) were searched. Two independent reviewers selected eligible publications based on inclusion and exclusion criteria. Data were extracted and quality assessed by four team members. Qualitative, quantitative or mixed studies conducted in low and middle-income countries and published from January 2000 to May 2022 were included. RESULTS The sustainability of digital health interventions is very complex and multidimensional. Successful sustainability of digital health interventions depends on interdependent complex factors that influence the implementation and scale-up level in the short, middle and long term. Barriers identified among others are associated with infrastructure, equipment, internet, electricity and the DHIs. As for the facilitators, they are more focused on the strong commitment and involvement of relevant stakeholders: Government, institutional, sectoral, stakeholders' support, collaborative networks with implementing partners, improved satisfaction, convenience, privacy, confidentiality and trust in clients, experience and confidence in using the system, motivation and competence of staff. All stakeholders play an essential role in the process of sustainability. Digital technology can have long term impacts on health workers, patients, and the health system, by improving data management for decision-making, the standard of healthcare service delivery and boosting attendance at health facilities and using services. Therefore, management changes with effective monitoring and evaluation before, during, and after DHIs are essential. CONCLUSION The sustainability of digital health interventions is crucial to maintain good quality healthcare, especially in low and middle-income countries. Considering potential barriers and facilitators for the sustainability of digital health interventions should inform all stakeholders, from their planning until their scaling up. Besides, it would be appropriate at the health facilities level to consolidate facilitators and efficiently manage barriers with the participation of all stakeholders.
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Affiliation(s)
- Soutongnoma Safiata Kaboré
- Centre D'excellence Africain, Université Nazi BONI, Bobo Dioulasso, Burkina Faso
- Direction Générale, Institut National de Santé Publique, Ouagadougou, Burkina Faso
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Patrice Ngangue
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département des Sciences de la Santé, Université du Québec en Abitibi Témiscamingue, Québec, Canada
| | - Dieudonné Soubeiga
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Abibata Barro
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Arzouma Hermann Pilabré
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département de Santé Publique, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Nestor Bationo
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
- Département de Santé Publique, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Yacouba Pafadnam
- Département des Sciences Infirmières et Obstétricales, Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de L'Éducation, Ouagadougou, Burkina Faso
| | - Koiné Maxime Drabo
- Institut de Recherche en Sciences de la Santé/Centre National Pour la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Hervé Hien
- Direction Générale, Institut National de Santé Publique, Ouagadougou, Burkina Faso
- Institut de Recherche en Sciences de la Santé/Centre National Pour la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
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Ngangue P, Pilabré AH, Barro A, Pafadnam Y, Bationo N, Soubeiga D. Public attitudes towards COVID-19 vaccines in Africa: A systematic review. J Public Health Afr 2022; 13:2181. [PMID: 35720806 PMCID: PMC9202457 DOI: 10.4081/jphia.2022.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/21/2021] [Indexed: 12/04/2022] Open
Abstract
As COVID-19 vaccine acquisition and deployment accelerates, tensions also increase. This review aims to identify and understand the significance of population attitudes toward COVID-19 vaccines in Africa. A systematic review was conducted. Searches were conducted in MEDLINE, CINAHL, EMBASE, and Global Health databases. Database searches began on June 23, 2021, and the last search date was June 30, 2021. The methodological quality of the studies included in this review was assessed using the Mixed methods appraisal tool. A total of 609 articles were retrieved, and 23 met the eligibility criteria. All 23 included studies were cross-sectional. Three attitudes were identified: acceptance, reluctance, and refusal to be vaccinated. Acceptance of vaccination was motivated by confidence in the accuracy of the government’s response to COVID-19 and the fact that relatives had been diagnosed with or died from COVID- 19. Reluctance was based on fear of vaccine quality and side effects, and insufficient clinical trials. Finally, refusal to be vaccinated was justified by reasons such as the unreliability of clinical trials and insufficient data regarding the vaccine’s adverse effects. This review revealed common attitudes of African populations toward COVID-19 vaccines. The results indicate that research needs to focus more on identifying facilitators of COVID-19 vaccination. However, they also provide essential elements for health personnel in charge of vaccination to develop strategies to achieve satisfactory coverage rates.
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Ngangue P, Brown JB, Forgues C, Ag Ahmed MA, Nguyen TN, Sasseville M, Loignon C, Gallagher F, Stewart M, Fortin M. Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study. BMJ Open 2021; 11:e046914. [PMID: 34561255 PMCID: PMC8475135 DOI: 10.1136/bmjopen-2020-046914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE A patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation. DESIGN A descriptive qualitative study was conducted in 2016-2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings. SETTING The study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada. PARTICIPANTS Ten managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed. RESULTS Many key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics-evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting-patients' needs and resources, external policies and incentives; (3) inner setting-structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs-knowledge and belief about the intervention; (5) process-planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating. CONCLUSION This study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care. TRIAL REGISTRATION NUMBER NCT02789800.
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Affiliation(s)
- Patrice Ngangue
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Catherine Forgues
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mohamed Ali Ag Ahmed
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Tu Ngoc Nguyen
- Westmead Apllied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maxime Sasseville
- Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Christine Loignon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Frances Gallagher
- School of Nursing, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Moira Stewart
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Pilabré AH, Ngangue P, Barro A, Pafadnam Y. An Imperative for the National Public Health School in Burkina Faso to Promote the Use of Information and Communication Technologies in Education During the COVID-19 Pandemic: Critical Analysis. JMIR Med Educ 2021; 7:e27169. [PMID: 33970868 PMCID: PMC8133167 DOI: 10.2196/27169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/21/2021] [Accepted: 04/11/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Several studies have reported the positive impact of information and communication technologies (ICTs) on academic performance and outcomes. Although some equipment is available, the ICTs for education at the National Public Health School (NPHS) of Burkina Faso have many shortcomings. These shortcomings were clearly revealed during the search for responses to the crisis caused by the COVID-19 pandemic. Indeed, to curb the spread of COVID-19, some measures were taken, such as closure of educational institutions. This resulted in a 2.5-month suspension of educational activities. Despite its willingness, the NPHS was unable to use ICTs to continue teaching during the closure period of educational institutions. OBJECTIVE In this paper, we aim to propose practical solutions to promote ICT use in teaching at the NPHS by analyzing the weaknesses and challenges related to its use. METHODS We conducted a critical analysis based on information from the gray literature of NPHS. This critical analysis was preceded by a review of systematic reviews on barriers and facilitating factors to using ICTs in higher education and a systematic review of ICT use during the COVID-19 pandemic in higher education. An ICT integration model and a clustering of ICT integration factors guided the analysis. RESULTS The weaknesses and challenges identified relate to the infrastructure and equipment for the use of ICTs in pedagogical situations in face-to-face and distance learning; training of actors, namely the teachers and students; availability of qualified resource persons and adequate and specific financial resources; motivation of teachers; and stage of use of ICTs. CONCLUSIONS To promote the use of ICTs in teaching at the NPHS, actions must be performed to strengthen the infrastructure and equipment, human resources, the skills of actors and the motivation of teachers in the pedagogical use of ICTs.
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Affiliation(s)
- Arzouma Hermann Pilabré
- Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de l'Éducation, Ouagadougou, Burkina Faso
| | - Patrice Ngangue
- Faculté de médecine et sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Abibata Barro
- Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de l'Éducation, Ouagadougou, Burkina Faso
| | - Yacouba Pafadnam
- Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de l'Éducation, Ouagadougou, Burkina Faso
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Diallo M, Adekpedjou R, Ahouada C, Ngangue P, Ly BA. Impact of Pre-antiretroviral Therapy CD4 Counts on Drug Resistance and Treatment Failure: A Systematic Review. AIDS Rev 2021; 22:78-92. [PMID: 32655148 DOI: 10.24875/aidsrev.20000012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The continuous rising of HIV drug resistance in low- and middle-income countries and its impact on treatment failure is a growing threat for the HIV treatment response. This review aimed to document pre-antiretroviral therapy (ART) CD4 counts, emerging drug resistance, and treatment failure in HIV-infected individuals initiating ART. We performed an online search in PubMed, Embase, Web of Science, African Index Medicus, Cochrane library, and The National Institute for Health Clinical Trials Registry of relevant articles published from January 1996 to June 2019. Of 1755 original studies retrieved, 28 were retained for final analysis. Treatment failure varied between 5% (95% confidence interval [CI]: 2.7-7.4) and 72% (95% CI: 55-89.6), while resistance varied between 1% (95% CI: 0.47-1.5) and 48% (95% CI: 28.4-67.6). Participants with a pre-ART CD4 count below 200 cell/μl and low adherence showed higher percentages of resistance and failure, while those with CD4 count above 200 showed lower resistance and failure regardless adherence levels. Most frequent resistance mutations included the M184I/V for the nucleoside reverse-transcriptase inhibitors (NRTIs), K103N, and Y181 for the non-NRTIs (NNRTIs), and L90M for the Protease inhibitors. Pre-ART CD4 count and adherence to treatment could play a key role in reducing drug resistance and treatment failure. The increased access to ART in resources limited settings should be accompanied by regular CD4 count testing, drug resistance monitoring, and continuous promotion of adherence. In addition, the rising of resistance mutations associated with NRTIs and NNRTIs, suggest that alternative ART regimens should be considered. (AIDS Rev. 2020;22:<FP>-0).
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Affiliation(s)
- Mamadou Diallo
- Laboratoire de Recherche en Épidémiologie de la Douleur Chronique, Université du Québec en Abitibi-Témiscamingue, Québec, Canada
| | - Rheda Adekpedjou
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Québec, Canada
| | | | - Patrice Ngangue
- Research Chair on Chronic Diseases in Primary Care, Faculty of Medicine and Health Sciences, University of Sherbrooke, Québec, Canada
| | - Birama Apho Ly
- Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Ngangue P, Fleurantin M, Adekpedjou R, Philibert L, Gagnon MP. Involvement of Male Partners of Pregnant Women in the Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Haiti: A Mixed-Methods Study. Am J Mens Health 2021; 15:15579883211006003. [PMID: 33874810 PMCID: PMC8060766 DOI: 10.1177/15579883211006003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/27/2022] Open
Abstract
This mixed-methods study aimed to determine the level of male involvement in the
prevention of mother-to-child transmission (PMTCT) services in Haiti and
identify barriers and associated factors. From May to June 2018, a questionnaire
was used to measure the level of male involvement. Semistructured interviews
with pregnant women were also conducted. Multivariate linear regression and
qualitative content analyses were performed to explore factors associated and
barriers to male partners’ involvement in PMTCT services. One hundred and two
pregnant women living with HIV completed the questionnaire. About 47% of male
partners had a high level of involvement. Specifically, 90% financially
supported their spouse, and 82% knew her appointment date at the antenatal
clinic (ANC). Only 25% of male partners accompanied their spouse to the ANC, and
19% routinely used a condom during sexual intercourse. Factors associated with
male involvement in PMTCT were being married and sharing HIV status with the
male partner. Male partners with a positive HIV status were more likely to be
involved in PMTCT. Qualitative findings revealed that barriers to male
involvement included the conflict between opening hours of the ANC and the male
partner’s schedule, waiting time at the ANC, and the perception of antenatal
care as being women’s business. Overall male partners’ involvement in PMTCT
services is moderate. Gender relations, sociocultural beliefs, and care
organization are likely to hinder this involvement. Developing and implementing
contextually and culturally accepted strategies for male partners of pregnant
women could contribute to strengthening their involvement in the PMTCT
program.
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Affiliation(s)
- Patrice Ngangue
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | | | - Leonel Philibert
- Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
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Fortin M, Stewart M, Ngangue P, Almirall J, Bélanger M, Brown JB, Couture M, Gallagher F, Katz A, Loignon C, Ryan BL, Sampalli T, Wong ST, Zwarenstein M. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med 2021; 19:126-134. [PMID: 33685874 PMCID: PMC7939717 DOI: 10.1370/afm.2650] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/20/2019] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. SECONDARY OUTCOMES health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
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Affiliation(s)
- Martin Fortin
- CORRESPONDING AUTHOR Martin Fortin Department of Family Medicine and Emergency Medicine Université de Sherbrooke 3001 12e Ave N Quebec, Canada, J1H 5N4
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Ahmed MAA, Almirall J, Ngangue P, Poitras ME, Fortin M. A bibliometric analysis of multimorbidity from 2005 to 2019. J Comorb 2020; 10:2235042X20965283. [PMID: 33110764 PMCID: PMC7557650 DOI: 10.1177/2235042x20965283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022]
Abstract
Context: Multimorbidity is frequently seen in primary care. We aimed to identify and analyze publications on multimorbidity, including those that most influenced this field. Method: A bibliometric analysis of publications from 2005 to 2019 in the PubMed database containing “multimorbidity” or “multi-morbidity” identified with the tool iCite. We analyzed the number of publications, total citations, the article-level metric Relative Citation Ratio (RCR), type of study, and journals with the most cited articles. Results: The number of publications using “multimorbidity” has continuously increased since 2005 (2005–2009: 138; 2010–2014: 823; 2015–2019: 3068). The median number of total citations per article was 3. The median RCR was 1.04. Articles with RCR at or above the 97th percentile (RCR = 7.43) were analyzed in detail (n = 104). In 34 publications of this subgroup (33%), the word multimorbidity was used but was not the subject of study. The remaining top 70 publications included 32 observational studies, 22 reviews, five guideline statements, three analysis papers, two randomized trials, three qualitative studies, two measurement development reports, and one conceptual framework development report. The publications were produced by authors from 32 countries. They were published in 37 different journals, ranging from one to four articles in the same journal. Conclusions: We found a continuous increase in the number of publications about multimorbidity since 2005. However, our study suggests that the numbers should be considered only a general trend because multimorbidity was not the main subject in 33% of publications in a subgroup of 104 analyzed in detail.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - José Almirall
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Patrice Ngangue
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
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Nguyen TN, Ngangue P, Haggerty J, Bouhali T, Fortin M. Multimorbidity, polypharmacy and primary prevention in community-dwelling adults in Quebec: a cross-sectional study. Fam Pract 2019; 36:706-712. [PMID: 31104072 PMCID: PMC6859520 DOI: 10.1093/fampra/cmz023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Polypharmacy carries the risk of adverse events, especially in people with multimorbidity. OBJECTIVE To investigate the prevalence of polypharmacy in community-dwelling adults, the association of multimorbidity with polypharmacy and the use of medications for primary prevention. METHODS Cross-sectional analysis of the follow-up data from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Multimorbidity was defined as the presence of three or more chronic diseases and polypharmacy as self-reported concurrent use of five or more medications. Primary prevention was conceptualized as the use of statin or low-dose antiplatelets without a reported diagnostic of cardiovascular disease. RESULTS Mean age 56.7 ± 11.6, 62.5% female, 30.3% had multimorbidity, 31.9% had polypharmacy (n = 971). The most common drugs used were statins, renin-angiotensin system inhibitors and psychotropics. Compared to participants without any chronic disease, the adjusted odds ratios (ORs) for having polypharmacy were 2.78 [95% confidence interval (CI): 1.23-6.28] in those with one chronic disease, 8.88 (95% CI: 4.06-19.20) in those with two chronic diseases and 25.31 (95% CI: 11.77-54.41) in those with three or more chronic diseases, P < 0.001. In participants without history of cardiovascular diseases, 16.2% were using antiplatelets and 28.5% were using statins. Multimorbidity was associated with increased likelihood of using antiplatelets (adjusted OR: 2.98, 95% CI: 1.98-4.48, P < 0.001) and statins (adjusted OR: 3.76, 95% CI: 2.63-5.37, P < 0.001) for primary prevention. CONCLUSION There was a high prevalence of polypharmacy in community-dwelling adults in Quebec and a strong association with multimorbidity. The use of medications for primary prevention may contribute to polypharmacy and raise questions about safety.
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Affiliation(s)
- Tu N Nguyen
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec
| | - Patrice Ngangue
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Quebec, Canada
| | - Tarek Bouhali
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec
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Nguyen TN, Ngangue P, Bouhali T, Ryan BL, Stewart M, Fortin M. Social Vulnerability in Patients with Multimorbidity: A Cross-Sectional Analysis. Int J Environ Res Public Health 2019; 16:ijerph16071244. [PMID: 30965571 PMCID: PMC6480630 DOI: 10.3390/ijerph16071244] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Social aspects play an important role in individual health and should be taken into consideration in the long-term care for people with multimorbidity. PURPOSES To describe social vulnerability, to examine its correlation with the number of chronic conditions, and to investigate which chronic conditions were significantly associated with the most socially vulnerable state in patients with multimorbidity. METHODS Cross-sectional analysis from the baseline data of the Patient-Centred Innovations for Persons with Multimorbidity (PACEinMM) Study. Participants were patients attending primary healthcare settings in Quebec, Canada. A social vulnerability index was applied to identify social vulnerability level. The index value ranges from 0 to 1 (1 as the most vulnerable). Spearman's rank correlation coefficient was calculated for the correlation between the social vulnerability index and the number of chronic conditions. Logistic regression was applied to investigate which chronic conditions were independently associated with the most socially vulnerable state. RESULTS There were 301 participants, mean age 61.0 ± 10.5, 53.2% female. The mean number of chronic health conditions was 5.01 ± 1.82, with the most common being hyperlipidemia (78.1%), hypertension (69.4%), and obesity (54.2%). The social vulnerability index had a median value of 0.13 (range 0.00⁻0.78). There was a positive correlation between the social vulnerability index and the number of chronic conditions (r = 0.24, p < 0.001). Obesity, depression/anxiety, and cardiovascular diseases were significantly associated with the most socially vulnerable patients with multimorbidity. CONCLUSIONS There was a significant correlation between social vulnerability and the total number of chronic conditions, with depression/anxiety, obesity, and cardiovascular diseases being the most related to social vulnerability.
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Affiliation(s)
- Tu N Nguyen
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC G7H 5H6, Canada.
| | - Patrice Ngangue
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC G7H 5H6, Canada.
| | - Tarek Bouhali
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC G7H 5H6, Canada.
| | - Bridget L Ryan
- Centre for Studies in Family Medicine, Department of Family Medicine, and Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada.
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, and Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada.
| | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC G7H 5H6, Canada.
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Pagé MG, Kudrina I, Ngangue P, Fortier M, Martin E, Ewusi-Boisvert E, Zomahoun HTV, Croteau J, Ziegler D, Beaulieu P, Charbonneau C, Cogan J, Daoust R, Martel MO, Néron A, Richebé P, Clarke H. Relative Frequency and Risk Factors for Prolonged Opioid Therapy after Surgery and Trauma: A Systematic Review and Meta-Analysis. Can J Pain 2019. [DOI: 10.1080/24740527.2019.1591853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- M Gabrielle Pagé
- Centre de recherche, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Irina Kudrina
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Patrice Ngangue
- Faculty of medicine and health sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maude Fortier
- Centre de recherche, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Elisabeth Martin
- Centre de recherche, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Esthelle Ewusi-Boisvert
- Centre de recherche, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Hervé T V Zomahoun
- Department of social and preventive medicine, Faculty of medicine, Université Laval, Québec, Quebec, Canada
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Health and Social Services Systems, Québec, Quebec, Canada
| | - Jordie Croteau
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Health and Social Services Systems, Québec, Quebec, Canada
| | - Daniela Ziegler
- Direction de l’enseignement et l’Académie, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Beaulieu
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of anesthesiology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Céline Charbonneau
- Association Québécoise de la douleur chronique (AQDC), Montreal, Quebec, Canada
| | - Jennifer Cogan
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Raoul Daoust
- Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Marc O Martel
- Faculty of Dentistry & Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Andrée Néron
- Pain clinic, Department of pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of anesthesiology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Hance Clarke
- Department of anesthesia and pain management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Zanaboni P, Ngangue P, Mbemba GIC, Schopf TR, Bergmo TS, Gagnon MP. Methods to Evaluate the Effects of Internet-Based Digital Health Interventions for Citizens: Systematic Review of Reviews. J Med Internet Res 2018; 20:e10202. [PMID: 29880470 PMCID: PMC6013714 DOI: 10.2196/10202] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 01/08/2023] Open
Abstract
Background Digital health can empower citizens to manage their health and address health care system problems including poor access, uncoordinated care and increasing costs. Digital health interventions are typically complex interventions. Therefore, evaluations present methodological challenges. Objective The objective of this study was to provide a systematic overview of the methods used to evaluate the effects of internet-based digital health interventions for citizens. Three research questions were addressed to explore methods regarding approaches (study design), effects and indicators. Methods We conducted a systematic review of reviews of the methods used to measure the effects of internet-based digital health interventions for citizens. The protocol was developed a priori according to Preferred Reporting Items for Systematic review and Meta-Analysis Protocols and the Cochrane Collaboration methodology for overviews of reviews. Qualitative, mixed-method, and quantitative reviews published in English or French from January 2010 to October 2016 were included. We searched for published reviews in PubMed, EMBASE, The Cochrane Database of Systematic Reviews, CINHAL and Epistemonikos. We categorized the findings based on a thematic analysis of the reviews structured around study designs, indicators, types of interventions, effects and perspectives. Results A total of 20 unique reviews were included. The most common digital health interventions for citizens were patient portals and patients' access to electronic health records, covered by 10/20 (50%) and 6/20 (30%) reviews, respectively. Quantitative approaches to study design included observational study (15/20 reviews, 75%), randomized controlled trial (13/20 reviews, 65%), quasi-experimental design (9/20 reviews, 45%), and pre-post studies (6/20 reviews, 30%). Qualitative studies or mixed methods were reported in 13/20 (65%) reviews. Five main categories of effects were identified: (1) health and clinical outcomes, (2) psychological and behavioral outcomes, (3) health care utilization, (4) system adoption and use, and (5) system attributes. Health and clinical outcomes were measured with both general indicators and disease-specific indicators and reported in 11/20 (55%) reviews. Patient-provider communication and patient satisfaction were the most investigated psychological and behavioral outcomes, reported in 13/20 (65%) and 12/20 (60%) reviews, respectively. Evaluation of health care utilization was included in 8/20 (40%) reviews, most of which focused on the economic effects on the health care system. Conclusions Although observational studies and surveys have provided evidence of benefits and satisfaction for patients, there is still little reliable evidence from randomized controlled trials of improved health outcomes. Future evaluations of digital health interventions for citizens should focus on specific populations or chronic conditions which are more likely to achieve clinically meaningful benefits and use high-quality approaches such as randomized controlled trials. Implementation research methods should also be considered. We identified a wide range of effects and indicators, most of which focused on patients as main end users. Implications for providers and the health system should also be included in evaluations or monitoring of digital health interventions.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Patrice Ngangue
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, QC, Canada
| | | | - Thomas Roger Schopf
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Trine Strand Bergmo
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Marie-Pierre Gagnon
- Research Center of the CHU de Québec-Université Laval, Québec, QC, Canada.,Faculty of Nursing Sciences, Université Laval, Québec, QC, Canada
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Ngangue P, Gagnon MP, Bedard E. Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services. BMC Int Health Hum Rights 2017; 17:9. [PMID: 28390398 PMCID: PMC5385024 DOI: 10.1186/s12914-017-0118-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/29/2017] [Indexed: 11/12/2022]
Abstract
Background The Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala’s district hospitals. Methods Two primary data collection methods supported by the Donabedian’s model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala. Results The study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals’ lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results. Conclusion The findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program. Electronic supplementary material The online version of this article (doi:10.1186/s12914-017-0118-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrice Ngangue
- Faculty of Nursing Sciences, Laval University, 1050, avenue de la medicine, Pavillon Vandry, Québec, Québec, G1V0A6, Canada. .,Population Health and Optimal Health Practices, CHU de Québec Research Center, 10, Rue de l'Espinay, D6, Québec, Québec, G1L 3L5, Canada.
| | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Laval University, 1050, avenue de la medicine, Pavillon Vandry, Québec, Québec, G1V0A6, Canada.,Population Health and Optimal Health Practices, CHU de Québec Research Center, 10, Rue de l'Espinay, D6, Québec, Québec, G1L 3L5, Canada
| | - Emmanuelle Bedard
- Université du Québec à Rimouski (UQAR), 1595 Boul. Alphonse-Desjardins, UQAR, Campus de Lévis, Lévis, Québec, Canada
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Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2015; 23:212-20. [PMID: 26078410 DOI: 10.1093/jamia/ocv052] [Citation(s) in RCA: 263] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 04/14/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this systematic review was to synthesize current knowledge of the factors influencing healthcare professional adoption of mobile health (m-health) applications. METHODS Covering a period from 2000 to 2014, we conducted a systematic literature search on four electronic databases (PubMed, EMBASE, CINAHL, PsychInfo). We also consulted references from included studies. We included studies if they reported the perceptions of healthcare professionals regarding barriers and facilitators to m-health utilization, if they were published in English, Spanish, or French and if they presented an empirical study design (qualitative, quantitative, or mixed methods). Two authors independently assessed study quality and performed content analysis using a validated extraction grid with pre-established categorization of barriers and facilitators. RESULTS The search strategy led to a total of 4223 potentially relevant papers, of which 33 met the inclusion criteria. Main perceived adoption factors to m-health at the individual, organizational, and contextual levels were the following: perceived usefulness and ease of use, design and technical concerns, cost, time, privacy and security issues, familiarity with the technology, risk-benefit assessment, and interaction with others (colleagues, patients, and management). CONCLUSION This systematic review provides a set of key elements making it possible to understand the challenges and opportunities for m-health utilization by healthcare providers.
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Affiliation(s)
- Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Quebec City, Canada Public Health and Practice-Changing Research, CHU de Québec Research Center, Quebec City, Canada
| | - Patrice Ngangue
- Faculty of Nursing, Université Laval, Quebec City, Canada Public Health and Practice-Changing Research, CHU de Québec Research Center, Quebec City, Canada
| | - Julie Payne-Gagnon
- Public Health and Practice-Changing Research, CHU de Québec Research Center, Quebec City, Canada
| | - Marie Desmartis
- Public Health and Practice-Changing Research, CHU de Québec Research Center, Quebec City, Canada
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Ndjepel J, Ngangue P, Vii Mballa Elanga E. [Health promotion in Cameroon: current situation and prospects]. Sante Publique 2014; 26:S35-S38. [PMID: 25380375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Health promotion (HP) is insufficiently implemented in Cameroon, despite a ministerial body in charge of HP. Health promotion activities are essentially limited to disease prevention and health education, while social determinants of health are virtually ignored. Although the Ottawa Charter constitutes the basic guidelines for HP, it presents a number of weaknesses when applied to the field, as the actions conducted do not comprise all lines of intervention of the charter. No action plane and no precise HP objectives have been defined and its conceptual framework is still poorly understood by the various stakeholders of the health system. Health is still considered to result from organization of health care and can only be ensured by medical personnel. In view of this fairly critical analysis of HP in Cameroon, concrete actions must be conducted to acquire a better knowledge of the conceptual framework of health promotion and its real application. Based on a critical review of the available literature on the social and health situation of Cameroon and the current status of HP, this article proposes actions to be conducted on organizational and political levels to ensure that HP has a real place in Cameroon and in order to improve significantly health indicators in this country. This approach inevitably requires the development of policies in favour of HP, reinforcement of HP capacities and finally the development of university structures specialized in HP practices and research.
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