@Article{info:doi/10.2196/59783, author="Mugasha, Rodney and Kwiringira, Andrew and Ntono, Vivian and Nakiire, Lydia and Ayebazibwe, Immaculate and Kyozira, Caroline and Muruta, Niyonzima Allan and Kasule, Namugga Juliet and Byonanebye, M. Dathan and Nanyondo, Judith and Walwema, Richard and Kakooza, Francis and Lamorde, Mohammed", title="Scaling Up and Enhancing the Functionality of the Electronic Integrated Diseases Surveillance and Response System in Uganda, 2020-2022: Description of the Journey, Challenges, and Lessons Learned", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="14", volume="11", pages="e59783", keywords="electronic Integrated Disease Surveillance and Response", keywords="eIDSR", keywords="disease surveillance", keywords="training of trainers", keywords="Uganda", keywords="digital surveillance systems", keywords="health worker", keywords="eHealth", keywords="public health", keywords="digital health", doi="10.2196/59783", url="https://publichealth.jmir.org/2025/1/e59783" } @Article{info:doi/10.2196/64886, author="Juqu, Z. Final and Baloyi, B. Olivia and Mbobnda Kapche, L. Esther and ten Ham-Baloyi, Wilma and Chironda, Geldine and Xulu-Kasaba, Nokuthula Zamadonda", title="Experiences of Birth Attendants on Upward Obstetric Emergency Referrals in Low- and Middle-Income Countries: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2025", month="Apr", day="10", volume="14", pages="e64886", keywords="referral systems", keywords="upward referral", keywords="obstetric emergencies", keywords="traditional birth attendants", keywords="skilled birth attendants", keywords="low- and middle-income countries", keywords="birth attendants", keywords="obstetric", keywords="middle-income countries", keywords="scoping review protocol", keywords="pregnancy", keywords="neonatal deaths", keywords="deaths", keywords="obstetric care", keywords="health care", keywords="medical education", keywords="mortality", keywords="Africa", keywords="pregnant", keywords="women's health", abstract="Background: Every day, approximately 800 women die from pregnancy-related causes, alongside 2.6 million stillbirths and 2.8 million neonatal deaths annually. Inadequate referral by skilled birth attendants hinders timely access to necessary emergency obstetric care, challenging progress toward the maternal health Sustainable Development Goal (SDG) 3. The COVID-19 pandemic further disrupted care in low- and middle-income countries, forcing women to rely on traditional birth attendants, thereby affecting the referral system. It is crucial to understand the experiences of both skilled and traditional birth attendants regarding upward referrals in emergency obstetric care to identify barriers and facilitators within these systems in low- and middle-income countries. Objective: This study aims to map existing evidence on the experiences of skilled and traditional birth attendants regarding upward referral systems in emergency obstetric care within low- and middle-income countries. Methods: We will conduct a scoping review guided by the Joanna Briggs Institute's methodological framework. Studies will be included if they report on experiences with upward referral in obstetrical emergencies. We will consider studies published in English and French from 2016 to July 2024. The literature search will be conducted in databases including PubMed, EBSCOhost (Academic Search Complete and CINAHL with full text), Scopus, Web of Science, and Google Scholar. Identified citations will be managed using EndNote version 21 (Clarivate Analytics) and Rayyan. Two independent reviewers will screen eligible studies and resolve disagreements through discussion with a third reviewer. Data will be extracted using a validated form and analyzed through content analysis, with findings presented narratively. This protocol aligns with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The review will offer a comprehensive narrative of upward referral systems in obstetrical emergencies, focusing on transitions from traditional birth attendants to health care facilities and from lower to higher levels of health care. Results: The preliminary search was completed in August 2024, and the database search will be conducted within the next 6 months. Findings will be disseminated through medical education conferences and publications. Conclusions: This review contributes a comprehensive narrative of upward referral systems in obstetrical emergencies, aiming to enhance understanding and improve transitions from traditional birth attendants to health care facilities and between different health care levels. It could significantly impact maternal and neonatal care by identifying the referral experiences of both skilled and traditional birth attendants. The insights may inform interventions that integrate traditional birth attendants into health care systems, potentially reducing maternal and neonatal mortality. The results will guide future research aimed at developing a model to improve upward referrals for obstetric emergencies in sub-Saharan Africa. Trial Registration: Open Science Framework 4HAVZ; https://osf.io/4havz International Registered Report Identifier (IRRID): PRR1-10.2196/64886 ", doi="10.2196/64886", url="https://www.researchprotocols.org/2025/1/e64886" } @Article{info:doi/10.2196/67166, author="Vadsaria, Khadija and Nuruddin, Rozina and Mohammed, Nuruddin and Azam, Iqbal and Sayani, Saleem", title="Efficacy of a Personalized mHealth App in Improving Micronutrient Supplement Use Among Pregnant Women in Karachi, Pakistan: Parallel-Group Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="9", volume="27", pages="e67166", keywords="calcium", keywords="folic acid", keywords="iron", keywords="mobile health intervention", keywords="micronutrient deficiencies", keywords="Pakistan", keywords="pregnancy", keywords="supplement use", keywords="vitamin D", keywords="artificial intelligence", abstract="Background: Micronutrient deficiencies in folate, ferritin, calcium, and vitamin D are common during pregnancy in low- and middle-income countries, often due to inadequate diets. Micronutrient supplementation can address this need, whereas innovative awareness strategies in antenatal practices could enhance supplement use compliance. Objective: We evaluated the efficacy of a personalized mobile health (mHealth) intervention, hypothesizing a 30\% improvement in supplement use in the intervention group compared to a conventional face-to-face counseling group. Methods: In an unblinded randomized controlled trial, we enrolled 306 first-trimester pregnant women from Aga Khan University Hospital between January 2020 and September 2021 who owned smartphones with internet connection. Women on regular medications or with dietary restrictions or critical illnesses were excluded. The intervention group received personalized micronutrient supplement use coaching through an mHealth app (PurUmeed Aaghaz) as thrice-a-week push messages and tailored recommendations over a 24-week period. The comparison group received standard face-to-face counseling at 6, 12, 18, and 24 weeks after enrollment. Baseline sociodemographic, obstetrics, anthropometric, dietary, and lifestyle data were collected through face-to-face interviews. At each follow-up, participants reported their weekly use of folic acid, iron, calcium, and vitamin D supplements, scored as 0 (daily), 1.5 (4-6 times weekly), and 3 (?3 times weekly). Scores were summed to calculate the cumulative supplement use score (CSUS; 0-12), with higher scores indicating greater inadequacy. Every fourth woman was invited for biochemical micronutrient assessment. Data were analyzed using Stata (version 14), with random-effects linear and logistic panel regression to compare CSUS and supplement use between the 2 groups from baseline to endline. Results: Of 153 participants per group, 107 (69.9\%) in the intervention and 125 (81.7\%) in the nonintervention group completed the study. After 24 weeks, the intervention group showed a greater but insignificant reduction in mean CSUS compared to the nonintervention group ($\beta$=--.27, 95\% CI ?0.65 to 0.12; P=.17). Daily supplement use improved by 20\% versus 22.4\% for folic acid, 11.2 times versus 2.1 times for iron, 1.2 times versus 14.2 times for calcium, and 3 times versus 1.3 times for vitamin D in the intervention versus nonintervention group, respectively. Multivariable analysis showed higher, though insignificant, odds of sufficient folic acid (adjusted odds ratio [aOR] 1.26, 95\% CI 0.68-2.36; P=.46) and iron (aOR 1.31, 95\% CI 0.95-1.81; P=.10) use in the intervention group, whereas vitamin D use was significantly higher (aOR 1.88, 95\% CI 1.43-2.47; P<.001). Calcium intake improved in the nonintervention group (aOR 0.59, 95\% CI 0.44-0.79; P<.001). Anemia decreased in the intervention group, whereas ferritin, calcium, and vitamin D deficiencies persisted or worsened, particularly in the nonintervention group. Conclusions: An appropriately implemented mHealth intervention can improve antenatal vitamin D supplementation. Affordable, accessible, and personalized counseling through mHealth could ameliorate micronutrient status during pregnancy. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/study/NCT04216446 ", doi="10.2196/67166", url="https://www.jmir.org/2025/1/e67166" } @Article{info:doi/10.2196/42406, author="Kola, Lola and Fatodu, Tobi and Kola, Manasseh and Olayemi, A. Bisola and Adefolarin, O. Adeyinka and Dania, Simpa and Kumar, Manasi and Ben-Zeev, Dror", title="Factors Impacting Mobile Health Adoption for Depression Care and Support by Adolescent Mothers in Nigeria: Preliminary Focus Group Study", journal="JMIR Form Res", year="2025", month="Apr", day="9", volume="9", pages="e42406", keywords="adolescent perinatal depression", keywords="primary care", keywords="mHealth app", keywords="user centered design", keywords="smartphone", keywords="human-centered design", keywords="HCD", keywords="depression", keywords="postpartum", keywords="perinatal", keywords="postnatal", keywords="teenage", keywords="adolescent", keywords="youth", keywords="low-middle-income countries", keywords="LMIC", keywords="middle income", keywords="adoption", keywords="acceptability", keywords="mobile health", keywords="mHealth", keywords="mobile app", keywords="women's health", keywords="mental health", keywords="depressive", abstract="Background: Mobile health (mHealth), the use of mobile technology in health care, is increasingly being used for mental health service delivery even in low- and middle-income countries to scale up treatment, and a variety of evidence supports their potential in different populations. Objective: This study aims to use the Social Cognitive Theory (SCT) as a lens to explain knowledge of mHealth use for mental health care, personal behavioral capabilities, and the external social contexts that can impact the adoption of an mHealth app for depression care among perinatal adolescents in Nigeria. Methods: At the preliminary stage of a user-centered design (UCD), 4 focus group discussions were conducted among 39 participants: 19 perinatal adolescents with a history of depression and 20 primary care providers. Guided by the SCT, a popular model used for predicting and explaining health behaviors, we documented participants' knowledge of mHealth use for health purposes, advantages, and challenges to the adoption of an mHealth app by young mothers, and approaches to mitigate challenges. Data collection and analysis was an iterative process until saturation of all topic areas was reached. Results: The mean age for young mothers was 17.3 (SD 0.9) years and 48 (SD 5.8) years for care providers. Mistrust from relatives on mobile phone use for therapeutic purposes, avoidance of clinic appointments, and sharing of application contents with friends were some challenges to adoption identified in the study population. Supportive personal factors and expressions of self-efficacy on mobile app use were found to be insufficient for adoption. This is because there are social complications and disapprovals that come along with getting pregnant at a young age. Adequate engagement of parents, guardians, and partners on mHealth solutions by care providers was identified as necessary to the uptake of digital tools for mental health care in this population. Conclusions: The SCT guided the interpretations of the study findings. Young mothers expressed excitement at the use of mHealth technology to manage perinatal depression. Real-life challenges, however, need to be attended to for successful implementation of such interventions. Communications between care providers and patients' relatives on the therapeutic use of mHealth are vital to the success of a mHealth mental health management plan for depression in young mothers in Nigeria. ", doi="10.2196/42406", url="https://formative.jmir.org/2025/1/e42406" } @Article{info:doi/10.2196/65745, author="Munir, Mamoon Malik and Ahmed, Nabil", title="Using Social Media Platforms to Raise Health Awareness and Increase Health Education in Pakistan: Structural Equation Modeling Analysis and Questionnaire Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="7", volume="12", pages="e65745", keywords="social media", keywords="health awareness", keywords="health education", keywords="innovation diffusion theory", keywords="structural equation modeling", keywords="disease burden", keywords="healthcare facilities", keywords="health professionals", keywords="misinformation", keywords="cost effective", abstract="Background: Current health care education methods in Pakistan use traditional media (eg, television and radio), community health workers, and printed materials, which often fall short of reach and engagement among most of the population. The health care sector in Pakistan has not yet used social media effectively to raise awareness and provide education about diseases. Research on the impact social media can have on health care education in Pakistan may expand current efforts, engage a wider audience, and reduce the disease burden on health care facilities. Objective: This study aims to evaluate the perceptions of health care professionals and paramedic staff regarding social media use to raise awareness and educate people about diseases as a potential means of reducing the disease burden in Pakistan. Methods: The study used two-stage structural equation modeling (SEM). Data analysis used AMOS 26.0 software, adopting scales from previous literature. Four-item scales for each social media usefulness and health awareness construct and 8-item scales for health care education constructs were adopted on the basis of their higher loading in alignment with psychometric literature. A 7-point Likert scale was used to measure each item. Data collection used convenience sampling, with questionnaires distributed to more than 450 health care professionals and paramedic staff from 2 private hospitals in Lahore, Pakistan. There were 389 useful responses received. However, 340 completed questionnaires were included in the data analysis. Results: The study found that all the squared multiple correlation (SMC) values were greater than 0.30. Furthermore, convergent validity was measured using (1) standardized factor loading (found greater than 0.5), (2) average variance explained (found greater than 0.5), and (3) composite reliability (found greater than 0.7). The confirmatory factor analysis (CFA) of the measurement model indicated the fitness of the constructs (Chi-square minimum [CMIN]=357.62; CMIN/degrees of freedom [DF]=1.80; Goodness of Fit [GFI]=0.90; Adjusted Goodness of Fit Index [AGFI]=0.89; Buntler-Bonett Normed Fit Index [NFI]=0:915; Comparative Fit Index [CFI]=0:93; Root Mean Square Residual [RMR]=0:075; Root Mean Square Error of Approximation [RMSEA]=0:055). Moreover, the structural model fitness was also confirmed (CMIN=488.6; CMIN/DF=1.85; GFI=0.861; AGFI=0.893; NFI=0.987; CFI=0.945; RMR=0:079; RMSEA=0.053). Hence, the results indicated that social media usefulness has a positive and significant effect on health awareness (hypothesis 1: $\beta$=.669, P<.001), and health awareness has a positive and significant effect on health care education in Pakistan (hypothesis 2: $\beta$=.557, P<.001). Conclusions: This study concludes that health care professionals and paramedic staff in private hospitals support the use of social media to raise awareness and provide health care education. It is considered an effective tool for reducing the disease burden in Pakistan. The study results also revealed that young health care professionals are more inclined toward social media usage and express the need for legislation to support it and establish a monitoring process to avoid misinformation. ", doi="10.2196/65745", url="https://humanfactors.jmir.org/2025/1/e65745" } @Article{info:doi/10.2196/64131, author="Dougherty, Kylie and Tesfaye, Yihenew and Biza, Heran and Belew, Mulusew and Benda, Natalie and Gebremariam Gobezayehu, Abebe and Cranmer, John and Bakken, Suzanne", title="User-Centered Design of an Electronic Dashboard for Monitoring Facility-Level Basic Emergency Obstetric Care Readiness in Amhara, Ethiopia: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="3", volume="12", pages="e64131", keywords="health information technology", keywords="design and evaluation", keywords="Ethiopia", keywords="usability", keywords="nursing informatics", keywords="user-centered design", keywords="basic emergency obstetric care", keywords="obstetric", keywords="nurse", keywords="user-centered", keywords="design", keywords="maternal mortality", keywords="maternal", keywords="develop", keywords="sub-Saharan Africa", keywords="Africa", keywords="dashboard", keywords="tracking", keywords="emergency care", abstract="Background: Maternal mortality remains a persistent public health concern in sub-Saharan African countries such as Ethiopia. Health information technology solutions are a flexible and low-cost method for improving health outcomes with proven benefits in low- to middle-income countries' health systems. Objective: This study aimed to develop and assess the usability of an electronic dashboard to monitor facility-level readiness to manage basic emergency obstetric care (BEmOC) in Amhara, Ethiopia. Methods: The study used three methods to iteratively refine the dashboard: (1) user-centered design sessions with individuals who interact with the BEmOC supply chain, (2) review and feedback from domain and information visualization subject matter experts (SMEs) to refine the dashboard, and (3) usability heuristic evaluation with human-computer interaction (HCI) SMEs. Results: User-centered design sessions resulted in a preliminary version of the dashboard informed by end-user preferences and perceptions, with recommendations focusing on aesthetic design, filtering and sorting, and matching with the real world. An example of an end-user recommendation included increasing font sizes on the dashboard and using a red, yellow, and green color-coding scheme. Next, domain and visualization SMEs continued the dashboard's iterative refinement, focusing on aesthetic design and navigation, by confirming design choices incorporated from the user-centered design sessions and recommending changes to enhance user experience moving through the dashboard, such as adding more filtering options. HCI SMEs rated the dashboard as highly usable (0.82 on a scale of 0-4, with 0 being no usability concern and 4 being a catastrophic usability concern). The principle with the highest usability severity scores was a match between the system and the real world with a score of 1.4. The HCI SMEs also rated the information visualization aspects of the dashboard favorably with 2 usability principles, spatial organization and information coding, scoring 0. Conclusions: Dashboards are a novel method for promoting and tracking facility capacity to manage BEmOC. By including targeted end users and SMEs in the design process, the team was able to tailor the dashboard to meet user needs, fit it into the existing government health systems, and ensure that the dashboard follows design best practices. Collectively, the novel, customized BEmOC dashboard can be used to track and improve facility-level readiness in Amhara, Ethiopia, and similar global BEmOC facilities. ", doi="10.2196/64131", url="https://humanfactors.jmir.org/2025/1/e64131" } @Article{info:doi/10.2196/64796, author="Abou Malham, Sabina and Traor{\'e}, Doufain and Dicko, Fatoumata and Blouin Genest, Gabriel and Boudreau, Jennyfer and Sidib{\'e}, Mansa Drissa and Sidib{\'e}, Souleymane and Go{\"i}ta, Souleymane Issa and Sangar{\'e}, Aminata and Togo, Mohamed and Diarra, Delphine and Rietmann, Mich{\`e}le and Ma{\"i}ga, Mahamoudou Mahamane and Boulanger, Suzie and Gr{\'e}goire, Isabelle Ann and Milot, David-Martin and Berbiche, Djamal and Stecko, Sarah", title="Assessment of Community Stakeholders' and Health Educators and Professionals' Needs for the Continuous Enhancement of Sexual and Reproductive Health and Rights in Mali (Project CLEFS): Protocol for a Convergent Mixed Methods Study", journal="JMIR Res Protoc", year="2025", month="Apr", day="1", volume="14", pages="e64796", keywords="mixed methods study", keywords="protocol", keywords="sexual and reproductive health and rights", keywords="Mali", keywords="primary health care providers", keywords="women and girls' health needs", abstract="Background: In Mali, a lack of qualified human resources in primary health care and sexual and reproductive health and rights (SRHR) is one of the greatest barriers to the population's access to standard health services. Frontline professional training must be strengthened to respond to the needs of the population, particularly those of women and girls. Training must be conducted using an interdisciplinary and adapted approach to promote gender equality. Objective: This study aims to identify the SRHR training needs among the community, educational actors, and primary health care providers. Methods: A concurrent mixed methods design was adopted, using 2 methods. A quantitative method, through a cross-sectional analytical survey, will be conducted at the community level with university community health centers (CSCom-U) users and adolescents in CSCom-U health areas, as well as at the health education institution and community health centers levels with teachers, students, and interdisciplinary professional groups within the CSCom-U and district hospital maternity. Descriptive and inferential analyses will be conducted to process quantitative data. This research is at the stage of data analysis and interpretation. A qualitative method, based on 3 sources of data (focus groups, individual semistructured interviews, and document analysis), which involved the same targets as the quantitative component, with additional community actors such as Community Health Associations (Associations de sant{\'e} communautaire) and Women's Service User Communities. A thematic analysis of the qualitative data using a mixed deductive and inductive method will be performed. Results: : Field data collection took place from March to April 2022. Quantitative data from 3153 participants are being analyzed using SPSS. Qualitative data from 11 interviews and 27 focus groups were processed with Qualitative Data Analysis Miner. Data analysis is still ongoing. Conclusions: This study will provide a better understanding of adolescents and SRHR user's service needs in terms of health services availability and quality and SRHR knowledge, issues related to student training quality, the level of adequacy between the training offered and the actual needs of the service recipients, and the level of preparation and ability of teachers to provide quality teaching taking gender equity into account. The recommendations drawn from this assessment will propose concrete actions to improve women and girls' health services provided by professionals, and to better adapt the future health professionals' profiles to the needs of communities, particularly those of women and girls. International Registered Report Identifier (IRRID): DERR1-10.2196/64796 ", doi="10.2196/64796", url="https://www.researchprotocols.org/2025/1/e64796" } @Article{info:doi/10.2196/69048, author="Oliveira, Fonseca Juliane and Vasconcelos, O. Adriano and Alencar, L. Andr{\^e}za and Cunha, L. Maria C{\'e}lia S. and Marcilio, Izabel and Barral-Netto, Manoel and P Ramos, Ivan Pablo", title="Balancing Human Mobility and Health Care Coverage in Sentinel Surveillance of Brazilian Indigenous Areas: Mathematical Optimization Approach", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="1", volume="11", pages="e69048", keywords="representative sentinel surveillance", keywords="early pathogen detection", keywords="indigenous health", keywords="human mobility", keywords="surveillance network optimization", keywords="infectious disease surveillance", keywords="public health strategy", keywords="Brazil", abstract="Background: Optimizing sentinel surveillance site allocation for early pathogen detection remains a challenge, particularly in ensuring coverage of vulnerable and underserved populations. Objective: This study evaluates the current respiratory pathogen surveillance network in Brazil and proposes an optimized sentinel site distribution that balances Indigenous population coverage and national human mobility patterns. Methods: We compiled Indigenous Special Health District (Portuguese: Distrito Sanit{\'a}rio Especial Ind{\'i}gena [DSEI]) locations from the Brazilian Ministry of Health and estimated national mobility routes by using the Ford-Fulkerson algorithm, incorporating air, road, and water transportation data. To optimize sentinel site selection, we implemented a linear optimization algorithm that maximizes (1) Indigenous region representation and (2) human mobility coverage. We validated our approach by comparing results with Brazil's current influenza sentinel network and analyzing the health attraction index from the Brazilian Institute of Geography and Statistics to assess the feasibility and potential benefits of our optimized surveillance network. Results: The current Brazilian network includes 199 municipalities, representing 3.6\% (199/5570) of the country's cities. The optimized sentinel site design, while keeping the same number of municipalities, ensures 100\% coverage of all 34 DSEI regions while rearranging 108 (54.3\%) of the 199 cities from the existing flu sentinel system. This would result in a more representative sentinel network, addressing gaps in 9 of 34 previously uncovered DSEI regions, which span 750,515 km{\texttwosuperior} and have a population of 1.11 million. Mobility coverage would improve by 16.8 percentage points, from 52.4\% (4,598,416 paths out of 8,780,046 total paths) to 69.2\% (6,078,747 paths out of 8,780,046 total paths). Additionally, all newly selected cities serve as hubs for medium- or high-complexity health care, ensuring feasibility for pathogen surveillance. Conclusions: The proposed framework optimizes sentinel site allocation to enhance disease surveillance and early detection. By maximizing DSEI coverage and integrating human mobility patterns, this approach provides a more effective and equitable surveillance network, which would particularly benefit underserved Indigenous regions. ", doi="10.2196/69048", url="https://publichealth.jmir.org/2025/1/e69048" } @Article{info:doi/10.2196/60296, author="Lazo-Porras, Maria and Tateishi-Serruto, Jose Francisco and Butler, Christopher and Cuba-Fuentes, Sof{\'i}a Mar{\'i}a and Rossini-Vilchez, Daniela and Perez-Leon, Silvana and L{\'u}car-Flores, Miriam and Miranda, Jaime J. and Bernabe-Ortiz, Antonio and Diez-Canseco, Francisco and Moore, Graham and Landeiro, Filipa and Cardenas, Kathia Maria and Vera Tudela, Carlos Juan and White, Lee and Calvo, A. Rafael and Whiteley, William and Hawkins, Jemma and ", title="Assessment of Health System Readiness and Quality of Dementia Services in Peru: Protocol for a Qualitative Study With Stakeholder Interviews and Documentation Review", journal="JMIR Res Protoc", year="2025", month="Mar", day="21", volume="14", pages="e60296", keywords="dementia", keywords="health system readiness", keywords="caregiver", keywords="comorbidities", keywords="Peru", keywords="study protocol", keywords="quality of care", keywords="comorbidity", keywords="patient journey", keywords="mHealth", abstract="Background: Dementia is a global health priority with significant challenges due to its complex nature and increasing prevalence. Health systems worldwide struggle to address chronic conditions like dementia, often providing fragmented care. However, information about how health systems respond to the needs of people with dementia and their carers, and the quality of care provided, is scarce in low- and middle-income countries. Objective: This study aims to assess the quality of the health system to provide diagnosis and care for people with dementia and their carers in Peru. In order to do this, the study will explore the response of the Peruvian health system to people with dementia and their carers, and explore the experiences of people with dementia of receiving their diagnosis, management, and quality of care for this condition. Methods: This study is part of a research program called ``IMPACT Salud: Innovations using Mhealth for people with dementia and Co-morbidities,'' aimed at strengthening health systems to provide care for people with dementia and their carers. The study has a descriptive, cross-sectional design that uses a qualitative methodology, including stakeholder interviews and documentation review, and consists of 2 substudies, a health system assessment (HSA) and an exploration of the patient journey. The first substudy uses an HSA methodology suitable for low- and middle-income countries, conducting 160 structured interviews with 12 different stakeholder types across 3 levels of the health system (micro, meso, and macro) in 4 Peruvian regions, each with distinct geographical and urbanization profiles. The second substudy uses a patient journey methodology, which involves conducting 40 in-depth interviews with people with dementia, carers, and health care workers from the same 4 regions. The insights into the people with dementia patient and caregiver experience within the health system from the interviews will be used to produce a patient journey map. The analysis will be guided by the high-quality health system framework, and the findings from the HSA and patient journey will be structured using the domains included in the framework through the lens of quality of services. Results: Data collection began in March 2024. As of the end of September 2024, a total of 156 interviews from the HSA and 38 interviews from the patient journey study have been conducted across 4 regions. Conclusions: This study will provide a national, multilevel insight into the current operation of the Peruvian health system, including an analysis of the quality of services provided with regard to dementia diagnosis, management, and care from the perspectives of stakeholders, patients, and their carers. International Registered Report Identifier (IRRID): DERR1-10.2196/60296 ", doi="10.2196/60296", url="https://www.researchprotocols.org/2025/1/e60296" } @Article{info:doi/10.2196/67228, author="Nguyen, Thu Hoai Thi and Tran, Ba Hieu and Tran, Minh Phuong and Pham, Manh Hung and Dao, Xuan Co and Le, Ngoc Thanh and Do, Doan Loi and Nguyen, Quoc Ha and Vu, Thi Thom and Kirkpatrick, James and Reid, Christopher and Nguyen, Viet Dung", title="Effect of a Telemedicine Model on Patients With Heart Failure With Reduced Ejection Fraction in a Resource-Limited Setting in Vietnam: Cohort Study", journal="J Med Internet Res", year="2025", month="Mar", day="19", volume="27", pages="e67228", keywords="heart failure", keywords="HFrEF", keywords="telemedicine", keywords="telecare", keywords="remote monitoring", keywords="remote management", keywords="heart failure hospitalization", keywords="all-cause mortality", keywords="Vietnam", keywords="telehealth", keywords="heart", keywords="cardiology", keywords="cohort", keywords="remote", keywords="monitoring", keywords="resource-limited", keywords="cost-effective", keywords="low-cost", keywords="cardiovascular disease", keywords="hospitalization", keywords="mortality", abstract="Background: Heart failure (HF) is a complex, life-threatening condition marked by high morbidity, mortality, reduced functional capacity, poor quality of life, and substantial health care costs. HF with reduced ejection fraction (HFrEF) represents the subgroup of HF with the highest risks of mortality and hospitalization, necessitating the prioritization of care and management models to optimize treatment outcomes in these patients. Currently, data on the effectiveness of telemedicine models in resource-limited settings, such as low- and middle-income countries, are scarce. Objective: This study aimed to evaluate the impact of telemedicine on improving prognosis in patients with HFrEF in Vietnam. Methods: In this prospective cohort study, we recruited patients who received either remote monitoring and management (telemedicine) or standard monitoring and management (usual care) in the outpatient department of the Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam. Eligible patients were ?18 years old, had a diagnosis of HFrEF defined as left ventricular ejection fraction (LVEF) ?40\%, had a history of HF hospitalization within the past 12 months, and presented with clinical symptoms classified as New York Heart Association (NYHA) II or III. The primary composite outcome was defined as the time to the first unplanned HF hospitalization or all-cause mortality. The follow-up period for all outcomes extended to 12 months. Results: In total, 426 patients (298/426, 70\% male; 128/426, 30\% female) with a mean age of 61.3 (SD 14.6) years and a mean LVEF of 32.1\% (SD 6.0\%) were included in our study. Of these patients, 121 received telemedicine care, while 305 received usual care. The primary outcome occurred in 23 (23/121, 19\%) patients in the telemedicine group and 82 (82/305, 26.9\%) patients in the usual care group during the follow-up period, indicating a significant reduction in risk (adjusted hazard ratio [aHR] 0.57, 95\% CI 0.35-0.94; P=.03). However, this effect was primarily driven by a significant reduction in unplanned HF hospital admissions (aHR 0.57, 95\% CI 0.33-0.98; P=.04) rather than in all-cause mortality (aHR 0.77, 95\% CI 0.36-1.63; P=.49). Conclusions: This study demonstrates that a simplified telemedicine model, even in resource-limited settings such as Vietnam, can effectively facilitate the remote monitoring and management of patients with HFrEF, resulting in significant reductions in HF-related hospitalizations and all-cause mortality. Trial Registration: National Agency for Science and Technology Information (NASATI), Vietnam CT07/01-2022-3; https://nsti.vista.gov.vn/projects/dth/xay-dung-mo-hinh-theo-doi-va-tu-van-suc-khoe-tim-mach-tu-xa-tai-thanh-pho-ha-noi-109276.html ", doi="10.2196/67228", url="https://www.jmir.org/2025/1/e67228" } @Article{info:doi/10.2196/51524, author="Vey, Trinity and Kinnicutt, Eleonora and Day, G. Andrew and West, Nicola and Sleeth, Jessica and Nchimbi, Bernard Kenneth and Yeates, Karen", title="Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama ``Secure Voucher'' Study Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Mar", day="19", volume="27", pages="e51524", keywords="malaria prevention", keywords="pregnant", keywords="mHealth", keywords="mobile health", keywords="short message service", keywords="behaviour change communication", keywords="long-lasting insecticidal nets", keywords="protozoan infections", keywords="parasitic diseases", keywords="vector borne diseases", keywords="randomized controlled trial", keywords="morbidity", keywords="mortality", keywords="intervention", abstract="Background: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention. Objective: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania. Methods: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data. Results: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70\%) and the control group (67\%). Younger participants were less likely to redeem e-vouchers. Conclusions: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 ", doi="10.2196/51524", url="https://www.jmir.org/2025/1/e51524" } @Article{info:doi/10.2196/58976, author="Sohail, Maira and Matthews, Lynn and Williams, Audra and Kempf, Mirjam-Colette and Phillips, Desiree and Goymer, Hannah and Johnson,, Bernadette and Mugavero, Michael and Elopre, Latesha", title="Improving Pre-Exposure Prophylaxis Provision as Part of Routine Gynecologic Care Among Black Cisgender Women (Project PrEP4Her): Protocol for the Implementation of an Intervention", journal="JMIR Res Protoc", year="2025", month="Mar", day="14", volume="14", pages="e58976", keywords="Black", keywords="cis-Gender women", keywords="PrEP", keywords="pre-exposure prophylaxis", keywords="South", keywords="HIV", keywords="gynecology", abstract="Background: Although HIV pre-exposure prophylaxis (PrEP) has been proven to be an effective prevention tool in decreasing HIV transmission, achieving adequate PrEP uptake has remained a challenge among Black cisgender women living in the Southern United States. Gynecology clinics, which provide primary health care services for many cisgender women, have the potential to be an ideal setting for the integration of PrEP services. Objective: We designed an intervention, PrEP4Her, which aims to implement PrEP service delivery at gynecology clinics in Alabama, the United States, as part of routine reproductive and sexual health care visits to improve PrEP engagement rates among Black cisgender women. Methods: Guided by the information gathered on (1) factors impacting PrEP implementation at gynecology clinics, including key barriers and facilitators to PrEP implementation and potential strategies to address the identified barriers (in-depth interviews with the gynecology care team), (2) structural barriers and provider-level barriers to PrEP implementation (cross-sectional study among gynecologists), and (3) implementation strategies on how to integrate PrEP services into routine gynecology care (in-depth interviews and focus groups with Black cisgender women), a multicomponent implementation strategy, tailored for Black cisgender women, was developed to integrate PrEP in routine women's health visits (ie, PrEP4Her). To determine the efficacy of the program, we will measure implementation outcomes, reach (increase in the absolute number of Black cisgender women receiving PrEP prescriptions), effectiveness (increase in the proportion of PrEP prescriptions over time), and adoption (proportion of team members willing to implement PrEP4Her) using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. In addition, acceptability (the extent to which providers and Black cisgender women feel PrEP4Her to be acceptable---in-depth interviews); Feasibility (appropriateness of PrEP4Her for a larger, full-scale trial---the Feasibility of Intervention Measure scale); and fidelity (the degree to which PrEP4Her program was implemented as designed---electronic survey with patients) will also be assessed. Results: The qualitative and quantitative data from the gynecology care team and the qualitative data from Black cisgender women were collected from August 9, 2022, to April 19, 2023, and were integrated through joint displays to identify major themes. The combined findings provided a comprehensive understanding of factors that were fundamental in the development and refinement of PrEP4Her implementation. The PrEP4Her was implemented from January 29, 2024, to August 16, 2024. The information gathered is being used to assess PrEP4Her efficacy (based on reach, effectiveness, adoption, acceptability, feasibility, and fidelity). Conclusions: Upon completion of our research, our interdisciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research, and psychology, will be primed to lead a multisite type III implementation trial for PrEP service delivery at gynecology clinics across the Southern United States. International Registered Report Identifier (IRRID): DERR1-10.2196/58976 ", doi="10.2196/58976", url="https://www.researchprotocols.org/2025/1/e58976", url="http://www.ncbi.nlm.nih.gov/pubmed/40085134" } @Article{info:doi/10.2196/60811, author="Franke, Anna Mara and Neumann, Anne and Nordmann, Kim and Suleymanova, Daniela and Ravololohanitra, Gabrielle Onja and Emmrich, Valentin Julius and Knauss, Samuel", title="Impact of a Mobile Money--Based Conditional Cash Transfer Intervention on Health Care Utilization in Southern Madagascar: Mixed-Methods Study", journal="JMIR Mhealth Uhealth", year="2025", month="Mar", day="3", volume="13", pages="e60811", keywords="cash transfer intervention", keywords="Madagascar", keywords="Sub-Saharan Africa", keywords="health care utilization", keywords="humanitarian assistance", keywords="Africa", keywords="mobile", keywords="mixed methods study", keywords="money", keywords="quantitative", keywords="qualitative", keywords="thematic analysis", keywords="policy", keywords="service", keywords="delivery", keywords="health care system", keywords="cash", keywords="economic", keywords="financial", keywords="payment", keywords="time series", abstract="Background: Mobile money--based cash transfer interventions are becoming increasingly utilized, especially in humanitarian settings. southern Madagascar faced a humanitarian emergency in 2021-2022, when the second wave of the COVID-19 pandemic and a severe famine affected the fragile region simultaneously. Objective: This mixed-methods study aims to analyze the impact and factors influencing the success of a mobile money--based conditional cash transfer intervention for health care utilization at 4 primary and 11 secondary facilities in Madagascar. Methods: We obtained quantitative data from 11 facility registers, detailing patient numbers per month, categorized into maternity care, surgical care, pediatric care, outpatient care, and inpatient care. An interrupted time series analysis, without a control group, was conducted using the end of the intervention in July 2022 as the cut off point. For qualitative data, 64 in-depth interviews were conducted with health care providers, NGO staff, policymakers, beneficiaries, and nonbeneficiaries of the intervention, and was interpreted by 4 independent researchers using reflexive thematic analysis to identify facilitators and barriers to implementation. Results: The interrupted time series analysis showed a significant negative impact on health care utilization, indicating a reduction in health care--seeking behavior after the end of the cash transfer intervention. The effect was stronger in the slope change of patient numbers per month (defined as P<.05), which significantly decreased in 39 of 55 (70\%) models compared to the step change at the end of the intervention, which showed a significant but lower change (P <.05) in 40\% (22/55) of models. The changes were most pronounced in surgical and pediatric care. The key factors that influenced the success of the implementation were grouped across three levels. At the community level, outreach conducted to inform potential beneficiaries about the project by community health workers and using the radio was a decisive factor for success. At participating facilities, high intrinsic staff motivation and strong digital literacy among facility staff positively influenced the intervention. Confusion regarding previous activities by the same implementing NGO and perceptions of unfair bonus payments for health care providers included in the project negatively affected the intervention. Finally, at the NGO-level, the staff present at each facility and the speed and efficiency of administrative processes during the intervention were decisive factors that influenced the intervention. Conclusions: The conditional cash transfer intervention was overarchingly successful in increasing health care utilization in southern Madagascar in a humanitarian setting. However, this success was conditional on key implementation factors at the community, facility, and NGO levels. In the future, similar interventions should proactively consider the key factors identified in this study to optimize the impact. ", doi="10.2196/60811", url="https://mhealth.jmir.org/2025/1/e60811" } @Article{info:doi/10.2196/58841, author="Cyuzuzo, Callixte and Dukuzimana, Josee Marie and Muhire, Clement and Sheldon Ames, Mathew and Ngwakongnwi, Emmanuel", title="Challenges to Rehabilitation Services in Sub-Saharan Africa From a User, Health System, and Service Provider Perspective: Scoping Review", journal="JMIR Hum Factors", year="2025", month="Feb", day="28", volume="12", pages="e58841", keywords="challenges", keywords="users", keywords="health system", keywords="service providers", keywords="Sub-Saharan Africa", keywords="scoping review", keywords="rehabilitation service", abstract="Background: Rehabilitation aims to restore and optimize the functioning of impaired systems for people with disabilities. It is an integral part of universal health coverage, and access to it is a human right. Objective: We aimed to identify the key challenges to rehabilitation services in Sub-Saharan Africa from a user, health system, and service provider perspective. Methods: This scoping review was conducted in accordance with the 5-stage framework proposed by Arksey and O'Malley. A comprehensive electronic search was run to identify published articles on rehabilitation services in Sub-Saharan Africa. Of the 131 articles retrieved, 83 articles were assessed for eligibility and 15 papers that met the inclusion criteria were considered. Results: The results show that people with disabilities in Sub-Saharan Africa face multifactorial challenges to access rehabilitation services. Poor access to rehabilitation services is associated with less attention given to rehabilitation by governments, which leads to less funding, negative cultural and social beliefs, fewer rehabilitation centers, poorly equipped rehabilitation units, failure of health systems, lack of training to rehabilitation practitioners, and logistical and financial constraints. This review also reveals that digital rehabilitation reduces costs and improves access to services in hard-to-reach geographical areas. However, digital rehabilitation faces challenges as well, including connectivity issues, inaccessibility to technology, a lack of technical knowledge, a lack of privacy, and ethical concerns. Conclusions: People with disabilities face multifactorial challenges to access rehabilitation services in Sub-Saharan Africa. It is therefore critical to address these challenges to optimize patients' health outcomes and offer better rehabilitation services. ", doi="10.2196/58841", url="https://humanfactors.jmir.org/2025/1/e58841" } @Article{info:doi/10.2196/67452, author="Shamebo, Dessalegn and Derseh Mebratie, Anagaw and Arsenault, Catherine", title="Using an Interactive Voice Response Survey to Assess Patient Satisfaction in Ethiopia: Development and Feasibility Study", journal="JMIR Form Res", year="2025", month="Feb", day="13", volume="9", pages="e67452", keywords="mobile phone surveys", keywords="patient satisfaction", keywords="interactive voice response", keywords="global health", keywords="surveys", keywords="Ethiopia", keywords="IVR", keywords="Africa", abstract="Background: Patient satisfaction surveys can offer crucial information on the quality of care but are rarely conducted in low-income settings. In contrast with in-person exit interviews, phone-based interactive voice response (IVR) surveys may offer benefits including standardization, patient privacy, reduced social desirability bias, and cost and time efficiency. IVR surveys have rarely been tested in low-income settings, particularly for patient satisfaction surveys. Objective: In this study, we tested the feasibility of using an IVR system to assess patient satisfaction with primary care services in Addis Ababa, Ethiopia. We described the methodology, response rates, and survey costs and identified factors associated with survey participation, completion, and duration. Methods: Patients were recruited in person from 18 public and private health facilities in Addis Ababa. Patients' sex, age, education, reasons for seeking care, and mobile phone numbers were collected. The survey included 15 questions that respondents answered using their phone keypad. We used a Heckman probit regression model to identify factors influencing the likelihood of IVR survey participation (picking up and answering at least 1 question) and completion (answering all survey questions) and a Weibull regression model to identify factors influencing the survey completion time. Results: A total of 3403 individuals were approached across 18 health facilities. Nearly all eligible patients approached (2985/3167, 94.3\%) had a functioning mobile phone, and 89.9\% (2415/2685) of those eligible agreed to be enrolled in the study. Overall, 92.6\% (2236/2415) picked up the call, 65.6\% (1584/2415) answered at least 1 survey question, and 42.9\% (1037/2415) completed the full survey. The average survey completion time was 8.1 (SD 1.7) minutes for 15 Likert-scale questions. We found that those aged 40-49 years and those aged 50+ years were substantially less likely to participate in (odds ratio 0.63, 95\% CI 0.53-0.74) and complete the IVR survey (odds ratio 0.77, 95\% CI 0.65-0.90) compared to those aged 18-30 years. Higher education levels were also strongly associated with survey participation and completion. In adjusted models, those enrolled in private facilities were less likely to participate and complete the survey compared to those in public health centers. Being male, younger, speaking Amharic, using a private hospital, and being called after 8 PM were associated with a shorter survey duration. The average survey costs were US \$7.90 per completed survey. Conclusions: Our findings reveal that an IVR survey is a feasible, low-cost, and rapid solution to assess patient satisfaction in an urban context in Ethiopia. However, survey implementation must be carefully planned and tailored to local challenges. Governments and health facilities should consider IVR to routinely collect patient satisfaction data to inform quality improvement strategies. ", doi="10.2196/67452", url="https://formative.jmir.org/2025/1/e67452" } @Article{info:doi/10.2196/60495, author="Perez Ramirez, Alejandra and Ortega, Adrian and Stephenson, Natalie and Mu{\~n}oz Osorio, Angel and Kazak, Anne and Phan, Thao-Ly", title="mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e60495", keywords="obesity", keywords="user testing", keywords="mHealth", keywords="mobile health", keywords="Spanish", keywords="child", keywords="rural population", abstract="Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform---the Healthy Lifestyle (Nemours Children's Health) dashboard---was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100\% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100\%) selected the same dashboard icon and 71\% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. ", doi="10.2196/60495", url="https://formative.jmir.org/2025/1/e60495", url="http://www.ncbi.nlm.nih.gov/pubmed/39932772" } @Article{info:doi/10.2196/58858, author="Muliokela, K. Rosemary and Banda, Kuwani and Hussen, Mohammed Abdulaziz and Malumo, Bvulani Sarai and Kashoka, Andrew and Mwiche, Angel and Chiboma, Innocent and Barreix, Maria and Nyirenda, Muyereka and Sithole, Zvanaka and Ratanaprayul, Natschja and Endehabtu, Fikadie Berhanu and Telake, Abayneh Hanna and Weldeab, Adane and Probert, M. William J. and Tun{\c{c}}alp, ?zge and Maya, Ernest and Woldetsadik, Mulatu and Tilahun, Binyam and Guure, Chris and Senya, Kafui and Say, Lale and Tamrat, Tigest", title="Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned", journal="JMIR Med Inform", year="2025", month="Feb", day="7", volume="13", pages="e58858", keywords="guidelines", keywords="reproductive health", keywords="maternal health", keywords="antenatal care", keywords="clinical decision support", keywords="clinical decision support systems", keywords="digital health", keywords="HIV/AIDS", keywords="family planning", keywords="electronic medical records", keywords="electronic health record", keywords="standards", keywords="interoperability", keywords="system uptake", keywords="digital health governance", abstract="Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts. Objective: This paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs. Methods: A DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings. Implementation (Results): Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health. Conclusions: Country experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact. ", doi="10.2196/58858", url="https://medinform.jmir.org/2025/1/e58858" } @Article{info:doi/10.2196/39950, author="Joshi, Ashish and Surapaneni, Mohan Krishna and Grover, Ashoo and Kaur, Harpreet and Saggu, Rani Sofia and Oliveira, Doilyn", title="Swasthya Pahal (Health for All) Using a Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored Informatics Framework in Rural and Urban Areas of Chennai, Tamil Nadu: Protocol for a Quantitative Study", journal="JMIR Res Protoc", year="2025", month="Feb", day="6", volume="14", pages="e39950", keywords="interventions", keywords="Swasthya Pahal", keywords="acceptance", keywords="health behavior", keywords="NCDs risks", keywords="self-management", keywords="healthcare", keywords="noncommunicable disease", abstract="Background: Noncommunicable diseases (NCDs) require a longer period of care, for which health care systems must acquire technologically advanced solutions to enhance patient care. Swasthya Pahal (health for all) is an innovative, interactive, multilingual, stand-alone, internet-enabled computer-based program that aims to improve the self-management of NCDs. Objective: This study aims to enhance the self-management of chronic NCDs (diabetes, hypertension, high cholesterol, and obesity) by determining the usefulness, acceptance, and effectiveness of the Swasthya Pahal program in hospital and community settings in both rural and urban areas of Chennai, Tamil Nadu. This objective can be met by generating risk factor profiles of individuals enrolled and enhancing their self-management of NCDs using a portable health information kiosk that uses the Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored (SMAART) model. Methods: A quantitative study will be conducted on a convenient sample of 2800 individuals from selected hospital and community settings in rural (n=1400) and urban areas (n=1400) in Chennai, Tamil Nadu. Data will be collected on sociodemographics, health behaviors, and clinical status, as well as knowledge, attitudes, and practices. Objective assessments such as weight, blood pressure, and random blood sugar levels will be measured. In addition, the usefulness, acceptance, and effectiveness of the Swasthya Pahal program will be determined. Results: Results will be summarized using descriptive analysis. Appropriate bivariate and multivariate regression analysis will be performed to determine the predictors of the outcome variables of usefulness, acceptance, and effectiveness of Swasthya Pahal in wider settings. All analyses will be performed using SAS (version 9.1; SAS Institute), and the results will be reported as 95\% CI values and P<.05. Conclusions: The study proposes to enhance the self-management of NCDs in both rural and urban community settings through the implementation of the Swasthya Pahal program based on the SMAART informatics framework. The study aims to understand the implementation, acceptability, and usability of Swasthya Pahal among a diverse sample of people in urban and rural settings. International Registered Report Identifier (IRRID): PRR1-10.2196/39950 ", doi="10.2196/39950", url="https://www.researchprotocols.org/2025/1/e39950" } @Article{info:doi/10.2196/52351, author="Mashilo, Johannah Nkoleleng and Oladimeji, Elizabeth Kelechi and Gumede, Siphamandla and Lalla-Edward, Tresha Samanta", title="Access to Health Care and Use of Health Care Services Among Males in Africa: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2025", month="Jan", day="31", volume="14", pages="e52351", keywords="health-seeking behavior", keywords="health care", keywords="access", keywords="uptake", keywords="services", keywords="men", keywords="boys", keywords="scoping review", keywords="Africa", keywords="male", keywords="health care services", keywords="accessibility", keywords="use", keywords="noncommunicable disease", keywords="depression", keywords="substance abuse", keywords="overdose", keywords="physical disability", keywords="stress", keywords="older men", keywords="men's health", keywords="well-being", keywords="health literacy", keywords="perception", keywords="systematic reviews", keywords="meta-analysis", keywords="electronic database", keywords="EHR", keywords="electronic health record", keywords="narrative synthesis", abstract="Background: There is a scarcity of data on males' health-seeking behavior, as well as their access to and use of health care services, in Africa. According to some studies, men are less likely than women to seek medical help for issues such as communicable and noncommunicable diseases, depression, substance abuse, physical disabilities, and stressful life events. The study of males' health-seeking behaviors is important, because it allows us to learn about male health, how masculinity encourages underuse of health care services, how this affects males' overall health and well-being, and how cultural values and backgrounds may impact older men's health-seeking behaviors. Objective: The objective of this review is to assess evidence on how males access and use health care services and their health knowledge, attitudes, and perceptions to identify gaps for targeted, context-specific strategies to improve males' health and outcomes, particularly in Africa. Methods: The scoping review process will be guided by the methodology frameworks of the Joanna Briggs Institute and Arksey and O'Malley and will follow the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols Extension for Scoping Reviews guidelines. The following electronic databases will be systematically searched for evidence published between January 2010 and 2023: PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar. Two reviewers will independently screen full texts and chart the data; a third reviewer will be engaged in the event of disagreement between the 2 independent reviewers. The results of this scoping review will be summarized quantitatively through numerical counts and qualitatively through a narrative synthesis. Results: The electronic database search was conducted between March and April 2023 and redone in April 2024 to include the most recent articles. A total of 114,737 articles were retrieved and 4258 removed as duplicates. After title screening, 337 results remained, and after abstract selection, 140 results remained. As of December 2024, the scoping review was in the full-text screening phase. We plan to complete data extraction, synthesis, and writing of the entire manuscript of the review in January 2025, and then submit it to a journal for peer review and publication in February 2025. Conclusions: The scoping review results will advance the current knowledge about health-seeking behavior and access to and uptake of health care services among African males. To our knowledge, this scoping review is the first on this topic, and it will identify vital information on the barriers to and facilitators of African males' health care access and uptake. It will also provide information on successful health care programs for males that may be tailored and adopted across different African contexts. Trial Registration: OSF Registries https://osf.io/xz6sr International Registered Report Identifier (IRRID): DERR1-10.2196/52351 ", doi="10.2196/52351", url="https://www.researchprotocols.org/2025/1/e52351" } @Article{info:doi/10.2196/62726, author="Omiyi, David and Arubuola, Ebenezer and Chilaka, Marcus and Rahman Jabin, Shafiqur Md", title="Migration of Health Workers and Its Impacts on the Nigerian Health Care Sector: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2025", month="Jan", day="30", volume="14", pages="e62726", keywords="training and education", keywords="health policy", keywords="healthcare workforce", keywords="policy interventions", keywords="socio-political factors", keywords="political instability", keywords="workforce capacity", abstract="Background: Health worker migration from Nigeria poses significant challenges to the Nigerian health care sector and has far-reaching implications for health care systems globally. Understanding the factors driving migration, its effects on health care delivery, and potential policy interventions is critical for addressing this complex issue. Objective: This study aims to comprehensively examine the factors encouraging the emigration of Nigerian health workers, map out the effects of health worker migration on the Nigerian health system, document the loss of investment in health training and education resulting from migration, identify relevant policy initiatives addressing migration, determine the effects of Nigerian health worker migration on destination countries, and identify the benefits and demerits to Nigeria of health worker migration. Methods: This study will follow the Joanna Briggs Institute methodology. A search strategy will retrieve published studies from MEDLINE, CINAHL, Embase, Global Health, Academic Search Premiere, and Web of Science. Unpublished studies will be sourced from dissertations and theses. A comprehensive search will involve keyword scans and citation searches. Exclusion criteria will filter out irrelevant studies, such as studies unrelated to the international migration of health workers and non-English language studies. A total of 2 independent reviewers will screen the titles and abstracts and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study. The study selection process will be shown using a PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flowchart. While the traditional risk of bias assessments is not applied to scoping reviews, the quality of included studies will be evaluated based on methodological transparency. Results: The process of selecting studies will be shown using a PRISMA ScR flowchart, and information gathering will be done through a charting table that has been prepared in advance. We plan to collect data from January 2025 to March 2025 and present the results to examine publication patterns and study details. The final summary is expected to be released by the summer of 2025. It will provide an in-depth look at how health worker migration impacts the health care sector in Nigeria. Conclusions: This study holds immense potential to contribute to understanding health worker migration from Nigeria and inform policy and practice interventions to address its challenges. By synthesizing existing evidence, the scoping review will guide future research and policy efforts to mitigate the adverse effects of migration on health care systems and workforce sustainability. Furthermore, the results will aid in recognizing deficiencies in the existing literature; this will offer a defined path for specific policy measures and methods to retain health care workers effectively and thus support the sustainability of health care systems. International Registered Report Identifier (IRRID): PRR1-10.2196/62726 ", doi="10.2196/62726", url="https://www.researchprotocols.org/2025/1/e62726" } @Article{info:doi/10.2196/56142, author="Muhammad, Shah and Soomro, Asif and Ahmed Khan, Samia and Najmi, Hina and Memon, Zahid and Ariff, Shabina and Soofi, Sajid and Bhutta, Ahmed Zufiqar", title="Scaling Up Kangaroo Mother Care Through a Facility Delivery Model in Rural Districts of Pakistan: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2025", month="Jan", day="29", volume="14", pages="e56142", keywords="kangaroo mother care", keywords="scale up intervention", keywords="health facility", keywords="community", keywords="preterm infants", abstract="Background: The neonatal mortality rate in Pakistan is the third highest in Asia, with 8.6 million preterm babies. These newborns require warmth, nutrition, and infection protection, typically provided by incubators. However, the high maintenance and repair costs of incubators pose a barrier to accessibility for many premature and low birth weight neonates in low- and middle-income countries. This study aims to implement a context-specific kangaroo mother care (KMC) model in Sanghar within secondary health care facilities and catchment communities. Objective: This study aims to achieve at least 80\% KMC coverage for premature and low birth weight neonates. Methods: This research uses a mixed methods design grounded in implementation science principles, with the goal of developing adaptive strategies tailored to district and facility managers, as well as health care workers, leveraging previous evidence on the benefits of KMC. The research is conducted in the district of Sanghar, Sindh with an emphasis on promoting KMC for infants weighing between 1200 and 2500 g in three facilities. It includes preimplementation data collection, training of health care providers and lady health workers, and intervention involving mother-baby skin-to-skin contact, breastfeeding initiation, and postdischarge follow-ups. Ethical considerations and data management are prioritized, to improve KMC coverage and neonatal health outcomes. Results: This research will be implemented over a period of 18 months. The primary objective of this research is to achieve an 80\% improvement in KMC coverage, with the secondary objective to promote optimal breastfeeding practices among postpartum mothers. Key indicators include the proportion of eligible infants enrolled in KMC, the percentage of mother-baby pairs receiving skin-to-skin care postdischarge, and the duration of KMC during the neonatal period. Additionally, the study will assess exclusive breastfeeding rates, neonatal weight gain, and neonatal deaths within the cohort. The data management team will evaluate the effectiveness of the model in achieving the targeted KMC coverage. Conclusions: The integration of KMC into the health care system will provide valuable insights for policy makers regarding effective implementation and scaling strategies. The study's findings will highlight facilitators and barriers to KMC adoption, benefiting regions across Pakistan and globally. Additionally, these findings will offer valuable insights for the development of future newborn care programs. International Registered Report Identifier (IRRID): DERR1-10.2196/56142 ", doi="10.2196/56142", url="https://www.researchprotocols.org/2025/1/e56142" } @Article{info:doi/10.2196/59414, author="Saleem, Maham and Zafar, Shamsa and Klein, Thomas and Koesters, Markus and Bashir, Adnan and Fuhr, C. Daniela and Sikander, Siham and Zeeb, Hajo", title="A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan", journal="JMIR Form Res", year="2025", month="Jan", day="28", volume="9", pages="e59414", keywords="digital mental health", keywords="digital technology", keywords="digital intervention", keywords="Problem Management Plus", keywords="lay health worker programme", keywords="common mental health disorders", keywords="low- and middle-income countries", keywords="co-production", abstract="Background: Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization--endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. Objective: We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for ``lady health workers'' (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. Methods: A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Results: Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Conclusions: Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants. ", doi="10.2196/59414", url="https://formative.jmir.org/2025/1/e59414", url="http://www.ncbi.nlm.nih.gov/pubmed/39874072" } @Article{info:doi/10.2196/64585, author="Baker, Jason and Cappon, Giacomo and Habineza, Claude Jean and Basch, H. Corey and Mey, Steven and Malkin-Washeim, L. Diana and Schuetz, Christian and Simon Pierre, Niyonsenga and Uwingabire, Etienne and Mukamazimpaka, Alvera and Mbonyi, Paul and Narayanan, Sandhya", title="Continuous Glucose Monitoring Among Patients With Type 1 Diabetes in Rwanda (CAPT1D) Phase I: Prospective Observational Feasibility Study", journal="JMIR Form Res", year="2025", month="Jan", day="21", volume="9", pages="e64585", keywords="CGM", keywords="feasibility", keywords="type 1 diabetes", keywords="self-management", keywords="complications", keywords="Rwanda", keywords="time in range", keywords="hypoglycemia", keywords="continuous glucose monitoring", keywords="single-arm", keywords="feasibility study", keywords="diabetes", keywords="diabetes mellitus", keywords="euglycemic", keywords="HbA1c", keywords="observational study", keywords="quantitative", keywords="adult", keywords="health", keywords="public health", keywords="health informatics", abstract="Background: The development of minimally invasive continuous glucose monitoring systems (CGMs) has transformed diabetes management. CGMs have shown clinical significance by improving time in the euglycemic range, decreasing rates of hypoglycemia, and improving hemoglobin A1c (HbA1c). In Rwanda, CGMs are currently not routinely used, and no clinical studies of CGM use were identified in the literature. Objective: This study aims to determine the impact and feasibility of real-time CGM use among people living with type 1 diabetes (T1D) in Rwanda through assessment of sensor use, time in range, rates of hypoglycemia and hyperglycemia, HbA1c, and rates of diabetes-related hospitalizations over time. Methods: The Continuous Glucose Monitoring Among Patients with Type 1 Diabetes in Rwanda (CAPT1D) study is a single-arm, prospective observational study conducted at the Rwandan Diabetes Association clinic in Kigali, Rwanda, aiming to assess the impact and feasibility of CGM use in Rwanda. A cohort of 50 participants diagnosed with T1D were enrolled. Participants were at least 21 years old, undergoing multiple daily insulin therapy, and not currently pregnant. Phase I of the study was conducted over 12 months, using the Dexcom G6 CGM. Phase II and Phase III extended CGM use for an additional 6 months respectively, using the next-generation Dexcom G7 CGM. Here, we report the quantitative results of the Phase I study. Results: Participants used the sensor for >80\% of the time throughout the study period. A significant increase in time in range was observed within 3 months and sustained over 12 months. HbA1c decreased significantly in 3 months and stayed lower throughout the 12-month period. Mean HbA1c levels decreased by 2.8\% at 6 months (P<.001) and 3.2\% at 12 months (P<.001). A total of 12 diabetes-related hospitalizations were reported during the study period. No cases of diabetic ketoacidosis or episodes of severe hypoglycemia occurred. Conclusions: Significant and meaningful improvements in key glycemic indices indicate the potential feasibility and impact of a CGM among people living with T1D in Rwanda. Future studies could be designed to include pre- and postintervention analysis to determine the effectiveness in terms of complications and costs. ", doi="10.2196/64585", url="https://formative.jmir.org/2025/1/e64585" } @Article{info:doi/10.2196/53460, author="Ramkumar, Vidya and Joshi B, Deepashree and Prabhakar, Anil and Hall, W. James and Vaidyanath, Ramya", title="Development and Beta Validation of an mHealth-Based Hearing Screener (SRESHT) for Young Children in Resource-Limited Countries: Pilot Validation Study", journal="JMIR Form Res", year="2025", month="Jan", day="13", volume="9", pages="e53460", keywords="audiometry", keywords="mHealth", keywords="devices", keywords="wireless", keywords="tablet-based screening", keywords="childhood hearing loss", keywords="early hearing detection and intervention", keywords="tablets", keywords="children", keywords="neonates", keywords="hearing loss", keywords="infants", keywords="development", keywords="validation", keywords="mobile phones", abstract="Background: The prevalence of hearing loss in infants in India varies between 4 and 5 per 1000. Objective-based otoacoustic emissions and auditory brainstem response have been used in high-income countries for establishing early hearing screening and intervention programs. Nevertheless, the use of objective screening tests in low- and middle-income countries (LMICs) such as India is not feasible. Mobile health (mHealth) solutions have been demonstrated to be a viable option for hearing screening in LMICs. Objective: This study aims to develop and beta-validate an affordable hearing screener for children younger than 6 years of age to identify moderately severe or higher degrees of hearing loss. Methods: In phase 1, a mHealth-based hearing screener (SRESHT) was developed using a single board computer with wireless commercial headphones and speakers as transducers, which were calibrated according to the standard procedure. Three subjective hearing screening modules were conceptualized and developed for different age groups: (1) behavioral observation audiometry--screening for infants aged from 0 to 1 year; (2) speech spectrum awareness task--screening for children 1 to 3 years old; and (3) speech recognition task--screening for children 3 to 6 years old. Different auditory stimuli for the screening modules were generated and suitability was assessed: (1) noisemakers, animal sounds, and environmental sounds for infants (birth to 1 year old); (2) animal sounds and nonsense syllables for children (1 to 3 years old); and (3) eighteen picturable spondee words for children (3 to 6 years old). In phase 2, the SRESHT screener was beta-validated in children aged below 6 years to establish the agreement between SRESHT modules and the gold-standard procedure in identifying moderately severe and higher degrees of hearing loss. Results: Off-the-shelf commercial speakers and headphones were selected and calibrated. On comparison of stimuli for behavioral observation audiometry on 15 children, Noisemaker stimuli were found suitable based on the average minimum response levels. On comparison of different stimuli for speech spectrum awareness task on 15 children, animal sounds were found to be suitable. On familiarity check of 18 spondee words for speech recognition task among 20 children, 12 spondee words had the eligibility cutoff (85\%) and a presentation level of 5 dB SL (re-pure tone threshold) was sufficient to achieve 80\% psychometric function. In phase 2, a total of 55 children aged 0 to 6 years (31 normal hearing and 24 hearing impairment) underwent SRESHT screening for beta validation. Cohen $\kappa$ indicated that the overall SRESHT screener had a very good agreement ($\kappa$=0.82) with gold-standard audiometric screening for identifying moderately severe and higher degrees of hearing loss. Conclusions: The development and beta validation of the SRESHT screener using the selected auditory stimuli showed that the stimuli were suitable for screening children. ", doi="10.2196/53460", url="https://formative.jmir.org/2025/1/e53460" } @Article{info:doi/10.2196/53969, author="Hamid, Fahmida and Roy, Tania", title="Unveiling Sociocultural Barriers to Breast Cancer Awareness Among the South Asian Population: Case Study of Bangladesh and West Bengal, India", journal="JMIR Hum Factors", year="2025", month="Jan", day="10", volume="12", pages="e53969", keywords="Bangladesh", keywords="West Bengal", keywords="India", keywords="Asia", keywords="breast cancer", keywords="awareness", keywords="early detection", keywords="screening", keywords="sociocultural barriers", keywords="health knowledge", keywords="cultural", keywords="stigma", keywords="social media", keywords="socioeconomic", abstract="Background: Bangladesh and West Bengal, India, are 2 densely populated South Asian neighboring regions with many socioeconomic and cultural similarities. In dealing with breast cancer (BC)--related issues, statistics show that people from these regions are having similar problems and fates. According to the Global Cancer Statistics 2020 and 2012 reports, for BC (particularly female BC), the age-standardized incidence rate is approximately 22 to 25 per 100,000 people, and the age-standardized mortality rate is approximately 11 to 13 per 100,000 for these areas. In Bangladesh, approximately 90\% of patients are at stages III or IV, compared with 60\% in India. For the broader South Asian population, this figure is 16\%, while it is 11\% in the United States and the United Kingdom.?These statistics highlight the need for an urgent investigation into the reasons behind these regions' late diagnoses and treatment. Objective: Early detection is essential for managing BC and reducing its impact on individuals. However, raising awareness in diverse societies is challenging due to differing cultural norms and socioeconomic conditions. We aimed to interview residents to identify barriers to BC awareness in specific regions. Methods: We conducted semistructured interviews with 17 participants from West Bengal and Bangladesh through Zoom (Zoom Video Communications). These were later transcribed and translated into English for qualitative data analysis. All our participants were older than 18 years, primarily identified as female, and most were married. Results: We have identified 20 significant barriers to effective BC care across 5 levels---individual, family, local society, health care system, and country or region. Key obstacles include neglect of early symptoms, reluctance to communicate, societal stigma, financial fears, uncertainty about treatment costs, inadequate mental health support, and lack of comprehensive health insurance. To address these issues, we recommend context-specific solutions such as integrating BC education into middle and high-school curricula, providing updates through media channels like talk shows and podcasts, promoting family health budgeting, enhancing communication at cultural events and religious gatherings, offering installment payment plans from health care providers, encouraging regular self-examination, and organizing statewide awareness campaigns. In addition, social media can be a powerful tool for raising mass awareness while respecting cultural and socioeconomic norms. Conclusions: Fighting BC or any fatal disease is challenging and requires support from various dimensions. However, studies show?that raising mass awareness is crucial for the?early detection of BC. By adopting a sensitive and well-informed approach, we aim to improve the early detection of BC and help reduce its impact on South Asian communities. ", doi="10.2196/53969", url="https://humanfactors.jmir.org/2025/1/e53969" } @Article{info:doi/10.2196/53748, author="Ishaque, Sana and Ela, Ola and Rissel, Chris and Canuto, Karla and Hall, Kerry and Bidargaddi, Niranjan and Briley, Annette and Roberts, T. Claire and Perkes, Jane Sarah and Dowling, Anna and Bonevski, Billie", title="Cultural Adaptation of an Aboriginal and Torres Strait Islanders Maternal and Child mHealth Intervention: Protocol for a Co-Design and Adaptation Research Study", journal="JMIR Res Protoc", year="2025", month="Jan", day="10", volume="14", pages="e53748", keywords="Aboriginal", keywords="co-design", keywords="mHealth", keywords="maternal", keywords="child health", keywords="digital health", keywords="children", keywords="women", keywords="female", keywords="cultural adaptation", keywords="Torres Strait", keywords="research study", keywords="Indigenous", keywords="digital health intervention", keywords="diversity", keywords="South Australia", keywords="pregnant", keywords="health professional", keywords="adaption", keywords="focus group", keywords="pretesting", keywords="usability", keywords="app", keywords="health disparities", keywords="information", keywords="technology", keywords="mobile phone", abstract="Background: There is limited evidence of high-quality, accessible, culturally safe, and effective digital health interventions for Indigenous mothers and babies. Like any other intervention, the feasibility and efficacy of digital health interventions depend on how well they are co-designed with Indigenous communities and their adaptability to intracultural diversity. Objective: This study aims to adapt an existing co-designed mobile health (mHealth) intervention app with health professionals and Aboriginal and/or Torres Strait Islander mothers living in South Australia. Methods: Potential participants include Aboriginal and/or Torres Strait Islander pregnant women and mothers of children aged 0-5 years, non-Aboriginal and/or Torres Strait Islander women who are mothers of Aboriginal and/or Torres Strait Islander babies, and health professionals who predominantly care for Aboriginal and/or Torres Strait Islander mothers and babies. Participants will be recruited from multiple Aboriginal and/or Torres Strait Islander--specific health services under the local health networks around metropolitan South Australia. In this study, data collection will be carried out via culturally safe, and family-friendly yarning circles, facilitated by Aboriginal research staff to collect feedback on the existing mHealth app from approximately 20 women and 10 health professionals, with the aim to achieve data saturation. This will inform the changes required to the mHealth app. All focus groups and interviews will be audio recorded and transcribed verbatim. Data will be inductively analyzed using realist epistemology via NVivo software (Lumivero). Themes about the mHealth app's cultural acceptability, usability, and appropriateness will be used to inform the changes applied to the app. Results: With the feedback received from participating women and health professionals, changes in the smartphone app will be made to ensure the intervention is supportive and meets the needs of Aboriginal and/or Torres Strait Islander mothers and families in South Australia. Participation of community members will promote ownership, community engagement, and implementation. Conclusions: A co-designed, culturally sensitive, and effective digital health intervention is likely to support Indigenous mothers and their children facing health disparities due to the disruption of Indigenous culture by colaying a foundation for a potential clinical trial and wider implementation. International Registered Report Identifier (IRRID): PRR1-10.2196/53748 ", doi="10.2196/53748", url="https://www.researchprotocols.org/2025/1/e53748" } @Article{info:doi/10.2196/50058, author="Savargaonkar, Deepali and Srivastava, Bina and Yadav, Prakash Chander and Singh, Pal Mrigendra and Anvikar, Anup and Sharma, Amit and Singh, Himmat and Sinha, Abhinav", title="Contribution of Travelers to Plasmodium Vivax Malaria in South West Delhi, India: Cross-Sectional Survey", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="8", volume="11", pages="e50058", keywords="malaria", keywords="Plasmodium vivax", keywords="imported malaria", keywords="population movement", keywords="transmission", keywords="elimination", keywords="India", abstract="Background: India is committed to malaria elimination by the year 2030. According to the classification of malaria endemicity, the National Capital Territory of Delhi falls under category 1, with an annual parasite incidence of <1, and was targeted for elimination by 2022. Among others, population movement across states is one of the key challenges for malaria control, as it can result in imported malaria, thus introducing local transmission in an area nearing elimination. Objective: This descriptive study attempts to assess the contribution of such imported Plasmodium vivax cases to the malaria burden in South West Delhi (SWD). Methods: A cross-sectional study was carried out at the fever clinic of the Indian Council of Medical Research-National Institute of Malaria Research in SWD from January 2017 to December 2019. Demographic and travel history data were recorded for all P vivax confirmed malaria cases diagnosed at the fever clinic. Vector and fever surveys along with reactive case detection were conducted in SWD and Bulandshahr district of Uttar Pradesh, 1 of the 6 geographical sources for a high number of imported malaria cases. Results: A total of 355 P vivax malaria cases were reported during the study period. The proportion of imported cases was 63\% (n=222). Of these, 96\% (n=213) of cases were from Uttar Pradesh. The distribution of malaria cases revealed that imported cases were significantly associated with travel during the transmission season compared with that in the nontransmission season. Entomological and fever surveys and reactive case detection carried out in areas visited by imported P vivax malaria cases showed the presence of adults and larvae of Anopheles species and P vivax parasitemia. Conclusions: Population movement is a key challenge for malaria elimination. Although additional P vivax infections and vector mosquitoes were detected at places visited by the imported malaria cases, the inability to detect the parasite in mosquitoes and the possibility of relapses associated with P vivax limit the significance of malaria associated with the travel. However, there remains a need to address migration malaria to prevent the introduction and re-establishment of malaria in areas with very low or 0 indigenous cases. ", doi="10.2196/50058", url="https://publichealth.jmir.org/2025/1/e50058" } @Article{info:doi/10.2196/65912, author="Hossain, Tasnim Aniqa and Rahman, Hafizur Md and Manna, Maher Ridwana and Akter, Ema and Islam, Hasibul S. M. and Hossain, Alamgir Md and Ara, Tasnu and Usmani, Ghani Nasimul and Chandra, Pradip and Khan, Ahmed Maruf and Rahman, Mustafizur S. M. and Ahmed, Uddin Helal and Mozumder, Kamruzzaman Muhammad and Juthi, Mahmuda Jesmin and Shahrin, Fatema and Shams, Afrose Sadia and Afroze, Fahmida and Banu, Jahan Mukta and Ameen, Shafiqul and Jabeen, Sabrina and Ahmed, Anisuddin and Amin, Robed Mohammad and Arifeen, El Shams and Shomik, Sohel Mohammad and Rahman, Ehsanur Ahmed", title="Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="3", volume="8", pages="e65912", keywords="Wellbeing Centers", keywords="antepartum", keywords="postpartum", keywords="depression", keywords="anxiety", keywords="implementation", abstract="Background: Globally, 10\% of pregnant women and 13\% of postpartum women experience mental disorders. In Bangladesh, nearly 50\% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh's Non-Communicable Disease Control program initiated ``Wellbeing Centers,'' telemental health services in selected public hospitals. Objective: This study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. Methods: Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization's implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95\% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. Results: Almost all health care providers (165/168, 98.2\%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50\%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8\%), useful (909/911, 99.8\%), and enhanced access to mental health care (906/911, 99.5\%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95\% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4\% (705/911) of women experienced depression symptoms, and 76.7\% (699/911) experienced anxiety symptoms. About 51.8\% (472/911) experienced tiredness or lack of energy, 50.9\% (464/911) felt nervous, anxious, or on edge, 57.2\% (521/911) felt worried, and 3.8\% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95\% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers' services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. Conclusions: To our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings. ", doi="10.2196/65912", url="https://pediatrics.jmir.org/2025/1/e65912" } @Article{info:doi/10.2196/46566, author="Khatun, Fatema and Das, Chandra Novel and Hoque, Rakibul Md and Saqeeb, Nazmus Kazi and Rahman, Monjur and Park, Ryul Kyung and Rasheed, Sabrina and Reidpath, D. Daniel", title="Users' Perceived Service Quality of National Telemedicine Services During the COVID-19 Pandemic in Bangladesh: Cross-Sectional Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="23", volume="11", pages="e46566", keywords="telemedicine", keywords="COVID-19", keywords="LMIC", keywords="low- and middle-income countries", keywords="Bangladesh", keywords="service quality", keywords="user satisfaction", keywords="structural equation modeling", keywords="digital health", abstract="Background: COVID-19 created an opportunity for using teleconsultation as an alternative way of accessing expert medical advice. Bangladesh has seen a 20-fold increase in the use of teleconsultation during the pandemic. Objective: The aim of our study was to assess the influence of service quality and user satisfaction on the intention to use teleconsultation in the future among users of national teleconsultation services during the pandemic. Methods: A cross-sectional survey was conducted in 2020 among users of the national teleconsultation service---Shastho Batayon for acute respiratory infection. A validated mobile health service quality model based on structural equation modeling and confirmatory factor analysis was used to analyze the data with SmartPLS (version 3.0). Results: Among the 2097 study participants, 1646 (78.5\%) were male, 1416 (67.5\%) were aged 18?39 years, 1588 (75.7\%) were urban residents, 1348 (64.2\%) had more than 10 years of schooling, and 1657 (79\%) were from middle-income households. From a consumer perspective, the quality of the service platform ($\beta$=.946), service interaction ($\beta$=.974), and outcome ($\beta$=.955) contributed to service quality. Service quality was positively associated with user satisfaction ($\beta$=.327; P<.001) and intention to use teleconsultation services ($\beta$=.102; P<.001). User satisfaction was positively associated with the intention to use teleconsultation services ($\beta$=.311; P<.001). Conclusions: The increase in the use of teleconsultation during the pandemic indicated that such services were potentially used for emergencies. However, the future use of teleconsultation will be dependent on the quality of service and user satisfaction. Our findings are relevant for low-income contexts where teleconsultation services are used to address gaps in service delivery. ", doi="10.2196/46566", url="https://humanfactors.jmir.org/2024/1/e46566" } @Article{info:doi/10.2196/54240, author="Brice, N. Syaribah and Boutilier, J. Justin and Palmer, Geraint and Harper, R. Paul and Knight, Vincent and Tuson, Mark and Gartner, Daniel", title="Close-Up on Ambulance Service Estimation in Indonesia: Monte Carlo Simulation Study", journal="Interact J Med Res", year="2024", month="Dec", day="13", volume="13", pages="e54240", keywords="emergency medical services", keywords="ambulance services", keywords="hospital emergency services", keywords="Southeast Asian countries", keywords="low-and-middle-income countries", keywords="EMS", keywords="survey", abstract="Background: Emergency medical services have a pivotal role in giving timely and appropriate responses to emergency events caused by medical, natural, or human-caused disasters. To provide adequate resources for the emergency services, such as ambulances, it is necessary to understand the demand for such services. In Indonesia, estimates of demand for emergency services cannot be obtained easily due to a lack of published literature or official reports concerning the matter. Objective: This study aimed to ascertain an estimate of the annual volume of hospital emergency visits and the corresponding demand for ambulance services in the city of Jakarta. Methods: In this study, we addressed the problem of emergency services demand estimation when aggregated detailed data are not available or are not part of the routine data collection. We used survey data together with the local Office of National Statistics reports and sample data from hospital emergency departments to establish parameter estimation. This involved estimating 4 parameters: the population of each area per period (day and night), the annual per capita hospital emergency visits, the probability of an emergency taking place in each period, and the rate of ambulance need per area. Monte Carlo simulation and na{\"i}ve methods were used to generate an estimation for the mean ambulance needs per area in Jakarta. Results: The results estimated that the total annual ambulance need in Jakarta is between 83,000 and 241,000. Assuming the rate of ambulance usage in Jakarta at 9.3\%, we estimated the total annual hospital emergency visits in Jakarta at around 0.9-2.6 million. The study also found that the estimation from using the simulation method was smaller than the average (na{\"i}ve) methods (P<.001). Conclusions: The results provide an estimation of the annual emergency services needed for the city of Jakarta. In the absence of aggregated routinely collected data on emergency medical service usage in Jakarta, our results provide insights into whether the current emergency services, such as ambulances, have been adequately provided. ", doi="10.2196/54240", url="https://www.i-jmr.org/2024/1/e54240" } @Article{info:doi/10.2196/55189, author="Greenall-Ota, Josephine and Yapa, Manisha H. and Fox, J. Greg and Negin, Joel", title="Qualitative Evaluation of mHealth Implementation for Infectious Disease Care in Low- and Middle-Income Countries: Narrative Review", journal="JMIR Mhealth Uhealth", year="2024", month="Dec", day="13", volume="12", pages="e55189", keywords="mHealth", keywords="implementation", keywords="LMIC", keywords="infectious diseases", keywords="Tailored Implementation for Chronic Diseases", keywords="mobile phone", keywords="interventions", keywords="short messaging service", keywords="chronic disease", keywords="narrative review", keywords="barrier", keywords="mHealth intervention", keywords="infectious disease", keywords="screening", keywords="community", keywords="design", keywords="health system", keywords="SMS", keywords="app", abstract="Background: Mobile health (mHealth) interventions have the potential to improve health outcomes in low- and middle-income countries (LMICs) by aiding health workers to strengthen service delivery, as well as by helping patients and communities manage and prevent diseases. It is crucial to understand how best to implement mHealth within already burdened health services to maximally improve health outcomes and sustain the intervention in LMICs. Objective: We aimed to identify key barriers to and facilitators of the implementation of mHealth interventions for infectious diseases in LMICs, drawing on a health systems analysis framework. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to select qualitative or mixed methods studies reporting on determinants of already implemented infectious disease mHealth interventions in LMICs. We searched MEDLINE, Embase, PubMed, CINAHL, the Social Sciences Citation Index, and Global Health. We extracted characteristics of the mHealth interventions and implementation experiences, then conducted an analysis of determinants using the Tailored Implementation for Chronic Diseases framework. Results: We identified 10,494 titles for screening, among which 20 studies met our eligibility criteria. Of these, 9 studies examined mHealth smartphone apps and 11 examined SMS text messaging interventions. The interventions addressed HIV (n=7), malaria (n=4), tuberculosis (n=4), pneumonia (n=2), dengue (n=1), human papillomavirus (n=1), COVID-19 (n=1), and respiratory illnesses or childhood infectious diseases (n=2), with 2 studies addressing multiple diseases. Within these studies, 10 interventions were intended for use by health workers and the remainder targeted patients, at-risk individuals, or community members. Access to reliable technological resources, familiarity with technology, and training and support were key determinants of implementation. Additional themes included users forgetting to use the mHealth interventions and mHealth intervention designs affecting ease of use. Conclusions: Acceptance of the intervention and the capacity of existing health care system infrastructure and resources are 2 key factors affecting the implementation of mHealth interventions. Understanding the interaction between mHealth interventions, their implementation, and health systems will improve their uptake in LMICs. ", doi="10.2196/55189", url="https://mhealth.jmir.org/2024/1/e55189" } @Article{info:doi/10.2196/60869, author="Atigossou, Gb{\`e}toho Orthelo L{\'e}onel and Capo-chichi, Martial S{\`e}gb{\'e}dji Joseph and Mitcha?, Mahutchegnon Penielle and Honado, S. Aristide", title="Evaluating the Impact of Assistive Technologies on Individuals With Disabilities in Benin: Protocol for a Cross-Sectional Study", journal="JMIR Res Protoc", year="2024", month="Dec", day="9", volume="13", pages="e60869", keywords="assistive technologies", keywords="assistive technology assessment", keywords="individuals with disabilities", keywords="disabilities", keywords="cross-sectional study", keywords="well-being", keywords="quality of life", keywords="effects", keywords="Benin", abstract="Background: A significant proportion of individuals with disabilities in resource-limited countries require at least 1 assistive technology (AT) device to enhance their functioning and autonomy. However, there is limited evidence regarding the actual needs of AT users in these regions concerning the adequacy of ATs. Objective: This research aims to assess the effects of ATs on AT users in a resource-limited country. Methods: A cross-sectional study will be conducted in Benin, a sub-Saharan African country, using a nonprobability sample of AT users. Participants will undergo evaluation using standardized tools to assess their psycho-affective status, satisfaction with ATs, perception of the functional effects of ATs, well-being, and quality of life. Additionally, a survey based on the World Health Organization's rATA (rapid assistive technology assessment) tool will be conducted to gather sociodemographic and other data concerning the use of ATs. The findings will be organized and discussed using the Consortium on Assistive Technology Outcomes Research taxonomy, focusing on aspects related to the effectiveness and social significance of ATs, as well as the subjective well-being of AT users. Results: The process of identifying potential participants began in August 2024, and data collection is scheduled to start in January 2025 and continue for 12 months. Conclusions: This research will provide an overview of the effects induced by the use of ATs, as well as describe the profile of AT users in Benin. To our knowledge, this will be the first study to examine the impact of ATs in Benin. It will therefore make a significant contribution to the existing data on the use of ATs in sub-Saharan Africa. International Registered Report Identifier (IRRID): PRR1-10.2196/60869 ", doi="10.2196/60869", url="https://www.researchprotocols.org/2024/1/e60869" } @Article{info:doi/10.2196/59621, author="Joshi, Anushree and Panchamia, Jallavi and Pandya, Apurvakumar", title="Incentivizing Rural Work Preferences Among Specialist Physicians: Protocol for a Discrete Choice Experiment", journal="JMIR Res Protoc", year="2024", month="Dec", day="9", volume="13", pages="e59621", keywords="discrete choice experiment", keywords="specialist physicians", keywords="community health centers", keywords="rural retention", keywords="policy interventions", abstract="Background: Retaining specialist physicians in rural parts of India poses a fundamental challenge, which affects the health care system's functionality and provision of standard health care services. There has been an acute shortfall of specialist physicians in the fields of medicine, pediatrics, obstetrics and gynecology, and surgery at rural community health centers. This necessitates urgent policy focus to address the shortages and design effective rural retention strategies. In this study, which uses a discrete choice experiment (DCE), individuals choose from multiple-choice preferences that resemble hypothetical job descriptions. Objective: DCEs are a quantitative approach to assessing several aspects of job selection. This study aims to develop a detailed plan of a DCE method used to determine specialist physicians' job choices. This protocol outlines the DCE method, which uses an exploratory sequential mixed methods research design to understand specialist physicians' preferences and design reward packages that would effectively motivate them to work in underserved regions. Methods: The qualitative phase of the study involved identifying job attributes and their corresponding levels for the DCE. We followed a meticulous process, which included reviewing relevant literature, performing qualitative pilot work, conducting in-depth individual interviews, and consulting with medical and health experts.?The quantitative phase involved generating a D-efficient orthogonal fractional factorial design using Ngene software to create choice scenarios using the identified job factors and their corresponding levels. The generated choice scenarios were blocked into 6 versions in 6 blocks. The DCE was?undertaken among final-year postgraduate medical residents and specialist physicians from several health care facilities in Rajasthan. Various statistical models will be applied to explore the response variability and quantify the trade-offs that participants are willing to make for nonmonetary features as a substitute for adjustments in the monetary attribute. Results: After the ethics committee's approval of the study, the qualitative data collection phase occurred from September to December 2021, while the quantitative phase took place from May to August 2022. Six attributes and 14 levels were identified and established through qualitative surveys. The experimental design resulted in 36 choice situations, which were grouped into 6 blocks. The preliminary investigation demonstrated that the instrument was valid and reliable. Statistical data analysis has been initiated, and the principal findings are expected to be disseminated in January 2025. Conclusions: The protocol provides a systematic framework to assess specialist physicians' preferences regarding working in rural health care centers. This research has the potential to substantially influence the future of rural health care by laying the foundation for understanding specialist physicians' choices, which will help design future incentive schemes, policy interventions, and research. International Registered Report Identifier (IRRID): DERR1-10.2196/59621 ", doi="10.2196/59621", url="https://www.researchprotocols.org/2024/1/e59621" } @Article{info:doi/10.2196/58076, author="Srinor, Watcharapol and Tanpradech, Suvimon and Thiengtham, Panupit and Karuchit, Samart and Naksuk, Charif and Yingyong, Thitipong and Naiwatanakul, Thananda and Northbrook, Sanny and Hladik, Wolfgang", title="Web-Based Respondent-Driven Sampling to Assess Biobehavioral Factors Among Men Who Have Sex With Men in Thailand: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="6", volume="10", pages="e58076", keywords="online respondent-driven sampling", keywords="HIV", keywords="men who have sex with men", keywords="MSM", keywords="Bangkok", keywords="health clinic", keywords="public health", keywords="testing", keywords="stigma", keywords="online testing", keywords="HIV prevention", keywords="research data collection", abstract="Background: Respondent-driven sampling (RDS) is the current standard for sampling key populations at risk for HIV infections but is usually limited to local implementation in single towns or cities. Web-based sampling eliminates this spatial constraint but often relies on self-selected convenience samples. We piloted a web-based RDS survey with biomarker collection among men who have sex with men (MSM) in Thailand. Objective: This study aimed to evaluate and demonstrate the feasibility of implementing a web-based RDS survey as a routine surveillance system in Thailand. The goal was to enhance surveillance efforts targeting hard-to-reach populations in the country. Methods: We developed a website to fully function like a conventional RDS survey office, including coupon verification, eligibility screening, consenting, interviewing (self-administered), peer recruitment training, coupon issuance, compensation, and recruitment tracking. All functions were automated; data managers monitored recruitment, data collection, and payment and could be contacted by recruits as needed. Eligible participants were male, older than 15 years, resided in Thailand, and had anal sex with a man in the past 6 months. Recruits who resided in Bangkok were additionally invited to physically attend a participating health clinic of their choice for an HIV-related blood draw. Data were weighted to account for the complex sampling design. Results: The survey was implemented from February to June 2022; seeds (21 at start, 14 added later) were identified mostly through targeted web-based banner ads; coupon uptake was 45.1\%. Of 2578 candidate recruits screened for eligibility, 2151 (83.4\%) were eligible and 2142 (83.1\%) enrolled. Almost all (2067/2578, 80.2\%) completed the questionnaire; however, 318 survey records were removed from analysis as fraudulent enrollments. The final sample size was 1749, the maximum number of waves achieved was 191, and sampling covered all 6 geographic regions and 75 of 77 (97.4\%) provinces; convergence was reached for several salient variables. The mean age was 20.5 (SD 4.0) years, and most (69.8\%) had never tested for HIV before, with fear of stigma as the biggest reason (97.1\%) for not having tested. Most (76.9\%) had visited gay-focused physical venues several times a week. A condom was used in 97.6\% of the last sex acts, 11.0\% had purchased sex from other men (past 12 mo), 4.5\% had sold sex to men (past 12 mo), and 95.3\% had 3+ male sex partners (last 3 mo). No participant in Bangkok presented for a blood draw. Conclusions: We successfully conducted a web-based RDS survey among MSM in Thailand, covering nearly the entire country, although, as in physical RDS surveys, sampling was dominated by younger MSM. The survey also failed to collect biomarkers in Bangkok. Public health interventions should aim at increasing testing and addressing (the perception of) stigma. ", doi="10.2196/58076", url="https://publichealth.jmir.org/2024/1/e58076" } @Article{info:doi/10.2196/63454, author="Dol, Justine and Mselle, Teddy Lilian and Campbell-Yeo, Marsha and Mbekenga, Columba and Kohi, Thecla and McMillan, Douglas and Dennis, Cindy-Lee and Tomblin Murphy, Gail and Aston, Megan", title="Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Dec", day="5", volume="13", pages="e63454", keywords="mobile health", keywords="maternal health", keywords="randomized controlled trial", keywords="parenting self-efficacy", keywords="self-efficacy", keywords="maternal", keywords="RCT", keywords="mother", keywords="text message", keywords="coaching", keywords="postnatal", keywords="newborn", keywords="child", keywords="low-income country", keywords="middle-income country", keywords="Africa", keywords="newborn care education", keywords="nurse midwife", keywords="Tanzania", abstract="Background: Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. Objective: We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. Methods: ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Results: Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. Conclusions: This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. Trial Registration: ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305 International Registered Report Identifier (IRRID): DERR1-10.2196/63454 ", doi="10.2196/63454", url="https://www.researchprotocols.org/2024/1/e63454" } @Article{info:doi/10.2196/63276, author="Abdulai, Ratif and Phalane, Edith and Atuahene, Kyeremeh and Phaswana-Mafuya, Nancy Refilwe", title="Consistent and Correct Use of Condoms With Lubricants and Associated Factors Among Men Who Have Sex With Men from the Ghana Men's Study II: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2024", month="Dec", day="3", volume="13", pages="e63276", keywords="men who have sex with men", keywords="consistent condom use", keywords="HIV", keywords="Ghana Men's Study", keywords="condom", keywords="Ghana", keywords="Africa", keywords="mixed methods", keywords="protocol", keywords="lubricant", keywords="qualitative", keywords="quantitative", abstract="Background: Men who have sex with men (MSM) experience a disproportionate burden of HIV infection globally, including in Ghana. The use of condoms with lubricants correctly and consistently plays a vital role in reducing the number of new HIV infections among MSM. However, there are concerns about the consistent and correct use of condoms and lubricants among MSM in Ghana. In this regard, there is a need to understand context-specific factors associated with consistent and correct condom use with lubricants. Objective: This study aims to determine the current scope of consistent and correct use of condoms with lubricants, associated factors, interventions, and user- and service-related challenges on correct condom and lubricant use among the MSM population in Ghana. Methods: The study will use a mixed methods study approach. First, a retrospective analysis of the Ghana Men's Study II data set involving 4095 MSM will be conducted to determine the scope of consistency and correct use of condoms with lubricants as well as associated factors. The data will be imported into STATA (version 17; StataCorp LLC) to treat missing data and outliers before the analysis. Bivariate and multivariate logistic regression analyses will be conducted to determine the associated factors of consistent condom use with lubricants. All statistical analyses will be done at a 95\% CI, with significant differences at P<.05. Second, in-depth interviews with a purposive sample of about 15-20 stakeholders will also be conducted to understand contextual issues regarding the factors identified, identify existing interventions for correct condom and lubricant use, user and service-related challenges, and how best to address those challenges from the stakeholders' perspectives. For qualitative data, thematic analysis will be conducted using Atlas.ti version 23.1.1. Results: Qualitative and quantitative results will be triangulated together with systematic review results, and key findings will be highlighted and used to guide the development of a predictive model for improving correct and consistent condom use with lubrication among MSM. This protocol paper, part of a doctoral study by the first author (RA), received approval from the Research and Ethics Committee of the University of Johannesburg on May 10, 2024. Data collection commenced on August 20, 2024, and the expected results will be published by October 2025. Conclusions: Results from qualitative interviews and secondary data analysis will be triangulated to develop a predictive model to strengthen the correct and consistent use of condoms with condom-compatible lubricants among MSM and other key population groups in Ghana and other parts of sub-Saharan Africa for future pandemic preparedness, policy making, and targeted budget allocation. International Registered Report Identifier (IRRID): DERR1-10.2196/63276 ", doi="10.2196/63276", url="https://www.researchprotocols.org/2024/1/e63276" } @Article{info:doi/10.2196/60805, author="Thomas, Joe and Jose, Maria and Rajmohan, Priyanka and Fathima, Naaz Farah and Moosan, Hisham and Jose, K. Nisha and Anish, Surendran Thekkumkara and Bairwa, Mohan and Goswami Mahanta, Tulika and Apte, Aditi and Cherian, Jose Jerin and Kuttichira, Praveenlal and Varma P, Prasad Ravi", title="Development and Validation of a Novel Tool to Measure Medication Adherence for Noncommunicable Diseases in India: Protocol for an Exploratory Sequential Mixed Methods Multicentric Study", journal="JMIR Res Protoc", year="2024", month="Dec", day="3", volume="13", pages="e60805", keywords="medication adherence", keywords="noncommunicable diseases", keywords="self-report", keywords="psychometric properties", keywords="validation", keywords="reproducibility of results", abstract="Background: In high-income countries, only 50\% of patients treated for chronic diseases adhere to the prescribed treatment. This issue is even more pronounced in resource-limited countries. Medication adherence scales are simple, low-cost approaches to identify nonadherence in clinical practice. In India, nonadherence to medication varies from 18.7\% to 74\%, assessed using scales validated in the Western population, as there is no validated medication adherence tool contextualized to the Indian setting. The phrasing of questions in scales validated elsewhere and its interpretations may vary when applied in Indian patients unless accounting for the unique cultural, social, and economic factors influencing medication adherence in India. This could result in inaccurate reports of adherence behavior. Objective: This study aims to develop and validate a novel medication adherence tool for select noncommunicable diseases (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, bronchial asthma, and coronary artery disease) in the Indian population. Methods: An exploratory sequential mixed methods design will be used, beginning with a qualitative phase where the construct of the scale is defined and preliminary items are generated through a scoping review, focus group discussions, and in-depth interviews. This will be followed by the tool's development phase, including an expert panel review and item revision. Finally, a quantitative phase in 4 zones in India (North, South, East, and West) will be conducted to confirm and validate the newly developed scale. Results: In the first phase, we will frame the construct definition and develop an inventory of potential items for the proposed medication adherence tool. In the second phase, item-level and scale-level content validity indices, along with content validity ratio, will be estimated. In the third phase, we will conduct an item reduction analysis and determine the scoring matrix and item weightage after expert review. We will assess the tool's psychometric properties, plot the receiver operating characteristic (ROC) curve to set an adherence cut-off score, and compute the construct validity and test-retest reliability from the quantitative survey. Conclusions: A medication adherence tool for noncommunicable diseases, developed after ensuring it is ethnically, culturally, and linguistically appropriate incorporating stakeholder perspectives and validated in community settings, would offer a real-world perspective of adherence. The tool will have 2 versions for clinical practice and research, aiding policy makers in adopting tailored adherence policies. International Registered Report Identifier (IRRID): PRR1-10.2196/60805 ", doi="10.2196/60805", url="https://www.researchprotocols.org/2024/1/e60805", url="http://www.ncbi.nlm.nih.gov/pubmed/39625743" } @Article{info:doi/10.2196/63415, author="Brugger, Curdin and Dietler, Dominik and Abu Hamad, A. Bassam and van Gastel, Tammo and Sittaro, Federico and Rossi, Rodolfo and Owen, Nia Branwen and Probst-Hensch, Nicole and Winkler, S. Mirko", title="Assessment of Health and Well-Being Effects Associated With the Challenging Drinking Water Situation in the Gaza Strip: Protocol for a Cross-Sectional Household Survey Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="29", volume="13", pages="e63415", keywords="drinking water", keywords="water quality", keywords="households survey", keywords="noncommunicable diseases", keywords="protracted conflict", keywords="humanitarian crisis", keywords="Gaza Strip", keywords="well-being", abstract="Background: The water supply in the Gaza Strip, Palestine, has been unstable and under strain for decades, resulting in major issues with drinking water quality, reliability, and acceptability. In 2018, between 25\% and 30\% of Gazans did not have regular access to running water. The progressive deterioration of water infrastructure and concerns over the quality of piped water have resulted in a complex mix of drinking water sources used in the Gaza Strip. The challenges of safe water provision in the Gaza Strip could potentially have severe adverse effects on the population's health and well-being. Objective: The main objectives of this survey are to determine the quality of drinking water at the household level and to investigate the association of various health outcomes with water quality at the household level in the Gaza Strip. Methods: We conducted a cross-sectional household survey in the North Gaza, Gaza, and Rafah governorates between January and March 2023. We selected a subsample of households from a representative cross-sectional survey conducted in the Gaza Strip in 2020 with persons aged 40 years and older. From each household in the 2023 survey, we invited 3 individuals (2 older than 40 years and 1 between 18 and 30 years) to participate. The face-to-face interview included questions on drinking water, mental health and well-being, self-reported diagnoses for selected diseases, use of antibiotics, and knowledge about antimicrobial resistance. Additionally, we measured each participant's blood pressure. We sampled drinking water from each household and analyzed the samples for microbial contamination, nitrate, sodium, and mineral content. Results: In total, we visited 905 households and interviewed 2291 participants. In both age groups, more female participants were interviewed. A total of 56.60\% (914/1615) were aged ?40 years, and 58.9\% (398/676) were aged between 18 and 30 years. We obtained water samples from nearly all households (902/905, 99.8\%). The results are expected to be published in several papers in 2025. Conclusions: The extensive survey components, coupled with drinking water testing and building on an existing survey, allowed us to identify a broad set of potential impacts on health and well-being and to track changes over time. This study intends to identify humanitarian and development interventions that could impact the population served most. However, we completed data collection before the escalation of violence in October 2023. Given the impact of the still ongoing conflict, the initial intent of this work is no longer valid. However, the results emerging from the survey may still serve as a valuable baseline to assess the impacts of the current escalations on physical and mental health and on drinking water quality. In addition, our findings could provide important information for rebuilding the Gaza Strip in a more health-promoting way. International Registered Report Identifier (IRRID): DERR1-10.2196/63415 ", doi="10.2196/63415", url="https://www.researchprotocols.org/2024/1/e63415", url="http://www.ncbi.nlm.nih.gov/pubmed/39612204" } @Article{info:doi/10.2196/63376, author="Mosnier, Emilie and S{\'e}g{\'e}ral, Olivier and Neth, Sansothy and Sagaon-Teyssier, Luis and Khuon, Dyna and Phoeung, Leakhena Chan and Mam, Sovatha and Chhay, Chhingsrean and Heang, Kimeang and Duclos-Vall{\'e}e, Charles Jean and Saphonn, Vonthanak", title="Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia: The ANRS 12384 CAM-C Cluster Randomized Controlled Trial---Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="20", volume="13", pages="e63376", keywords="hepatitis C virus", keywords="HCV", keywords="community-based intervention", keywords="cluster randomized controlled trial", keywords="Cambodia", keywords="cost-effectiveness analysis", keywords="qualitative analysis", abstract="Background: In Cambodia, hepatitis C constitutes a significant public health challenge, particularly among older adults (>45 years) for whom prevalence is estimated to be 5\%. To facilitate the elimination of hepatitis C among the general population, enhancing access to screening and treatment is imperative. In this regard, the evaluation of community-based screening programs emerges as a crucial step toward improving health care accessibility. Objective: This study aims to assess the comparative efficacy of a community-based versus a facility-based approach in enhancing the uptake of hepatitis C antibody testing among the general population older than 40 years of age in Cambodia. Methods: The CAM-C (Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia) study uses a cluster-randomized controlled trial design across two Cambodian provinces to compare community-based and facility-based hepatitis testing interventions. Sampling involves a multistage cluster approach, targeting individuals older than 40 years of age due to their higher prevalence and risk of chronic hepatitis complications. This study incorporates a qualitative analysis of acceptability and a cost-effectiveness comparison. Interventions include facility-based testing with subsequent referral and community-based testing with direct in-home assessments. Follow-up for positive cases involves comprehensive management and potential direct-acting antiviral treatment. This study aims to identify a significant increase in testing uptake, requiring the screening of 6000 individuals older than 40 years of age, facilitated by a structured sampling and intervention approach to minimize contamination risks. Results: The final protocol including the quantitative, qualitative, and cost-effectiveness part of the study was registered and was approved in 2019 by the National Ethical Cambodian for Health Research. Inclusions were completed by mid-2024, with analyses starting in May 2024. Conclusions: Using a mixed methods approach that combines a robust methodology (cluster-randomized controlled trial) with a cost-effectiveness analysis and qualitative research, such a study should provide invaluable information to guide the Ministry of Health in its hepatitis C virus screening strategy and move toward elimination. Trial Registration: ClinicalTrials.gov NCT03992313; https://clinicaltrials.gov/study/NCT03992313 International Registered Report Identifier (IRRID): DERR1-10.2196/63376 ", doi="10.2196/63376", url="https://www.researchprotocols.org/2024/1/e63376" } @Article{info:doi/10.2196/63298, author="Albor, Yesica and Gonz{\'a}lez, No{\'e} and Benjet, Corina and Salamanca-Sanabria, Alicia and Hern{\'a}ndez-de la Rosa, Cristiny and Eslava-Torres, Viridiana and Garc{\'i}a-Alfaro, Carolina Mar{\'i}a and Melchor-Audirac, Andr{\'e}s and Montoya-Montero, Itzel Laura and Su{\'a}rez, Karla", title="Cultural Adaptation and User Satisfaction of an Internet-Delivered Cognitive Behavioral Program for Depression and Anxiety Among College Students in Two Latin American Countries: Focus Group Study With Potential Users and a Cross-Sectional Questionnaire Study With Actual Users", journal="JMIR Form Res", year="2024", month="Nov", day="15", volume="8", pages="e63298", keywords="culturally competent care", keywords="mental health", keywords="digital health", keywords="student health services", keywords="Colombia", keywords="Mexico", keywords="SilverCloud", keywords="anxiety", keywords="depression", abstract="Background: To scale up mental health care in low-resource settings, digital interventions must consider cultural fit. Despite the findings that culturally adapted digital interventions have greater effectiveness, there is a lack of empirical evidence of interventions that have been culturally adapted or their adaptation documented. Objective: This study aimed to document the cultural adaptation of the SilverCloud Health Space from Depression and Anxiety program for university students in Colombia and Mexico and evaluate user satisfaction with the adapted program. Methods: A mixed methods process was based on Cultural Sensitivity and Ecological Validity frameworks. In phase 1, the research team added culturally relevant content (eg, expressions, personal stories, photos) for the target population to the intervention. In phase 2, potential users (9 university students) first evaluated the vignettes and photos used throughout the program. We calculated median and modal responses. They then participated in focus groups to evaluate and assess the cultural appropriateness of the materials. Their comments were coded into the 8 dimensions of the Ecological Validity Framework. Phase 3 consisted of choosing the vignettes most highly rated by the potential users and making modifications to the materials based on the student feedback. In the final phase, 765 actual users then engaged with the culturally adapted program and rated their satisfaction with the program. We calculated the percentage of users who agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them attain their goals. Results: The potential users perceived the original vignettes as moderately genuine, or true, which were given median scores between 2.5 and 3 (out of a possible 4) and somewhat identified with the situations presented in the vignettes given median scores between 1.5 and 3. The majority of comments or suggestions for modification concerned language (126/218, 57.5\%), followed by concepts (50/218, 22.8\%). Much less concerned methods (22/218, 10\%), persons (9/218, 4.1\%), context (5/218, 2.3\%), or content (2/218, 0.9\%). There were no comments about metaphors or goals. Intervention materials were modified based on these results. Of the actual users who engaged with the adapted version of the program, 87.7\%-96.2\% of them agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them to attain their goals. Conclusions: We conclude that the adapted version is satisfactory for this population based on the focus group discussions and the satisfaction scores. Conducting and documenting such cultural adaptations and involving the users in the cultural adaptation process will likely improve the effectiveness of digital mental health interventions in low- and middle-income countries and culturally diverse contexts. ", doi="10.2196/63298", url="https://formative.jmir.org/2024/1/e63298" } @Article{info:doi/10.2196/58624, author="Reynolds, W. Christopher and Lee, HaEun and Sieka, Joseph and Perosky, Joseph and Lori, R. Jody", title="Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="13", volume="12", pages="e58624", keywords="mHealth", keywords="mobile triage", keywords="referral pathways", keywords="Liberia", keywords="LMIC", keywords="low- income country", keywords="obstetric triage", keywords="third delay", keywords="mobile health", keywords="mobile application", keywords="digital health", keywords="digital intervention", keywords="smartphone", keywords="middle-income country", abstract="Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61\%), nurses (20/62, 32\%), physicians assistants (3/62, 5\%), and physicians (1/62, 2\%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100\%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92\%), increasing health worker attentiveness (39/62, 63\%), and contributing to improved patient care (34/62, 55\%). MORES was perceived as sustainable and scalable (62/62, 100\%), particularly if technological barriers (21/62, 34\%) and staff training (19/62, 31\%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89\%), feedback mechanisms for hospitals and RHFs (48/62, 77\%), interprofessional teamwork (21/62, 34\%), longitudinal follow-up care (20/62, 32\%), creating a record of care delays (17/62, 27\%), and electronic health record infrastructure (13/62, 21\%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. ", doi="10.2196/58624", url="https://mhealth.jmir.org/2024/1/e58624" } @Article{info:doi/10.2196/48664, author="Gulzar, Saleema and Rahim, Shirin and Dossa, Khadija and Saeed, Sana and Agha, Insiyah and Khoja, Shariq and Karmaliani, Rozina", title="Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Nov", day="12", volume="8", pages="e48664", keywords="teleconsultation", keywords="digital health", keywords="school health", keywords="child health", keywords="information technology", keywords="eConsultation", keywords="telehealth", abstract="Background: In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. Objective: This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. Methods: This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. Results: A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3\%, 233/393). Only 1.24\% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. Conclusions: This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue. ", doi="10.2196/48664", url="https://formative.jmir.org/2024/1/e48664" } @Article{info:doi/10.2196/57609, author="Liu, Yayuan and Jin, Haofeng and Yu, Zhuoyuan and Tong, Yu", title="Impact of Internet Hospital Consultations on Outpatient Visits and Expenses: Quasi-Experimental Study", journal="J Med Internet Res", year="2024", month="Nov", day="11", volume="26", pages="e57609", keywords="internet hospital", keywords="online consultation", keywords="telehealth", keywords="outpatient visits", keywords="outpatient expenses", keywords="urban-rural healthcare disparity", abstract="Background: Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients' offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. Objective: This study aimed to analyze the impact of patients' adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. Methods: The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Results: Our findings highlight 3 key results. First, patients' adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4\% per month (P<.001), and the associated expenses by 15.5\% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1\% increase in the distance between patients' residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3\% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4\% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. Conclusions: This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients' adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients' urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals. ", doi="10.2196/57609", url="https://www.jmir.org/2024/1/e57609" } @Article{info:doi/10.2196/55140, author="Han, Tao and Wei, Qinpeng and Wang, Ruike and Cai, Yijin and Zhu, Hongyi and Chen, Jiani and Zhang, Zhiruo and Li, Sisi", title="Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire", journal="J Med Internet Res", year="2024", month="Nov", day="8", volume="26", pages="e55140", keywords="service quality", keywords="SERVQUAL", keywords="Service Quality Questionnaire", keywords="internet hospital", keywords="e-hospital", keywords="digital medical care", keywords="health care professionals", keywords="Chinese digital health care", abstract="Background: Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. Objective: This study aims to investigate the current status of patients' use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients' expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients' overall satisfaction toward associated medical platforms. Methods: This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Results: Among the surveyed participants, 51.2\% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8\%) did not know internet hospital services well, 68.1\% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. Conclusions: In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients' familiarity with and willingness to use these services. ", doi="10.2196/55140", url="https://www.jmir.org/2024/1/e55140" } @Article{info:doi/10.2196/58711, author="Jordan, Arne and Nothacker, Julia and Paucke, Valentina and Hager, Heinz Klaus and Hueber, Susann and Karimzadeh, Arian and K{\"o}tter, Thomas and L{\"o}ffler, Christin and M{\"u}ller, Sigrid Beate and Tajdar, Daniel and L{\"u}hmann, Dagmar and Scherer, Martin and Sch{\"a}fer, Ingmar", title="Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="4", volume="10", pages="e58711", keywords="climate change", keywords="online survey", keywords="open internet data", keywords="climate", keywords="environment", keywords="rising temperature", keywords="heatexposure", keywords="chronic disease management", keywords="epidemiology", abstract="Background: As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients' issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear. Objective: This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints. Methods: We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites). Results: Of the 291 eligible patients, 61 (21.0\%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51\%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38\%) and diabetes mellitus (n=20, 33\%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9\%) and shortness of breath (142/294 observations, 48.3\%). Compared with temperatures of 27{\textdegree}C or lower, a heat index between over 27{\textdegree}C and 32{\textdegree}C ($\beta$=1.02, 95\% CI 0.08-1.96, P=.03) and over 32{\textdegree}C ($\beta$=1.35, 95\% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy ($\beta$=--0.25, 95\% CI --0.49 to --0.01, P=.04) and better self-reported protective behavior ($\beta$=0.65, 95\% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy ($\beta$=--0.39, 95\% CI --0.54 to --0.23, P<.001) and higher somatosensory amplification ($\beta$=0.18, 95\% CI 0.07-0.28, P=.001) were associated with a higher symptom burden. Conclusions: Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously. Trial Registration: ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163 ", doi="10.2196/58711", url="https://publichealth.jmir.org/2024/1/e58711" } @Article{info:doi/10.2196/51376, author="Wani, Carolina and McCann, Lisa and Lennon, Marilyn and Radu, Caterina", title="Digital Mental Health Interventions for Adolescents in Low- and Middle-Income Countries: Scoping Review", journal="J Med Internet Res", year="2024", month="Oct", day="29", volume="26", pages="e51376", keywords="adolescents", keywords="mental health", keywords="low- and middle-income countries", keywords="LMICs", keywords="digital mental health interventions", keywords="DMHIs", keywords="cultural appropriateness", keywords="implementation", keywords="design", keywords="evaluation", keywords="mobile phone", abstract="Background: Digital mental health interventions (DMHIs) are increasingly recognized as potential solutions for adolescent mental health, particularly in low- and middle-income countries (LMICs). The United Nations' Sustainable Development Goals and universal health coverage are instrumental tools for achieving mental health for all. Within this context, understanding the design, evaluation, as well as the barriers and facilitators impacting adolescent engagement with mental health care through DMHIs is essential. Objective: This scoping review aims to provide insights into the current landscape of DMHIs for adolescents in LMICs. Methods: The Joanna Briggs Institute scoping review methodology was used, following the recommendations of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Our search strategy incorporated 3 key concepts: population ``adolescents,'' concept ``digital mental health interventions,'' and context ``LMICs.'' We adapted this strategy for various databases, including ACM Digital Library, APA PsycINFO, Cochrane Library, Google Scholar (including gray literature), IEEE Xplore, ProQuest, PubMed (NLM), ScienceDirect, Scopus, and Web of Science. The articles were screened against a specific eligibility criterion from January 2019 to March 2024. Results: We analyzed 20 papers focusing on DMHIs for various mental health conditions among adolescents, such as depression, well-being, anxiety, stigma, self-harm, and suicide ideation. These interventions were delivered in diverse formats, including group delivery and self-guided interventions, with support from mental health professionals or involving lay professionals. The study designs and evaluation encompassed a range of methodologies, including randomized controlled trials, mixed methods studies, and feasibility studies. Conclusions: While there have been notable advancements in DMHIs for adolescents in LMICs, the research base remains limited. Significant knowledge gaps persist regarding the long-term clinical benefits, the maturity and readiness of LMIC digital infrastructure, cultural appropriateness, and cost-effectiveness across the heterogeneous LMIC settings. Addressing these gaps necessitates large-scale, co-designed, and culturally sensitive DMHI trials. Future work should address this. ", doi="10.2196/51376", url="https://www.jmir.org/2024/1/e51376" } @Article{info:doi/10.2196/54710, author="Alam, Ashraful Md and Sajib, Zaman Md Refat Uz and Rahman, Fariya and Ether, Saraban and Hanson, Molly and Sayeed, Abu and Akter, Ema and Nusrat, Nowrin and Islam, Tahrin Tanjeena and Raza, Sahar and Tanvir, M. K. and Chisti, Jobayer Mohammod and Rahman, Sadeq-ur Qazi and Hossain, Akm and Layek, MA and Zaman, Asaduz and Rana, Juwel and Rahman, Moshfiqur Syed and Arifeen, El Shams and Rahman, Ehsanur Ahmed and Ahmed, Anisuddin", title="Implications of Big Data Analytics, AI, Machine Learning, and Deep Learning in the Health Care System of Bangladesh: Scoping Review", journal="J Med Internet Res", year="2024", month="Oct", day="28", volume="26", pages="e54710", keywords="machine learning", keywords="deep learning", keywords="artificial intelligence", keywords="big data analytics", keywords="public health", keywords="health care", keywords="mobile phone", keywords="Bangladesh", abstract="Background: The rapid advancement of digital technologies, particularly in big data analytics (BDA), artificial intelligence (AI), machine learning (ML), and deep learning (DL), is reshaping the global health care system, including in Bangladesh. The increased adoption of these technologies in health care delivery within Bangladesh has sparked their integration into health care and public health research, resulting in a noticeable surge in related studies. However, a critical gap exists, as there is a lack of comprehensive evidence regarding the research landscape; regulatory challenges; use cases; and the application and adoption of BDA, AI, ML, and DL in the health care system of Bangladesh. This gap impedes the attainment of optimal results. As Bangladesh is a leading implementer of digital technologies, bridging this gap is urgent for the effective use of these advancing technologies. Objective: This scoping review aims to collate (1) the existing research in Bangladesh's health care system, using the aforementioned technologies and synthesizing their findings, and (2) the limitations faced by researchers in integrating the aforementioned technologies into health care research. Methods: MEDLINE (via PubMed), IEEE Xplore, Scopus, and Embase databases were searched to identify published research articles between January 1, 2000, and September 10, 2023, meeting the following inclusion criteria: (1) any study using any of the BDA, AI, ML, and DL technologies and health care and public health datasets for predicting health issues and forecasting any kind of outbreak; (2) studies primarily focusing on health care and public health issues in Bangladesh; and (3) original research articles published in peer-reviewed journals and conference proceedings written in English. Results: With the initial search, we identified 1653 studies. Following the inclusion and exclusion criteria and full-text review, 4.66\% (77/1653) of the articles were finally included in this review. There was a substantial increase in studies over the last 5 years (2017-2023). Among the 77 studies, the majority (n=65, 84\%) used ML models. A smaller proportion of studies incorporated AI (4/77, 5\%), DL (7/77, 9\%), and BDA (1/77, 1\%) technologies. Among the reviewed articles, 52\% (40/77) relied on primary data, while the remaining 48\% (37/77) used secondary data. The primary research areas of focus were infectious diseases (15/77, 19\%), noncommunicable diseases (23/77, 30\%), child health (11/77, 14\%), and mental health (9/77, 12\%). Conclusions: This scoping review highlights remarkable progress in leveraging BDA, AI, ML, and DL within Bangladesh's health care system. The observed surge in studies over the last 5 years underscores the increasing significance of AI and related technologies in health care research. Notably, most (65/77, 84\%) studies focused on ML models, unveiling opportunities for advancements in predictive modeling. This review encapsulates the current state of technological integration and propels us into a promising era for the future of digital Bangladesh. ", doi="10.2196/54710", url="https://www.jmir.org/2024/1/e54710", url="http://www.ncbi.nlm.nih.gov/pubmed/39466315" } @Article{info:doi/10.2196/57285, author="Abejew, Agalu Asrat and Wubetu, Yismaw Gizachew and Fenta, Gedif Teferi", title="Antibiotic Prescribing Behavior of Physicians in Outpatient Departments in Hospitals in Northwest Ethiopia: Structural Equation Modeling Approach", journal="Interact J Med Res", year="2024", month="Oct", day="23", volume="13", pages="e57285", keywords="antibiotic prescribing behavior", keywords="Ethiopia", keywords="outpatient departments", keywords="physicians", keywords="SEM", keywords="TPB", abstract="Background: Antibiotic resistance, fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding antibiotic prescribing behavior and associated factors is important to promote good prescribing practice. Objective: This study aimed to determine the factors affecting antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in northwest Ethiopia in 2022. Methods: A cross-sectional study was conducted from September 2022 to October 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the modified theory of planned behavior was used to determine factors affecting antibiotic prescribing behavior. The percentages of physicians' estimated prescriptions for patients with upper respiratory tract infections (URTIs) and during weekly outpatient visits were used to predict antibiotic prescribing behavior and finally linked with behavioral constructs. A P value <.05 was considered significant. Results: Physicians estimated that they prescribed antibiotics for 54.8\% (9896/18,049) of weekly outpatient encounters, and 178 (96.2\%) of the 185 physicians estimated they prescribed antibiotics for patients who presented with symptoms of a URTI. Physicians aged ?30 years were less likely to prescribe antibiotics (48/100, 48\%) for patients who presented with a URTI than physicians older than 30 years (51/100, 51\%; P=.004), and general practitioners were less likely to prescribe antibiotics (47/100, 47\%) for patients who presented with a URTI than residents (51/100, 51\%; P=.03). Similarly, during outpatient visits, physicians ?30 years old were less likely to prescribe antibiotics (54/100, 54\%) than physicians older than 30 years (57/100, 57\%; P<.001), male physicians were less likely to prescribe antibiotics (53/100, 53\%) than female physicians (64/100, 64\%; P=.03), and general practitioners were less likely to prescribe antibiotics (53/100, 53\%) than residents (57/100, 57\%; P=.02). Physicians with good knowledge were less affected by perceived social pressure (mean 4.4, SD 0.6) than those with poor knowledge (mean 4.0, SD 0.9; P<.001) and felt it was easy to make rational decisions (mean 4.1, SD 1.1) compared with those with poor knowledge (mean 3.8, SD 1; P<.001). However, intentions to reduce and prescribe antibiotics were not affected by attitudes, subjective norms, or perceived behavioral control, and perceived antibiotic prescribing behavior was not related to intentions to reduce or prescribe antibiotics. Conclusions: Antibiotic prescribing behavior was not under the volitional control of physicians. This calls for a systematic approach to change antibiotic prescribing practices in hospital. ", doi="10.2196/57285", url="https://www.i-jmr.org/2024/1/e57285", url="http://www.ncbi.nlm.nih.gov/pubmed/39441643" } @Article{info:doi/10.2196/58720, author="Thoma, Yann and Cathignol, E. Annie and P{\'e}termann, J. Yuan and Sariko, L. Margaretha and Said, Bibie and Csajka, Chantal and Guidi, Monia and Mpagama, G. Stellah", title="Toward a Clinical Decision Support System for Monitoring Therapeutic Antituberculosis Medical Drugs in Tanzania (Project TuberXpert): Protocol for an Algorithm' Development and Implementation", journal="JMIR Res Protoc", year="2024", month="Oct", day="21", volume="13", pages="e58720", keywords="TDM", keywords="therapeutic drug monitoring", keywords="pharmacometrics", keywords="tuberculosis", keywords="model-informed precision dosing software", keywords="clinical pharmacology", keywords="clinical decision support system", keywords="Tanzania", keywords="mobile phone", abstract="Background: The end tuberculosis (TB) strategy requires a novel patient treatment approach contrary to the one-size-fits-all model. It is well known that each patient's physiology is different and leads to various rates of drug elimination. Therapeutic drug monitoring (TDM) offers a way to manage drug dosage adaptation but requires trained pharmacologists, which is scarce in resource-limited settings. Objective: We will develop an automated clinical decision support system (CDSS) to help practitioners with the dosage adaptation of rifampicin, one of the essential medical drugs targeting TB, that is known for large pharmacokinetic variability and frequent suboptimal blood exposure. Such an advanced system will encourage the spread of a dosage-individualization culture, including among practitioners not specialized in pharmacology. Thus, the objectives of this project are to (1) develop the appropriate population pharmacokinetic (popPK) model for rifampicin for Tanzanian patients, (2) optimize the reporting of relevant information to practitioners for drug dosage adjustment, (3) automate the delivery of the report in line with the measurement of drug concentration, and (4) validate and implement the final system in the field. Methods: A total of 3 teams will combine their efforts to deliver the first automated TDM CDSS for TB. A cross-sectional study will be conducted to define the best way to display information to clinicians. In parallel, a rifampicin popPK model will be developed taking advantage of the published literature, complemented with data provided by existing literature data from the Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics (panACEA), and samples collected within this project. A decision tree will be designed and implemented as a CDSS, and an automated report generation will be developed and validated through selected case studies. Expert pharmacologists will validate the CDSS, and finally, field implementation in Tanzania will occur, coupled with a prospective study to assess clinicians' adherence to the CDSS recommendations. Results: The TuberXpert project started in November 2022. In July 2024, the clinical study in Tanzania was completed with the enrollment of 50 patients to gather the required data to build a popPK model for rifampicin, together with a qualitative study defining the report design, as well as the CDSS general architecture definition. Conclusions: At the end of the TuberXpert project, Tanzania will possess a new tool to help the practitioners with the adaptation of drug dosage targeting complicated TB cases (TB or HIV, TB or diabetes mellitus, and TB or malnutrition). This automated system will be validated and used in the field and will be proposed to other countries affected by endemic TB. In addition, this approach will serve as proof of concept regarding the feasibility and suitability of CDSS-assisted TDM for further anti-TB drugs in TB-burdened areas deprived of TDM experts, including second-line treatments considered important to monitor. International Registered Report Identifier (IRRID): DERR1-10.2196/58720 ", doi="10.2196/58720", url="https://www.researchprotocols.org/2024/1/e58720" } @Article{info:doi/10.2196/59423, author="Berube, T. Lauren and Shrestha, Archana and Shrestha, Abha and Daneault, Jean-Francois and Shakya, Raj Prabin and Dhimal, Meghnath and Shrestha, Roman and Rawal, Shristi", title="Development and Testing of a Mobile App for Management of Gestational Diabetes in Nepal: Protocol for a User-Centered Design Study and Exploratory Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="21", volume="13", pages="e59423", keywords="gestational diabetes mellitus", keywords="mobile health", keywords="mHealth", keywords="self-management", keywords="pregnancy", keywords="maternal and child health", keywords="South Asia", keywords="Nepal", keywords="low- and middle-income country", keywords="mobile phone", abstract="Background: The prevalence of gestational diabetes mellitus (GDM) is increasing, particularly in low- and middle-income countries (LMICs) like Nepal. GDM self-management, including intensive dietary and lifestyle modifications and blood glucose monitoring, is critical to maintain glycemic control and prevent adverse outcomes. However, in resource-limited settings, several barriers hinder optimal self-management. Mobile health (mHealth) technology holds promise as a strategy to augment GDM treatment by promoting healthy behaviors and supporting self-management, but this approach has not yet been tested in any LMIC. Objective: This report describes the protocol to develop a culturally tailored mHealth app that supports self-management and treatment of GDM (GDM--Dhulikhel Hospital [GDM-DH] app, phase 1) and test its usability and preliminary efficacy (phase 2) among patients with GDM in a periurban hospital setting in Nepal. Methods: The study will be conducted at Dhulikhel Hospital in Dhulikhel, Nepal. In the development phase (phase 1), a prototype of the GDM-DH app will be developed based on expert reviews and a user-centered design approach. To understand facilitators and barriers to GDM self-management and to gather feedback on the prototype, focus groups and in-depth interviews will be conducted with patients with GDM (n=12), health care providers (n=5), and family members (n=3), with plans to recruit further if saturation is not achieved. Feedback will be used to build a minimum viable product, which will undergo user testing with 18 patients with GDM using a think-aloud protocol. The final GDM-DH app will be developed based on user feedback and following an iterative product design and user testing process. In the randomized controlled trial phase (phase 2), newly diagnosed patients with GDM (n=120) will be recruited and randomized to either standard care alone or standard care plus the GDM-DH app from 24-30 weeks gestation until delivery. In this proof-of-concept trial, feasibility outcomes will be app usage, self-monitoring adherence, and app usability and acceptability. Exploratory treatment outcomes will be maternal glycemic control at 6 weeks post partum, birth weight, and rates of labor induction and cesarean delivery. Qualitative data obtained from phase 1 will be analyzed using thematic analysis. In phase 2, independent 2-tailed t tests or chi-square analyses will examine differences in outcomes between the 2 treatment conditions. Results: As of July 2024, we have completed phase 1. Phase 2 is underway. The first participant was enrolled in October 2021, with 99 participants enrolled as of July 2024. We anticipate completing recruitment by December 2024 and disseminating findings by December 2025. Conclusions: App-based lifestyle interventions for GDM management are not common in LMICs, where GDM prevalence is rapidly increasing. This proof-of-concept trial will provide valuable insights into the potential of leveraging mHealth app--based platforms for GDM self-management in LMICs. Trial Registration: ClinicalTrials.gov NCT04198857; https://clinicaltrials.gov/study/NCT04198857 International Registered Report Identifier (IRRID): DERR1-10.2196/59423 ", doi="10.2196/59423", url="https://www.researchprotocols.org/2024/1/e59423" } @Article{info:doi/10.2196/54715, author="Deribe, Leul and Girma, Eshetu and Lindstr{\"o}m, Nataliya and Gidey, Abdulkadir and Teferra, Solomon and Addissie, Adamu", title="Association of Family-Centered Care With Psychological Distress Among Caregivers of Children With Cancer at a Tertiary-Level Hospital in Ethiopia: Cross-Sectional Study", journal="JMIR Cancer", year="2024", month="Oct", day="10", volume="10", pages="e54715", keywords="child cancer", keywords="psychological distress", keywords="Ethiopia", keywords="parent", keywords="caregivers", keywords="family", abstract="Background: Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress. Objective: The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. Methods: An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95\% CI was calculated, and a P value less than .05 was considered statistically significant. Results: A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95\% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2\%), 35 (9.1\%), and 51 (13.3\%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6\% (95\% CI 28.9\%-38.3\%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95\% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95\% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95\% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95\% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95\% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95\% CI 1.25-5.76) were significantly associated with higher level of PD. Conclusions: A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse. ", doi="10.2196/54715", url="https://cancer.jmir.org/2024/1/e54715" } @Article{info:doi/10.2196/52411, author="Faulkenberry, Grey and Masizana, Audrey and Mosesane, Badisa and Ndlovu, Kagiso", title="Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment", journal="JMIR Res Protoc", year="2024", month="Oct", day="9", volume="13", pages="e52411", keywords="global health", keywords="health information systems", keywords="electronic health care records", keywords="EHRs", keywords="interoperability", keywords="data flow", keywords="access to information", keywords="health information interoperability", keywords="pediatric", keywords="pediatrics", keywords="infant", keywords="infants", keywords="clinical data", keywords="mixed method", keywords="Botswana", keywords="health care information", keywords="child health", keywords="tuberculosis", keywords="HIV", keywords="eLearning", keywords="survey", keywords="health informatics", keywords="communication", abstract="Background: Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that ``there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level,'' seconded by the Botswana National eLearning strategy (2020), which states that ``there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating.'' Objective: The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. Methods: The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. Results: The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75\% (112/150) of health care professionals participating came from clinics, 20\% (30/150) from hospitals, and 5\% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. Conclusions: This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. International Registered Report Identifier (IRRID): DERR1-10.2196/52411 ", doi="10.2196/52411", url="https://www.researchprotocols.org/2024/1/e52411" } @Article{info:doi/10.2196/51080, author="Apte, Aditi and Bright, Rew Heber and Kadam, Sandeep and Sundarsanam, David Thambu and Chandy, J. Sujith", title="Facilitators, Barriers, and Potential Impacts of Implementation of e-Pharmacy in India and its Potential Impact on Cost, Quality, and Access to Medicines: Scoping Review", journal="Online J Public Health Inform", year="2024", month="Oct", day="9", volume="16", pages="e51080", keywords="online pharmacy", keywords="internet pharmacy", keywords="telepharmacy", keywords="ePharmacy", keywords="prescribing systems", keywords="drug prescribing", keywords="prescriptions", keywords="medications", abstract="Background: e-Pharmacy can potentially solve problems related to the quality of services and products, cost, and access to medicines in low- and middle-income countries. This review aims to understand the facilitators and barriers to the implementation of e-pharmacy in India. Objective: This scoping review aimed (1) to understand the facilitators and barriers to the use of e-pharmacy in India and (2) to estimate the potential for e-pharmacy in India for improving access to medication, improving the quality of services and medicines, and decreasing costs of medications. Methods: All published and gray literature from July 1, 2011, to June 30, 2021, relating to e-pharmacy, was searched from MEDLINE, Scopus, ProQuest, and Google using a systematic search strategy. Results: In total, 1464 titles and abstracts were screened, of which 47 full-texts were included in the review. e-Pharmacy can potentially improve access to medications for remote areas, and old and debilitated individuals. e-Pharmacies can enable lean supply chain management, lower cost, and allow easy tracking of dispensed medicines. There is potential for integration of e-pharmacy services into the national program of Bhartiya Jan Aushadhi Pariyojana. However, the country is not adequately regulated to prevent the growth of illicit e-pharmacies. Lack of global accreditation and internet coverage, digital literacy, and transnational access are other challenges. Conclusions: E-pharmacy has the potential to improve universal health coverage in India by improving access to medicines and lowering the overall cost of health care. However, future growth will need specific regulations and accreditation mechanisms. Trial Registration: Open Science Forum; https://doi.org/10.17605/OSF.IO/6R9YQ ", doi="10.2196/51080", url="https://ojphi.jmir.org/2024/1/e51080" } @Article{info:doi/10.2196/44294, author="Oluokun, Oluwatosin Emmanuel and Adedoyin, Fatai Festus and Dogan, Huseyin and Jiang, Nan", title="Digital Interventions for Managing Medication and Health Care Service Delivery in West Africa: Systematic Review", journal="J Med Internet Res", year="2024", month="Oct", day="9", volume="26", pages="e44294", keywords="digital interventions", keywords="medications delivery", keywords="phone-based intervention", keywords="tele and e-based intervention", keywords="West Africa", keywords="management, technology", keywords="intervention", keywords="medication", keywords="tool", keywords="smartphone", abstract="Background: As a result of the recent advancements in technology, the incorporation of digital interventions into the health care system has gained a lot of attention and adoption globally. However, these interventions have not been fully adopted, thereby limiting their impact on health care delivery in West Africa. Objective: This review primarily aims at evaluating the current digital interventions for medication and health care delivery in West Africa. Its secondary aim is to assess the impacts of digital interventions in managing medication and health care service delivery with the intent of providing vital recommendations that would contribute to an excellent adoption of digital intervention tools in the health care space in West Africa. Methods: In line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a comprehensive search through various databases yielded 529 results. After a rigorous screening, 29 articles that provided information on 3 broad digital health intervention tools were found eligible for this review. Results: Out of 29 studies, 16 (55\%) studies examined phone-based interventions, 9 (31\%) studies focused on tele- and e-based interventions, and 4 (14\%) studies evaluated digital interventions. These interventions were used for diverse purposes, some of which are monitoring adverse drug reactions, general health, sexual and reproductive health, and training of health care practitioners. The phone-based intervention appears to be the most known and impactful of all the interventions, followed by tele- and e-based, while digital interventions were scarcely used. Conclusions: Digital interventions have had a considerable level of impact on medication and health care delivery across West Africa. However, the overall impact is limited. Therefore, strategies must be developed to address the challenges limiting the use of digital intervention tools so that these tools can be fully incorporated into the health care space in West Africa. ", doi="10.2196/44294", url="https://www.jmir.org/2024/1/e44294" } @Article{info:doi/10.2196/45122, author="Peiffer-Smadja, Nathan and Descousse, Sophie and Courr{\`e}ges, Elsa and Nganbou, Audrey and Jeanmougin, Pauline and Birgand, Gabriel and L{\'e}naud, S{\'e}verin and Beaumont, Anne-Lise and Durand, Claire and Delory, Tristan and Le Bel, Josselin and Bouvet, Elisabeth and Lariven, Sylvie and D'Ortenzio, Eric and Konat{\'e}, Issa and Bouyou-Akotet, Karine Marielle and Ouedraogo, Abdoul-Salam and Kouakou, Affoue Gis{\`e}le and Poda, Armel and Akpovo, Corinne and Lescure, Fran{\c{c}}ois-Xavier and Tanon, Aristophane", title="Implementation of a Clinical Decision Support System for Antimicrobial Prescribing in Sub-Saharan Africa: Multisectoral Qualitative Study", journal="J Med Internet Res", year="2024", month="Oct", day="7", volume="26", pages="e45122", keywords="antimicrobial resistance", keywords="implementation research", keywords="Consolidated Framework for Implementation Research", keywords="CDSS", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="mobile phone", abstract="Background: Suboptimal use of antimicrobials is a driver of antimicrobial resistance in West Africa. Clinical decision support systems (CDSSs) can facilitate access to updated and reliable recommendations. Objective: This study aimed to assess contextual factors that could facilitate the implementation of a CDSS for antimicrobial prescribing in West Africa and Central Africa and to identify tailored implementation strategies. Methods: This qualitative study was conducted through 21 semistructured individual interviews via videoconference with health care professionals between September and December 2020. Participants were recruited using purposive sampling in a transnational capacity-building network for hospital preparedness in West Africa. The interview guide included multiple constructs derived from the Consolidated Framework for Implementation Research. Interviews were transcribed, and data were analyzed using thematic analysis. Results: The panel of participants included health practitioners (12/21, 57\%), health actors trained in engineering (2/21, 10\%), project managers (3/21, 14\%), antimicrobial resistance research experts (2/21, 10\%), a clinical microbiologist (1/21, 5\%), and an anthropologist (1/21, 5\%). Contextual factors influencing the implementation of eHealth tools existed at the individual, health care system, and national levels. At the individual level, the main challenge was to design a user-centered CDSS adapted to the prescriber's clinical routine and structural constraints. Most of the participants stated that the CDSS should not only target physicians in academic hospitals who can use their network to disseminate the tool but also general practitioners, primary care nurses, midwives, and other health care workers who are the main prescribers of antimicrobials in rural areas of West Africa. The heterogeneity in antimicrobial prescribing training among prescribers was a significant challenge to the use of a common CDSS. At the country level, weak pharmaceutical regulations, the lack of official guidelines for antimicrobial prescribing, limited access to clinical microbiology laboratories, self-medication, and disparity in health care coverage lead to inappropriate antimicrobial use and could limit the implementation and diffusion of CDSS for antimicrobial prescribing. Participants emphasized the importance of building a solid eHealth ecosystem in their countries by establishing academic partnerships, developing physician networks, and involving diverse stakeholders to address challenges. Additional implementation strategies included conducting a local needs assessment, identifying early adopters, promoting network weaving, using implementation advisers, and creating a learning collaborative. Participants noted that a CDSS for antimicrobial prescribing could be a powerful tool for the development and dissemination of official guidelines for infectious diseases in West Africa. Conclusions: These results suggest that a CDSS for antimicrobial prescribing adapted for nonspecialized prescribers could have a role in improving clinical decisions. They also confirm the relevance of adopting a cross-disciplinary approach with participants from different backgrounds to assess contextual factors, including social, political, and economic determinants. ", doi="10.2196/45122", url="https://www.jmir.org/2024/1/e45122", url="http://www.ncbi.nlm.nih.gov/pubmed/39374065" } @Article{info:doi/10.2196/58890, author="Adjei-Banuah, Yaw Nhyira and Ayiku, Barkey Roberta Naa and Reichenberger, Veronika and Sasu, David and Mirzoev, Tolib and Murphy, Adrianna and Ohene, Sammy and Antwi, Edward and Agyepong, Akua Irene", title="Factors Influencing Primary Care Access for Common Mental Health Conditions Among Adults in West Africa: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Oct", day="2", volume="13", pages="e58890", keywords="scoping review", keywords="mental health", keywords="noncommunicable disease", keywords="primary care", keywords="access", keywords="barriers", keywords="enablers", abstract="Background: Mental health conditions are expressed in various ways in different people, and access to health care for these conditions is affected by individual factors, health care provider factors, and contextual factors. These factors may be enablers or barriers to accessing primary care for mental health conditions. Studies have reported a gap in treatment for mental health conditions in many countries in West Africa due to barriers along the access pathway. However, to the best of our knowledge, there is yet to be a review of the factors influencing access to primary care for common mental health conditions among adults in West Africa. Objective: Our scoping review will explore the factors influencing access to primary care for common mental health conditions among adults aged 18 years and older in West Africa from 2002 to 2024. Methods: Our review will follow the approach to scoping reviews developed by Arksey and O'Malley in 2005. This approach has five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. We will search electronic databases (PubMed, Embase, PsycINFO, Cairn.info, and Google Scholar), source gray literature from relevant websites (the World Health Organization and country-specific websites), and manually explore reference lists of relevant studies to identify eligible records. Pairs of independent authors (NYA-B, RNBA, VR, or DS) will screen the titles, abstracts, and full texts of studies based on predefined eligibility criteria. We will use a data extraction tool adopted from the JBI Manual for Evidence Synthesis to chart the data. Deductive, thematic analysis will be used to categorize factors influencing access to mental health care under predetermined themes. New themes derived from the literature will also be charted. Results: Database searches were conducted between February 1, 2024, and February 12, 2024. As of July 2024, the review report is being drafted, and it will be disseminated through publication in a peer-reviewed journal. Conclusions: The results of the review will inform decision-making on policies, programs, and their implementation in West Africa to improve primary care access for mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/58890 ", doi="10.2196/58890", url="https://www.researchprotocols.org/2024/1/e58890" } @Article{info:doi/10.2196/57703, author="Musheghyan, Lusine and Harutyunyan, M. Nika and Sikder, Abu and Reid, W. Mark and Zhao, Daniel and Lulejian, Armine and Dickhoner, W. James and Andonian, T. Nicole and Aslanyan, Lusine and Petrosyan, Varduhi and Sargsyan, Zhanna and Shekherdimian, Shant and Dorian, Alina and Espinoza, C. Juan", title="Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="30", volume="10", pages="e57703", keywords="COVID-19", keywords="remote patient monitoring", keywords="Armenia", keywords="web platform", keywords="home oxygen therapy", keywords="pandemic", keywords="global health care", keywords="low and middle-income countries", keywords="health care infrastructure", keywords="Yerevan", keywords="home monitoring", keywords="resource-constrained", abstract="Background: The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. Objective: The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Methods: Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Results: Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94\% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1\% and low re-admission rate. Opportunities for operational and data quality improvements were identified. Conclusions: This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program's success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments. ", doi="10.2196/57703", url="https://publichealth.jmir.org/2024/1/e57703", url="http://www.ncbi.nlm.nih.gov/pubmed/39348686" } @Article{info:doi/10.2196/54304, author="Mutale, Jacob and Sikombe, Kombatende and Mwale, Boroma and Lumpa, Mwansa and Simbeza, Sandra and Bukankala, Chama and Mukamba, Njekwa and Mody, Aaloke and Beres, K. Laura and Holmes, B. Charles and Bolton Moore, Carolyn and Geng, H. Elvin and Sikazwe, Izukanji and Pry, M. Jake", title="Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study", journal="J Med Internet Res", year="2024", month="Sep", day="30", volume="26", pages="e54304", keywords="mHealth", keywords="mobile health", keywords="survey", keywords="incentives", keywords="HIV", keywords="Zambia", keywords="airtime", keywords="USSD", keywords="unstructured supplementary service data", keywords="HIV care", keywords="pilot study", keywords="mobile phone", keywords="public health service", keywords="urban", keywords="rural", keywords="regression model", keywords="longitudinal", keywords="mobile", keywords="patient feedback", abstract="Background: This pilot study evaluates the effectiveness of mobile talk-time incentives in maintaining participation in a longitudinal mobile health (mHealth) data collection program among people living with HIV in Lusaka, Zambia. While mHealth tools, such as mobile phone surveys, provide vital health feedback, optimal incentive strategies to ensure long-term engagement remain limited. This study explores how different incentive levels affect response rates in multiple survey rounds, providing insights into effective methods for encouraging ongoing participation, especially in the context of Zambia's prepaid mobile system and multi-SIM usage, a common practice in sub-Saharan Africa. Objective: This study aimed to assess the response rate success across multiple invitations to participate in a care experience survey using a mobile phone short codes and unstructured supplementary service data (USSD) model among individuals in an HIV care setting in the Lusaka, Zambia. Methods: Participants were recruited from 2 study clinics--1 in a periurban setting and 1 in an urban setting. A total of 2 rounds of survey invitations were sent to study participants on a 3-month interval between November 1, 2018, and September 23, 2019. Overall, 3 incentive levels were randomly assigned by participant and survey round: (1) no incentive, (2) 2 Zambian Kwacha (ZMW; US \$0.16), and (3) 5 ZMW (US \$0.42). Survey response rates were analyzed using mixed-effects Poisson regression, adjusting for individual- and facility-level factors. Probability plots for survey completion were generated based on language, incentive level, and survey round. We projected the cost per additional response for different incentive levels. Results: A total of 1006 participants were enrolled, with 72.3\% (727/1006) from the urban HIV care facility and 62.4\% (628/1006) requesting the survey in English. We sent a total of 1992 survey invitations for both rounds. Overall, survey completion across both surveys was 32.1\% (637/1992), with significantly different survey completion between the first (40.5\%, 95\% CI 37.4-43.6\%) and second (23.7\%, 95\% CI 21.1-26.4) invitations. Implementing a 5 ZMW (US \$0.42) incentive significantly increased the adjusted prevalence ratio (aPR) for survey completion compared with those that received no incentive (aPR 1.35, 95\% CI 1.11-1.63). The cost per additional response was highest at 5 ZMW, equivalent to US \$0.42 (72.8 ZMW [US \$5.82] per 1\% increase in response). Conclusions: We observed a sharp decline of almost 50\% in survey completion success from the initial invitation to follow-up survey administered 3 months later. This substantial decrease suggests that longitudinal data collection potential for a care experience survey may be limited without additional sensitization and, potentially, added survey reminders. Implementing a moderate incentive increased response rates to our health care experience survey. Tailoring survey strategies to accommodate language preferences and providing moderate incentives can optimize response rates in Zambia. Trial Registration: Pan African Clinical Trial Registry PACTR202101847907585; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14613 ", doi="10.2196/54304", url="https://www.jmir.org/2024/1/e54304", url="http://www.ncbi.nlm.nih.gov/pubmed/39348170" } @Article{info:doi/10.2196/53370, author="Sood, Ishaana and Sabherwal, Shalinder and Mathur, Umang and Jain, Elesh and Bhadauria, Madhu and Agrawal, Deepshikha and Khurana, Ashi and Mittal, Vikas and Mahindrakar, Avinash and Govindahari, Vishal and Kulkarni, Sucheta and Nischal, K. Ken", title="Harnessing Generalizable Real-World Ophthalmic Big Data: Descriptive Analysis of the Bodhya Eye Consortium Model for Collaborative Research", journal="Online J Public Health Inform", year="2024", month="Sep", day="30", volume="16", pages="e53370", keywords="anthropological and genomic heterogeneity", keywords="big data", keywords="consortium", keywords="collaborative research", keywords="generalizability", keywords="global health impact", keywords="North India", abstract="Background: Eye care organizations and professionals worldwide are increasingly focusing on bridging the gap between population health and medical practice. Recent advances in genomics and anthropology have revealed that most Indian groups trace their ancestry to a blend of 2 genetically distinct populations: Ancestral North Indians, who share genetic affinities with Central Asians, Middle Easterners, Caucasians, and Europeans; and Ancestral South Indians, genetically distinct from groups outside the Indian subcontinent. Studies conducted among North Indian populations can therefore offer insights that are potentially applicable to these diverse global populations, underscoring significant implications for global health. Objective: The Bodhya Eye Consortium is a collaboration among 8 high-volume nonprofit eyecare organizations from across North India. The consortium aims to harness real-world data consistently and with assured quality for collaborative research. This paper outlines the formation of the consortium as a proposed model for controlled collaborative research among the leading eyecare organizations of North India. Methods: We detail the creation and effective implementation of a consortium following a structured road map that included planning and assessment, establishing an exploratory task force, defining specialty areas, setting objectives and priorities, and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis. Central to this process was a comprehensive data audit aimed at standardizing data collection across all participating organizations. Results: The consortium currently comprises 9 organizations, each represented in the governance structure by the Governing Council. Scientific standards for published research are established and overseen by the Scientific Committee, while the Conflict Resolution Committee manages any unresolved disputes. The consortium's working groups, organized by various eyecare specialties, collaborate on research projects through virtual interactions. A foundational step in this process was the organizationwide data audit, which revealed that most organizations complied with accurate and standardized data collection practices. Organizations with deficiencies in data completeness developed action plans to address them. Subsequently, the consortium adopted data collection proformas, contributing to the publication of high-quality manuscripts characterized by low dropout rates. Conclusions: The collaborative research conducted by the Bodhya Eye Consortium---a group of high-volume eyecare organizations primarily from North India---offers a unique opportunity to contribute to scientific knowledge across various domains of eyecare. By leveraging the established heterogeneity of anthropological and genomic origins within the population, the findings can be generalizable, to some extent, to European, Middle Eastern, and European American populations. This access to potentially invaluable, generalizable data has significant global health implications and opens possibilities for broader collaboration. The model outlined in this descriptive paper can serve as a blueprint for other health care organizations looking to develop similar collaborations for research and knowledge sharing. ", doi="10.2196/53370", url="https://ojphi.jmir.org/2024/1/e53370", url="http://www.ncbi.nlm.nih.gov/pubmed/39348171" } @Article{info:doi/10.2196/48794, author="Iacoella, Francesco and Tirivayi, Nyasha", title="Mobile Phones and HIV Testing: Multicountry Instrumental Variable Analysis From Sub-Saharan Africa", journal="J Med Internet Res", year="2024", month="Sep", day="27", volume="26", pages="e48794", keywords="information and knowledge", keywords="communication", keywords="health and economic development", keywords="public health", keywords="technological change", keywords="choices and consequences", keywords="mobile phone", keywords="connectivity", keywords="access", keywords="HIV", keywords="testing", keywords="Sub-Saharan Africa", keywords="women's health", abstract="Background: Sub-Saharan Africa has been a technological hothouse when it comes to mobile phone technology adoption. However, evidence on the role played by mobile technology on infectious disease prevention has been mostly limited to experimental studies. Objective: This observational study investigates the role of mobile phone connectivity on HIV testing in sub-Saharan Africa. Methods: We make use of the novel and comprehensive OpenCelliD cell tower database and Demographic and Health Survey geocoded information for over 400,000 women in 29 sub-Saharan African countries. We examine, through ordinary least square and instrumental variable regressions, whether women's community distance from the closest cell tower influences knowledge about HIV testing facilities and the likelihood of ever being tested for HIV. Results: After finding a negative and significant impact of distance to the nearest cell tower on knowledge of HIV testing facility (--0.7 percentage points per unit increase in distance) and HIV testing (--0.5 percentage points per unit increase), we investigate the mechanisms through which such effects might occur. Our analysis shows that distance to a cell tower reduces HIV-related knowledge (--0.4 percentage points per unit increase) as well as reproductive health knowledge (--0.4 percentage points per unit increase). Similar results are observed when the analysis is performed at community level. Conclusions: Results suggest that the effect of mobile phone connectivity is channeled through increased knowledge of HIV, sexually transmittable infections, and modern contraceptive methods. Further analysis shows that cell phone ownership has an even larger impact on HIV testing and knowledge. This paper adds to the recent literature on the impact of mobile-based HIV prevention schemes by showing through large-scale analysis that better mobile network access is a powerful tool to spread reproductive health knowledge and increase HIV awareness. ", doi="10.2196/48794", url="https://www.jmir.org/2024/1/e48794" } @Article{info:doi/10.2196/53560, author="Sosanya, Eloho Mercy and Samuel, Olukemi Folake and Bashir, Sadia and Omoera, Osariemen Victoria and Freeland-Graves, H. Jeanne", title="A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study", journal="J Med Internet Res", year="2024", month="Sep", day="26", volume="26", pages="e53560", keywords="mobile health", keywords="mHealth", keywords="mobile gaming app", keywords="validation", keywords="infant and young child feeding", keywords="teenage mother", keywords="Nigeria", keywords="mobile phone", abstract="Background: Undernutrition is an underlying factor in nearly 50\% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists. Objective: This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices. Methods: To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country's capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use. Results: Large proportions of the study participants were married (53/90, 59\%) and had no personal income (63/90, 70\%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80\%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001). Conclusions: This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria. ", doi="10.2196/53560", url="https://www.jmir.org/2024/1/e53560" } @Article{info:doi/10.2196/59917, author="Hertz, T. Julian and Sakita, M. Francis and Rahim, O. Faraan and Mmbaga, T. Blandina and Shayo, Frida and Kaboigora, Vivian and Mtui, Julius and Bloomfield, S. Gerald and Bosworth, B. Hayden and Bettger, P. Janet and Thielman, M. Nathan", title="Multicomponent Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Protocol for a Pilot Implementation Trial", journal="JMIR Res Protoc", year="2024", month="Sep", day="24", volume="13", pages="e59917", keywords="myocardial infarction", keywords="Tanzania", keywords="sub-Saharan Africa", keywords="implementation science", keywords="quality improvement", abstract="Background: Although the incidence of acute myocardial infarction (AMI) is rising in sub-Saharan Africa, the uptake of evidence-based care for the diagnosis and treatment of AMI is limited throughout the region. In Tanzania, studies have revealed common misdiagnosis of AMI, infrequent administration of aspirin, and high short-term mortality rates following AMI. Objective: This study aims to evaluate the implementation and efficacy outcomes of an intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), which was developed to improve the delivery of evidence-based AMI care in Tanzania. Methods: This single-arm pilot trial will be conducted in the emergency department (ED) at a referral hospital in northern Tanzania. The MIMIC intervention will be implemented by the ED staff for 1 year. Approximately 400 adults presenting to the ED with possible AMI symptoms will be enrolled, and research assistants will observe their care. Thirty days later, a follow-up survey will be administered to assess mortality and medication use. The primary outcome will be the acceptability of the MIMIC intervention, which will be measured by the Acceptability of Intervention Measurement (AIM) instrument. Acceptability will further be assessed via in-depth interviews with key stakeholders. Secondary implementation outcomes will include feasibility and fidelity. Secondary efficacy outcomes will include the following: the proportion of participants who receive electrocardiogram and cardiac biomarker testing, the proportion of participants with AMI who receive aspirin, 30-day mortality among participants with AMI, and the proportion of participants with AMI taking aspirin 30 days following enrollment. Results: Implementation of MIMIC began on September 1, 2023. Enrollment is expected to be completed by September 1, 2024, and the first results are expected to be published by December 31, 2024. Conclusions: This study will be the first to evaluate an intervention for improving AMI care in sub-Saharan Africa. If MIMIC is found to be acceptable, the findings from this study will inform a future cluster-randomized trial to assess effectiveness and scalability. Trial Registration: ClinicalTrials.gov NCT04563546; https://clinicaltrials.gov/study/NCT04563546 International Registered Report Identifier (IRRID): DERR1-10.2196/59917 ", doi="10.2196/59917", url="https://www.researchprotocols.org/2024/1/e59917" } @Article{info:doi/10.2196/53034, author="Mackworth-Young, Sina Constance Ruth and Charashika, Privillage and and Larsson, Leyla and Wilding-Davies, Jane Olivia and Simpson, Nikita and Kydd, Sorrel Anna and Chinyanga, Tinashe Theonevus and Ferrand, Abbas Rashida and Mangombe, Aveneni and Webb, Karen and Doyle, Margaret Aoife", title="Digital Intervention to Improve Health Services for Young People in Zimbabwe: Process Evaluation of `Zvatinoda!' (What We Want) Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework", journal="JMIR Form Res", year="2024", month="Sep", day="24", volume="8", pages="e53034", keywords="adolescents", keywords="young people", keywords="digital health", keywords="mobile intervention", keywords="HIV", keywords="sexual and reproductive health", keywords="Zimbabwe", abstract="Background: Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services. Objective: The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe. Methods: The intervention utilized mobile phone--based discussion groups, complemented by ``ask the expert'' sessions. Peer facilitators, supported by an ``Auntie,'' led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50\%, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators' debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance. Results: Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14\% (4/28) for contraception to 86\% (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100\% (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50\% (14/28) preintervention to 86\% (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57\% (16/28) preintervention to 89\% (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32\% (9/28) preintervention to 86\% (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable ``Auntie,'' and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance). Conclusions: The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people's knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers. ", doi="10.2196/53034", url="https://formative.jmir.org/2024/1/e53034" } @Article{info:doi/10.2196/57254, author="Sharma, Divya and Yadav, Jyoti and Gupta, Madhu and Halder, Pritam and Rajan, K. Abin and Kiran, Tanvi", title="Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="24", volume="10", pages="e57254", keywords="breastfeeding", keywords="institutional deliveries", keywords="delayed initiation", keywords="moderation analysis", keywords="Indian mothers", keywords="socio-economic", keywords="cross-sectional study", keywords="infant", keywords="infancy", keywords="infant feeding", keywords="human milk", keywords="breastfeeding initiation", keywords="mother", keywords="women", keywords="India", keywords="healthcare services", keywords="awareness", keywords="pregnancy", keywords="public health", abstract="Background: Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them. Objective: We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery. Methods: This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression--based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26. Results: The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ?36 years (58.3\%), lacking formal education (60.9\%), belonging to lower wealth groups (58.1\%), residing in rural areas (57.4\%), and having home births (64.1\%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95\% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95\% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95\% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95\% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95\% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation. Conclusions: Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation. ", doi="10.2196/57254", url="https://publichealth.jmir.org/2024/1/e57254", url="http://www.ncbi.nlm.nih.gov/pubmed/39316434" } @Article{info:doi/10.2196/58162, author="Turkington, Robin and Potts, Courtney and Mulvenna, Maurice and Bond, Raymond and O'Neill, Siobh{\'a}n and Ennis, Edel and Hardcastle, Katie and Scowcroft, Elizabeth and Moore, Ciaran and Hamra, Louise", title="Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis", journal="JMIR Ment Health", year="2024", month="Sep", day="19", volume="11", pages="e58162", keywords="crisis helplines", keywords="call duration", keywords="mental health", keywords="suicide", keywords="suicidal", keywords="suicide prevention", keywords="population-based", keywords="help-seeking behavior", keywords="Samaritans", keywords="UK", keywords="telephony", keywords="telephone", keywords="telephones", keywords="one-way analysis", keywords="call", keywords="calls", keywords="talk time", keywords="support", keywords="talk time differences", abstract="Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom's 4 countries or regions. Objectives: The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller's current region (intraregional calls) or routed to a branch that is in a different region from that of the caller's current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene's test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration. Results: ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin. Conclusions: Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service. ", doi="10.2196/58162", url="https://mental.jmir.org/2024/1/e58162" } @Article{info:doi/10.2196/59836, author="Iqbal, Meesha and Cazaban, Ganduglia Cecilia and Morgan, Robert and Bauer, Cici and Siddiqi, Sameen", title="Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study", journal="JMIR Res Protoc", year="2024", month="Sep", day="18", volume="13", pages="e59836", keywords="health system", keywords="healthcare system", keywords="health care", keywords="responsiveness", keywords="Pakistan", keywords="Low-and middle-income countries", abstract="Background: Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. Objective: We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L\&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L\&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. Methods: The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L\&MICs. Cronbach ? will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an ``observation checklist'' of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. Results: The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L\&MICs. Conclusions: This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L\&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. International Registered Report Identifier (IRRID): DERR1-10.2196/59836 ", doi="10.2196/59836", url="https://www.researchprotocols.org/2024/1/e59836" } @Article{info:doi/10.2196/55290, author="O'Connor, Y. Suji and Mationg, Lorraine Mary and Kelly, J. Matthew and Williams, M. Gail and Clements, CA Archie and Sripa, Banchob and Sayasone, Somphou and Khieu, Virak and Wangdi, Kinley and Stewart, E. Donald and Tangkawattana, Sirikachorn and Suwannatrai, T. Apiporn and Savathdy, Vanthanom and Khieu, Visal and Odermatt, Peter and Gordon, A. Catherine and Wannachart, Sangduan and McManus, P. Donald and Gray, J. Darren", title="Examining the Acceptability of Helminth Education Packages ``Magic Glasses Lower Mekong'' and ``Magic Glasses Opisthorchiasis'' and Their Impact on Knowledge, Attitudes, and Practices Among Schoolchildren in the Lower Mekong Basin: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Sep", day="16", volume="13", pages="e55290", keywords="attitude", keywords="child", keywords="health education", keywords="helminths", keywords="knowledge", keywords="practices", keywords="Opisthorchis viverrini", keywords="randomized controlled trial", keywords="schools", keywords="Ascaris lumbricoides", keywords="Trichuris trichiura", keywords="hookworm", keywords="Magic Glasses", abstract="Background: Helminths are a major global health issue, impacting health, educational, and socioeconomic outcomes. Infections, often starting in childhood, are linked to anemia, malnutrition, cognitive deficit, and in chronic cases of Opisthorchis viverrini (OV), cholangiocarcinoma. The main control strategy for helminth infection is mass drug administration; however, this does not prevent reinfection. As such, prevention strategies are needed. The ``Magic Glasses'' is a school-based cartoon health education package that has demonstrated success in improving knowledge, attitudes, and practices (KAP) surrounding soil-transmitted helminths (STH) in China and the Philippines. This study is designed to assess the acceptability and impact of the 2 new versions of the Magic Glasses targeting STH and OV designed for the Lower Mekong audience in Cambodia, Lao People's Democratic Republic (PDR), and Thailand. Objective: The objective of this study is to evaluate the acceptability of the ``Magic Glasses Lower Mekong'' and ``Magic Glasses Opisthorchiasis'' education packages among schoolchildren in the Lower Mekong Basin, and the impact of these education packages on students' KAP surrounding STH and OV, respectively. Methods: Schoolchildren will be recruited into a cluster randomized controlled trial with intervention and control arms in rural schools in Cambodia, Lao PDR, and Thailand. Schoolchildren's initial acceptability of the intervention will be evaluated using an adapted questionnaire. Sustained acceptability will be assessed at 9-month follow-up through focus group discussions with students and interviews with teachers. Impact will be evaluated by KAP questionnaires on STH and OV. KAP questionnaires will be administered to children at baseline and at follow-up. Indirect impact on parents' KAP of OV and STH will be assessed through focus group discussions at follow-up. Results: The trial is in progress in Lao PDR and Thailand and is expected to commence in Cambodia in January 2024. The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the intervention arm of the study will have higher KAP scores for STH and OV, compared with the participants in the control arm at follow-up. We expect that students will have initial and sustained acceptability of these intervention packages. Conclusions: This trial will examine the acceptability of the ``Magic Glasses Opisthorchiasis'' and ``Magic Glasses Lower Mekong'' interventions and provide evidence on the effectiveness of the ``Magic Glasses'' on KAP related to OV and STH among schoolchildren in the Lower Mekong Basin. Study results will provide insight on acceptability and impact indicators and inform a scaling up protocol for the ``Magic Glasses'' education packages in Cambodia, Lao PDR, and Thailand. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000271606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385315\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/55290 ", doi="10.2196/55290", url="https://www.researchprotocols.org/2024/1/e55290" } @Article{info:doi/10.2196/54323, author="Isangula, Ganka Kahabi and Usiri, Itaeli Aminieli and Pallangyo, Siaity Eunice", title="Capitalizing on Community Groups to Improve Women's Resilience to Maternal and Child Health Challenges: Protocol for a Human-Centered Design Study in Tanzania", journal="JMIR Res Protoc", year="2024", month="Sep", day="10", volume="13", pages="e54323", keywords="maternal and child health", keywords="maternal and child deaths", keywords="human-centered design", keywords="income generating associations", keywords="sub-Saharan Africa", keywords="Tanzania", keywords="community groups", keywords="community", keywords="capitalizing", keywords="resilience", keywords="maternal deaths", keywords="neonatal deaths", keywords="mortality", keywords="co-design", abstract="Background: Maternal and neonatal deaths remain a major public health issue worldwide. Income Generation Associations (IGAs) could form a critical entry point to addressing poverty-related contributors. However, there have been limited practical interventions to leverage the power of IGAs in addressing the challenges associated with maternal care and childcare. Objective: This study aims to co-design an intervention package with women in IGAs to improve their readiness and resilience to address maternal and child health (MCH) challenges using a human-centered design approach. Methods: The study will use a qualitative descriptive design with purposefully selected women in IGAs and key MCH stakeholders in the Shinyanga and Arusha Regions of Tanzania. A 4-step adaptation of the human-centered design process will be used involving (1) mapping of IGAs and exploring their activities, level of women's engagement, and MCH challenges faced; (2) co-designing of the intervention package to address identified MCH challenges or needs considering the perceived acceptability, feasibility, and sustainability; (3) validation of the emerging intervention package through gathering insights of women in IGAs who did not take part in initial steps; and (4) refinement of the intervention package with MCH stakeholders based on the validation findings. Results: The participants, procedures, and findings of each co-design step will be presented. More specifically, MCH challenges facing women in IGAs, a list of potential solutions proposed, and the emerging prototype will be presented. As of August 2024, we have completed the co-design of the intervention package and are preparing validation. The findings from the validation of the emerging prototype with a new group of women in IGAs and its refinement through multistakeholder engagement will be presented. A final co-designed intervention package with the potential to improve women's resilience and readiness to handle MCH challenges will be generated. Conclusions: The emerging intervention package will be discussed given relevant literature on the topic. We believe that subsequent testing and refinement of the package could form the basis for scaling up to broader settings and that the package could then be promoted as one of the key strategies in addressing MCH challenges facing women in low- and middle-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/54323 ", doi="10.2196/54323", url="https://www.researchprotocols.org/2024/1/e54323" } @Article{info:doi/10.2196/57384, author="Aggarwal, Sumit and Simmy, Simmy and Mahajan, Nupur and Nigam, Kuldeep", title="Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis", journal="JMIR Form Res", year="2024", month="Sep", day="10", volume="8", pages="e57384", keywords="challenges", keywords="thematic analysis", keywords="infrastructure", keywords="communication", keywords="supply distribution", keywords="resilience", keywords="adaptability", keywords="vaccination awareness", keywords="innovative solutions", abstract="Background: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. Objective: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. Methods: This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Results: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Conclusions: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland. ", doi="10.2196/57384", url="https://formative.jmir.org/2024/1/e57384", url="http://www.ncbi.nlm.nih.gov/pubmed/39255009" } @Article{info:doi/10.2196/59690, author="Dougherty, Kylie and Gebremariam, Abebe and Biza, Heran and Belew, Mulusew and Benda, Natalie and Tesfaye, Yihenew and Cranmer, John and Bakken, Suzanne", title="Obstetric Emergency Supply Chain Dynamics and Information Flow Among Obstetric Emergency Supply Chain Employees: Key Informant Interview Study", journal="JMIR Form Res", year="2024", month="Sep", day="5", volume="8", pages="e59690", keywords="basic emergency obstetric care needs", keywords="BEmOC", keywords="supply chain", keywords="Ethiopia", keywords="Sociotechnical Model", abstract="Background: For the past several decades, the Ethiopian Ministry of Health has worked to decrease the maternal mortality ratio (MMR)---the number of pregnant women dying per 100,000 live births. However, with the most recently reported MMR of 267, Ethiopia still ranks high in the MMR globally and needs additional interventions to lower the MMR to achieve the sustainable development goal of 70. One factor contributing to the current MMR is the frequent stockouts of critical medications and supplies needed to treat obstetric emergencies. Objective: This study describes the obstetric emergency supply chain (OESC) dynamics and information flow in Amhara, Ethiopia, as a crucial first step in closing stockouts and gaps in supply availability. Methods: Applying qualitative descriptive methodology, the research team performed 17 semistructured interviews with employees of the OESC at the federal, regional, and facility level to describe and gain an understanding of the system in the region, communication flow, and current barriers and facilitators to consistent emergency supply availability. The team performed inductive and deductive analysis and used the ``Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems'' to guide the deductive portion. Results: The interviews identified several locations within the OESC where barriers could be addressed to improve overall facility-level readiness, such as gaps in communication about supply needs and availability in health care facilities and regional supply hubs and a lack of data transparency at the facility level. Ordering supplies through the integrated pharmaceutical logistics system was a well-established process and a frequently noted strength. Furthermore, having inventory data in one place was a benefit to pharmacists and supply managers who would need to use the data to determine their historic consumption. The greatest concern related to the workflow and communication of the OESC was an inability to accurately forecast future supply needs. This is a critical issue because inaccurate forecasting can lead to undersupplying and stockouts or oversupplying and waste of medication due to expiration. Conclusions: As a result of these interviews, we gained a nuanced understanding of the information needs for various levels of the health system to maintain a consistent supply of obstetric emergency resources and ultimately increase maternal survival. This study's findings will inform future work to create customized strategies that increase supply availability in facilities and the region overall, specifically the development of electronic dashboards to increase data availability at the regional and facility levels. Without comprehensive and timely data about the OESC, facilities will continue to remain in the dark about their true readiness to manage basic obstetric emergencies, and the central Ethiopian Pharmaceutical Supply Service and regional hubs will not have the necessary information to provide essential emergency supplies prospectively before stockouts and maternal deaths occur. ", doi="10.2196/59690", url="https://formative.jmir.org/2024/1/e59690", url="http://www.ncbi.nlm.nih.gov/pubmed/39235860" } @Article{info:doi/10.2196/59266, author="Chanpitakkul, Methee and Praveen, Devarsetty and John, Renu and Ghosh, Arpita and Lekagul, Salyaveth and Kaewhiran, Malulee and Tungsanga, Kriang and Jha, Vivekanand", title="Rationale, Design, and Intervention Development of a Mobile Health--Led Primary Care Program for Management of Type 2 Diabetes in Rural Thailand: Protocol for a SMARThealth Diabetes Study", journal="JMIR Res Protoc", year="2024", month="Aug", day="16", volume="13", pages="e59266", keywords="health workforce", keywords="primary health care", keywords="diabetes", keywords="digital technology", keywords="Thailand", keywords="capacity building.", abstract="Background: Noncommunicable diseases (NCDs), particularly diabetes and chronic kidney diseases, pose a significant health burden in Thailand, especially among socioeconomically disadvantaged populations. The existing primary health care system faces challenges in providing optimal care for NCDs due to inadequate primary care workforce. The SMARThealth program offers a technology-based solution to enhance NCD management through task-sharing among nonphysician health care workers. Objective: This study aims to adapt and implement the SMARThealth Diabetes program in rural Thailand to improve diabetes management. The main objectives are to (1) adapt, validate, and integrate the SMARThealth Diabetes program for improving the management of type 2 diabetes mellitus at the primary health care level; and (2) to determine the feasibility and acceptability of the SMARThealth Diabetes program in rural communities of Thailand. Methods: A pragmatic, type 2 hybrid effectiveness or implementation, parallel-group cluster randomized controlled trial of 12 months duration and involving 51 subdistrict health offices in rural communities of Kamphaeng Phet province, Thailand, will be conducted. The intervention arm will receive the SMARThealth Diabetes program, including workforce restructuring, clinical decision support system, and continuous performance monitoring, while the control arm will continue with usual practice. Data will be collected using the SMARThealth platform and will be stored on a server in Thailand. The primary outcome measure will be the change in mean hemoglobin A1c (HbA1c) measured at randomization and 12 months from randomization between the intervention and control clusters. Secondary outcomes will include the difference in change in albuminuria status, estimated glomerular filtration rate, systolic blood pressure, and low-density lipoprotein cholesterol level. The analysis for change in HbA1c between baseline and end of study will be performed using linear mixed models. Any imbalances between the 2 arms will be addressed by sensitivity analyses. Additionally, a mixed methods process evaluation will be conducted to assess the implementation process, that will include in-depth interviews and focus group discussions, in addition to the quantitative data collected during the implementation process. The qualitative data will be thematically analyzed to explore factors that promote or inhibit the implementation and maintenance of the program. Results: The data collection commenced in November 2022, and the results will be ready for publication by the first quarter of 2025. Effectiveness of the intervention package will be assessed by change in mean HbA1c measures, and detailed feasibility, barriers, and enablers for the implementation of the intervention will be documented through a detailed process evaluation. Conclusions: The study protocol outlines a novel approach to enhancing diabetes management in rural Thailand through digital technology--based interventions that will facilitate task-sharing among health care workers. This can help inform future strategies for improving NCD care in low-resource settings globally. Trial Registration: Thai Clinical Trials Registry TCTR20200322006; https://www.thaiclinicaltrials.org/show/TCTR20200322006 International Registered Report Identifier (IRRID): DERR1-10.2196/59266 ", doi="10.2196/59266", url="https://www.researchprotocols.org/2024/1/e59266" } @Article{info:doi/10.2196/59484, author="Wu, XiuLi and Kang, Aimei", title="Demand Forecasting of Nurse Talents in China Based on the Gray GM (1,1) Model: Model Development Study", journal="Asian Pac Isl Nurs J", year="2024", month="Aug", day="14", volume="8", pages="e59484", keywords="nursing human resource", keywords="nursing manpower", keywords="Gray GM (1,1) model", keywords="forecasting", keywords="nursing", abstract="Background: In a global context, the shortage of nursing personnel has emerged as a significant challenge, particularly in countries such as China experiencing population aging. The inadequacy of nursing human resources has become one of the primary threats affecting the quality of health services available to Chinese residents. Therefore, forecasting the demand for nursing personnel has become an important issue. Objective: This study presents a Gray GM (1,1) forecasting model for predicting the future 10-year demand for nursing workforce and the number of specialized geriatric nurses, aiming to provide a scientific basis for the development of policies in health care institutions in China. Methods: Based on data from the China Statistical Yearbook 2022, the Gray GM (1,1) model was used to predict the demand for nursing jobs and geriatric nurses over the next 10 years (2024-2033). Results: The results indicate that from 2024 to 2033, amidst a continuous growth in the overall population and an increasingly pronounced trend of population aging, the demand for nursing workforce in China, especially for specialized geriatric nurses, is projected to steadily increase. Conclusions: The paper provides a reference basis for the establishment of China's health care workforce system and the involvement of government departments in health care workforce planning. ", doi="10.2196/59484", url="https://apinj.jmir.org/2024/1/e59484" } @Article{info:doi/10.2196/50047, author="Xie, Yijun and Wu, Jing and Li, Yao and Liu, Hui and Peng, Yanyan and Zhou, Ping and Sun, Yizhou and Kang, Luyan and Jiang, Chenghua and Wu, Hengjing", title="Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review", journal="Interact J Med Res", year="2024", month="Aug", day="7", volume="13", pages="e50047", keywords="children with disabilities", keywords="barriers", keywords="health services", keywords="middle- and high-income countries", keywords="child", keywords="low income", keywords="middle income", keywords="disability", keywords="children", keywords="disabilities", keywords="income", keywords="barrier", keywords="rehabilitation", keywords="suitability", keywords="availability", keywords="affordability", keywords="support system", keywords="support", keywords="awareness", keywords="policy", abstract="Background: The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. Objective: This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. Methods: A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. Results: The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. Conclusions: Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level. ", doi="10.2196/50047", url="https://www.i-jmr.org/2024/1/e50047", url="http://www.ncbi.nlm.nih.gov/pubmed/39110502" } @Article{info:doi/10.2196/48213, author="Haq, Ul Zaeem and Naeem, Ayesha and Zaeem, Durayya and Sohail, Mohina and Pervaiz, Ain Noor ul", title="Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study", journal="JMIRx Med", year="2024", month="Jul", day="31", volume="5", pages="e48213", keywords="primary health care", keywords="mother and child health", keywords="community health worker", keywords="slums", keywords="digital applications", keywords="health communication.", abstract="Background: Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective: This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods: We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results: Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers' self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions: Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time. ", doi="10.2196/48213", url="https://xmed.jmir.org/2024/1/e48213" } @Article{info:doi/10.2196/49205, author="Knauss, Samuel and Andriamiadana, Gracia and Leitheiser, Roxane and Rampanjato, Zavaniarivo and B{\"a}rnighausen, Till and Emmrich, Valentin Julius", title="Effect of the COVID-19 Lockdown on Mobile Payments for Maternal Health: Regression Discontinuity Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="30", volume="10", pages="e49205", keywords="digital health", keywords="behavioral surveillance", keywords="digital health wallet", keywords="mobile money", keywords="COVID-19", keywords="health financing", keywords="public health", keywords="sub-Saharan Africa", abstract="Background: The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood. Objective: This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services. Methods: We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes. Results: We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5\% (P<.001), payments by 45.8\% (P<.001), and voucher use by 49.6\% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using {\textpm}20 days of the optimal bandwidth. Conclusions: The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women's expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols. ", doi="10.2196/49205", url="https://publichealth.jmir.org/2024/1/e49205", url="http://www.ncbi.nlm.nih.gov/pubmed/39078698" } @Article{info:doi/10.2196/47520, author="Basu, Saurav and Desai, Meghana and Karan, Anup and Bhardwaj, Surbhi and Negandhi, Himanshu and Jadhav, Nitin and Maske, Amar and Zodpey, Sanjay", title="COVID-19 Resilience and Risk Reduction Intervention in Rural Populations of Western India: Retrospective Evaluation", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="29", volume="10", pages="e47520", keywords="COVID-19", keywords="community intervention", keywords="COVID-19 vaccination", keywords="COVID-appropriate behavior", keywords="impact evaluation", keywords="rural health", keywords="community-based intervention", keywords="rural population", keywords="awareness", keywords="disease prevention", keywords="health literacy", keywords="public health", keywords="pandemic", keywords="digital health", keywords="community awareness", keywords="effectiveness", keywords="low- and middle-income countries", keywords="vaccination", keywords="infodemic", abstract="Background: Globally, especially in the low- and middle-income countries (LMICs), rural populations were more susceptible to the negative impact of the COVID-19 pandemic due to lower levels of community awareness, poor hygiene, and health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide to mitigate the COVID-19 pandemic by empowering people to mount both individual and collective public health responses against the pandemic. However, to date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effects of COVID-19, especially from the perspective of LMICs. Objective: This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community--based intervention, the COVID-Free Village Program (CFVP), on COVID-19 resilience and control in rural populations in Maharashtra, India. Methods: The intervention site was the rural areas of the Pune district where CFVP was implemented from August 2021 to February 2022, while the adjoining district, Satara, represented the control district where the COVID-Free Village Scheme was implemented. Data were collected during April-May 2022 from 3500 sample households in villages across intervention and comparison arms by using the 2-stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods. Results: The participants in Pune had a significantly higher combined COVID-19 awareness index by 0.43 (95\% CI 0.29-0.58) points than those in Satara. Furthermore, the adherence to COVID-appropriate behaviors, including handwashing, was 23\% (95\% CI 3\%-45\%) and masking was 17\% (0\%-38\%) higher in Pune compared to those in Satara. The probability of perception of COVID as a serious illness in patients with heart disease was 22\% (95\% CI 1.036-1.439) higher in Pune compared to that in Satara. The awareness index of COVID-19 variants and preventive measures were also higher in Pune by 0.88 (95\% CI 0.674-1.089) points. In the subgroup analysis, when the highest household educational level was restricted to middle school, the awareness about the COVID-control program was 0.69 (95\% CI 0.36-1.021) points higher in Pune, while the awareness index of COVID-19 variants and preventive measures was higher by 0.45 (95\% CI 0.236-0.671) points. We did not observe any significant changes in the overall COVID-19 vaccination coverage due to CFVP implementation. Furthermore, the number of COVID-19 deaths in both the sampled populations were very low. The probability of observing COVID-19--related stigma or discrimination in Pune was 68\% (95\% CI 0.133-0.191) lower than that in Satara. Conclusions: CFVP contributed to improved awareness and sustainability of COVID-appropriate behaviors in a large population although there was no evidence of higher COVID-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness, especially in resource-constrained settings. ", doi="10.2196/47520", url="https://publichealth.jmir.org/2024/1/e47520", url="http://www.ncbi.nlm.nih.gov/pubmed/39073851" } @Article{info:doi/10.2196/54272, author="Rabbani, Fauziah and Nafis, Javeria and Akhtar, Samina and Khan, Shahid Muhammad and Sayani, Saleem and Siddiqui, Amna and Siddiqi, Sameen and Merali, Zul", title="Technology-Assisted Mental Health Intervention Delivered by Frontline Workers at Community Doorsteps for Reducing Anxiety and Depression in Rural Pakistan: Protocol for the mPareshan Mixed Methods Implementation Trial", journal="JMIR Res Protoc", year="2024", month="Jul", day="23", volume="13", pages="e54272", keywords="anxiety", keywords="depression", keywords="feasibility", keywords="mental health", keywords="health workers", keywords="mPareshan app", keywords="implementation research", abstract="Background: There is a dearth of specialized mental health workforce in low- and middle-income countries. Use of mobile technology by frontline community health workers (CHWs) is gaining momentum in Pakistan and needs to be explored as an alternate strategy to improve mental well-being. Objective: The aim of this study is to assess the feasibility, acceptability, and usefulness of an app-based counseling intervention delivered by government lady health workers (LHWs) to reduce anxiety and depression in rural Pakistan. Methods: Project mPareshan is a single-arm, pre- and posttest implementation research trial in Badin District, Sindh, using mixed methods of data collection executed in 3 phases (preintervention, intervention, and postintervention). In the preintervention phase, formative qualitative assessments through focus group discussions and in-depth interviews assess the acceptability and appropriateness of intervention through perceptions of all concerned stakeholders using a specific interview guide. A REDCap (Research Electronic Data Capture)-based baseline survey using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 Scale (GAD-7) determines the point prevalence of depression and anxiety among consenting men and women older than 18 years. Individuals with mild and moderate anxiety and depression are identified as screen positives (SPs) and are eligible for mPareshan app--based intervention. Mental health literacy of health workers is improved through customized training adapting the World Health Organization's Mental Health Gap Action Programme guide 2.0. The intervention (mPareshan app) consists of tracking, counseling, and referral segments. The tracking segment facilitates participant consent and enrollment while the referral segment is used by LHWs to transfer severe cases to the next level of specialist care. Through the counseling segment, identified SPs are engaged during LHWs' routine home visits in 6 face-to-face 20-minute counseling sessions over 6 months. Each session imparts psychoeducation through audiovisual aids, breathing exercises, and coping skills to reduce stress. Clinical and implementation outcomes include change in mean anxiety and depression scores and identification of facilitators and barriers in intervention uptake and rollout. Results: At the time of this submission (April 2024), we are analyzing the results of 366 individuals who participated in the baseline prevalence survey, the change in knowledge and skills of 72 health workers who took the mPareshan training, change in anxiety and depression scores of 98 SPs recruited for app-based counseling intervention, and perceptions of stakeholders pre- and postintervention gathered through 8 focus group discussions and 18 in-depth interviews. Conclusions: This trial will assess the feasibility of early home-based mental health screening, counseling, and prompt referrals by frontline health workers to reduce anxiety and depression in the community. The study findings will set the stage for integrating mental health into primary health care. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12622000989741; https://tinyurl.com/5n844c8z International Registered Report Identifier (IRRID): DERR1-10.2196/54272 ", doi="10.2196/54272", url="https://www.researchprotocols.org/2024/1/e54272" } @Article{info:doi/10.2196/52395, author="Bulcha, Gebeyehu and Abdissa, Gutema Hordofa and Noll, Josef and Sori, Amenu Demisew and Koricha, Birhanu Zewdie", title="Effectiveness of a Mobile Phone Messaging--Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Jul", day="23", volume="13", pages="e52395", keywords="message framing", keywords="mHealth", keywords="digital health", keywords="SMS", keywords="maternal health", keywords="newborn health", keywords="cluster randomized controlled trials", keywords="RCT", keywords="Ethiopia", keywords="mobile phone", keywords="effectiveness", keywords="SMS-based interventions", keywords="text messaging", keywords="maternal", keywords="newborn care practice", keywords="randomized", keywords="controlled trial", keywords="controlled trials", keywords="mobile phone messaging", keywords="phone-based intervention", abstract="Background: Ethiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging--based message framing for maternal and newborn health. Objective: This research aims to examine the effectiveness of mobile phone messaging--based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. Methods: A 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone--based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. Results: Recruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. Conclusions: This trial was carried out to understand how mobile phone--based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Trial Registration: Pan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49 International Registered Report Identifier (IRRID): DERR1-10.2196/52395 ", doi="10.2196/52395", url="https://www.researchprotocols.org/2024/1/e52395" } @Article{info:doi/10.2196/54129, author="Posner, Jessica and Ndhlovu, Paxon Adamson and Musangulule, Mushinka Jemmy and Duffy, Malia and Casella, Amy and Madevu-Matson, Caitlin and Davis, Nicole and Sharer, Melissa", title="Evaluating the Preliminary Effectiveness of the Person-Centered Care Assessment Tool (PCC-AT) in Zambian Health Facilities: Protocol for a Mixed Methods Cross-Sectional Study", journal="JMIR Res Protoc", year="2024", month="Jul", day="23", volume="13", pages="e54129", keywords="person-centered care", keywords="HIV", keywords="action plans", keywords="preliminary", keywords="person-centered care assessment tool", keywords="PCC-AT", keywords="assessment tool", keywords="Zambia", keywords="health facility", keywords="exploratory study", keywords="HIV treatment", keywords="inequities", keywords="framework", keywords="practitioners", keywords="health services", abstract="Background: Person-centered care (PCC) within HIV treatment services has demonstrated potential to overcome inequities in HIV service access while improving treatment outcomes. Despite PCC being widely considered a best practice, no consensus exists on its assessment and measurement. This study in Zambia builds upon previous research that informed development of a framework for PCC and a PCC assessment tool (PCC-AT). Objective: This mixed methods study aims to examine the preliminary effectiveness of the PCC-AT through assessing the association between client HIV service delivery indicators and facility PCC-AT scores. We hypothesize that facilities with higher PCC-AT scores will demonstrate more favorable HIV treatment continuity, viral load (VL) coverage, and viral suppression in comparison to those of facilities with lower PCC-AT scores. Methods: We will implement the PCC-AT at 30 randomly selected health facilities in the Copperbelt and Central provinces of Zambia. For each study facility, data will be gathered from 3 sources: (1) PCC-AT scores, (2) PCC-AT action plans, and (3) facility characteristics, along with service delivery data. Quantitative analysis, using STATA, will include descriptive statistics on the PCC-AT results stratified by facility characteristics. Cross-tabulations and/or regression analysis will be used to determine associations between scores and treatment continuity, VL coverage, and/or viral suppression.?Qualitative data will be collected via action planning, with detailed notes collected and recorded into an action plan template. Descriptive coding and emerging themes will be analyzed with NVivo software. Results: As of May 2024, we enrolled 29 facilities in the study and data analysis from the key informant interviews is currently underway. Results are expected to be published by September 2024. Conclusions: Assessment and measurement of PCC within HIV treatment settings is a novel approach that offers HIV treatment practitioners the opportunity to examine their services and identify actions to improve PCC performance. Study results and the PCC-AT will be broadly disseminated for use among all project sites in Zambia as well as other HIV treatment programs, in addition to making the PCC-AT publicly available to global HIV practitioners. International Registered Report Identifier (IRRID): DERR1-10.2196/54129 ", doi="10.2196/54129", url="https://www.researchprotocols.org/2024/1/e54129" } @Article{info:doi/10.2196/49367, author="Li, Qin and Kanduma, Elsa and Ramiro, Isa{\'i}as and Xu, (Roman) Dong and Cuco, Manjate Rosa Marlene and Chaquisse, Eusebio and Yang, Yili and Wang, Xiuli and Pan, Jay", title="Spatial Access to Continuous Maternal and Perinatal Health Care Services in Low-Resource Settings: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="18", volume="10", pages="e49367", keywords="continuous maternal and perinatal health care services", keywords="sub-Saharan Africa", keywords="SSA", keywords="spatial access", keywords="resource allocation", keywords="low-resource settings", abstract="Background: Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving access to continuous maternal and perinatal health care services (CMPHS) has been addressed as a critical strategy. Objective: This study aims to provide a widely applicable procedure to illuminate the current challenges in ensuring access to CMPHS for women of reproductive age. The findings are intended to inform targeted recommendations for prioritizing resource allocation and policy making in low-resource settings. Methods: In accordance with the World Health Organization guidelines and existing literature, and taking into account the local context of CMPHS delivery to women of reproductive age in Mozambique, we first proposed the identification of CMPHS as the continuum of 3 independent service packages, namely antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC). Then, we used the nearest-neighbor method (NNM) to assess spatial access to each of the 3 service packages. Lastly, we carried out an overlap analysis to identify 8 types of resource-shortage zones. Results: The median shortest travel times for women of reproductive age to access ANC, ID, and PNC were 2.38 (IQR 1.38-3.89) hours, 3.69 (IQR 1.87-5.82) hours, and 4.16 (IQR 2.48-6.67) hours, respectively. Spatial barriers for women of reproductive age accessing ANC, ID, and PNC demonstrated large variations both among and within regions. Maputo City showed the shortest travel time and the best equity within the regions (0.46, IQR 0.26-0.69 hours; 0.74, IQR 0.47-1.04 hours; and 1.34, IQR 0.83-1.85 hours, respectively), while the provinces of Niassa (4.07, IQR 2.41-6.63 hours; 18.20, IQR 11.67-24.65 hours; and 7.69, IQR 4.74-13.05 hours, respectively) and Inhambane (2.69, IQR 1.49-3.91 hours; 4.43, IQR 2.37-7.16 hours; and 10.76, IQR 7.73-13.66 hours, respectively) lagged behind significantly in both aspects. In general, more than 51\% of the women of reproductive age, residing in 83.25\% of Mozambique's land area, were unable to access any service package of CMPHS in time (within 2 hours), while only about 21\%, living in 2.69\% of Mozambique's land area, including Maputo, could access timely CMPHS. Conclusions: The spatial accessibility and equity of CMPHS in Mozambique present significant challenges in achieving SDG3 and UHC, especially in the Inhambane and Niassa regions. For Inhambane, policy makers should prioritize the implementation of a decentralization allocation strategy to increase coverage and equity through upgrading existing health care facilities. For Niassa, the cultivation of well-trained midwives who can provide door-to-door ANC and PNC at home should be prioritized, with an emphasis on strengthening communities' engagement. The proposed 2-step procedure should be implemented in other low-resource settings to promote the achievement of SDG3. ", doi="10.2196/49367", url="https://publichealth.jmir.org/2024/1/e49367" } @Article{info:doi/10.2196/51743, author="G{\'o}mez-Valverde, J. Juan and S{\'a}nchez-Jacob, Ram{\'o}n and Rib{\'o}, Luis Jos{\'e} and Schaaf, Simon H. and Garc{\'i}a Delgado, Lara and Hernanz-Lobo, Alicia and Capell{\'a}n-Mart{\'i}n, Daniel and Lancharro, {\'A}ngel and Augusto, Orvalho and Garc{\'i}a-Basteiro, L. Alberto and Santiago-Garc{\'i}a, Bego{\~n}a and L{\'o}pez-Varela, Elisa and Ledesma-Carbayo, J. Mar{\'i}a", title="Chest X-Ray--Based Telemedicine Platform for Pediatric Tuberculosis Diagnosis in Low-Resource Settings: Development and Validation Study", journal="JMIR Pediatr Parent", year="2024", month="Jul", day="1", volume="7", pages="e51743", keywords="telemedicine", keywords="telehealth", keywords="pediatric tuberculosis", keywords="tuberculosis", keywords="screening", keywords="chest radiograph", keywords="usability", keywords="low-resource settings", abstract="Background: Tuberculosis (TB) remains a major cause of morbidity and death worldwide, with a significant impact on children, especially those under the age of 5 years. The complex diagnosis of pediatric TB, compounded by limited access to more accurate diagnostic tests, underscores the need for improved tools to enhance diagnosis and care in resource-limited settings. Objective: This study aims to present a telemedicine web platform, BITScreen PTB (Biomedical Image Technologies Screen for Pediatric Tuberculosis), aimed at improving the evaluation of pulmonary TB in children based on digital chest x-ray (CXR) imaging and clinical information in resource-limited settings. Methods: The platform was evaluated by 3 independent expert readers through a retrospective assessment of a data set with 218 imaging examinations of children under 3 years of age, selected from a previous study performed in Mozambique. The key aspects assessed were the usability through a standardized questionnaire, the time needed to complete the assessment through the platform, the performance of the readers to identify TB cases based on the CXR, the association between the TB features identified in the CXRs and the initial diagnostic classification, and the interreader agreement of the global assessment and the radiological findings. Results: The platform's usability and user satisfaction were evaluated using a questionnaire, which received an average rating of 4.4 (SD 0.59) out of 5. The average examination completion time ranged from 35 to 110 seconds. In addition, the study on CXR showed low sensitivity (16.3\%-28.2\%) but high specificity (91.1\%-98.2\%) in the assessment of the consensus case definition of pediatric TB using the platform. The CXR finding having a stronger association with the initial diagnostic classification was air space opacification ($\chi$21>20.38, P<.001). The study found varying levels of interreader agreement, with moderate/substantial agreement for air space opacification ($\kappa$=0.54-0.67) and pleural effusion ($\kappa$=0.43-0.72). Conclusions: Our findings support the promising role of telemedicine platforms such as BITScreen PTB in enhancing pediatric TB diagnosis access, particularly in resource-limited settings. Additionally, these platforms could facilitate the multireader and systematic assessment of CXR in pediatric TB clinical studies. ", doi="10.2196/51743", url="https://pediatrics.jmir.org/2024/1/e51743", url="http://www.ncbi.nlm.nih.gov/pubmed/38949860" } @Article{info:doi/10.2196/51993, author="Kaewkungwal, Jaranit and Roobsoong, Wanlapa and Lawpoolsri, Saranath and Nguitragool, Wang and Thammapalo, Suwich and Prikchoo, Pathomporn and Khamsiriwatchara, Amnat and Pawarana, Rungrawee and Jarujareet, Pawinee and Parker, M. Daniel and Sripoorote, Piyarat and Kengganpanich, Mondha and Ngamjarus, Chetta and Sattabongkot, Jetsumon and Cui, Liwang", title="Effectiveness, Safety, and Acceptability of Primaquine Mass Drug Administration in Low-Endemicity Areas in Southern Thailand: Proof-of-Concept Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="26", volume="10", pages="e51993", keywords="mass drug administration", keywords="cluster-crossover randomized controlled trial", keywords="community-based trial", keywords="participatory epidemiology", keywords="Plasmodium vivax", keywords="primaquine", abstract="Background: A challenge in achieving the malaria-elimination target in the Greater Mekong Subregion, including Thailand, is the predominance of Plasmodium vivax malaria, which has shown extreme resilience to control measures. Objective: This proof-of-concept study aimed to provide evidence for implementing primaquine mass drug administration (pMDA) as a strategy for P. vivax elimination in low-endemicity settings. Methods: The study employed a mixed-methods trial to thoroughly evaluate the effectiveness, safety, acceptability, and community engagement of pMDA. The quantitative part was designed as a 2-period cluster-crossover randomized controlled trial. The intervention was pMDA augmented to the national prevention and control standards with directly observed treatment (DOT) by village health volunteers. The qualitative part employed in-depth interviews and brainstorming discussions. The study involved 7 clusters in 2 districts of 2 southern provinces in Thailand with persistently low P. vivax transmission. In the quantitative part, 5 cross-sectional blood surveys were conducted in both the pMDA and control groups before and 3 months after pMDA. The effectiveness of pMDA was determined by comparing the proportions of P. vivax infections per 1000 population between the 2 groups, with a multilevel zero-inflated negative binomial model adjusted for cluster and time as covariates and the interaction. The safety data comprised adverse events after drug administration. Thematic content analysis was used to assess the acceptability and engagement of stakeholders. Results: In the pre-pMDA period, the proportions of P. vivax infections in the pMDA (n=1536) and control (n=1577) groups were 13.0 (95\% CI 8.2-20.4) and 12.0 (95\% CI 7.5-19.1), respectively. At month 3 post-pMDA, these proportions in the pMDA (n=1430) and control (n=1420) groups were 8.4 (95\% CI 4.6-15.1) and 5.6 (95\% CI 2.6-11.5), respectively. No statistically significant differences were found between the groups. The number of malaria cases reduced in all clusters in both groups, and thus, the impact of pMDA was inconclusive. There were no major safety concerns. Acceptance among the study participants and public health care providers at local and national levels was high, and they believed that pMDA had boosted awareness in the community. Conclusions: pMDA was associated with high adherence, safety, and tolerability, but it may not significantly impact P. vivax transmission. As this was a proof-of-concept study, we decided not to scale up the intervention with larger clusters and samples. An alternative approach involving a targeted primaquine treatment strategy with primaquine and DOT is currently being implemented. We experienced success regarding effective health care workforces at point-of-care centers, effective collaborations in the community, and commitment from authorities at local and national levels. Our efforts boosted the acceptability of the malaria-elimination initiative. Community engagement is recommended to achieve elimination targets. Trial Registration: Thai Clinical Trials Registry TCTR20190806004; https://www.thaiclinicaltrials.org/show/TCTR20190806004 ", doi="10.2196/51993", url="https://publichealth.jmir.org/2024/1/e51993", url="http://www.ncbi.nlm.nih.gov/pubmed/38922648" } @Article{info:doi/10.2196/50248, author="Arshed, Muhammad and Mahmud, Aidalina and Minhat, Sakdiah Halimatus and Lim, Ying Poh and Zakar, Rubeena", title="Effectiveness of a Multifaceted Mobile Health Intervention (Multi-Aid-Package) in Medication Adherence and Treatment Outcomes Among Patients With Hypertension in a Low- to Middle-Income Country: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="19", volume="12", pages="e50248", keywords="mobile health", keywords="mHealth", keywords="intervention", keywords="medication adherence", keywords="hypertension", keywords="low- to middle-income country", keywords="effectiveness", keywords="randomized controlled trial", keywords="Pakistan", keywords="drug adherence", keywords="tool", keywords="mHealth module", keywords="self-efficacy", keywords="systolic blood pressure", keywords="feedback", abstract="Background: The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence. Objective: We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Methods: A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication. Results: Of 439 participants, 423 (96.4\%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2\% vs 2/219, 0.9\%; P<.001), as well as within the intervention group (difference of n=83, 37.2\% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95\% CI 2.387-3.825), time (AOR 1.837, 95\% CI 1.625-2.754), and age (AOR 1.618, 95\% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8\% acceptability score. Conclusions: The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Trial Registration: ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157 ", doi="10.2196/50248", url="https://mhealth.jmir.org/2024/1/e50248" } @Article{info:doi/10.2196/54313, author="Bhattacharjee, Parinita and McClarty, M. Leigh and Kimani, Joshua and Isac, Shajy and Wanjiru Kabuti, Rhoda and Kinyua, Antony and Karakaja Okoyana, Jaffred and Njeri Ndukuyu, Virjinia and Musyoki, Helgar and Kiplagat, Anthony and Arimi, Peter and Shaw, Souradet and Emmanuel, Faran and Gandhi, Monica and Becker, Marissa and Blanchard, James", title="Assessing Outcomes in HIV Prevention and Treatment Programs With Female Sex Workers and Men Who Have Sex With Men: Expanded Polling Booth Survey Protocol", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="19", volume="10", pages="e54313", keywords="female sex workers", keywords="men who have sex with men", keywords="Kenya", keywords="polling booth survey", keywords="program science", keywords="HIV prevention", keywords="outcome assessment", abstract="Background: Assessing HIV outcomes in key population prevention programs is a crucial component of the program cycle, as it facilitates improved planning and monitoring of anticipated results. The Joint United Nations Programme on HIV and AIDS recommends using simple, rapid methods to routinely measure granular and differentiated program outcomes for key populations. Following a program science approach, Partners for Health and Development in Africa, in partnership with the Nairobi County Government and the University of Manitoba, aims to conduct an outcome assessment using a novel, expanded polling booth survey (ePBS) method with female sex workers and men who have sex with men in Nairobi County, Kenya. Objective: This study aims to (1) estimate the incidence and prevalence of HIV; (2) assess biomedical, behavioral, and structural outcomes; and (3) understand barriers contributing to gaps in access and use of available prevention and treatment services among female sex workers and men who have sex with men in Nairobi. Methods: The novel ePBS approach employs complementary data collection methods, expanding upon the traditional polling booth survey (PBS) method by incorporating additional quantitative, qualitative, and biological data collection components and an improved sampling methodology. Quantitative methods will include (1) PBS, a group interview method in which individuals provide responses through a ballot box in an unlinked and anonymous way, and (2) a behavioral and biological survey (BBS), including a face-to-face individual interview and collection of linked biological samples. Qualitative methods will include focus group discussions. The ePBS study uses a 2-stage, population- and location-based random sampling approach involving the random selection of locations from which random participants are selected at a predetermined time on a randomly selected day. PBS data will be analyzed at the group level, and BBS data will be analyzed at an individual level. Qualitative data will be analyzed thematically. Results: Data were collected from April to May 2023. The study has enrolled 759 female sex workers (response rate: 759/769, 98.6\%) and 398 men who have sex with men (response rate: 398/420, 94.7\%). Data cleaning and analyses are ongoing, with a focus on assessing gaps in program coverage and inequities in program outcomes. Conclusions: The study will generate valuable HIV outcome data to inform program improvement and policy development for Nairobi County's key population HIV prevention program. This study served as a pilot for the novel ePBS method, which combines PBS, BBS, and focus group discussions to enhance its programmatic utility. The ePBS method holds the potential to fill an acknowledged gap for a rapid, low-cost, and simple method to routinely measure HIV outcomes within programs and inform incremental program improvements through embedded learning processes. ", doi="10.2196/54313", url="https://publichealth.jmir.org/2024/1/e54313" } @Article{info:doi/10.2196/48815, author="Miao, Huazhang and He, Hui and Nie, Chuan and Ren, Jianbing and Luo, Xianqiong", title="Spatiotemporal Characteristics and Risk Factors for All and Severity-Specific Preterm Births in Southern China, 2014-2021: Large Population-Based Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="18", volume="10", pages="e48815", keywords="preterm birth", keywords="spatiotemporal", keywords="incidence", keywords="risk", keywords="neonatal", keywords="infant", keywords="pregnancy health", keywords="pregnancy complication", keywords="pregnancy", keywords="birth defect", keywords="birth defects", keywords="obstetric labor", keywords="premature", abstract="Background: The worldwide incidence of preterm births is increasing, and the risks of adverse outcomes for preterm infants significantly increase with shorter gestation, resulting in a substantial socioeconomic burden. Limited epidemiological studies have been conducted in China regarding the incidence and spatiotemporal trends of preterm births. Seasonal variations in risk indicate the presence of possible modifiable factors. Gender influences the risk of preterm birth. Objective: This study aims to assess the incidence rates of preterm birth, very preterm birth, and extremely preterm birth; elucidate their spatiotemporal distribution; and investigate the risk factors associated with preterm birth. Methods: We obtained data from the Guangdong Provincial Maternal and Child Health Information System, spanning from January 1, 2014, to December 31, 2021, pertaining to neonates with gestational ages ranging from 24 weeks to 42 weeks. The primary outcome measures assessed variations in the rates of different preterm birth subtypes over the course of the study, such as by year, region, and season. Furthermore, we examined the relationship between preterm birth incidence and per capita gross domestic product (GDP), simultaneously analyzing the contributing risk factors. Results: The analysis incorporated data from 13,256,743 live births. We identified 754,268 preterm infants and 12,502,475 full-term infants. The incidences of preterm birth, very preterm birth, and extremely preterm birth were 5.69 per 100 births, 4.46 per 1000 births, and 4.83 per 10,000 births, respectively. The overall incidence of preterm birth increased from 5.12\% in 2014 to 6.38\% in 2021. The incidence of extremely preterm birth increased from 4.10 per 10,000 births in 2014 to 8.09 per 10,000 births in 2021. There was a positive correlation between the incidence of preterm infants and GDP per capita. In more developed economic regions, the incidence of preterm births was higher. Furthermore, adjusted odds ratios revealed that advanced maternal age, multiple pregnancies, and male infants were associated with an increased risk of preterm birth, whereas childbirth in the autumn season was associated with a protective effect against preterm birth. Conclusions: The incidence of preterm birth in southern China exhibited an upward trend, closely linked to enhancements in the care capabilities for high-risk pregnant women and critically ill newborns. With the recent relaxation of China's 3-child policy, coupled with a temporary surge in advanced maternal age and multiple pregnancies, the risk of preterm birth has risen. Consequently, there is a pressing need to augment public health investments aimed at mitigating the risk factors associated with preterm birth, thereby alleviating the socioeconomic burden it imposes. ", doi="10.2196/48815", url="https://publichealth.jmir.org/2024/1/e48815", url="http://www.ncbi.nlm.nih.gov/pubmed/38888944" } @Article{info:doi/10.2196/42050, author="Rahi, Manju and Mishra, AK and Chand, Gyan and Baharia, RK and Hazara, RK and Singh, SP and Khan, Siraj and Sreehari, U. and Kamaraju, Divya and Kumar, Gaurav and Gupta, Kumar Sanjeev and Sharma, Amit and Raghavendra, K. and Gunasekaran, K. and Singh, P. Om and Subbarao, K. Sarala", title="Malaria Vector Bionomics: Countrywide Surveillance Study on Implications for Malaria Elimination in India", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="17", volume="10", pages="e42050", keywords="malaria", keywords="bionomics", keywords="sibling species", keywords="insecticide resistance", keywords="elimination", keywords="India", abstract="Background: The biological characteristics of mosquito vectors vary, impacting their response to control measures. Thus, having up-to-date information on vector bionomics is essential to maintain the effectiveness of existing control strategies and tools, particularly as India aims for malaria elimination by 2030. Objective: This study aims to assess the proportions of vector species resting indoors and outdoors, determine their preference for host biting/feeding, identify transmission sites, and evaluate the susceptibility of vectors to insecticides used in public health programs. Methods: Mosquito collections were conducted in 13 districts across 8 Indian states from 2017 to 2020 using various methods to estimate their densities. Following morphological identification in the field, sibling species of Anopheles mosquitoes were identified molecularly using polymerase chain reaction (PCR)--specific alleles. Plasmodium falciparum and Plasmodium vivax infections in the vectors were detected using enzyme-linked immunosorbent assay (ELISA) and PCR assays. In addition, we assessed the insecticide susceptibility status of primary malaria vectors following the World Health Organization (WHO) protocol. Results: Anopheles culicifacies, a primary malaria vector, was collected (with a man-hour density ranging from 3.1 to 15.9) from all states of India except those in the northeastern region. Anopheles fluviatilis, another primary vector, was collected from the states of Madhya Pradesh, Maharashtra, Karnataka, and Odisha. In Haryana and Karnataka, An. culicifacies sibling species A predominated, whereas species C and E were predominant in Madhya Pradesh and Maharashtra. An. culicifacies displayed mainly endophilic behavior across all states, except in Madhya Pradesh, where the proportion of semigravid and gravid mosquitoes was nearly half of that of unfed mosquitoes. The human blood index of An. culicifacies ranged from 0.001 to 0.220 across all study sites. The sporozoite rate of An. culicifacies ranged from 0.06 to 4.24, except in Madhya Pradesh, where none of the vector mosquitoes were found to be infected with the Plasmodium parasite. In the study area, An. culicifacies exhibited resistance to DDT (dichlorodiphenyltrichloroethane; with <39\% mortality). Moreover, it showed resistance to malathion (with mortality rates ranging from 49\% to 78\%) in all districts except Angul in Odisha and Palwal in Haryana. In addition, resistance to deltamethrin was observed in districts of Maharashtra, Gujarat, Haryana, and Karnataka. Conclusions: Our study offers vital insights into the prevalence, resting behavior, and sibling species composition of malaria vectors in India. It is evident from our findings that resistance development in An. culicifacies, the primary vector, to synthetic pyrethroids is on the rise in the country. Furthermore, the results of our study suggest a potential change in the resting behavior of An. culicifacies in Madhya Pradesh, although further studies are required to confirm this shift definitively. These findings are essential for the development of effective vector control strategies in India, aligning with the goal of malaria elimination by 2030. ", doi="10.2196/42050", url="https://publichealth.jmir.org/2024/1/e42050", url="http://www.ncbi.nlm.nih.gov/pubmed/38885497" } @Article{info:doi/10.2196/55418, author="Zhou, Qingqing and Zeng, Huatang and Wu, Liqun and Diao, Kaichuan and He, Rongxin and Zhu, Bin", title="Geographic Disparities in Access to Assisted Reproductive Technology Centers in China: Spatial-Statistical Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="12", volume="10", pages="e55418", keywords="assisted reproductive technology", keywords="spatial accessibility", keywords="travel time", keywords="travel cost", keywords="China", doi="10.2196/55418", url="https://publichealth.jmir.org/2024/1/e55418", url="http://www.ncbi.nlm.nih.gov/pubmed/38865169" } @Article{info:doi/10.2196/47631, author="Tegenaw, Sahle Geletaw and Sori, Amenu Demisew and Teklemariam, Ketema Girum and Verbeke, Frank and Cornelis, Jan and Jansen, Bart", title="Evaluation of a Computer-Aided Clinical Decision Support System for Point-of-Care Use in Low-Resource Primary Care Settings: Acceptability Evaluation Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="11", volume="11", pages="e47631", keywords="low-resource setting", keywords="clinical decision support system", keywords="point-of-care instrument", keywords="evaluation", keywords="user acceptance", keywords="structural equation modeling", keywords="partial least squares structural equation modeling", keywords="decision-making", keywords="decision making", keywords="decision support", keywords="caregiver", keywords="users", keywords="acceptance", keywords="system quality", abstract="Background: A clinical decision support system (CDSS) based on the logic and philosophy of clinical pathways is critical for managing the quality of health care and for standardizing care processes. Using such a system at a point-of-care setting is becoming more frequent these days. However, in a low-resource setting (LRS), such systems are frequently overlooked. Objective: The purpose of the study was to evaluate the user acceptance of a CDSS in LRSs. Methods: The CDSS evaluation was carried out at the Jimma Health Center and the Jimma Higher Two Health Center, Jimma, Ethiopia. The evaluation was based on 22 parameters organized into 6 categories: ease of use, system quality, information quality, decision changes, process changes, and user acceptance. A Mann-Whitney U test was used to investigate whether the difference between the 2 health centers was significant (2-tailed, 95\% CI; $\alpha$=.05). Pearson correlation and partial least squares structural equation modeling (PLS-SEM) was used to identify the relationship and factors influencing the overall acceptance of the CDSS in an LRS. Results: On the basis of 116 antenatal care, pregnant patient care, and postnatal care cases, 73 CDSS evaluation responses were recorded. We found that the 2 health centers did not differ significantly on 16 evaluation parameters. We did, however, detect a statistically significant difference in 6 parameters (P<.05). PLS-SEM results showed that the coefficient of determination, R2, of perceived user acceptance was 0.703. More precisely, the perceived ease of use ($\beta$=.015, P=.91) and information quality ($\beta$=.149, P=.25) had no positive effect on CDSS acceptance but, rather, on the system quality and perceived benefits of the CDSS, with P<.05 and $\beta$=.321 and $\beta$=.486, respectively. Furthermore, the perceived ease of use was influenced by information quality and system quality, with an R2 value of 0.479, indicating that the influence of information quality on the ease of use is significant but the influence of system quality on the ease of use is not, with $\beta$=.678 (P<.05) and $\beta$=.021(P=.89), respectively. Moreover, the influence of decision changes ($\beta$=.374, P<.05) and process changes ($\beta$=.749, P<.05) both was significant on perceived benefits (R2=0.983). Conclusions: This study concludes that users are more likely to accept and use a CDSS at the point of care when it is easy to grasp the perceived benefits and system quality in terms of health care professionals' needs. We believe that the CDSS acceptance model developed in this study reveals specific factors and variables that constitute a step toward the effective adoption and deployment of a CDSS in LRSs. ", doi="10.2196/47631", url="https://humanfactors.jmir.org/2024/1/e47631", url="http://www.ncbi.nlm.nih.gov/pubmed/38861298" } @Article{info:doi/10.2196/48464, author="Oliveira, Alves Clara Rodrigues and Pires, Carvalho Magda and Meira, Cardoso Karina and de Jesus, Cristina Jordana and Borges, Nascimento Isabela and Paix{\~a}o, Cristina Maria and Mendes, Santos Mayara and Ribeiro, Bonisson Leonardo and Marcolino, Soriano Milena and Alkmim, Moreira Maria Beatriz and Ribeiro, Pinho Antonio Luiz", title="Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study", journal="J Med Internet Res", year="2024", month="Jun", day="10", volume="26", pages="e48464", keywords="COVID-19", keywords="telehealth", keywords="health care", keywords="clinical outcomes", keywords="hospital admission", keywords="mortality", keywords="adoption", keywords="effectiveness", keywords="digital health tool", keywords="flu", keywords="teleconsultation", keywords="digital health", keywords="digital literacy", keywords="telemonitoring", abstract="Background: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce.? Objective: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. Methods: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. Results: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4\%), patients supported by TeleCOVID-MG (n=14,493, 17.6\%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95\% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95\% CI 0.86-1.12; P=.83). Conclusions: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy.?The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues. ", doi="10.2196/48464", url="https://www.jmir.org/2024/1/e48464", url="http://www.ncbi.nlm.nih.gov/pubmed/38857068" } @Article{info:doi/10.2196/50957, author="Faizah, Aaya and Hardian, Azzahra Alifah Fatimah and Nandini, Devina Rania and Handayani, Wuri Putu and Harahap, Cyldea Nabila", title="The Influence of Incentive-Based Mobile Fitness Apps on Users' Continuance Intention With Gender Moderation Effects: Quantitative and Qualitative Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="5", volume="11", pages="e50957", keywords="incentive", keywords="fitness", keywords="mobile fitness apps", keywords="gender", keywords="continuance usage intention", keywords="Indonesia", keywords="mobile phone", abstract="Background: A survey conducted by McKinsey \& Company reported that, as of May 2022, as many as 26\% of Indonesians had recently started to engage actively in physical activity, 32\% undertook regular physical activity, and 9\% exercised intensely. The Fourth Industrial Revolution has spurred the rapid development of mobile fitness apps (MFAs) used to track people's sports activities. However, public interest in using these apps for any length of time is still relatively low. Objective: In this study, we aimed to determine the effect of incentives (eg, self-monitoring, social support, platform rewards, and external influence) on the use of MFAs and the moderating effect of gender on users' continuance usage intention. Methods: The study used a mixed methods approach. Quantitative data were collected through a web-based questionnaire and qualitative data from interviews with 30 respondents. The quantitative data, collected from 379 valid responses, were processed using covariance-based structural equation modeling. The qualitative data were processed using thematic analysis. The MFAs included in this research were those used as sports or physical activity trackers, such as Apple Fitness, Strava, Nike Run Club, and Fita. Results: The results of the data analysis show that 3 groups of incentives, namely, self-monitoring, platform rewards, and external influence (with the exception of social support), affect the perceived usefulness of these apps. Gender was also shown to moderate user behavior in relation to physical activity. The study showed that women were more likely to be motivated to exercise by social and external factors, while men paid greater attention to the tracking features of the app and to challenges and rewards. Conclusions: This research contributes to the field of health promotion by providing guidance for MFA developers. ", doi="10.2196/50957", url="https://humanfactors.jmir.org/2024/1/e50957", url="http://www.ncbi.nlm.nih.gov/pubmed/38837199" } @Article{info:doi/10.2196/54983, author="Ilhan, I. Elif and Jola, N. Lucia and van der Zalm, M. Marieke and Bernstein, Mike and Goussard, Pierre and Redfern, Andrew and Hesseling, C. Anneke and Hoddinott, Graeme and McCollum, D. Eric and King, Carina", title="Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers", journal="JMIR Hum Factors", year="2024", month="May", day="30", volume="11", pages="e54983", keywords="pediatrics", keywords="human-centered design", keywords="participatory design", keywords="pulse oximeter", keywords="South Africa", keywords="smartphone", keywords="mobile phone", abstract="Background: Pulse oximeters noninvasively measure blood oxygen levels, but these devices have rarely been designed for low-resource settings and are inconsistently available at outpatient clinics. Objective: The Phefumla project aims to develop and validate a pediatric smartphone-based pulse oximeter designed specifically for this context. We present the process of human-centered oximeter design with health care workers in South Africa. Methods: We purposively sampled 19 health care workers from 5 clinics in Khayelitsha, Cape Town. Using a human-centered design approach, we conducted participatory workshops with four activities with health care workers: (1) they received 3D-printed prototypes of potential oximeter designs to provide feedback; (2) we demonstrated on dolls how they would use the novel oximeter; (3) they used pile sorting to rank design features and suggest additional features they desired; and (4) they designed their preferred user interface using a whiteboard, marker, and magnetized features that could be repositioned. We audio recorded the workshops, photographed outputs, and took detailed field notes. Analysis involved iterative review of these data to describe preferences, identify key design updates, and provide modifications. Results: Participants expressed a positive sentiment toward the idea of a smartphone pulse oximeter and suggested that a pediatric device would address an important gap in outpatient care. Specifically, participants expressed a preference for the prototype that they felt enabled more diversity in the way it could be used. There was a strong tendency to prioritize pragmatic design features, such as robustness, which was largely dictated by health care worker context. They also added features that would allow the oximeter device to serve other clinical functions in addition to oxygen saturation measurement, such as temperature and respiratory rate measurements. Conclusions: Our end user--centered rapid participatory approach led to tangible design changes and prompted design discussions that the team had not previously considered. Overall, health care workers prioritized pragmatism for pediatric pulse oximeter device design. ", doi="10.2196/54983", url="https://humanfactors.jmir.org/2024/1/e54983" } @Article{info:doi/10.2196/41567, author="Jain, Lovely and Pradhan, Sreya and Aggarwal, Arun and Padhi, Kumar Bijaya and Itumalla, Ramaiah and Khatib, Nazli Mahalaqua and Gaidhane, Shilpa and Zahiruddin, Syed Quazi and Santos, Guimar{\~a}es Celso Augusto and AL-Mugheed, Khalid and Alrahbeni, Tahani and Kukreti, Neelima and Satapathy, Prakasini and Rustagi, Sarvesh and Heidler, Petra and Marzo, Rillera Roy", title="Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study", journal="JMIR Public Health Surveill", year="2024", month="May", day="24", volume="10", pages="e41567", keywords="undernutrition", keywords="malnutrition", keywords="stunting", keywords="wasting", keywords="underweight", keywords="sanitation", keywords="WaSH", keywords="LISA", keywords="NFHS", keywords="DHS", keywords="spatial epidemiology", keywords="epidemiology", keywords="children", keywords="child", keywords="India", keywords="intervention", abstract="Background: Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. Objective: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. Methods: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. Results: Our study showed a decreasing trend in stunting (44.9\%-38.4\%) and underweight (46.7\%-35.7\%) but an increasing prevalence of wasting (15.7\%-21.0\%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. Conclusions: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas. ", doi="10.2196/41567", url="https://publichealth.jmir.org/2024/1/e41567", url="http://www.ncbi.nlm.nih.gov/pubmed/38787607" } @Article{info:doi/10.2196/55297, author="Lule, Herman and Mugerwa, Micheal and Ssebuufu, Robinson and Kyamanywa, Patrick and B{\"a}rnighausen, Till and Posti, P. Jussi and Wilson, Lowery Michael", title="Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident--Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="May", day="7", volume="13", pages="e55297", keywords="randomized controlled trial", keywords="medical education", keywords="trauma team", keywords="trauma registry", keywords="rural health", keywords="global health", keywords="team development", keywords="Africa", keywords="rural", keywords="trauma", keywords="motorcycle injury", keywords="multicenter cluster randomized controlled clinical trial", keywords="injury", keywords="accident", keywords="low- and middle-income countries", keywords="patient outcomes", keywords="education program", abstract="Background: Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. Objective: This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident--related injuries in an African low-resource setting. Methods: This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident--related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95\% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. Results: The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. Conclusions: This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. Trial Registration: Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763 International Registered Report Identifier (IRRID): DERR1-10.2196/55297 ", doi="10.2196/55297", url="https://www.researchprotocols.org/2024/1/e55297", url="http://www.ncbi.nlm.nih.gov/pubmed/38713507" } @Article{info:doi/10.2196/50385, author="Donkin, Liesje and Bidois-Putt, Marie-Claire and Wilson, Holly and Hayward, Penelope and Chan, Yan Amy Hai", title="An Exploration of the Goodness of Fit of Web-Based Tools for M?ori: Qualitative Study Using Interviews and Focus Groups", journal="JMIR Form Res", year="2024", month="May", day="2", volume="8", pages="e50385", keywords="Indigenous people", keywords="M?ori", keywords="eHealth", keywords="mental health", keywords="web-based intervention", keywords="digital intervention", abstract="Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for M?ori people who are t?ngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of M?ori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 M?ori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the M?ori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for M?ori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao M?ori (the M?ori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for M?ori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with M?ori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of M?ori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations' world views. ", doi="10.2196/50385", url="https://formative.jmir.org/2024/1/e50385", url="http://www.ncbi.nlm.nih.gov/pubmed/38696236" } @Article{info:doi/10.2196/51628, author="Cano, Mireia and Ruiz-Postigo, A. Jos{\'e} and Macharia, Paul and Ampem Amoako, Yaw and Odame Phillips, Richard and Kinyeru, Esther and Carrion, Carme", title="Evaluating the World Health Organization's SkinNTDs App as a Training Tool for Skin Neglected Tropical Diseases in Ghana and Kenya: Cross-Sectional Study", journal="J Med Internet Res", year="2024", month="Apr", day="30", volume="26", pages="e51628", keywords="SkinNTDs app", keywords="mHealth", keywords="mobile health", keywords="neglected tropical diseases", keywords="NTDs", keywords="skin neglected tropical diseases", keywords="low- and middle-income countries", keywords="tropical disease", keywords="app", keywords="training tool", keywords="digital health", keywords="intervention", keywords="decision support tool", keywords="mobile phone", abstract="Background: Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, primarily impoverished populations in low- and middle-income countries. Skin NTDs, a significant subgroup, manifest primarily as skin lesions and require extensive diagnosis and treatment resources, including trained personnel and financial backing. The World Health Organization has introduced the SkinNTDs app, a mobile health tool designed to train and be used as a decision support tool for frontline health care workers. As most digital health guidelines prioritize the thorough evaluation of mobile health interventions, it is essential to conduct a rigorous and validated assessment of this app. Objective: This study aims to assess the usability and user experience of World Health Organization SkinNTDs app (version 3) as a capacity-building tool and decision-support tool for frontline health care workers. Methods: A cross-sectional study was conducted in Ghana and Kenya. Frontline health care workers dealing with skin NTDs were recruited through snowball sampling. They used the SkinNTDs app for at least 5 days before completing a web-based survey containing demographic variables and the user version of the Mobile Application Rating Scale (uMARS), a validated scale for assessing health apps. A smaller group of participants took part in semistructured interviews and one focus group. Quantitative data were analyzed using SPSS with a 95\% CI and P?.05 for statistical significance and qualitative data using ATLAS.ti to identify attributes, cluster themes, and code various dimensions that were explored. Results: Overall, 60 participants participated in the quantitative phase and 17 in the qualitative phase. The SkinNTDs app scored highly on the uMARS questionnaire, with an app quality mean score of 4.02 (SD 0.47) of 5, a subjective quality score of 3.82 (SD 0.61) of 5, and a perceived impact of 4.47 (SD 0.56) of 5. There was no significant association between the app quality mean score and any of the categorical variables examined, according to Pearson correlation analysis; app quality mean score vs age (P=.37), sex (P=.70), type of health worker (P=.35), country (P=.94), work context (P=.17), frequency of dealing with skin NTDs (P=.09), and dermatology experience (P=.63). Qualitative results echoed the quantitative outcomes, highlighting the ease of use, the offline functionality, and the potential utility for frontline health care workers in remote and resource-constrained settings. Areas for improvement were identified, such as enhancing the signs and symptoms section. Conclusions: The SkinNTDs app demonstrates notable usability and user-friendliness. The results indicate that the app could play a crucial role in improving capacity building of frontline health care workers dealing with skin NTDs. It could be improved in the future by including new features such as epidemiological context and direct contact with experts. The possibility of using the app as a diagnostic tool should be considered. International Registered Report Identifier (IRRID): RR2-10.2196/39393 ", doi="10.2196/51628", url="https://www.jmir.org/2024/1/e51628", url="http://www.ncbi.nlm.nih.gov/pubmed/38687587" } @Article{info:doi/10.2196/55491, author="Cooper, Hal and Nadzri, Mohd Farah Zeehan and Vyas, Seema and Juhari, Rumaya and Ismail, Nellie and Arshat, Zarinah and Rajandiran, Durgesh and Markle, Laurie and Calderon, Francisco and Vallance, Inge and Melendez-Torres, J. G. and Facciol{\`a}, Chiara and Senesathith, Vanisa and Gardner, Frances and Lachman, M. Jamie", title="A Hybrid Digital Parenting Program Delivered Within the Malaysian Preschool System: Protocol for a Feasibility Study of a Small-Scale Factorial Cluster Randomized Trial", journal="JMIR Res Protoc", year="2024", month="Apr", day="26", volume="13", pages="e55491", keywords="parenting intervention", keywords="chatbot-led public health intervention", keywords="engagement", keywords="implementation science", keywords="feasibility", keywords="evidence-based program", abstract="Background: The United Nations' Sustainable Development Goal 4, and particularly target 4.2, which seeks to ensure that, by 2030, all children have access to quality early childhood development, care, and preprimary education so that they are ready for primary education, is far from being achieved. The COVID-19 pandemic compromised progress by disrupting education, reducing access to well-being resources, and increasing family violence. Evidence from low- and middle-income countries suggests that in-person parenting interventions are effective at improving child learning and preventing family violence. However, scaling up these programs is challenging because of resource constraints. Integrating digital and human-delivered intervention components is a potential solution to these challenges. There is a need to understand the feasibility and effectiveness of such interventions in low-resource settings. Objective: This study aims to determine the feasibility and effectiveness of a digital parenting program (called Naungan Kasih in Bahasa Melayu [Protection through Love]) delivered in Malaysia, with varying combinations of 2 components included to encourage engagement. The study is framed around the following objectives: (1) to determine the recruitment, retention, and engagement rates in each intervention condition; (2) to document implementation fidelity; (3) to explore program acceptability among key stakeholders; (4) to estimate intervention costs; and (5) to provide indications of the effectiveness of the 2 components. Methods: This 10-week factorial cluster randomized trial compares ParentText, a chatbot that delivers parenting and family violence prevention content to caregivers of preschool-aged children in combination with 2 engagement components: (1) a WhatsApp support group and (2) either 1 or 2 in-person sessions. The trial aims to recruit 160 primary and 160 secondary caregivers of children aged 4-6 years from 8 schools split equally across 2 locations: Kuala Lumpur and Negeri Sembilan. The primary outcomes concern the feasibility and acceptability of the intervention and its components, including recruitment, retention, and engagement. The effectiveness outcomes include caregiver parenting practices, mental health and relationship quality, and child development. The evaluation involves mixed methods: quantitative caregiver surveys, digitally tracked engagement data of caregivers' use of the digital intervention components, direct assessments of children, and focus group discussions with caregivers and key stakeholders. Results: Overall, 208 parents were recruited at baseline December 2023: 151 (72.6\%) primary caregivers and 57 (27.4\%) secondary caregivers. In January 2024, of these 208 parents, 168 (80.8\%) enrolled in the program, which was completed in February. Postintervention data collection was completed in March 2024. Findings will be reported in the second half of 2024. Conclusions: This is the first factorial cluster randomized trial to assess the feasibility of a hybrid human-digital playful parenting program in Southeast Asia. The results will inform a large-scale optimization trial to establish the most effective, cost-effective, and scalable version of the intervention. Trial Registration: OSF Registries; https://osf.io/f32ky International Registered Report Identifier (IRRID): DERR1-10.2196/55491 ", doi="10.2196/55491", url="https://www.researchprotocols.org/2024/1/e55491", url="http://www.ncbi.nlm.nih.gov/pubmed/38669679" } @Article{info:doi/10.2196/49815, author="Hasan, Zahid Md and Rabbani, Golam Md and Akter, Orin and Mehdi, Golam Gazi and Ahmed, Wahid Mohammad and Ahmed, Sayem and Chowdhury, Elahi Mahbub", title="Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Apr", day="24", volume="8", pages="e49815", keywords="Shasthyo Surokhsha Karmasuchi", keywords="health care services", keywords="health care utilization", keywords="satisfaction", keywords="below poverty line", keywords="Bangladesh", keywords="patient satisfaction", keywords="physician behavior", abstract="Background: Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. Objective: We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. Methods: A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. Results: We found that 55.1\% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ?15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. Conclusions: More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility. ", doi="10.2196/49815", url="https://formative.jmir.org/2024/1/e49815", url="http://www.ncbi.nlm.nih.gov/pubmed/38656783" } @Article{info:doi/10.2196/56348, author="Munce, EP Sarah", title="Introducing JMIR Rehabilitation and Assistive Technologies: A Venue for Publishing Interdisciplinary Research on the Development, Implementation, and Evaluation of Health Innovations and Emerging Technologies in the Field of Rehabilitation", journal="JMIR Rehabil Assist Technol", year="2024", month="Apr", day="22", volume="11", pages="e56348", keywords="rehabilitation", keywords="assistive technologies", keywords="JMIR Rehabilitation and Assistive Technologies", keywords="digital", keywords="online", doi="10.2196/56348", url="https://rehab.jmir.org/2024/1/e56348", url="http://www.ncbi.nlm.nih.gov/pubmed/38648632" } @Article{info:doi/10.2196/53362, author="?erne, Tina and Turk, Eva and Mirosevic, Spela and Rotar Pavli{\v c}, Danica", title="Needs and Experiences With Health Care Providers of Adult Rare Disease Patients and Caregivers of People With Rare Diseases: Protocol for a Qualitative Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="22", volume="13", pages="e53362", keywords="rare diseases", keywords="patients", keywords="caregivers", keywords="needs", keywords="barriers", keywords="access to health care", abstract="Background: Rare diseases in Europe are defined as diseases with a prevalence of less than 5 per 10,000 people. Despite their individual rarity, the total number of rare diseases is considerable. Rare diseases are often chronic and complex, affecting physical, mental, and neurological health. People with rare diseases face challenges such as delayed diagnosis, limited medical support, and financial burden. Caregivers, usually family members, bear significant physical and emotional burdens. Understanding the experiences of patients with rare disease and their caregivers is critical to effective care, but this is still underresearched. Better support and understanding of the challenges faced by both patients and caregivers is clearly needed. Our study will explore the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. Objective: This study aims to explore the experiences of patients with rare disease and their caregivers with Slovenian health care providers and to create a theoretical model of needs and experiences. Methods: This is a qualitative thematic analysis study, using the codebook approach. The study will conduct semi--open-ended interviews to understand the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. The interview questions will be based on an extensive literature review. Data from the interviews will be analyzed using thematic analysis to identify patterns and build a thematic map. Data will be analyzed by at least 2 coders. To ensure reliability, respondent validation will be conducted and negative cases investigated. Any discrepancies will be resolved by consulting the entire research team until a consensus is reached. Results: This study was not specifically funded. However, author T? is supported by grant number P3-0339 from the Slovenian Agency for Research and Innovation. This study was approved by the Medical Ethics Committee of the Republic of Slovenia (0120-47/2022/3), and recruitment is expected to begin in May 2024, with data analysis results anticipated by the end of 2025. Conclusions: This study will fill an important research gap in Slovenia by exploring the needs and experiences of people living with rare diseases and their caregivers. The results will contribute to the broader field of rare diseases and add knowledge that can inform future research processes and intervention strategies. It also aims to identify neglected areas that have a significant impact on the lives of people with rare diseases. This study is important not only because it addresses the immediate needs of the Slovenian rare disease community, but also because it contributes to a discussion on patient-centered care, health policy design, and the inclusion of psychosocial components in health care. International Registered Report Identifier (IRRID): PRR1-10.2196/53362 ", doi="10.2196/53362", url="https://www.researchprotocols.org/2024/1/e53362", url="http://www.ncbi.nlm.nih.gov/pubmed/38648088" } @Article{info:doi/10.2196/48144, author="Mabetha, Khuthala and Soepnel, M. Larske and Mabena, Gugulethu and Motlhatlhedi, Molebogeng and Nyati, Lukhanyo and Norris, A. Shane and Draper, E. Catherine", title="Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Apr", day="8", volume="8", pages="e48144", keywords="mobile technologies", keywords="health promotion", keywords="mixed methods", keywords="clinical practice", keywords="mobile phone", abstract="Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1\%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9\%). Two outcomes of interest in the quantitative phase were ``contactability of the participants'' and ``participants' mobile number changes,'' and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ?12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9\%) were hard to reach telephonically, whereas approximately 189 (52.1\%) were easy to reach telephonically. Most participants (133/243, 54.7\%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75\%) being reported to have changed their mobile number ?2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice. ", doi="10.2196/48144", url="https://formative.jmir.org/2024/1/e48144", url="http://www.ncbi.nlm.nih.gov/pubmed/38588527" } @Article{info:doi/10.2196/55270, author="Wang, Zheng and Kempen, John and Luo, Gang", title="Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study", journal="JMIR Form Res", year="2024", month="Apr", day="4", volume="8", pages="e55270", keywords="vision screening", keywords="refractive error", keywords="strabismus", keywords="smartphone", keywords="visual acuity", keywords="vision", keywords="visual", keywords="eye", keywords="eyes", keywords="screening", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="feasibility", keywords="optometry", keywords="ophthalmology", abstract="Background: While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4\% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. Objective: We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. Methods: A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. Results: A total of 5 of 73 (6.8\%, 95\% CI 2.3\%-15.3\%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72--prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). Conclusions: The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas. ", doi="10.2196/55270", url="https://formative.jmir.org/2024/1/e55270", url="http://www.ncbi.nlm.nih.gov/pubmed/38573757" } @Article{info:doi/10.2196/56002, author="Gautam, Kamal and Aguilar, Camille and Paudel, Kiran and Dhakal, Manisha and Wickersham, A. Jeffrey and Acharya, Bibhav and Sapkota, Sabitri and Deuba, Keshab and Shrestha, Roman", title="Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study", journal="JMIR Hum Factors", year="2024", month="Mar", day="29", volume="11", pages="e56002", keywords="mental health", keywords="MSM", keywords="mHealth", keywords="smartphone apps", keywords="digital health", keywords="Nepal", keywords="gay", keywords="homosexual", keywords="homosexuality", keywords="men who have sex with men", keywords="focus group", keywords="focus groups", keywords="qualitative", keywords="barrier", keywords="barriers", keywords="thematic", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", abstract="Background: Men who have sex with men (MSM) are disproportionately burdened by poor mental health. Despite the increasing burden, evidence-based interventions for MSM are largely nonexistent in Nepal. Objective: This study explored mental health concerns, contributing factors, barriers to mental health care and support, and preferred interventions to improve access to and use of mental health support services among MSM in Nepal. Methods: We conducted focus groups with MSM in Kathmandu, Nepal, in January 2023. In total, 28 participants took part in 5 focus group sessions. Participants discussed several topics related to the mental health issues they experienced, factors contributing to these issues, and their suggestions for potential interventions to address existing barriers. The discussions were recorded, transcribed, and analyzed using Dedoose (version 9.0.54; SocioCultural Research Consultants, LLC) software for thematic analysis. Results: Participants reported substantial mental health problems, including anxiety, depression, suicidal ideation, and behaviors. Contributing factors included family rejection, isolation, bullying, stigma, discrimination, and fear of HIV and other sexually transmitted infections. Barriers to accessing services included cost, lack of lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+)--friendly providers, and the stigma associated with mental health and sexuality. Participants suggested a smartphone app with features such as a mental health screening tool, digital consultation, helpline number, directory of LGBTIQA+-friendly providers, mental health resources, and a discussion forum for peer support as potential solutions. Participants emphasized the importance of privacy and confidentiality to ensure mobile apps are safe and accessible. Conclusions: The findings of this study have potential transferability to other low-resource settings facing similar challenges. Intervention developers can use these findings to design tailored mobile apps to facilitate mental health care delivery and support for MSM and other marginalized groups. ", doi="10.2196/56002", url="https://humanfactors.jmir.org/2024/1/e56002", url="http://www.ncbi.nlm.nih.gov/pubmed/38551632" } @Article{info:doi/10.2196/50532, author="Haque, Ghazal and Asif, Fozia and Ahmed, Ali Fasih and Ayub, Farwa and Syed, Hassan Sabih ul and Pradhan, Akber Nousheen and Hameed, Malika and Siddiqui, Ullah Muhammad Muneeb and Mahmood, Shafaq and Zaidi, Tahani and Siddiqi, Sameen and Latif, Asad", title="Assessment of Patient Safety in a Low-Resource Health Care System: Proposal for a Multimethod Study", journal="JMIR Res Protoc", year="2024", month="Mar", day="27", volume="13", pages="e50532", keywords="patient safety", keywords="health systems", keywords="quality assessment", keywords="safety culture", keywords="assessment", keywords="healthcare delivery", keywords="health system", keywords="hospital", keywords="low-middle-income countries", keywords="research methodology", abstract="Background: The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources. Objective: This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting. Methods: We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization's Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility. Results: The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs. Conclusions: A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non--resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs. International Registered Report Identifier (IRRID): PRR1-10.2196/50532 ", doi="10.2196/50532", url="https://www.researchprotocols.org/2024/1/e50532", url="http://www.ncbi.nlm.nih.gov/pubmed/38536223" } @Article{info:doi/10.2196/50407, author="He, Yao and Kouabenan, Yves-Rolland and Assoa, Henri Paul and Puttkammer, Nancy and Wagenaar, H. Bradley and Xiao, Hong and Gloyd, Stephen and Hoffman, G. Noah and Komena, Pascal and Kamelan, Fourier N'zi Pierre and Iiams-Hauser, Casey and Pongathie, Sanogo Adama and Kouakou, Alain and Flowers, Jan and Abiola, Nadine and Kohemun, Natacha and Amani, Jean-Bernard and Adje-Toure, Christiane and Perrone, A. Lucy", title="Laboratory Data Timeliness and Completeness Improves Following Implementation of an Electronic Laboratory Information System in C{\^o}te d'Ivoire: Quasi-Experimental Study on 21 Clinical Laboratories From 2014 to 2020", journal="JMIR Public Health Surveill", year="2024", month="Mar", day="20", volume="10", pages="e50407", keywords="clinical laboratory", keywords="electronic laboratory information system", keywords="data quality", keywords="evaluation", keywords="impact evaluation", keywords="time series", keywords="laboratory", keywords="information system", keywords="information systems", keywords="HIV", keywords="sexually transmitted infection", keywords="sexually transmitted disease", keywords="sexually transmitted", keywords="lab", keywords="labs", keywords="adoption", keywords="implementation", keywords="effectiveness", abstract="Background: The Ministry of Health in C{\^o}te d'Ivoire and the International Training and Education Center for Health at the University of Washington, funded by the United States President's Emergency Plan for AIDS Relief, have been collaborating to develop and implement the Open-Source Enterprise-Level Laboratory Information System (OpenELIS). The system is designed to improve HIV-related laboratory data management and strengthen quality management and capacity at clinical laboratories across the nation. Objective: This evaluation aimed to quantify the effects of implementing OpenELIS on data quality for laboratory tests related to HIV care and treatment. Methods: This evaluation used a quasi-experimental design to perform an interrupted time-series analysis to estimate the changes in the level and slope of 3 data quality indicators (timeliness, completeness, and validity) after OpenELIS implementation. We collected paper and electronic records on clusters of differentiation 4 (CD4) testing for 48 weeks before OpenELIS adoption until 72 weeks after. Data collection took place at 21 laboratories in 13 health regions that started using OpenELIS between 2014 and 2020. We analyzed the data at the laboratory level. We estimated odds ratios (ORs) by comparing the observed outcomes with modeled counterfactual ones when the laboratories did not adopt OpenELIS. Results: There was an immediate 5-fold increase in timeliness (OR 5.27, 95\% CI 4.33-6.41; P<.001) and an immediate 3.6-fold increase in completeness (OR 3.59, 95\% CI 2.40-5.37; P<.001). These immediate improvements were observed starting after OpenELIS installation and then maintained until 72 weeks after OpenELIS adoption. The weekly improvement in the postimplementation trend of completeness was significant (OR 1.03, 95\% CI 1.02-1.05; P<.001). The improvement in validity was not statistically significant (OR 1.34, 95\% CI 0.69-2.60; P=.38), but validity did not fall below pre-OpenELIS levels. Conclusions: These results demonstrate the value of electronic laboratory information systems in improving laboratory data quality and supporting evidence-based decision-making in health care. These findings highlight the importance of OpenELIS in C{\^o}te d'Ivoire and the potential for adoption in other low- and middle-income countries with similar health systems. ", doi="10.2196/50407", url="https://publichealth.jmir.org/2024/1/e50407", url="http://www.ncbi.nlm.nih.gov/pubmed/38506899" } @Article{info:doi/10.2196/50743, author="Tuyishime, Elysee and Remera, Eric and Kayitesi, Catherine and Malamba, Samuel and Sangwayire, Beata and Habimana Kabano, Ignace and Ruisenor-Escudero, Horacio and Oluoch, Tom and Unna Chukwu, Angela", title="Estimation of the Population Size of Street- and Venue-Based Female Sex Workers and Sexually Exploited Minors in Rwanda in 2022: 3-Source Capture-Recapture", journal="JMIR Public Health Surveill", year="2024", month="Mar", day="15", volume="10", pages="e50743", keywords="population size", keywords="female sex workers", keywords="capture-recapture", keywords="3-source", keywords="Rwanda", keywords="HIV", keywords="surveillance", keywords="population", keywords="epidemiology", keywords="prevention", keywords="AIDS", keywords="sexually transmitted disease", keywords="STD", keywords="minor", keywords="young adult", keywords="sexually exploited minor", keywords="children", abstract="Background: HIV surveillance among key populations is a priority in all epidemic settings. Female sex workers (FSWs) globally as well as in Rwanda are disproportionately affected by the HIV epidemic; hence, the Rwanda HIV and AIDS National Strategic Plan (2018-2024) has adopted regular surveillance of population size estimation (PSE) of FSWs every 2-3 years. Objective: We aimed at estimating, for the fourth time, the population size of street- and venue-based FSWs and sexually exploited minors aged ?15 years in Rwanda. Methods: In August 2022, the 3-source capture-recapture method was used to estimate the population size of FSWs and sexually exploited minors in Rwanda. The field work took 3 weeks to complete, with each capture occasion lasting for a week. The sample size for each capture was calculated using shinyrecap with inputs drawn from previously conducted estimation exercises. In each capture round, a stratified multistage sampling process was used, with administrative provinces as strata and FSW hotspots as the primary sampling unit. Different unique objects were distributed to FSWs in each capture round; acceptance of the unique object was marked as successful capture. Sampled FSWs for the subsequent capture occasions were asked if they had received the previously distributed unique object in order to determine recaptures. Statistical analysis was performed in R (version 4.0.5), and Bayesian Model Averaging was performed to produce the final PSE with a 95\% credibility set (CS). Results: We sampled 1766, 1848, and 1865 FSWs and sexually exploited minors in each capture round. There were 169 recaptures strictly between captures 1 and 2, 210 recaptures exclusively between captures 2 and 3, and 65 recaptures between captures 1 and 3 only. In all 3 captures, 61 FSWs were captured. The median PSE of street- and venue-based FSWs and sexually exploited minors in Rwanda was 37,647 (95\% CS 31,873-43,354), corresponding to 1.1\% (95\% CI 0.9\%-1.3\%) of the total adult females in the general population. Relative to the adult females in the general population, the western and northern provinces ranked first and second with a higher concentration of FSWs, respectively. The cities of Kigali and eastern province ranked third and fourth, respectively. The southern province was identified as having a low concentration of FSWs. Conclusions: We provide, for the first time, both the national and provincial level population size estimate of street- and venue-based FSWs in Rwanda. Compared with the previous 2 rounds of FSW PSEs at the national level, we observed differences in the street- and venue-based FSW population size in Rwanda. Our study might not have considered FSWs who do not want anyone to know they are FSWs due to several reasons, leading to a possible underestimation of the true PSE. ", doi="10.2196/50743", url="https://publichealth.jmir.org/2024/1/e50743", url="http://www.ncbi.nlm.nih.gov/pubmed/38488847" } @Article{info:doi/10.2196/51660, author="Toure, Mahamoudou and Shaffer, G. Jeffrey and Sanogo, Daouda and Keita, Soumba and Keita, Moussa and Kane, Fousseyni and Traore, Bourama and Dabitao, Djeneba and Kone, Aissata and Doumbia, Oumar Cheick and Keating, Joseph and Yukich, Joshua and Hansson, H. Helle and Barry, E. Alyssa and Diakit{\'e}, Mahamadou and Alifrangis, Michael and Doumbia, Seydou", title="Seasonal Malaria Chemoprevention Therapy in Children Up To 9 Years of Age: Protocol for a Cluster-Randomized Trial Study", journal="JMIR Res Protoc", year="2024", month="Jan", day="22", volume="13", pages="e51660", keywords="malaria", keywords="seasonal malaria chemoprevention", keywords="RCT", keywords="randomized", keywords="controlled trial", keywords="controlled trials", keywords="parasite", keywords="parasites", keywords="mosquito", keywords="mosquitoes", keywords="vector-borne", keywords="malarial", keywords="antimalarial", keywords="age", keywords="Plasmodium falciparum, protocol, cluster-randomized trial", keywords="child", keywords="children", keywords="infant", keywords="infants", keywords="pediatric", keywords="pediatrics", keywords="clinical trial", keywords="clinical trials", keywords="drug", keywords="drugs", keywords="pharmacy", keywords="pharmacology", keywords="pharmaceutic", keywords="pharmaceutics", keywords="pharmaceuticals", keywords="pharmaceutical", keywords="medication", keywords="medications", abstract="Background: Seasonal malaria chemoprevention (SMC) is recommended by the World Health Organization for the sub-Sahel region in sub-Saharan Africa for preventing malaria in children 3 months old to younger than 5 years. Since 2016, the Malian National Malaria Control Program has deployed SMC countrywide during its high malaria transmission season at a rate of 4 monthly cycles annually. The standard SMC regimen includes sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ). Resistance against SP is suspected to be rising across West Africa; therefore, assessing the effectiveness of an alternative antimalarial drug for SMC is needed to provide a second-line regimen when it is ultimately needed. It is not well understood whether SMC effectively prevents malaria in children aged 5 years or older. Objective: The primary goal of the study is to compare 2 SMC regimens (SP-AQ and dihydroartemisinin-piperaquine [DHA-PQ]) in preventing uncomplicated Plasmodium falciparum malaria in children 3 months to 9 years old. Secondly, we will assess the possible use of DHA-PQ as an alternative SMC drug in areas where resistance to SP or AQ may increase following intensive use. Methods: The study design is a 3-arm cluster-randomized design comparing the SP-AQ and DHA-PQ arms in 2 age groups (younger than 5 years and 5-9 years) and a control group for children aged 5-9 years. Standard SMC (SP-AQ) for children younger than 5 years was provided to the control arm, while SMC with SP-AQ was delivered to children aged 3 months to 9 years (arm 2), and SMC with DHA-PQ will be implemented in study arm 3 for children up to 9 years of age. The study was performed in Mali's Koulikoro District, a rural area in southwest Mali with historically high malaria transmission rates. The study's primary outcome is P falciparum incidence for 2 SMC regimens in children up to 9 years of age. Should DHA-PQ provide an acceptable alternative to SP-AQ, a plausible second-line prevention option would be available in the event of SP resistance or drug supply shortages. A significant byproduct of this effort included bolstering district health information systems for rapid identification of severe malaria cases. Results: The study began on July 1, 2019. Through November 2022, a total of 4556 children 3 months old to younger than 5 years were enrolled. Data collection ended in spring 2023, and the findings are expected to be published later in early 2024. Conclusions: Routine evaluation of antimalarial drugs is needed to establish appropriate SMC age targets. The study goals here may impact public health policy and provide alternative therapies in the event of drug shortages or resistance. Trial Registration: ClinicalTrials.gov NCT04149106, https://clinicaltrials.gov/ct2/show/NCT04149106 International Registered Report Identifier (IRRID): DERR1-10.2196/51660 ", doi="10.2196/51660", url="https://www.researchprotocols.org/2024/1/e51660", url="http://www.ncbi.nlm.nih.gov/pubmed/38252481" } @Article{info:doi/10.2196/42462, author="Thomson, Patrick and Stoler, Justin and Byford, Michelle and Bradley, J. David", title="The Impact of Rapid Handpump Repairs on Diarrhea Morbidity in Children: Cross-Sectional Study in Kwale County, Kenya", journal="JMIR Public Health Surveill", year="2024", month="Jan", day="16", volume="10", pages="e42462", keywords="water", keywords="Kenya", keywords="WASH", keywords="water, sanitation, and hygiene", keywords="maintenance", keywords="diarrhea", keywords="diarrhoea", keywords="SDG 6", keywords="service provision", keywords="handpump", keywords="child health", abstract="Background: Handpumps are used by millions of people as their main source of water. Although handpumps represent only a basic form of water provision, there have been continuous efforts to improve the performance of these systems as they are likely to remain in use for many years to come. The introduction of a professional maintenance service in southern Kenya has shown an order of magnitude improvement in operational performance over community-based management, with 90\% of handpump faults repaired within 3 days of being reported. One driver behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. However, it is not clear if operational improvements lead to health gains. Despite limited empirical evidence, some modeling studies suggest that even short periods of drinking contaminated water can lead to disproportionate negative health impacts. Objective: The aim of this study was to assess whether the improvements in operational performance from the rapid professional maintenance of rural handpumps lead to improved household health outcomes. Methods: From a sample of households using handpumps as their primary water source in Kwale County, Kenya, we measured the 2-week prevalence of World Health Organization--defined diarrhea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which the households' handpumps were being professionally maintained. We then conducted a cross-sectional analysis, fitting logistic regression models with reported diarrhea as the dependent variable and speed of repair as the independent exposure of interest, adjusting for household socioeconomic characteristics; dwelling construction; and Water, Sanitation, and Hygiene (WASH)-related factors. We fitted an additional model to examine select interactions between covariates. Results: Reported diarrhea in children was lower in households whose pumps had been repaired within 24 hours (adjusted odds ratio 0.35, 95\% CI 0.24-0.51). This effect was robust to the inclusion of multiple categories of covariates. No reduction was seen in households whose pump repairs took more than 24 hours. Analysis of interaction terms showed that certain interventions associated with improved WASH outcomes were only associated with reductions in diarrhea in conjunction with socioeconomic improvements. Conclusions: Only pump repairs consistently made within 24 hours of failure led to a reduction in diarrhea in the children of families using handpumps. While the efficacy of reduction in diarrhea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts. ", doi="10.2196/42462", url="https://publichealth.jmir.org/2024/1/e42462", url="http://www.ncbi.nlm.nih.gov/pubmed/38227359" } @Article{info:doi/10.2196/52523, author="Vasudevan, Lavanya and Ostermann, Jan and Thielman, Nathan and Baumgartner, Noel Joy and Solomon, David and Mosses, Anna and Hobbie, Amy and Hair, L. Nicole and Liang, Chen and van Zwetselaar, Marco and Mfinanga, Sayoki and Ngadaya, Esther", title="Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study", journal="JMIR Res Protoc", year="2024", month="Jan", day="12", volume="13", pages="e52523", keywords="childhood vaccinations", keywords="timeliness", keywords="vaccine hesitancy", keywords="digital health", keywords="community health workers", keywords="Tanzania", keywords="low- and middle-income countries", keywords="SMS", keywords="reminder", keywords="conditional incentive", abstract="Background: Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with children in rural settings being more likely to receive delayed or no vaccinations. Further research is necessary to identify effective and scalable interventions that can bridge rural-urban gaps in childhood vaccination while accounting for multifaceted barriers to vaccination. Objective: This protocol describes a type 1 effectiveness-implementation hybrid study to evaluate Chanjo Kwa Wakati (timely vaccination in Kiswahili), a community-based digital health intervention to improve vaccination timeliness. The intervention combines human resources (community health workers), low-cost digital strategies (electronic communication, digital case management, and task automation), a vaccination knowledge intervention, and insights from behavioral economics (reminders and incentives) to promote timely childhood vaccinations. Methods: The study will be conducted in 2 predominantly rural regions in Tanzania with large numbers of unvaccinated or undervaccinated children: Shinyanga and Mwanza. Forty rural health facilities and their catchment areas (clusters) will be randomized to an early or delayed onset study arm. From each cluster, 3 cohorts of mother-child dyads (1 retrospective cohort and 2 prospective cohorts) will be enrolled in the study. The timeliness and coverage of all vaccinations recommended during the first year of life will be observed for 1200 children (n=600, 50\% intervention group children and n=600, 50\% nonintervention group children). The primary effectiveness outcome will be the timeliness of the third dose of the pentavalent vaccine (Penta3). Quantitative surveys, vaccination records, study logs, fidelity checklists, and qualitative interviews with mothers and key informants will inform the 5 constructs of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The results will be used to develop an implementation blueprint to guide future adaptations and scale-up of Chanjo Kwa Wakati. Results: The study was funded in August 2022. Data collection is expected to last from February 2024 to July 2027. Conclusions: This study will address the lack of rigorous evidence on the effectiveness of community-based digital health interventions for promoting vaccination coverage and timeliness among children from sub-Saharan Africa and identify potential implementation strategies to facilitate the deployment of vaccination promotion interventions in low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT06024317; https://www.clinicaltrials.gov/study/NCT06024317 International Registered Report Identifier (IRRID): PRR1-10.2196/52523 ", doi="10.2196/52523", url="https://www.researchprotocols.org/2024/1/e52523", url="http://www.ncbi.nlm.nih.gov/pubmed/38214956" } @Article{info:doi/10.2196/52938, author="Jinah, Norehan and Abdullah Sharin, Ili and Bakit, Pangie and Adnan, Khirman Izzuan and Lee, Yun Kun", title="Overview of Retention Strategies for Medical Doctors in Low- and Middle-Income Countries and Their Effectiveness: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Jan", day="8", volume="13", pages="e52938", keywords="health care workforce", keywords="retention strategies", keywords="medical doctors", keywords="low-income and middle-income countries", keywords="scoping review", abstract="Background: The global shortage and maldistribution of health care workers, especially medical doctors, pose a significant threat to achieving the United Nations' sustainable development goal 3 of ensuring well-being and healthy lives for all. Low- and middle-income countries (LMICs) are disproportionately affected by this crisis, with a high rate of brain drain from rural to urban areas, as well as to high-income countries. Various retention strategies have been implemented in different settings and organizations. However, their effectiveness remains underexplored, particularly in LMICs. Objective: We aim to review the available retention strategies for medical doctors in LMICs and to determine the effectiveness of the various strategies. This review aims to compile relevant research findings on this issue to generate a thorough summary of all the retention strategies practiced in LMICs and, more importantly, to provide the current state of evidence of the effectiveness of these strategies in retaining medical doctors in countries with limited resources and high disease burden. Methods: The structured framework given by Arksey and O'Malley will serve as the basis for conducting this scoping review. A comprehensive search strategy will be conducted across 4 electronic databases (PubMed, EBSCOHost, Scopus, and ScienceDirect). A systematic approach following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be executed to search, screen, review, and extract data from studies that meet predefined inclusion criteria. Data encompassing bibliographical information, study location, retention strategies, influencing factors, and outcomes (effectiveness) will be obtained from the selected studies using standardized data extraction. Endnote and Microsoft Excel will be used for reference management and removal of duplicate studies. A narrative synthesis will be performed after categorizing and analyzing all the extracted data to identify recurrent themes. Results: This ongoing review will generate a comprehensive compilation of retention strategies implemented in LMICs to prevent brain drain among medical doctors. Data extraction is currently in progress, and completion is expected by early 2024. Themes regarding the types of strategies, influencing factors, and outcomes will be synthesized. The findings will highlight effective retention strategies, gaps, and challenges in implementation for the benefits of future research. By identifying common barriers and facilitators, this review will provide insights into enhancing the policies and initiatives for doctor retention in LMICs. Conclusions: This scoping review explores the retention strategies practiced in LMICs and attempts to identify effective strategies from existing research. By evaluating the barriers and challenges that influence the effectiveness of these strategies, policymakers and health care leaders can strive to obtain balanced and optimal health human resources in their respective organizations and countries. Trial Registration: Malaysian National Medical Research Register (NMRR) ID-23-01994-OGW; https://nmrr.gov.my/research-directory/ac4f5b88-8619-4b2b-b6c7-9abcef65fdcd International Registered Report Identifier (IRRID): DERR1-10.2196/52938 ", doi="10.2196/52938", url="https://www.researchprotocols.org/2024/1/e52938", url="http://www.ncbi.nlm.nih.gov/pubmed/38190235" } @Article{info:doi/10.2196/43120, author="Powell, Leigh and Nour, Radwa and Sleibi, Randa and Al Suwaidi, Hanan and Zary, Nabil", title="Democratizing the Development of Chatbots to Improve Public Health: Feasibility Study of COVID-19 Misinformation", journal="JMIR Hum Factors", year="2023", month="Dec", day="28", volume="10", pages="e43120", keywords="COVID-19", keywords="vaccine hesitancy", keywords="infodemic", keywords="chatbot", keywords="motivational interviewing", keywords="social media", keywords="conversational agent", keywords="misinformation", keywords="online health information", keywords="usability study", keywords="vaccine misinformation", abstract="Background: Chatbots enable users to have humanlike conversations on various topics and can vary widely in complexity and functionality. An area of research priority in chatbots is democratizing chatbots to all, removing barriers to entry, such as financial ones, to help make chatbots a possibility for the wider global population to improve access to information, help reduce the digital divide between nations, and improve areas of public good (eg, health communication). Chatbots in this space may help create the potential for improved health outcomes, potentially alleviating some of the burdens on health care providers and systems to be the sole voices of outreach to public health. Objective: This study explored the feasibility of developing a chatbot using approaches that are accessible in low- and middle-resource settings, such as using technology that is low cost, can be developed by nonprogrammers, and can be deployed over social media platforms to reach the broadest-possible audience without the need for a specialized technical team. Methods: This study is presented in 2 parts. First, we detailed the design and development of a chatbot, VWise, including the resources used and development considerations for the conversational model. Next, we conducted a case study of 33 participants who engaged in a pilot with our chatbot. We explored the following 3 research questions: (1) Is it feasible to develop and implement a chatbot addressing a public health issue with only minimal resources? (2) What is the participants' experience with using the chatbot? (3) What kinds of measures of engagement are observed from using the chatbot? Results: A high level of engagement with the chatbot was demonstrated by the large number of participants who stayed with the conversation to its natural end (n=17, 52\%), requested to see the free online resource, selected to view all information about a given concern, and returned to have a dialogue about a second concern (n=12, 36\%). Conclusions: This study explored the feasibility of and the design and development considerations for a chatbot, VWise. Our early findings from this initial pilot suggest that developing a functioning and low-cost chatbot is feasible, even in low-resource environments. Our results show that low-resource environments can enter the health communication chatbot space using readily available human and technical resources. However, despite these early indicators, many limitations exist in this study and further work with a larger sample size and greater diversity of participants is needed. This study represents early work on a chatbot in its virtual infancy. We hope this study will help provide those who feel chatbot access may be out of reach with a useful guide to enter this space, enabling more democratized access to chatbots for all. ", doi="10.2196/43120", url="https://humanfactors.jmir.org/2023/1/e43120", url="http://www.ncbi.nlm.nih.gov/pubmed/37290040" } @Article{info:doi/10.2196/51427, author="Arcos, Daniela and Russo, N. Lyric and Kazmierski, M. Kelly F. and Zhou, Elayne and Montiel, Itzel Gloria and Bracho, America and Mejia, Nancy and Borelli, L. Jessica", title="A Relationship-Based Resilience Program for Promotores: Protocol for a Randomized Controlled Waitlist Trial", journal="JMIR Res Protoc", year="2023", month="Dec", day="19", volume="12", pages="e51427", keywords="psychosocial intervention", keywords="relational savoring", keywords="cardiometabolic health", keywords="community service providers", keywords="Hispanic or Latinx", keywords="CSP", abstract="Background: Community service providers (CSPs) play an integral role in the health care of low-income Hispanic or Latinx (HL) communities. CSPs have high-stress frontline jobs and share the high-risk demographics of their communities. Relational savoring (RS) has been associated with lower cardiovascular reactivity and psychosocial benefits, with particular promise among HL participants. In this study, we aim to identify RS's potential in promoting CSPs' cardiometabolic health and, in so doing, having broader impacts on the community they serve. Objective: This randomized controlled waitlist study aims to examine the effect of an RS intervention on (1) CSPs' cardiometabolic health (cardiometabolic risk factors and outcomes) and (2) CSPs' threats to leaving the workforce. Methods: We will recruit a sample of 80 CSPs from community health agencies serving low-income HL populations. Participating CSPs will be randomized into an experimental or a waitlist control. Participants will complete 1 or 2 baseline assessment batteries (before the intervention), depending on the assigned group, and then complete 2 more assessment batteries following the 4-week RS intervention (after the intervention and at a 3-mo follow-up). The RS intervention consists of guided reflections on positive moments of connection with others. Electrocardiogram data will be obtained from a wearable device (Polar Verity Sense or Movisens) to measure heart rate variability. The primary outcome is cardiometabolic health, consisting of cardiometabolic risk (obtained from heart rate variability) and cardiometabolic health behaviors. The secondary outcomes include CSPs' threats to leaving the workforce (assessed via psychological well-being), intervention acceptability, and CSPs' delivery of cardiometabolic health programming to the community (exploratory). Analyses of covariance will be used to examine the effects of RS on cardiometabolic health and on CSPs' threats to leaving the workforce, comparing outcomes at baseline, postintervention, and at follow-up across participants in the experimental versus waitlist group. Results: The study has been approved by the University of California, Irvine, Institutional Review Board and is currently in the data collection phase. By May 2023, 37 HL CSPs have been recruited: 34 have completed the baseline assessment, 28 have completed the 4 intervention sessions, 27 have completed the posttreatment assessment, and 10 have completed all assessments (including the 3-mo follow-up). Conclusions: This study will provide valuable information on the potential of RS to support cardiometabolic health in HL CSPs and, indirectly, in the communities they serve. Trial Registration: ClinicalTrials.gov NCT05560893; https://clinicaltrials.gov/study/NCT05560893 International Registered Report Identifier (IRRID): DERR1-10.2196/51427 ", doi="10.2196/51427", url="https://www.researchprotocols.org/2023/1/e51427", url="http://www.ncbi.nlm.nih.gov/pubmed/38113093" } @Article{info:doi/10.2196/50371, author="Hartinger Pena, Maria Stella and M{\"a}usezahl, Daniel and J{\"a}ggi, Lena and Aguilar, Leonel and Alvarado Llatance, Milagros and Castellanos, Andreana and Huaylinos Bustamante, Maria-Luisa and Hinckley, Kristen and Charles McCoy, Dana and Zhang, Ce and Fink, G{\"u}nther", title="Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Dec", day="14", volume="12", pages="e50371", keywords="child development", keywords="digital support", keywords="parenting", keywords="Peru", keywords="child", keywords="children", keywords="childhood", keywords="parent", keywords="parents", keywords="education", keywords="support", keywords="parental", keywords="cost", keywords="low income", keywords="low resource", keywords="digital health", keywords="platforms", keywords="pediatric", keywords="pediatrics", keywords="eHealth", keywords="e-health", keywords="RCT", keywords="RCTs", keywords="randomized", keywords="controlled trial", keywords="development", keywords="scalable", abstract="Background: Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. Objective: The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. Methods: This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna M{\'a}s) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. Results: Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. Conclusions: This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. Trial Registration: ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106 International Registered Report Identifier (IRRID): DERR1-10.2196/50371 ", doi="10.2196/50371", url="https://www.researchprotocols.org/2023/1/e50371", url="http://www.ncbi.nlm.nih.gov/pubmed/38096020" } @Article{info:doi/10.2196/50985, author="Chilakam, Nagavalli and Lakshminarayanan, Varsha and Keremutt, Sushanth and Rajendran, Ambigai and Thunga, Girish and Poojari, Gopal Pooja and Rashid, Muhammed and Mukherjee, Nirmalya and Bhattacharya, Paramita and John, Denny", title="Economic Burden of Mosquito-Borne Diseases in Low- and Middle-Income Countries: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2023", month="Dec", day="11", volume="12", pages="e50985", keywords="cost of illness", keywords="economic burden", keywords="out-of-pocket expenditure", keywords="OOPE", keywords="mosquito-borne diseases", keywords="vector-borne diseases", abstract="Background: Globally, among all the vector-borne diseases, mosquito-borne diseases are responsible for a substantial number of cases and deaths and amount to an economic cost of US \$12 billion per year. However, there is a dearth of systematic research conducted on the economic burden of mosquito-borne diseases. To address the lack of comprehensive information on this topic, a systematic review will be conducted to synthesize evidence for informing targeted policies and strategies addressing this growing burden and for better financial protection of households. Objective: The systematic review aims to review the economic burden of mosquito-borne diseases in low- and middle-income countries (LMICs). The review estimates the total cost, which is the compilation of both the direct costs and indirect costs. Additionally, it reports cost estimates per disease, country, and patient. The review outcome will also discuss the impact of the economic burden in terms of out-of-pocket expenditure, catastrophic health expenditure, impoverishment, and gross domestic product impact due to mosquito-borne diseases in LMICs. Methods: Systematic searches will be conducted in PubMed (MEDLINE), Ovid Embase, Scopus, the cumulative index of nursing and allied health literacy, and Cochrane CENTRAL. Additionally, websites of the World Bank, World Health Organization, and Asian Development Bank as well as grey literature (eg, Malaria No More and the Ministry of Health websites) will be searched to gather comprehensive information on the topic and identify studies published in the English language. The titles and abstracts will be independently screened by 2 reviewers, followed by a full-text review against the inclusion criteria. Disagreements will be resolved through discussion with a third author. The methodological reporting quality of the studies will be evaluated using the Larg and Moss checklist, Cochrane risk-of-bias tool for randomized trials, and the Consensus on Health Economic Criteria. Data will be extracted using a standardized data extraction form. Results: The protocol was registered in PROSPERO (CRD42023427111) prior to the initiation of the search strategy. The review is currently ongoing and will synthesize information from the identified studies through a process involving structured screening, data extraction, and critical appraisal in the form of tables and a narrative summary of studies reporting the economic burden incurred due to mosquito-borne diseases in LMICs. Conclusions: This review seeks to report the economic burden of mosquito-borne diseases. It will act as evidence for policymakers to prioritize their decisions regarding containing the prevalence of mosquito-borne diseases and the means to lowering the incidence of diseases spread by mosquitoes. Trial Registration: PROSPERO CRD42023427111; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=427111 International Registered Report Identifier (IRRID): PRR1-10.2196/50985 ", doi="10.2196/50985", url="https://www.researchprotocols.org/2023/1/e50985", url="http://www.ncbi.nlm.nih.gov/pubmed/38079215" } @Article{info:doi/10.2196/49578, author="Memon, Zahid and Ahmed, Wardah and Muhammad, Shah and Soofi, Sajid and Chohan, Shanti and Rizvi, Arjumand and Barach, Paul and Bhutta, A. Zulfiqar", title="Facility-Based Audit System With Integrated Community Engagement to Improve Maternal and Perinatal Health Outcomes in Rural Pakistan: Protocol for a Mixed Methods Implementation Study", journal="JMIR Res Protoc", year="2023", month="Nov", day="30", volume="12", pages="e49578", keywords="audit system", keywords="perinatal outcome", keywords="neonatal mortality", keywords="stillbirth", keywords="maternal", keywords="mortality", keywords="implementation research", keywords="death audit", abstract="Background: Maternal and newborn mortality in Pakistan remains as a major public health challenge. Pakistan faces significant infrastructure challenges and inadequate access to quality health care, exacerbated by sociocultural factors. Facility-based audit systems coupled with community engagement are key elements in achieving improved health system performance. We describe an implementation approach adapted from the World Health Organization audit cycle in real-world settings, with a plan to scale-up through mixed methods evaluation plan. Objective: This study aims to implement a locally acceptable and relevant audit system and evaluate its feasibility within the rural health system of Pakistan for scale-up. Methods: The implementation of the audit system comprises six phases: (1) identify facility and community leadership through consultative meetings with government district health offices, (2) establish the audit committee under the supervision of district health officer, (3) initiate audit with ongoing community engagement, (4) train the audit committee members, (5) launch the World Health Organization audit cycle (monthly meetings), and (6) quarterly review and refresher training. Data from all deliveries, live births, maternal deaths, maternal near misses, stillbirths, and neonatal deaths will be identified and recorded from four sources: (1) secondary-level care rural health facilities, (2) lady health workers' registers, (3) community representatives, and (4) project routine survey team. Concurrent quantitative and qualitative data will be drawn from case assessments, process analysis, and recommendations as components of iterative improvement cycles during the project. Outcomes will be the geographic distribution of mortality to measure the reach, proportion of facilities initiated to implement an audit system for measuring the adoption, proportion of audit committees with community representation, and proportion of audit committee members' sharing feedback regularly to measure acceptability and feasibility. In addition, outcomes of effectiveness will be measured based on data recording and reporting trends, identified modifiable factors for mortality and morbidity as underpinned by the Three Delays framework. Qualitative data will be analyzed based on perceived facilitators, barriers, and lessons learned for policy implications. Results will be summarized in frequencies and percentages and triangulated by the project team. Data will be analyzed using Stata (version 16; StataCorp) and NVivo (Lumivero) software. Results: The study will be implemented for 20 months, followed by an additional 4-month period for follow-up. Initial results will be presented to the district health office and the District Health Program Management Team Meeting in the districts. Conclusions: This study will generate evidence about the feasibility and potential scale-up of a facility-based mortality audit system with integrated community engagement in rural Pakistan. Audit committees will complete the feedback loop linking health care providers, community representatives, and district health officials (policy makers). This implementation approach will serve decision makers in improving maternal and perinatal health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/49578 ", doi="10.2196/49578", url="https://www.researchprotocols.org/2023/1/e49578", url="http://www.ncbi.nlm.nih.gov/pubmed/38032708" } @Article{info:doi/10.2196/49603, author="Wu, Yuanyang and Wang, Qianning and Zheng, Feiyang and Yu, Tiantian and Wang, Yanting and Fan, Si and Zhang, Xinping and Yang, Lianping", title="Effects of the Implementation of Transport-Driven Poverty Alleviation Policy on Health Care--Seeking Behavior and Medical Expenditure Among Older People in Rural Areas: Quasi-Experimental Study", journal="JMIR Public Health Surveill", year="2023", month="Nov", day="28", volume="9", pages="e49603", keywords="transport-driven poverty alleviation", keywords="health care--seeking behavior", keywords="medical expenditures", keywords="difference-in-differences", keywords="quasi-experimental study", abstract="Background: Improving the rural residents' accessibility to and affordability of health care is recognized as a common target globally. The Health in All Policies approach, from the Declaration of Helsinki to the United Nations' Decade Of Healthy Ageing, strengthened the far-reaching effect of large-scale public policies on health care--seeking behavior; however, the effects of national transport policy on health care--seeking behavior is unclear. Objective: This quasi-experimental study aimed to examine the effects of the implementation of transport-driven poverty alleviation (TPA) policy on health care--seeking behavior and medical expenditure among older adults in rural areas and the mechanism underlying these effects. Methods: We designed a quasi-experiment to estimate the effects of TPA policy implementation on health care--seeking behavior and medical expenditure among older adults in rural areas through a difference-in-differences (DID) analysis based on data from the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018. The underlying mechanism was analyzed and effect modification patterns were further investigated by poor households, health status, and age. Results: Our findings validated a positive contribution of TPA policy on health care--seeking behavior among older adults in rural areas. After the implementation of TPA policy, the number of inpatient visits increased by annually 0.35 times per person, outpatient medical expenditure increased by 192\% per month, and inpatient medical expenditure increased by 57\% annually compared with those of older adults in rural areas without the implementation of TPA policy. Further, there was a significant modification effect, with a positive effect among poor households, healthier older adults, and those aged 60-80 years. Additionally, the policy improved the patients' capabilities to seek long-distance care ($\beta$=23.16, 95\% CI --0.99 to 45.31) and high-level hospitals ($\beta$=.08, 95\% CI --0.02 to 0.13), and increased individual income to acquire more medical services ($\beta$=4.57, 95\% CI --4.46 to 4.68). Conclusions: These findings validate the positive contribution of TPA policy on health care--seeking behavior among older adults in rural areas; however, the medical expenditure incurred was also high. Concerted efforts are needed to address health care--seeking dilemmas in rural areas, and attention must be paid to curbing medical expenditure growth for older adults in rural areas during TPA policy implementation. ", doi="10.2196/49603", url="https://publichealth.jmir.org/2023/1/e49603", url="http://www.ncbi.nlm.nih.gov/pubmed/38015603" } @Article{info:doi/10.2196/47052, author="Ye, Jiancheng and Xiong, Shangzhi and Wang, Tengyi and Li, Jingyi and Cheng, Nan and Tian, Maoyi and Yang, Yang", title="The Roles of Electronic Health Records for Clinical Trials in Low- and Middle-Income Countries: Scoping Review", journal="JMIR Med Inform", year="2023", month="Nov", day="22", volume="11", pages="e47052", keywords="electronic health records", keywords="clinical trials", keywords="low- and middle-income countries", abstract="Background: Clinical trials are a crucial element in advancing medical knowledge and developing new treatments by establishing the evidence base for safety and therapeutic efficacy. However, the success of these trials depends on various factors, including trial design, project planning, research staff training, and adequate sample size. It is also crucial to recruit participants efficiently and retain them throughout the trial to ensure timely completion. Objective: There is an increasing interest in using electronic health records (EHRs)---a widely adopted tool in clinical practice---for clinical trials. This scoping review aims to understand the use of EHR in supporting the conduct of clinical trials in low- and middle-income countries (LMICs) and to identify its strengths and limitations. Methods: A comprehensive search was performed using 5 databases: MEDLINE, Embase, Scopus, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. We followed the latest version of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guideline to conduct this review. We included clinical trials that used EHR at any step, conducted a narrative synthesis of the included studies, and mapped the roles of EHRs into the life cycle of a clinical trial. Results: A total of 30 studies met the inclusion criteria: 13 were randomized controlled trials, 3 were cluster randomized controlled trials, 12 were quasi-experimental studies, and 2 were feasibility pilot studies. Most of the studies addressed infectious diseases (15/30, 50\%), with 80\% (12/15) of them about HIV or AIDS and another 40\% (12/30) focused on noncommunicable diseases. Our synthesis divided the roles of EHRs into 7 major categories: participant identification and recruitment (12/30, 40\%), baseline information collection (6/30, 20\%), intervention (8/30, 27\%), fidelity assessment (2/30, 7\%), primary outcome assessment (24/30, 80\%), nonprimary outcome assessment (13/30, 43\%), and extended follow-up (2/30, 7\%). None of the studies used EHR for participant consent and randomization. Conclusions: Despite the enormous potential of EHRs to increase the effectiveness and efficiency of conducting clinical trials in LMICs, challenges remain. Continued exploration of the appropriate uses of EHRs by navigating their strengths and limitations to ensure fitness for use is necessary to better understand the most optimal uses of EHRs for conducting clinical trials in LMICs. ", doi="10.2196/47052", url="https://medinform.jmir.org/2023/1/e47052", url="http://www.ncbi.nlm.nih.gov/pubmed/37991820" } @Article{info:doi/10.2196/41207, author="Tadesse, Tilahun Birkneh and Khanam, Farhana and Ahmmed, Faisal and Liu, Xinxue and Islam, Taufiqul Md and Kim, Ryun Deok and Kang, SY Sophie and Im, Justin and Chowdhury, Fahima and Ahmed, Tasnuva and Aziz, Binte Asma and Hoque, Masuma and Park, Juyeon and Pak, Gideok and Jeon, Jin Hyon and Zaman, Khalequ and Khan, Islam Ashraful and Kim, H. Jerome and Marks, Florian and Qadri, Firdausi and Clemens, D. John", title="Association Among Household Water, Sanitation, and Hygiene (WASH) Status and Typhoid Risk in Urban Slums: Prospective Cohort Study in Bangladesh", journal="JMIR Public Health Surveill", year="2023", month="Nov", day="20", volume="9", pages="e41207", keywords="water", keywords="sanitation", keywords="sanitary", keywords="contaminated", keywords="contamination", keywords="hygiene", keywords="hygienic", keywords="WASH", keywords="water, sanitation and hygiene", keywords="typhoid fever", keywords="enteric fever", keywords="typhus", keywords="typhoid", keywords="enteric", keywords="salmonella", keywords="protection", keywords="recursive partitioning", keywords="Bangladesh", keywords="low- and middle-income countries", keywords="LMIC", keywords="bacteria", keywords="bacterial", keywords="bacterial infection", keywords="machine learning", keywords="algorithm", keywords="algorithms", keywords="model", keywords="low income", keywords="slum", keywords="slums", keywords="risk", keywords="infection control", keywords="incidence", keywords="prevalence", keywords="epidemiology", keywords="epidemiological", keywords="poverty", abstract="Background: Typhoid fever, or enteric fever, is a highly fatal infectious disease that affects over 9 million people worldwide each year, resulting in more than 110,000 deaths. Reduction in the burden of typhoid in low-income countries is crucial for public health and requires the implementation of feasible water, sanitation, and hygiene (WASH) interventions, especially in densely populated urban slums. Objective: In this study, conducted in Mirpur, Bangladesh, we aimed to assess the association between household WASH status and typhoid risk in a training subpopulation of a large prospective cohort (n=98,087), and to evaluate the performance of a machine learning algorithm in creating a composite WASH variable. Further, we investigated the protection associated with living in households with improved WASH facilities and in clusters with increasing prevalence of such facilities during a 2-year follow-up period. Methods: We used a machine learning algorithm to create a dichotomous composite variable (``Better'' and ``Not Better'') based on 3 WASH variables: private toilet facility, safe drinking water source, and presence of water filter. The algorithm was trained using data from the training subpopulation and then validated in a distinct subpopulation (n=65,286) to assess its sensitivity and specificity. Cox regression models were used to evaluate the protective effect of living in ``Better'' WASH households and in clusters with increasing levels of ``Better'' WASH prevalence. Results: We found that residence in households with improved WASH facilities was associated with a 38\% reduction in typhoid risk (adjusted hazard ratio=0.62, 95\% CI 0.49-0.78; P<.001). This reduction was particularly pronounced in individuals younger than 10 years at the first census participation, with an adjusted hazard ratio of 0.49 (95\% CI 0.36-0.66; P<.001). Furthermore, we observed an inverse relationship between the prevalence of ``Better'' WASH facilities in clusters and the incidence of typhoid, although this association was not statistically significant in the multivariable model. Specifically, the adjusted hazard of typhoid decreased by 0.996 (95\% CI 0.986-1.006) for each percent increase in the prevalence of ``Better'' WASH in the cluster (P=.39). Conclusions: Our findings demonstrate that existing variations in household WASH are associated with differences in the risk of typhoid in densely populated urban slums. This suggests that attainable improvements in WASH facilities can contribute to enhanced typhoid control, especially in settings where major infrastructural improvements are challenging. These findings underscore the importance of implementing and promoting comprehensive WASH interventions in low-income countries as a means to reduce the burden of typhoid and improve public health outcomes in vulnerable populations. ", doi="10.2196/41207", url="https://publichealth.jmir.org/2023/1/e41207", url="http://www.ncbi.nlm.nih.gov/pubmed/37983081" } @Article{info:doi/10.2196/48234, author="Wang, Dongqing and Nguyen, H. Christine and Fawzi, W. Wafaie", title="The Effects of Antenatal Interventions on Gestational Weight Gain in Low- and Middle-Income Countries: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2023", month="Nov", day="8", volume="12", pages="e48234", keywords="low- and middle-income countries", keywords="pregnant women", keywords="gestational weight gain", keywords="maternal nutrition", keywords="interventions", keywords="randomized controlled trials", keywords="systematic review", keywords="protocols", keywords="RCT", keywords="maternal", keywords="pregnant", keywords="pregnancy", keywords="review methodology", keywords="nutrition", keywords="gestational", keywords="weight", keywords="prenatal", keywords="LMIC", keywords="low income", keywords="middle income", abstract="Background: Gestational weight gain (GWG) is a crucial determinant of maternal and child outcomes yet remains an underused target for antenatal interventions in low- and middle-income countries (LMICs). Objective: This systematic review aims to identify and summarize educational, behavioral, nutritional, and medical interventions on GWG from randomized controlled trials conducted in LMICs. Methods: Randomized controlled trials that documented the effects of antenatal interventions on GWG in LMICs will be included. The interventions of interest will be educational, behavioral, nutritional, or medical. A systematic literature search will be conducted using PubMed, Embase, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from the inception of each database through October 2022 (with an updated search in January 2024). A total of 2 team members will independently perform the screening of studies and data extraction. A narrative synthesis of all the included studies will be provided. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The certainty of the evidence for each homogeneous group of interventions will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. A narrative synthesis of the included studies will be conducted to summarize mean differences (with 95\% CIs) for continuous outcomes and risk ratios, rate ratios, hazard ratios, or odds ratios (with 95\% CIs) for dichotomous or categorical outcomes. Available information on the costs of interventions will also be summarized to facilitate the adoption and scale-up of effective GWG interventions. Results: The development of the research questions, search strategy, and search protocol was started on September 20, 2022. The database searches and the importation of the identified records into Covidence were performed on October 7, 2022. As of September 2023, the title and abstract screening was ongoing. The target completion time of this systematic review is April 2024. Conclusions: Without effective interventions to manage GWG, the potential to improve maternal and child health through optimal GWG remains unrealized in LMICs. This systematic review will inform the design and implementation of antenatal interventions to prevent inadequate and excessive GWG in resource-limited settings. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022366354; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=366354 International Registered Report Identifier (IRRID): PRR1-10.2196/48234 ", doi="10.2196/48234", url="https://www.researchprotocols.org/2023/1/e48234", url="http://www.ncbi.nlm.nih.gov/pubmed/37938874" } @Article{info:doi/10.2196/45671, author="Koenig, R. Leah and Becker, Andr{\'e}a and Ko, Jennifer and Upadhyay, D. Ushma", title="The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis", journal="JMIR Public Health Surveill", year="2023", month="Nov", day="7", volume="9", pages="e45671", keywords="telehealth", keywords="abortion", keywords="spatial analysis", keywords="health equity", keywords="barriers", keywords="abortion access", keywords="legal", keywords="young people", keywords="remote", keywords="rural", abstract="Background: Even preceding the Supreme Court's 2022 Dobbs v. Jackson Women's Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear. Objective: We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility. Methods: We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients' residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility. Results: The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43\% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95\% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95\% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95\% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95\% CI 1.3-1.9). Conclusions: These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity. ", doi="10.2196/45671", url="https://publichealth.jmir.org/2023/1/e45671", url="http://www.ncbi.nlm.nih.gov/pubmed/37934583" } @Article{info:doi/10.2196/45624, author="Padhye, Rashmi and Sahasrabudhe, D. Shruti and Orme, W. Mark and Pina, Ilaria and Dhamdhere, Dipali and Borade, Suryakant and Bhakare, Meenakshi and Ahmed, Zahira and Barton, Andy and Modi, Mahavir and Malcolm, Dominic and Salvi, Sundeep and Singh, J. Sally", title="Perspectives of Patients With Chronic Respiratory Diseases and Medical Professionals on Pulmonary Rehabilitation in Pune, India: Qualitative Analysis", journal="JMIR Form Res", year="2023", month="Nov", day="7", volume="7", pages="e45624", keywords="COPD", keywords="chronic obstructive pulmonary disease", keywords="asthma", keywords="patients' suffering", keywords="self-management", keywords="digital mode of PR", keywords="integrating yoga with PR", keywords="thematic qualitative analysis", keywords="knowledge about PR", keywords="barriers to PR", keywords="chronic respiratory diseases", keywords="CRD", keywords="India", keywords="pulmonary rehabilitation", keywords="medical professional", keywords="treatment", keywords="inhaler", abstract="Background: Chronic respiratory diseases (CRDs) contribute significantly to morbidity and mortality worldwide and in India. Access to nonpharmacological options, such as pulmonary rehabilitation (PR), are, however, limited. Given the difference between need and availability, exploring PR, specifically remotely delivered PR, in a resource-poor setting, will help inform future work. Objective: This study explored the perceptions, experiences, needs, and challenges of patients with CRDs and the potential of and the need for PR from the perspective of patients as well as medical professionals involved in the referral (doctors) and delivery (physiotherapists) of PR. Methods: In-depth qualitative semistructured interviews were conducted among 20 individuals diagnosed with CRDs and 9 medical professionals. An inductive thematic analysis approach was used as we sought to identify the meanings shared both within and across the 2 participant groups. Results: The 20 patients considered lifestyle choices (smoking and drinking), a lack of physical activity, mental stress, and heredity as the triggering factors for their CRDs. All of them equated the disease with breathlessness and a lack of physical strength, consulting multiple doctors about their physical symptoms. The most commonly cited treatment choice was an inhaler. Most of them believed that yoga and exercise are good self-management strategies, and some were performing yoga postures and breathing exercises, as advised by friends or family members or learned from a televised program or YouTube videos. None of them identified with the term ``pulmonary rehabilitation,'' but many were aware of the exercise component and its benefits. Despite being naive to smartphone technology or having difficulty in reading, most of them were enthusiastic about enrolling in an application-based remotely delivered digital PR program. The 9 medical professionals were, however, reluctant to depend on a PR program delivered entirely online. They recommended that patients with CRDs be supported by their family to use technology, with some time spent with a medical professional during the program. Conclusions: Patients with CRDs in India currently manage their disease with nonguided strategies but are eager to improve and would benefit from a guided PR program to feel better. A home-based PR program, with delivery facilitated by digital solutions, would be welcomed by patients and health care professionals involved in their care, as it would reduce the need for travel, specialist equipment, and setup. However, low digital literacy, low resource availability, and a lack of expertise are of concern to health care professionals. For India, including yoga could be a way of making PR ``culturally congruent'' and more successful. The digital PR intervention should be flexible to individual patient needs and should be complemented with physical sessions and a feedback mechanism for both practitioners as well as patients for better uptake and adherence. ", doi="10.2196/45624", url="https://formative.jmir.org/2023/1/e45624", url="http://www.ncbi.nlm.nih.gov/pubmed/37934558" } @Article{info:doi/10.2196/42604, author="Zaki, Sasha", title="Tailoring Educational Materials to Cultural Context Matters", journal="J Med Internet Res", year="2023", month="Nov", day="6", volume="25", pages="e42604", keywords="Bangladesh", keywords="health education", keywords="health knowledge", keywords="quality of life", keywords="motivation", keywords="randomized controlled trial", keywords="RCT", keywords="campaign", keywords="chronic kidney disease", keywords="knowledge", keywords="mobile health", keywords="mHealth", keywords="kidney", keywords="chronic disease", keywords="chronic condition", keywords="patient education", keywords="patient knowledge", keywords="low- and middle-income countries", keywords="LMIC", doi="10.2196/42604", url="https://www.jmir.org/2023/1/e42604", url="http://www.ncbi.nlm.nih.gov/pubmed/37930771" } @Article{info:doi/10.2196/48558, author="Hedges, Joanne and Hermes Soares, Gustavo and Cadet-James, Yvonne and Dodd, Zell and Cooney, Sinon and Newman, James and Mittinty, Murthy and Kularatna, Sanjeewa and Larkins, Priscilla and Zwolak, Roman and Roberts, Rachel and Jamieson, Lisa", title="A Silver Fluoride Intervention to Improve Oral Health Trajectories of Young Indigenous Australians: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Nov", day="2", volume="12", pages="e48558", keywords="clinical trial", keywords="community", keywords="dental caries", keywords="Indigenous Australian", keywords="intervention", keywords="silver fluoride intervention", abstract="Background: Indigenous Australian children and adolescents experience profound levels of preventable dental disease. The application of silver fluoride (AgF) to active dental caries is a noninvasive alternative to traditional dental treatment approaches. There is particular utility among Indigenous children and young people with dental fear, who may not have access to timely or culturally safe dental service provisions. Objective: The aims of this study are to: (1) assess levels of active dental caries among Indigenous children and young people in 6 Australian states and territories; (2) determine if an AgF intervention reduces levels of active disease over 12-24 months; (3) measure the impact of improved oral health on social and emotional well-being (SEWB) and oral health-related quality of life; and (4) calculate the cost-effectiveness of implementing such an initiative. Methods: The study will use a 2-arm, parallel cluster randomized controlled trial design. Approximately 1140 Indigenous children and youth aged between 2 and 18 years will be recruited. Each state or territory will have 2 clusters. The intervention group will receive the AgF intervention at the start of the study, with the delayed intervention group receiving the AgF intervention 12 months after study commencement. The primary outcome will be the arrest of active carious lesions, with arrested caries defined as nonpenetration by a dental probe. Secondary outcomes will include SEWB, oral health-related quality of life, and dental anxiety, with covariates including dental behaviors (brushing and dental visits). Effectiveness measures for the economic evaluation will include the number of children and young people managed in primary oral health care without the need for specialist referral, changes in SEWB, the numbers and types of treatments provided, and caries increments. Results: Participant recruitment will commence in May 2023. The first results are expected to be submitted for publication 1 year after a 24-month follow-up. Conclusions: Our findings have the potential to change the way in which active dental disease among Indigenous children and young people can be managed through the inclusion of specifically tailored AgF applications to improve dental health and SEWB delivered by Indigenous health care workers. Desired impacts include cost savings on expensive dental treatments; improved SEWB, nutrition, social, and learning outcomes; and improved quality of life for both children and young people and their caregivers and the broader Indigenous community. The AgF application could be easily implemented into the training program of Indigenous health workers and yield critical information in the management armamentarium of health and well-being recommendations for Australia's First Peoples. International Registered Report Identifier (IRRID): PRR1-10.2196/48558 ", doi="10.2196/48558", url="https://www.researchprotocols.org/2023/1/e48558", url="http://www.ncbi.nlm.nih.gov/pubmed/37917128" } @Article{info:doi/10.2196/44702, author="Sapari, Hadita and Selamat, Ikhsan Mohamad and Isa, Rodi Mohamad and Ismail, Rohaida and Wan Mahiyuddin, Rozita Wan", title="The Impact of Heat Waves on Health Care Services in Low- or Middle-Income Countries: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2023", month="Oct", day="16", volume="12", pages="e44702", keywords="heat wave", keywords="burden", keywords="health care service", keywords="morbidity", keywords="low- or middle-income countries", keywords="LMICs", keywords="mortality", abstract="Background: Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce. Objective: This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs. Methods: We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity. Results: This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs. Conclusions: The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities. Trial Registration: PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=365471 International Registered Report Identifier (IRRID): DERR1-10.2196/44702 ", doi="10.2196/44702", url="https://www.researchprotocols.org/2023/1/e44702", url="http://www.ncbi.nlm.nih.gov/pubmed/37843898" } @Article{info:doi/10.2196/42450, author="Mundra, Anuj and Kalantri, Ashwini and Jakasania, Arjunkumar and Sathe, Harshal and Raut, Abhishek and Maliye, Chetna and Bahulekar, Pramod and Dawale, Ajay and Paradkar, J. Rameshwar and Siriah, Sakshi and Kumar, Satish and Gupta, S. Subodh and Garg, Bishan", title="Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="29", volume="12", pages="e42450", keywords="noncommunicable diseases", keywords="action research", keywords="implementation research", keywords="community-based participatory research", keywords="salutogenesis", keywords="primary prevention", abstract="Background: Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. Objective: This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. Methods: The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. Results: We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. Conclusions: This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Trial Registration: Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597\&EncHid=\&userName=V-CaN International Registered Report Identifier (IRRID): DERR1-10.2196/42450 ", doi="10.2196/42450", url="https://www.researchprotocols.org/2023/1/e42450", url="http://www.ncbi.nlm.nih.gov/pubmed/37773622" } @Article{info:doi/10.2196/50486, author="Werkmeister, Benjamin and Haase, M. Anne and Fleming, Theresa and Officer, N. Tara", title="Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Sep", day="22", volume="7", pages="e50486", keywords="telehealth", keywords="mental health services", keywords="Aotearoa New Zealand", keywords="mixed methods research", keywords="clinician", keywords="COVID-19", abstract="Background: The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. Objective: This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians' use of telehealth services to inform policy and practice. Methods: Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between September 2, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes. Results: The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians' flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth. Conclusions: For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives. ", doi="10.2196/50486", url="https://formative.jmir.org/2023/1/e50486", url="http://www.ncbi.nlm.nih.gov/pubmed/37738075" } @Article{info:doi/10.2196/46690, author="Gaetz, Stephen and Bonakdar, Ahmad and Ecker, John and MacDonald, Cora and Ilyniak, Sophia and Ward, Ashley and Kimura, Lauren and Vijayaratnam, Aranie and Banchani, Emmanuel", title="Evaluating the Effectiveness of the Housing First for Youth Intervention for Youth Experiencing Homelessness in Canada: Protocol for a Multisite, Mixed Methods Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="19", volume="12", pages="e46690", keywords="youth homelessness", keywords="Housing First for Youth", keywords="Canada", keywords="randomized controlled trial", keywords="RCT", keywords="Making the Shift", abstract="Background: Emerging evidence at the international level suggests that the Housing First approach could improve the housing stability of young people experiencing homelessness. However, there is a dearth of literature in Canada on whether the Housing First intervention for young people experiencing homelessness can improve outcomes including housing stability, health and well-being, and access to complementary supports. Adapted from the original Housing First model, Housing First for Youth (HF4Y) was developed in Canada as a rights-based approach tailored specifically for young people aged 16 to 24 years who are experiencing or are at risk of homelessness. Objective: The Making the Shift Youth Homelessness Social Innovation Lab is testing the effectiveness of the HF4Y intervention in Canada. The objective of this study is to determine whether the HF4Y model results in better participant-level outcomes than treatment-as-usual services for young people experiencing homelessness in 2 urban settings: Ottawa and Toronto, Ontario. Primary outcomes include housing stability, health and well-being, and complementary supports, and secondary outcomes include employment and educational attainment and social inclusion. Methods: The HF4Y study used a multisite, mixed methods, randomized controlled trial research approach for data collection and analysis. Eligible participants included young people aged 16 to 24 years who were experiencing homelessness or housing precarity. The participants were randomly assigned to either the treatment-as-usual group or the housing first intervention group. Survey and interview data in Ottawa and Toronto, Ontario are being collected at multiple time points (3-6 months) over 4 years to capture a range of outcomes. Analytic strategies for quantitative data will include mixed-effects modeling for repeated measures and logistic models. A thematic analysis will be used to analyze qualitative data based on participants' narratives and life journeys through homelessness. Furthermore, program fidelity evaluations are conducted within each HF4Y program. These evaluations assess how well the intervention aligns with the HF4Y model and identify any areas that may require adjustments or additional support. Results: The HF4Y study has received human participant research ethics approval from the Office of Research Ethics at York University. Recruitment was conducted between February 2018 and March 2020. Data collection is expected to be completed at both sites by March 2024. A preliminary analysis of the quantitative and qualitative data collected between baseline and 24 months is underway. Conclusions: This pilot randomized controlled trial is the first to test the effectiveness of the HF4Y intervention in Canada. The findings of this study will enhance our understanding of how to effectively deliver and scale up the HF4Y intervention, with the aim of continually improving the HF4Y model to promote better outcomes for youth. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) ISRCTN10505930; https://www.isrctn.com/ISRCTN10505930 International Registered Report Identifier (IRRID): DERR1-10.2196/46690 ", doi="10.2196/46690", url="https://www.researchprotocols.org/2023/1/e46690", url="http://www.ncbi.nlm.nih.gov/pubmed/37725430" } @Article{info:doi/10.2196/51643, author="Lawton, Beverley and MacDonald, Jane Evelyn and Storey, Francesca and Stanton, Jo-Ann and Adcock, Anna and Gibson, Melanie and Parag, Varsha and Sparkes, Kereru Ngaire and Kaimoana, Bobby and King, Frances and Terry, Marion and Watson, Huti and Bennett, Matthew and Lambert, Seymour Charles and Geller, Stacie and Paasi, Isitokia and Hibma, Merilyn and Sykes, Peter and Hawkes, David and Saville, Marion", title="A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a Cluster Randomized Crossover Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="14", volume="12", pages="e51643", keywords="uterine cervical neoplasms", keywords="cervical intraepithelial neoplasia", keywords="early detection of cancer", keywords="papillomavirus infections", keywords="New Zealand", keywords="self-testing", keywords="primary health care", keywords="Indigenous people", keywords="M?ori", keywords="point-of-care systems", keywords="colposcopy", keywords="health equity", abstract="Background: M?ori are the Indigenous people of Aotearoa (New Zealand). Despite global acceptance that cervical cancer is almost entirely preventable through vaccination and screening, w?hine M?ori (M?ori women) are more likely to have cervical cancer and 2.5 times more likely to die from it than non-M?ori women. Rural M?ori residents diagnosed with cervical cancer have worse outcomes than urban residents. Living in rural Aotearoa means experiencing barriers to appropriate and timely health care, resulting from distance, the lack of community resourcing, and low prioritization of rural needs by the health system and government. These barriers are compounded by the current screening processes and referral pathways that create delays at each step. Screening for high-risk human papillomavirus (hrHPV) and point-of-care (POC) testing are scientific advances used globally to prevent cervical cancer. Objective: This study aims to compare acceptability, feasibility, timeliness, referral to, and attendance for colposcopy following hrHPV detection between a community-controlled pathway and standard care. Methods: This is a cluster randomized crossover trial, with 2 primary care practices (study sites) as clusters. Each site was randomized to implement either pathway 1 or 2, with crossover occurring at 15 months. Pathway 1 (community-controlled pathway) comprises HPV self-testing, 1-hour POC results, face-to-face information, support, and immediate referral to colposcopy for women with a positive test result. Pathway 2 (standard care) comprises HPV self-testing, laboratory analysis, usual results giving, information, support, and standard referral pathways for women with a positive test result. The primary outcome is the proportion of women with hrHPV-positive results having a colposcopy within 20 working days of the HPV test (national performance indicator). Qualitative research will analyze successes and challenges of both pathways from the perspectives of governance groups, clinical staff, women, and their family. This information will directly inform the new National Cervical Screening Program. Results: In the first 15-month period, 743 eligible HPV self-tests were performed: 370 in pathway 1 with POC testing and 373 in pathway 2 with laboratory testing. The positivity rate for hrHPV was 7.3\% (54/743). Data collection for the second period, qualitative interviews, and analyses are ongoing. Conclusions: This M?ori-centered study combines quantitative and qualitative research to compare 2 clinical pathways from detection of hrHPV to colposcopy. This protocol draws on rural community practices strengths, successfully engaging M?ori from a wh?nau ora (family wellness) approach including kanohi ki te kanohi (face-to-face), kai?whina (nonclinical community health workers), and multiple venues for interventions. It will inform the theory and practice of rural models of the use of innovative technology, addressing M?ori cervical cancer inequities and facilitating M?ori wellness. The findings are anticipated to be applicable to other Indigenous and rural people in high-income countries. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000553875; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000553875 International Registered Report Identifier (IRRID): DERR1-10.2196/51643 ", doi="10.2196/51643", url="https://www.researchprotocols.org/2023/1/e51643", url="http://www.ncbi.nlm.nih.gov/pubmed/37707939" } @Article{info:doi/10.2196/43654, author="Sewpaul, Ronel and Resnicow, Ken and Crutzen, Rik and Dukhi, Natisha and Ellahebokus, Afzal and Reddy, Priscilla", title="A Tailored mHealth Intervention for Improving Antenatal Care Seeking and Health Behavioral Determinants During Pregnancy Among Adolescent Girls and Young Women in South Africa: Development and Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="13", volume="12", pages="e43654", keywords="antenatal care", keywords="adolescent girls and young women", keywords="AGYW", keywords="adolescent pregnancy", keywords="mobile health", keywords="mHealth", keywords="tailoring", keywords="motivational interviewing", keywords="South Africa", keywords="mobile phone", abstract="Background: South Africa, a middle-income country, has an adolescent fertility rate far higher than that of high-income countries. Adolescent girls and young women have an increased risk of pregnancy-related complications and lower antenatal appointment attendance rates than older adult pregnant women. Mobile health (mHealth) interventions to improve health behaviors among pregnant adolescent girls and young women in low- and middle-income countries are scarce. Objective: This paper describes the development and components of an mHealth intervention to improve antenatal appointment attendance and health behavioral determinants among pregnant adolescent girls and young women in South Africa and details the protocol for a pilot randomized controlled trial that evaluated the intervention's efficacy and user acceptability. Methods: The intervention, Teen MomConnect, sent tailored motivational behavior change and behavioral reinforcement SMS text messages to participants about antenatal appointment keeping and pregnancy behaviors. The delivery methodology of the intervention was adapted from MomConnect, an mHealth education program for pregnant women in South Africa that has nationwide coverage. In addition, participants received a face-to-face motivational interviewing session delivered by a trained research assistant. Pregnant adolescent girls and young women aged 13 to 20 years were recruited from health facilities and community networks. Participants were randomized into the control group that received the standard MomConnect health SMS text messages or the experimental group that received the Teen MomConnect intervention. Participants completed a baseline questionnaire upon enrollment in the study and a follow-up questionnaire after the end of their pregnancy. The questionnaires assessed demographic characteristics, pregnancy behaviors, and the psychosocial determinants of antenatal appointment attendance (knowledge, attitudes, social support, risk perceptions, self-efficacy, intention, and action planning). Feasibility was assessed using descriptive analyses of acceptability, study implementation processes, and perceived satisfaction with the intervention. The number of appointments attended was obtained from the participants' clinic records. Appointment attendance was compared between the control and experimental groups, as were awareness of HIV status and the psychosocial determinants of antenatal appointment attendance. Results: Participant recruitment was conducted from May 2018 to December 2018, and the questionnaire-based data collection was completed by December 2019. Overall, 412 participants were enrolled. Conclusions: This paper describes the Teen MomConnect intervention to improve antenatal appointment attendance and pregnancy health behaviors among adolescent girls and young women. The results on the intervention's preliminary efficacy and user acceptability will inform policy makers and health program officers on how tailored, age-appropriate, and motivational health behavior messages can be delivered via mobile phone to pregnant adolescent girls and young women. Trial Registration: Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565 International Registered Report Identifier (IRRID): DERR1-10.2196/43654 ", doi="10.2196/43654", url="https://www.researchprotocols.org/2023/1/e43654", url="http://www.ncbi.nlm.nih.gov/pubmed/37703092" } @Article{info:doi/10.2196/50927, author="Joshi, Vibha and Joshi, Kumar Nitin and Bhardwaj, Pankaj and Singh, Kuldeep and Ojha, Deepika and Jain, Kumar Yogesh", title="The Health Impact of mHealth Interventions in India: Systematic Review and Meta-Analysis", journal="Online J Public Health Inform", year="2023", month="Sep", day="4", volume="15", pages="e50927", keywords="mobile applications", keywords="mobile apps", keywords="cost-benefit analysis", keywords="telemedicine", keywords="technology", keywords="India", keywords="patient satisfaction", keywords="pregnancy", abstract="Background: Considerable use of mobile health (mHealth) interventions has been seen, and these interventions have beneficial effects on health and health service delivery processes, especially in resource-limited settings. Various functionalities of mobile phones offer a range of opportunities for mHealth interventions. Objective: This review aims to assess the health impact of mHealth interventions in India. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies conducted in India, and published between April 1, 2011, and March 31, 2021, were considered. A literature search was conducted using a combination of MeSH (Medical Subject Headings) terms in different databases to identify peer-reviewed publications. Thirteen out of 1350 articles were included for the final review. Risk of bias was assessed using the Risk of Bias 2 tool for RCTs and Risk Of Bias In Non-randomised Studies - of Interventions tool (for nonrandomized trials), and a meta-analysis was performed using RevMan for 3 comparable studies on maternal, neonatal, and child health. Results: The meta-analysis showed improved usage of maternal and child health services including iron--folic acid supplementation (odds ratio [OR] 14.30, 95\% CI 6.65-30.75), administration of both doses of the tetanus toxoid (OR 2.47, 95\% CI 0.22-27.37), and attending 4 or more antenatal check-ups (OR 1.82, 95\% CI 0.65-5.09). Meta-analysis for studies concerning economic evaluation and chronic diseases could not be performed due to heterogeneity. However, a positive economic impact was observed from a societal perspective (ReMiND [reducing maternal and newborn deaths] and ImTeCHO [Innovative Mobile Technology for Community Health Operation] interventions), and chronic disease interventions showed a positive impact on clinical outcomes, patient and provider satisfaction, app usage, and improvement in health behaviors. Conclusions: This review provides a comprehensive overview of mHealth technology in all health sectors in India, analyzing both health and health care usage indicators for interventions focused on maternal and child health and chronic diseases. Trial Registration: PROSPERO 2021 CRD42021235315; https://tinyurl.com/yh4tp2j7 ", doi="10.2196/50927", url="https://ojphi.jmir.org/2023/1/e50927", url="http://www.ncbi.nlm.nih.gov/pubmed/38046564" } @Article{info:doi/10.2196/43492, author="Bisrat, Haileleul and Manyazewal, Tsegahun and Fekadu, Abebaw", title="Mobile Health--Supported Active Syndrome Surveillance for COVID-19 Early Case Finding in Addis Ababa, Ethiopia: Comparative Study", journal="Interact J Med Res", year="2023", month="Aug", day="28", volume="12", pages="e43492", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="COVID-19", keywords="syndrome assessment", keywords="surveillance", keywords="Ethiopia", keywords="public health", keywords="syndrome surveillance", keywords="self-care", keywords="telemedicine", keywords="telecom, SARS-CoV-2", abstract="Background: Since most people in low-income countries do not have access to reliable laboratory services, early diagnosis of life-threatening diseases like COVID-19 remains challenging. Facilitating real-time assessment of the health status in a given population, mobile health (mHealth)--supported syndrome surveillance might help identify disease conditions earlier and save lives cost-effectively. Objective: This study aimed to evaluate the potential use of mHealth-supported active syndrome surveillance for COVID-19 early case finding in Addis Ababa, Ethiopia. Methods: A comparative cross-sectional study was conducted among adults randomly selected from the Ethio telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview for COVID-19 syndromic assessments, and their symptoms were scored and interpreted based on national guidelines. Participants who exhibited COVID-19 syndromes were advised to have COVID-19 diagnostic testing at nearby health care facilities and seek treatment accordingly. Participants were asked about their test results, and these were cross-checked against the actual facility-based data. Estimates of COVID-19 detection by mHealth-supported syndromic assessments and facility-based tests were compared using Cohen Kappa ($\kappa$), the receiver operating characteristic curve, sensitivity, and specificity analysis. Results: A total of 2741 adults (n=1476, 53.8\% men and n=1265, 46.2\% women) were interviewed through the mHealth platform during the period from December 2021 to February 2022. Among them, 1371 (50\%) had COVID-19 symptoms at least once and underwent facility-based COVID-19 diagnostic testing as self-reported, with 884 (64.5\%) confirmed cases recorded in facility-based registries. The syndrome assessment model had an optimal likelihood cut-off point sensitivity of 46\% (95\% CI 38.4-54.6) and specificity of 98\% (95\% CI 96.7-98.9). The area under the receiver operating characteristic curve was 0.87 (95\% CI 0.83-0.91). The level of agreement between the mHealth-supported syndrome assessment and the COVID-19 test results was moderate ($\kappa$=0.54, 95\% CI 0.46-0.60). Conclusions: In this study, the level of agreement between the mHealth-supported syndromic assessment and the actual laboratory-confirmed results for COVID-19 was found to be reasonable, at 89\%. The mHealth-supported syndromic assessment of COVID-19 represents a potential alternative method to the standard laboratory-based confirmatory diagnosis, enabling the early detection of COVID-19 cases in hard-to-reach communities, and informing patients about self-care and disease management in a cost-effective manner. These findings can guide future research efforts in developing and integrating digital health into continuous active surveillance of emerging infectious diseases. ", doi="10.2196/43492", url="https://www.i-jmr.org/2023/1/e43492", url="http://www.ncbi.nlm.nih.gov/pubmed/37556182" } @Article{info:doi/10.2196/47519, author="Adams, Joyce Yenupini and Agbenyo, Stephen John", title="Improving the Quality of Postpartum Care in Ghana: Protocol for a Parallel Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Aug", day="22", volume="12", pages="e47519", keywords="postpartum care", keywords="postnatal care", keywords="maternal mortality", keywords="Ghana", keywords="randomized controlled trial", keywords="protocol", abstract="Background: Although the postpartum period poses substantial risks and can result in significant maternal morbidity and mortality, postpartum care of the mother receives much less attention in transitional countries. Objective: We describe the protocol for a randomized controlled trial to implement and evaluate a postpartum care delivery model titled Focused-PPC (Focused Postpartum Care). Methods: Focused-PPC is an integrated group postpartum care model that meets the clinical care, education, and support needs of mothers up to 1 year after birth. The Focused-PPC intervention is a parallel randomized controlled trial with a total of 192 postpartum women at 4 health centers in Tamale, Ghana. Participants will be randomized into 1 of 2 trial arms at a 1:1 allocation ratio: (1) the control arm, which receives the standard postnatal care currently delivered in health facilities, or (2) the intervention arm, which receives the Focused-PPC model of care. Women enrolled in the intervention arm will receive postpartum clinical assessments and education for the first 6 weeks and will continue to receive education, measures of vital signs, and peer support for 12 months post partum during child welfare visits. Led by trained midwives, each postpartum group in the intervention arm will meet at 1-2 weeks, 6 weeks, and monthly thereafter for up to 1 year post partum, following the Ghana Health Service postnatal care schedule. Results: The Focused-PPC guide, data collection tools, and audiovisual education materials were successfully developed and translated into the local language. We have enrolled and conducted baseline surveys for 192 women (sample size met) in the Focused-PPC trial who have been randomized into intervention and control arms. We have established a total of 12 Focused-PPC groups in the intervention arm, 3 groups from each site, all of which have sessions underway. Conclusions: Focused-PPC has the potential to change the postpartum care delivery model in Ghana and other countries in sub-Saharan Africa and beyond. Trial Registration: ClinicalTrials.gov NCT05280951; https://clinicaltrials.gov/study/NCT05280951 International Registered Report Identifier (IRRID): DERR1-10.2196/47519 ", doi="10.2196/47519", url="https://www.researchprotocols.org/2023/1/e47519", url="http://www.ncbi.nlm.nih.gov/pubmed/37606965" } @Article{info:doi/10.2196/45917, author="Shrestha, Rachana and Sapkota, Diksha and Mehra, Devika and Ekstr{\"o}m, Mia Anna and Deuba, Keshab", title="Feasibility and Effectiveness of an Intervention to Reduce Intimate Partner Violence and Psychological Distress Among Women in Nepal: Protocol for the Domestic Violence Intervention (DeVI) Cluster-Randomized Trial", journal="JMIR Res Protoc", year="2023", month="Aug", day="15", volume="12", pages="e45917", keywords="intimate partner violence", keywords="intervention", keywords="violence prevention", keywords="mental health", keywords="cluster-randomized trial", keywords="depression", keywords="anxiety", keywords="posttraumatic stress disorder", keywords="low-income country", keywords="women", keywords="Nepal", abstract="Background: Intimate partner violence (IPV) disproportionately affects people in low-and middle-income countries (LMICs), such as Nepal. Women experiencing IPV are at higher risk of developing depression, anxiety, and posttraumatic stress disorder. The shortage of trained frontline health care providers, coupled with stigma related to IPV and mental health disorders, fuels low service uptake among women experiencing IPV. The Domestic Violence Intervention (DeVI) combines the Problem Management Plus counseling program developed by the World Health Organization with a violence prevention component. Objective: This study aims to implement and evaluate the feasibility, acceptability, and effectiveness of DeVI in addressing psychological distress and enabling the secondary prevention of violence for women experiencing IPV. Methods: A parallel cluster-randomized trial will be conducted across 8 districts in Madhesh Province in Nepal, involving 24 health care facilities. The study will include women aged 18-49 years who are either nonpregnant or in their first trimester, have experienced IPV within the past 12 months, have a 12-item General Health Questionnaire (GHQ-12) score of 3 or more (indicating current mental health issues), and have lived with their husbands or in-laws for at least 6 months. A total sample size of 912 was estimated at 80\% power and $\alpha$<.05 statistical significance level to detect a 15\% absolute risk reduction in the IPV frequency and a 50\% reduction in the GHQ-12 score in the intervention arm. The health care facilities will be randomly assigned to either the intervention or the control arm in a 1:1 ratio. Women visiting the health care facilities in the intervention and control arms will be recruited into the respective arms. In total, 38 participants from each health care facility will be included in the trial to meet the desired sample size. Eligible participants allocated to either arm will be assessed at baseline and follow-up visits after 6, 17, and 52 weeks after baseline. Results: This study received funding in 2019. As of December 29, 2022, over 50\% of eligible women had been recruited from both intervention and control sites. In total, 269 eligible women have been enrolled in the intervention arm and 309 eligible women in the control arm. The trial is currently in the recruitment phase. Data collection is expected to be completed by December 2023, after which data analysis will begin. Conclusions: If the intervention proves effective, it will provide evidence of how nonspecialist mental health care providers can address the harmful effects of IPV in resource-constrained settings with a high burden of IPV, such as Nepal. The study findings could also contribute evidence for integrating similar services into routine health programs in LMICs to prevent IPV and manage mental health problems among women experiencing IPV. Trial Registration: ClinicalTrials.gov NCT05426863; https://clinicaltrials.gov/ct2/show/NCT05426863 International Registered Report Identifier (IRRID): DERR1-10.2196/45917 ", doi="10.2196/45917", url="https://www.researchprotocols.org/2023/1/e45917", url="http://www.ncbi.nlm.nih.gov/pubmed/37581909" } @Article{info:doi/10.2196/37136, author="Coulibaly, Abou and Kouanda, S{\'e}ni", title="Effects of the Pregnancy and Newborn Diagnostic Assessment (PANDA) App on Antenatal Care Quality in Burkina Faso: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Aug", day="9", volume="12", pages="e37136", keywords="telemedicine", keywords="PANDA", keywords="pregnancy and newborn diagnostic assessment", keywords="quality", keywords="antenatal care", keywords="Burkina Faso", keywords="trial", keywords="pregnancy", keywords="pregnant", keywords="newborn", keywords="diagnostic", keywords="mobile app", keywords="prenatal care", keywords="randomized trial", keywords="first trimester", keywords="postpartum", keywords="qualitative research", keywords="maternity", keywords="prenatal", keywords="antenatal", keywords="mobile phone", abstract="Background: The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a digital clinical decision support tool that can facilitate diagnosis and decision-making by health care personnel in antenatal care (ANC). Studies conducted in Madagascar and Burkina Faso showed that PANDA is a feasible system acceptable to various stakeholders. Objective: This study primarily aims to evaluate the effects of the PANDA system on ANC quality at rural health facilities in Burkina Faso. The secondary objectives of this study are to test the effects of the PANDA system on women's satisfaction, women's knowledge on birth preparedness and complication readiness, maternal and child health service use, men's involvement in maternal health service utilization, and women's contraception use at 6 weeks postpartum. Further, we will identify the factors that hinder or promote such an app and contribute to cost-effectiveness analysis. Methods: This is a randomized controlled trial implementing the PANDA system in 2 groups of health facilities (intervention and comparison groups) randomized using a matched-pair method. We included pregnant women who were <20 weeks pregnant during their first antenatal consultation in health facilities, and we followed up with them until their sixth week postpartum. Thirteen health centers were included, and 423 and 272 women were enrolled in the intervention and comparison groups, respectively. The primary outcome is a binary variable derived from the quality score, coded 1 (yes) for women with at least 75\% of the total score and 0 if not. Data were collected electronically using tablets by directly interviewing the women and by extracting data from ANC registers, delivery registers, ANC cards, and health care records. The study procedures were standardized across all sites. We will compare unadjusted and adjusted primary outcome results (ANC quality scores) between the 2 study arms. We added a qualitative evaluation of the implementation of the PANDA system to identify barriers and catalysts. We also included an economic evaluation to determine whether the PANDA strategy is more cost-effective than the usual ANC strategy. Results: The enrollment ran from July 2020 to January 2021 due to the COVID-19 pandemic. Data collection ended in September 2022. Data analyses started in January 2023, ended in June 2023, and the results are expected to be published in February 2024. Conclusions: The PANDA system is one of the most comprehensive apps for ANC because it has many features. However, the use of computerized systems for ANC is limited. Therefore, our trial will be beneficial for evaluating the intrinsic capacity of the PANDA system to improve the quality of care. By including qualitative research and economic evaluation, our findings will be significant because electronic consultation registries are expected to be used for maternal health care in the future in Burkina Faso. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR202009861550402; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12374 International Registered Report Identifier (IRRID): DERR1-10.2196/37136 ", doi="10.2196/37136", url="https://www.researchprotocols.org/2023/1/e37136", url="http://www.ncbi.nlm.nih.gov/pubmed/37556195" } @Article{info:doi/10.2196/42844, author="Mosnier, Emilie and Artigas, Fernanda and Richard, Elodie and Hoyer, Maxime and Michels, David and Vandentorren, Stephanie and Girard, Gabriel and Nagot, Nicolas and Regnault, Hippolyte and Mosnier, Marine and Inegbeze, Gr{\^a}ce and Roux, Perrine and Spire, Bruno and Eldin, Carole", title="Effectiveness of a Community Empowerment Intervention to Improve Access to Pre-exposure Prophylaxis in Migrant Women Sex Workers: Protocol for a Mixed Methods Implementation Study", journal="JMIR Res Protoc", year="2023", month="Aug", day="4", volume="12", pages="e42844", keywords="community empowerment", keywords="sexual health", keywords="implementation science", keywords="migrants", keywords="women", keywords="sex workers", keywords="mixed methods", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="treatment", keywords="intervention", keywords="France", keywords="care", keywords="healthcare", keywords="health care", keywords="community", abstract="Background: The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection. However, at-risk women very rarely use PrEP in France---this represents a critical issue among migrant women sex workers (MWSWs). Previous studies on PrEP use among women sex workers or migrants focused on individual or social determinants of motivation. However, operational studies in real-word settings using a holistic population approach to maximize PrEP adherence among MWSWs are lacking. Objective: FASSETS (ie, ``Favoriser l'Acc{\`e}s {\`a} la Sant{\'e} Sexuelle des Travailleuses du Sexe''; English: ``facilitate the access to Sexual Health in women sex workers'') is a participative, multilevel, mixed methods study aiming to improve global knowledge of and access to sexual health care and PrEP among MWSWs through targeted empowerment strategies. Methods: This study comprises several phases: (1) phase 1: an initial qualitative study combining semistructured interviews, informal interviews, and participative observations will be performed among MWSWs, local community nongovernmental organizations, and institutions providing sexual reproductive health services to identify the determinants of PrEP access among MWSWs and for respondent-driven sampling (RDS); (2) phase 2: the size of the hidden MWSW population is estimated in Marseille through capture-recapture (the RDS survey will serve as ``recapture''); (3) phase 3: a longitudinal cohort will be formed through RDS to represent the MWSW population with a goal of 150 inclusions---this cohort will be followed up for 12 months, and sequential questionnaires exploring medical history; knowledge of sexual health, HIV, and sexually transmitted infections; migration route; and current living conditions will be administered at inclusion (month 0) and months 3, 6, and 12 to measure the following interventional phase's outcomes; and (4) phase 4: an interventional study with community empowerment actions about sexual health and PrEP will be conducted with community health workers; standardized questionnaires and semistructured interviews, observations, and focus groups will highlight MWSWs' experiences with empowerment resources, concerns about sexual health, and especially PrEP use or uptake, and we will evaluate whether and how community-adapted empowerment actions conducted by community health workers are effective in increasing access to sexual health, prevention and screening of sexually transmitted infections, and PrEP knowledge and access among MWSWs. Results: Recruitment commenced on March 1, 2022. We estimate the follow-up period to end on September 30, 2023. Conclusions: This multiphase study will provide robust evidence about the magnitude of the MWSW population in Marseille (the second largest town in France) and their current conditions of living, access to and knowledge of sexual health, and PrEP access. Using a mixed methods analysis, we will investigate whether individual and collective community health empowerment approaches can facilitate access to PrEP and its initiation, use, and adherence in this vulnerable population. International Registered Report Identifier (IRRID): DERR1-10.2196/42844 ", doi="10.2196/42844", url="https://www.researchprotocols.org/2023/1/e42844", url="http://www.ncbi.nlm.nih.gov/pubmed/37540547" } @Article{info:doi/10.2196/48799, author="Chiwanga, S. Faraja and Woodford, Joanne and Masika, M. Golden and Richards, A. David and Savi, Victor and von Essen, Louise", title="An mHealth Intervention to Improve Guardians' Adherence to Children's Follow-Up Care for Acute Lymphoblastic Leukemia in Tanzania (GuardiansCan Project): Protocol for a Development and Feasibility Study", journal="JMIR Res Protoc", year="2023", month="Aug", day="2", volume="12", pages="e48799", keywords="childhood cancer", keywords="eHealth", keywords="feasibility", keywords="guardians", keywords="intervention development", keywords="low- and middle-income countries", keywords="Tanzania", keywords="mHealth", keywords="mobile health", keywords="public contribution", keywords="public involvement", keywords="mHealth intervention", keywords="leukemia", keywords="psychological distress", abstract="Background: Cancer is a leading cause of death during childhood and in low- and middle-income countries survival rates can be as low as 20\%. A leading reason for low childhood cancer survival rates in low- and middle-income countries such as Tanzania is treatment abandonment. Contributing factors include poor communication between health care providers and children's guardians, insufficient cancer knowledge, and psychological distress. Objective: Our aim is to respond to Tanzanian guardians' poor adherence to children's follow-up care after treatment for acute lymphoblastic leukemia with the help of mobile health (mHealth) technology. Our goal is to increase guardians' adherence to children's medications and follow-up visits and to decrease their psychological distress. Methods: Following the Medical Research Council framework for developing and evaluating complex interventions, we will undertake the GuardiansCan project in an iterative phased approach to develop an mHealth intervention for subsequent testing. Public contribution activities will be implemented throughout via the establishment of a Guardians Advisory Board consisting of guardians of children with acute lymphoblastic leukemia. We will examine the acceptability, feasibility, and perceived impact of Guardians Advisory Board activities via an impact log and semistructured interviews (study I). In phase 1 (intervention development) we will explore guardians' needs and preferences for the provision of follow-up care reminders, information, and emotional support using focus group discussions and photovoice (study II). We will then co-design the mHealth intervention with guardians, health care professionals, and technology experts using participatory action research (study III). In phase 2 (feasibility), we will examine clinical, methodological, and procedural uncertainties associated with the intervention and study procedures to prepare for the design and conduct of a future definitive randomized controlled trial using a single-arm pre-post mixed methods feasibility study (study IV). Results: Data collection for the GuardiansCan project is anticipated to take 3 years. We plan to commence study I by recruiting Guardians Advisory Board members in the autumn of 2023. Conclusions: By systematically following the intervention development and feasibility phases of the Medical Research Council Framework, and working alongside an advisory board of guardians, we intend to develop an acceptable, culturally appropriate, feasible, and relevant mHealth intervention with the potential to increase guardians' adherence to children's follow-up care after treatment of acute lymphoblastic leukemia, leading to a positive impact on children's health and chances to survive, and reducing distress for guardians. International Registered Report Identifier (IRRID): PRR1-10.2196/48799 ", doi="10.2196/48799", url="https://www.researchprotocols.org/2023/1/e48799", url="http://www.ncbi.nlm.nih.gov/pubmed/37403706" } @Article{info:doi/10.2196/44362, author="Nagraj, Shobhana and Kennedy, Stephen and Jha, Vivekananda and Norton, Robyn and Hinton, Lisa and Billot, Laurent and Rajan, Eldho and Mohammed Abdul, Ameer and Phalswal, Anita and Arora, Varun and Praveen, Devarsetty and Hirst, Jane", title="A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial", journal="JMIR Form Res", year="2023", month="Jul", day="20", volume="7", pages="e44362", keywords="decision support systems", keywords="clinical", keywords="telemedicine", keywords="community health workers", keywords="pregnancy", keywords="high risk", keywords="diabetes", keywords="gestational", keywords="cardiovascular diseases", abstract="Background: Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT). Objective: The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability. Methods: In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh. Results: SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2\%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100\% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5\%) and GDM (2\%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition. Conclusions: SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT. Trial Registration: ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952 International Registered Report Identifier (IRRID): RR2-10.3389/fgwh.2021.620759 ", doi="10.2196/44362", url="https://formative.jmir.org/2023/1/e44362", url="http://www.ncbi.nlm.nih.gov/pubmed/37471135" } @Article{info:doi/10.2196/46710, author="Jorgensen, L. Andrea and Orrell, Catherine and Waitt, Catriona and Toh, Cheng-Hock and Sekaggya-Wiltshire, Christine and Hughes, A. Dyfrig and Allen, Elizabeth and Okello, Emmy and Tatz, Gayle and Culeddu, Giovanna and Asiimwe, G. Innocent and Semakula, Roy Jerome and Mouton, P. Johannes and Cohen, Karen and Blockman, Marc and Lamorde, Mohammed and Pirmohamed, Munir", title="A ``Bundle of Care'' to Improve Anticoagulation Control in Patients Receiving Warfarin in Uganda and South Africa: Protocol for an Implementation Study", journal="JMIR Res Protoc", year="2023", month="Jul", day="19", volume="12", pages="e46710", keywords="drug monitoring", keywords="international normalized ratio", keywords="Sub-Saharan Africa", keywords="warfarin bundle", keywords="warfarin", keywords="anticoagulation control", abstract="Background: The quality of warfarin anticoagulation among Sub-Saharan African patients is suboptimal. This is due to several factors, including a lack of standardized dosing algorithms, difficulty in providing timely international normalized ratio (INR) results, a lack of patient feedback on their experiences with treatment, a lack of education on adherence, and inadequate knowledge and training of health care workers. Low quality of warfarin anticoagulation, expressed as time in therapeutic range (TTR), is associated with higher adverse event rates, including bleeding and thrombosis, and ultimately, increased morbidity and mortality. Processes and interventions that improve this situation are urgently needed. Objective: This study aims to evaluate the implementation of the ``warfarin bundle,'' a package of interventions to improve the quality of anticoagulation and thereby clinical outcomes. The primary outcome for this study is TTR over the initial 3 months of warfarin therapy. Methods: Patients aged 18 years or older who are newly initiated on warfarin for venous thromboembolism, atrial fibrillation, or valvular heart disease will be enrolled and followed up for 3 months at clinics in Cape Town, South Africa, and Kampala, Uganda, where the warfarin bundle is implemented. A retrospective review of the clinical records of patients on warfarin treatment before implementation (controls) will be used for comparison. This study uses a mixed methods approach of the implementation of patient- and process-centered activities to improve the quality of anticoagulation. Patient-centered activities include the use of clinical dosing algorithms, adherence support, and root cause analysis, whereas process-centered activities include point-of-care INR testing, staff training, and patient education and training. We will assess the impact of these interventions by comparing the TTR and safety outcomes across the 2 groups, as well as the cost-effectiveness and acceptability of the package. Results: We started recruitment in June 2021 and stopped in August 2022, having recruited 167 participants. We obtained ethics approval from the University of Cape Town Faculty of Health Sciences Human Research Ethics Committee, the Provincial Health Research Committees in South Africa, the Joint Clinical Research Centre Institutional Review Board, Kampala, and the University of Liverpool Research Ethics Committee. As of February 2023, data cleaning and formal analysis are underway. We expect to publish the full results by December 2023. Conclusions: We anticipate that the ``bundle of care,'' which includes a clinical algorithm to guide individualized dosing of warfarin, will improve INR control and TTR of patients in Uganda and South Africa. We will use these findings to design a larger, multisite clinical trial across several Sub-Saharan African countries. International Registered Report Identifier (IRRID): DERR1-10.2196/46710 ", doi="10.2196/46710", url="https://www.researchprotocols.org/2023/1/e46710", url="http://www.ncbi.nlm.nih.gov/pubmed/37467034" } @Article{info:doi/10.2196/41836, author="Amick, Erick and Naanyu, Violet and Bucher, Sherri and Henry, W. Beverly", title="Perceptions of Global Health Engagements in Relation to the COVID-19 Pandemic Among Health Care Workers and Administrators in Western Kenya: Protocol for a Multistage Qualitative Study", journal="JMIR Res Protoc", year="2023", month="Jul", day="19", volume="12", pages="e41836", keywords="global health", keywords="global health engagements", keywords="GHEs", keywords="health care workers", keywords="local perspectives", keywords="low- and middle-income countries", keywords="LMICs", abstract="Background: There has been significant interest in global health in low- and middle-income countries (LMICs) among individuals living in high-income countries (HICs) over the past 30 years. Much of the literature on global health engagements (GHEs) has been presented from the perspective of individuals from high-income countries. Local stakeholders such as health care workers and health care administrators represent critical constituencies for global health activities, yet their perspectives are underrepresented in the literature. The purpose of this study is to examine the experiences of local health care workers and administrators with GHEs in Kenya. We will explore the perceived role GHEs play in preparing the health system to address a public health crisis, as well as their role in pandemic recovery and its aftermath. Objective: The aims of this study are to (1) examine how Kenyan health care workers and administrators interpret experiences with GHEs as having advantaged or hindered them and the local health system to provide care during an acute public health crisis and (2) to explore recommendations to reimagine GHEs in a postpandemic Kenya. Methods: This study will be conducted at a large teaching and referral hospital in western Kenya with a long history of hosting GHEs in support of its tripartite mission of providing care, training, and research. This qualitative study will be conducted in 3 phases. In phase 1, in-depth interviews will be conducted to capture participants' lived experience in relation to their unique understandings of the pandemic, GHEs, and the local health system. In phase 2, group discussions using nominal group techniques will be conducted to determine potential priority areas to reimagine future GHEs. In phase 3, in-depth interviews will be conducted to explore these priority areas in greater detail to explore recommendations for potential strategies, policies, and other actions that might be used to achieve the priorities determined to be of highest importance. Results: The study activities commenced in late summer 2022, with findings to be published in 2023. It is anticipated that the findings from this study will provide insight into the role GHEs play in a local health system in Kenya and provide critical stakeholder and partner input from persons hitherto ignored in the design, implementation, and management of GHEs. Conclusions: This qualitative study will examine the perspectives of GHEs in relation to the COVID-19 pandemic among Kenyan health care workers and health care administrators in western Kenya using a multistage protocol. Using a combination of in-depth interviews and nominal group techniques, this study aims to shed light on the roles global health activities are perceived to play in preparing health care professionals and the health system to address an acute public health crisis. International Registered Report Identifier (IRRID): PRR1-10.2196/41836 ", doi="10.2196/41836", url="https://www.researchprotocols.org/2023/1/e41836", url="http://www.ncbi.nlm.nih.gov/pubmed/37315197" } @Article{info:doi/10.2196/42775, author="Verma, Neha and Buch, Bimal and Taralekar, Radha and Acharya, Soumyadipta", title="Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial", journal="JMIR Form Res", year="2023", month="Jun", day="23", volume="7", pages="e42775", keywords="telemedicine", keywords="telehealth", keywords="eHealth", keywords="opensource", keywords="digital assistant", keywords="diagnostic concordance", keywords="COVID-19", keywords="primary care", keywords="rural health", keywords="teleconsultation", keywords="patient care", abstract="Background: With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards. Objective: This study aims to compare the diagnosis and treatment decisions from teleconsultations to those of in-person care in teleclinics in rural Gujarat. Methods: We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at 10 telemedicine primary care clinics. Patients reporting to 10 telemedicine primary care clinics were randomly assigned to first receive an in-person doctor consultation (59/104, 56.7\%) or to first receive a health worker--assisted telemedicine consultation (45/104, 43.3\%). The 2 groups were then switched, with the first group undergoing a telemedicine consultation following the in-person consultation and the second group receiving an in-person consultation after the teleconsultation. The in-person doctor and remote doctor were blinded to the diagnosis and management plan of the other. The diagnosis and treatment plan of in-person doctors was considered the gold standard. Results: We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74\% (77/104) diagnostic concordance and 79.8\% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker--doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95\% concordance; Cohen kappa=0.93) and diabetes (14/15, 93\% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33\%) and patients presenting with nonspecific symptoms (3/10, 30\%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols. Conclusions: The findings reflect that telemedicine can be a safe and acceptable alternative mode of care especially in remote rural settings when in-person care is not accessible. Telemedicine has advantages. for the potential gains for improved health care--seeking behavior for patients, reduced costs for the patient, and improved health system efficiency by reducing overcrowding at tertiary health facilities. ", doi="10.2196/42775", url="https://formative.jmir.org/2023/1/e42775", url="http://www.ncbi.nlm.nih.gov/pubmed/37130015" } @Article{info:doi/10.2196/46486, author="Brathwaite, Rachel and Mutumba, Massy and Nanteza, Jacqueline and Filiatreau, M. Lindsey and Migadde, Herbert and Namatovu, Phionah and Nabisere, Betina and Mugisha, James and Mwebembezi, Abel and Ssewamala, M. Fred", title="Assessing the Feasibility of Economic Approaches to Prevent Substance Abuse Among Adolescents: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Jun", day="14", volume="12", pages="e46486", keywords="adolescents living with HIV", keywords="alcohol", keywords="Sub-Saharan Africa", keywords="substance use", keywords="Uganda", abstract="Background: Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50\% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them. Objective: We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda's fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them. Methods: This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group). Results: Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024. Conclusions: Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them. Trial Registration: ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865 International Registered Report Identifier (IRRID): PRR1-10.2196/46486 ", doi="10.2196/46486", url="https://www.researchprotocols.org/2023/1/e46486", url="http://www.ncbi.nlm.nih.gov/pubmed/37314844" } @Article{info:doi/10.2196/45236, author="Jing, Zhengyue and Li, Jie and Wang, Yi and Zhou, Chengchao", title="Prevalence and Trends of Sexual Behaviors Among Young Adolescents Aged 12 Years to 15 Years in Low and Middle-Income Countries: Population-Based Study", journal="JMIR Public Health Surveill", year="2023", month="Jun", day="7", volume="9", pages="e45236", keywords="risky sexual behaviors", keywords="early sexual intercourse", keywords="multiple sexual partners", keywords="condom use", keywords="young adolescents", keywords="low and middle-income countries", abstract="Background: Risky sexual behaviors remain significant public health challenges among adolescents. Nearly 90\% of adolescents live in low and middle-income countries (LMICs), but few studies have used standardized methodology to monitor the prevalence and trends of sexual behaviors among adolescents in LMICs. Objective: This study aimed to assess the prevalence of sexual behaviors (ever had sexual intercourse, multiple sexual partners, and condom use) among adolescents aged 12 years to 15 years as well as the trends in prevalence between 2003 and 2017. Methods: For this population-based study, we used recent data from the Global School-based Student Health Survey conducted in 69 LMICs from 2003 to 2017 to assess the recent prevalence of sexual behaviors by using complex analysis and a random effects meta-analyses method. Using the chi-square trend test, we also assessed the trends in the prevalence of sexual behaviors in 17 countries that had conducted ?1 round of surveys from 2003 to 2017. Results: We included 145,277 adolescents aged 12 years to 15 years (64,719/145,277, 44.5\% boys) from the 69 LMICs that had conducted ?1 survey and 80,646 adolescents aged 12 years to 15 years (34,725/80,646, 43.1\% boys) from the 17 LMICs that had conducted ?1 round of surveys. The recent global prevalence of ever had sexual intercourse was 6.9\% (95\% CI 6.2\%-7.6\%) and was higher among boys (10.0\%, 95\% CI 9.1\%-11.1\%) than girls (4.2\%, 95\% CI 3.7\%-4.7\%) and among those aged 14 years to 15 years (8.5\%, 95\% CI 7.7\%-9.3\%) than those aged 12 years to 13 years (4\%, 95\% CI 3.4\%-4.7\%). Among adolescents who had ever had sex, the recent global prevalence of having multiple sexual partners was 52\% (95\% CI 50.4\%-53.6\%) and was higher among boys (58\%, 95\% CI 56.1\%-59.9\%) than girls (41.4\%, 95\% CI 38.9\%-43.9\%) and among those aged 14 years to 15 years (53.5\%, 95\% CI 51.6\%-55.4\%) than those aged 12 years to 13 years (49.7\%, 95\% CI 45.9\%-53.5\%). Among adolescents who had ever had sex, the recent global prevalence of condom use was 58.1\% (95\% CI 56.2\%-59.9\%) and was higher among girls (59.2\%, 95\% CI 56.4\%-61.9\%) than boys (57.7\%, 95\% CI 55.7\%-59.7\%) and among those aged 14 years to 15 years (59.9\%, 95\% CI 58.0\%-61.8\%) than those aged 12 years to 13 years (51.6\%, 95\% CI 47.5\%-55.7\%). Between the earliest and latest surveys, the overall prevalence of ever had sexual intercourse (3.1\% decrease) and condom use (2.0\% decrease) showed downward trends. The overall prevalence of having multiple sexual partners increased by 2.6\%. Conclusions: We provide evidence and important implication for policymakers to develop targeted policy support systems to prevent and reduce risky sexual behaviors among young adolescents in LMICs with a high prevalence of risky sexual behaviors. ", doi="10.2196/45236", url="https://publichealth.jmir.org/2023/1/e45236", url="http://www.ncbi.nlm.nih.gov/pubmed/37285196" } @Article{info:doi/10.2196/44551, author="Frick, Ulrich and Sipar, Dilan and B{\"u}cheler, Leonie and Haug, Fabian and Haug, Julian and Almeqbaali, Mohammed Khalifa and Pryss, R{\"u}diger and Rosner, Rita and Comtesse, Hannah", title="A Mobile-Based Preventive Intervention for Young, Arabic-Speaking Asylum Seekers During the COVID-19 Pandemic in Germany: Design and Implementation", journal="JMIR Form Res", year="2023", month="Jun", day="5", volume="7", pages="e44551", keywords="prevention", keywords="COVID-19", keywords="refugees", keywords="asylum seekers", keywords="adolescents", keywords="feasibility", keywords="behavior planning", keywords="vaccination", keywords="mobile phone", abstract="Background: Most individuals seeking asylum in Germany live in collective housing and are thus exposed to a higher risk of contagion during the COVID-19 pandemic. Objective: In this study, we aimed to test the feasibility and efficacy of a culture-sensitive approach combining mobile app--based interventions and a face-to-face group intervention to improve knowledge about COVID-19 and promote vaccination readiness among collectively accommodated Arabic-speaking adolescents and young adults. Methods: We developed a mobile app that consisted of short video clips to explain the biological basis of COVID-19, demonstrate behavior to prevent transmission, and combat misconceptions and myths about vaccination. The explanations were provided in a YouTube-like interview setting by a native Arabic-speaking physician. Elements of gamification (quizzes and rewards for solving the test items) were also used. Consecutive videos and quizzes were presented over an intervention period of 6 weeks, and the group intervention was scheduled as an add-on for half of the participants in week 6. The manual of the group intervention was designed to provide actual behavioral planning based on the health action process approach. Sociodemographic information, mental health status, knowledge about COVID-19, and available vaccines were assessed using questionnaire-based interviews at baseline and after 6 weeks. Interpreters assisted with the interviews in all cases. Results: Enrollment in the study proved to be very challenging. In addition, owing to tightened contact restrictions, face-to-face group interventions could not be conducted as planned. A total of 88 participants from 8 collective housing institutions were included in the study. A total of 65 participants completed the full-intake interview. Most participants (50/65, 77\%) had already been vaccinated at study enrollment. They also claimed to comply with preventive measures to a very high extent (eg, ``always wearing masks'' was indicated by 43/65, 66\% of participants), but practicing behavior that was not considered as effective against COVID-19 transmission was also frequently reported as a preventive measure (eg, mouth rinsing). By contrast, factual knowledge of COVID-19 was limited. Preoccupation with the information materials presented in the app steeply declined after study enrollment (eg, 12/61, 20\% of participants watched the videos scheduled for week 3). Of the 61 participants, only 18 (30\%) participants could be reached for the follow-up interviews. Their COVID-19 knowledge did not increase after the intervention period (P=.56). Conclusions: The results indicated that vaccine uptake was high and seemed to depend on organizational determinants for the target group. The current mobile app--based intervention demonstrated low feasibility, which might have been related to various obstacles faced during the delivery. Therefore, in the case of future pandemics, transmission prevention in a specific target group should rely more on structural aspects rather than sophisticated psychological interventions. ", doi="10.2196/44551", url="https://formative.jmir.org/2023/1/e44551", url="http://www.ncbi.nlm.nih.gov/pubmed/37134019" } @Article{info:doi/10.2196/42041, author="Chetty, Terusha and Singh, Yages and Odendaal, Willem and Mianda, Solange and Abdelatif, Nada and Manda, Samuel and Schneider, Helen and Goga, Ameena", title="Intervention in Mothers and Newborns to Reduce Maternal and Perinatal Mortality in 3 Provinces in South Africa Using a Quality Improvement Approach: Protocol for a Mixed Method Type 2 Hybrid Evaluation", journal="JMIR Res Protoc", year="2023", month="Jun", day="5", volume="12", pages="e42041", keywords="health systems", keywords="quality improvement", keywords="antenatal", keywords="postnatal", keywords="maternal", keywords="child", keywords="HIV", keywords="mixed methods evaluation", abstract="Background: The COVID-19 pandemic undermined gains in reducing maternal and perinatal mortality in South Africa. The Mphatlalatsane Initiative is a health system intervention to reduce mortality and morbidity in women and newborns to desired levels. Objective: Our evaluation aims to determine the effect of various exposures, including the COVID-19 pandemic, and a system-level, complex, patient-centered quality improvement (QI) intervention (the Mphatlalatsane Initiative) on maternal and neonatal health services at 21 selected South African facilities. The objectives are to determine whether Mphatlalatsane reduces the institutional maternal mortality ratio, neonatal mortality rate, and stillbirth rate (objective 1) and improves patients' experiences (objective 2) and quality of care (objective 3). Objective 4 assesses the contextual and implementation process factors, including the COVID-19 pandemic, that shape Mphatlalatsane uptake and variation. Methods: This study is an implementation science type 2 hybrid effectiveness, controlled before-and-after design with quantitative and qualitative components. The Mphatlalatsane intervention commenced at the end of 2019. For objective 1, intervention and control facility-level data from the District Health Information System are compared for changes in institutional maternal and neonatal mortality and stillbirth rates and associations with QI, the COVID-19 pandemic, and both. This first analysis includes data from 18 facilities, regardless of their allocation to intervention or comparison, to obtain a general idea of the effect of the COVID-19 pandemic. For objectives 2 to 3, data collectors abstract data from maternal and neonatal records, interview participants, and conduct neonatal facility assessments. For objective 4, interviews, program documentation, surveys, and observations are used to assess how contextual factors at the macro-, meso-, and microlevels explain variation in intervention uptake and outcome. The intervention dose is measured at the microlevel only in the intervention facilities. The study assesses the Mphatlalatsane Initiative from 2020 to 2022. Results: From preliminary analysis, across the 3 provinces, maternal and neonatal deaths increased during the COVID-19 pandemic, whereas stillbirths remained unchanged. Maternal satisfaction with quality of care was >90\%. The COVID-19 pandemic severely disrupted the QI teams functioning. However, the QI teams regained their pre--COVID-19 momentum by adapting the QI model, with advisers providing mentoring and support. Variation in adoption at the mesolevel was related to stable and motivated leadership (particularly at the facility level), poor integration into routine processes, and buy-in from senior district managers who were affected by competing priorities. Varying referral and specialist outreach systems, staff availability and development, and service delivery infrastructure are plausible factors in variable outcomes. Conclusions: Few evaluations rigorously evaluated the effect of health system interventions on improving health services and outcomes. Results will inform the scaling up of successful intervention components and strategies to mitigate the effects of the COVID-19 pandemic or similar emerging epidemics on maternal and neonatal mortality. International Registered Report Identifier (IRRID): DERR1-10.2196/42041 ", doi="10.2196/42041", url="https://www.researchprotocols.org/2023/1/e42041", url="http://www.ncbi.nlm.nih.gov/pubmed/37000902" } @Article{info:doi/10.2196/38828, author="Leddy, Anna and Ggita, Joseph and Berger, A. Christopher and Kityamuwesi, Alex and Sanyu, Nakate Agnes and Tinka, Kunihira Lynn and Crowder, Rebecca and Turyahabwe, Stavia and Katamba, Achilles and Cattamanchi, Adithya", title="Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study", journal="J Med Internet Res", year="2023", month="May", day="30", volume="25", pages="e38828", keywords="digital adherence technology", keywords="gender norms", keywords="tuberculosis", keywords="adherence", keywords="sub-Saharan Africa", abstract="Background: Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. Objective: We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone--based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Methods: Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Results: Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone--access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women's narratives centered on the ways the platform facilitated and improved their adherence, whereas the men's narratives did not. Conclusions: Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources. ", doi="10.2196/38828", url="https://www.jmir.org/2023/1/e38828", url="http://www.ncbi.nlm.nih.gov/pubmed/37252774" } @Article{info:doi/10.2196/40561, author="Haricharan, Jensen Hanne and Hacking, Damian and Lau, Kwan Yan and Heap, Marion", title="Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging--Based Information Campaign: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2023", month="May", day="22", volume="6", pages="e40561", keywords="SMS text messages", keywords="cell phones", keywords="mobile health", keywords="mHealth", keywords="health information", keywords="health literacy", keywords="healthy behavior", keywords="maternal health", keywords="antenatal care", keywords="Deaf", keywords="South Africa", abstract="Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging--based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants' knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging--based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women's knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people's health knowledge. However, attention should be paid to Deaf participants' specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe ", doi="10.2196/40561", url="https://pediatrics.jmir.org/2023/1/e40561", url="http://www.ncbi.nlm.nih.gov/pubmed/37213174" } @Article{info:doi/10.2196/39864, author="Manton, Danielle and Williams, Megan and Hayen, Andrew", title="The Bunya Project: Protocol for a Mixed-Methods Approach to Developing a Culturally Informed Curriculum", journal="JMIR Res Protoc", year="2023", month="May", day="18", volume="12", pages="e39864", keywords="Indigenous", keywords="university", keywords="curriculum", keywords="leadership", keywords="cocreation", keywords="self-determination", abstract="Background: Indigenous peoples live across all continents, representing approximately 90 nations and cultures and 476 million people. There have long been clear statements about the rights of Indigenous peoples to self-determine services, policies, and resource allocations that affect our lives, particularly via the United Nations Declaration on the Rights of Indigenous Peoples. An area for urgent improvement is curricula that train the predominantly non-Indigenous health workforce about their responsibilities and that offer practical strategies to use when engaging with Indigenous peoples and issues. Objective: The Bunya Project is designed to advance Indigenous community-led teaching and evaluation of the embeddedness of strategies to achieve an Indigenous Graduate Attribute in Australia. The project centers the relationships with Aboriginal community services to lead education design relating to Indigenous peoples. The project aims to articulate community recommendations for university education in allied health in the usable format of digital stories to create culturally informed andragogy, curriculum, and assessment measures for use in teaching. It also aims to understand the impact of this work on student attitudes and knowledge about Indigenous peoples' allied health needs. Methods: Multilayered project governance was established, along with a 2-stage process using mixed methods participatory action research and critical reflection, using the reflective cycle by Gibbs. The first stage, preparing the soil, used community engagement, drew on lived experience, encouraged critical self-reflection, embodied reciprocity, and demanded working collectively. The second stage, planting the seed, requires more critical self-reflection, the development of community data through interviews and focus group discussions, the development of resources with an academic working group and community participants, the implementation of those resources with student feedback, the analysis of the feedback from students and community members, and reflection. Results: The protocol for the first stage, preparing the soil, is complete. The results of the first stage are the relationships built and the trust earned and gained, and it has resulted in the development of the planting the seed protocol. As of February 2023, we have recruited 24 participants. We will analyze data shortly and expect to publish the results in 2024. Conclusions: The readiness of non-Indigenous staff to engage with Indigenous communities has not been ascertained by Universities Australia, nor can it be assured. Staff preparation and skills to support the curriculum, create a safe learning environment, and develop teaching and learning strategies to guide academics to recognize that how students learn is as important as the content students learn. This learning has broad implications and benefits for staff and students within their professional practice and for lifelong learning. International Registered Report Identifier (IRRID): DERR1-10.2196/39864 ", doi="10.2196/39864", url="https://www.researchprotocols.org/2023/1/e39864", url="http://www.ncbi.nlm.nih.gov/pubmed/37200069" } @Article{info:doi/10.2196/44051, author="Kawuki, Joseph and Chan, Shing-fong Paul and Fang, Yuan and Chen, Siyu and Mo, H. Phoenix K. and Wang, Zixin", title="Knowledge and Practice of Personal Protective Measures Against COVID-19 in Africa: Systematic Review", journal="JMIR Public Health Surveill", year="2023", month="May", day="16", volume="9", pages="e44051", keywords="personal protective measures", keywords="mask use", keywords="social distancing", keywords="hand hygiene", keywords="COVID-19", keywords="Africa", keywords="nonpharmaceutical interventions", abstract="Background: With COVID-19 being a newly evolving disease, its response measures largely depend on the practice of and compliance with personal protective measures (PPMs). Objective: This systematic review aimed to examine the knowledge and practice of COVID-19 PPMs in African countries as documented in the published literature. Methods: A systematic search was conducted on the Scopus, PubMed, and Web of Science databases using appropriate keywords and predefined eligibility criteria for the selection of relevant studies. Only population-based original research studies (including qualitative, quantitative, and mixed methods studies) conducted in Africa and published in the English language were included. The screening process and data extraction were performed according to a preregistered protocol in PROSPERO (CRD42022355101) and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Thematic analysis was used to systematically summarize the studies into 4 predefined domains: knowledge and perception of PPMs, mask use, social and physical distancing, and handwashing and hand hygiene, including their respective levels and associated factors. Results: A total of 58 studies across 12 African countries were included, published between 2019 and 2022. African communities, including various population groups, had varying levels of knowledge and practice of COVID-19 PPMs, with the lack of personal protective equipment (mainly face masks) and side effects (among health care workers) being the major reasons for poor compliance. Lower rates of handwashing and hand hygiene were particularly noted in several African countries, especially among low-income urban and slum dwellers, with the main barrier being the lack of safe and clean water. Various cognitive (knowledge and perception), sociodemographic, and economic factors were associated with the practice of COVID-19 PPMs. Moreover, there were evident research inequalities at the regional level, with East Africa contributing 36\% (21/58) of the studies, West Africa contributing 21\% (12/58), North Africa contributing 17\% (10/58), Southern Africa contributing 7\% (4/58), and no single-country study from Central Africa. Nonetheless, the overall quality of the included studies was generally good as they satisfied most of the quality assessment criteria. Conclusions: There is a need to enhance local capacity to produce and supply personal protective equipment. Consideration of various cognitive, demographic, and socioeconomic differences, with extra focus on the most vulnerable, is crucial for inclusive and more effective strategies against the pandemic. Moreover, more focus and involvement in community behavioral research are needed to fully understand and address the dynamics of the current pandemic in Africa. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022355101; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42022355101 ", doi="10.2196/44051", url="https://publichealth.jmir.org/2023/1/e44051", url="http://www.ncbi.nlm.nih.gov/pubmed/37058578" } @Article{info:doi/10.2196/43604, author="Williams, Cynthia and Shang, Di", title="Telehealth Usage Among Low-Income Racial and Ethnic Minority Populations During the COVID-19 Pandemic: Retrospective Observational Study", journal="J Med Internet Res", year="2023", month="May", day="12", volume="25", pages="e43604", keywords="COVID-19", keywords="telehealth", keywords="health equity", keywords="minority health", keywords="low income", keywords="healthcare access", keywords="pandemic", keywords="USA", keywords="United States", keywords="healthcare system", keywords="health care", keywords="risk", keywords="minority", keywords="database", keywords="utilization", keywords="education", abstract="Background: Despite considerable efforts to encourage telehealth use during the COVID-19 pandemic, we witnessed a potential widening of health inequities that may continue to plague the US health care system unless we mitigate modifiable risk factors. Objective: This study aimed to examine the hypothesis that there are systemic differences in telehealth usage among people who live at or below 200\% of the federal poverty level. Factors that we consider are age, gender, race, ethnicity, education, employment status, household size, and income. Methods: A retrospective observational study was performed using the COVID-19 Research Database to analyze factors contributing to telehealth inequities. The study period ranged from March 2020 to April 2021. The Office Ally database provided US claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore Consumer database is nationally representative of 242.5 million US adults aged 19 years and older. We analyzed medical claims to investigate the influence of demographic and socioeconomic factors on telehealth usage among the low-income racial and ethnic minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in diverse groups using telehealth during the study period. Results: Among 2,850,831 unique patients, nearly 60\% of them were female, 75\% of them had a high school education or less, 49\% of them were unemployed, and 62\% of them identified as non-Hispanic White. Our results suggest that 9.84\% of the patients had ?1 telehealth claims during the study period. Asian (odds ratio [OR] 1.569, 95\% CI 1.528-1.611, P<.001) and Hispanic (OR 1.612, 95\% CI 1.596-1.628, P<.001) patients were more likely to use telehealth than non-Hispanic White and -Black patients. Patients who were employed full-time were 15\% (OR 1.148, 95\% CI 1.133-1.164, P<.001) more likely to use telehealth than unemployed patients. Patients who identified as male were 12\% (OR 0.875, 95\% CI 0.867-0.883, P<.001) less likely to use telehealth than those who identified as female. Patients with high school education or less were 5\% (OR 0.953, 95\% CI 0.944-0.962, P<.001) less likely to use telehealth than those with a bachelor's degree or higher. Patients in the 18-44--year age group were 32\% (OR 1.324, 95\% CI 1.304-1.345, P<.001) more likely to use telehealth than those in the ?65-year age group. Conclusions: Factors that impact telehealth usage include age, gender, race, education, employment status, and income. While low-income racial and ethnic minority communities are at greater risk for health inequities among this group, Hispanic communities are more likely to use telehealth, and non-Hispanic Black patients continue to demonstrate telehealth inequity. Gender, age, and household income contribute to health inequities across gradients of poverty. Strategies to improve health use should consider characteristics of subgroups, as people do not experience poverty equally. ", doi="10.2196/43604", url="https://www.jmir.org/2023/1/e43604", url="http://www.ncbi.nlm.nih.gov/pubmed/37171848" } @Article{info:doi/10.2196/41487, author="Mamuye, Adane and Nigatu, Mesfin Araya and Chanyalew, Asressie Moges and Amor, Ben Lamia and Loukil, Sihem and Moyo, Chris and Quarshie, Samuel and Antypas, Konstantinos and Tilahun, Binyam", title="Facilitators and Barriers to the Sustainability of eHealth Solutions in Low- and Middle-Income Countries: Descriptive Exploratory Study", journal="JMIR Form Res", year="2023", month="May", day="12", volume="7", pages="e41487", keywords="attributes", keywords="Africa", keywords="eHealth", keywords="low- and middle-income countries", keywords="sustainability", abstract="Background: Despite the widely anticipated benefits of eHealth technologies in enhancing health care service delivery, the sustainable usage of eHealth in transitional countries remains low. There is limited evidence supporting the low sustainable adoption of eHealth in low- and middle-income countries. Objective: The aim of this study was to explore the facilitators and barriers to the sustainable use of eHealth solutions in low- and middle-income nations. Methods: A qualitative descriptive exploratory study was conducted in 4 African nations from September to December 2021. A semistructured interview guide was used to collect the data. Data were audio-recorded and transcribed from the local to the English language verbatim, and the audio data were transcribed. On the basis of the information gathered, we assigned codes to the data, searched for conceptual patterns, and created emerging themes. Data were analyzed thematically using OpenCode software. Results: A total of 49 key informant interviews (10 from Tunisia, 15 from Ethiopia, 13 from Ghana, and 11 from Malawi) were conducted. About 40.8\% (20/49) of the study participants were between the ages of 26 and 35 years; 73.5\% (36/49) of them were male participants; and 71.4\% (35/49) of them had a master's degree or higher in their educational background. Additionally, the study participants' work experience ranged from 2 to 35 years. Based on the data we gathered, we identified 5 themes: organizational, technology and technological infrastructure, human factors, economy or funding, and policy and regulations. Conclusions: This study explores potential facilitators and barriers to long-term eHealth solution implementation. Addressing barriers early in the implementation process can aid in the development of eHealth solutions that will better fulfill the demands of end users. Therefore, focusing on potential challenges would enhance the sustainability of eHealth solutions in low- and middle-income countries. ", doi="10.2196/41487", url="https://formative.jmir.org/2023/1/e41487", url="http://www.ncbi.nlm.nih.gov/pubmed/37171865" } @Article{info:doi/10.2196/45440, author="Sbaffi, Laura and Zamani, Efpraxia and Kalua, Khumbo", title="Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach", journal="J Med Internet Res", year="2023", month="May", day="11", volume="25", pages="e45440", keywords="informal caregivers", keywords="HIV/AIDS", keywords="rural Malawi", keywords="health advisory messages", keywords="mobile phone", abstract="Background: People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. Objective: This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. Methods: We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. Results: The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. Conclusions: This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers' role. ", doi="10.2196/45440", url="https://www.jmir.org/2023/1/e45440", url="http://www.ncbi.nlm.nih.gov/pubmed/37166971" } @Article{info:doi/10.2196/42606, author="Al-Janaideh, Redab and Speidel, Ruth and Colasante, Tyler and Malti, Tina", title="Evaluating a Social-Emotional Training Program for Refugee Families and Service Providers: Pilot Study", journal="JMIR Form Res", year="2023", month="May", day="5", volume="7", pages="e42606", keywords="social-emotional training", keywords="strengths-based", keywords="mental health", keywords="refugee children", keywords="refugee caregivers", keywords="service providers", abstract="Background: Refugee children are often exposed to adversities that present a threat to their healthy development. Promoting refugee children's social-emotional capacities may be an opportune, strengths-based avenue to nurture their resilience, coping strategies, and mental health outcomes amid these risks. Furthermore, supporting caregivers' and service providers' capacities to provide strengths-based care may result in more sustainable, caring environments for refugee children. However, culturally adapted initiatives that aim to promote social-emotional capacities and mental health in refugee children, caregivers, and service providers are limited. Objective: In this pilot study, we aimed to assess the feasibility and efficacy of a brief, 3-week social-emotional training program for refugee caregivers of children aged between 2 and 12 years and service providers who support refugees. This study had 3 central objectives. First, we examined whether refugee caregivers' and service providers' knowledge of core social-emotional concepts increased from pre- to posttraining, whether these increases were maintained 2 months later, and whether caregivers and service providers reported a high use of training-based strategies after the training. Second, we assessed if refugee caregivers reported any improvements in their children's social-emotional capacities and mental health from pre- to posttraining and 2 months later. Finally, we evaluated whether caregivers and service providers experienced any improvements in their own mental health symptoms from pre- to posttraining and 2 months later. Methods: A total of 50 Middle Eastern refugee caregivers of children (n=26) aged between 2 and 12 years and service providers (n=24) were recruited using convenience sampling and participated in a 3-week training program. Training sessions were delivered via a web-based learning management system and involved a combination of asynchronous (video-based) and synchronous (web-based live group) sessions. The training was evaluated using an uncontrolled pre-, post-, and 2-month follow-up design. Caregivers and service providers reported their understanding of social-emotional concepts and mental health at pre-, post-, and 2 months after training and reported their use of training strategies after training. Caregivers reported their children's social-emotional capacities and mental health through a presurvey, a series of postsurveys (after each module session and 1 week after the training), and a 2-month follow-up survey. The participants also reported their demographic information. Results: Caregivers' and service providers' knowledge of social-emotional concepts increased significantly from pre- to posttraining, and the service providers' knowledge increase was sustained at the 2-month follow-up. Both caregivers and service providers reported high levels of strategy use. Furthermore, 2 markers of children's social-emotional development (ie, emotion regulation and sadness over wrongdoing) improved after training. Conclusions: The findings highlight the potential of strengths-based, culturally adapted social-emotional initiatives to support refugee caregivers' and service providers' abilities to provide high-quality social-emotional care to refugee children. ", doi="10.2196/42606", url="https://formative.jmir.org/2023/1/e42606", url="http://www.ncbi.nlm.nih.gov/pubmed/37145855" } @Article{info:doi/10.2196/41485, author="Collin, St{\'e}phanie and Johnson, Claire and Dub{\'e}, Anik and Laforest, Marie-Eve and Lauzier, Martin and Landry, H. Michel and Cormier, Manon and Sonier-Ferguson, Brigitte", title="Addressing the Shortage of Health Professionals in Official Language Minority Communities to Strengthen Retention Strategies for the Benefit of New Brunswick Francophone and Acadian Communities: Protocol for a Mixed Methods Design", journal="JMIR Res Protoc", year="2023", month="May", day="3", volume="12", pages="e41485", keywords="human resource shortage", keywords="retention", keywords="health care professional", keywords="health care provider", keywords="shortage", keywords="health care professionals' retention", keywords="registered nurse retention", keywords="physicians' retention", keywords="retention factors", keywords="Francophone communities", keywords="linguistic minorities", keywords="rural communities", keywords="minority", keywords="minorities", keywords="language", keywords="rural", keywords="ethnic", keywords="French", keywords="Francophone", keywords="Acadian", keywords="Canada", abstract="Background: COVID-19 has highlighted already existing human resource gaps in health care systems. New Brunswick health care services are significantly weakened by a shortage of nurses and physicians, affecting regions where Official Language Minority Communities (OLMCs) reside. Since 2008, Vitalit{\'e} Health Network (the ``Network''), whose work language is French (with services delivered in both official languages, English and French), has provided health care to OLMCs in New Brunswick. The Network currently needs to fill hundreds of vacant physician and nurse positions. It is imperative to strengthen the network's retention strategies to ensure its viability and maintain adequate health care services for OLMCs. The study is a collaborative effort between the Network (our partner) and the research team to identify and implement organizational and structural strategies to upscale retention. Objective: The aim of this study is to support one of New Brunswick health networks in identifying and implementing strategies to promote physician and registered nurse retention. More precisely, it wishes to make 4 important contributions to identify (and enhance our understanding of) the factors related to the retention of physicians and nurses within the Network; determine, based on the ``Magnet Hospital'' model and the ``Making it Work'' framework, on which aspects of the Network's environment (internal or external) it should focus for its retention strategy; define clear and actionable practices to help the Network replenish its strength and vitality; and improve the quality of health care services to OLMCs. Methods: The sequential methodology combines quantitative and qualitative approaches based on a mixed methods design. For the quantitative part, data collected through the years by the Network will be used to take stock of vacant positions and examine turnover rates. These data will also help determine which areas have the most critical challenges and which ones have more successful approaches regarding retention. Recruitment will be made in those areas for the qualitative part of the study to conduct interviews and focus groups with different respondents, either currently employed or who have left it in the last 5 years. Results: This study was funded in February 2022. Active enrollment and data collection started in the spring of 2022. A total of 56 semistructured interviews were conducted with physicians and nurses. As of manuscript submission, qualitative data analysis is in progress and quantitative data collection is intended to end by February 2023. Summer and fall 2023 is the anticipated period to disseminate the results. Conclusions: Applying the ``Magnet Hospital'' model and the ``Making it Work'' framework outside urban settings will offer a novel outlook to the knowledge of professional resource shortages within OLMCs. Furthermore, this study will generate recommendations that could contribute to a more robust retention plan for physicians and registered nurses. International Registered Report Identifier (IRRID): DERR1-10.2196/41485 ", doi="10.2196/41485", url="https://www.researchprotocols.org/2023/1/e41485", url="http://www.ncbi.nlm.nih.gov/pubmed/37133908" } @Article{info:doi/10.2196/37359, author="Mwenda, Valerian and Makena, Ireen and Ogweno, Vincent and Obonyo, James and Were, Vincent", title="The Effectiveness of Interactive Text Messaging and Structured Psychosocial Support Groups on Developmental Milestones of Children From Adolescent Pregnancies in Kenya: Quasi-Experimental Study", journal="JMIR Pediatr Parent", year="2023", month="May", day="1", volume="6", pages="e37359", keywords="text messages", keywords="adolescent pregnancy", keywords="milestones", keywords="mHealth", keywords="psychosocial support", keywords="Kenya", keywords="nurturing care", abstract="Background: In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. Objective: We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers' knowledge and practices as well as infant growth and development. Methods: This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. Results: We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8\% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5\% vs 112/220, 50.9\%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4\% vs 112/220, 50.9\%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). Conclusions: An interactive text messaging platform improved adolescent mothers' knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. Trial Registration: Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse ", doi="10.2196/37359", url="https://pediatrics.jmir.org/2023/1/e37359", url="http://www.ncbi.nlm.nih.gov/pubmed/37126373" } @Article{info:doi/10.2196/41005, author="Ghosh, Arka and Cherian, J. Rithwik and Wagle, Surbhit and Sharma, Parth and Kannan, R. Karthikeyan and Bajpai, Alok and Gupta, Nitin", title="An Unguided, Computerized Cognitive Behavioral Therapy Intervention (TreadWill) in a Lower Middle-Income Country: Pragmatic Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="Apr", day="26", volume="25", pages="e41005", keywords="computerized cognitive behavioral therapy", keywords="cCBT", keywords="depression", keywords="digital intervention", keywords="mobile phone", abstract="Background: Globally, most individuals who are susceptible to depression do not receive adequate or timely treatment. Unguided computerized cognitive behavioral therapy (cCBT) has the potential to bridge this treatment gap. However, the real-world effectiveness of unguided cCBT interventions, particularly in low- and middle-income countries (LMICs), remains inconclusive. Objective: In this study, we aimed to report the design and development of a new unguided cCBT--based multicomponent intervention, TreadWill, and its pragmatic evaluation. TreadWill was designed to be fully automated, engaging, easy to use, and accessible to LMICs. Methods: To evaluate the effectiveness of TreadWill and the engagement level, we performed a double-blind, fully remote, and randomized controlled trial with 598 participants in India and analyzed the data using a completer's analysis. Results: The users who completed at least half of the modules in TreadWill showed significant reduction in depression-related (P=.04) and anxiety-related (P=.02) symptoms compared with the waitlist control. Compared with a plain-text version with the same therapeutic content, the full-featured version of TreadWill showed significantly higher engagement (P=.01). Conclusions: Our study provides a new resource and evidence for the use of unguided cCBT as a scalable intervention in LMICs. Trial Registration: ClinicalTrials.gov NCT03445598; https://clinicaltrials.gov/ct2/show/NCT03445598 ", doi="10.2196/41005", url="https://www.jmir.org/2023/1/e41005", url="http://www.ncbi.nlm.nih.gov/pubmed/37099376" } @Article{info:doi/10.2196/44720, author="McBride, Bronwyn and O'Neil, John and Nguyen, Chi Phuong and Linh, Thuy Dang and Trinh, Thi Hue and Vu, C. Nguyen and Nguyen, T. Liem", title="Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project", journal="JMIR Res Protoc", year="2023", month="Apr", day="24", volume="12", pages="e44720", keywords="mobile health", keywords="digital health", keywords="Vietnam", keywords="maternal health", keywords="maternal, newborn, and child health", keywords="MNCH, health equity, ethnic minority", keywords="maternal and child health", keywords="child health", keywords="ethnography", keywords="coronavirus", keywords="COVID-19", keywords="perinatal", keywords="antenatal", keywords="woman", keywords="mother", keywords="pregnancy", keywords="newborn", keywords="infant", keywords="baby", keywords="ethnic", keywords="ethnicity", keywords="visible minority", keywords="culture", abstract="Background: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15\% of the Vietnamese population, these disparities are significant. mMOM---a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam---was implemented from 2013-2016 with promising results. Despite mMOM's findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. Objective: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19--related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. Methods: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women's unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam's Ministry of Health for adoption and further scaling up. Results: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. Conclusions: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. International Registered Report Identifier (IRRID): PRR1-10.2196/44720 ", doi="10.2196/44720", url="https://www.researchprotocols.org/2023/1/e44720", url="http://www.ncbi.nlm.nih.gov/pubmed/37058576" } @Article{info:doi/10.2196/45771, author="Stevens-Uninsky, Maya and Barkhad, Aisha and MacDonald, Tonya and Perez, Alexander and Mbuagbaw, Lawrence", title="Decolonization in Sexual and Reproductive Health Research Methods: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2023", month="Apr", day="14", volume="12", pages="e45771", keywords="sexual and reproductive health", keywords="decolonized research", keywords="decolonized methodologies", keywords="community-centered research", keywords="indigenous research", keywords="scoping review", keywords="electronic database", keywords="colonialism", keywords="decolonization", keywords="indigenous peoples", keywords="decolonizing methodologies", keywords="decolonizing method", keywords="human sexuality, reproduction", keywords="reproductive health", keywords="Aboriginal", abstract="Background: As researchers and implementors begin to acknowledge the repercussions of institutionalized colonialism on community and individual health, the need to decolonize research has become clear. Despite this, there is neither a singular definition of decolonizing methodologies nor an overview of the shared principles and characteristics of decolonized research needed to codify this work as common practice in global health. Objective: The review will identify papers that reference principles of decolonization and identify shared characteristics between them. The aim of this scoping review is to review decolonized research methodologies through the lens of sexual health as a step in creating a shared understanding of best practices. We will further examine the tools and methods used to collect and analyze data within the included studies. Methods: The protocol for this scoping review was developed using the framework from the Joanna Briggs Institute and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). The search strategy will comprise a search of electronic databases (JSTOR, Embase, EMCare, MEDLINE [Ovid], Global Health Database, Web of Science), gray literature sources, and key studies. Titles and abstracts will be reviewed by 2 or more independent reviewers against inclusion criteria. Bibliometric details, study design, methodology, community involvement, and other indicators will be collected using a data extraction tool developed for this review. Extracted data will be analyzed using descriptive statistics and qualitative analysis of content and themes to identify common practices in decolonized methodologies within sexual health. Narrative summaries will be used to describe results in relation to the research question, and identified gaps will be discussed. Results: The initial title or abstract review of 4967 studies identified by the search strategy was completed in November 2022. In total, 1777 studies met initial inclusion criteria and were sent to a second round of title or abstract review, which was completed in January 2023. In total, 706 studies were downloaded for full-text inclusion, which is expected to be completed by April 2023. We aim to complete data extraction and analysis by May 2023 and expect to publish the findings by the end of July 2023. Conclusions: There remains a gap in the research on the meaning and application of decolonized research strategies, particularly within sexual and reproductive health. The findings of this study will contribute to a shared definition of decolonized methodologies and how they can be applied as a common practice in global health research. Applications include the development of decolonized frameworks, theoretical discourses, and methodologies. The study will inform the design and implementation of future decolonized research and evaluation strategies, particularly around sexual and reproductive health. International Registered Report Identifier (IRRID): DERR1-10.2196/45771 ", doi="10.2196/45771", url="https://www.researchprotocols.org/2023/1/e45771", url="http://www.ncbi.nlm.nih.gov/pubmed/37058333" } @Article{info:doi/10.2196/42161, author="Till, Sarina and Mkhize, Mirriam and Farao, Jaydon and Shandu, Deborah Londiwe and Muthelo, Livhuwani and Coleman, Lauren Toshka and Mbombi, Masenyani and Bopape, Mamara and Klingberg, Sonja and van Heerden, Alastair and Mothiba, Tebogo and Densmore, Melissa and Verdezoto Dias, Xavier Nervo and ", title="Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation", journal="J Med Internet Res", year="2023", month="Apr", day="7", volume="25", pages="e42161", keywords="maternal health", keywords="child health", keywords="digital health", keywords="community", keywords="scoping review", keywords="low- and middle-income countries", keywords="LMIC", keywords="technology", keywords="co-design", keywords="mobile phone", abstract="Background: Maternal and child health (MCH) is a global health concern, especially impacting low- and middle-income countries (LMIC). Digital health technologies are creating opportunities to address the social determinants of MCH by facilitating access to information and providing other forms of support throughout the maternity journey. Previous reviews in different disciplines have synthesized digital health intervention outcomes in LMIC. However, contributions in this space are scattered across publications in different disciplines and lack coherence in what digital MCH means across fields. Objective: This cross-disciplinary scoping review synthesized the existing published literature in 3 major disciplines on the use of digital health interventions for MCH in LMIC, with a particular focus on sub-Saharan Africa. Methods: We conducted a scoping review using the 6-stage framework by Arksey and O'Malley across 3 disciplines, including public health, social sciences applied to health, and human-computer interaction research in health care. We searched the following databases: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS. A stakeholder consultation was undertaken to inform and validate the review. Results: During the search, 284 peer-reviewed articles were identified. After removing 41 duplicates, 141 articles met our inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from human-computer interaction research in health care. These articles were then tagged (labeled) by 3 researchers using a custom data extraction framework to obtain the findings. First, the scope of digital MCH was found to target health education (eg, breastfeeding and child nutrition), care and follow-up of health service use (to support community health workers), maternal mental health, and nutritional and health outcomes. These interventions included mobile apps, SMS text messaging, voice messaging, web-based applications, social media, movies and videos, and wearable or sensor-based devices. Second, we highlight key challenges: little attention has been given to understanding the lived experiences of the communities; key role players (eg, fathers, grandparents, and other family members) are often excluded; and many studies are designed considering nuclear families that do not represent the family structures of the local cultures. Conclusions: Digital MCH has shown steady growth in Africa and other LMIC settings. Unfortunately, the role of the community was negligible, as these interventions often do not include communities early and inclusively enough in the design process. We highlight key opportunities and sociotechnical challenges for digital MCH in LMIC, such as more affordable mobile data; better access to smartphones and wearable technologies; and the rise of custom-developed, culturally appropriate apps that are more suited to low-literacy users. We also focus on barriers such as an overreliance on text-based communications and the difficulty of MCH research and design to inform and translate into policy. ", doi="10.2196/42161", url="https://www.jmir.org/2023/1/e42161", url="http://www.ncbi.nlm.nih.gov/pubmed/37027199" } @Article{info:doi/10.2196/43224, author="Kosowicz, Leona and Tran, Kham and Khanh, Tran Toan and Dang, Ha Thu and Pham, An Van and Ta Thi Kim, Hue and Thi Bach Duong, Hoang and Nguyen, Dong Tran and Phuong, Tuyet Anh and Le, Hieu Trong and Ta, Anh Van and Wickramasinghe, Nilmini and Schofield, Penelope and Zelcer, John and Pham Le, Tuan and Nguyen, Anh Tuan", title="Lessons for Vietnam on the Use of Digital Technologies to Support Patient-Centered Care in Low- and Middle-Income Countries in the Asia-Pacific Region: Scoping Review", journal="J Med Internet Res", year="2023", month="Apr", day="5", volume="25", pages="e43224", keywords="digital health technologies", keywords="digital health", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="patient-centered care", keywords="Vietnam", keywords="Asia-Pacific region", keywords="digital", keywords="disease", keywords="technology", keywords="database", keywords="self-management", keywords="clinical", keywords="users", abstract="Background: A rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam's health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. Objective: This study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. Methods: A scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: Of the 264 publications identified, 45 (17\%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45\%), followed by tier B (14/33, 42\%) and tier A (4/33, 12\%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users' individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. Conclusions: The use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake. ", doi="10.2196/43224", url="https://www.jmir.org/2023/1/e43224", url="http://www.ncbi.nlm.nih.gov/pubmed/37018013" } @Article{info:doi/10.2196/41269, author="Albali, Nawaf and Almudarra, Sami and Al-Farsi, Yahya and Alarifi, Abdullah and Al Wahaibi, Adil and Penttinen, Pasi", title="Comparative Performance Evaluation of the Public Health Surveillance Systems in 6 Gulf Cooperation Countries: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Apr", day="5", volume="7", pages="e41269", keywords="Gulf Cooperation Council", keywords="surveillance systems", keywords="program evaluation", keywords="performance evaluation", keywords="disease monitoring", keywords="emerging technologies", abstract="Background: Evaluating public health surveillance systems is important to ensure that events of public health importance are appropriately monitored. Evaluation studies based on the Centers for Disease Control and Prevention (CDC) guidelines have been used to appraise surveillance systems globally. Previous evaluation studies undertaken in member countries of the Gulf Cooperation Council (GCC) were limited to specific illnesses within a single nation. Objective: We aimed to evaluate public health surveillance systems in GCC countries using CDC guidelines and recommend necessary improvements to enhance these systems. Methods: The CDC guidelines were used for evaluating the surveillance systems in GCC countries. A total of 6 representatives from GCC countries were asked to rate 43 indicators across the systems' level of usefulness, simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, data quality, stability, and timeliness. Descriptive data analysis and univariate linear regression analysis were performed. Results: All surveillance systems in the GCC covered communicable diseases, and approximately two-thirds (4/6, 67\%, 95\% CI 29.9\%-90.3\%) of them covered health care--associated infections. The mean global score was 147 (SD 13.27). The United Arab Emirates scored the highest in the global score with a rating of 167 (83.5\%, 95\% CI 77.7\%-88.0\%), and Oman obtained the highest scores for usefulness, simplicity, and flexibility. Strong correlations were observed between the global score and the level of usefulness, flexibility, acceptability, representativeness, and timeliness, and a negative correlation was observed between stability and timeliness score. Disease coverage was the most substantial predictor of the GCC surveillance global score. Conclusions: GCC surveillance systems are performing optimally and have shown beneficial outcomes. GCC countries must use the lessons learned from the success of the systems of the United Arab Emirates and Oman. To maintain GCC surveillance systems so that they are viable and adaptable to future potential health risks, measures including centralized information exchange, deployment of emerging technologies, and system architecture reform are necessary. ", doi="10.2196/41269", url="https://formative.jmir.org/2023/1/e41269", url="http://www.ncbi.nlm.nih.gov/pubmed/37018033" } @Article{info:doi/10.2196/41146, author="Susanto, Tantut and Rasny, Hanny and Kurdi, Fahruddin and Yunanto, Adi Rismawan and Rahmawati, Ira", title="Management of Hypertension Using a Plant-Based Diet Among Farmers: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Apr", day="3", volume="12", pages="e41146", keywords="hypertension", keywords="farming", keywords="plant-based diet", keywords="nursing", abstract="Background: Farmers in Indonesia have a high risk for hypertension owing to their lifestyle and working environment. Diet management is a solution to reduce hypertension, and Indonesia has natural resources in the agricultural sector that could help manage hypertension. Optimizing vegetable and fruit intake in a plant-based diet (PBD) could help maintain blood pressure among farmers in Indonesia. Objective: This study aims to explore the health problem of hypertension and the characteristics of local food sources to formulate a PBD menu for treating hypertension, as well as assess the prevalence of hypertension, level of acceptability of a PBD, and associated sociodemographic factors. Further, we want to examine the effectiveness of a community-based nursing program for managing hypertension using a PBD. Methods: We will use the exploratory sequential mixed methods approach. There will be a qualitative study (phase I) in 2022 and a quantitative study (phase II) in 2023. We will analyze data using a thematic framework in phase I. In phase II, the study will involve (1) questionnaire development and validation; (2) examination of the prevalence of hypertension, the level of acceptability of a PBD, and the associated factors; and (3) a randomized controlled trial. We will recruit farmers with hypertension who meet the study criteria. Moreover, in phase II, we will invite expert nurses and nutritionists to assess the face and content validity of the questionnaire. We will use multiple logistic regression models to estimate the associated sociodemographic factors and the level of acceptability of a PBD. Furthermore, a linear generalized estimating equation will be used to estimate the parameters of a generalized linear model with a possible unmeasured correlation between observations from different time points for systolic and diastolic blood pressure. Results: A model PBD for hypertension management is expected to be developed. In 2022, we will collect information on hypertension and the characteristics of local food sources for managing hypertension, and will formulate a PBD menu to treat hypertension among farmers. In 2023, we will develop a questionnaire to assess the acceptability of a PBD to manage hypertension among farmers, the prevalence of hypertension, and the sociodemographic factors associated with hypertension among farmers. We will implement a community-based nursing program for managing hypertension using a PBD among farmers. Conclusions: The PBD model will not be readily available for other agricultural areas since validation of local food variation is required to design the menu. We expect contributions from the local government to implement the intervention as one of the policies in the management of hypertension for farmers in the agricultural plantation areas of Jember. This program may also be implemented in other agricultural countries with similar problems, so that hypertension can be optimally treated among farmers. International Registered Report Identifier (IRRID): PRR1-10.2196/41146 ", doi="10.2196/41146", url="https://www.researchprotocols.org/2023/1/e41146", url="http://www.ncbi.nlm.nih.gov/pubmed/37010908" } @Article{info:doi/10.2196/39383, author="Wittenauer, Rachel and Dolan, B. Samantha and Njoroge, Anne and Onyango, Penina and Owiso, George and Rabinowitz, Peter and Puttkammer, Nancy", title="Usability and Acceptability of Electronic Immunization Registry Data Entry Workflows From the Health Care Worker Perspective in Siaya, Kenya (Part 3): Pre-Post Study", journal="JMIR Form Res", year="2023", month="Mar", day="30", volume="7", pages="e39383", keywords="workflow", keywords="digital health", keywords="electronic immunization registry", keywords="usability", keywords="acceptability", keywords="health care worker", keywords="technology adoption", abstract="Background: Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate the challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health and the International Training and Education Center for Health Kenya implemented an EIR system in 161 immunizing clinics in Siaya County between 2018 and 2019. The successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the health care workers (HCWs) using the EIR. Objective: This study aimed to evaluate HCWs' perceptions of the usability and acceptability of multiple clinic workflows using the new EIR. Methods: We performed a mixed methods pre-post study using semistructured interviews with HCWs at 6 facilities in Siaya County, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after the implementation of 3 different workflow modifications (n=24 interviews). The baseline state was dual data entry with paper records and the EIR. We then implemented 3 workflow modifications for 1 full day each: fully paperless data entry, preparation of an appointment diary before patient visits for the day, and a combination of the 2 workflows. We compared ratings and themes across interviews after each of the 4 workflows to understand the changes in the usability and acceptability of the EIR. Results: HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow most favorably. In all workflows, HCWs' perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of data entry when using the EIR, and ease of identification of errors. Perceived barriers to the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors in saving records and missing fields, and workflow challenges such as the dual data entry burden of using paper and digital tools simultaneously. Conclusions: Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon the presence of supporting contextual clinic factors and the resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation, both for Siaya's program and for other efforts around the globe, as digital health interventions become more widely used. ", doi="10.2196/39383", url="https://formative.jmir.org/2023/1/e39383", url="http://www.ncbi.nlm.nih.gov/pubmed/36995755" } @Article{info:doi/10.2196/45389, author="Meherali, Salima and Munro, Sarah and Puinean, Giulia and Salami, Bukola and Wong, Pui-Hing Josephine and Vandermorris, Ashley and Benoit, Andrew James Russell and Flicker, Sarah and Okeke-Ihejirika, Philomina and Stroulia, Eleni and Norman, V. Wendy and Scott, D. Shannon", title="Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="22", volume="12", pages="e45389", keywords="adolescent health", keywords="health promotion", keywords="immigrants", keywords="information needs", keywords="mHealth", keywords="sexual and reproductive health", keywords="access to care", abstract="Background: Canada is one of the world's most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents' sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents' SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. Objective: The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. Methods: We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. Results: Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. Conclusions: Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. International Registered Report Identifier (IRRID): PRR1-10.2196/45389 ", doi="10.2196/45389", url="https://www.researchprotocols.org/2023/1/e45389", url="http://www.ncbi.nlm.nih.gov/pubmed/36947124" } @Article{info:doi/10.2196/44219, author="Li, Li and Nguyen, Anh Tuan and Liang, Li-Jung and Lin, Chunqing and Pham, Hong Thang and Nguyen, Thanh Ha Thi and Kha, Steven", title="Strengthening Addiction Care Continuum Through Community Consortium in Vietnam: Protocol for a Cluster-Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Mar", day="22", volume="12", pages="e44219", keywords="addiction service", keywords="community consortium", keywords="drug addiction", keywords="health care worker", keywords="health", keywords="family", keywords="Vietnam", abstract="Background: A chronic condition, drug addiction, requires long-term multipronged health care and treatment services. Community-based approaches can offer the advantages of managing integrated care along the care continuum and improving clinical outcomes. However, scant rigorous research focuses on sustainable, community-based care and service delivery. Objective: This protocol describes a study aiming to develop and test an intervention that features the alliance of community health workers and family members to provide integrated support and individualized services and treatment for people who use drugs (PWUD) in community settings. Methods: Based on the National Institute on Drug Abuse's Seek-Test-Treat-Retain (STTR) framework, an intervention that provides training to community health workers will be developed and piloted before an intervention trial. Trained community health workers will conduct home visits and provide support for PWUD and their families. The intervention trial will be conducted in 3 regions in Vietnam, with 60 communities (named communes). These communes will be randomized to either an intervention or control condition. Intervention outcomes will be evaluated at baseline and at 3, 6, 9, and 12 months. The primary outcome measure is PWUD's STTR fulfillment, consisting of multiple individual fulfillment indicators across 5 domains: Seek, Test, Treat, Retain, and Health. The secondary outcomes of interest are the community health workers' service provision and family members' support. The primary analysis will follow an intention-to-treat approach. Generalized mixed-effects regression models will be used to compare changes in the outcome measures from baseline between intervention and control conditions. Results: During the first year of the project, we conducted formative studies, including in-depth interviews and focus groups, to identify service barriers and intervention strategies. The intervention and assessment pilots are scheduled in 2023 before commencing the trial. Reports based on the baseline data will be distributed in early 2024. The intervention outcome results will be available within 6 months of the final data collection date, that is, the main study findings are expected to be available in early 2026. Conclusions: This study will inform the establishment of community health workers and family members alliance, a locally available infrastructure, to support addiction services and care for PWUD. The methodology, findings, and lessons learned are expected to shed light on the addiction service continuum's implementation and demonstrate a community-based addiction service delivery model that can be transferable to other countries. Trial Registration: ClinicalTrials.gov NCT05315492; https://clinicaltrials.gov/ct2/show/NCT05315492 International Registered Report Identifier (IRRID): DERR1-10.2196/44219 ", doi="10.2196/44219", url="https://www.researchprotocols.org/2023/1/e44219", url="http://www.ncbi.nlm.nih.gov/pubmed/36947125" } @Article{info:doi/10.2196/41190, author="Hailat, Ekhlas and Amiri, Mirwais and Debnath, Nitish and Rahman, Mahmudur and Nurul Islam, Md and Fatima, Zahida and Khader, Yousef and Al Nsour, Mohannad", title="Strengthening the One Health Approach in the Eastern Mediterranean Region", journal="Interact J Med Res", year="2023", month="Mar", day="21", volume="12", pages="e41190", keywords="One Health", keywords="operationalization", keywords="zoonosis", keywords="antimicrobial resistance, Eastern Mediterranean region countries", doi="10.2196/41190", url="https://www.i-jmr.org/2023/1/e41190", url="http://www.ncbi.nlm.nih.gov/pubmed/36943329" } @Article{info:doi/10.2196/44908, author="Isehunwa, O. Oluwaseyi and Hill, V. Samantha and Menninger, Tobias Alex and Hubner, Brook and Krakower, Douglas and Long, M. Dustin and Pratt, C. Madeline and Clement, E. Meredith and Wagoner, Van Nicholas and Lanzi, Gaines Robin and Simpson, Tina and Elopre, Latesha and Matthews, T. Lynn", title="A Multicomponent Intervention to Train and Support Family Medicine Providers to Promote Pre-exposure Prophylaxis (PrEP) for Adolescent Girls and Young Women in the Deep South: Protocol for the PrEP-Pro Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="21", volume="12", pages="e44908", keywords="pre-exposure prophylaxis (PrEP)", keywords="training", keywords="PrEP Pro intervention", keywords="family medicine trainees", keywords="adolescent girls and young women (AGYW)", keywords="family medicine", keywords="teens", keywords="young women", keywords="prevention", keywords="HIV", keywords="community", keywords="sexual health", keywords="reproductive health", abstract="Background: Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention intervention and a major strategy for reducing the HIV burden in the United States. However, PrEP provision and uptake remain lower than estimated needs, and in ways that may exacerbate HIV disparities among Black adolescent girls and young women in the southern United States. Data suggest that gaps in provider knowledge of HIV epidemiology and PrEP and skills assessing sexual health practices are important barriers to provision and uptake, with limited evidence-based interventions to address these gaps. Objective: This paper describes the ``PrEP-Pro'' intervention, a multicomponent intervention to train and support family medicine (FM) trainees to promote PrEP for adolescent girls and young women in Alabama. Methods: The PrEP-Pro intervention comprises 3 main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): (1) provider HIV epidemiology and PrEP education, (2) sexual history taking, and (3) PrEP Champions. In phase 1, we will work with community advisory boards (providers and clients) and then conduct focus groups with FM trainees to adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies, including provider-facing tools and client-facing educational materials. In phase 2, we will pretest and then pilot-test the initially adapted PrEP-Pro intervention with FM trainees. FM trainees will complete baseline, 3-, and 6-month questionnaires post PrEP-Pro intervention. We will also conduct in-depth interviews (IDIs) with FM pilot participants, adolescent girls and young women who accessed care after the PrEP-Pro pilot, and key stakeholders. The primary outcomes are PrEP-Pro acceptability and feasibility, which would be assessed using validated instruments at months 3 (among pretest participants) and 6 (among pilot participants). Secondary outcomes will also be assessed, including PrEP knowledge, sexual history-taking attitudes and practices, PrEP prescriptions among adolescent girls and young women encounters, and sexually transmitted infections (STIs) and HIV testing among adolescent girls and young women encounters in 6 months. Results: Study results will be disseminated to practices, state health officials, and other key stakeholders to solicit feedback on implementation opportunities and challenges to inform a hybrid effectiveness implementation trial. Our results will also be presented at local and national conferences and submitted to peer-reviewed journals. Conclusions: As PrEP grows, there is a pressing need to train FM providers and develop appropriate, contextually relevant tools to support PrEP implementation. The PrEP-Pro intervention is a multicomponent intervention to train FM residents across Alabama on sexual history-taking, PrEP provision for adolescent girls and young women, and supporting practice-based PrEP Champions. The PrEP-Pro intervention is anticipated to increase PrEP prescriptions for adolescent girls and young women and expand comprehensive sexual and reproductive health care for adolescent girls and young women in rural and urban Alabama. International Registered Report Identifier (IRRID): PRR1-10.2196/44908 ", doi="10.2196/44908", url="https://www.researchprotocols.org/2023/1/e44908", url="http://www.ncbi.nlm.nih.gov/pubmed/36943364" } @Article{info:doi/10.2196/43066, author="Kim, Jiyeong and Aryee, D. Lois M. and Bang, Heejung and Prajogo, Steffi and Choi, K. Yong and Hoch, S. Jeffrey and Prado, L. Elizabeth", title="Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis", journal="JMIR Ment Health", year="2023", month="Mar", day="20", volume="10", pages="e43066", keywords="digital mental health", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="low- and middle-income country", keywords="depression", keywords="anxiety", keywords="mobile phone", abstract="Background: Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80\% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. Objective: We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance. Results: Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14\% in the intervention group and n=6018, 49.85\% in the control group) and 96 studies in the systematic review. The pooled effect sizes were ?0.61 (95\% CI ?0.78 to ?0.44; n=67 comparisons) for depression and ?0.73 (95\% CI ?0.93 to ?0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high. Conclusions: Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal. Trial Registration: PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=289709 ", doi="10.2196/43066", url="https://mental.jmir.org/2023/1/e43066", url="http://www.ncbi.nlm.nih.gov/pubmed/36939820" } @Article{info:doi/10.2196/39777, author="Dolan, B. Samantha and Wittenauer, Rachel and Njoroge, Anne and Onyango, Penina and Owiso, George and Shearer, C. Jessica and Lober, B. William and Liu, Shan and Puttkammer, Nancy and Rabinowitz, Peter", title="Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows", journal="JMIR Form Res", year="2023", month="Mar", day="16", volume="7", pages="e39777", keywords="immunizations", keywords="electronic immunization registry", keywords="workflow", keywords="time and motion", keywords="digital health intervention", keywords="mixed methods evaluation", abstract="Background: Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25\% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries. Objective: We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual--data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs). Methods: We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient's total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models. Results: Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR's performance and ability to connect to the internet were particularly insightful about potential causes of delays. Conclusions: We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology. ", doi="10.2196/39777", url="https://formative.jmir.org/2023/1/e39777", url="http://www.ncbi.nlm.nih.gov/pubmed/36927606" } @Article{info:doi/10.2196/43494, author="Memon, Ali Zahid and Mian, Abeer and Reale, Sophie and Spencer, Rachael and Bhutta, Zulfiqar and Soltani, Hora", title="Community and Health Care Provider Perspectives on Barriers to and Enablers of Family Planning Use in Rural Sindh, Pakistan: Qualitative Exploratory Study", journal="JMIR Form Res", year="2023", month="Mar", day="10", volume="7", pages="e43494", keywords="gender", keywords="sexual and reproductive health", keywords="modern contraception", keywords="family planning", abstract="Background: Unmet need for family planning in Pakistan is high, with 17\% of all married women wanting to avoid or delay pregnancy. However, they cannot owing to a lack of access to modern contraception and sociocultural hindrances. With the modern contraceptive prevalence rate stagnant at approximately 25\% over the last 5 years, it is important to explore barriers and enablers to modern contraception uptake to reduce maternal and child mortality and improve reproductive health outcomes for young girls and women. Objective: A formative research approach was taken to explore community member and health care provider perspectives on access to and use of family planning methods in 2 rural districts of Sindh, Pakistan. The broader goal of this study was to provide evidence to design and implement a socioculturally appropriate family planning intervention within the existing service delivery platforms to increase modern contraceptive uptake in the context of rural Sindh. Methods: A qualitative exploratory design was used. Between October 2020 and December 2020, 11 focus group discussions and 11 in-depth interviews were conducted. Focus group discussions were held with men and women from the community, including adolescents, to build an understanding of community beliefs and concepts regarding modern contraceptive methods. In-depth interviews were conducted with health care workers and explored intersections between family planning and reproductive health service delivery at the facility and outreach levels. Results: The findings revealed that limited financial autonomy, restricted women's mobility, discriminatory gender norms, and cultural practices left women with little opportunity for independent decision-making on the use of modern contraceptive methods. Furthermore, facility-level and supply-side barriers, including frequent stock-outs of modern contraceptives combined with a lack of capacity of health workers to provide quality family planning services and counseling, played an important role in demotivating women from seeking services. In addition, a lack of integration of family planning with maternal and child health service delivery at the health system level was emphasized as a major missed opportunity for contraceptive uptake. Several demand-side barriers to family planning uptake were also highlighted. These included husbands' or in-laws' disapproval, social stigma, and perceived fear of side effects regarding modern family planning method use. More importantly, a lack of adolescent-friendly reproductive health services and spaces for counseling was identified as a critical intervention area. Conclusions: This study provides qualitative evidence on issues related to the effectiveness of family planning interventions, specifically in the context of rural Sindh. The findings emphasize the need to design socioculturally appropriate and health system--relevant family planning interventions---the effectiveness of which can be improved through their integration with maternal and child health service delivery mechanisms, consistent service provision, and opportunities for the capacity building of the health care workforce. International Registered Report Identifier (IRRID): RR2-10.2196/35291 ", doi="10.2196/43494", url="https://formative.jmir.org/2023/1/e43494", url="http://www.ncbi.nlm.nih.gov/pubmed/36897626" } @Article{info:doi/10.2196/34341, author="Lubuzo, Buhle and Hlongwana, Khumbulani and Ginindza, Themba", title="Model for Achieving a Coordinated Access to Lung Cancer Care in Selected Public Health Facilities in KwaZulu-Natal, South Africa: Protocol for a Qualitative Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="3", volume="12", pages="e34341", keywords="Africa", keywords="cancer care", keywords="cancer", keywords="coordination model", keywords="KwaZulu-Natal", keywords="lung cancer", keywords="lung", keywords="low income", keywords="middle income", keywords="LMIC", keywords="care access", keywords="care coordination", keywords="coordinated care", keywords="care model", keywords="cost", keywords="health care system", keywords="oncology", abstract="Background: Timely delivery of high-quality cancer care to all patients is barely achieved in South Africa and many other low- and middle-income countries, mainly due to poor care coordination and access to care services. After health care visits, many patients leave facilities confused about their diagnosis, prognosis, options for treatment, and the next steps in their care continuum. They often find the health care system disempowering and inaccessible, thereby making access to health care services inequitable, with the resultant outcome of increased cancer mortality rates. Objective: The aim of this study is to propose a model for cancer care coordination interventions that can be used to guide and achieve coordinated access to lung cancer care in the selected public health care facilities in KwaZulu-Natal. Methods: This study will be conducted through a grounded theory design and an activity-based costing approach that will include health care providers, patients, and their caregivers. The study participants will be purposively selected, and a nonprobability sample will be selected based on characteristics, experiences of the health care providers, and the objectives of the study. With the study's objectives in mind, communities in Durban and Pietermaritzburg were selected as study sites, for the study along with the 3 public health facilities that provide cancer diagnosis, treatment, and care in the province. The study involves a range of data collection techniques, namely, in-depth interviews, evidence synthesis reviews, and focus group discussions. A thematic and cost-benefit analysis will be used. Results: This study receives support from the Multinational Lung Cancer Control Program. The study obtained ethics approval and gatekeeper permission from the University's Ethics Committee and the KwaZulu-Natal Provincial Department of Health, as it is being conducted in health facilities in KwaZulu-Natal province. As of January 2023, we had enrolled 50 participants, both health care providers and patients. Dissemination activities will involve community and stakeholder dissemination meetings, publications in peer-reviewed journals, and presentations at regional and international conferences. Conclusions: This study will provide comprehensive data to inform and empower patients, professionals, policy architects, and related decision makers to manage and improve cancer care coordination. This unique intervention or model will address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of coordination programs to promote optimal cancer care for underserved patients. International Registered Report Identifier (IRRID): DERR1-10.2196/34341 ", doi="10.2196/34341", url="https://www.researchprotocols.org/2023/1/e34341", url="http://www.ncbi.nlm.nih.gov/pubmed/36867453" } @Article{info:doi/10.2196/40269, author="Siddiqi, Arif Danya and Ali, Feroz Rozina and Shah, Taighoon Mubarak and Dharma, Kumar Vijay and Khan, Ali Anokhi and Roy, Tapash and Chandir, Subhash", title="Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study", journal="JMIR Pediatr Parent", year="2023", month="Feb", day="17", volume="6", pages="e40269", keywords="missed opportunities for vaccination", keywords="mobile-based immunization decision support system", keywords="catch-up immunizations", abstract="Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs. Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs. Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization--recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators' understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants. Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8\% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8\% (17,378/17,961) of all immunization doses. A total of 3.2\% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology. Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs. ", doi="10.2196/40269", url="https://pediatrics.jmir.org/2023/1/e40269", url="http://www.ncbi.nlm.nih.gov/pubmed/36800221" } @Article{info:doi/10.2196/40883, author="Nguyen, Tuan Ba and Blizzard, Leigh Christopher and Palmer, Andrew and Nguyen, Tu Huu and Cong Quyet, Thang and Tran, Viet and Nelson, Mark", title="COVID-19 in Vietnam and Its Impact on Road Trauma: Retrospective Study Based on National Data", journal="Interact J Med Res", year="2023", month="Feb", day="6", volume="12", pages="e40883", keywords="COVID-19", keywords="impact", keywords="road trauma", keywords="low- and middle-income country", keywords="LMIC", keywords="mortality", keywords="pandemic", keywords="trauma", keywords="social distancing", keywords="lockdown", keywords="Vietnam", keywords="disease", keywords="policy", keywords="deaths", abstract="Background: Despite significant improvement in the last decade, road trauma remains a substantial contributor to deaths in Vietnam. The COVID-19 pandemic necessitated public health measures that had an unforeseen benefit on road trauma in high-income countries. We investigate if this reduction was also seen in a low- to middle-income country like Vietnam. Objective: Our aim was to investigate how the COVID-19 pandemic and the government policies implemented in response to it impacted road trauma fatalities in Vietnam. We also compared this impact to other government policies related to road trauma implemented in the preceding 14 years (2007-2020). Methods: COVID-19 data were extracted from the Vietnamese Ministry of Health database. Road traffic deaths from 2007 to 2021 were derived from the Vietnamese General Statistical Office. We used Stata software (version 17; StataCorp) for statistical analysis. Poisson regression modeling was used to estimate trends in road fatality rates based on annual national mortality data for the 2007-2021 period. The actual change in road traffic mortality in 2021 was compared with calculated figures to demonstrate the effect of COVID-19 on road trauma fatalities. We also compared this impact to other government policies that aimed to reduce traffic-related fatalities from 2007 to 2020. Results: Between 2007 and 2020, the number of annual road traffic deaths decreased by more than 50\%, from 15.3 to 7 per 100,000 population, resulting in an average reduction of 5.4\% per annum. We estimated that the road traffic mortality rate declined by 12.1\% (95\% CI 8.9-15.3\%) in 2021 relative to this trend. The actual number of road trauma deaths fell by 16.4\%. This reduction was largely seen from August to October 2021 when lockdown and social distancing measures were in force. Conclusions: In 2021, the road traffic--related death reduction in Vietnam was 3 times greater than the trend seen in the preceding 14 years. The public health response to the COVID-19 pandemic in Vietnam was associated with a third of this reduction. It can thus be concluded that government policies implemented to address the COVID-19 pandemic resulted in a 4.3\% decrease in road traffic deaths in 2021. This has been observed in high-income countries, but we have demonstrated this for the first time in a low- and middle-income country. ", doi="10.2196/40883", url="https://www.i-jmr.org/2023/1/e40883", url="http://www.ncbi.nlm.nih.gov/pubmed/36718815" } @Article{info:doi/10.2196/34823, author="Koech, Angela and Musitia, Muoga Peris and Mwashigadi, Mkanjala Grace and Kinshella, Woo Mai-Lei and Vidler, Marianne and Temmerman, Marleen and Craik, Rachel and von Dadelszen, Peter and Noble, Alison J. and Papageorghiou, T. Aris and ", title="Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study", journal="JMIR Hum Factors", year="2022", month="Dec", day="27", volume="9", number="4", pages="e34823", keywords="gestational age", keywords="gestation", keywords="gynecology", keywords="gynecologist", keywords="prenatal", keywords="antenatal", keywords="maternal", keywords="fetus", keywords="fetal", keywords="ultrasound", keywords="imaging", keywords="pregnancy dating", keywords="handheld", keywords="portable", keywords="trust", keywords="artificial intelligence", keywords="sub-Saharan Africa", keywords="Africa", keywords="low cost", keywords="LMIC", keywords="low income", keywords="feasibility", keywords="acceptability", keywords="AI", keywords="pregnancy", keywords="pregnant", keywords="maternity", keywords="women's health", keywords="obstetrics", keywords="obstetrician", keywords="rural", keywords="remote", keywords="remote location", keywords="misconception", keywords="eHealth", keywords="digital health", abstract="Background: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. Objective: The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. Methods: A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Results: Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. Conclusions: This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended. ", doi="10.2196/34823", url="https://humanfactors.jmir.org/2022/4/e34823", url="http://www.ncbi.nlm.nih.gov/pubmed/36574278" } @Article{info:doi/10.2196/40771, author="Du, Yumeng and Zhou, Qiru and Cheng, Weibin and Zhang, Zhang and Hoelzer, Samantha and Liang, Yizhi and Xue, Hao and Ma, Xiaochen and Sylvia, Sean and Tian, Junzhang and Tang, Weiming", title="Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study", journal="JMIR Public Health Surveill", year="2022", month="Dec", day="23", volume="8", number="12", pages="e40771", keywords="telemedicine", keywords="telehealth", keywords="rural residents", keywords="mixed methods", keywords="China", keywords="mobile phone", abstract="Background: The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking. Objective: We aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China. Methods: Our study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis. Results: A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70\% (1364/2101, 72.94\%) of the household respondents were male. Less than 1\% (14/2101, 0.67\%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95\% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95\% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support. Conclusions: This study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support. ", doi="10.2196/40771", url="https://publichealth.jmir.org/2022/12/e40771", url="http://www.ncbi.nlm.nih.gov/pubmed/36563026" } @Article{info:doi/10.2196/43318, author="Shrestha, Roman and Wickersham, A. Jeffrey and Khati, Antoine and Azwa, Iskandar and Ni, Zhao and Kamarulzaman, Adeeba and Sullivan, Sean Patrick and Jadkarim, Luzan and Eger, H. William and Gautam, Kamal and Altice, L. Frederick", title="Clinic-Integrated Mobile Health Intervention (``JomPrEP'' App) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and Multiphase Trial", journal="JMIR Res Protoc", year="2022", month="Dec", day="21", volume="11", number="12", pages="e43318", keywords="men who have sex with men", keywords="mHealth", keywords="HIV prevention", keywords="pre-exposure prophylaxis", keywords="smartphone app", keywords="Malaysia", abstract="Background: Men who have sex with men (MSM) are disproportionately affected by the HIV epidemic in Malaysia and globally. Cross-cutting prevention strategies such as mobile health (mHealth), particularly smartphone apps, hold great promise for HIV prevention efforts among Malaysian MSM, especially when linked to HIV testing and pre-exposure prophylaxis (PrEP). Objective: This study aims to adapt an existing app to create and test a clinic-integrated app (JomPrEP), a virtual platform to deliver HIV testing and PrEP services for MSM in Malaysia. Methods: The JomPrEP project involves developing and testing an app-based platform for HIV prevention among Malaysian MSM and will be conducted in 2 phases. In phase I (development phase), we will adapt an existing mHealth app (HealthMindr) to create a new clinic-integrated app called ``JomPrEP'' to deliver holistic HIV prevention services (eg, HIV testing, PrEP, support services for mental health and substance use) among MSM in Malaysia. During phase II (testing phase), we will use a type I hybrid implementation science trial design to test the efficacy of JomPrEP while gathering information on implementation factors to guide future scale-up in real-world settings. Results: As of September 2022, we have completed phase I of the proposed study. Based on a series of formative work completed during phase I, we developed a fully functional, clinic-integrated JomPrEP app, which provides a virtual platform for MSM in Malaysia to facilitate their engagement in HIV prevention in a fast and convenient manner. Based on participant feedback provided during phase I, we are currently optimizing JomPrEP and the research protocols for a large-scale efficacy trial (phase II), which will commence in January 2023. Conclusions: Scant HIV prevention resources coupled with entrenched stigma, discrimination, and criminalization of same-sex sexual behavior and substance use hamper access to HIV prevention services in Malaysia. If found efficacious, JomPrEP can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT05325476; https://clinicaltrials.gov/ct2/show/NCT05325476 International Registered Report Identifier (IRRID): DERR1-10.2196/43318 ", doi="10.2196/43318", url="https://www.researchprotocols.org/2022/12/e43318", url="http://www.ncbi.nlm.nih.gov/pubmed/36542425" } @Article{info:doi/10.2196/33624, author="Chen, Yi-Lung and Ho, Hsing-Ying", title="Comprehensive Comparisons of Family Health Between Families With One Immigrant Parent and Native Families in Taiwan: Nationwide Population-Based Cohort Study", journal="JMIR Public Health Surveill", year="2022", month="Dec", day="19", volume="8", number="12", pages="e33624", keywords="international marriage immigrant family", keywords="family health", keywords="physical health", keywords="mental health", keywords="mortality", keywords="reduced inequalities", keywords="good health and well-being", abstract="Background: Mothers and children in families with one immigrant parent have been reported to be healthier than those in native families; however, the health of the fathers in these families has rarely been discussed in literature. Objective: We aimed to comprehensively compare the health of all the family members between families with one immigrant parent (native fathers, immigrant mothers, and their children) and native families (native fathers, native mothers, and their children). Methods: We conducted a cohort study by using the Taiwan Maternal and Child Health Database to recruit live-born children and their parents from 2004 to 2016. Overall, we identified 90,670 fathers, 91,270 mothers, and 132,457 children in families with one immigrant parent and 1,666,775 fathers, 1,734,104 mothers, and 2,637,191 children in native families and followed up with them from 2004 to 2017. The outcomes comprised common physical and mental disorders, catastrophic illnesses, mortality, and child adversities and accidents. The covariates comprised the child's year of birth, parental age, low-income status, and physical or mental disorder status. Logistic regression was performed to compare the risks of the outcomes between families with one immigrant parent and native families. Results: The parents in families with one immigrant parent were more likely to be of low-income status and were older than the parents in native families. After adjusting for the covariates, fathers in families with one immigrant parent were found to have higher risks of physical and mental disorders, catastrophic illness, and mortality than fathers in native families. Conversely, mothers in families with one immigrant parent had lower risks of physical and mental disorders, catastrophic illness, and mortality than mothers in native families. Finally, the children in families with one immigrant parent generally had better physical and mental health but higher risks for leukemia, liver diseases, autism spectrum disorder, and road traffic accidents than children in native families. Conclusions: The health status of the members of families with one immigrant parent was nonhomogeneous, and the poorer general health of fathers in such families suggests health inequalities in families with one immigrant parent. ", doi="10.2196/33624", url="https://publichealth.jmir.org/2022/12/e33624", url="http://www.ncbi.nlm.nih.gov/pubmed/36534459" } @Article{info:doi/10.2196/39685, author="Sethi, Sneha and Poirier, Faye Brianna and Hedges, Joanne and Dodd, Zell and Larkins, Priscilla and Zbierski, Cindy and McDonald, P. Stephen and Jesudason, Shilpanjali and Jamieson, Lisa and ", title="Maximizing Oral Health Outcomes of Aboriginal and Torres Strait Islander People With End-stage Kidney Disease Through Culturally Secure Partnerships: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2022", month="Dec", day="16", volume="11", number="12", pages="e39685", keywords="end-stage kidney disease", keywords="Aboriginal and Torres Strait Islander health", keywords="oral health", keywords="health promotion", keywords="cultural security", keywords="health services", keywords="Indigenous health", abstract="Background: Dialysis for end-stage kidney disease (ESKD) is the leading cause of hospitalization among Aboriginal and Torres Strait Islander individuals in Australia. Poor oral health is commonly the only obstacle preventing Aboriginal and Torres Strait Islander people with ESKD in Australia from receiving kidney transplant. Objective: This study aims to improve access, provision, and delivery of culturally secure dental care for Aboriginal and Torres Strait Islander individuals with ESKD in South Australia through the following objectives: investigate the facilitators of and barriers to providing oral health care to Aboriginal and Torres Strait Islander patients with ESKD in South Australia; investigate the facilitators of and barriers to maintaining oral health among Aboriginal and Torres Strait Islander people with ESKD in South Australia; facilitate access to and completion of culturally secure dental care for Aboriginal and Torres Strait Islander individuals with ESKD and their families; provide oral health promotion training for Aboriginal health workers (AHWs) at each of the participating Aboriginal Community Controlled Health Services, with a specific emphasis on oral health needs of patients with ESKD; generate co-designed strategies to better facilitate access to and provision of culturally secure dental services for Aboriginal and Torres Strait Islander people living with ESKD; and evaluate participant progress and AHW oral health training program. Methods: This collaborative study is divided into 3 phases: exploratory phase (baseline), intervention phase (baseline), and evaluation phase (after 6 months). The exploratory phase will involve collaboration with stakeholders in different sectors to identify barriers to providing oral health care; the intervention phase will involve patient yarns, patient oral health journey mapping, clinical examinations, culturally secure dental care provision, and strategy implementation workshops; and the evaluation phase will involve 6-month follow-up clinical examinations, participant evaluations of dental care provision, and AHW evaluation of oral health training. Results: Stakeholder interviews were initiated in November 2021, and participant recruitment commenced in February 2022. The first results are expected to be submitted for publication in December 2022. Conclusions: Expected outcomes will identify the burden of oral disease experienced by Aboriginal and Torres Strait Islander people with ESKD in South Australia. Qualitative outcomes are expected to develop a deeper appreciation of the unique challenges regarding oral health for individuals with ESKD. Through stakeholder engagement, responsive strategies and policies will be co-designed to address participant-identified and stakeholder-identified challenges to ensure accessibility to culturally secure dental services for Aboriginal and Torres Strait Islander individuals with ESKD. International Registered Report Identifier (IRRID): PRR1-10.2196/39685 ", doi="10.2196/39685", url="https://www.researchprotocols.org/2022/12/e39685", url="http://www.ncbi.nlm.nih.gov/pubmed/36525292" } @Article{info:doi/10.2196/41586, author="Kikuchi, Kimiyo and Islam, Rafiqul and Sato, Yoko and Nishikitani, Mariko and Izukura, Rieko and Jahan, Nusrat and Yokota, Fumihiko and Ikeda, Subaru and Sultana, Nazneen and Nessa, Meherun and Nasir, Morshed and Ahmed, Ashir and Kato, Kiyoko and Morokuma, Seiichi and Nakashima, Naoki", title="Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study", journal="JMIR Res Protoc", year="2022", month="Dec", day="15", volume="11", number="12", pages="e41586", keywords="telehealth care", keywords="continuum of care", keywords="maternal, newborn, and child health", keywords="portable health clinic", keywords="parenting", keywords="prenatal", keywords="pediatrics", abstract="Background: Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. Objective: Our study will examine the telehealth care system's effectiveness in improving women's and infants' care uptake and detecting their health problems. Methods: A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (?16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants' health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants' health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention's effectiveness. Results: Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. Conclusions: Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women's and infants' health status. Trial Registration: ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621 International Registered Report Identifier (IRRID): DERR1-10.2196/41586 ", doi="10.2196/41586", url="https://www.researchprotocols.org/2022/12/e41586", url="http://www.ncbi.nlm.nih.gov/pubmed/36520523" } @Article{info:doi/10.2196/43741, author="Shau, Wen-Yi and Setia, Sajita and Shinde, Prakash Salil and Santoso, Handoko and Furtner, Daniel", title="Contemporary Databases in Real-world Studies Regarding the Diverse Health Care Systems of India, Thailand, and Taiwan: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="Dec", day="13", volume="11", number="12", pages="e43741", keywords="Asia", keywords="health care databases", keywords="real-world data", keywords="real-world evidence", keywords="scoping review", abstract="Background: Real-world data (RWD) related to patient health status or health care delivery can be broadly defined as data collected outside of conventional clinical trials, including those from databases, treatment and disease registries, electronic medical records, insurance claims, and information directly contributed by health care professionals or patients. RWD are used to generate real-world evidence (RWE), which is increasingly relevant to policy makers in Asia, who use RWE to support decision-making in several areas, including public health policy, regulatory health technology assessment, and reimbursement; set priorities; or inform clinical practice. Objective: To support the achievement of the benefits of RWE in Asian health care strategies and policies, we sought to identify the linked contemporary databases used in real-world studies from three representative countries---India, Thailand, and Taiwan---and explore variations in results based on these countries' economies and health care reimbursement systems by performing a systematic scoping review. Herein, we describe the protocol and preliminary findings of our scoping review. Methods: The PubMed search strategy covered 3 concepts. Concept 1 was designed to identify potential RWE and RWD studies by applying various Medical Subject Headings (MeSH) terms (``Treatment Outcome,'' ``Evidence-Based Medicine,'' ``Retrospective Studies,'' and ``Time Factors'') and related keywords (eg, ``real-world,'' ``actual life,'' and ``actual practice''). Concept 2 introduced the three countries---India, Taiwan, and Thailand. Concept 3 focused on data types, using a combination of MeSH terms (``Electronic Health Records,'' ``Insurance, Health,'' ``Registries,'' ``Databases, Pharmaceutical,'' and ``Pharmaceutical Services'') and related keywords (eg, ``electronic medical record,'' ``electronic healthcare record,'' ``EMR,'' ``EHR,'' ``administrative database,'' and ``registry''). These searches were conducted with filters for language (English) and publication date (publications in the last 5 years before the search). The retrieved articles will undergo 2 screening phases (phase 1: review of titles and abstracts; phase 2: review of full texts) to identify relevant and eligible articles for data extraction. The data to be extracted from eligible studies will include the characteristics of databases, the regions covered, and the patient populations. Results: The literature search was conducted on September 27, 2022. We retrieved 3,172,434, 1,094,125, and 672,794 articles for concepts 1, 2, and 3, respectively. After applying all 3 concepts and the language and publication date filters, 2277 articles were identified. These will be further screened to identify eligible studies. Based on phase 1 screening and our progress to date, approximately 44\% (1003/2277) of articles have undergone phase 2 screening to judge their eligibility. Around 800 studies will be used for data extraction. Conclusions: Our research will be crucial for nurturing advancement in RWD generation within Asia by identifying linked clinical RWD databases and new avenues for public-private partnerships and multiple collaborations for expanding the scope and spectrum of high-quality, robust RWE generation in Asia. International Registered Report Identifier (IRRID): DERR1-10.2196/43741 ", doi="10.2196/43741", url="https://www.researchprotocols.org/2022/12/e43741", url="http://www.ncbi.nlm.nih.gov/pubmed/36512386" } @Article{info:doi/10.2196/38045, author="Gerdts, Caitlin and Jayaweera, T. Ruvani and Motana, Relebohile and Bessenaar, Tshegofatso and Wesson, Paul", title="Incidence of and Experiences with Abortion Attempts in Soweto, South Africa: Respondent-Driven Sampling Study", journal="JMIR Public Health Surveill", year="2022", month="Dec", day="8", volume="8", number="12", pages="e38045", keywords="induced abortion", keywords="respondent-driven sampling", keywords="self-managed abortion", keywords="abortion incidence", abstract="Background: Estimation of abortion incidence, particularly in settings where most abortions occur outside of health facility settings, is critical for understanding information gaps and service delivery needs in different settings. However, the existing methods for measuring out-of-facility abortion incidence are plagued with methodological challenges. Respondent-driven sampling (RDS) may offer a methodological improvement in the estimation of abortion incidence. Objective: In this study, we tested the feasibility of using RDS to recruit participants into a study about abortion and estimated the proportion of people who ever attempted abortion as well as 1-year and 5-year incidence of abortion (both in-facility and out-of-facility settings) among women of reproductive age in Soweto, South Africa. Methods: Participants were eligible if they identified as a woman; were aged between 15 and 49 years; spoke English, Tswana, isiZulu, Sotho, or Xhosa; and lived in Soweto. Working with community partners, we identified 11 seeds who were provided with coupons to refer eligible peers to the study. Upon arrival at the study site, the recruits completed an interviewer-administered questionnaire that solicited information about demographic characteristics, social network composition, health behaviors, sexual history, pregnancy history, and experience with abortion; recruits also received 3 recruitment coupons. Recruitment was tracked using coupon numbering. We used the RDS-II estimator to estimate the population proportions of demographic characteristics and our primary outcome, the proportion of people who ever attempted abortion. Results: Between April 4, 2018, and December 17, 2018, 849 eligible participants were recruited into the study. The estimated proportion of people who ever attempted abortion was 12.1\% (95\% CI 9.7\%-14.4\%). A total of 7.1\% (95\% CI 5.4\%-8.9\%) reported a facility-based abortion, and 4.4\% (95\% CI 3.0\%-5.8\%) reported an out-of-facility abortion. Conclusions: The estimated proportion of people who ever attempted abortion of 12\% (102/849) in our study likely represents a substantial underestimation of the actual proportion of abortion attempts among this study population---representing a failure of the RDS method to generate more reliable estimates of abortion incidence in our study. We caution against the use of RDS to measure the incidence of abortion because of persistent concerns with underreporting but consider potential alternative applications of RDS with respect to the study of abortion. ", doi="10.2196/38045", url="https://publichealth.jmir.org/2022/12/e38045", url="http://www.ncbi.nlm.nih.gov/pubmed/36480253" } @Article{info:doi/10.2196/42342, author="Logie, H. Carmen and Okumu, Moses and Kortenaar, Jean-Luc and Gittings, Lesley and Khan, Naimul and Hakiza, Robert and Kibuuka Musoke, Daniel and Nakitende, Aidah and Katisi, Brenda and Kyambadde, Peter and Khan, Torsum and Lester, Richard and Mbuagbaw, Lawrence", title="Mobile Health--Supported Virtual Reality and Group Problem Management Plus: Protocol for a Cluster Randomized Trial Among Urban Refugee and Displaced Youth in Kampala, Uganda (Tushirikiane4MH, Supporting Each Other for Mental Health)", journal="JMIR Res Protoc", year="2022", month="Dec", day="8", volume="11", number="12", pages="e42342", keywords="adolescents and youth", keywords="mental health", keywords="refugee", keywords="implementation research", keywords="virtual reality", keywords="mobile health", keywords="Uganda", keywords="urban", abstract="Background: Although mental health challenges disproportionately affect people in humanitarian contexts, most refugee youth do not receive the mental health support needed. Uganda is the largest refugee-hosting nation in Africa, hosting over 1.58 million refugees in 2022, with more than 111,000 living in the city of Kampala. There is limited information about effective and feasible interventions to improve mental health outcomes and mental health literacy, and to reduce mental health stigma among urban refugee adolescents and youth in low- and middle-income countries (LMICs). Virtual reality (VR) is a promising approach to reduce stigma and improve mental health and coping, yet such interventions have not yet been tested in LMICs where most forcibly displaced people reside. Group Problem Management Plus (GPM+) is a scalable brief psychological transdiagnostic intervention for people experiencing a range of adversities, but has not been tested with adolescents and youth to date. Further, mobile health (mHealth) strategies have demonstrated promise in promoting mental health literacy. Objective: The aim of this study is to evaluate the feasibility and effectiveness of two youth-tailored mental health interventions (VR alone and VR combined with GMP+) in comparison with the standard of care in improving mental health outcomes among refugee and displaced youth aged 16-24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomized in a 1:1:1 design. Approximately 330 adolescents (110 per cluster) are enrolled and will be followed for approximately 16 weeks. Data will be collected at three time points: baseline enrollment, 8 weeks following enrollment, and 16 weeks after enrollment. Primary (depression) and secondary outcomes (mental health literacy, attitudes toward mental help--seeking, adaptive coping, mental health stigma, mental well-being, level of functioning) will be evaluated. Results: The study will be conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (\#40965; May 12, 2021), Mildmay Uganda Research Ethics Committee (MUREC-2021-41; June 24, 2021), and Uganda National Council for Science \& Technology (SS1021ES; January 1, 2022). A qualitative formative phase was conducted using focus groups and in-depth, semistructured key informant interviews to understand contextual factors influencing mental well-being among urban refugee and displaced youth. Qualitative findings will inform the VR intervention, SMS text check-in messages, and the adaptation of GPM+. Intervention development was conducted in collaboration with refugee youth peer navigators. The trial launched in June 2022 and the final follow-up survey will be conducted in November 2022. Conclusions: This study will contribute to the knowledge of youth-tailored mental health intervention strategies for urban refugee and displaced youth living in informal settlements in LMIC contexts. Findings will be shared in peer-reviewed publications, conference presentations, and with community dissemination. Trial Registration: ClinicalTrials.gov NCT05187689; https://clinicaltrials.gov/ct2/show/NCT05187689 International Registered Report Identifier (IRRID): DERR1-10.2196/42342 ", doi="10.2196/42342", url="https://www.researchprotocols.org/2022/12/e42342", url="http://www.ncbi.nlm.nih.gov/pubmed/36480274" } @Article{info:doi/10.2196/39393, author="Frej, Asmae and Cano, Mireia and Ruiz-Postigo, A. Jos{\'e} and Macharia, Paul and Phillips, Odame Richard and Amoako, Ampem Yaw and Carrion, Carme", title="Assessing the Quality of the World Health Organization's Skin NTDs App as a Training Tool in Ghana and Kenya: Protocol for a Cross-sectional Study", journal="JMIR Res Protoc", year="2022", month="Dec", day="8", volume="11", number="12", pages="e39393", keywords="Skin NTDs App", keywords="mHealth", keywords="mobile health", keywords="neglected tropical diseases", keywords="skin neglected tropical diseases", keywords="low- and middle-income countries", abstract="Background: Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, the majority of them belonging to impoverished populations in low- and middle-income countries (LMICs). Skin NTDs are a subgroup of NTDs that manifest primarily as skin lesions. The diagnosis and treatment of skin NTDs entail considerable resources, including trained personnel and financial backing. Many interventions are being launched and evaluated, particularly mobile health (mHealth) interventions, such as Skin NTDs App, a training and decision support tool offered by the World Health Organization (WHO) for frontline health workers (FHWs). As most digital health guidelines prioritize the thorough evaluation of mHealth interventions, it is essential to conduct a rigorous and validated assessment of Skin NTDs App. Objective: We aim to assess the quality of version 3 of Skin NTDs App, developed for the WHO by Universal Doctor and Netherlands Leprosy Relief as a training and decision support tool for FHWs. Methods: A cross-sectional study will be conducted in 2 LMICs: Ghana and Kenya. We will use snowball sampling recruitment to select 48 participants from the target population of all FHWs dealing with skin NTDs. The sample group of FHWs will be asked to download and use Skin NTDs App for at least 5 days before answering a web-based survey containing demographic variables and the user Mobile App Rating Scale (uMARS) questionnaire. A semistructured interview will then be conducted. Quantitative and qualitative data will be analyzed using SPSS (version 25; SPSS Inc), with statistical significance for all tests set at a 95\% CI and P?.05 considered significant. Data derived from the semistructured interviews will be clustered in themes and coded to enable analysis of various dimensions using ATLAS.ti. Results: The estimated completion date of the study is in the third quarter of 2022. The results are expected to show that Skin NTDs App version 3 has a good reported user experience, as assessed using the uMARS scale. No differences are expected to be found, except for those related to experience in dermatology and the use of mobile technology that could influence the final score. Semistructured interviews are expected to complete the results obtained on the uMARS scale. Moreover, they will be the previous step before assessing other aspects of the app, such as its efficiency and how it should be disseminated or implemented. Conclusions: This study is the first step in a qualitative and quantitative assessment of Skin NTDs App as a training and support tool for FHWs diagnosing and managing skin NTDs. Our results will serve to improve future versions of the App. International Registered Report Identifier (IRRID): PRR1-10.2196/39393 ", doi="10.2196/39393", url="https://www.researchprotocols.org/2022/12/e39393", url="http://www.ncbi.nlm.nih.gov/pubmed/36480252" } @Article{info:doi/10.2196/36328, author="Zaccone, Sophie and Jamieson, Graham and Murray, V. Clara and Lock, J. Mark and Doyle, David", title="Recasting Jung Through an Indigenist Approach to Deepen Shared Knowledges of Well-being and Healing on Australian Soils: Protocol for a Qualitative Landscape Research Study", journal="JMIR Res Protoc", year="2022", month="Dec", day="8", volume="11", number="12", pages="e36328", keywords="Jungian psychology", keywords="participatory research", keywords="participatory action research", keywords="co-design", keywords="marginalized", keywords="Indigenous", keywords="landscape research", keywords="qualitative research", keywords="qualitative methodology", keywords="user need", keywords="community need", keywords="relational study", keywords="ritual", keywords="Indigenist approach", keywords="First Nation", keywords="shared knowledge", keywords="knowledge sharing", keywords="well-being", keywords="healing", keywords="Australia", abstract="Background: The colonization of Australia is responsible for complex layers of trauma for the First Nations peoples of the continent. First Nations Australians' well-being is irrevocably tied to the well-being of the land. The application of a landscape-based approach to collaborative research shows promise in enabling genuine relationships that yield rich and informative data. However, there is a lack of practical evidence in the field of landscape research---research tied to First Nations Australians' worldviews of landscape. Objective: This study aims to deepen shared knowledges of well-being and healing on Australian soils. We aim to examine ritual co-design as a novel method for deepening these shared knowledges. Methods: This research comprises a qualitative and participatory action research design operationalized through an Indigenist approach. It is a 2-phase project that is co-designed with First Nations Australians. Phase 1 of this project is a relational study that endeavors to deepen the theory underpinning the project, alongside the development of meaningful and reciprocal community connections. Phase 2 is a series of 3 participatory action research cycles to co-design a new communal ritual. This process seeks to privilege First Nations Australians' voices and ways of knowing, which are themselves communal, ritual, and symbolic. The framework developed by psychiatrist Carl Jung informs the psychological nature of the enquiry. An Indigenist approach to landscape research recasts the Jungian frame to enable a culturally safe, context-specific, and landscape-based method of qualitative research. Results: The research is in the preliminary stages of participant recruitment. It is expected that data collection will commence in late 2022. Conclusions: It is expected that this qualitative and co-designed project will strengthen the cross-cultural co-designer relationships and that the data gathered from these relationships, and the accompanying practical outcomes, will provide new insight into the interaction between human and landscape well-being. The field of landscape research is in an embryonic phase. This new field is embedded in the understanding that First Nations Australians' well-being is irrevocably tied to the well-being of the land, and this study seeks to build on this evidence base. A strength of this research is the relational methodology, in which First Nations Peoples' needs and desires will inform future research directions. It is limited by its context specific nature; however, it is expected that findings will be usable in guiding future research directions in the multidisciplinary field of landscape research. International Registered Report Identifier (IRRID): PRR1-10.2196/36328 ", doi="10.2196/36328", url="https://www.researchprotocols.org/2022/12/e36328", url="http://www.ncbi.nlm.nih.gov/pubmed/36480249" } @Article{info:doi/10.2196/36174, author="Akinsulore, Adesanmi and Aloba, Olutayo and Oginni, Olakunle and Oloniniyi, Ibidunni and Ibigbami, Olanrewaju and Seun-Fadipe, Tobi Champion and Opakunle, Tolulope and Owojuyigbe, Muyiwa Afolabi and Olibamoyo, Olushola and Mapayi, Boladale and Okorie, Ogbonnaya Victor and Adewuya, Olugbenga Abiodun", title="Developing an mHealth Intervention to Reduce COVID-19--Associated Psychological Distress Among Health Care Workers in Nigeria: Protocol for a Design and Feasibility Study", journal="JMIR Res Protoc", year="2022", month="Nov", day="16", volume="11", number="11", pages="e36174", keywords="COVID-19", keywords="psychological distress", keywords="Nigeria", keywords="health care workers", keywords="mental health", keywords="well-being", keywords="pandemic", keywords="mHealth", keywords="mobile health", keywords="digital health intervention", keywords="health intervention", keywords="health care", keywords="smartphone", keywords="mobile phone", abstract="Background: Globally, COVID-19--related psychological distress is seriously eroding health care workers' mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19--related psychological distress among health care workers in Nigeria. Objective: Our objective is to present a study protocol to determine the level of COVID-19--related psychological distress among health care workers in Nigeria; explore health care workers' experience of COVID-19--related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction). Methods: A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention. Results: This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021. Conclusions: This is the first study to report the development of an mHealth-based intervention to reduce COVID-19--related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19--related psychological distress among health care workers in Nigeria. International Registered Report Identifier (IRRID): DERR1-10.2196/36174 ", doi="10.2196/36174", url="https://www.researchprotocols.org/2022/11/e36174", url="http://www.ncbi.nlm.nih.gov/pubmed/36318638" } @Article{info:doi/10.2196/39225, author="LaMonica, M. Haley and Crouse, J. Jacob and Song, C. Yun J. and Alam, Mafruha and Ekambareshwar, Mahalakshmi and Loblay, Victoria and Yoon, Adam and Cha, Grace and Wilson, Chloe and Sweeney-Nash, Madelaine and Foo, Nathanael and Teo, Melissa and Perhirin, Mikael and Troy, Jakelin and Hickie, B. Ian", title="Developing a Parenting App to Support Young Children's Socioemotional and Cognitive Development in Culturally Diverse Low- and Middle-Income Countries: Protocol for a Co-design Study", journal="JMIR Res Protoc", year="2022", month="Oct", day="31", volume="11", number="10", pages="e39225", keywords="child development", keywords="digital technology", keywords="global health", keywords="co-design", keywords="participatory research", keywords="stakeholder participation", keywords="mobile app", abstract="Background: Digital technologies are widely recognized for their equalizing effect, improving access to affordable health care regardless of gender, ethnicity, socioeconomic status, or geographic region. The Thrive by Five app is designed to promote positive interactions between children and their parents, extended family, and trusted members of the community to support socioemotional and cognitive development in the first 5 years of life and to strengthen connections to culture and community. Objective: This paper aims to describe the iterative co-design process that underpins the development and refinement of Thrive by Five's features, functions, and content. Minderoo Foundation commissioned this work as a quality improvement activity to support an engaging user experience and inform the development of culturally appropriate and relevant content for parents and caregivers in each country where the app is implemented. Methods: The app content, referred to as Collective Actions, comprises ``The Why,'' that presents scientific principles that underpin socioemotional and cognitive development in early childhood. The scientific information is coupled with childrearing activities for parents, extended family, and members of the community to engage in with the children to support their healthy development and to promote positive connections between parents, families, and communities and these young children. Importantly, the initial content is designed and iteratively refined in collaboration with a subject matter expert group from each country (ie, alpha testing). This content is then configured into the app (either a beta version or localized version) for testing (ie, beta testing) by local parents and caregivers as well as experts who are invited to provide their feedback and suggestions for improvements in app content, features, and functions via a brief web-based survey and a series of co-design workshops. The quantitative survey data will be analyzed using descriptive statistics, whereas the analysis of qualitative data from the workshops will follow established thematic techniques. Results: To date, the co-design protocol has been completed with subject matter experts, parents, and caregivers from 9 countries, with the first results expected to be published by early 2023. The protocol will be implemented serially in the remaining 21 countries. Conclusions: Mobile technologies are the primary means of internet connection in many countries worldwide, which underscores the potential for mobile health programs to improve access to valuable, evidence-based, and previously unavailable parenting information. However, for maximum impact, it is critically important to ensure that mobile health programs are designed in collaboration with the target audience to support the alignment of content with parents' cultural values and traditions and its relevance to their needs and circumstances. International Registered Report Identifier (IRRID): DERR1-10.2196/39225 ", doi="10.2196/39225", url="https://www.researchprotocols.org/2022/10/e39225", url="http://www.ncbi.nlm.nih.gov/pubmed/36315237" } @Article{info:doi/10.2196/42554, author="Hu, Lu and Islam, Nadia and Zhang, Yiyang and Shi, Yun and Li, Huilin and Wang, Chan and Sevick, Ann Mary", title="Leveraging Social Media to Increase Access to an Evidence-Based Diabetes Intervention Among Low-Income Chinese Immigrants: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Oct", day="28", volume="11", number="10", pages="e42554", keywords="diabetes", keywords="health equity", keywords="immigrant health", keywords="mobile health", keywords="social media", keywords="messaging app", keywords="health education", keywords="education video", keywords="diabetes education", keywords="self-management", abstract="Background: Type 2 diabetes (T2D) in Chinese Americans is a rising public health concern for the US health care system. The majority of Chinese Americans with T2D are foreign-born older immigrants and report limited English proficiency and health literacy. Multiple social determinants of health limit access to evidence-based diabetes interventions for underserved Chinese immigrants. A social media--based diabetes intervention may be feasible to reach this community. Objective: The purpose of the Chinese American Research and Education (CARE) study was to examine the potential efficacy of a social media--based intervention on glycemic control in Chinese Americans with T2D. Additionally, the study aimed to explore the potential effects of the intervention on psychosocial and behavioral factors involved in successful T2D management. In this report, we describe the design and protocol of the CARE trial. Methods: CARE was a pilot randomized controlled trial (RCT; n=60) of a 3-month intervention. Participants were randomized to one of two arms (n=30 each): wait-list control or CARE intervention. Each week, CARE intervention participants received two culturally and linguistically tailored diabetes self-management videos for a total of 12 weeks. Video links were delivered to participants via WeChat, a free and popular social media app among Chinese immigrants. In addition, CARE intervention participants received biweekly phone calls from the study's community health workers to set goals related to T2D self-management and work on addressing goal-achievement barriers. Hemoglobin A1c (HbA1c), self-efficacy, diabetes self-management behaviors, dietary intake, and physical activity were measured at baseline, 3 months, and 6 months. Piecewise linear mixed-effects modeling will be performed to examine intergroup differences in HbA1c and psychosocial and behavioral outcomes. Results: This pilot RCT study was approved by the Institutional Review Board at NYU Grossman School of Medicine in March 2021. The first participant was enrolled in March 2021, and the recruitment goal (n=60) was met in March 2022. All data collection is expected to conclude by November 2022, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. Conclusions: This study will serve as an important first step in exploring scalable interventions to increase access to evidence-based diabetes interventions among underserved, low-income, immigrant populations. This has significant implications for chronic care in other high-risk immigrant groups, such as low-income Hispanic immigrants, who also bear a high T2D burden, face similar barriers to accessing diabetes programs, and report frequent social media use (eg, WhatsApp). Trial Registration: ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697 International Registered Report Identifier (IRRID): DERR1-10.2196/42554 ", doi="10.2196/42554", url="https://www.researchprotocols.org/2022/10/e42554", url="http://www.ncbi.nlm.nih.gov/pubmed/36306161" } @Article{info:doi/10.2196/40066, author="Leidman, Eva and Jatoi, Ali Muhammad and Bollemeijer, Iris and Majer, Jennifer and Doocy, Shannon", title="Accuracy of Fully Automated 3D Imaging System for Child Anthropometry in a Low-Resource Setting: Effectiveness Evaluation in Malakal, South Sudan", journal="JMIR Biomed Eng", year="2022", month="Oct", day="21", volume="7", number="2", pages="e40066", keywords="mobile health", keywords="mHealth", keywords="child nutrition", keywords="anthropometry", keywords="3D imaging", keywords="imaging", keywords="accuracy", keywords="measurement", keywords="child stature", keywords="software", keywords="algorithm", keywords="automated", keywords="device", keywords="child health", keywords="pediatric health", keywords="height", keywords="length", keywords="arm circumference", abstract="Background: Adoption of 3D imaging systems in humanitarian settings requires accuracy comparable with manual measurement notwithstanding additional constraints associated with austere settings. Objective: This study aimed to evaluate the accuracy of child stature and mid--upper arm circumference (MUAC) measurements produced by the AutoAnthro 3D imaging system (third generation) developed by Body Surface Translations Inc. Methods: A study of device accuracy was embedded within a 2-stage cluster survey at the Malakal Protection of Civilians site in South Sudan conducted between September 2021 and October 2021. All children aged 6 to 59 months within selected households were eligible. For each child, manual measurements were obtained by 2 anthropometrists following the protocol used in the 2006 World Health Organization Child Growth Standards study. Scans were then captured by a different enumerator using a Samsung Galaxy 8 phone loaded with a custom software, AutoAnthro, and an Intel RealSense 3D scanner. The scans were processed using a fully automated algorithm. A multivariate logistic regression model was fit to evaluate the adjusted odds of achieving a successful scan. The accuracy of the measurements was visually assessed using Bland-Altman plots and quantified using average bias, limits of agreement (LoAs), and the 95\% precision interval for individual differences. Key informant interviews were conducted remotely with survey enumerators and Body Surface Translations Inc developers to understand challenges in beta testing, training, data acquisition and transmission. Results: Manual measurements were obtained for 539 eligible children, and scan-derived measurements were successfully processed for 234 (43.4\%) of them. Caregivers of at least 10.4\% (56/539) of the children refused consent for scan capture; additional scans were unsuccessfully transmitted to the server. Neither the demographic characteristics of the children (age and sex), stature, nor MUAC were associated with availability of scan-derived measurements; team was significantly associated (P<.001). The average bias of scan-derived measurements in cm was ?0.5 (95\% CI ?2.0 to 1.0) for stature and 0.7 (95\% CI 0.4-1.0) for MUAC. For stature, the 95\% LoA was ?23.9 cm to 22.9 cm. For MUAC, the 95\% LoA was ?4.0 cm to 5.4 cm. All accuracy metrics varied considerably by team. The COVID-19 pandemic--related physical distancing and travel policies limited testing to validate the device algorithm and prevented developers from conducting in-person training and field oversight, negatively affecting the quality of scan capture, processing, and transmission. Conclusions: Scan-derived measurements were not sufficiently accurate for the widespread adoption of the current technology. Although the software shows promise, further investments in the software algorithms are needed to address issues with scan transmission and extreme field contexts as well as to enable improved field supervision. Differences in accuracy by team provide evidence that investment in training may also improve performance. ", doi="10.2196/40066", url="https://biomedeng.jmir.org/2022/2/e40066" } @Article{info:doi/10.2196/40381, author="Timothy, Roberta and Chin-see, Ainsley Robert and Martyniuk, Julia and Djiadeu, Pascal", title="The National and Global Impact of Systemic and Structural Violence on the Effective Prevention, Treatment, and Management of COVID-19 in African or Black Communities: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="Oct", day="17", volume="11", number="10", pages="e40381", keywords="African", keywords="Black people", keywords="COVID-19", keywords="systemic and structural barriers", keywords="health disparities", keywords="minority health", keywords="racism", keywords="racial health inequity", keywords="structural violence", keywords="anti-Black racism", keywords="decolonizing", keywords="resistance", keywords="social justice", abstract="Background: As COVID-19 ravages the globe and cases increase rapidly, countries are presented with challenging policy choices to contain and mitigate its spread. In Canada and globally, the COVID-19 pandemic has added a new stratum to the debate concerning the root causes of global and racial health inequities and disparities. Individuals who exist as targets of systemic inequities are not only more susceptible to contracting COVID-19, but also more likely to bear the greatest social, economic, and physical burdens. Therefore, data collection that focuses on the impact of COVID-19 on the lives and health of African/Black communities worldwide is needed to develop intersectional, culturally relative, antiracist/antioppression, and empowerment-centered interventions and social policies for supporting affected communities. Objective: The primary objective of this review is to investigate the impact and management of COVID-19 among African/Black individuals and communities, and understand how anti-Black racism and intersectional violence impact the health of African/Black communities during the pandemic. Moreover, the study aims to explore research pertaining to the impact of COVID-19 on Black communities in the global context. We seek to determine how Black communities are impacted with regard to structural violence, systematic racism, and health outcomes, and the ways in which attempts have been made to mitigate or manage the consequences of the pandemic and other injurious agents. Methods: A systematic search of quantitative and qualitative studies published on COVID-19 will be conducted in MEDLINE (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (EBSCO), Cochrane Library, PsychInfo (Ovid), CAB Abstracts (Ovid), Scopus (Elsevier), Web of Science (Clarivate), and Global Index Medicus. To be included in the review, studies should present data on COVID-19 in relation to African/Black individuals, populations, and communities in the global sphere. Studies must discuss racism, oppression, antioppression, or systemic and structural violence and be published in English, French, Spanish, or Portuguese. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, the findings will be synthesized quantitatively and qualitatively through thematic analysis. The risk of bias will not be assessed. Results: Title, abstract, and full-text screening concluded in June 2022. Data collection is in progress and is expected to be completed by December 2022. Data analysis and drafting of the manuscript will be done thereafter. Findings from the scoping review are expected to be provided for peer review in 2023. Conclusions: This review will collect important data and evidence related to COVID-19 in African/Black communities. The findings could help identify existing gaps in COVID-19 management in African/Black communities and inform future research paradigms. Furthermore, the findings could be applied to decision-making for health policy and promotion, and could potentially influence services provided by health care facilities and community organizations around the globe. International Registered Report Identifier (IRRID): DERR1-10.2196/40381 ", doi="10.2196/40381", url="https://www.researchprotocols.org/2022/10/e40381", url="http://www.ncbi.nlm.nih.gov/pubmed/36219749" } @Article{info:doi/10.2196/36260, author="Benda, C. Natalie and Zawtha, Sakie and Anderson, Kyrie and Sharma, Manoj Mohit and Lin, Be Phoe and Zawtha, Beichotha and Masterson Creber, Ruth", title="Developing Population Health Surveillance Using mHealth in Low-Resource Settings: Qualitative Assessment and Pilot Evaluation", journal="JMIR Form Res", year="2022", month="Oct", day="14", volume="6", number="10", pages="e36260", keywords="mobile health", keywords="mHealth", keywords="low- and middle-income countries", keywords="population health surveillance", keywords="user-centered design", keywords="mobile phone", abstract="Background: Population surveillance data are essential for understanding population needs and evaluating health programs. Governmental and nongovernmental organizations in western Myanmar did not previous have means for conducting robust, electronic population health surveillance. Objective: This study involved developing mobile health (mHealth)--based population health surveillance in a rural, low-resource setting with minimal cellular infrastructure in western Myanmar. This was an early formative study in which our goal was to establish the initial feasibility of conducting mHealth population health surveillance, optimizing procedures, and building capacity for future work. Methods: We used an iterative design process to develop mHealth-based population health surveillance focused on general demographics (eg, total census, age category, sex, births, and deaths). Interviews were conducted with international consultants (nurse midwives) and local clinicians (nurses and physicians) in Myanmar. Our analytic approach was informed by the Systems Engineering Initiative for Patient Safety work systems model to capture the multilevel user needs for developing health interventions, which was used to create a prototype data collection tool. The prototype was then pilot-tested in 33 villages to establish an initial proof of concept. Results: We conducted 7 interviews with 5 participants who provided feedback regarding the domains of the work system, including environmental, organizational, sociocultural, technological, informational, and task- and people-based considerations, for adapting an mHealth tool. Environmental considerations included managing limited electricity and internet service. Organizational needs involved developing agreements to work within existing government infrastructure as well as leveraging the communal nature of societies to describe the importance of surveillance data collection and gain buy-in. Linguistic diversity and lack of experience with technology were both cited as people- and technology-based aspects to inform prototype design. The use of mobile tools was also viewed as a means to improve the quality of the data collected and as a feasible option for working in settings with limited internet access. Following the prototype design based on the findings of initial interviews, the mHealth tool was piloted in 33 villages, allowing our team to collect census data from 11,945 people for an initial proof of concept. We also detected areas of potentially missing data, which will need to be further investigated and mitigated in future studies. Conclusions: Previous studies have not focused heavily on the early stages of developing population health surveillance capacity in low- and middle-income countries. Findings related to key design considerations using a work systems lens may be informative to others developing technology-based solutions in extremely low-resource settings. Future work will involve collecting additional health-related data and further evaluating the quality of the data collected. Our team established an initial proof of concept for using an mHealth tool to collect census-related information in a low-resource, extremely rural, and low-literacy environment. ", doi="10.2196/36260", url="https://formative.jmir.org/2022/10/e36260", url="http://www.ncbi.nlm.nih.gov/pubmed/36239997" } @Article{info:doi/10.2196/35176, author="Koumamba, Patrice Aim{\'e} and Ngoungou, Brice Edgard and Engohang-Ndong, Jean and Ibinga, Euloge and Ondzigue Mbenga, Raymond and Diallo, Gayo", title="From Real-world Individuals' Data to National Health Indicators: Multiphase Pilot Study in Gabon", journal="JMIR Form Res", year="2022", month="Oct", day="7", volume="6", number="10", pages="e35176", keywords="health data quality", keywords="decision support information system", keywords="low- and middle-income countries", keywords="LMICs", keywords="mobile phone", abstract="Background: Achieving health goals requires informed decision-making supported by transparent, reliable, and relevant health information. This helps decision makers, such as health managers, to better understand the functioning of their health system and improve their ability to respond quickly to health demands. To achieve this, the health system needs to be supported by a digitized decision-making information system. In Sub-Saharan African countries, inadequate digital infrastructure, including limited internet connectivity and insufficient access to appropriate computer software, makes it difficult to collect, process, and analyze data for health statistics. The processing of data is done manually in this case; however, this situation affects the quality of the health statistics produced and compromises the quality of health intervention choices in these countries. Objective: This study aimed to describe the conceptual approach of a data production and dissemination platform model proposed and implemented in Gabon. More precisely, it aimed to present the approach applied for the multidimensional analysis of the data production and dissemination process in the existing information system and present the results of an evaluation of the proposed model implemented in a real context. Methods: The research was carried out in 3 phases. First, a platform was designed and developed based on the examination of the various data production and indicator generation procedures. Then, the platform was implemented in chosen health facilities in Gabon. Finally, a platform evaluation was carried out with actual end users. Results: A total of 14 users with 12 years of average experience in health data management were interviewed. The results show that the use of the proposed model significantly improved the completeness, timeliness, and accuracy of data compared with the traditional system (93\% vs 12\%, P<.001; 96\% vs 18\%, P<.001; and 100\% vs 18\%, P<.001; respectively). Conclusions: The proposed model contributes significantly to the improvement of health data quality in Gabon. ", doi="10.2196/35176", url="https://formative.jmir.org/2022/10/e35176", url="http://www.ncbi.nlm.nih.gov/pubmed/36206045" } @Article{info:doi/10.2196/36077, author="Mohd Hisham, Faiz Muhammad and Ahmad, Haryati Fazila and Mohamed Haris, Hasmah and Lodz, Aliza Noor and Yoep, Norzawati and Muhammad, Nurhadzira Eida and Ali, Rafidah and Muhamad, Asiah Nor", title="Soil-Transmitted Helminth Infection in Malaysia: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="Oct", day="5", volume="11", number="10", pages="e36077", keywords="STH", keywords="soil-transmitted helminth", keywords="PRISMA-ScR", keywords="Malaysia", keywords="helminth", keywords="tropical disease", abstract="Background: Soil-transmitted helminth (STH) infection is 1 of the 20 notable neglected tropical diseases according to the Centers for Disease Control and Prevention and World Health Organization. In 2010, it is estimated that 1.73 billion people are infected with STH globally, of which 70\% of cases occur in Asia. To date, there is a dearth of published literature on the prevalence of STH infection throughout Malaysia. Objective: The objectives of this study are to review research activity on STH infection in Malaysia, to estimate the prevalence of STH infection among Malaysians, and to identify significant risk factors associated with the infection. This review aims to provide the current state of evidence pertaining to STH infections, focusing on the main areas, limitations, and biases of research and mapping out the morbidity distribution of the diseases and their causative agents, and to identify significant risk factors for preventive measures. Methods: We will conduct a scoping review based on the 6-stage structured framework developed by Arksey and O'Malley. A comprehensive search strategy focusing on STH infection will be executed using electronic databases (Scopus, PubMed, Web of Science, and Embase). A systematic approach for searching, screening, reviewing, and data extraction will be applied based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Mendeley software and Microsoft Excel will be used to manage the references and to remove duplicates. Relevant data from selected articles will be extracted using a standardized data extraction form. Results: A total of 164 potential manuscripts were retrieved. Data extraction is currently in progress and completion is expected by the end of 2022. Conclusions: Our scoping review will summarize the current state of research in this field and provide comprehensive information regarding STH infections in Malaysia for future reference. Trial Registration: National Medical Research Register NMRR-20-2889-54348; https://nmrr.gov.my/research-directory/e52ea778-d31c-4eb4-9163-a45bb3680bbf International Registered Report Identifier (IRRID): DERR1-10.2196/36077 ", doi="10.2196/36077", url="https://www.researchprotocols.org/2022/10/e36077", url="http://www.ncbi.nlm.nih.gov/pubmed/36197715" } @Article{info:doi/10.2196/37364, author="Benjamin, Fatiema and Adebiyi, O. Babatope and Rich, Edna and Roman, Vanessa Nicolette", title="Developing an Anxiety Screening Tool for Children in South Africa: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2022", month="Sep", day="27", volume="11", number="9", pages="e37364", keywords="South Africa", keywords="mental health", keywords="anxiety", keywords="anxiety screening tool", keywords="screening", keywords="assessment", keywords="early childhood development", keywords="child", keywords="parent", keywords="primary caregiver", keywords="teacher", keywords="preschool", keywords="foundation phase", keywords="children", keywords="school", keywords="youth", keywords="development", keywords="perception", abstract="Background: Early childhood experiences such as trauma, exposure to violence, and poverty can significantly contribute to childhood anxiety, which is viewed as the most common mental health issue among children. In South Africa, there is no uniform tool to screen for anxiety during early childhood. This study aims to develop a tool to screen for anxiety in children aged 4 to 8 years, which could be utilized by preschool and foundation phase teachers to aid in the early identification of childhood anxiety. Objective: The overall objective of this study is to explore understanding and perceptions of childhood anxiety among teachers, parents, and experts and to develop a tool to screen for anxiety in children aged 4 to 8 years. Methods: This project will use a mixed method design that will consist of 4 stages. Stage 1 will consist of a scoping review. In Stage 2, data will be collected via semistructured interviews with 60 participants, including parents, teachers, and experts, and will be thematically analyzed. Stage 3 will consist of 20 experts and the researcher collaboratively formulating the proposed screening tool in the form of an e-Delphi component. Once the tool is refined, it will be piloted in Stage 4 with 20 teachers, and data will be analyzed with the Shapiro-Wilk test to test for normality. Additionally, factor analysis will be done to refine and restructure the tool as necessary. Results: This project was funded from April 2020 to December 2021. Data collection began in September 2022 and is projected to conclude in December 2022 for the qualitative component. The e-Delphi component is expected to be carried out from March to November 2023. Ethical approval was obtained from the Biomedical Research Ethics Committee in November 2021. Conclusions: Anxiety in early childhood has been linked to various repercussions in adolescence and adulthood, such as school dropout, substance abuse, anxiety disorders, depression, and suicide ideation. Therefore, identifying the presence of anxiety earlier on and providing the necessary referral services could aid in reducing the negative consequences of unidentified and untreated anxiety in early childhood. International Registered Report Identifier (IRRID): PRR1-10.2196/37364 ", doi="10.2196/37364", url="https://www.researchprotocols.org/2022/9/e37364", url="http://www.ncbi.nlm.nih.gov/pubmed/36166280" } @Article{info:doi/10.2196/36403, author="Baker, Kevin and Aide, Pedro and Bonnington, A. Craig and Rassi, Christian and Richardson, Sol and Roca-Feltrer, Arantxa and Rodrigues, Maria and Sitoe, Mercia and Pulido Tarquino, Alejandro Ivan and Enosse, Sonia and McGugan, Caitlin and de Carvalho, Amelia Eva and Saute, Francisco and Mayor Aparicio, Gabriel Alfredo and Candrinho, Baltazar", title="Feasibility, Acceptability, and Protective Efficacy of Seasonal Malaria Chemoprevention Implementation in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study", journal="JMIR Res Protoc", year="2022", month="Sep", day="23", volume="11", number="9", pages="e36403", keywords="malaria", keywords="chemoprevention", keywords="children", keywords="protocol", keywords="Nampula", keywords="Mozambique", keywords="feasibility", keywords="effectiveness", keywords="mixed methods", keywords="SMC", keywords="SP+AQ", keywords="hybrid effectiveness", keywords="cRCT", abstract="Background: Seasonal malaria chemoprevention (SMC) is a highly effective community-based intervention to prevent malaria infections in areas where the malaria burden is high and transmission occurs mainly during the rainy season. In Africa, so far, SMC has been implemented in the Sahel region. Mozambique contributes 4\% of the global malaria cases, and malaria is responsible for one-quarter of all deaths in the country. Based on recommendations in the Malaria Strategic Plan, the Malaria Consortium, in partnership with the National Malaria Control Programme in Mozambique, initiated a phased SMC implementation study in the northern province of Nampula. The first phase of this 2-year implementation study was conducted in 2020-2021 and focused on the feasibility and acceptability of SMC. The second phase will focus on demonstrating impact. This paper describes phase 2 of the implementation study. Objective: Specific objectives include the following: (1) to determine the effectiveness of SMC in terms of its reduction in incidence of malaria infection among children aged 3 to 59 months; (2) to determine the chemoprevention efficacy of sulfadoxine-pyrimethamine plus amodiaquine (SP+AQ) when used for SMC in Nampula Province, Mozambique, and the extent to which efficacy is impacted by drug resistance and drug concentrations; (3) to investigate the presence and change in SP+AQ-- and piperaquine-resistance markers over time as a result of SMC implementation; and (4) to understand the impact of the SMC implementation model, determining the process and acceptability outcomes for the intervention. Methods: This type 2, hybrid, effectiveness-implementation study uses a convergent mixed methods approach. SMC will be implemented in four monthly cycles between December 2021 and March 2022 in four districts of Nampula Province. Phase 2 will include four components: (1) a cluster randomized controlled trial to establish confirmed malaria cases, (2) a prospective cohort to determine the chemoprevention efficacy of the antimalarials used for SMC and whether drug concentrations or resistance influence the duration of protection, (3) a resistance marker study in children aged 3 to 59 months to describe changes in resistance marker prevalence over time, and (4) a process evaluation to determine feasibility and acceptability of SMC. Results: Data collection began in mid-January 2022, and data analysis is expected to be completed by October 2022. Conclusions: This is the first effectiveness trial of SMC implemented in Mozambique. The findings from this trial will be crucial to policy change and program expansion to other suitable geographies outside of the Sahel. The chemoprevention efficacy cohort study is a unique opportunity to better understand SMC drug efficacy in this new SMC environment. Trial Registration: ClinicalTrials.gov NCT05186363; https://clinicaltrials.gov/ct2/show/NCT05186363 International Registered Report Identifier (IRRID): DERR1-10.2196/36403 ", doi="10.2196/36403", url="https://www.researchprotocols.org/2022/9/e36403", url="http://www.ncbi.nlm.nih.gov/pubmed/36149743" } @Article{info:doi/10.2196/38368, author="Choudhury, Avishek and Choudhury, Murari", title="Mobile for Mothers mHealth Intervention to Augment Maternal Health Awareness and Behavior of Pregnant Women in Tribal Societies: Randomized Quasi-Controlled Study", journal="JMIR Mhealth Uhealth", year="2022", month="Sep", day="21", volume="10", number="9", pages="e38368", keywords="maternal health", keywords="mHealth", keywords="digital divide", keywords="disparity", keywords="socioeconomic", keywords="India", keywords="health", keywords="awareness", keywords="mobile", keywords="intervention", keywords="adherence", keywords="health behaviors", keywords="tribal", keywords="community", keywords="education", abstract="Background: Despite several initiatives taken by government bodies, disparities in maternal health have been noticeable across India's socioeconomic gradient due to poor health awareness. Objective: The aim of this study was to implement an easy-to-use mobile health (mHealth) app---Mobile for Mothers (MfM)---as a supporting tool to improve (1) maternal health awareness and (2) maternal health--related behavioral changes among tribal and rural communities in India. Methods: Pregnant women, aged 18 to 45 years, were selected from two rural villages of Jharkhand, India: (1) the intervention group received government-mandated maternal care through an mHealth app and (2) the control group received the same government-mandated care via traditional means (ie, verbally). A total of 800 accredited social health activists (ASHAs) were involved, of which 400 were allocated to the intervention group. ASHAs used the MfM app to engage with pregnant women during each home visit in the intervention group. The mHealth intervention commenced soon after the baseline survey was completed in February 2014. The end-line data were collected between November 2015 and January 2016. We calculated descriptive statistics related to demographics and the percentage changes for each variable between baseline and end line per group. The baseline preintervention groups were compared to the end-line postintervention groups using Pearson chi-square analyses. Mantel-Haenszel tests for conditional independence were conducted to determine if the pre- to postintervention differences in the intervention group were significantly different from those in the control group. Results: Awareness regarding the five cleans (5Cs) in the intervention group increased (P<.001) from 143 (baseline) to 555 (end line) out of 740 participants. Awareness about tetanus vaccine injections and the fact that pregnant women should receive two shots of tetanus vaccine in the intervention group significantly increased (P<.001) from 73 out of 740 participants (baseline) to 372 out of 555 participants (end line). In the intervention group, awareness regarding the fact that problems like painful or burning urination and itchy genitals during pregnancy are indicative of a reproductive tract infection increased (P<.001) from 15 (baseline) to 608 (end line) out of 740 participants. Similarly, knowledge about HIV testing increased (P<.001) from 39 (baseline) to 572 (end line) out of 740 participants. We also noted that the number of pregnant women in the intervention group who consumed the prescribed dosage of iron tablets increased (P<.001) from 193 (baseline) out of 288 participants to 612 (end line) out of 663 participants. Conclusions: mHealth interventions can augment awareness of, and persistence in, recommended maternal health behaviors among tribal communities in Jharkhand, India. In addition, mHealth could act as an educational tool to help tribal societies break away from their traditional beliefs about maternal health and take up modern health care recommendations. Trial Registration: OSF Registries 9U8D5; https://doi.org/10.17605/OSF.IO/9U8D5 ", doi="10.2196/38368", url="https://mhealth.jmir.org/2022/9/e38368", url="http://www.ncbi.nlm.nih.gov/pubmed/36129749" } @Article{info:doi/10.2196/30372, author="Kuringe, Evodius and Christensen, Alice and Materu, Jacqueline and Drake, Mary and Majani, Esther and Casalini, Caterina and Mjungu, Deusdedit and Mbita, Gaspar and Kalage, Esther and Komba, Albert and Nyato, Daniel and Nnko, Soori and Shao, Amani and Changalucha, John and Wambura, Mwita", title="Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2022", month="Sep", day="19", volume="8", number="9", pages="e30372", keywords="adolescent", keywords="female", keywords="HIV infections/epidemiology", keywords="HIV infections/prevention and control", keywords="herpes simplex virus type 2", keywords="incidence", keywords="motivation", keywords="Tanzania", abstract="Background: Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. Objective: This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. Methods: A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. Results: Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95\% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95\% CI 0.29-0.71; P=.001), adjusted for potential confounders. Conclusions: Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. Trial Registration: ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243 ", doi="10.2196/30372", url="https://publichealth.jmir.org/2022/9/e30372", url="http://www.ncbi.nlm.nih.gov/pubmed/36121686" } @Article{info:doi/10.2196/34568, author="Pfeuffer, Nils and Beyer, Angelika and Penndorf, Peter and Leiz, Maren and Radicke, Franziska and Hoffmann, Wolfgang and van den Berg, Neeltje", title="Evaluation of a Health Information Exchange System for Geriatric Health Care in Rural Areas: Development and Technical Acceptance Study", journal="JMIR Hum Factors", year="2022", month="Sep", day="15", volume="9", number="3", pages="e34568", keywords="electronic health records", keywords="health information exchange", keywords="geriatrics", keywords="community-based participatory research", keywords="technical acceptance", keywords="usability", keywords="health information network", keywords="postacute care", keywords="patient-centered care", abstract="Background: Patients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients. Objective: This study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation. Methods: The development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach. Results: A total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. Conclusions: Participating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients' free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources. ", doi="10.2196/34568", url="https://humanfactors.jmir.org/2022/3/e34568", url="http://www.ncbi.nlm.nih.gov/pubmed/36107474" } @Article{info:doi/10.2196/35093, author="Vahabi, Mandana and Lofters, K. Aisha and Mishra, Gauravi and Pimple, Sharmila and Wong, Pui-Hing Josephine", title="A Family-Centered Sexual Health Intervention to Promote Cervical Cancer Screening Uptake Among Low-Income Rural Women in India: Protocol for a Community-Based Mixed Methods Pilot Study", journal="JMIR Res Protoc", year="2022", month="Sep", day="8", volume="11", number="9", pages="e35093", keywords="cervical cancer screening", keywords="human papillomavirus self-sampling", keywords="India", keywords="low income", keywords="sexual health", keywords="health literacy", keywords="women", keywords="family-centered care", keywords="rural area", keywords="rural", keywords="sexual health literacy", keywords="human papillomavirus", keywords="screening", keywords="cancer screening", keywords="cervical", keywords="cancer", keywords="sexually transmitted infection", abstract="Background: Human papillomavirus (HPV) is the primary cause of cervical cancer, which is preventable through screening and early treatment. The Papanicolaou (Pap) test and visual inspection with acetic acid (VIA), which are traditionally performed in clinical settings, have been used effectively to screen for cervical cancer and precancerous changes and reduce cervical cancer mortality in high-income countries for many decades. However, these screening methods are not easily accessible to women living in low- and middle-income countries, especially women living in rural areas. Objective: The project will use HPV self-sampling, which will be supported by a sexual health literacy intervention, to increase rural women's participation in cervical cancer screening. The objectives are to determine the effectiveness of this program in (1) increasing sexual health literacy, (2) reducing the gendered stigma of HPV and cervical cancer, and (3) promoting cervical cancer screening by using HPV self-sampling. Methods: The pilot study will use a community-based, family-centered, mixed methods design. We will recruit 120 women aged 30 to 69 years who are underscreened or were never screened for cervical cancer, along with 120 supportive male relatives or friends from 3 low-income rural/tribal villages in Maharashtra, India. Participants will attend gender-specific sexual health education sessions, followed by a movie matinee. Data will be collected through an interviewer-administered questionnaire before and after sexual health education sessions. The questionnaire will include items on social demographics, medical histories, attitudes, sexual health stigma, cervical cancer knowledge, and screening practices. Women will self-select whether to use HPV self-sampling. Those who do not may undergo a Pap test or VIA. Participants' views regarding barriers and facilitators and their suggestions for improving access and uptake will also be elicited. This protocol was approved by the research ethics boards of Toronto Metropolitan University (formerly known as Ryerson University; reference number: REB 2020-104) and Tata Memorial Center (reference number: OIEC/3786/2021 /00003). Results: The Preventing Cervical Cancer in India Through Self-Sampling study was funded in January 2020 for 15 months. Due to the COVID-19 pandemic, the project was extended by 1 year. The study outcome measures will include changes in knowledge and attitudes about cervical cancer screening, the proportion of participants who self-select into each cohort, the proportion of positive test results in each cohort, and the proportion of participants with confirmed cervical cancer. Women's experiences regarding barriers and facilitators of screening uptake will be captured. Conclusions: Our multifaceted work could lead to reduced cervical cancer mortality and morbidity and increased community capacity in sexual health promotion and cervical cancer prevention. The insights and lessons learned from our project can be used to inform the adaptation and scale-up of HPV self-sampling among women across India and in other countries; promote collective commitment to family-centered wellness; and support women to make healthful, personalized cervical screening decisions. International Registered Report Identifier (IRRID): PRR1-10.2196/35093 ", doi="10.2196/35093", url="https://www.researchprotocols.org/2022/9/e35093", url="http://www.ncbi.nlm.nih.gov/pubmed/36074549" } @Article{info:doi/10.2196/36747, author="Te, Vannarath and Wouters, Edwin and Buffel, Veerle and Van Damme, Wim and van Olmen, Josefien and Ir, Por", title="Generation of Cascades of Care for Diabetes and Hypertension Care Continuum in Cambodia: Protocol for a Population-Based Survey Protocol", journal="JMIR Res Protoc", year="2022", month="Sep", day="2", volume="11", number="9", pages="e36747", keywords="diabetes", keywords="hypertension", keywords="cascade of care", keywords="implementation research", keywords="care models", keywords="population-based survey", keywords="continuum of care", abstract="Background: Cardiovascular diseases (CVDs) were accountable for 24\% of the total deaths in Cambodia, one of the low- and middle-income countries, where primary health care (PHC) settings generally do not perform well in the early detection, diagnosis, and monitoring of leading risk factors for CVDs, that is, type 2 diabetes (T2D) and hypertension (HT). Integrated care for T2D and HT in the Cambodian PHC system remains limited, with more than two-thirds of the population never having had their blood glucose measured and more than half of the population with T2D having not received treatment, with only few of them achieving recommended treatment targets. With regard to care for T2D and HT in the public health care system, 3 care models are being scaled up, including (1) a hospital-based model, (2) a health center--based model, and (3) a community-based model. These 3 care models are implemented in isolation with relatively little interaction between each other. The question arises as to what extent the 3 care models have performed in providing care to patients with T2D or HT or both in Cambodia. Objective: This protocol aims to show how to use primary data from a population-based survey to generate data for the cascades of care to assess the continuum of care for T2D and HT across different care models. Methods: We adapt the HIV test-treat-retain cascade of care to assess the continuum of care for patients living with T2D and HT. The cascade-of-care approach outlines the sequential steps in long-term care: testing, diagnosis, linkage with care, retention in care, adherence to treatment, and reaching treatment targets. Five operational districts (ODs) in different provinces will be purposefully selected out of 103 ODs across the country. The population-based survey will follow a multistage stratified random cluster sampling, with expected recruitment of 5280 eligible individuals aged 40 and over as the total sample size. Data collection process will follow the STEPS (STEPwise approach to NCD risk factor surveillance) survey approach, with modification of the sequence of the steps to adapt the data collection to the study context. Data collection involves 3 main steps: (1) structured interviews with questionnaires, (2) anthropometric measurements, and (3) biochemical measurements. Results: As of December 2021, the recruitment process was completed, with 5072 eligible individuals participating in the data collection; however, data analysis is pending. Results are expected to be fully available in mid-2022. Conclusions: The cascade of care will allow us to identify leakages in the system as well as the unmet need for care. Identifying gaps in the health system is vital to improve efficiency and effectiveness of its performance. This study protocol and its expected results will help implementers and policy makers to assess scale-up and adapt strategies for T2D and HT care in Cambodia. Trial Registration: International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN41932064; https://www.isrctn.com/ISRCTN41932064 International Registered Report Identifier (IRRID): DERR1-10.2196/36747 ", doi="10.2196/36747", url="https://www.researchprotocols.org/2022/9/e36747", url="http://www.ncbi.nlm.nih.gov/pubmed/36053576" } @Article{info:doi/10.2196/40134, author="Shinde, Sachin and Wang, Dongqing and Yussuf, H. Mashavu and Mwanyika-Sando, Mary and Aboud, Said and Fawzi, W. Wafaie", title="Micronutrient Supplementation for Pregnant and Lactating Women to Improve Maternal and Infant Nutritional Status in Low- and Middle-Income Countries: Protocol for a Systematic Review and Meta-analysis", journal="JMIR Res Protoc", year="2022", month="Aug", day="30", volume="11", number="8", pages="e40134", keywords="antenatal care", keywords="multiple micronutrient supplementation", keywords="pregnant and lactating women", keywords="systematic review and meta-analysis", keywords="review", keywords="meta-analysis", keywords="meta-analyses", keywords="low- and middle-income countries", keywords="LMIC", keywords="low income", keywords="middle income", keywords="women's health", keywords="pregnant", keywords="pregnancy", keywords="natal", keywords="maternal", keywords="maternity", keywords="infant", keywords="baby", keywords="babies", keywords="lactation", keywords="lactating", keywords="breastfeed", keywords="nutrition", keywords="vitamin", keywords="nutrient", keywords="supplement", abstract="Background: Two billion people in low- and middle-income countries (LMICs) are deficient in key nutrients. Nutritional deficiencies worsen during pregnancy, causing adverse outcomes for the mother and the fetus, with consequences after pregnancy. These effects may be mitigated by providing micronutrient supplementation to women during pregnancy and lactation. However, the effects of micronutrient supplementation on the nutritional status of pregnant and lactating women and that of their infants remain largely unclear in LMICs.? Objective: The purpose of this systematic review and meta-analysis is to determine the effects of single, double, or multiple micronutrient supplements during pregnancy or lactation on maternal and infant nutritional status in LMICs. Methods: Randomized controlled trials of single, double, or combinations of micronutrients assessing effects on the maternal (serum, plasma, and breastmilk) and infant (serum and plasma) nutritional status will be included.?MEDLINE (through PubMed), EMBASE, CENTRAL (through Cochrane Library), and the World Health Organization (WHO) library database will be used to identify relevant published studies, starting from the inception of each database until February 28, 2022. The?Cochrane Risk of Bias Tool will be used to assess the risk of bias in the included studies. The selection of studies, data extraction, and risk of bias assessment will be carried out independently by 2 reviewers. A narrative summary will be provided of all the included studies. Meta-analyses will be performed whenever possible, and the heterogeneity of effects will be evaluated using I2, subgroup analyses, and metaregression.?The certainty of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. Results: We will conduct meta-analyses using Stata software (version 16, StataCorp) and present both a narrative and systematic summary of all studies included in this review in text and table form.?For continuous outcomes, effect estimates will be expressed as mean differences and standardized mean differences, while for binary outcomes, they will be expressed as risk ratios, rate ratios, hazards ratios, or odds ratios, all with 95\% CIs and comparing the intervention group with the control group.?When studies for an outcome are adequately consistent with respect to intervention, comparator, and definition of the outcome, a random-effects, inverse variance-weighted meta-analysis will be conducted. We will provide a narrative synthesis for outcomes with insufficient data or extreme heterogeneity. Conclusions: This review will provide evidence upon which to base policy and programming for women in LMICs to supplement micronutrients in pregnancy and lactation. Detailed results disaggregated by variables such as maternal age, sex of infant, duration, and dose of intervention may also help policy makers, researchers, practitioners, and government agencies to adopt more effective maternal and child health policies and programs in LMICs.?The review will also identify any gaps in the existing evidence. Trial Registration: PROSPERO CRD42022308715; https://tinyurl.com/y33cxekr. International Registered Report Identifier (IRRID): PRR1-10.2196/40134 ", doi="10.2196/40134", url="https://www.researchprotocols.org/2022/8/e40134", url="http://www.ncbi.nlm.nih.gov/pubmed/36040761" } @Article{info:doi/10.2196/25735, author="Tahsina, Tazeen and Iqbal, Afrin and Rahman, Ehsanur Ahmed and Chowdhury, Kanti Suman and Chowdhury, Iqbal Atique and Billah, Masum Sk and Rahman, Ataur and Parveen, Monira and Ahmed, Lubana and Rahman, Sadequr Qazi and Ashrafi, Akbar Shah Ali and Arifeen, El Shams", title="Birth and Death Notifications for Improving Civil Registration and Vital Statistics in Bangladesh: Pilot Exploratory Study", journal="JMIR Public Health Surveill", year="2022", month="Aug", day="29", volume="8", number="8", pages="e25735", keywords="notification", keywords="registration", keywords="birth", keywords="death", keywords="CRVS", keywords="mobile phone", keywords="mobile app", keywords="mobile technology", keywords="technology-based platform", keywords="community health", keywords="low- and middle-income countries", keywords="mHealth", keywords="Bangladesh", abstract="Background: Effective health policy formulation requires sound information of the numerical data and causes of deaths in a population. Currently, in Bangladesh, neither births nor deaths are fully and promptly registered. Birth registration in Bangladesh is around 54\% nationally. Although the legal requirements are to register within 45 days of an event, only 4.5\% of births and 35.9\% of deaths were reported within the required time frame in 2020. This study adopted an innovative digital notification approach to improve the coverage of registration of these events at the community level. Objective: Our primary objective was to assess (1) the proportion of events identified by the new notification systems (success rate) and the contribution of the different notifiers individually and in combination (completeness) and (2) the proportion of events notified within specific time limits (timeliness of notifications) after introducing the innovative approach. Methods: We conducted a pilot study in 2016 in 2 subdistricts of Bangladesh to understand whether accurate, timely, and complete information on births and deaths can be collected and notified by facility-based service providers; community health workers, including those who routinely visit households; local government authorities; and key informants from the community. We designed a mobile technology--based platform, an app, and a call center through which the notifications were recorded. All notifications were verified through the confirmation of events by family members during visits to the concerned households. We undertook a household survey--based assessment at the end of the notification period. Results: Our innovative system gathered 13,377 notifications for births and deaths from all channels, including duplicate reports from multiple sources. Project workers were able to verify 92\% of the births and 93\% of the deaths through household visits. The household survey conducted among a subsample of the project population identified 1204 births and 341 deaths. After matching the notifications with the household survey, we found that the system was able to capture over 87\% of the births in the survey areas. Health assistants and family welfare assistants were the primary sources of information. Notifications from facilities were very low for both events. Conclusions: The Global Civil Registration and Vital Statistics: Scaling Up Investment Plan 2015-2024 and the World Health Organization reiterated the importance of building an evidence base for improving civil registration and vital statistics. Our pilot innovation revealed that it is possible to coordinate with the routine health information system to note births and deaths as the first step to ensure registration. Health assistants could capture more than half of the notifications as a stand-alone source. ", doi="10.2196/25735", url="https://publichealth.jmir.org/2022/8/e25735", url="http://www.ncbi.nlm.nih.gov/pubmed/36036979" } @Article{info:doi/10.2196/35631, author="Adong, Julian and Fatch, Robin and Emenyonu, Nneka and Muyindike, Winnie and Ngabirano, Christine and Cheng, Debbie and Hahn, Judith", title="Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Aug", day="23", volume="6", number="8", pages="e35631", keywords="cell phone use", keywords="phone usage", keywords="cell phone", keywords="mHealth", keywords="HIV", keywords="low resource setting", keywords="low resource", keywords="mobile health", keywords="antiretroviral", keywords="Uganda", keywords="Africa", keywords="alcohol", keywords="text message", keywords="text messaging", keywords="cellphone", keywords="low income", keywords="LMIC", keywords="TB", keywords="tuberculosis", keywords="viral infection", keywords="infectious disease", keywords="sexually transmitted", keywords="STD", abstract="Background: HIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone--delivered services for medical and public health practice. Objective: Here we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB). Methods: We performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use---a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ?8 ng/mL. Results: A total of 300 participants (median age 40 years; n=146, 48.7\% male) were included in the analysis. Most (n=267, 89.0\%) participants had access to a phone and of them, 26 (9.7\%) shared the phone with someone else. In total, 262/300 (87.3\%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7\%) rarely or never sent text messages, and over two-thirds (n=200, 66.9\%) rarely or never received text messages. Most (n=214, 71.3\%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95\% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95\% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95\% CI 0.70-2.47; P=.40) text messages. Conclusions: There is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only. ", doi="10.2196/35631", url="https://formative.jmir.org/2022/8/e35631", url="http://www.ncbi.nlm.nih.gov/pubmed/35998023" } @Article{info:doi/10.2196/38201, author="Parvez, Masud Sarker and Hasan, Sharif Shaikh and Knibbs, D. Luke and Jahan, Farjana and Rahman, Mahbubur and Raqib, Rubhana and Islam, Nafisa and Aich, Nirupam and Moniruzzaman, Mohammad and Islam, Zahir and Fujimura, Masatake and Sly, D. Peter", title="Ecological Burden of e-Waste in Bangladesh---an Assessment to Measure the Exposure to e-Waste and Associated Health Outcomes: Protocol for a Cross-sectional Study", journal="JMIR Res Protoc", year="2022", month="Aug", day="16", volume="11", number="8", pages="e38201", keywords="e-waste", keywords="lead", keywords="cadmium", keywords="mercury", keywords="environment", keywords="exposure", keywords="recycling", keywords="toxicants", keywords="health outcomes", keywords="Bangladesh", abstract="Background: e-Waste is a rapidly growing waste stream worldwide, and Bangladesh is a hub of e-waste handling. Informal e-waste recycling operations involve crude methods for dismantling, repairing, sorting, and recycling electronic goods with bare hands and without personal health protections. Direct inhalation or dermal exposure to toxicants during informal recycling is common. Evidence suggests that e-waste--derived toxicants pollute the terrestrial ecosystem and have been linked with adverse health effects. However, e-waste recycling--related occupational health hazards have not been adequately explored in the context of Bangladesh. Objective: Our study aims to expand the current understanding of exposure to e-waste. This study will measure the metal concentrations in biological and environmental samples and evaluate the relationship between heavy metals and the biochemical systems of the e-waste workers. Methods: The study uses a cross-sectional study design consisting of an exposed site and a nonexposed control site. The trained team collected information on individual exposures, detailed work and medical history, and biological samples (blood, urine, and hair) from each subject. This study will measure heavy metal levels (lead, cadmium, and mercury) and biochemical parameters (hematological, hormonal, renal, and others) from the biological samples with reported physical function as outcomes of interest. In addition, we also collected soil and dust samples from both exposed and nonexposed control sites to measure the health risk. All the environmental samples will be analyzed using inductively coupled plasma mass spectrometer to determine metal concentrations. We will also conduct a qualitative investigation for a deeper understanding of the e-waste management system in Bangladesh. Results: The protocol has been approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh, and The University of Queensland's Human Behavioral Ethics Committee. Informed written consent was obtained from all participants. We recruited 199 workers from the e-waste sites with at least 5 years of exposure and 104 control subjects with no industrial or e-waste exposure. Sample analysis is estimated to be completed in 2022. Conclusions: Although many studies have identified potential adverse health outcomes from exposure to e-waste, there is a lack of published epidemiological research in Bangladesh. Research in this field is particularly pressing in the context of the current e-waste trend and the need to deepen the understanding of exposures and outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/38201 ", doi="10.2196/38201", url="https://www.researchprotocols.org/2022/8/e38201", url="http://www.ncbi.nlm.nih.gov/pubmed/35972788" } @Article{info:doi/10.2196/37314, author="Sarker, Rahman Mohammad Habibur and Moriyama, Michiko and Rashid, Ur Harun and Rahman, Moshiur Md and Chisti, Jobayer Mohammod and Das, Kumar Sumon and Saha, Kumar Samir and Arifeen, El Shams and Ahmed, Tahmeed and Faruque, G. A. S.", title="Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Aug", day="11", volume="24", number="8", pages="e37314", keywords="Bangladesh", keywords="health education", keywords="health knowledge", keywords="quality of life", keywords="motivation", keywords="randomized controlled trial", keywords="RCT", keywords="campaign", keywords="chronic kidney disease", keywords="knowledge", keywords="mobile health", keywords="mHealth", keywords="kidney", keywords="chronic disease", keywords="chronic condition", keywords="patient education", keywords="patient knowledge", keywords="low- and middle-income countries", keywords="LMIC", abstract="Background: Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. Objective: This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. Methods: This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. Results: The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group {\texttimes} time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group {\texttimes} time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group {\texttimes} time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). Conclusions: The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. International Registered Report Identifier (IRRID): RR2-10.2196/30191 ", doi="10.2196/37314", url="https://www.jmir.org/2022/8/e37314", url="http://www.ncbi.nlm.nih.gov/pubmed/35969429" } @Article{info:doi/10.2196/35249, author="Reitzug, Fabian and Luby, P. Stephen and Pullabhotla, K. Hemant and Geldsetzer, Pascal", title="The Effect of Particulate Matter Exposure During Pregnancy on Pregnancy and Child Health Outcomes in South Asia: Protocol for an Instrumental Variable Analysis", journal="JMIR Res Protoc", year="2022", month="Aug", day="10", volume="11", number="8", pages="e35249", keywords="PM2.5", keywords="air pollution", keywords="fine particulate matter", keywords="birth weight", keywords="still birth", keywords="child and maternal health", keywords="Indo-Gangetic Plain", keywords="India", keywords="Pakistan", keywords="Bangladesh", keywords="Nepal", abstract="Background: Determining the longer-term health effects of air pollution has been difficult owing to the multitude of potential confounding variables in the relationship between air pollution and health. Air pollution in many areas of South Asia is seasonal, with large spikes in particulate matter (PM) concentration occurring in the winter months. This study exploits this seasonal variation in PM concentration through a natural experiment. Objective: This project aims to determine the causal effect of PM exposure during pregnancy on pregnancy and child health outcomes. Methods: We will use an instrumental variable (IV) design whereby the estimated month of conception is our instrument for exposure to PM with a diameter less than 2.5 $\mu$m (PM2.5) during pregnancy. We will assess the plausibility of our assumption that timing of conception is exogenous with regard to our outcomes of interest and will adjust for date of monsoon onset to control for confounding variables related to harvest timing. Our outcomes are 1) birth weight, 2) pregnancy termination resulting in miscarriage, abortion, or still birth, 3) neonatal death, 4) infant death, and 5) child death. We will use data from the Demographic and Health Surveys (DHS) conducted in relevant regions of Bangladesh, India, Nepal, and Pakistan, along with monthly gridded data on PM2.5 concentration (0.1{\textdegree}{\texttimes}0.1{\textdegree} spatial resolution), precipitation data (0.5{\textdegree}{\texttimes}0.5{\textdegree} resolution), temperature data (0.5{\textdegree}{\texttimes}0.5{\textdegree}), and agricultural land use data (0.1{\textdegree}{\texttimes}0.1{\textdegree} resolution). Results: Data access to relevant DHSs was granted on June 6, 2021 for India, Nepal, Bangladesh, August 24, 2021 for Pakistan, and June 19 2022 for the latest DHS from India. Conclusions: If the assumptions for a causal interpretation of our instrumental variable analysis are met, this analysis will provide important causal evidence on the maternal and child health effects of PM2.5 exposure during pregnancy. This evidence is important to inform personal behavior and interventions, such as the adoption of indoor air filtration during pregnancy as well as environmental and health policy. International Registered Report Identifier (IRRID): DERR1-10.2196/35249 ", doi="10.2196/35249", url="https://www.researchprotocols.org/2022/8/e35249", url="http://www.ncbi.nlm.nih.gov/pubmed/35947440" } @Article{info:doi/10.2196/35840, author="Luo, Wei and Liu, Zhaoyin and Zhou, Yuxuan and Zhao, Yumin and Li, Elita Yunyue and Masrur, Arif and Yu, Manzhu", title="Investigating Linkages Between Spatiotemporal Patterns of the COVID-19 Delta Variant and Public Health Interventions in Southeast Asia: Prospective Space-Time Scan Statistical Analysis Method", journal="JMIR Public Health Surveill", year="2022", month="Aug", day="9", volume="8", number="8", pages="e35840", keywords="COVID-19", keywords="Delta variant", keywords="space-time scan", keywords="intervention", keywords="Southeast Asia", abstract="Background: The COVID-19 Delta variant has presented an unprecedented challenge to countries in Southeast Asia (SEA). Its transmission has shown spatial heterogeneity in SEA after countries have adopted different public health interventions during the process. Hence, it is crucial for public health authorities to discover potential linkages between epidemic progression and corresponding interventions such that collective and coordinated control measurements can be designed to increase their effectiveness at reducing transmission in SEA. Objective: The purpose of this study is to explore potential linkages between the spatiotemporal progression of the COVID-19 Delta variant and nonpharmaceutical intervention (NPI) measures in SEA. We detected the space-time clusters of outbreaks of COVID-19 and analyzed how the NPI measures relate to the propagation of COVID-19. Methods: We collected district-level daily new cases of COVID-19 from June 1 to October 31, 2021, and district-level population data in SEA. We adopted prospective space-time scan statistics to identify the space-time clusters. Using cumulative prospective space-time scan statistics, we further identified variations of relative risk (RR) across each district at a half-month interval and their potential public health intervention linkages. Results: We found 7 high-risk clusters (clusters 1-7) of COVID-19 transmission in Malaysia, the Philippines, Thailand, Vietnam, and Indonesia between June and August, 2021, with an RR of 5.45 (P<.001), 3.50 (P<.001), 2.30 (P<.001), 1.36 (P<.001), 5.62 (P<.001), 2.38 (P<.001), 3.45 (P<.001), respectively. There were 34 provinces in Indonesia that have successfully mitigated the risk of COVID-19, with a decreasing range between --0.05 and --1.46 due to the assistance of continuous restrictions. However, 58.6\% of districts in Malaysia, Singapore, Thailand, and the Philippines saw an increase in the infection risk, which is aligned with their loosened restrictions. Continuous strict interventions were effective in mitigating COVID-19, while relaxing restrictions may exacerbate the propagation risk of this epidemic. Conclusions: The analyses of space-time clusters and RRs of districts benefit public health authorities with continuous surveillance of COVID-19 dynamics using real-time data. International coordination with more synchronized interventions amidst all SEA countries may play a key role in mitigating the progression of COVID-19. ", doi="10.2196/35840", url="https://publichealth.jmir.org/2022/8/e35840", url="http://www.ncbi.nlm.nih.gov/pubmed/35861674" } @Article{info:doi/10.2196/24595, author="Hammami, Rania and Boudiche, Selim and Rami, Tlili and Ben Halima, Nejeh and Jamel, Ahmed and Rekik, Bassem and Gribaa, Rym and Imtinene, Mrad Ben and Charfeddine, Salma and Ellouze, Tarek and Bahloul, Amine and H{\'e}di, Slima Ben and Langar, Jamel and Ben Ahmed, Habib and Ibn Elhadj, Zied and Hmam, Mohamed and Ben Abdessalem, Aymen Mohamed and Maaoui, Sabri and Fennira, Sana and Lobna, Laroussi and Hassine, Majed and Ouanes, Sami and Mohamed Faouzi, Drissi and Mallek, Souad and Mahdhaoui, Abdallah and Meriem, Dghim and Jomaa, Walid and Zayed, Sofien and Kateb, Tawfik and Bouchahda, Nidhal and Azaiez, Fares and Ben Salem, Helmi and Marouen, Morched and Noamen, Aymen and Abdesselem, Salem and Hichem, Denguir and Ibn Hadj Amor, Hassen and Abdeljelil, Farhati and Amara, Amine and Bejar, Karim and Khaldoun, Hamda Ben and Hamza, Chiheb and Ben Jamaa, Mohsen and Fourati, Sami and Elleuch, Faycal and Grati, Zeineb and Chtourou, Slim and Marouene, Sami and Sahnoun, Mohamed and Hadrich, Morched and Mohamed Abdelkader, Maalej and Bouraoui, Hatem and Kamoun, Kamel and Hadrich, Moufid and Ben Chedli, Tarek and Drissa, Akrem Mohamed and Charfeddine, Hanene and Saadaoui, Nizar and Achraf, Gargouri and Ahmed, Siala and Ayari, Mokdad and Nabil, Marsit and Mnif, Sabeur and Sahnoun, Maher and Kammoun, Helmi and Ben Jemaa, Khaled and Mostari, Gharbi and Hamrouni, Nebil and Yamen, Maazoun and Ellouz, Yassine and Smiri, Zahreddine and Hdiji, Amine and Bassem, Jerbi and Ayadi, Wacef and Zouari, Amir and Abbassi, Chedly and Fatma, Masmoudi Boujelben and Battikh, Kais and Kharrat, Elyes and Gtif, Imen and Sami, Milouchi and Bezdah, Leila and Kachboura, Salem and Maatouk, Faouzi Mohamed and Kraiem, Sondes and Jeridi, Gouider and Neffati, Elyes and Kammoun, Samir and Ben Ameur, Youssef and Fehri, Wafa and Gamra, Habib and Zakhama, Lilia and Addad, Faouzi and Mohamed Sami, Mourali and Abid, Leila", title="Design and Rationale of the National Tunisian Registry of Percutaneous Coronary Intervention: Protocol for a Prospective Multicenter Observational Study", journal="JMIR Res Protoc", year="2022", month="Aug", day="5", volume="11", number="8", pages="e24595", keywords="percutaneous coronary intervention", keywords="1-year outcome", keywords="Tunisia", keywords="national", keywords="multicentric", keywords="registry", keywords="percutaneous", keywords="coronary", keywords="artery disease", abstract="Background: Coronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries. Objective: The aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia. Methods: We will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis. Results: In this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9\%) are managed in the public sector and 601 (24.1\%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9\%) were included before the COVID-19 pandemic and 1779 (60.1\%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022. Conclusions: This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region. Trial Registration: Clinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761 International Registered Report Identifier (IRRID): RR1-10.2196/24595 ", doi="10.2196/24595", url="https://www.researchprotocols.org/2022/8/e24595", url="http://www.ncbi.nlm.nih.gov/pubmed/35930353" } @Article{info:doi/10.2196/32330, author="Kirkwood, K. Elizabeth and Clymer, Caitlin and Imbulana, Kheminda and Mozumder, Sumaya and Dibley, J. Michael and Alam, Ashraful Neeloy", title="The Role of mHealth Interventions in Changing Gender Relations: Systematic Review of Qualitative Findings", journal="JMIR Hum Factors", year="2022", month="Jul", day="21", volume="9", number="3", pages="e32330", keywords="mobile health", keywords="mHealth", keywords="gender relations", keywords="systematic review", keywords="low- and middle-income countries", keywords="mobile phone", abstract="Background: The rapid and widespread growth of mobile technologies in low- and middle-income countries can offer groundbreaking ways of disseminating public health interventions. However, gender-based inequalities present a challenge for women in accessing mobile technology. Research has shown that mobile health (mHealth) interventions can affect gender relations in both positive and negative ways; however, few mHealth programs use a gender-sensitive lens when designing, implementing, or analyzing programs. Objective: This systematic review aims to identify and summarize the findings of qualitative research studies that explore the impact of mHealth interventions on gender relations as a result of participating in such initiatives in low- and middle-income countries. Methods: We performed a systematic literature review to examine empirical evidence of changes in gender relations attributed to participation in an mHealth intervention in low- and middle-income countries. Peer-reviewed articles were included based on whether they evaluated an mHealth intervention and were published between 2013 and 2020. Articles using mHealth that solely targeted health workers, did not assess a specific intervention, used mobile technology for data collection only, or were formative or exploratory in nature were excluded. The search terms were entered into 4 key electronic databases---MEDLINE, EMBASE, PsycINFO, and Scopus---generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report the themes that emerged from our data. Results: Of the 578 full-text articles retrieved, 14 (2.4\%) were eligible for inclusion in the study. None of the articles appraised gender from the outset. The articles uncovered findings on gender relations through the course of the intervention or postprogram evaluation. Most studies took place in sub-Saharan Africa, with the remainder in South and Southeast Asia. The articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found that mHealth programs could enhance spousal communication, foster emotional support between couples, improve women's self-efficacy and autonomy in seeking health information and services, and increase their involvement in health-related decision-making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision-makers, and exacerbating relationship problems. Conclusions: These results suggest that given the rapid and persistent upscale of mHealth interventions in low- and middle-income settings, it is imperative to design interventions that consider their impact on power dynamics and gender relations. Future research is needed to fill the evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and that they need to actively participate and be empowered by mHealth interventions. ", doi="10.2196/32330", url="https://humanfactors.jmir.org/2022/3/e32330", url="http://www.ncbi.nlm.nih.gov/pubmed/35862143" } @Article{info:doi/10.2196/37211, author="Tran, V. Ha and Nong, T. Ha T. and Tran, T. Thuy T. and Filipowicz, R. Teresa and Landrum, R. Kelsey and Pence, W. Brian and Le, M. Giang and Nguyen, X. Minh and Chibanda, Dixon and Verhey, Ruth and Go, F. Vivian and Ho, T. Hien and Gaynes, N. Bradley", title="Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam: Formative Study", journal="JMIR Form Res", year="2022", month="Jul", day="8", volume="6", number="7", pages="e37211", keywords="Friendship Bench", keywords="Vietnam", keywords="Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing", keywords="ADAPT-ITT", keywords="common mental disorders", keywords="people living with HIV", keywords="PWH", keywords="people who inject drugs", keywords="PWID", keywords="methadone maintenance treatment", keywords="MMT", keywords="depression", keywords="anxiety", keywords="stress disorder", abstract="Background: The prevalence of common mental disorders (CMDs) among people living with HIV and people who inject drugs is high worldwide and in Vietnam. However, few evidence-informed CMD programs for people living with HIV who inject drugs have been adapted for use in Vietnam. We adapted the Friendship Bench (FB), a problem-solving therapy (PST)--based program that was successfully implemented among patients with CMDs in primary health settings in Zimbabwe and Malawi for use among people living with HIV on methadone maintenance treatment (MMT) with CMDs in Hanoi, Vietnam. Objective: This study aimed to describe the adaptation process with a detailed presentation of 4 phases from the third (adaptation) to the sixth (integration) of the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) framework. Methods: The adaptation phase followed a qualitative study design to explore symptoms of CMDs, facilitators, and barriers to conducting FB for people living with HIV on MMT in Vietnam, and patient, provider, and caretaker concerns about FB. In the production phase, we revised the original program manual and developed illustrated PST cases. In the topical expert and integration phases, 2 investigators (BNG and BWP) and 3 subject matter experts (RV, DC, and GML) reviewed the manual, with reviewer comments incorporated in the final, revised manual to be used in the training. The draft program will be used in the training and testing phases. Results: The study was methodologically aligned with the ADAPT-ITT goals as we chose a proven, effective program for adaptation. Insights from the adaptation phase addressed the who, where, when, and how of FB program implementation in the MMT clinics. The ADAPT-ITT framework guided the appropriate adaptation of the program manual while maintaining the core components of the PST of the original program throughout counseling techniques in all program sessions. The deliverable of this study was an adapted FB manual to be used for training and piloting to make a final program manual. Conclusions: This study successfully illustrated the process of operationalizing the ADAPT-ITT framework to adapt a mental health program in Vietnam. This study selected and culturally adapted an evidence-informed PST program to improve CMDs among people living with HIV on MMT in Vietnam. This adapted program has the potential to effectively address CMDs among people living with HIV on MMT in Vietnam. Trial Registration: ClinicalTrials.gov NCT04790201; https://clinicaltrials.gov/ct2/show/NCT04790201 ", doi="10.2196/37211", url="https://formative.jmir.org/2022/7/e37211", url="http://www.ncbi.nlm.nih.gov/pubmed/35802402" } @Article{info:doi/10.2196/37947, author="Isangula, Kahabi and Shumba, Constance and Pallangyo, S. Eunice and Mbekenga, Columba and Ndirangu-Mugo, Eunice", title="Strengthening Interpersonal Relationships in Maternal and Child Health Care in Rural Tanzania: Protocol for a Human-Centered Design Intervention", journal="JMIR Res Protoc", year="2022", month="Jul", day="7", volume="11", number="7", pages="e37947", keywords="human-centered design", keywords="user-centred design", keywords="human-centred design", keywords="provider-patient relationship", keywords="nurse-client relationship", keywords="nurse", keywords="nursing", keywords="maternal and child health", keywords="maternal", keywords="maternity", keywords="mother", keywords="child", keywords="primary health care", keywords="primary care", keywords="rural", keywords="Tanzania", keywords="Africa", keywords="community-based", keywords="focus group", keywords="co-design", keywords="prototype", keywords="validation", keywords="nurse-patient", keywords="provider-client", abstract="Background: Evidence indicates that clients' dissatisfaction with providers' competencies within maternal and child health (MCH) continues to impact trust in formal health care systems, service uptake, continuity with care, and MCH outcomes. A major problem with existing interventions is the failure to address all the complexities of provider-client relationships necessitating targeted, contextualized, innovative solutions that place providers and clients at the forefront as agents of change in optimizing intervention design and implementation. To improve the provider-client relationship, the Aga Khan University is piloting a human-centered design (HCD) intervention where MCH nurses and clients are invited to partner with researchers in the intervention design and evaluation process. Objective: The objective of this research is to co-design an intervention package (prototype) for improving nurse-client relationships in the rural Shinyanga region of Tanzania using a series of iterative HCD steps, involving key stakeholders to tailor solutions for complex problems impacting provider-client interactions in MCH care. Methods: The following 5-step HCD approach will be implemented: (1) community-driven discovery through qualitative descriptive research methods using focus group discussions and key informant interviews; (2) co-design of an intervention package through consultative ideation and cocreation meetings with nurses, clients, and other stakeholders; (3) prototype validation through qualitative insight gathering using focus group discussions; (4) refinement and adaptation meeting; and (5) documentation and sharing of lessons learned before the final prototype is tested and validated in a broader community. Results: A prototype characterized by a package of interventions for improving nurse-client relationships in MCH care in rural contexts is expected to be developed from the co-design process. Conclusions: An HCD approach provides a novel entry point for strengthening provider-client relationships, where clients are invited to partner with providers in the design of acceptable and feasible interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/37947 ", doi="10.2196/37947", url="https://www.researchprotocols.org/2022/7/e37947", url="http://www.ncbi.nlm.nih.gov/pubmed/35797107" } @Article{info:doi/10.2196/36925, author="Zeidler, Henriette and Farrow, Claire and Jarman, Megan and Koteng, Grace and Simatende, Barnabas and Matthews, Danielle and Mooya, Haatembo and Shapiro, R. Laura and Wadende, Pamela", title="The Role of Mealtimes in Fostering Language Development and Aligning Home and School Learning: Protocol for a Multi-Method Study of Preschool Children in Rural Kenya and Zambia", journal="JMIR Res Protoc", year="2022", month="Jul", day="5", volume="11", number="7", pages="e36925", keywords="language development", keywords="nutrition", keywords="preschool education", keywords="school", keywords="education", keywords="home", keywords="environment", keywords="academic", keywords="children", keywords="student", keywords="language learning", keywords="language", keywords="caregiving", keywords="responsive caregiving", keywords="speech", keywords="child-directed speech", keywords="nutritional level", abstract="Background: The association between school and home is fundamental to sustainable education: parents' understanding of the school's priorities and teachers' understanding of their pupils' home environment are both vital for children to remain in school and succeed academically. The relationship between parents and teachers is closest in preschool settings, providing a valuable opportunity to build bridges between home and school. In this protocol paper, we outline our planned methods for identifying beneficial home and school behaviors. Objective: Our project aims to identify culture-specific structures and behaviors in home and school settings, which influence the quantity and quality of child-directed speech and identify positive experiences that can help improve children's linguistic development and nutrition. Methods: Using a mixed methods approach and focusing on early language learning, nutrition, and responsive caregiving, we will video-record and analyze mealtime language and eating behaviors at home and in school, targeting 80 preschool children and their families in rural Kenya and Zambia. In addition, we will assess children's language skills through audio recordings and use questionnaire-based interviews to collect extensive sociodemographic and dietary data. Results: Between the start of our project in January 2020 and the end of December 2021, we had collected complete sets of sociodemographic, observational, and food recall data for 40 children in Kenya and 16 children in Zambia. By the end of May 2022, we had started data collection for an additional 24 children in Zambia and transcribed and coded approximately 85\% of the data. By the end of September, 2022, we plan to complete data collection, transcription, and coding for the entire sample of 80 children across both countries. From September 2022 onwards, we will focus on analyzing our language data, and we hope to have results ready for publication in early 2023. By relating children's language outcomes and nutritional intake to the observed mealtime behaviors, we hope to identify practices that increase the quantity and quality of child-directed speech and improve children's nutritional intake. Conclusions: Good nutrition and the promotion of language learning are key issues in early childhood development. By using a cross-cultural approach, combining a variety of methods, and working closely with stakeholders and policy makers throughout the project, we hope to find and share best practices for improving children's linguistic outcomes and nutrition and lay the foundation for the development of practitioner networks and parent outreach programs. International Registered Report Identifier (IRRID): DERR1-10.2196/36925 ", doi="10.2196/36925", url="https://www.researchprotocols.org/2022/7/e36925", url="http://www.ncbi.nlm.nih.gov/pubmed/35788473" } @Article{info:doi/10.2196/36242, author="Hu, Maogui and Feng, Yuqing and Li, Tao and Zhao, Yanlin and Wang, Jinfeng and Xu, Chengdong and Chen, Wei", title="Unbalanced Risk of Pulmonary Tuberculosis in China at the Subnational Scale: Spatiotemporal Analysis", journal="JMIR Public Health Surveill", year="2022", month="Jul", day="1", volume="8", number="7", pages="e36242", keywords="pulmonary tuberculosis", keywords="infectious disease", keywords="pattern", keywords="notification rates", keywords="Bayesian", keywords="spatiotemporal pattern", keywords="tuberculosis", keywords="public health", keywords="China", keywords="disease burden", keywords="spatial data", keywords="regional inequality", keywords="risk", keywords="TB", keywords="unbalanced", keywords="notification data", keywords="trend", keywords="cases", keywords="incidence", abstract="Background: China has one of the highest tuberculosis (TB) burdens in the world. However, the unbalanced spatial and temporal trends of TB risk at a fine level remain unclear. Objective: We aimed to investigate the unbalanced risks of pulmonary tuberculosis (PTB) at different levels and how they evolved from both temporal and spatial aspects using PTB notification data from 2851 counties over a decade in China. Methods: County-level notified PTB case data were collected from 2009 to 2018 in mainland China. A Bayesian hierarchical model was constructed to analyze the unbalanced spatiotemporal patterns of PTB notification rates during this period at subnational scales. The Gini coefficient was calculated to assess the inequality of the relative risk (RR) of PTB across counties. Results: From 2009 to 2018, the number of notified PTB cases in mainland China decreased from 946,086 to 747,700. The average number of PTB cases in counties was 301 (SD 26) and the overall average notification rate was 60 (SD 6) per 100,000 people. There were obvious regional differences in the RRs for PTB (Gini coefficient 0.32, 95\% CI 0.31-0.33). Xinjiang had the highest PTB notification rate, with a multiyear average of 155/100,000 (RR 2.3, 95\% CI 1.6-2.8; P<.001), followed by Guizhou (117/100,000; RR 1.8, 95\% CI 1.3-1.9; P<.001) and Tibet (108/100,000; RR 1.7, 95\% CI 1.3-2.1; P<.001). The RR for PTB showed a steady downward trend. Gansu (local trend [LT] 0.95, 95\% CI 0.93-0.96; P<.001) and Shanxi (LT 0.94, 95\% CI 0.92-0.96; P<.001) experienced the fastest declines. However, the RRs for PTB in the western region (such as counties in Xinjiang, Guizhou, and Tibet) were significantly higher than those in the eastern and central regions (P<.001), and the decline rate of the RR for PTB was lower than the overall level (P<.001). Conclusions: PTB risk showed significant regional inequality among counties in China, and western China presented a high plateau of disease burden. Improvements in economic and medical service levels are required to boost PTB case detection and eventually reduce PTB risk in the whole country. ", doi="10.2196/36242", url="https://publichealth.jmir.org/2022/7/e36242", url="http://www.ncbi.nlm.nih.gov/pubmed/35776442" } @Article{info:doi/10.2196/30088, author="Ooi, Phaik Yoon and Reed, Marnie and Marchal-Jones, Emma and Meyer, Hans Andrea and Gaab, Jens", title="Sociocultural Adjustment and Well-being Among Third Culture Kids and Their Families: Protocol for a Longitudinal Study", journal="JMIR Res Protoc", year="2022", month="Jul", day="1", volume="11", number="7", pages="e30088", keywords="family functioning", keywords="resilience", keywords="sociocultural adjustment", keywords="stress", keywords="third culture kids", keywords="well-being", abstract="Background: Increasing globalization has led to more families with children being relocated each year, highlighting the importance of issues, such as adjustment and psychological well-being, in this population. These children, commonly known as third culture kids, often spend a significant part of their developmental years in countries and cultures foreign to them. Objective: Our longitudinal study aims to examine the roles of cognitive, psychological, sociocultural, and family factors in the longitudinal trajectories of the well-being and sociocultural adjustment of third culture kids and their families over time. Methods: This study adopts both quantitative and qualitative procedures. Data from both procedures will be collected at baseline and at a 1-year follow-up. We aim to recruit 150 to 200 participants between 7 and 17 years old and one of their primary caregivers. After providing informed consent, participants will complete an online survey. Outcome measures include validated questionnaires on well-being and sociocultural adjustment. Predictor measures include validated questionnaires on negative self-thoughts, emotion regulation, resilience, psychological attributes, self-esteem, stress, acculturative stress, cultural intelligence, couple satisfaction, and family functioning. A multiple regression model will be used to analyze quantitative data. In addition, 15 to 20 families who participate in the online survey will be randomly selected to take part in a family interview focusing on questions related to well-being, relocation experiences, cultural issues, and challenges. A concurrent triangulation mixed methods design will be used to analyze and interpret data from both quantitative and qualitative methods. Results: As of March 15, 2022, a total of 138 children and 126 parents have completed the baseline online survey. In addition, 44 children and 48 parents have completed the 1-year follow-up online survey. A total of 8 families have completed the baseline family interview, while 4 families have completed the 1-year follow-up interview. Data analyses, transcription of the interview, and preparation for publication are on-going. Conclusions: Findings from this study would enable us to understand the adjustment processes, and risk and protective factors associated with the well-being and sociocultural adjustment of third culture kids and their families in Switzerland, which could have implications on the development of intervention programs for individuals and families to address acculturation and adjustment issues. International Registered Report Identifier (IRRID): RR1-10.2196/30088 ", doi="10.2196/30088", url="https://www.researchprotocols.org/2022/7/e30088", url="http://www.ncbi.nlm.nih.gov/pubmed/35776500" } @Article{info:doi/10.2196/32577, author="Reid, Woodruff Hadley and Proeschold-Bell, Jean Rae and Makarushka, Christina and Melgar Vega, Dayllan Katherine and Huchko, Megan and Jeronimo, Jose and Vasudevan, Lavanya", title="Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspecci{\'o}n Visual con {\'A}cido Ac{\'e}tico System: Mixed Methods Case Study", journal="JMIR Form Res", year="2022", month="Jun", day="23", volume="6", number="6", pages="e32577", keywords="cervical cancer", keywords="mobile health", keywords="Peru", keywords="colposcopy", keywords="implementation science", keywords="Consolidated Framework for Implementation Research", keywords="CFIR", abstract="Background: There is growing evidence supporting the use of mobile health (mHealth) interventions in low- and middle-income countries to address resource limitations in the delivery of health information and services to vulnerable populations. In parallel, there is an increasing emphasis on the use of implementation science tools and frameworks for the early identification of implementation barriers and to improve the acceptability, appropriateness, and adoption of mHealth interventions in resource-limited settings. However, there are limited examples of the application of implementation science tools and frameworks to the formative phase of mHealth design for resource-limited settings despite the potential benefits of this work for enhancing subsequent implementation, scale-up, and sustainability. Objective: We presented a case study on the use of an implementation science framework in mHealth design. In particular, we illustrated the usability of the Consolidated Framework for Implementation Research (CFIR) for organizing and interpreting formative research findings during the design of the mobile Inspecci{\'o}n Visual con {\'A}cido Ac{\'e}tico (mIVAA) system in Lima, Peru. Methods: We collected formative data from prospective users of the mIVAA intervention using multiple research methodologies, including structured observations, surveys, group and individual interviews, and discussions with local stakeholders at the partnering organization in Peru. These activities enabled the documentation of clinical workflows, perceived barriers to and facilitators of mIVAA, overarching barriers to cervical cancer screening in community-based settings, and related local policies and guidelines in health care. Using a convergent mixed methods analytic approach and the CFIR as an organizing framework, we mapped formative research findings to identify key implementation barriers and inform iterations of the mIVAA system design. Results: In the setting of our case study, most implementation barriers were identified in the CFIR domains of intervention characteristics and inner setting. All but one barrier were addressed before mIVAA deployment by modifying the system design and adding supportive resources. Solutions involved improvements to infrastructure, including cellular data plans to avoid disruption from internet failure; improved process and flow, including an updated software interface; and better user role definition for image capture to be consistent with local health care laws. Conclusions: The CFIR can serve as a comprehensive framework for organizing formative research data and identifying key implementation barriers during mHealth intervention design. In our case study of the mIVAA system in Peru, formative research contributing to the CFIR domains of intervention characteristics and inner setting elicited the most key barriers to implementation. The early identification of barriers enabled design iterations before system deployment. Future efforts to develop mHealth interventions for low- and middle-income countries may benefit from using the approach presented in this case study as well as prioritizing the CFIR domains of intervention characteristics and inner setting. ", doi="10.2196/32577", url="https://formative.jmir.org/2022/6/e32577", url="http://www.ncbi.nlm.nih.gov/pubmed/35737455" } @Article{info:doi/10.2196/18188, author="Sibuyi, Idon-Nkhenso and de la Harpe, Retha and Nyasulu, Peter", title="A Stakeholder-Centered mHealth Implementation Inquiry Within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case", journal="JMIR Mhealth Uhealth", year="2022", month="Jun", day="16", volume="10", number="6", pages="e18188", keywords="MomConnect", keywords="mHealth", keywords="patient-facing eHealth", keywords="digital health innovation ecosystem", keywords="practitioner-researcher", keywords="stakeholder-centered design", keywords="re-engineering in health services", keywords="sustainable development goals", keywords="principles of digital development", keywords="global digital health index", keywords="strong structuration theory", abstract="Background: The internet is a useful web-based multimedia platform for accessing and disseminating information unconstrained by time, distance, and place. To the health care sector's benefit, the advent and proliferation of mobile devices have provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalized people and their communities, particularly in developing societies. Objective: This study aimed to report on the perspectives of the different stakeholders involved in the study and to review an existing government mobile health (mHealth) program. It forms part of a study to design a re-engineered strategy based on the best demonstrated practices (considerations and methods) and learned experiences from the perspectives of multiple stakeholders within the digital health innovation ecosystem in South Africa. Methods: This study used an ethnographic approach involving document review, stakeholder mapping, semistructured individual interviews, focus group discussions, and participant observations to explore, describe, and analyze the perspectives of its heterogeneous participant categories representing purposively sampled but different constituencies. Results: Overall, 80 participants were involved in the study, in addition to the 6 meetings the researcher attended with members of a government-appointed task team. In addition, 46 archived records and reports were consulted and reviewed as part of gathering data relating to the government's MomConnect project. Among the consulted stakeholders, there was general consensus that the existing government-sponsored MomConnect program should be implemented beyond mere piloting, to as best as possible capacity within the available resources and time. It was further intimated that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem was hamstrung by challenges that included stakeholder mismanagement, impact assessment inadequacies, management of data, lack of effective leadership and political support, inappropriate technology choices, eHealth and mHealth funding, integration of mHealth to existing health programs in tandem with Goal 3 of the Sustainable Development Goals, integration of lessons learned from other mHealth initiatives to avoid resource wastage and duplication of efforts, proactive evaluation of both mHealth and eHealth strategies, and change management and developing human resources for eHealth. Conclusions: This study has only laid a foundation for the re-engineering of mHealth services within the digital health innovation ecosystem. This study articulated the need for stakeholder collaboration, such as continuous engagement among academics, technologists, and mHealth fieldwork professionals. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer-reviewed or systematic research documents from which South African professionals, research experts, and practitioners could learn. Further research is needed for the retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa. ", doi="10.2196/18188", url="https://mhealth.jmir.org/2022/6/e18188", url="http://www.ncbi.nlm.nih.gov/pubmed/35708756" } @Article{info:doi/10.2196/32964, author="Downie, Andrew and Mashanya, Titus and Chipwaza, Beatrice and Griffiths, Frances and Harris, Bronwyn and Kalolo, Albino and Ndegese, Sylvester and Sturt, Jackie and De Valliere, Nicole and Pemba, Senga", title="Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic", journal="JMIR Form Res", year="2022", month="Jun", day="14", volume="6", number="6", pages="e32964", keywords="remote consultation", keywords="mobile consulting", keywords="digital health", keywords="telehealth", keywords="mHealth", keywords="eHealth", keywords="mobile health", keywords="health care", keywords="cascade", keywords="train the trainer", keywords="low- and middle-income countries", keywords="rural areas", keywords="Tanzania", keywords="Kirkpatrick", keywords="consultation", keywords="training", keywords="low- and middle-income", keywords="rural", keywords="COVID-19", abstract="Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania's rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17\%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8\%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97\%) completed the cascaded training. Of the 10 (83\%) tier 1 trainees who completed the survey, 9 (90\%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees' behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings. ", doi="10.2196/32964", url="https://formative.jmir.org/2022/6/e32964", url="http://www.ncbi.nlm.nih.gov/pubmed/35507772" } @Article{info:doi/10.2196/37927, author="Bello-Manga, Halima and Haliru, Lawal and Ahmed, Abdulkareem Kudrat and Tabari, Musa Abdulkadir and Farouk, Usman Bilkisu and Bahago, Yimi Gloria and Kazaure, Shuaibu Aisha and Muhammad, Sani Abdulrasheed and Gwarzo, Abubakar Samira and Baumann, A. Ana and DeBaun, R. Michael and King, A. Allison", title="Primary Prevention of Stroke in Children With Sickle Cell Anemia in Nigeria: Protocol for a Mixed Methods Implementation Study in a Community Hospital", journal="JMIR Res Protoc", year="2022", month="Jun", day="13", volume="11", number="6", pages="e37927", keywords="sickle cell anemia", keywords="stroke prevention", keywords="transcranial Doppler ultrasonography", abstract="Background: In Nigeria, approximately 150,000 children with sickle cell anemia (SCA) are born annually, accounting for more than half of all SCA births worldwide. Without intervention, about 11\% of children with SCA will develop a stroke before their 20th birthday. Evidence-based practices for primary stroke prevention include screening for abnormal transcranial Doppler (TCD) measurements coupled with regular blood transfusion therapy for at least one year, followed by hydroxyurea (HU) therapy indefinitely. In high-resource countries, this strategy contributes to a 92\% decrease in stroke incidence rates. In 2016, as part of a capacity building objective of the Stroke Prevention Trial in Nigeria (1R01NS094041: SPRING), TCD screening was adopted as standard care at Barau Dikko Teaching Hospital in Kaduna. However, with just 70 radiologists and only 3 certified in TCD screening in the state, just 5.49\% (1101/20,040) of eligible children with SCA were screened. Thus, there is a need to explore alternate implementation strategies to ensure children with SCA receive standard care TCD screening to decrease stroke incidence. Objective: This protocol describes a study to create a stroke prevention program in a community hospital in Kaduna through task shifting TCD screening to nurses and training medical officers to initiate and monitor HU utilization for stroke prevention. Methods: This study will be conducted at 2 sites (teaching hospital and community hospital) over a period of 3 years (November 2020 to November 2023), in 3 phases using both quasi-experimental and effectiveness-implementation study designs. In the needs assessment phase, focus groups and structured interviews will be conducted with health care providers and hospital administrators to identify barriers and facilitators to evidence-based stroke prevention practices. Results from the needs assessment will inform intervention strategies and a process plan to fit the needs of the community hospital. In the capacity building phase, nurses and medical officers at the community hospital will be trained on TCD screening and HU initiation and monitoring. In the implementation phase, children with SCA aged 2-16 years will be recruited into a nonrandomized single-arm prospective trial to determine the feasibility of initiating a task-shifted stroke prevention program by recording recruitment, retention, and adherence rates. The Reach and Effectiveness components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework will be used to evaluate implementation outcomes between the community and teaching hospitals. Results: The needs assessment phase of the study was completed in February 2021. Manuscript on findings is currently in preparation. Capacity building is ongoing with TCD training and sickle cell disease and stroke education sessions for nurses and doctors in the community hospital. Recruitment for the implementation trial is expected to commence in July 2022. Conclusions: This study proposes a structured, theory-driven approach to create a stroke prevention program in a community hospital in Kaduna, Nigeria, to decrease stroke incidence among children with SCA. Results will provide preliminary data for a definitive randomized clinical trial in implementation science. International Registered Report Identifier (IRRID): PRR1-10.2196/37927 ", doi="10.2196/37927", url="https://www.researchprotocols.org/2022/6/e37927", url="http://www.ncbi.nlm.nih.gov/pubmed/35700018" } @Article{info:doi/10.2196/34904, author="Chelberg, R. Georgina and Butten, Kaley and Mahoney, Ray and ", title="Culturally Safe eHealth Interventions With Aboriginal and Torres Strait Islander People: Protocol for a Best Practice Framework", journal="JMIR Res Protoc", year="2022", month="Jun", day="10", volume="11", number="6", pages="e34904", keywords="eHealth", keywords="mHealth", keywords="telehealth", keywords="Aboriginal", keywords="Indigenous", keywords="First Nations", keywords="best practice", keywords="Australia", keywords="development", keywords="framework", keywords="Torres Strait Islander", keywords="co-design", keywords="culturally safe", keywords="culturally sensitive", keywords="evaluation", keywords="health care model", abstract="Background: There is growing global evidence on the adoption and effectiveness of eHealth (including mobile health and telehealth) by First Nation peoples including Aboriginal and Torres Strait Islander people. Although there are frameworks to guide eHealth development, implementation, and evaluation, it is unknown whether they adequately encapsulate the health, cultural, and community-related priorities of Aboriginal and Torres Strait Islander people. Objective: The aim of this research program is to prepare a best practice framework that will guide the co-design, implementation, and evaluation of culturally safe eHealth interventions within existing models of health care for Aboriginal and Torres Strait Islander people. The framework will be a synthesis of evidence that represents best practices in eHealth, as determined by Aboriginal and Torres Strait Islander people. Methods: Research activities to develop the best practice framework will occur in stepped but overlapping qualitative research phases with governance from an existing multiagency research collaboration (the Collaboration). The research protocol has been informed by key research frameworks such as the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and Developers of Health Research Reporting Guidelines. The seven phases of research will include the following: systematic literature review, scoping review, theme development, theme consultation, Delphi processes for expert reviews, and dissemination. Results: Members of the Collaboration conceived this research program in August 2020, and a draft was produced in June 2021 with subsequent funding obtained in July 2021. The Collaboration approved the protocol in December 2021. Results for several research phases of the best practice framework development are expected by January 2023, commencing with the systematic literature review and the scoping review. Conclusions: The research program outlined in this protocol is a timely response to the growing number of eHealth interventions with Aboriginal and Torres Strait Islander people. A best practice framework is needed to guide the rigorous development and evaluation of eHealth innovations to promote genuine co-design and ensure cultural safety and clinical effectiveness for Aboriginal and Torres Strait Islander people. International Registered Report Identifier (IRRID): DERR1-10.2196/34904 ", doi="10.2196/34904", url="https://www.researchprotocols.org/2022/6/e34904", url="http://www.ncbi.nlm.nih.gov/pubmed/35687420" } @Article{info:doi/10.2196/35155, author="Kateera, Fredrick and Riviello, Robert and Goodman, Andrea and Nkurunziza, Theoneste and Cherian, Teena and Bikorimana, Laban and Nkurunziza, Jonathan and Nahimana, Evrard and Habiyakare, Caste and Ntakiyiruta, Georges and Matousek, Alexi and Gaju, Erick and Gruendl, Magdalena and Powell, Brittany and Sonderman, Kristin and Koch, Rachel and Hedt-Gauthier, Bethany", title="The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Jun", day="8", volume="10", number="6", pages="e35155", keywords="obstetric surgery", keywords="community health workers", keywords="mobile health", keywords="surgical site infections", keywords="c-section", keywords="infection", keywords="community health", keywords="Rwanda", abstract="Background: The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)--led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include postoperative care for women after c-section, such as SSI screenings. Objective: This trial assesses whether CHW's use of a mobile health (mHealth)--facilitated checklist administered in person or via phone call improved rates of return to care among women who develop an SSI following c-section at a rural Rwandan district hospital. A secondary objective was to assess the feasibility of implementing the CHW-led mHealth intervention in this rural district. Methods: A total of 1025 women aged ?18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into the three following postoperative care arms: (1) home visit intervention (n=335, 32.7\%), (2) phone call intervention (n=334, 32.6\%), and (3) standard of care (n=356, 34.7\%). A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in the two intervention arms, while patients in the standard of care arm were instructed to adhere to routine health center follow-up. We assessed intervention completion in each intervention arm and used logistic regression to assess the odds of returning to care. Results: The majority of women in Arm 1 (n=295, 88.1\%) and Arm 2 (n=226, 67.7\%) returned to care and were assessed for an SSI at their local health clinic. There were no significant differences in the rates of returning to clinic within 30 days (P=.21), with high rates found consistently across all three arms (Arm 1: 99.7\%, Arm 2: 98.4\%, and Arm 3: 99.7\%, respectively). Conclusions: Home-based post--c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. In this study, we found no difference in return to care rates between the intervention arms and standard of care. However, given our previous study findings describing the significant patient-incurred financial burden posed by traveling to a health center, we believe this intervention has the potential to reduce this burden by limiting patient travel to the health center when an SSI is ruled out at home. Further studies are needed (1) to determine the acceptability of this intervention by CHWs and patients as a new standard of care after c-section and (2) to assess whether an app supplementing the mHealth screening checklist with image-based machine learning could improve CHW diagnostic accuracy. Trial Registration: ClinicalTrials.gov NCT03311399; https://clinicaltrials.gov/ct2/show/NCT03311399 ", doi="10.2196/35155", url="https://mhealth.jmir.org/2022/6/e35155", url="http://www.ncbi.nlm.nih.gov/pubmed/35675108" } @Article{info:doi/10.2196/28885, author="Stocks, Jacob and Ibrahim, Saduma and Park, Lawrence and Huchko, Megan", title="Mobile Phone Ownership and Use Among Women Screening for Cervical Cancer in a Community-Based Setting in Western Kenya: Observational Study", journal="JMIR Public Health Surveill", year="2022", month="Jun", day="7", volume="8", number="6", pages="e28885", keywords="cell phone", keywords="mobile health", keywords="mHealth", keywords="cervical cancer screening", keywords="Kenya", keywords="human papillomavirus", keywords="HPV testing", abstract="Background: Mobile phone ownership among women of reproductive age in western Kenya is not well described, and our understanding of its link with care-seeking behaviors is nascent. Understanding access to and use of mobile phones among this population as well as willingness to participate in mobile health interventions are important in improving and more effectively implementing mobile health strategies. Objective: This study aims to describe patterns of mobile phone ownership and use among women attending cervical cancer screening and to identify key considerations for the use of SMS text message--guided linkage to treatment strategies and other programmatic implications for cervical cancer screening in Kenya. Methods: This analysis was nested within a cluster randomized trial evaluating various strategies for human papillomavirus (HPV)--based cervical cancer screening and prevention in a rural area in western Kenya between February and November 2018. A total of 3299 women were surveyed at the time of screening and treatment. Questionnaires included items detailing demographics, health history, prior care-seeking behaviors, and patterns of mobile phone ownership and use. We used bivariate and multivariable log-binomial regression to analyze associations between independent variables and treatment uptake among women testing positive for high-risk HPV. Results: Rates of mobile phone ownership (2351/3299, 71.26\%) and reported daily use (2441/3299, 73.99\%) were high among women. Most women (1953/3277, 59.59\%) were comfortable receiving their screening results via SMS text messages, although the most commonly preferred method of notification was via phone calls. Higher levels of education (risk ratio 1.23, 95\% CI 1.02-1.50), missing work to attend screening (risk ratio 1.29, 95\% CI 1.10-1.52), and previous cervical cancer screening (risk ratio 1.27, 95\% CI 1.05-1.55) were significantly associated with a higher risk of attending treatment after testing high-risk HPV--positive, although the rates of overall treatment uptake remained low (278/551, 50.5\%) among this population. Those who shared a mobile phone with their partner or spouse were less likely to attend treatment than those who owned a phone (adjusted risk ratio 0.69, 95\% CI 0.46-1.05). Treatment uptake did not vary significantly according to the type of notification method, which were SMS text message, phone call, or home visit. Conclusions: Although the rates of mobile phone ownership and use among women in western Kenya are high, we found that individual preferences for communication of messages about HPV results and treatment varied and that treatment rates were low across the entire cohort, with no difference by modality (SMS text message, phone call, or home visit). Therefore, although text-based results performed as well as phone calls and home visits, our findings highlight the need for more work to tailor communication about HPV results and support women as they navigate the follow-up process. ", doi="10.2196/28885", url="https://publichealth.jmir.org/2022/6/e28885", url="http://www.ncbi.nlm.nih.gov/pubmed/35671089" } @Article{info:doi/10.2196/34298, author="Schmude, Marcel and Salim, Nahya and Azadzoy, Hila and Bane, Mustafa and Millen, Elizabeth and O'Donnell, Lisa and Bode, Philipp and T{\"u}rk, Ewelina and Vaidya, Ria and Gilbert, Stephen", title="Investigating the Potential for Clinical Decision Support in Sub-Saharan Africa With AFYA (Artificial Intelligence-Based Assessment of Health Symptoms in Tanzania): Protocol for a Prospective, Observational Pilot Study", journal="JMIR Res Protoc", year="2022", month="Jun", day="7", volume="11", number="6", pages="e34298", keywords="differential diagnosis", keywords="artificial intelligence", keywords="clinical decision support systems", keywords="decision support", keywords="diagnostic decision support systems", keywords="diagnosis", keywords="Africa", keywords="low income", keywords="middle income", keywords="user centred design", keywords="user centered design", keywords="symptom assessment", keywords="chatbot", keywords="health app", keywords="prototype", abstract="Background: Low- and middle-income countries face difficulties in providing adequate health care. One of the reasons is a shortage of qualified health workers. Diagnostic decision support systems are designed to aid clinicians in their work and have the potential to mitigate pressure on health care systems. Objective: The Artificial Intelligence--Based Assessment of Health Symptoms in Tanzania (AFYA) study will evaluate the potential of an English-language artificial intelligence--based prototype diagnostic decision support system for mid-level health care practitioners in a low- or middle-income setting. Methods: This is an observational, prospective clinical study conducted in a busy Tanzanian district hospital. In addition to usual care visits, study participants will consult a mid-level health care practitioner, who will use a prototype diagnostic decision support system, and a study physician. The accuracy and comprehensiveness of the differential diagnosis provided by the diagnostic decision support system will be evaluated against a gold-standard differential diagnosis provided by an expert panel. Results: Patient recruitment started in October 2021. Participants were recruited directly in the waiting room of the outpatient clinic at the hospital. Data collection will conclude in May 2022. Data analysis is planned to be finished by the end of June 2022. The results will be published in a peer-reviewed journal. Conclusions: Most diagnostic decision support systems have been developed and evaluated in high-income countries, but there is great potential for these systems to improve the delivery of health care in low- and middle-income countries. The findings of this real-patient study will provide insights based on the performance and usability of a prototype diagnostic decision support system in low- or middle-income countries. Trial Registration: ClinicalTrials.gov NCT04958577; http://clinicaltrials.gov/ct2/show/NCT04958577 International Registered Report Identifier (IRRID): DERR1-10.2196/34298 ", doi="10.2196/34298", url="https://www.researchprotocols.org/2022/6/e34298", url="http://www.ncbi.nlm.nih.gov/pubmed/35671073" } @Article{info:doi/10.2196/37356, author="Phoo, Nge Nang Nge and Lobo, Roanna and Vujcich, Daniel and Reid, Alison", title="Comparison of the ACASI Mode to Other Survey Modes in Sexual Behavior Surveys in Asia and Sub-Saharan Africa: Systematic Literature Review", journal="J Med Internet Res", year="2022", month="May", day="31", volume="24", number="5", pages="e37356", keywords="ACASI", keywords="survey mode", keywords="sexual behaviors", keywords="HIV", keywords="STI", keywords="hepatitis", keywords="blood-borne virus", keywords="Asia", keywords="sub-Saharan Africa", keywords="review", abstract="Background: Reliable data about sexual behaviors is fundamental in the prevention and control of HIV, hepatitis, and other sexually transmitted infections. Generally, sexual behaviors are regarded as a sociocultural taboo in Africa and Asia, and this results in biased sexual behavior survey data due to social desirability. Various modes of survey delivery, including audio computer-assisted self-interviews (ACASIs), have been investigated to improve data quality. Objective: This study aimed to review studies that compared the ACASI mode to other survey modes in sexual behavior surveys in Asia and sub-Saharan Africa to ascertain the impact of survey mode on responses to sexual behavior questions. Methods: A systematic literature review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The review protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews). Six databases were searched. Results: A total of 21 papers were included. The face-to-face interview (FTFI) mode was the survey mode most frequently compared to the ACASI mode. Among the most commonly reported outcome variable groups, ACASI participants were more likely to report sexual behaviors, such as ``forced sex,'' ``multiple partners,'' ``transactional sex,'' and ``ever had sex,'' as compared to FTFI participants. In addition to the survey mode effect, other factors were found to have had an impact on data quality, for example, participant characteristics, social norms, study design, and data collection setting. Conclusions: Use of ACASIs for administering sexual behavior surveys among populations in Asia and sub-Saharan Africa demonstrated higher reports for some sexual behaviors than the use of FTFIs. More studies that compare the ACASI mode to other survey modes would improve our understanding of the usefulness of ACASIs in sexual behavior surveys in these regions. ", doi="10.2196/37356", url="https://www.jmir.org/2022/5/e37356", url="http://www.ncbi.nlm.nih.gov/pubmed/35639465" } @Article{info:doi/10.2196/34071, author="Ntina, Georgia and Mavromanolaki, Eirini and Flouris, D. Andreas", title="Toward More Inclusive Networks and Initiatives in Innovation Ecosystems: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2022", month="May", day="25", volume="11", number="5", pages="e34071", keywords="stakeholders", keywords="investors", keywords="best practice", keywords="resources", keywords="cluster", keywords="accelerator", keywords="hub", keywords="diverse", keywords="diversity", keywords="innovative", keywords="ecosystem", keywords="innovation ecosystem", keywords="opening-up strategies", abstract="Background: Expanding the cooperation and enlarging the participation of more diverse stakeholders within innovation ecosystems will increase their efficiency and capacity to contribute at local, regional, and national levels. Objective: This paper presents the protocol for a systematic review that will identify ``opening-up'' strategies of innovation ecosystems for increasing the participation of more diverse innovation stakeholders, particularly from low-innovation countries, during the ecosystem formation period. Methods: An algorithmic search in 4 databases (Web of Science, Cochrane Library, Scopus, and Social Science Research Network) will be applied based on the PerSPecTIF (perspective, setting, phenomenon of interest/problem, environment, optional comparison, time/timing, and findings) methodology, the Cochrane guidelines for qualitative evidence synthesis, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Selection criteria for eligibility include peer-reviewed articles published after December 31, 1999, and containing original data. No restrictions will be placed on the article language and study region, design, or methodology. Methodological strengths and limitations will be assessed using the Critical Appraisal Skills Programme tool. The thematic synthesis method will be adopted, and the GRADE-CERQual tool will be used to assess confidence. Results: A preliminary search in Web of Science revealed 2758 records. This work is part of the ANGIE project, which was funded by the European Union's Horizon 2020 research and innovation program (grant 952152) in January 2021. We anticipate that the results of this systematic review will be published in spring 2022. Conclusions: We anticipate that the outcomes of this systematic review will outline the best practices used by initiatives and networks, as well as their impacts on creating larger and more inclusive ecosystems. Trial Registration: OSF Registries osf.io/hc62k 10.17605/OSF.IO/HC62K International Registered Report Identifier (IRRID): PRR1-10.2196/34071 ", doi="10.2196/34071", url="https://www.researchprotocols.org/2022/5/e34071", url="http://www.ncbi.nlm.nih.gov/pubmed/35612890" } @Article{info:doi/10.2196/37659, author="MacDonell, Kolmodin Karen and Wang, Bo and Phanuphak, Nittaya and Janamnuaysook, Rena and Srimanus, Peevara and Rongkavilit, Chokechai and Naar, Sylvie", title="Optimizing an mHealth Intervention to Improve Uptake and Adherence to HIV Pre-exposure Prophylaxis in Young Transgender Women: Protocol for a Multi-Phase Trial", journal="JMIR Res Protoc", year="2022", month="May", day="19", volume="11", number="5", pages="e37659", keywords="transgender women", keywords="PrEP", keywords="HIV prevention", keywords="mHealth", keywords="motivational interviewing", keywords="Thailand", keywords="mobile phone", abstract="Background: Vulnerable adolescents and emerging adults (aged 18-29 years), particularly young transgender women, are among the fastest-growing HIV positive populations worldwide. Thailand has the highest adult HIV seroprevalence in Asia, with a rate of infection among this population of 18\%. Widespread technology offers opportunities for innovative mobile health (mHealth) interventions. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy recommended for at-risk individuals. PrEP is highly effective when taken as prescribed, but uptake and adherence have been low, with high discontinuation rates among youth. Objective: We propose to develop and pilot a multi-component, technology-based intervention to promote PrEP usage. We will adapt an existing 2-session, technology-delivered, motivational interviewing-based intervention to focus on PrEP use in transgender women in Thailand. We call this the Motivational Enhancement System for PrEP Uptake and Adherence (MES-PrEP). We will also refine and enhance YaCool, a mobile app with integrated text messaging developed and used clinically by our Thai team. The new version of the app is called Enhanced YaCool, and it enables self-management of gender and sexual health (including PrEP). Our primary aim is to develop and assess the preliminary efficacy of this mHealth intervention. Methods: We will utilize a multiphase optimization strategy (MOST) to identify the most effective intervention component or combination of components to improve PrEP usage in Thai transgender women. The study includes two phases: phase I (R21) includes qualitative interviews with key stakeholders to explore barriers and facilitators of PrEP usage through thematic analysis to inform intervention adaptation. Following this, we will adapt and beta-test MES-PrEP and Enhanced YaCool for functionality and feasibility using a community advisory board of HIV-negative Thai transgender women. In phase II (R33), we will conduct a MOST design-based trial to evaluate the feasibility, acceptability, and preliminary efficacy of MES-PrEP and Enhanced YaCool. Eighty HIV-negative participants who are currently taking PrEP and 80 participants who are not will be randomized to four conditions: (1) standard PrEP counseling (the control condition); (2) MES-PrEP and standard PrEP counseling; (3) Enhanced YaCool and standard PrEP counseling; and (4) MES-PrEP, Enhanced YaCool, and standard PrEP counseling. Feasibility and acceptability of the intervention will be assessed through usage patterns and the System Usability Scale. Preliminary impact will be assessed by evaluating the proportion of participants who initiate PrEP and their level of adherence to PrEP. Assessments will be at baseline and 1, 3, 6, 9, and 12 months postintervention. Biomarkers of adherence to PrEP, HIV, and other sexually transmitted infections will be collected. Results: Upon project completion, we will have an optimized mHealth intervention to support the use of PrEP by transgender women that will be ready for testing in a larger efficacy trial. Conclusions: Even though transgender women in Thailand face increasing risks of HIV, few interventions have targeted them. Effective developmentally and culturally tailored interventions are needed to prevent HIV transmission in this high-risk population. Trial Registration: ClinicalTrials.gov NCT05262426; https://clinicaltrials.gov/ct2/show/NCT05262426 International Registered Report Identifier (IRRID): PRR1-10.2196/37659 ", doi="10.2196/37659", url="https://www.researchprotocols.org/2022/5/e37659", url="http://www.ncbi.nlm.nih.gov/pubmed/35587370" } @Article{info:doi/10.2196/34041, author="Watkins, L. Rebecca and Browne, A. Felicia and Kizakevich, N. Paul and Howard, N. Brittni and Turner, B. Leslie and Eckhoff, Randall and Wechsberg, M. Wendee", title="An Evidence-Based HIV Risk--Reduction Intervention for Young African American Women in the US South Using mHealth: Adaptation and Development Study", journal="JMIR Form Res", year="2022", month="May", day="9", volume="6", number="5", pages="e34041", keywords="substance use", keywords="prevention", keywords="e-learning", keywords="adaptation", keywords="mobile apps", keywords="health risk behaviors", keywords="self-directed learning", keywords="HIV", keywords="women", keywords="young women", keywords="violence", keywords="mHealth app", keywords="gamification", keywords="mobile phone", abstract="Background: Young African American women have higher rates of sexually transmitted infections, including HIV, than those of young women of other racial and ethnic groups. Gender-, culture-, and age-specific interventions are needed to end the HIV epidemic. The Women's CoOp (WC) is an HIV risk--reduction intervention that is proven to be efficacious in various face-to-face formats. Objective: This study aims to adapt the delivery method of an evidence-based intervention, the WC, from an in-person format to a self-guided mobile health (mHealth) format while ensuring that core elements are maintained for intervention comparability and fidelity. Methods: Several adaptation phases were conducted by using the Personal Health Informatics and Intervention Toolkit (PHIT) as a guiding point to create the mobile app version of the WC. Throughout 5 phases, we established the implementation groundwork for the app; conducted formative research activities to test the initial draft of the app and obtain feedback; applied the PHIT toolkit programming structure to produce the mHealth version of the WC intervention; conducted usability testing and pretesting with interested parties, followed by in-house testing by WC interventionists and PHIT developers; and deployed the app to tablets and distributed it to study participants. The app underwent regular maintenance updates during the study. Results: The team converted the seven elements of the WC as accurately as possible for comparability to determine efficacy in a mobile app format while changing little about the basic delivery methods. For instance, cue card presentations of the materials delivered by the intervention staff were presented within the app but with voice-over narration and in a self-guided format rather than being led by a staff member. Other aspects of the intervention did not lend themselves to such straightforward adaptation, such as hands-on condom proficiency practice and one-on-one goal-setting activities. In these cases, the subject matter experts and app developers worked together to find comparable analogs to be used within the app. Once developed, tested, and finalized, the mHealth WC app was deployed into local health departments as part of a randomized trial. Conclusions: This systematic adaptation process created an accurate mHealth equivalent of an existing, in-person behavioral health intervention. Although participants' reception of the app during the formative developmental phase was overall positive, maintaining fidelity to the in-person delivery compromised the natural capabilities of a mobile app, such as further gamification, different types of interactivity, and integrated notifications and messaging, which could be helpful for participants' adherence to the intervention schedule. Given the development and implementation of the app, the next step is to examine the impact of the app and its efficacy in HIV and substance use risk-reduction. ", doi="10.2196/34041", url="https://formative.jmir.org/2022/5/e34041", url="http://www.ncbi.nlm.nih.gov/pubmed/35532978" } @Article{info:doi/10.2196/34262, author="Matthews, T. Lynn and Psaros, Christina and Mathenjwa, Mxolisi and Mosery, Nzwakie and Greener, Rambally Letitia and Khidir, Hazar and Hovey, R. Jacquelyn and Pratt, C. Madeline and Harrison, Abigail and Bennett, Kara and Bangsberg, R. David and Smit, A. Jennifer and Safren, A. Steven", title="Demonstration and Acceptability of a Safer Conception Intervention for Men With HIV in South Africa: Pilot Cohort Study", journal="JMIR Form Res", year="2022", month="May", day="4", volume="6", number="5", pages="e34262", keywords="men with HIV", keywords="HIV prevention", keywords="safer conception", keywords="U=U", keywords="treatment as prevention", keywords="reproductive health", keywords="South Africa", abstract="Background: Many men with HIV (MWH) want to have children. HIV viral suppression minimizes sexual HIV transmission risks while allowing for conception and optimization of the health of men, their partners, and their infants. Objective: This study developed and evaluated the feasibility and acceptability of an intervention to promote serostatus disclosure, antiretroviral therapy (ART) uptake and adherence, and viral suppression among MWH who want to have children in South Africa. Methods: We developed a safer conception intervention (Sinikithemba Kwabesilisa or We give hope to men) to promote viral suppression via ART uptake and adherence, HIV serostatus disclosure, and other safer conception strategies for MWH in South Africa. Through 3 counseling and 2 booster sessions over 12 weeks, we offered education on safer conception strategies and aided participants in developing a safer conception plan. We recruited MWH (HIV diagnosis known for >1 month), not yet accessing ART or accessing ART for <3 months, in a stable partnership with an HIV-negative or unknown-serostatus woman, and wanting to have a child in the following year. We conducted an open pilot study to evaluate acceptability based on patient participation and exit interviews and feasibility based on recruitment and retention. In-depth exit interviews were conducted with men to explore intervention acceptability. Questionnaires collected at baseline and exit assessed disclosure outcomes; CD4 and HIV-RNA data were used to evaluate preliminary impacts on clinical outcomes of interest. Results: Among 31 eligible men, 16 (52\%) enrolled in the study with a median age of 29 (range 27-44) years and a median time-since-diagnosis of 7 months (range 1 month to 9 years). All identified as Black South African, with 56\% (9/16) reporting secondary school completion and 44\% (7/16) reporting full-time employment. Approximately 44\% (7/16) of participants reported an HIV-negative (vs unknown-serostatus) partner. Approximately 88\% (14/16) of men completed the 3 primary counseling sessions. In 11 exit interviews, men reported personal satisfaction with session content and structure while also suggesting that they would refer their peers to the program. They also described the perceived effectiveness of the intervention and self-efficacy to benefit. Although significance testing was not conducted, 81\% (13/16) of men were taking ART at the exit, and 100\% (13/13) of those on ART were virally suppressed at 12 weeks. Of the 16 men, 12 (75\%) reported disclosure to pregnancy partners. Conclusions: These preliminary data suggest that safer conception care is acceptable to men and has the potential to reduce HIV incidence among women and their children while supporting men's health. Approximately half of the men who met the screening eligibility criteria were enrolled. Accordingly, refinement to optimize uptake is needed. Providing safer conception care and peer support at the community level may help reach men. Trial Registration: ClinicalTrials.gov NCT03818984; https://clinicaltrials.gov/ct2/show/NCT03818984 International Registered Report Identifier (IRRID): RR2-10.1007/s10461-017-1719-4 ", doi="10.2196/34262", url="https://formative.jmir.org/2022/5/e34262", url="http://www.ncbi.nlm.nih.gov/pubmed/35507406" } @Article{info:doi/10.2196/33552, author="El Tantawi, Maha and Folayan, O. Morenike and Bhayat, Ahmed", title="Oral Health Status and Practices, and Anthropometric Measurements of Preschool Children: Protocol for a Multi-African Country Survey", journal="JMIR Res Protoc", year="2022", month="Apr", day="27", volume="11", number="4", pages="e33552", keywords="oral health", keywords="early childhood caries", keywords="oral hygiene", keywords="dietary intake", keywords="Africa", keywords="preschool children", keywords="dentistry", keywords="oral disease", abstract="Background: Oral diseases are among the most prevalent conditions with significant impact on the growth and development of young children. Data are required to plan effectively for the management of early childhood caries (ECC) and other oral diseases in this age. There are currently very few African countries with updated and nationally representative data on ECC prevalence, and risk indicators and regional data on ECC and other oral diseases are scarce. Objective: We aim to determine the oral health status and practices, dietary intake, and anthropometric measurements of preschool children in several African countries. Methods: A cross-sectional study will be conducted in several African countries using a standardized questionnaire and clinical examination for data collection from healthy preschool children in kindergartens and primary health care facilities. The clinical examination will assess ECC using the decayed, missing due to caries, and filled teeth (dmft) index according to the World Health Organization (WHO) criteria, dental erosion (using the Basic Erosive Wear Examination Index), deciduous molar hypomineralization (using the European Association of Paediatric Dentistry criteria), dental fluorosis (using Dean's Index), oral hygiene status (using the Oral Hygiene Index Simplified), and oral mucosal lesions. Oral hygiene habits and dental visits will be assessed using the WHO child questionnaire, and dietary intake will be assessed using the Food and Agriculture Organization method. Anthropometric measurements will be obtained following the International Society for the Advancement of Kinanthropometry standard protocol, and the children's nutritional status will be assessed following the WHO child growth standards. To train and calibrate examiners, educational resources and electronic forms will be used to reach interexaminer and intraexaminer reliability with $\kappa$>0.6. Descriptive analysis will determine the prevalence of clinical conditions by age and sex. Bivariate analysis and multivariable regression will assess associations between the clinical conditions and sociodemographic factors, and oral health behaviors. Results: Data collection will begin after approvals and ethical clearance are obtained. The first stage will include 3 countries, namely Egypt, Nigeria, and South Africa, and collaborators from other African countries will join afterward. Conclusions: This study will lay down the foundations for using validated tools to collect data on the oral health of young children in Africa, allowing researchers from different countries across Africa to collect standardized data on ECC and other oral conditions. This will facilitate comparisons and analysis of risk factors that might be unique to the African continent. The results will provide baseline data on the prevalence of oral diseases and enable planning to address the treatment needs of young African children and design programs to prevent oral diseases in the African continent. International Registered Report Identifier (IRRID): PRR1-10.2196/33552 ", doi="10.2196/33552", url="https://www.researchprotocols.org/2022/4/e33552", url="http://www.ncbi.nlm.nih.gov/pubmed/35476047" } @Article{info:doi/10.2196/30518, author="Chanyalew, Asressie Moges and Yitayal, Mezgebu and Atnafu, Asmamaw and Mengiste, Anagaw Shegaw and Tilahun, Binyam", title="The Effectiveness of the Capacity Building and Mentorship Program in Improving Evidence-Based Decision-making in the Amhara Region, Northwest Ethiopia: Difference-in-Differences Study", journal="JMIR Med Inform", year="2022", month="Apr", day="22", volume="10", number="4", pages="e30518", keywords="capacity building", keywords="mentorship", keywords="mentoring", keywords="mentor", keywords="training", keywords="data use", keywords="information use", keywords="facility head", keywords="department head", keywords="quasi-experiment", keywords="difference-in-differences", keywords="Ethiopia", keywords="Amhara", keywords="weak health information system", keywords="HIS", keywords="health information system", keywords="CBMP", keywords="DID", keywords="decision-making", keywords="Africa", keywords="evidence based", keywords="effectiveness", abstract="Background: Weak health information systems (HISs) hobble countries' abilities to effectively manage and distribute their resources to match the burden of disease. The Capacity Building and Mentorship Program (CBMP) was implemented in select districts of the Amhara region of Ethiopia to improve HIS performance; however, evidence about the effectiveness of the intervention was meager. Objective: This study aimed to determine the effectiveness of routine health information use for evidence-based decision-making among health facility and department heads in the Amhara region, Northwest Ethiopia. Methods: The study was conducted in 10 districts of the Amhara region: five were in the intervention group and five were in the comparison group. We employed a quasi-experimental study design in the form of a pretest-posttest comparison group. Data were collected from June to July 2020 from the heads of departments and facilities in 36 intervention and 43 comparison facilities. The sample size was calculated using the double population formula, and we recruited 172 participants from each group. We applied a difference-in-differences analysis approach to determine the effectiveness of the intervention. Heterogeneity of program effect among subgroups was assessed using a triple differences method (ie, difference-in-difference-in-differences [DIDID] method). Thus, the $\beta$ coefficients, 95\% CIs, and P values were calculated for each parameter, and we determined that the program was effective if the interaction term was significant at P<.05. Results: Data were collected using the endpoint survey from 155 out of 172 (90.1\%) participants in the intervention group and 166 out of 172 (96.5\%) participants in the comparison group. The average level of information use for the comparison group was 37.3\% (95\% CI 31.1\%-43.6\%) at baseline and 43.7\% (95\% CI 37.9\%-49.5\%) at study endpoint. The average level of information use for the intervention group was 52.2\% (95\% CI 46.2\%-58.3\%) at baseline and 75.8\% (95\% CI 71.6\%-80.0\%) at study endpoint. The study indicated that the net program change over time was 17\% (95\% CI 5\%-28\%; P=.003). The subgroup analysis also indicated that location showed significant program effect heterogeneity, with a DIDID estimate equal to 0.16 (95\% CI 0.026-0.29; P=.02). However, sex, age, educational level, salary, and experience did not show significant heterogeneity in program effect, with DIDID estimates of 0.046 (95\% CI --0.089 to 0.182), --0.002 (95\% CI --0.015 to 0.009), --0.055 (95\% CI --0.190 to 0.079), --1.63 (95\% CI --5.22 to 1.95), and --0.006 (95\% CI --0.017 to 0.005), respectively. Conclusions: The CBMP was effective at enhancing the capacity of study participants in using the routine HIS for decision-making. We noted that urban facilities had benefited more than their counterparts. The intervention has been shown to produce positive outcomes and should be scaled up to be used in other districts. Moreover, the mentorship modalities for rural facilities should be redesigned to maximize the benefits. Trial Registration: Pan African Clinical Trials Registry PACTR202001559723931; https://tinyurl.com/3j7e5ka5 ", doi="10.2196/30518", url="https://medinform.jmir.org/2022/4/e30518", url="http://www.ncbi.nlm.nih.gov/pubmed/35451990" } @Article{info:doi/10.2196/32784, author="Odom, J. Krista and Ottosson, Amanda and Draru, Joyce and Komujuni, Harriet and Karamagi Nkolo, Karungi Esther and Faramand, Harb Taroub", title="Improving Viral Load Suppression Among Men and Children Active in Care Through Community-Designed and Led Solutions: Protocol for Retrospective Closed Cohort Study in Eastern Uganda", journal="JMIR Res Protoc", year="2022", month="Apr", day="13", volume="11", number="4", pages="e32784", keywords="HIV/AIDS", keywords="viral load suppression", keywords="Uganda", keywords="people living with HIV", keywords="95-95-95", keywords="social and behavior change", keywords="USAID", keywords="gender, youth, and social inclusion", keywords="virus", keywords="HIV", keywords="AIDS", keywords="antiretroviral therapy", keywords="behavioral science", keywords="implementation science", keywords="behavior change", keywords="men", keywords="children", keywords="community design", keywords="methodology", abstract="Background: In collaboration with facilities, communities, district local government, and the United States Agency for International Development (USAID) implementing partners, the iDARE methodology was implemented at the community level to address root causes of low HIV antiretroviral therapy adherence among men and children actively enrolled in care, resulting in low viral load suppression (VLS) in two districts in the eastern region of Uganda. The methodology encourages the use of cocreated sustainable solutions addressing gender, youth, and social inclusion issues to reduce barriers to care and reach the 95-95-95 Joint United Nations Programme on HIV/AIDS target for HIV epidemic control. We aim to measure the impact of iDARE on VLS for men and children active in care and investigate the practical scale up of the solutions designed using the iDARE methodology. Objective: The primary objective of this study will be to measure the implementation impact of the iDARE methodology at the facility and community levels on VLS for people living with HIV. The secondary objective is to investigate the practical scale up of the iDARE methodology using evidence-based gender, youth, and social inclusion social behavior change packages to rapidly meet the Ugandan Ministry of Health targets for VLS. Methods: A retrospective cohort study design will be used to analyze program data that aims to increase the rates of VLS in men and children who are classified as active in care using community engagement and quality improvement techniques. We will examine 3 pilot health centers' data from a USAID-funded program aimed at social behavior change to increase health-seeking behavior in Uganda. Based on the iDARE process and results, change packages were developed to highlight lessons learned and best practices in order to share with subsequent implementation sites. Results: The USAID-funded Social and Behavior Change Activity began implementation of iDARE in September 2020, with baseline data collected in August 2020. Conclusions: Data on viral load suppression was collected from facilities on a monthly basis to record progress toward the 95-95-95 goal. The expected primary outcome is an increase in actively enrolled men and children reaching VLS in order to meet the Ugandan Ministry of Health target of 95\% VLS among those active in care. International Registered Report Identifier (IRRID): DERR1-10.2196/32784 ", doi="10.2196/32784", url="https://www.researchprotocols.org/2022/4/e32784", url="http://www.ncbi.nlm.nih.gov/pubmed/35416790" } @Article{info:doi/10.2196/29906, author="Qu, Shuiling and Wang, Ailing and Wang, Xiaoyan and Yang, Yehuan and Pan, Xiaoping and Zhang, Tong", title="Health-Related Quality of Life of HIV-Positive and HIV-Negative Pregnant Women in an Impoverished Area: Cross-sectional Study", journal="JMIR Public Health Surveill", year="2022", month="Apr", day="5", volume="8", number="4", pages="e29906", keywords="health-related quality of life", keywords="EQ-5D-3L", keywords="HIV", keywords="impoverished area", keywords="public health", keywords="pregnant women", keywords="depression", keywords="anxiety", abstract="Background: Liangshan prefecture of Sichuan province was an impoverished mountainous area in China, where the annual number of HIV-positive pregnant women accounted for approximately 10\% of China's total population in the decades before 2020. In general, pregnant women living here are likely to be physically and mentally different from those in other places. Objective: This study aims to explore the health-related quality of life (HRQoL) of pregnant women living with HIV in an impoverished area. Methods: From December 2018 to January 2019, HIV-positive and HIV-negative parturients within 18 months after delivery were recruited in Liangshan Prefecture, Sichuan Province. Questionnaires were designed to collect their demographic data, while the EuroQol 5-Dimension, 3-Level questionnaire was used to measure their HRQoL when they were in the second trimester from 4 to 6 months of pregnancy, and their quantitative health scores were converted to corresponding healthy utility values by using the Chinese Utility Value Integral System (time trade-off coefficient). Results: A total of 250 pregnant women (133 HIV-positive and 117 HIV-negative) were enrolled in the study. Among them, 55 (41.35\%) and 75 (64.10\%) of HIV-positive and HIV-negative pregnant women self-reported full health (healthy state 11111), respectively. The median health utility value of the 250 pregnant women was 0.961 (IQR --0.046 to 0.961), and those of the HIV-positive and HIV-negative pregnant women were 0.875 (0.424-0.961) and 0.961 (IQR --0.046 to 0.961), respectively. We observed a significant difference only in the dimension of anxiety or depression between the two groups (P=.002) and no significant difference in the distribution of health utility indices between the two groups in terms of maternal age, education level, occupation, annual household income, prenatal care visits, family size, and medical insurance category. Multivariate ordinal logistic regression analysis showed that age (odds ratio [OR] 0.62, P<.05) and prenatal care visit (OR 0.29, P<.01) were independent risk factors for health status. Conclusions: Most pregnant women self-reported satisfactory HRQoL in this impoverished mountainous area. HIV-negative pregnant women had an edge over HIV-positive pregnant women, and there were significant differences in anxiety or depression dimensions between the two groups. ", doi="10.2196/29906", url="https://publichealth.jmir.org/2022/4/e29906", url="http://www.ncbi.nlm.nih.gov/pubmed/35380543" } @Article{info:doi/10.2196/33325, author="Rosen, K. Rochelle and Garbern, C. Stephanie and Gainey, Monique and Lantini, Ryan and Nasrin, Sabiha and Nelson, J. Eric and Elshabassi, Nour and Alam, H. Nur and Sultana, Sufia and Hasnin, Tahmida and Qu, Kexin and Schmid, H. Christopher and Levine, C. Adam", title="Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study", journal="JMIR Hum Factors", year="2022", month="Mar", day="25", volume="9", number="1", pages="e33325", keywords="clinical decision support tools", keywords="diarrhea management", keywords="focus group", keywords="formative qualitative research", keywords="low- and middle-income countries", keywords="mobile phone", abstract="Background: The availability of mobile clinical decision support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and apps. Although health care providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns have been raised, including perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider's perspective on the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle-income countries. Objective: This study aims to describe providers' perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on the preliminary components of the mobile CDS tool to address clinicians' concerns and incorporate their preferences. Methods: From November to December 2020, qualitative data were gathered through 8 web-based focus group discussions with physicians and nurses from 3 Bangladeshi hospitals. Each discussion was conducted in the local language---Bangla---and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo (version 12; QSR International), and applied thematic analysis was used to identify themes that explore the clinical utility of an mHealth app for assessing dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data; thematic memos were written and used for the final analysis. Results: Of the 27 focus group participants, 14 (52\%) were nurses and 13 (48\%) were physicians; 15 (56\%) worked at a diarrhea specialty hospital and 12 (44\%) worked in government district or subdistrict hospitals. Participants' experience in their current position ranged from 2 to 14 years, with an average of 10.3 (SD 9.0) years. Key themes from the qualitative data analysis included current experience with CDS, overall perception of the app's utility and its potential role in clinical care, barriers to and facilitators of app use, considerations of overtreatment and undertreatment, and guidelines for the app's clinical recommendations. Participants felt that the tool would initially take time to use, but once learned, it could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. In addition, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. Conclusions: Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to revise the mobile CDS tool. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh. ", doi="10.2196/33325", url="https://humanfactors.jmir.org/2022/1/e33325", url="http://www.ncbi.nlm.nih.gov/pubmed/35333190" } @Article{info:doi/10.2196/36060, author="Cockcroft, Anne and Omer, Khalid and Gidado, Yagana and Mohammed, Rilwanu and Belaid, Loubna and Ansari, Umaira and Mitchell, Claudia and Andersson, Neil", title="Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Mar", day="15", volume="11", number="3", pages="e36060", keywords="adolescents", keywords="sexual and reproductive health", keywords="participatory research", keywords="mixed methods research", keywords="dialogic intervention", keywords="co-design", keywords="cultural safety", keywords="Nigeria", abstract="Background: Adolescents (10-19 years) are a big segment of the Nigerian population, and they face serious risks to their health and well-being. Maternal mortality is very high in Nigeria, and rates of pregnancy and maternal deaths are high among female adolescents. Rates of HIV infection are rising among adolescents, gender violence and sexual abuse are common, and knowledge about sexual and reproductive health risks is low. Adolescent sexual and reproductive health (ASRH) indicators are worse in the north of the country. Objective: In Bauchi State, northern Nigeria, the project will document the nature and extent of ASRH outcomes and risks, discuss the findings and codesign solutions with local stakeholders, and measure the short-term impact of the discussions and proposed solutions. Methods: The participatory research project is a sequential mixed-methods codesign of a pragmatic cluster randomized controlled trial. Focus groups of local stakeholders (female and male adolescents, parents, traditional and religious leaders, service providers, and planners) will identify local priority ASRH concerns. The same stakeholder groups will map their knowledge of factors causing these concerns using the fuzzy cognitive mapping (FCM) technique. Findings from the maps and a scoping review will inform the contextualization of survey instruments to collect information about ASRH from female and male adolescents and parents in households and from local service providers. The survey will take place in 60 Bauchi communities. Adolescents will cocreate materials to share the findings from the maps and survey. In 30 communities, randomly allocated, the project will engage adolescents and other stakeholders in households, communities, and services to discuss the evidence and to design and implement culturally acceptable actions to improve ASRH. A follow-up survey in communities with and without the intervention will measure the short-term impact of these discussions and actions. We will also evaluate the intervention process and use narrative techniques to assess its impact qualitatively. Results: Focus groups to explore ASRH concerns of stakeholders began in October 2021. Baseline data collection in the household survey is expected to take place in mid-2022. The study was approved by the Bauchi State Health Research Ethics Committee, approval number NREC/03/11/19B/2021/03 (March 1, 2021), and by the Faculty of Medicine and Health Sciences Institutional Review Board McGill University (September 13, 2021). Conclusions: Evidence about factors related to ASRH outcomes in Nigeria and implementation and testing of a dialogic intervention to improve these outcomes will fill a gap in the literature. The project will document and test the effectiveness of a participatory approach to ASRH intervention research. Trial Registration: ISRCTN Registry ISRCTN18295275; https://www.isrctn.com/ISRCTN18295275 International Registered Report Identifier (IRRID): DERR1-10.2196/36060 ", doi="10.2196/36060", url="https://www.researchprotocols.org/2022/3/e36060", url="http://www.ncbi.nlm.nih.gov/pubmed/35289762" } @Article{info:doi/10.2196/33076, author="Karim, Aliya and de Savigny, Don and Ngaima, Serge Jean and M{\"a}usezahl, Daniel and Cobos Mu{\~n}oz, Daniel and Tshefu, Antoinette", title="Assessing Determinants of Programmatic Performance of Community Management of Malaria, Pneumonia, and Diarrhea in Children in Africa: Protocol and Data Collection for a Mixed Methods Evaluation of Integrated Community Case Management", journal="JMIR Res Protoc", year="2022", month="Mar", day="14", volume="11", number="3", pages="e33076", keywords="iCCM", keywords="integrated community case management", keywords="systems thinking", keywords="malaria", keywords="study design", keywords="systems methods", keywords="child health", keywords="program evaluation", abstract="Background: Integrated community case management (iCCM) is a child health program designed to provide integrated community-based care for children with pneumonia, malaria, or diarrhea in hard-to-reach areas of low- and middle-income countries. The foundation of the intervention is service delivery by community health workers (CHWs) who depend on reliable provision of drugs and supplies, consistent supervision, comprehensive training, and community acceptance and participation to perform optimally. The effectiveness of the program may also depend on a number of other elements, including an enabling policy environment, financing mechanisms from the national to the local level, data transmission systems, and appropriate monitoring and evaluation. The extent to which these factors act upon each other to influence the effectiveness and viability of iCCM is both variable and challenging to assess, especially across different implementation contexts. Objective: In this paper, we describe a mixed methods systems-based study protocol to assess the programmatic components of iCCM that are associated with intervention effectiveness and report preliminary results of data collection. Methods: This protocol uses a mixed qualitative and quantitative study design based on a systems thinking approach within four iCCM programs in Malawi, Democratic Republic of the Congo, and Niger State and Abia State in Nigeria. Routine monitoring data are collected to determine intervention effectiveness, namely testing, treatment, and referral outcomes. Surveys with CHWs, supervisors, and caregivers are performed to collect quantitative data on their demographics, activities, and experiences within the program and how these relate to the areas of intervention effectiveness. Focus group discussions are conducted with these stakeholders as well as local traditional leaders to contextualize these data. Key informant interviews are undertaken with national- and district-level program stakeholders and officers knowledgeable in critical program processes. Results: We performed 3836 surveys and 45 focus group discussions of 379 participants with CHWs, supervisors, caregivers, and traditional leaders, as well as 120 key informant interviews with district- and national-level program managers, health officers, and ministry officials. Policy and program documents were additionally collected for review. Conclusions: We expect that evidence from this study will inform child health programs and practice in low- and middle-income settings as well as future policy development within the iCCM intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/33076 ", doi="10.2196/33076", url="https://www.researchprotocols.org/2022/3/e33076", url="http://www.ncbi.nlm.nih.gov/pubmed/35285813" } @Article{info:doi/10.2196/35291, author="Memon, Ali Zahid and Reale, Sophie and Ahmed, Wardah and Spencer, Rachael and Lashari, Hussain Talib and Bhutta, Zulfiqar and Soltani, Hora", title="Effects of Integrating Family Planning With Maternal, Newborn, and Child Health Services on Uptake of Voluntary Modern Contraceptive Methods in Rural Pakistan: Protocol for a Quasi-experimental Study", journal="JMIR Res Protoc", year="2022", month="Mar", day="8", volume="11", number="3", pages="e35291", keywords="family planning", keywords="integrated health services", keywords="contraceptive prevalence rate", keywords="modern contraceptive prevalence rate", keywords="modern contraceptive method", keywords="rural Pakistan", abstract="Background: The uptake of modern contraceptive methods (MCMs) remains low, with 25\% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services. Objective: The main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs. Methods: A quasi-experimental, sequential, mixed methods study design with pre- and postevaluation will be adopted to evaluate the impact of integration of FP with MNCH services. The interventions include the following: (1) capacity strengthening of health care providers, including technical trainings; training in counseling of women who attend immunization centers, antenatal care (ANC) clinics, and postnatal care (PNC) clinics; and provision of job aids; (2) counseling of women and girls attending ANC, PNC, and pediatric clinics; (3) ensuring sustained provision of supplies and commodities; (4) community engagement, including establishing adolescent-friendly spaces; and (5) use of District Health Information System data in decision-making. Descriptive statistics will be used to estimate prevalence (ie, proportions) and frequencies of outcome indicators. A univariate difference-in-difference analytical approach will be used to estimate the effect of the interventions. In addition, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantify determinants of the modern contraceptive prevalence rate. Results: The intervention phase began in July 2021 and will run until June 2022. The impact assessment will be conducted from July to September 2022. Conclusions: This project will evaluate the impact of integrating FP with MNCH services. Furthermore, this study will identify the drivers and barriers in uptake of MCMs and will simultaneously help in modifying the interventional strategies that can be scaled up through existing service delivery platforms within the public and private sectors, according to the local sociocultural and health system context. Trial Registration: ClinicalTrials.gov NCT05045599; https://clinicaltrials.gov/ct2/show/NCT05045599 International Registered Report Identifier (IRRID): DERR1-10.2196/35291 ", doi="10.2196/35291", url="https://www.researchprotocols.org/2022/3/e35291", url="http://www.ncbi.nlm.nih.gov/pubmed/35258461" } @Article{info:doi/10.2196/32213, author="Ateudjieu, J{\'e}r{\^o}me and Tchio-Nighie, Hirma Ketina and Goura, Pascal Andr{\'e} and Ndinakie, Yakum Martin and Dieffi Tchifou, Miltiade and Amada, Lapia and Tsafack, Marcelin and Kiadjieu Dieumo, Forex Frank and Guenou, Etienne and Nangue, Charlette and Kenfack, Bruno", title="Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization: Field-Based Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2022", month="Mar", day="1", volume="8", number="3", pages="e32213", keywords="immunization status", keywords="coverage", keywords="completeness", keywords="timeliness", keywords="EPI vaccines", keywords="children under five", keywords="Foumban", keywords="Cameroon", keywords="mobile phone", abstract="Background: Countries' Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. Objective: We aim to assess whether involving community volunteers (CVs) to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children's vaccination timeliness, completeness, and coverage. Methods: This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. Results: Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5\%) and 718 (98.4\%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6\%) and 636 (97.7\%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette--Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95\% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95\% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95\% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi\thinspace+Hb) dose 3 (aOR 2.0, 95\% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95\% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95\% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95\% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. Conclusions: Findings support that involving CVs to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children's vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. Trial Registration: Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548 ", doi="10.2196/32213", url="https://publichealth.jmir.org/2022/3/e32213", url="http://www.ncbi.nlm.nih.gov/pubmed/35230249" } @Article{info:doi/10.2196/33848, author="Ashworth, Henry and Ebrahim, Senan and Ebrahim, Hassaan and Bhaiwala, Zahra and Chilazi, Michael", title="A Free, Open-Source, Offline Digital Health System for Refugee Care", journal="JMIR Med Inform", year="2022", month="Feb", day="11", volume="10", number="2", pages="e33848", keywords="electronic health record", keywords="mHealth", keywords="refugee", keywords="displaced population", keywords="digital health", keywords="COVID-19", keywords="health care", abstract="Background: Rise of conflict, extreme weather events, and pandemics have led to larger displaced populations worldwide. Displaced populations have unique acute and chronic health needs that must be met by low-resource health systems. Electronic health records (EHRs) have been shown to improve health outcomes in displaced populations, but need to be adapted to meet the constraints of these health systems. Objective: The aim of this viewpoint is to describe the development and deployment of an EHR designed to care for displaced populations in low-resource settings. Methods: Using a human-centered design approach, we conducted in-depth interviews and focus groups with patients, health care providers, and administrators in Lebanon and Jordan to identify the essential EHR features. These features, including modular workflows, multilingual interfaces, and offline-first capabilities, led to the development of the Hikma Health EHR, which has been deployed in Lebanon and Nicaragua. Results: We report the successes and challenges from 12 months of Hikma Health EHR deployment in a mobile clinic providing care to Syrian refugees in Bekaa Valley, Lebanon. Successes include the EHR's ability to (1) increase clinical efficacy by providing detailed patient records, (2) be adaptable to the threats of COVID-19, and (3) improve organizational planning. Lessons learned include technical fixes to methods of identifying patients through name or their medical record ID. Conclusions: As the number of displaced people continues to rise globally, it is imperative that solutions are created to help maximize the health care they receive. Free, open-sourced, and adaptable EHRs can enable organizations to better provide for displaced populations. ", doi="10.2196/33848", url="https://medinform.jmir.org/2022/2/e33848", url="http://www.ncbi.nlm.nih.gov/pubmed/35147509" } @Article{info:doi/10.2196/32392, author="Tran, Minh Duc and Thwaites, Louise C. and Van Nuil, Ilo Jennifer and McKnight, Jacob and Luu, Phuoc An and Paton, Chris and ", title="Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review", journal="J Med Internet Res", year="2022", month="Feb", day="9", volume="24", number="2", pages="e32392", keywords="digital health", keywords="eHealth", keywords="policy", keywords="Vietnam", keywords="hospital care", keywords="data", keywords="health", keywords="electronic medical records", keywords="standards", keywords="compulsory", keywords="patient ID", keywords="administrative information", keywords="health insurance ID", keywords="mobile phone", abstract="Background: There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence--based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government's requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability. Objective: This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals. Methods: We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Th? Vi?n Ph{\'a}p Lu?t, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step. Results: In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians' performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system's capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks. Conclusions: Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting. ", doi="10.2196/32392", url="https://www.jmir.org/2022/2/e32392", url="http://www.ncbi.nlm.nih.gov/pubmed/35138264" } @Article{info:doi/10.2196/30755, author="John, Oommen and Sarbadhikari, Nath Suptendra and Prabhu, Thanga and Goel, Ashvini and Thomas, Alexander and Shroff, Sunil and Allaudin, Fazilah and Weerabaddana, Chaminda and Alhuwail, Dari and Koirala, Udaya and Johnrose, Jayalal and Codyre, Patricia and Bleaden, Andy and Singh, Shubnum and Bajaj, Shuchin", title="Implementation and Experiences of Telehealth: Balancing Policies With Practice in Countries of South Asia, Kuwait, and the European Union", journal="Interact J Med Res", year="2022", month="Feb", day="8", volume="11", number="1", pages="e30755", keywords="telehealth policy and practice", keywords="implementation lessons", keywords="challenges in scaling up", keywords="capacity building of human resources", keywords="data privacy", keywords="telehealth", keywords="health policy", keywords="telemedicine", keywords="implementation", keywords="challenges", keywords="human resources", keywords="digital health", keywords="data security", doi="10.2196/30755", url="https://www.i-jmr.org/2022/1/e30755", url="http://www.ncbi.nlm.nih.gov/pubmed/35133279" } @Article{info:doi/10.2196/31696, author="Baumert, O. Brittney and Fiedler, Nancy and Prapamontol, Tippawan and Suttiwan, Panrapee and Naksen, Warangkana and Panuwet, Parinya and Sittiwang, Supattra and Dokjunyam, Chayada and Smarr, M. Melissa and Marsit, J. Carmen and Ryan, Barry P. and Siriwong, Wattasit and Robson, G. Mark and Barr, Boyd Dana", title="Investigation of Prenatal Pesticide Exposure and Neurodevelopmental Deficits in Northern Thailand: Protocol for a Longitudinal Birth Cohort Study", journal="JMIR Res Protoc", year="2022", month="Feb", day="7", volume="11", number="2", pages="e31696", keywords="birth cohort", keywords="farmworker", keywords="neurodevelopment", keywords="organophosphate", keywords="pesticide", keywords="pregnant women", keywords="Thailand", abstract="Background: Prenatal exposure to pesticides has been linked to adverse neurodevelopmental outcomes. Gaps exist in the current literature about the timing and magnitude of exposures that result in these adverse outcomes. Objective: The Study of Asian Women and their Offspring's Development and Environmental Exposures (SAWASDEE) cohort was established to investigate the impact of prenatal exposure to pesticides on early indicators of cognitive and motor skills, inhibitory control, emotion regulation, and memory that have been found to be important in the development of subsequent neurobehavioral and neurodevelopmental diseases. The overarching goal is to find earlier predictors of potential adverse neurologic outcomes in order to enable earlier interventions that could result in better outcome prognoses. Methods: Recruitment of this prospective, longitudinal birth cohort began in July 2017 and was completed in June 2019 in Chom Thong and Fang, 2 farming districts in Chiang Mai Province in northern Thailand. Follow-up of the study participants is ongoing. During pregnancy, 7 questionnaires were administered. Time-resolved biospecimen samples were collected monthly (for urine) and during each trimester (for blood) during antenatal care visits. Medical records were abstracted. Infants were administered the NICU Network Neurobehavioral Scale (NNNS) test at 1 month of age. A total of 322 mother-child pairs completed the NNNS test. All children will be followed until 3 years of age and undergo a series of neurodevelopmental tests. We will complete several additional exposure related analyses. Results: A total of 1298 women were screened, and of those, 394 (30.35\%) women were enrolled. The mean gestational age at enrollment was 9.9 weeks (SD 2.6). Differences in literacy were observed between Chom Thong and Fang participants. In Fang, about 54 of 105 (51.4\%) participants reported being able to read in Thai compared to about 206 of 217 (94.9\%) participants in Chom Thong. The percentages were comparable for reporting to be able to write in Thai. Conclusions: This longitudinal birth cohort study will inform risk assessment standards for pregnant women in Thailand and other countries. Building awareness of how insecticide exposure during specific windows of pregnancy affects the neurodevelopmental trajectories of children in developing countries is a specific need recognized by the World Health Organization. International Registered Report Identifier (IRRID): DERR1-10.2196/31696 ", doi="10.2196/31696", url="https://www.researchprotocols.org/2022/2/e31696", url="http://www.ncbi.nlm.nih.gov/pubmed/35129451" } @Article{info:doi/10.2196/31475, author="Mihrshahi, Seema and Ara, Gulshan and Khanam, Mansura and Rasheed, Sabrina and Agho, Emwinyore Kingsley and Kabir, Iqbal A. K. M. and Roy, K. S. and Haider, Rukhsana and Derakhshani Hamadani, Jena and Tofail, Fahmida and Alam, Ashraful and Dibley, J. Michael", title="The Shishu Pushti Trial--Extended Peer Counseling for Improving Feeding Practices and Reducing Undernutrition in Children Aged 0-48 Months in Urban Bangladesh: Protocol for a Cluster-Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Feb", day="7", volume="11", number="2", pages="e31475", keywords="child stunting", keywords="prevention", keywords="nutrition behavior change", keywords="breastfeeding: infant and young child feeding", keywords="peer counseling, child development", abstract="Background: The aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age. Objective: Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development. Methods: This study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements.The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). Results: We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. Conclusions: This study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. Trial Registration: ClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995 International Registered Report Identifier (IRRID): DERR1-10.2196/31475 ", doi="10.2196/31475", url="https://www.researchprotocols.org/2022/2/e31475", url="http://www.ncbi.nlm.nih.gov/pubmed/35129457" } @Article{info:doi/10.2196/34369, author="Nguyen, Tuan Ba and Phung, Lam Toi and Khuc, Hanh Thi Hong and Nguyen, Thi Van Anh and Blizzard, Leigh Christopher and Palmer, Andrew and Nguyen, Tu Huu and Cong Quyet, Thang and Nelson, Mark", title="Trauma Care Training in Vietnam: Narrative Scoping Review", journal="JMIR Med Educ", year="2022", month="Jan", day="24", volume="8", number="1", pages="e34369", keywords="trauma training", keywords="Vietnamese medical education system", keywords="medical curricula", keywords="short course", abstract="Background: The model of trauma in Vietnam has changed significantly over the last decade and requires reforming medical education to deal with new circumstances. Our aim is to evaluate this transition regarding the new target by analyzing trauma and the medical training system as a whole. Objective: This study aimed to establish if medical training in the developing country of Vietnam has adapted to the new disease pattern of road trauma emerging in its economy. Methods: A review was performed of Vietnamese medical school, Ministry of Health, and Ministry of Education and Training literature on trauma education. The review process and final review paper were prepared following the guidelines on scoping reviews and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. Results: The current trauma training at the undergraduate level is minimal and involves less than 5\% of the total credit. At the postgraduate level, only the specialties of surgery and anesthesia have a significant and increasing trauma training component ranging from 8\% to 22\% in the content. Trauma training, which focuses on practical skills, accounts for 31\% and 32\% of the training time of orientation courses for young doctors in ``basic surgery'' and ``basic anesthesia,'' respectively. Other relevant short course trainings, such as continuing medical education, in trauma are available, but they vary in topics, facilitators, participants, and formats. Conclusions: Medical training in Vietnam has not adapted to the new emerging disease pattern of road trauma. In the interim, the implementation of short courses, such as basic trauma life support and primary trauma care, can be considered as an appropriate method to compensate for the insufficient competency-related trauma care among health care workers while waiting for the effectiveness of medical training reformation. ", doi="10.2196/34369", url="https://mededu.jmir.org/2022/1/e34369", url="http://www.ncbi.nlm.nih.gov/pubmed/34967756" } @Article{info:doi/10.2196/32455, author="Secor, M. Andrew and Mtenga, Hassan and Richard, John and Bulula, Ngwegwe and Ferriss, Ellen and Rathod, Mansi and Ryman, K. Tove and Werner, Laurie and Carnahan, Emily", title="Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania", journal="JMIR Public Health Surveill", year="2022", month="Jan", day="21", volume="8", number="1", pages="e32455", keywords="immunization", keywords="immunization information system", keywords="electronic immunization registry", keywords="digital health", keywords="eHealth", abstract="Background: There is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions. Objective: The aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study. Methods: This study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs. Results: The analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52\% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94\% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28\%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine--1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine--1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10\% of facilities, indicating the potential for EIRs to target quality improvement efforts. Conclusions: EIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses. ", doi="10.2196/32455", url="https://publichealth.jmir.org/2022/1/e32455", url="http://www.ncbi.nlm.nih.gov/pubmed/35060919" } @Article{info:doi/10.2196/27270, author="Awan, Javed Najma and Chaudhry, Ambreen and Hussain, Zakir and Baig, Iqbal Zeeshan and Baig, Amir Mirza and Asghar, Jawad Rana and Khader, Yousef and Ikram, Aamer", title="Risk Factors of Dengue Fever in Urban Areas of Rawalpindi District in Pakistan During 2017: A Case Control Study", journal="JMIR Public Health Surveill", year="2022", month="Jan", day="19", volume="8", number="1", pages="e27270", keywords="dengue fever", keywords="outbreak", keywords="Rawalpindi", keywords="risk factors", keywords="stored water", keywords="urban", abstract="Background: During August 2017, increased numbers of suspected dengue fever cases were reported in the hospitals of Rawalpindi district. A case control study was conducted to determine the risk factors among urban areas, dengue serotype, and recommend preventive measures. Objective: The objective of the investigation was to determine the risk factors among urban areas, dengue serotype, and recommend preventive measures. Methods: A case was defined as having acute febrile illness with one or more of the following symptoms: retro-orbital pain, headache, rash, myalgia, arthralgia, and hemorrhage. The cases were residents of Rawalpindi and were confirmed for dengue fever from August 30, 2017, to October 30, 2017. All NS1 confirmed cases from urban areas of Rawalpindi were recruited from tertiary care hospitals. Age- and sex-matched controls were selected from the same community with a 1:1 ratio. Frequency, univariate, and multivariate analyses were performed at 95\% CI with P<.05 considered statistically significant. Results: Totally 373 cases were recruited. The mean age was 36 (SD 2.9) years (range 10-69 years), and 280 cases (75\%) were male. The most affected age group was 21-30 years (n=151, attack rate [AR] 40\%), followed by 31-40 years (n=66, AR 23\%). Further, 2 deaths were reported (case fatality rate of 0.53\%). The most frequent signs or symptoms were fever (n=373, 100\%), myalgia and headache (n=320, 86\%), and retro-orbital pain (n=272, 73\%). Serotype identification was carried out in 322 cases, and DEN-2 was the dominant serotype (n=126, 34\%). Contact with a confirmed dengue case (odds ratio [OR] 4.27; 95\% CI 3.14-5.81; P<.001), stored water in open containers at home (OR 2.04; 95\% CI 1.53-2.73; P<.001), and travel to a dengue outbreak area (OR 2.88; 95\% CI 2.12-3.92; P<.001) were the main reasons for the outbreak, whereas use of mosquito repellents (OR 0.12; 95\% CI 0.09-0.18; P<.001) and regular water supply at home (OR 0.03; 95\% CI 0.02-0.04; P<.001) showed protective effects. The geographical distribution of cases was limited to densely populated areas and all the 5 randomly collected water samples tested positive for dengue larvae. Conclusions: Stored water in containers inside houses and subsequent mosquito breeding were the most probable causes of this outbreak. Based on the study findings, undertaking activities to improve the use of mosquito repellents and removing sources of breeding (uncovered water stored indoors) are some recommendations for preventing dengue outbreaks. ", doi="10.2196/27270", url="https://publichealth.jmir.org/2022/1/e27270", url="http://www.ncbi.nlm.nih.gov/pubmed/35044313" } @Article{info:doi/10.2196/25105, author="Sevilla-Gonzalez, Rocio Magdalena Del and Bourguet-Ramirez, Brigette and Lazaro-Carrera, Sofia Laura and Martagon-Rosado, J. Alexandro and Gomez-Velasco, Veronica Donaji and Viveros-Ruiz, Leticia Tannia", title="Evaluation of a Web Platform to Record Lifestyle Habits in Subjects at Risk of Developing Type 2 Diabetes in a Middle-Income Population: Prospective Interventional Study", journal="JMIR Diabetes", year="2022", month="Jan", day="17", volume="7", number="1", pages="e25105", keywords="mHealth", keywords="prediabetes", keywords="type 2 diabetes", keywords="preventive medicine", keywords="diabetes", keywords="lifestyle", keywords="body mass index", abstract="Background: Lifestyle is the focus of type 2 diabetes (T2D) prevention strategies. Prevention strategies using mobile health (mHealth)--based therapy have shown positive results for T2D prevention in high-income settings, but little is known about their effectiveness in low- and middle-income populations where the burden of T2D is substantial. ``Vida Sana'' is a web platform designed to record lifestyle habits and medication use within a lifestyle change program. Objective: We sought to identify the barriers, feasibility, usability, and effectiveness of Vida Sana to record lifestyle habits in subjects at risk of developing T2D in a middle-income setting. Methods: This was a 3-month prospective interventional study in Mexican individuals. A total of 77 subjects at risk of T2D (with prediabetes and BMI between 24 and 40 kg/m2) were selected. Feasibility was assessed by study retention. Usability was evaluated with the System Usability Scale (SUS). Effectiveness measures included changes in weight, body composition, BMI, glycated hemoglobin A1c (HbA1c), and fasting blood glucose from baseline to 3 months. Linear regression models were used to account for covariates. Results: The feasibility of Vida Sana was 42\%, with 33 subjects using the platform, and the usability was 48.7 (SD 14.24). Reported barriers to platform usage were; difficulty in accessing the platform from difficulty of use (12 subjects, 36\%), lack of time to record their habits (11 subjects, 34\%), lack of interest to record their habits (6 subjects, 18\%), and lack of resources (4 subjects, 11\%). The platform was effective for lowering glucose in fasting (--3.1 mg/dL vs --0.11 [SD 8.08] mg/dL; P=.038) and at 2 hours (--16.9 mg/dL vs 2.5 [SD 26.1] mg/dL; P=.045), body fat percentage (--1.3 [--2.2 to --0.7] vs --1.02 [--1.9 to --0.3]; P=.02), and waist circumference (--3.2 [SD 5.1] cm vs --1.7 [SD 5.0] cm; P=.02) independent of their age, sex, treatment, and education level. Conclusions: The use of the web platform was effective for improving glycemic and anthropometric parameters in a population at risk of developing diabetes. Improving accessibility and ease of navigation could improve the acceptance of digital health solutions in a middle-income population. ", doi="10.2196/25105", url="https://diabetes.jmir.org/2022/1/e25105", url="http://www.ncbi.nlm.nih.gov/pubmed/35037888" } @Article{info:doi/10.2196/32610, author="Sanchez Antelo, Victoria and Szwarc, Lucila and Paolino, Melisa and Saimovici, Diana and Massaccesi, Silvia and Viswanath, Kasisomayajula and Arrossi, Silvina", title="A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina", journal="JMIR Form Res", year="2022", month="Jan", day="13", volume="6", number="1", pages="e32610", keywords="mHealth", keywords="mobile application", keywords="counseling", keywords="HPV test", keywords="cervical cancer", keywords="health belief model", keywords="integrated behavioral model", keywords="patient education", keywords="Argentina", abstract="Background: Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective: This study aims to understand HPV-tested women's perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods: We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results: We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users' needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions: Providing information that meets women's needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women. ", doi="10.2196/32610", url="https://formative.jmir.org/2022/1/e32610", url="http://www.ncbi.nlm.nih.gov/pubmed/35023843" } @Article{info:doi/10.2196/34530, author="Stapinski, Lexine and Routledge, Kylie and Snijder, Mieke and Doyle, Michael and Champion, Katrina and Chapman, Cath and Ward, James and Baumgart, Amanda and Lee, Kylie K. S. and Teesson, Maree and Newton, Nicola", title="A Web-Based Alcohol and Other Drug Prevention Program (Strong \& Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jan", day="7", volume="11", number="1", pages="e34530", keywords="Aboriginal and Torres Strait Islander", keywords="prevention", keywords="alcohol", keywords="tobacco", keywords="substance use", keywords="universal prevention", keywords="well-being", keywords="harm minimization", keywords="Indigenous", keywords="web-based", abstract="Background: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong \& Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective: This paper presents the protocol to evaluate the effectiveness of Strong \& Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods: The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40\% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong \& Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong \& Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results: The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions: This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038\&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/34530 ", doi="10.2196/34530", url="https://www.researchprotocols.org/2022/1/e34530", url="http://www.ncbi.nlm.nih.gov/pubmed/34994696" } @Article{info:doi/10.2196/30663, author="Ariff, Shabina and Maznani, Ikram and Bhura, Maria and Memon, Zahid and Arshad, Tayyaba and Samejo, Ahmed Tariq and Zaidi, Shujaat and Umer, Muhammad and Ahmed, Imran and Habib, Atif Muhammad and Soofi, Bashir Sajid and Bhutta, A. Zulfiqar", title="Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study", journal="JMIR Form Res", year="2022", month="Jan", day="7", volume="6", number="1", pages="e30663", keywords="kangaroo mother care", keywords="low birth weight", keywords="neonatal mortality formative research", keywords="Pakistan", keywords="newborn care", abstract="Background: Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant's morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity. Objective: We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan. Methods: We conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions. Results: Newborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies. Conclusions: KMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice. ", doi="10.2196/30663", url="https://formative.jmir.org/2022/1/e30663", url="http://www.ncbi.nlm.nih.gov/pubmed/34994692" } @Article{info:doi/10.2196/27696, author="Brody, Carinne and Chhoun, Pheak and Tuot, Sovannary and Fehrenbacher, E. Anne and Moran, Alexander and Swendeman, Dallas and Yi, Siyan", title="A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Jan", day="4", volume="24", number="1", pages="e27696", keywords="mHealth", keywords="female sex workers", keywords="HIV", keywords="sexually transmitted infection", keywords="linkage to services", keywords="sexual and reproductive health", keywords="gender-based violence", keywords="low- and middle-income countries", abstract="Background: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. Objective: This study evaluated the efficacy of the Mobile Link intervention in improving FEWs' health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. Methods: A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. Results: A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95\% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95\% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95\% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95\% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. Conclusions: The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs' health outcomes in the future. Trial Registration: Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2614-7 ", doi="10.2196/27696", url="https://www.jmir.org/2022/1/e27696", url="http://www.ncbi.nlm.nih.gov/pubmed/34982716" } @Article{info:doi/10.2196/23236, author="Ogundaini, Oluwamayowa and de la Harpe, Retha", title="The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach", journal="JMIR Form Res", year="2022", month="Jan", day="4", volume="6", number="1", pages="e23236", keywords="agency", keywords="health care professionals", keywords="technology performativity", keywords="sub-Saharan Africa", keywords="service design", keywords="work activities", keywords="mobile phone", abstract="Background: The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective: The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods: An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants' data were addressed as per the university ethics review committee and provincial department of health. Results: The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions: The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs. ", doi="10.2196/23236", url="https://formative.jmir.org/2022/1/e23236", url="http://www.ncbi.nlm.nih.gov/pubmed/34982713" } @Article{info:doi/10.2196/27266, author="Mehmood, Amjad and Khalid Khan, Fawad and Chaudhry, Ambreen and Hussain, Zakir and Laghari, Ali Mumtaz and Shah, Ijaz and Baig, Iqbal Zeeshan and Baig, Amir Mirza and Khader, Yousef and Ikram, Aamer", title="Risk Factors Associated with a Dengue Fever Outbreak in Islamabad, Pakistan: Case-Control Study", journal="JMIR Public Health Surveill", year="2021", month="Dec", day="30", volume="7", number="12", pages="e27266", keywords="dengue fever", keywords="DENV-2", keywords="outbreak investigation", keywords="Islamabad", keywords="Pakistan", keywords="outbreak", keywords="epidemiology", keywords="disease surveillance", keywords="surveillance", keywords="vector", abstract="Background: On October 23, 2016, 79 dengue fever cases were reported from the Union Council Tarlai to Federal Disease Surveillance and Response Unit Islamabad. A team was established to investigate the suspected dengue outbreak. Objective: The aim of this study was to determine the extent of the outbreak and identify the possible risk factors. Methods: Active case finding was performed through a house-to-house survey. A case was defined as an acute onset of fever ?38{\textcelcius} in a resident of Tarlai from October 2 to November 11, 2016, with a positive dengue virus (nonstructural protein, NS-1) test and any of the two of following signs and symptoms: retroorbital/ocular pain, headache, rash, myalgia, arthralgia, and hemorrhagic manifestations. A structured questionnaire was used to collect data. Age- and sex-matched controls (1:1) were identified from residents in the same area as cases. Blood samples were taken and sent to the National Institute of Health for genotype identification. Results: During the active case search, 145 cases of dengue fever were identified by surveying 928 houses from October 23 to November 11, 2016. The attack rate (AR) was 17.0/10,000. The mean age was 34.4 (SD 14.4) years. More than half of the cases were male (80/145, 55.2\%). Among all cases, 29\% belonged to the 25-34 years age group and the highest AR was found in the 35-44 years age group (35.6/10,000), followed by the 55-64 years age group (35.5/10,000). All five blood samples tested positive for NS-1 (genotype DENV-2). The most frequent presenting signs/symptoms were fever and headache (both 100\%). Stagnant water around houses (odds ratio [OR] 4.86, 95\% CI 2.94-8.01; P<.001), presence of flower pots in the home (OR 2.73, 95\% CI 1.67-4.45; P<.001), and open water containers (OR 2.24, 95\% CI 1.36-3.60; P<.001) showed higher odds among cases. Conversely, use of bed nets (OR 0.44, 95\% CI 0.25-0.77; P=.003), insecticidal spray (OR 0.33, 95\% CI 0.22-0.55; P<.001), door screens (OR 0.27, 95\% CI 0.15-0.46; P<.001), mosquito coil/mat (OR 0.26, 95\% CI 0.16-0.44; P<.001), and cleanliness of the house (OR 0.12, 95\% CI 0.05-0.26; P<.001) showed significant protective effects. Conclusions: Stagnant water acting as breeding grounds for vectors was identified as the probable cause of spread of the dengue outbreak. Establishment of surveillance and an early reporting system along with use of protective measures against the vector are strongly recommended. ", doi="10.2196/27266", url="https://publichealth.jmir.org/2021/12/e27266", url="http://www.ncbi.nlm.nih.gov/pubmed/34967753" } @Article{info:doi/10.2196/30106, author="Silenou, C. Bernard and Nyirenda, Z. John L. and Zaghloul, Ahmed and Lange, Berit and Doerrbecker, Juliane and Schenkel, Karl and Krause, G{\'e}rard", title="Availability and Suitability of Digital Health Tools in Africa for Pandemic Control: Scoping Review and Cluster Analysis", journal="JMIR Public Health Surveill", year="2021", month="Dec", day="23", volume="7", number="12", pages="e30106", keywords="mobile applications", keywords="mHealth", keywords="epidemiological surveillance", keywords="communicable diseases", keywords="outbreak response", keywords="health information management", keywords="public health", keywords="review", keywords="transmission network", abstract="Background: Gaining oversight into the rapidly growing number of mobile health tools for surveillance or outbreak management in Africa has become a challenge. Objective: The aim of this study is to map the functional portfolio of mobile health tools used for surveillance or outbreak management of communicable diseases in Africa. Methods: We conducted a scoping review by combining data from a systematic review of the literature and a telephone survey of experts. We applied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching for articles published between January 2010 and December 2020. In addition, we used the respondent-driven sampling method and conducted a telephone survey from October 2019 to February 2020 among representatives from national public health institutes from all African countries. We combined the findings and used a hierarchical clustering method to group the tools based on their functionalities (attributes). Results: We identified 30 tools from 1914 publications and 45 responses from 52\% (28/54) of African countries. Approximately 13\% of the tools (4/30; Surveillance Outbreak Response Management and Analysis System, Go.Data, CommCare, and District Health Information Software 2) covered 93\% (14/15) of the identified attributes. Of the 30 tools, 17 (59\%) tools managed health event data, 20 (67\%) managed case-based data, and 28 (97\%) offered a dashboard. Clustering identified 2 exceptional attributes for outbreak management, namely contact follow-up (offered by 8/30, 27\%, of the tools) and transmission network visualization (offered by Surveillance Outbreak Response Management and Analysis System and Go.Data). Conclusions: There is a large range of tools in use; however, most of them do not offer a comprehensive set of attributes, resulting in the need for public health workers having to use multiple tools in parallel. Only 13\% (4/30) of the tools cover most of the attributes, including those most relevant for response to the COVID-19 pandemic, such as laboratory interface, contact follow-up, and transmission network visualization. ", doi="10.2196/30106", url="https://publichealth.jmir.org/2021/12/e30106", url="http://www.ncbi.nlm.nih.gov/pubmed/34941551" } @Article{info:doi/10.2196/28958, author="Jaafa, Kasiiti Noah and Mokaya, Benard and Savai, Muhindi Simon and Yeung, Ada and Siika, Mosigisi Abraham and Were, Martin", title="Implementation of Fingerprint Technology for Unique Patient Matching and Identification at an HIV Care and Treatment Facility in Western Kenya: Cross-sectional Study", journal="J Med Internet Res", year="2021", month="Dec", day="22", volume="23", number="12", pages="e28958", keywords="biometrics", keywords="patient matching", keywords="fingerprints", keywords="unique patient identification", keywords="electronic medical record systems", keywords="low- and middle-income countries (LMICs)", abstract="Background: Unique patient identification remains a challenge in many health care settings in low- and middle-income countries (LMICs). Without national-level unique identifiers for whole populations, countries rely on demographic-based approaches that have proven suboptimal. Affordable biometrics-based approaches, implemented with consideration of contextual ethical, legal, and social implications, have the potential to address this challenge and improve patient safety and reporting accuracy. However, limited studies exist to evaluate the actual performance of biometric approaches and perceptions of these systems in LMICs. Objective: The aim of this study is to evaluate the performance and acceptability of fingerprint technology for unique patient matching and identification in the LMIC setting of Kenya. Methods: In this cross-sectional study conducted at an HIV care and treatment facility in Western Kenya, an open source fingerprint application was integrated within an implementation of the Open Medical Record System, an open source electronic medical record system (EMRS) that is nationally endorsed and deployed for HIV care in Kenya and in more than 40 other countries; hence, it has potential to translate the findings across multiple countries. Participants aged >18 years were conveniently sampled and enrolled into the study. Participants' left thumbprints were captured and later used to retrieve and match records. The technology's performance was evaluated using standard measures: sensitivity, false acceptance rate, false rejection rate, and failure to enroll rate. The Wald test was used to compare the accuracy of the technology with the probabilistic patient-matching technique of the EMRS. Time to retrieval and matching of records were compared using the independent samples 2-tailed t test. A survey was administered to evaluate patient acceptance and satisfaction with use of the technology. Results: In all, 300 participants were enrolled; their mean age was 36.3 (SD 12.2) years, and 58\% (174/300) were women. The relevant values for the technology's performance were sensitivity 89.3\%, false acceptance rate 0\%, false rejection rate 11\%, and failure to enroll rate 2.3\%. The technology's mean record retrieval speed was 3.2 (SD 1.1) seconds versus 9.5 (SD 1.9) seconds with demographic-based record retrieval in the EMRS (P<.001). The survey results revealed that 96.3\% (289/300) of the participants were comfortable with the technology and 90.3\% (271/300) were willing to use it. Participants who had previously used fingerprint biometric systems for identification were estimated to have more than thrice increased odds of accepting the technology (odds ratio 3.57, 95\% CI 1.0-11.92). Conclusions: Fingerprint technology performed very well in identifying adult patients in an LMIC setting. Patients reported a high level of satisfaction and acceptance. Serious considerations need to be given to the use of fingerprint technology for patient identification in LMICs, but this has to be done with strong consideration of ethical, legal, and social implications as well as security issues. ", doi="10.2196/28958", url="https://www.jmir.org/2021/12/e28958", url="http://www.ncbi.nlm.nih.gov/pubmed/34941557" } @Article{info:doi/10.2196/33116, author="Shrestha, Ruchi and Singh, Prerana and Dhakhwa, Parami and Tetali, Shailaja and Batchu, Tripura and Shrestha Thapa, Pragati", title="Augmenting the Referral Pathway for Retinal Services Among Patients With Diabetes Mellitus at Reiyukai Eiko Masunaga Eye Hospital, Nepal: Protocol for a Nonrandomized, Pre--Post Intervention Study", journal="JMIR Res Protoc", year="2021", month="Dec", day="17", volume="10", number="12", pages="e33116", keywords="diabetes mellitus", keywords="diabetic retinopathy", keywords="Nepal", keywords="health education", keywords="study protocol", abstract="Background: Diabetic retinopathy (DR) is an important public health issue in Nepal with a huge social and economic impact. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. Published studies on referral pathways in Nepal are scarce. Improving DR awareness among general physicians has the potential to address these challenges. Objective: The aim of this study is to evaluate the effect of a health education intervention on health personnel, establish a referral pathway, and assess the impact of the intervention on the attendance of patients with diabetes mellitus for retinal screening at Reiyukai Eiko Masunaga Eye Hospital in Nepal. Methods: This is a nonrandomized, pre- and postintervention study. Health education on DR will be provided to selected health personnel of the intervention hospital (Scheer Memorial) using information education and communication (IEC) materials in the form of PowerPoint presentations, posters, pamphlets, videos, and pre- and postevaluation questionnaires along with referral slip. Pre- and postevaluation will be undertaken during the study period. Data will be analyzed using MS Excel and Epi Info 7. Results: The ethical approval for this study has been obtained from the Ethical Review Board of the Nepal Health Research Council (ERB Protocol Registration Number \# 582/2020P). The study is expected to be completed in 18 months from the start of the project. The baseline data collection was from June to January 2020 for a period of 8 months. The postintervention data collection was from February to September 2021 for a period of 8 months. The last 2 months are planned for data analysis and report writing. Conclusions: Health education intervention could be a low-cost solution to improve the awareness, access, and utilization of retinal health care services; this is an understudied topic in Nepal. Working closely with the stakeholders, this study will evaluate the role of health education interventions (which are already validated in other low-income settings) to strengthen referral and reduce the burden of DR in Nepal. Trial Registration: ClinicalTrials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084 International Registered Report Identifier (IRRID): DERR1-10.2196/33116 ", doi="10.2196/33116", url="https://www.researchprotocols.org/2021/12/e33116", url="http://www.ncbi.nlm.nih.gov/pubmed/34927596" } @Article{info:doi/10.2196/26381, author="Were, Chieng Martin and Savai, Simon and Mokaya, Benard and Mbugua, Samuel and Ribeka, Nyoman and Cholli, Preetam and Yeung, Ada", title="mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale", journal="J Med Internet Res", year="2021", month="Dec", day="14", volume="23", number="12", pages="e26381", keywords="mobile health", keywords="electronic medical records", keywords="developing countries", keywords="digital divide", keywords="digital health", keywords="global health", abstract="Background: The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide. Objective: We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS). Methods: The ``Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)'' checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima's architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems. Results: mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO's Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas. Conclusions: Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains. ", doi="10.2196/26381", url="https://www.jmir.org/2021/12/e26381", url="http://www.ncbi.nlm.nih.gov/pubmed/34904952" } @Article{info:doi/10.2196/32203, author="Akhtar, Hashaam and Khalid, Sundas and Rahman, ur Fazal and Umar, Muhammad and Ali, Sabahat and Afridi, Maham and Hassan, Faheem and Saleh Khader, Yousef and Akhtar, Nasim and Khan, Mujeeb Muhammad and Ikram, Aamer", title="Presenting Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in Pakistan: Retrospective Observational Study", journal="JMIR Public Health Surveill", year="2021", month="Dec", day="14", volume="7", number="12", pages="e32203", keywords="COVID-19", keywords="indicators", keywords="symptoms", keywords="risk factors", keywords="comorbidities", keywords="severity", keywords="Pakistan", abstract="Background: COVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan's population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19. Objective: COVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups. Methods: A retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender. Results: This study identified fever (1592/1812, 87.9\%), cough (1433/1812, 79.1\%), and shortness of breath (998/1812, 55.1\%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4\% (n=443) required ICU admission and 21.5\% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9\% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality. Conclusions: Older adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes. ", doi="10.2196/32203", url="https://publichealth.jmir.org/2021/12/e32203", url="http://www.ncbi.nlm.nih.gov/pubmed/34710053" } @Article{info:doi/10.2196/28644, author="Zombre, David and Kortenaar, Jean-Luc and Zareef, Farhana and Doumbia, Moussa and Doumbia, Sekou and Haidara, Fadima and McLaughlin, Katie and Sow, Samba and Bhutta, A. Zulfiqar and Bassani, G. Diego", title="Combined Clinical Audits and Low-Dose, High-frequency, In-service Training of Health Care Providers and Community Health Workers to Improve Maternal and Newborn Health in Mali: Protocol for a Pragmatic Cluster Randomized Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="10", volume="10", number="12", pages="e28644", keywords="perinatal mortality", keywords="low dose high frequency training", keywords="maternal and newborn health outcomes", keywords="Mali", abstract="Background: Although most births in Mali occur in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly because of existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills. Objective: This trial aims to assess the effectiveness and cost-effectiveness of an intervention combining clinical audits and low-dose, high-frequency (LDHF) in-service training of health care providers and community health workers to reduce perinatal mortality. Methods: The study is a three-arm cluster randomized controlled trial in the Koulikoro region in Mali. The units of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits, followed by one-day LDHF training biweekly, for 6 months. The health workers in the second intervention arm (28 facilities) will receive a refresher course in maternal neonatal and child health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcomes are perinatal deaths in the intervention arms compared with those in the control arm. A final sample of approximately 600 deliveries per cluster was expected for a total of 30,000 newborns over 14 months. Data sources included both routine health records and follow-up household surveys of all women who recently gave birth in the study facility 7 days postdelivery. Data collection tools will capture perinatal deaths, complications, and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting. Results: The trial is complete. The recruitment began on July 15, 2019, and data collection began on July 23, 2019, and was completed in November 2020. Data cleaning or analyses began at the time of submission of the protocol. Conclusions: The results will provide policy makers and practitioners with crucial information on the impact of different health care provider training modalities on maternal and newborn health outcomes and how to successfully implement these strategies in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT03656237; https://clinicaltrials.gov/ct2/show/NCT03656237 International Registered Report Identifier (IRRID): DERR1-10.2196/28644 ", doi="10.2196/28644", url="https://www.researchprotocols.org/2021/12/e28644", url="http://www.ncbi.nlm.nih.gov/pubmed/34889776" } @Article{info:doi/10.2196/20767, author="Liu, Dianbo and Zheng, Ming and Sepulveda, Andres Nestor", title="Using Artificial Neural Network Condensation to Facilitate Adaptation of Machine Learning in Medical Settings by Reducing Computational Burden: Model Design and Evaluation Study", journal="JMIR Form Res", year="2021", month="Dec", day="8", volume="5", number="12", pages="e20767", keywords="artificial neural network", keywords="electronic medical records", keywords="parameter pruning", keywords="machine learning", keywords="computational burden", keywords="", abstract="Background: Machine learning applications in the health care domain can have a great impact on people's lives. At the same time, medical data is usually big, requiring a significant number of computational resources. Although this might not be a problem for the wide adoption of machine learning tools in high-income countries, the availability of computational resources can be limited in low-income countries and on mobile devices. This can limit many people from benefiting from the advancement in machine learning applications in the field of health care. Objective: In this study, we explore three methods to increase the computational efficiency and reduce model sizes of either recurrent neural networks (RNNs) or feedforward deep neural networks (DNNs) without compromising their accuracy. Methods: We used inpatient mortality prediction as our case analysis upon review of an intensive care unit dataset. We reduced the size of RNN and DNN by applying pruning of ``unused'' neurons. Additionally, we modified the RNN structure by adding a hidden layer to the RNN cell but reducing the total number of recurrent layers to accomplish a reduction of the total parameters used in the network. Finally, we implemented quantization on DNN by forcing the weights to be 8 bits instead of 32 bits. Results: We found that all methods increased implementation efficiency, including training speed, memory size, and inference speed, without reducing the accuracy of mortality prediction. Conclusions: Our findings suggest that neural network condensation allows for the implementation of sophisticated neural network algorithms on devices with lower computational resources. ", doi="10.2196/20767", url="https://formative.jmir.org/2021/12/e20767", url="http://www.ncbi.nlm.nih.gov/pubmed/34889747" } @Article{info:doi/10.2196/31645, author="Syed Abdul, Shabbir and Ramaswamy, Meghna and Fernandez-Luque, Luis and John, Oommen and Pitti, Thejkiran and Parashar, Babita", title="The Pandemic, Infodemic, and People's Resilience in India: Viewpoint", journal="JMIR Public Health Surveill", year="2021", month="Dec", day="8", volume="7", number="12", pages="e31645", keywords="pandemic", keywords="COVID-19", keywords="India", keywords="digital health", keywords="infodemics", keywords="Sustainable Development Goals", keywords="SDGs", doi="10.2196/31645", url="https://publichealth.jmir.org/2021/12/e31645", url="http://www.ncbi.nlm.nih.gov/pubmed/34787574" } @Article{info:doi/10.2196/25833, author="Espinoza, Juan and Sikder, Taher Abu and Dickhoner, James and Lee, Thomas", title="Assessing Health Data Security Risks in Global Health Partnerships: Development of a Conceptual Framework", journal="JMIR Form Res", year="2021", month="Dec", day="8", volume="5", number="12", pages="e25833", keywords="health information technology", keywords="low- and middle-income countries", keywords="low income", keywords="conceptual framework analysis", keywords="framework method", keywords="data security", keywords="decision-making", keywords="database", keywords="information use", keywords="misuse", keywords="global health", keywords="security", abstract="Background: Health care databases contain a wealth of information that can be used to develop programs and mature health care systems. There is concern that the sensitive nature of health data (eg, ethnicity, reproductive health, sexually transmitted infections, and lifestyle information) can have significant impact on individuals if misused, particularly among vulnerable and marginalized populations. As academic institutions, nongovernmental organizations, and international agencies begin to collaborate with low- and middle-income countries to develop and deploy health information technology (HIT), it is important to understand the technical and practical security implications of these initiatives. Objective: Our aim is to develop a conceptual framework for risk stratification of global health data partnerships and HIT projects. In addition to identifying key conceptual domains, we map each domain to a variety of publicly available indices that could be used to inform a quantitative model. Methods: We conducted an overview of the literature to identify relevant publications, position statements, white papers, and reports. The research team reviewed all sources and used the framework method and conceptual framework analysis to name and categorize key concepts, integrate them into domains, and synthesize them into an overarching conceptual framework. Once key domains were identified, public international data sources were searched for relevant structured indices to generate quantitative counterparts. Results: We identified 5 key domains to inform our conceptual framework: State of HIT, Economics of Health Care, Demographics and Equity, Societal Freedom and Safety, and Partnership and Trust. Each of these domains was mapped to a number of structured indices. Conclusions: There is a complex relationship among the legal, economic, and social domains of health care, which affects the state of HIT in low- and middle-income countries and associated data security risks. The strength of partnership and trust among collaborating organizations is an important moderating factor. Additional work is needed to formalize the assessment of partnership and trust and to develop a quantitative model of the conceptual framework that can help support organizational decision-making. ", doi="10.2196/25833", url="https://formative.jmir.org/2021/12/e25833", url="http://www.ncbi.nlm.nih.gov/pubmed/34889752" } @Article{info:doi/10.2196/33296, author="Izadi, Neda and Etemad, Koorosh and Mehrabi, Yadollah and Eshrati, Babak and Hashemi Nazari, Saeed Seyed", title="The Standardization of Hospital-Acquired Infection Rates Using Prediction Models in Iran: Observational Study of National Nosocomial Infection Registry Data", journal="JMIR Public Health Surveill", year="2021", month="Dec", day="7", volume="7", number="12", pages="e33296", keywords="hospital-acquired infections", keywords="standardized infection ratio", keywords="prediction model", keywords="Iran", abstract="Background: Many factors contribute to the spreading of hospital-acquired infections (HAIs). Objective: This study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method. Methods: In this study, the Iranian nosocomial infections surveillance system (INIS) was used to gather data on patients with HAIs (126,314 infections). In addition, the hospital statistics and information system (AVAB) was used to collect data on hospital characteristics. First, well-performing hospitals, including 357 hospitals from all over the country, were selected. Data were randomly split into training (70\%) and testing (30\%) sets. Finally, the standardized infection ratio (SIR) and the corrected SIR were calculated for the HAIs. Results: The mean age of the 100,110 patients with an HAI was 40.02 (SD 23.56) years. The corrected SIRs based on the observed and predicted infections for respiratory tract infections (RTIs), urinary tract infections (UTIs), surgical site infections (SSIs), and bloodstream infections (BSIs) were 0.03 (95\% CI 0-0.09), 1.02 (95\% CI 0.95-1.09), 0.93 (95\% CI 0.85-1.007), and 0.91 (95\% CI 0.54-1.28), respectively. Moreover, the corrected SIRs for RTIs in the infectious disease, burn, obstetrics and gynecology, and internal medicine wards; UTIs in the burn, infectious disease, internal medicine, and intensive care unit wards; SSIs in the burn and infectious disease wards; and BSIs in most wards were >1, indicating that more HAIs were observed than expected. Conclusions: The results of this study can help to promote preventive measures based on scientific evidence. They can also lead to the continuous improvement of the monitoring system by collecting and systematically analyzing data on HAIs and encourage the hospitals to better control their infection rates by establishing a benchmarking system. ", doi="10.2196/33296", url="https://publichealth.jmir.org/2021/12/e33296", url="http://www.ncbi.nlm.nih.gov/pubmed/34879002" } @Article{info:doi/10.2196/33433, author="Oganesyan, Ani and Sivesind, Torunn and Dellavalle, Robert", title="From the Cochrane Library: Interventions for Impetigo", journal="JMIR Dermatol", year="2021", month="Dec", day="3", volume="4", number="2", pages="e33433", keywords="impetigo", keywords="pustular lesions", keywords="Staphylococcus aureus", keywords="Streptococcus pyogenes", keywords="dermatology", keywords="skin infection", doi="10.2196/33433", url="https://derma.jmir.org/2021/2/e33433" } @Article{info:doi/10.2196/30525, author="Trofholz, Amanda and Tate, Allan and Janowiec, Mark and Fertig, Angela and Loth, Katie and de Brito, N. Junia and Berge, Jerica", title="Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study", journal="JMIR Res Protoc", year="2021", month="Dec", day="1", volume="10", number="12", pages="e30525", keywords="methods", keywords="ecological momentary assessment", keywords="weight-related behaviors", keywords="racially and ethnically diverse", keywords="children", keywords="mobile phone", abstract="Background: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent's stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child's day). Results: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants' time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID): DERR1-10.2196/30525 ", doi="10.2196/30525", url="https://www.researchprotocols.org/2021/12/e30525", url="http://www.ncbi.nlm.nih.gov/pubmed/34855612" } @Article{info:doi/10.2196/27626, author="Al kalali, Ahmed Fadwa Salem and Mahyoub, Essam and Al-Hammadi, Abdulbary and Anam, Labiba and Khader, Yousef", title="Evaluation of the National Tuberculosis Surveillance System in Sana'a, Yemen, 2018: Observational Study", journal="JMIR Public Health Surveill", year="2021", month="Nov", day="30", volume="7", number="11", pages="e27626", keywords="evaluation", keywords="surveillance system", keywords="tuberculosis", keywords="Yemen", abstract="Background: Tuberculosis remains a public problem that is considered one of the top causes of morbidity and mortality worldwide. The National Tuberculosis Control Program in Yemen was established in 1970 and included in the national health policy under the leadership of the Ministry of Public Health and Population to monitor tuberculosis control. The surveillance system must be evaluated periodically to produce recommendations for improving performance and usefulness. Objective: This study aims to assess the usefulness and the performance of the tuberculosis surveillance system attributes and to identify the strengths and weaknesses of the system. Methods: A quantitative and qualitative evaluation of the national tuberculosis surveillance system was conducted using the Centers for Disease Control and Prevention's updated guidelines. The study was carried out in 10 districts in Sana'a City. A total of 28 public health facilities providing tuberculosis services for the whole population in their assigned catchment areas were purposively selected. All participants were interviewed based on their involvement with key aspects of tuberculosis surveillance activities. Results: The tuberculosis surveillance system was found to have an average performance in usefulness (57/80, 71\%), flexibility (30/40, 75\%), acceptability (174/264, 66\%), data quality (4/6, 67\%), and positive predictive value (78/107, 73\%), and poor performance in simplicity (863/1452, 59\%) and stability (15\%, 3/20). In addition, the system also had a good performance in sensitivity (78/81, 96\%). Conclusions: The tuberculosis surveillance system was found to be useful. The flexibility, positive predictive value, and data quality were average. Stability and simplicity were poor. The sensitivity was good. The main weaknesses in the tuberculosis surveillance system include a lack of governmental financial support, a paper-based system, and a lack of regular staff training. Developing an electronic system, securing governmental finances, and training the staff on tuberculosis surveillance are strongly recommended to improve the system performance. ", doi="10.2196/27626", url="https://publichealth.jmir.org/2021/11/e27626", url="http://www.ncbi.nlm.nih.gov/pubmed/34851294" } @Article{info:doi/10.2196/30632, author="Tsou, Christina and Robinson, Suzanne and Boyd, James and Jamieson, Andrew and Blakeman, Robert and Yeung, Justin and McDonnell, Josephine and Waters, Stephanie and Bosich, Kylie and Hendrie, Delia", title="Effectiveness of Telehealth in Rural and Remote Emergency Departments: Systematic Review", journal="J Med Internet Res", year="2021", month="Nov", day="26", volume="23", number="11", pages="e30632", keywords="telehealth", keywords="telemedicine", keywords="clinical effectiveness", keywords="treatment outcome", keywords="rural population", keywords="rural health", keywords="remote", abstract="Background: Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. Objective: The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. Methods: The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. Results: A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and---depending on the context---improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. Conclusions: Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. Trial Registration: PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry ", doi="10.2196/30632", url="https://www.jmir.org/2021/11/e30632", url="http://www.ncbi.nlm.nih.gov/pubmed/34842537" } @Article{info:doi/10.2196/33088, author="Shilton, Sonjelle and Ivanova Reipold, Elena and Roca {\'A}lvarez, Albert and Mart{\'i}nez-P{\'e}rez, Z. Guillermo", title="Assessing Values and Preferences Toward SARS-CoV-2 Self-testing Among the General Population and Their Representatives, Health Care Personnel, and Decision-Makers: Protocol for a Multicountry Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Nov", day="26", volume="10", number="11", pages="e33088", keywords="COVID-19", keywords="SARS-CoV-2", keywords="diagnostic", keywords="self-testing", keywords="mixed methods", keywords="testing", keywords="protocol", keywords="preference", keywords="population", keywords="health care worker", keywords="decision-making", keywords="accessibility", keywords="transmission", keywords="screening", abstract="Background: Accessible, safe, and client-centered SARS-CoV-2 testing services are an effective way to halt its transmission. Testing enables infected individuals to isolate or quarantine to prevent further transmission. In countries with limited health systems and laboratory capacity, it can be challenging to provide accessible and safe screening for COVID-19. Self-testing provides a convenient, private, and safe testing option; however, it also raises important concerns about lack of counseling and ensuring timely reporting of self-test results to national surveillance systems. Investigating community members' views and perceptions regarding SARS-CoV-2 self-testing is crucial to inform the most effective and safe strategies for implementing said testing. Objective: We aimed to determine whether SARS-CoV-2 self-testing was useful to diagnose and prevent the spread of SARS-CoV-2 for populations in low-resource settings and under which circumstances it would be acceptable. Methods: This multisite, mixed methods, observational study will be conducted in 9 countries---Brazil, India, Indonesia, Kenya, Malawi, Nigeria, Peru, the Philippines, and South Africa---and will consists of 2 components: cross-sectional surveys and interviews (semistructured and group) among 4 respondent groupings: the general population, general population representatives, health care workers, and decision-makers. General population and health care worker survey responses will be analyzed separately from each other, using bivariate and multivariate inferential analysis and descriptive statistics. Semistructured interviews and group interviews will be audiorecorded, transcribed, and coded for thematic comparative analysis. Results: As of November 19, 2021, participant enrollment is ongoing; 4364 participants have been enrolled in the general population survey, and 2233 participants have been enrolled in the health care workers survey. In the qualitative inquiry, 298 participants have been enrolled. We plan to complete data collection by December 31, 2021 and publish results in 2022 via publications, presentations at conferences, and dissemination events specifically targeted at local decision-makers, civil society, and patient groups. Conclusions: The views and perceptions of local populations are crucial in the discussion of the safest strategies for implementing SARS-CoV-2 self-testing. We intend to identify sociocultural specificities that may hinder or accelerate the widespread utilization of SARS-CoV-2 self-testing. International Registered Report Identifier (IRRID): DERR1-10.2196/33088 ", doi="10.2196/33088", url="https://www.researchprotocols.org/2021/11/e33088", url="http://www.ncbi.nlm.nih.gov/pubmed/34726608" } @Article{info:doi/10.2196/29214, author="Atukunda, Cathyln Esther and Matthews, T. Lynn and Musiimenta, Angella and Mugyenyi, Rwambuka Godfrey and Mugisha, Samuel and Ware, C. Norma and Obua, Celestino and Siedner, J. Mark", title="mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study", journal="JMIR Form Res", year="2021", month="Nov", day="25", volume="5", number="11", pages="e29214", keywords="mHealth app", keywords="app development", keywords="messaging", keywords="health education", keywords="health promotion", keywords="mobile phone", abstract="Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52\%) had at least a primary education and 75 (100\%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner's involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women's significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women's preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. ", doi="10.2196/29214", url="https://formative.jmir.org/2021/11/e29214", url="http://www.ncbi.nlm.nih.gov/pubmed/34842541" } @Article{info:doi/10.2196/27054, author="Hurst, Rachel and Liljenquist, Kendra and Lowry, J. Sarah and Szilagyi, G. Peter and Fiscella, A. Kevin and Weaver, R. Marcia and Porras-Javier, Lorena and Ortiz, Janette and Sotelo Guerra, J. Laura and Coker, R. Tumaini", title="A Parent Coach--Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="25", volume="10", number="11", pages="e27054", keywords="preventive care", keywords="well-child care", keywords="community health centers", abstract="Background: The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator (Parent Coach) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. Objective: This study aims to evaluate the impact of PARENT using a cluster randomized controlled trial. Methods: This study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California. We conducted a cluster randomized controlled trial that included 916 families with children aged ?12 months at the time of the baseline survey. Parents will be followed up at 6 and 12 months after enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination and any concerns that require a clinician's attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health-related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. Our primary outcomes were receipt of anticipatory guidance and emergency department use. Results: Participant recruitment began in March 2019. After recruitment, 6- and 12-month follow-up surveys will be completed. As of August 30, 2021, we enrolled a total of 916 participants. Conclusions: This large pragmatic trial of PARENT in partnership with federally qualified health centers will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. Trial Registration: ClinicalTrials.gov: NCT03797898; https://clinicaltrials.gov/ct2/show/NCT03797898 International Registered Report Identifier (IRRID): DERR1-10.2196/27054 ", doi="10.2196/27054", url="https://www.researchprotocols.org/2021/11/e27054", url="http://www.ncbi.nlm.nih.gov/pubmed/34842563" } @Article{info:doi/10.2196/26252, author="Pant, Ichhya and Rimal, Rajiv and Yilma, Hagere and Bingenheimer, Jeffrey and Sedlander, Erica and Behera, Sibabrata", title="mHealth for Anemia Reduction: Protocol for an Entertainment Education--Based Dual Intervention", journal="JMIR Res Protoc", year="2021", month="Nov", day="22", volume="10", number="11", pages="e26252", keywords="mHealth", keywords="interactive", keywords="voice response", keywords="entertainment", keywords="education", keywords="rural", keywords="anemia", keywords="bystander", keywords="violence against women", abstract="Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India's burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education--based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women--related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study's primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms--based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women--related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 ", doi="10.2196/26252", url="https://www.researchprotocols.org/2021/11/e26252", url="http://www.ncbi.nlm.nih.gov/pubmed/34812735" } @Article{info:doi/10.2196/30191, author="Sarker, Rahman Mohammad Habibur and Moriyama, Michiko and Rashid, Ur Harun and Rahman, Moshiur Md and Chisti, Jobayer Mohammod and Das, Kumar Sumon and Jahan, Yasmin and Saha, Kumar Samir and Arifeen, El Shams and Ahmed, Tahmeed and Faruque, G. A. S.", title="Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="19", volume="10", number="11", pages="e30191", keywords="chronic kidney disease", keywords="campaign", keywords="mHealth", keywords="knowledge", keywords="Bangladesh", abstract="Background: Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective: The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods: A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients' increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results: Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients' mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71\%) females in the control group and 38 out of 63 (60\%) females in the intervention group. In addition, there were 38 out of 63 (60\%) literate patients in the control group and 33 out of 63 (52\%) literate patients in the intervention group. Conclusions: It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID): DERR1-10.2196/30191 ", doi="10.2196/30191", url="https://www.researchprotocols.org/2021/11/e30191", url="http://www.ncbi.nlm.nih.gov/pubmed/34806998" } @Article{info:doi/10.2196/25824, author="Oladele, David and Iwelunmor, Juliet and Gbajabiamila, Titilola and Obiezu-Umeh, Chisom and Okwuzu, Ogoamaka Jane and Nwaozuru, Ucheoma and Musa, Zaidat Adesola and Idigbe, Ifeoma and Tahlil, Kadija and Tang, Weiming and Conserve, F. Donaldson and Rosenberg, E. Nora and David, N. Agatha and Tucker, Joseph and Ezechi, Oliver", title="The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences", journal="JMIR Form Res", year="2021", month="Nov", day="17", volume="5", number="11", pages="e25824", keywords="HIV self-testing", keywords="adolescents", keywords="young people", keywords="photo verification", keywords="mobile app", keywords="Nigeria", abstract="Background: Despite the global expansion of HIV self-testing (HIVST), many research studies still rely on self-reported outcomes. New HIVST verification methods are needed, especially in resource-limited settings. Objective: This study aims to evaluate the user experience of a mobile health (mHealth) app to enhance HIVST result reporting and verification. Methods: Semistructured, in-depth interviews were used to evaluate the user experience of the 4 Youth By Youth mHealth photo verification app for HIVST. We used a think-aloud approach, and participants performed usability tasks and completed a qualitative exit interview. The app included HIV educational resources, step-by-step video instructions for performing HIVST, a 20-minute timer, a guide on interpreting results with linkages to care, an offline version, and a photo verification system. Demographic characteristics were reported by using descriptive statistics. Qualitative data were analyzed by using thematic analysis. Results: A total of 19 users---12 women and 7 men---with a mean age of 22 years, participated in the study. The users completed the usability tasks and successfully uploaded a photo of their test results by using the app without assistance. Four main themes were identified in the data.?First, in terms of user-friendly design, the participants noted the user-friendly features of the offline version and the app's low data use. However, some wanted the app to work in the background when using their mobile phone, and the font used should be more youth friendly.?Second, in terms of ease of use, participants?remarked that the app's self-explanatory nature and instructions that guided them on how to use the app enhanced its use.?Third, in terms of a user's privacy, many participants?reinforced the importance of privacy settings and tools that protect confidentiality among users.?Finally, in terms of linkage to care, participants noted that the app's linkage to care features were useful, particularly in relation to referrals to trained counselors upon the completion of the test. All the participants noted that the app provided a convenient and private means of verifying the HIV test results. Conclusions: Our findings demonstrated the importance of engaging end users in the development phase of health technology innovations that serve youth. Clinical trials are needed to determine the efficacy of using an mHealth app to verify HIVST results among young people. ", doi="10.2196/25824", url="https://formative.jmir.org/2021/11/e25824", url="http://www.ncbi.nlm.nih.gov/pubmed/34787579" } @Article{info:doi/10.2196/28780, author="Biau, Sandrine and Bonnet, Emmanuel and Dagenais, Christian and De Allegri, Manuela and Traor{\'e}, Zoumana and Ouedraogo, Wahabo Abdoul and Sow, Abdramane and Dubois-Nguyen, Karina and Ridde, Val{\'e}ry", title="Using Information and Communication Technologies to Engage Citizens in Health System Governance in Burkina Faso: Protocol for Action Research", journal="JMIR Res Protoc", year="2021", month="Nov", day="16", volume="10", number="11", pages="e28780", keywords="health governance", keywords="ICTs", keywords="citizen participation", keywords="responsiveness", keywords="social responsibility", keywords="Burkina Faso", keywords="technology platforms", keywords="democracy", keywords="health systems", keywords="equity", keywords="West Africa", keywords="public health", keywords="participation", keywords="health policy", abstract="Background: Health systems are complex systems involving a vast range of actors. In West Africa, they are often not accessible or responsive. Burkina Faso has widely expressed, in its public health policy, the need to improve both access to quality care and health system responsiveness. There is also a strong wish to give more voice to citizens. To support Burkinab{\`e} institutions in achieving these goals, we have developed an action research (AR) protocol. Objective: This paper presents the protocol that will address citizens' participation in health policies and their empowerment through the expression of opinions, for accountability, as well as the strengthening of the health system using information and communication technologies (ICTs). Methods: Our approach will consist of (1) enabling people to express their opinions on the health system by means of a toll-free (TF) service coupled with an interactive voice server (IVS); (2) building an information base with anonymous and reliable data; and (3) conducting information awareness-raising activities, including knowledge transfer (KT) and advocacy, social integration activities, development of OpenData platforms, and the capitalization and media coverage of governance issues. For this purpose, the AR project will be implemented in Burkina Faso. The design uses a concurrent mixed-methods approach. This AR project will evaluate the acceptability, process, effectiveness, and economic costs of the device's implementation. We will also analyze the potential for the data collected by the device to be used to improve practices. Results: Data collection is in progress; the TF number was officially launched on July 1, 2020, and data collection is planned to continue throughout 2021. By using mixed methods, our AR will be approached from a variety of perspectives. Mixed methods will support us in combining the partial insights into sophisticated realities from qualitative inquiries with the data analyses produced by quantitative research. Conclusions: This AR is expected to add knowledge on how to increase the empowerment of the population, especially the most vulnerable, to participate in democratic processes and enjoy and exercise their human rights. This protocol recommends implementing a low-cost, contextually adapted technology, associated with an evidence-based approach and carried out on a significant scale. The originality of this approach lies in the fact that it introduces a real AR dimension with local communities and nongovernmental organizations (NGOs), combined with an integrated strategy of KT and application throughout the project for all stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/28780 ", doi="10.2196/28780", url="https://www.researchprotocols.org/2021/11/e28780", url="http://www.ncbi.nlm.nih.gov/pubmed/34783671" } @Article{info:doi/10.2196/29020, author="Berry, Isha and Mangtani, Punam and Rahman, Mahbubur and Khan, Ansary Iqbal and Sarkar, Sudipta and Naureen, Tanzila and Greer, L. Amy and Morris, K. Shaun and Fisman, N. David and Flora, Sabrina Meerjady", title="Population Health Surveillance Using Mobile Phone Surveys in Low- and Middle-Income Countries: Methodology and Sample Representativeness of a Cross-sectional Survey of Live Poultry Exposure in Bangladesh", journal="JMIR Public Health Surveill", year="2021", month="Nov", day="12", volume="7", number="11", pages="e29020", keywords="mobile telephone survey", keywords="health surveillance", keywords="survey methodology", keywords="Bangladesh", abstract="Background: Population-based health surveys are typically conducted using face-to-face household interviews in low- and middle-income countries (LMICs). However, telephone-based surveys are cheaper, faster, and can provide greater access to hard-to-reach or remote populations. The rapid growth in mobile phone ownership in LMICs provides a unique opportunity to implement novel data collection methods for population health surveys. Objective: This study aims to describe the development and population representativeness of a mobile phone survey measuring live poultry exposure in urban Bangladesh. Methods: A population-based, cross-sectional, mobile phone survey was conducted between September and November 2019 in North and South Dhaka City Corporations (DCC), Bangladesh, to measure live poultry exposure using a stratified probability sampling design. Data were collected using a computer-assisted telephone interview platform. The call operational data were summarized, and the participant data were weighted by age, sex, and education to the 2011 census. The demographic distribution of the weighted sample was compared with external sources to assess population representativeness. Results: A total of 5486 unique mobile phone numbers were dialed, with 1047 respondents completing the survey. The survey had an overall response rate of 52.2\% (1047/2006) and a co-operation rate of 89.0\% (1047/1176). Initial results comparing the sociodemographic profile of the survey sample to the census population showed that mobile phone sampling slightly underrepresented older individuals and overrepresented those with higher secondary education. After weighting, the demographic profile of the sample population matched well with the latest DCC census population profile. Conclusions: Probability-based mobile phone survey sampling and data collection methods produced a population-representative sample with minimal adjustment in DCC, Bangladesh. Mobile phone--based surveys can offer an efficient, economic, and robust way to conduct surveillance for population health outcomes, which has important implications for improving population health surveillance in LMICs. ", doi="10.2196/29020", url="https://publichealth.jmir.org/2021/11/e29020", url="http://www.ncbi.nlm.nih.gov/pubmed/34766914" } @Article{info:doi/10.2196/23874, author="Chukwu, Emeka and Gilroy, Sonia and Addaquay, Kojo and Jones, Nafisa Nki and Karimu, Gbadia Victor and Garg, Lalit and Dickson, Eva Kim", title="Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey", journal="JMIR Form Res", year="2021", month="Nov", day="12", volume="5", number="11", pages="e23874", keywords="young people", keywords="short message service", keywords="SMS", keywords="chatbot", keywords="text message", keywords="interactive voice response", keywords="IVR", keywords="WhatsApp", keywords="Facebook", keywords="family planning", keywords="contraceptives", keywords="Sierra Leone", abstract="Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media--only internet bundle, with the cost ranging from 1000 leones (US \$0.11) to 1500 leones (US \$0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US \$0.11) and 5000 leones (US \$0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. ", doi="10.2196/23874", url="https://formative.jmir.org/2021/11/e23874", url="http://www.ncbi.nlm.nih.gov/pubmed/34766908" } @Article{info:doi/10.2196/28951, author="Pal Bhowmick, Ipsita and Chutia, Dibyajyoti and Chouhan, Avinash and Nishant, Nilay and Raju, N. P. L. and Narain, Kanwar and Kaur, Harpreet and Pebam, Rocky and Debnath, Jayanta and Tripura, Rabindra and Gogoi, Kongkona and Ch Nag, Suman and Nath, Aatreyee and Tripathy, Debabrata and Debbarma, Jotish and Das, Nirapada and Sarkar, Ujjwal and Debbarma, Rislyn and Roy, Rajashree and Debnath, Bishal and Dasgupta, Dipanjan and Debbarma, Suraj and Joy Tripura, Kamal and Reang, Guneram and Sharma, Amit and Rahi, Manju and Chhibber-Goel, Jyoti", title="Validation of a Mobile Health Technology Platform (FeverTracker) for Malaria Surveillance in India: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Nov", day="10", volume="5", number="11", pages="e28951", keywords="fever", keywords="health system", keywords="mHealth app", keywords="malaria", keywords="surveillance", keywords="mobile phone", abstract="Background: A surveillance system is the foundation for disease prevention and control. Malaria surveillance is crucial for tracking regional and temporal patterns in disease incidence, assisting in recorded details, timely reporting, and frequency of analysis. Objective: In this study, we aim to develop an integrated surveillance graphical app called FeverTracker, which has been designed to assist the community and health care workers in digital surveillance and thereby contribute toward malaria control and elimination. Methods: FeverTracker uses a geographic information system and is linked to a web app with automated data digitization, SMS text messaging, and advisory instructions, thereby allowing immediate notification of individual cases to district and state health authorities in real time. Results: The use of FeverTracker for malaria surveillance is evident, given the archaic paper-based surveillance tools used currently. The use of the app in 19 tribal villages of the Dhalai district in Tripura, India, assisted in the surveillance of 1880 suspected malaria patients and confirmed malaria infection in 93.4\% (114/122; Plasmodium falciparum), 4.9\% (6/122; P vivax), and 1.6\% (2/122; P falciparum/P vivax mixed infection) of cases. Digital tools such as FeverTracker will be critical in integrating disease surveillance, and they offer instant data digitization for downstream processing. Conclusions: The use of this technology in health care and research will strengthen the ongoing efforts to eliminate malaria. Moreover, FeverTracker provides a modifiable template for deployment in other disease systems. ", doi="10.2196/28951", url="https://formative.jmir.org/2021/11/e28951", url="http://www.ncbi.nlm.nih.gov/pubmed/34757321" } @Article{info:doi/10.2196/18969, author="Nwaogu, Mayowa Janet and Chan, C. Albert P. and Naslund, A. John and Hon, H. Carol K. and Belonwu, Christopher and Yang, Jackie", title="Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study", journal="JMIR Form Res", year="2021", month="Nov", day="9", volume="5", number="11", pages="e18969", keywords="mental health", keywords="construction personnel", keywords="digital technology", keywords="digital intervention", keywords="barriers", keywords="motivators", keywords="mobile phone", abstract="Background: Work-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry. Objective: This study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions. Methods: This qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis. Results: A total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability. Conclusions: This study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions. ", doi="10.2196/18969", url="https://formative.jmir.org/2021/11/e18969", url="http://www.ncbi.nlm.nih.gov/pubmed/34751652" } @Article{info:doi/10.2196/30350, author="Malamsha, Proches Maria and Sauli, Elingarami and Luhanga, Talina Edith", title="Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study", journal="JMIR Serious Games", year="2021", month="Nov", day="8", volume="9", number="4", pages="e30350", keywords="child sexual abuse", keywords="social cultural belief", keywords="ecological setting", keywords="prevention", keywords="parents", keywords="caretakers", keywords="child experts", keywords="mobile game", abstract="Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa---where sexual education is still taboo---that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods: ?HappyToto children's game was co-designed with 111 parents and caretakers (females: n=58, 52.3\%; male: n=53, 47.7\%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game's interface, storylines, and options. To validate the application's prototype, 32 parents (females: n=18, 56\%; males: n=14, 44\%) of children aged 3-5 years and 5 children (females: n=2, 40\%; males: n=3, 60\%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education. ", doi="10.2196/30350", url="https://games.jmir.org/2021/4/e30350", url="http://www.ncbi.nlm.nih.gov/pubmed/34747703" } @Article{info:doi/10.2196/33047, author="Hatch, Gabe S. and Lobaina, Diana and Doss, D. Brian", title="Optimizing Coaching During Web-Based Relationship Education for Low-Income Couples: Protocol for Precision Medicine Research", journal="JMIR Res Protoc", year="2021", month="Nov", day="4", volume="10", number="11", pages="e33047", keywords="online relationship education", keywords="precision medicine", keywords="low-income couples", keywords="coaching", keywords="OurRelationship", keywords="ePREP", abstract="Background: In-person relationship education classes funded by the federal government tend to experience relatively high attrition rates and have only a limited effect on relationships. In contrast, low-income couples tend to report meaningful gains from web-based relationship education when provided with individualized coach contact. However, little is known about the method and intensity of practitioner contact that a couple requires to complete the web-based program and receive the intended benefit. Objective: The aim of this study is to use within-group models to create an algorithm to assign future couples to different programs and levels of coach contact, identify the most powerful predictors of treatment adherence and gains in relationship satisfaction within 3 different levels of coaching, and examine the most powerful predictors of treatment adherence and gains in relationship satisfaction among the 3 levels of coach contact. Methods: To accomplish these goals, this project intends to use data from a web-based Sequential Multiple Assignment Randomized Trial of the OurRelationship and web-based Prevention and Relationship Enhancement programs, in which the method and type of coach contact were randomly varied across 1248 couples (2496 individuals), with the hope of advancing theory in this area and generating accurate predictions. This study was funded by the US Department of Health and Human Services, Administration for Children and Families (grant number 90PD0309). Results: Data collection from the Sequential Multiple Assignment Randomized Trial of the OurRelationship and web-based Prevention and Relationship Enhancement Program was completed in October of 2020. Conclusions: Some of the direct benefits of this study include benefits to social services program administrators, tailoring of more effective relationship education, and effective delivery of evidence- and web-based relationship health interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/33047 ", doi="10.2196/33047", url="https://www.researchprotocols.org/2021/11/e33047", url="http://www.ncbi.nlm.nih.gov/pubmed/34734838" } @Article{info:doi/10.2196/31951, author="Sabherwal, Shalinder and Chinnakaran, Anand and Sood, Ishaana and Garg, K. Gaurav and Singh, P. Birendra and Shukla, Rajan and Reddy, A. Priya and Gilbert, Suzanne and Bassett, Ken and Murthy, S. Gudlavalleti V. and ", title="Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study", journal="JMIR Res Protoc", year="2021", month="Nov", day="4", volume="10", number="11", pages="e31951", keywords="study protocol", keywords="randomized intervention study", keywords="vision centers", keywords="door-to-door screening", keywords="cost-effectiveness", keywords="sustainability", keywords="screening", keywords="awareness", keywords="vision", keywords="eye", keywords="utilization", keywords="usage", keywords="India", keywords="rural", keywords="intervention", keywords="engagement", keywords="scalability", abstract="Background: A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community's vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. Objective: Our organization is planning an awareness-cum-engagement intervention---door-to-door basic eye checkup and visual acuity screening in VCs coverage areas---to connect with the community and improve the rational use of VCs. Methods: In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ?10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. Results: Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. Conclusions: Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. Trial Registration: ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718 International Registered Report Identifier (IRRID): DERR1-10.2196/31951 ", doi="10.2196/31951", url="https://www.researchprotocols.org/2021/11/e31951", url="http://www.ncbi.nlm.nih.gov/pubmed/34734839" } @Article{info:doi/10.2196/30293, author="Calvo-Valderrama, Gabriela Maria and Marroqu{\'i}n-Rivera, Arturo and Burn, Erin and Ospina-Pinillos, Laura and Bird, Victoria and G{\'o}mez-Restrepo, Carlos", title="Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study", journal="JMIR Form Res", year="2021", month="Nov", day="3", volume="5", number="11", pages="e30293", keywords="pandemic", keywords="COVID-19", keywords="online focus groups", keywords="qualitative research", keywords="technology", keywords="adolescents", keywords="public health", abstract="Background: Although focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This challenge has been further compounded by the global COVID-19 pandemic and the subsequent lockdown and physical distancing measures implemented, which caused exceptional challenges to human activities. Online focus groups (OFGs) are an example of an alternative strategy and require further study. At present, OFGs have mostly been studied and used in high-income countries, with little information relating to their implementation in low- and middle-income countries (LMICs). Objective: The aim of this study is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. Methods: As part of a broader study, OFGs were developed with adults and adolescents in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via email in two different cities of Colombia to participate in OFGs conducted via Microsoft Teams. Researcher notes and discussion were used to capture participant and facilitator experiences, as well as practical considerations. Results: Technical issues were encountered, but various measures were taken to minimize them, such as using a web conferencing service that was familiar to participants, sending written instructions, and performing a trial meeting prior to the OFG. Adolescent participants, unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. Conclusions: OFGs have great potential in research settings, especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (ie, internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings. ", doi="10.2196/30293", url="https://formative.jmir.org/2021/11/e30293", url="http://www.ncbi.nlm.nih.gov/pubmed/34637395" } @Article{info:doi/10.2196/27114, author="Bhattacharjee, Ananya and Haque, Taiabul S. M. and Hady, Abdul Md and Alam, Raihanul S. M. and Rabbi, Mashfiqui and Kabir, Ashad Muhammad and Ahmed, Ishtiaque Syed", title="Understanding the Social Determinants of Mental Health of Undergraduate Students in Bangladesh: Interview Study", journal="JMIR Form Res", year="2021", month="Nov", day="2", volume="5", number="11", pages="e27114", keywords="Bangladesh", keywords="global south", keywords="social determinant", keywords="students", keywords="undergraduate", keywords="religion", keywords="women", keywords="mobile phone", abstract="Background: The undergraduate student population has been actively studied in digital mental health research. However, the existing literature primarily focuses on students from high-income nations, and undergraduates from limited-income nations remain understudied. Objective: This study aims to identify the broader social determinants of mental health among undergraduate students in Bangladesh, a limited-income nation in South Asia; study the manifestation of these determinants in their day-to-day lives; and explore the feasibility of self-monitoring tools in helping them identify the specific factors or relationships that affect their mental health. Methods: We conducted a 21-day study with 38 undergraduate students from 7 universities in Bangladesh. We conducted 2 semistructured interviews: one prestudy and one poststudy. During the 21-day study, participants used an Android app to self-report and self-monitor their mood after each phone conversation. The app prompted participants to report their mood after each phone conversation and provided graphs and charts so that the participants could independently review their mood and conversation patterns. Results: Our results show that academics, family, job and economic condition, romantic relationship, and religion are the major social determinants of mental health among undergraduate students in Bangladesh. Our app helped the participants pinpoint the specific issues related to these factors, as the participants could review the pattern of their moods and emotions from past conversation history. Although our app does not provide any explicit recommendation, the participants took certain steps on their own to improve their mental health (eg, reduced the frequency of communication with certain persons). Conclusions: Although some of the factors (eg, academics) were reported in previous studies conducted in the Global North, this paper sheds light on some new issues (eg, extended family problems and religion) that are specific to the context of the Global South. Overall, the findings from this study would provide better insights for researchers to design better solutions to help the younger population from this part of the world. ", doi="10.2196/27114", url="https://formative.jmir.org/2021/11/e27114", url="http://www.ncbi.nlm.nih.gov/pubmed/34726609" } @Article{info:doi/10.2196/26136, author="Perrins, Genevieve and Ferdous, Tabassum and Hay, Dawn and Harreveld, Bobby and Reid-Searl, Kerry", title="Conducting Health Literacy Research With Hard-to-Reach Regional Culturally and Linguistically Diverse Populations: Evaluation Study of Recruitment and Retention Methods Before and During COVID-19", journal="JMIR Form Res", year="2021", month="Nov", day="2", volume="5", number="11", pages="e26136", keywords="health literacy", keywords="cultural and linguistic diversity", keywords="COVID-19", keywords="health care barriers", keywords="hard-to-reach research participants", keywords="regional Australia", keywords="health literacy profiles", keywords="literacy", abstract="Background: In health research, culturally and linguistically diverse (CALD) health care consumers are cited as hidden or hard to reach. This paper evaluates the approach used by researchers to attract and retain hard-to-reach CALD research participants for a study investigating health communication barriers between CALD health care users and health care professionals in regional Australia. As the study was taking place during the COVID-19 pandemic, subsequent restrictions emerged. Thus, recruitment and retention methods were adapted. This evaluation considered the effectiveness of recruitment and retention used throughout the pre-COVID and during-COVID periods. Objective: This evaluation sought to determine the effectiveness of recruitment and retention efforts of researchers during a study that targeted regional hard-to-reach CALD participants. Methods: Recruitment and retention methods were categorized into the following 5 phases: recruitment, preintervention data collection, intervention, postintervention data collection, and interviews. To compare the methods used by researchers, recruitment and retention rates were divided into pre-COVID and during-COVID periods. Thereafter, in-depth reflections of the methods employed within this study were made. Results: This paper provides results relating to participant recruitment and retainment over the course of 5 research phases that occurred before and during COVID. During the pre-COVID recruitment phase, 22 participants were recruited. Of these participants, 15 (68\%) transitioned to the next phase and completed the initial data collection phase. By contrast, 18 participants completed the during-COVID recruitment phase, with 13 (72\%) continuing to the next phase. The success rate of the intervention phase in the pre-COVID period was 93\% (14/15), compared with 84.6\% (11/13) in the during-COVID period. Lastly, 93\% (13/14) of participants completed the postintervention data collection in the pre-COVID period, compared with 91\% (10/11) in the during-COVID period. In total, 40 participants took part in the initial data collection phase, with 23 (58\%) completing the 5 research phases. Owing to the small sample size, it was not determined if there was any statistical significance between the groups (pre- and during-COVID periods). Conclusions: The success of this program in recruiting and maintaining regional hard-to-reach CALD populations was preserved over the pre- and during-COVID periods. The pandemic required researchers to adjust study methods, thereby inadvertently contributing to the recruitment and retention success of the project. The maintenance of participants during this period was due to flexibility offered by researchers through adaptive methods, such as the use of cultural gatekeepers, increased visibility of CALD researchers, and use of digital platforms. The major findings of this evaluation are 2-fold. First, increased diversity in the research sample required a high level of flexibility from researchers, meaning that such projects may be more resource intensive. Second, community organizations presented a valuable opportunity to connect with potential hard-to-reach research participants. ", doi="10.2196/26136", url="https://formative.jmir.org/2021/11/e26136", url="http://www.ncbi.nlm.nih.gov/pubmed/34581673" } @Article{info:doi/10.2196/32639, author="Saad, K. Randa and Al Nsour, Mohannad and Khader, Yousef and Al Gunaid, Magid", title="Public Health Surveillance Systems in the Eastern Mediterranean Region: Bibliometric Analysis of Scientific Literature", journal="JMIR Public Health Surveill", year="2021", month="Nov", day="1", volume="7", number="11", pages="e32639", keywords="public health", keywords="surveillance", keywords="Eastern Mediterranean Region", keywords="bibliometric analysis", keywords="literature", keywords="research", keywords="review", abstract="Background: The Eastern Mediterranean Region (EMR) hosts some of the world's worst humanitarian and health crises. The implementation of health surveillance in this region has faced multiple constraints. New and novel approaches in surveillance are in a constant state of high and immediate demand. Identifying the existing literature on surveillance helps foster an understanding of scientific development and thus potentially supports future development directions. Objective: This study aims to illustrate the scientific production, quantify the scholarly impact, and highlight the characteristics of publications on public health surveillance in the EMR over the past decade. Methods: We performed a Scopus search using keywords related to public health surveillance or its disciplines, cross-referenced with EMR countries, from 2011 to July 2021. Data were exported and analyzed using Microsoft Excel and Visualization of Similarities Viewer. Quality of journals was determined using SCImago Journal Rank and CiteScore. Results: We retrieved 1987 documents, of which 1927 (96.98\%) were articles or reviews. There has been an incremental increase in the number of publications (exponential growth, R2=0.80) over the past decade. Publications were mostly affiliated with Iran (501/1987, 25.21\%), the United States (468/1987, 23.55\%), Pakistan (243/1987, 12.23\%), Egypt (224/1987, 11.27\%), and Saudi Arabia (209/1987, 10.52\%). However, Iran only had links with 40 other countries (total link strength 164), and the biggest collaborator from the EMR was Egypt, with 67 links (total link strength 402). Within the other EMR countries, only Morocco, Lebanon, and Jordan produced ?79 publications in the 10-year period. Most publications (1551/1987, 78.06\%) were affiliated with EMR universities. Most journals were categorized as medical journals, and the highest number of articles were published in the Eastern Mediterranean Health Journal (SCImago Journal Rank 0.442; CiteScore 1.5). Retrieved documents had an average of 18.4 (SD 125.5) citations per document and an h-index of 66. The top-3 most cited documents were from the Global Burden of Diseases study. We found 70 high-frequency terms, occurring ?10 times in author keywords, connected in 3 clusters. COVID-19, SARS-CoV-2, and pandemic represented the most recent 2020 cluster. Conclusions: This is the first research study to quantify the published literature on public health surveillance and its disciplines in the EMR. Research productivity has steadily increased over the past decade, and Iran has been the leading country publishing relevant research. Recurrent recent surveillance themes included COVID-19 and SARS-CoV-2. This study also sheds light on the gaps in surveillance research in the EMR, including inadequate publications on noncommunicable diseases and injury-related surveillance. ", doi="10.2196/32639", url="https://publichealth.jmir.org/2021/11/e32639", url="http://www.ncbi.nlm.nih.gov/pubmed/34723831" } @Article{info:doi/10.2196/29280, author="Doukani, Asmae and Cerga Pashoja, Arlinda and Fanaj, Naim and Qirjako, Gentiana and Meksi, Andia and Mustafa, Sevim and Vis, Christiaan and Hug, Juliane", title="Organizational Readiness for Implementing an Internet-Based Cognitive Behavioral Therapy Intervention for Depression Across Community Mental Health Services in Albania and Kosovo: Directed Qualitative Content Analysis", journal="JMIR Form Res", year="2021", month="Nov", day="1", volume="5", number="11", pages="e29280", keywords="e-mental health", keywords="digital mental health", keywords="internet-based cognitive behavioral therapy", keywords="implementation science", keywords="organizational readiness for implementing change", keywords="community mental health center", keywords="qualitative interviews", keywords="content analysis", keywords="Albania and Kosovo", abstract="Background: The use of digital mental health programs such as internet-based cognitive behavioral therapy (iCBT) holds promise in increasing the quality and access of mental health services. However very little research has been conducted in understanding the feasibility of implementing iCBT in Eastern Europe. Objective: The aim of this study was to qualitatively assess organizational readiness for implementing iCBT for depression within community mental health centers (CMHCs) across Albania and Kosovo. Methods: We used qualitative semistructured focus group discussions that were guided by Bryan Weiner's model of organizational readiness for implementing change. The questions broadly explored shared determination to implement change (change commitment) and shared belief in their collective capability to do so (change efficacy). Data were collected between November and December 2017. A range of health care professionals working in and in association with CMHCs were recruited from 3 CMHCs in Albania and 4 CMHCs in Kosovo, which were participating in a large multinational trial on the implementation of iCBT across 9 countries (Horizon 2020 ImpleMentAll project). Data were analyzed using a directed approach to qualitative content analysis, which used a combination of both inductive and deductive approaches. Results: Six focus group discussions involving 69 mental health care professionals were conducted. Participants from Kosovo (36/69, 52\%) and Albania (33/69, 48\%) were mostly females (48/69, 70\%) and nurses (26/69, 38\%), with an average age of 41.3 years. A directed qualitative content analysis revealed several barriers and facilitators potentially affecting the implementation of digital CBT interventions for depression in community mental health settings. While commitment for change was high, change efficacy was limited owing to a range of situational factors. Barriers impacting ``change efficacy'' included lack of clinical fit for iCBT, high stigma affecting help-seeking behaviors, lack of human resources, poor technological infrastructure, and high caseload. Facilitators included having a high interest and capability in receiving training for iCBT. For ``change commitment,'' participants largely expressed welcoming innovation and that iCBT could increase access to treatments for geographically isolated people and reduce the stigma associated with mental health care. Conclusions: In summary, participants perceived iCBT positively in relation to promoting innovation in mental health care, increasing access to services, and reducing stigma. However, a range of barriers was also highlighted in relation to accessing the target treatment population, a culture of mental health stigma, underdeveloped information and communications technology infrastructure, and limited appropriately trained health care workforce, which reduce organizational readiness for implementing iCBT for depression. Such barriers may be addressed through (1) a public-facing campaign that addresses mental health stigma, (2) service-level adjustments that permit staff with the time, resources, and clinical supervision to deliver iCBT, and (3) establishment of a suitable clinical training curriculum for health care professionals. Trial Registration: ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883 ", doi="10.2196/29280", url="https://formative.jmir.org/2021/11/e29280", url="http://www.ncbi.nlm.nih.gov/pubmed/34723822" } @Article{info:doi/10.2196/25099, author="Muwanguzi, A. Patience and Ngabirano, Denis Tom and Kiwanuka, Noah and Nelson, E. LaRon and Nasuuna, M. Esther and Osingada, Peter Charles and Nabunya, Racheal and Nakanjako, Damalie and Sewankambo, K. Nelson", title="The Effects of Workplace-Based HIV Self-testing on Uptake of Testing and Linkage to HIV Care or Prevention by Men in Uganda (WISe-Men): Protocol for a Cluster Randomized Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="1", volume="10", number="11", pages="e25099", keywords="Africa", keywords="workplace HIV testing", keywords="HIV self-testing", keywords="linkage to care", keywords="linkage to prevention", abstract="Background: HIV testing uptake remains low among men in sub-Saharan Africa. HIV self-testing (HIVST) at the workplace is a novel approach to increase the availability of, and access to, testing among men. However, both access and linkage to posttest services remain a challenge. Objective: The aim of this protocol is to describe a cluster randomized trial (CRT)---Workplace-Based HIV Self-testing Among Men (WISe-Men)---to evaluate the effect of HIVST in workplace settings on the uptake of HIV testing services (HTS) and linkage to treatment and prevention services among men employed in private security services in Uganda. Methods: This is a two-arm CRT involving men employed in private security services in two Ugandan districts. The participants in the intervention clusters will undergo workplace-based HIVST using OraQuick test kits. Those in the control clusters will receive routine HTS at their work premises. In addition to HTS, participants in both the intervention and control arms will undergo other tests and assessments, which include blood pressure assessment, blood glucose and BMI measurement, and rapid diagnostic testing for syphilis. The primary outcome is the uptake of HIV testing. The secondary outcomes include HIV status reporting, linkage into HIV care and confirmatory testing following HIVST, initiation of antiretroviral therapy following a confirmatory HIV test, the uptake of voluntary medical male circumcision, consistent condom use, and the uptake of pre-exposure prophylaxis by the most at-risk populations. Results: Participant enrollment commenced in February 2020, and the trial is still recruiting study participants. Follow-up for currently enrolled participants is ongoing. Data collection and analysis is expected to be completed in December 2021. Conclusions: The WISe-Men trial will provide information regarding whether self-testing at worksites increases the uptake of HIV testing as well as the linkage to care and prevention services at male-dominated workplaces in Uganda. Additionally, the findings will help us propose strategies for improving men's engagement in HTS and ways to improve linkage to further care following a reactive or nonreactive HIVST result. Trial Registration: ClinicalTrials.gov NCT04164433; https://clinicaltrials.gov/ct2/show/NCT04164433 International Registered Report Identifier (IRRID): DERR1-10.2196/25099 ", doi="10.2196/25099", url="https://www.researchprotocols.org/2021/11/e25099", url="http://www.ncbi.nlm.nih.gov/pubmed/34723826" } @Article{info:doi/10.2196/26177, author="Mpunga, Elizabeth and Persaud, Navindra and Akolo, Christopher and Boyee, Dorica and Kamanga, Gift and Trapence, Gift and Chilongozi, David and Ruberintwari, Melchiade and Masankha Banda, Louis", title="Readiness for Use of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in Malawi: Qualitative Focus Group and Interview Study", journal="JMIR Public Health Surveill", year="2021", month="Oct", day="27", volume="7", number="10", pages="e26177", keywords="MSM", keywords="readiness to use", keywords="PrEP", keywords="HIV prevention", keywords="qualitative assessment", keywords="HIV", keywords="men who have sex with men", keywords="Malawi", keywords="prophylaxis", abstract="Background: Men who have sex with men (MSM) are a key group for HIV interventions in Malawi considering their high HIV prevalence (17.5\% compared to 8.4\% among men in the general population). The use of oral preexposure prophylaxis (PrEP) presents a new opportunity for MSM to be protected. We present the findings from a qualitative assessment designed to assess awareness of and willingness and barriers to using PrEP among MSM in Malawi. Objective: The 3 main objectives of this assessment were to determine: (1) awareness of PrEP, (2) factors that influence willingness to use PrEP, and (3) potential barriers to PrEP use and adherence among MSM in order to guide the design and implementation of a PrEP program in Malawi. Methods: Ahead of the introduction of PrEP in Malawi, a qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in October 2018 in Blantyre, Lilongwe, and rural districts of Mzimba North and Mangochi. With support of members of the population, study participants were purposively recruited from 4 MSM-friendly drop-in centers where MSM receive a range of health services to ensure representativeness across sites and age. Participants were asked what they had heard about PrEP, their willingness to use PrEP, their barriers to PrEP use, and their preferences for service delivery. The data were analyzed using a thematic content analysis framework that was predetermined in line with objectives. Results: A total of 109 MSM were interviewed---13 through IDIs and 96 through FGDs. Most participants were aware of PrEP as a new HIV intervention but had limited knowledge related to its use. However, the majority were willing to use it and were looking forward to having access to it. IDI participants indicated that they will be more willing to take PrEP if the dosing frequency were appropriate and MSM were involved in information giving and distribution of the drug. FGD participants emphasized that places of distribution and characteristics of the service provider are the key factors that will affect use. Knowing the benefits of PrEP emerged as a key theme in both the IDIs and FGDs. Participants highlighted barriers that would hinder them from taking PrEP such as side effects which were cited in IDIs and FGDs. Key factors from FGDs include cost, fear of being outed, drug stockouts, fear of being known as MSMs by wives, and lack of relevant information. FGDs cited stigma from health care workers, forgetfulness, and community associated factors. Conclusions: Despite having inadequate knowledge about PrEP, study participants were largely willing to use PrEP if available. Programs should include an effective information, education, and communication component around their preferences and provide PrEP in MSM-friendly sites. ", doi="10.2196/26177", url="https://publichealth.jmir.org/2021/10/e26177", url="http://www.ncbi.nlm.nih.gov/pubmed/34228627" } @Article{info:doi/10.2196/32921, author="Xiao, Jin and Luo, Jiebo and Ly-Mapes, Oriana and Wu, Tong Tong and Dye, Timothy and Al Jallad, Nisreen and Hao, Peirong and Ruan, Jinlong and Bullock, Sherita and Fiscella, Kevin", title="Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study", journal="JMIR Res Protoc", year="2021", month="Oct", day="22", volume="10", number="10", pages="e32921", keywords="artificial intelligence", keywords="smartphone app", keywords="mDentistry", keywords="dental caries", keywords="underserved population", keywords="mobile dentistry", abstract="Background: Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55\% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85\% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. Objective: This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence--powered smartphone app, AICaries, to be used by children's parents/caregivers for dental caries detection in their children. Methods: Our previous work has led to the prototype of AICaries, which offers artificial intelligence--powered caries detection using photos of children's teeth taken by the parents' smartphones, interactive caries risk assessment, and personalized education on reducing children's ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children's teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents' satisfaction. Results: The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. Conclusions: Using AICaries, parents can use their regular smartphones to take photos of their children's teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. International Registered Report Identifier (IRRID): PRR1-10.2196/32921 ", doi="10.2196/32921", url="https://www.researchprotocols.org/2021/10/e32921", url="http://www.ncbi.nlm.nih.gov/pubmed/34529582" } @Article{info:doi/10.2196/29954, author="Nabadda, Susan and Kakooza, Francis and Kiggundu, Reuben and Walwema, Richard and Bazira, Joel and Mayito, Jonathan and Mugerwa, Ibrahimm and Sekamatte, Musa and Kambugu, Andrew and Lamorde, Mohammed and Kajumbula, Henry and Mwebasa, Henry", title="Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data", journal="JMIR Public Health Surveill", year="2021", month="Oct", day="21", volume="7", number="10", pages="e29954", keywords="antimicrobial resistance", keywords="surveillance", keywords="microbiology", keywords="laboratory", keywords="Uganda", keywords="implementation", keywords="WHO", keywords="collection", keywords="analysis", keywords="data", keywords="antimicrobial", keywords="progress", keywords="bacteria", keywords="feasibility", keywords="resistance", keywords="antibiotic", abstract="Background: Antimicrobial resistance (AMR) is an emerging public health crisis in Uganda. The World Health Organization (WHO) Global Action Plan recommends that countries should develop and implement National Action Plans for AMR. We describe the establishment of the national AMR program in Uganda and present the early microbial sensitivity results from the program. Objective: The aim of this study is to describe a national surveillance program that was developed to perform the systematic and continuous collection, analysis, and interpretation of AMR data. Methods: A systematic qualitative description of the process and progress made in the establishment of the national AMR program is provided, detailing the progress made from 2015 to 2020. This is followed by a report of the findings of the isolates that were collected from AMR surveillance sites. Identification and antimicrobial susceptibility testing (AST) of the bacterial isolates were performed using standard methods at both the surveillance sites and the reference laboratory. Results: Remarkable progress has been achieved in the establishment of the national AMR program, which is guided by the WHO Global Laboratory AMR Surveillance System (GLASS) in Uganda. A functional national coordinating center for AMR has been established with a supporting designated reference laboratory. WHONET software for AMR data management has been installed in the surveillance sites and laboratory staff trained on data quality assurance. Uganda has progressively submitted data to the WHO GLASS reporting system. Of the 19,216 isolates from WHO GLASS priority specimens collected from October 2015 to June 2020, 22.95\% (n=4411) had community-acquired infections, 9.46\% (n=1818) had hospital-acquired infections, and 68.57\% (n=12,987) had infections of unknown origin. The highest proportion of the specimens was blood (12,398/19,216, 64.52\%), followed by urine (5278/19,216, 27.47\%) and stool (1266/19,216, 6.59\%), whereas the lowest proportion was urogenital swabs (274/19,216, 1.4\%). The mean age was 19.1 (SD 19.8 years), whereas the median age was 13 years (IQR 28). Approximately 49.13\% (9440/19,216) of the participants were female and 50.51\% (9706/19,216) were male. Participants with community-acquired infections were older (mean age 28, SD 18.6 years; median age 26, IQR 20.5 years) than those with hospital-acquired infections (mean age 17.3, SD 20.9 years; median age 8, IQR 26 years). All gram-negative (Escherichia coli, Klebsiella pneumoniae, and Neisseria gonorrhoeae) and gram-positive (Staphylococcus aureus and Enterococcus sp) bacteria with AST showed resistance to each of the tested antibiotics. Conclusions: Uganda is the first African country to implement a structured national AMR surveillance program in alignment with the WHO GLASS. The reported AST data indicate very high resistance to the recommended and prescribed antibiotics for treatment of infections. More effort is required regarding quality assurance of laboratory testing methodologies to ensure optimal adherence to WHO GLASS--recommended pathogen-antimicrobial combinations. The current AMR data will inform the development of treatment algorithms and clinical guidelines. ", doi="10.2196/29954", url="https://publichealth.jmir.org/2021/10/e29954", url="http://www.ncbi.nlm.nih.gov/pubmed/34673531" } @Article{info:doi/10.2196/26164, author="Vera Cruz dos Santos, Daniela and Coelho de So{\'a}rez, Patr{\'i}cia and Cavero, Victoria and U Rocha, I. Tha{\'i}s and Aschar, Suzana and Daley, Louise Kate and Garcia Claro, Helo{\'i}sa and Abud Scotton, George and Fernandes, Ivan and Diez-Canseco, Francisco and Brandt, Rebeca Lena and Toyama, Mauricio and Martins Castro, Carolina Hellen and Miranda, Jaime J. and Araya, Ricardo and Quayle, Julieta and Rossi Menezes, Paulo", title="A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru", journal="JMIR Res Protoc", year="2021", month="Oct", day="13", volume="10", number="10", pages="e26164", keywords="cost-effectiveness", keywords="depression", keywords="diabetes", keywords="hypertension", keywords="noncommunicable diseases", keywords="randomized trials", keywords="low- and middle-income countries", keywords="mHealth", keywords="task shifting", keywords="behavioral activation", abstract="Background: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. Methods: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in S{\~a}o Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50\% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top--down and bottom--up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95\% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. Results: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. Conclusions: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426 International Registered Report Identifier (IRRID): DERR1-10.2196/26164 ", doi="10.2196/26164", url="https://www.researchprotocols.org/2021/10/e26164", url="http://www.ncbi.nlm.nih.gov/pubmed/34643538" } @Article{info:doi/10.2196/23648, author="Jo, Youngji and Barthel, Nathan and Stierman, Elizabeth and Clifton, Kathryn and Pak, Semee Esther and Ezeiru, Sonachi and Ekweremadu, Diwe and Onugu, Nnaemeka and Ali, Zainab and Egwu, Elijah and Akoh, Ochayi and Uzunyayla, Orkan and Van Hulle, Suzanne", title="The Potential of Digital Data Collection Tools for Long-lasting Insecticide-Treated Net Mass Campaigns in Nigeria: Formative Study", journal="JMIR Form Res", year="2021", month="Oct", day="8", volume="5", number="10", pages="e23648", keywords="long-lasting insecticide-treated nets", keywords="malaria", keywords="Nigeria", keywords="information communication technology", keywords="geographic information system", keywords="supply chain management", abstract="Background: Nigeria has the world's largest malaria burden, accounting for 27\% of the world's malaria cases and 23\% of malaria mortality globally. This formative study describes the operational process of the mass distribution of long-lasting insecticide-treated nets (LLINs) during a campaign program in Nigeria. Objective: This study aims to assess whether and how digital data collection and management tools can change current practices and help resolve major implementation issues. Methods: Qualitative data on the technical features and operational processes of paper-based and information and communication technology (ICT)--based systems in the Edo and Kwara states from June 2 to 30, 2017, were collected on the basis of documented operation manuals, field observations, and informant interviews. During the LLIN campaign in Edo State, we recruited 6 local government area focal persons and monitors and documented daily review meetings during household mobilization (9 days) and net distribution (5 days) to understand the major program implementation issues associated with the following three aspects: logistic issues, technical issues, and demand creation. Each issue was categorized according to the expected degree (low, mid, and high) of change by the ICT system. Results: The net campaign started with microplanning and training, followed by a month-long implementation process, which included household mobilization, net movement, net distribution, and end process monitoring. The ICT system can improve management and oversight issues related to data reporting and processes through user-centered interface design, built-in data quality control logic flow or algorithms, and workflow automation. These often require more than 50\% of staff time and effort in the current paper-based practice. Compared with the current paper-based system, the real-time system is expected to reduce the time to payment compensation for health workers by about 20 days and produce summary campaign statistics for at least 20 to 30 days. Conclusions: The ICT system can facilitate the measurement of population coverage beyond program coverage during an LLIN campaign with greater data reliability and timeliness, which are often compromised due to the limited workforce capacity in a paper-based system. ", doi="10.2196/23648", url="https://formative.jmir.org/2021/10/e23648", url="http://www.ncbi.nlm.nih.gov/pubmed/34623310" } @Article{info:doi/10.2196/27478, author="Jiang, Nan and Nguyen, Nam and Siman, Nina and Cleland, M. Charles and Nguyen, Trang and Doan, Thi Hue and Abroms, C. Lorien and Shelley, R. Donna", title="Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="8", volume="9", number="10", pages="e27478", keywords="smoking cessation", keywords="text messaging", keywords="mHealth", keywords="mobile health", keywords="low- and middle-income country", keywords="smoking", keywords="developing countries", keywords="SMS", keywords="Vietnam", abstract="Background: Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. Objective: The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. Methods: The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. Results: Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8\%) reset the quit date and 19 (38\%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98\% [49/50] vs 82\% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20\% [10/50] vs 2\% [1/50]; P=.01), but the effect was not significant at 12 weeks (12\% [6/50] vs 6\% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. Conclusions: The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. Trial Registration: ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541 ", doi="10.2196/27478", url="https://mhealth.jmir.org/2021/10/e27478", url="http://www.ncbi.nlm.nih.gov/pubmed/34623318" } @Article{info:doi/10.2196/31733, author="Gold, Rachel and Sheppler, Christina and Hessler, Danielle and Bunce, Arwen and Cottrell, Erika and Yosuf, Nadia and Pisciotta, Maura and Gunn, Rose and Leo, Michael and Gottlieb, Laura", title="Using Electronic Health Record--Based Clinical Decision Support to Provide Social Risk--Informed Care in Community Health Centers: Protocol for the Design and Assessment of a Clinical Decision Support Tool", journal="JMIR Res Protoc", year="2021", month="Oct", day="8", volume="10", number="10", pages="e31733", keywords="social determinants of health", keywords="decision support systems, clinical", keywords="electronic health records", keywords="community health centers", keywords="health status disparities", abstract="Background: Consistent and compelling evidence demonstrates that social and economic adversity has an impact on health outcomes. In response, many health care professional organizations recommend screening patients for experiences of social and economic adversity or social risks---for example, food, housing, and transportation insecurity---in the context of care. Guidance on how health care providers can act on documented social risk data to improve health outcomes is nascent. A strategy recommended by the National Academy of Medicine involves using social risk data to adapt care plans in ways that accommodate patients' social risks. Objective: This study's aims are to develop electronic health record (EHR)--based clinical decision support (CDS) tools that suggest social risk--informed care plan adaptations for patients with diabetes or hypertension, assess tool adoption and its impact on selected clinical quality measures in community health centers, and examine perceptions of tool usability and impact on care quality. Methods: A systematic scoping review and several stakeholder activities will be conducted to inform development of the CDS tools. The tools will be pilot-tested to obtain user input, and their content and form will be revised based on this input. A randomized quasi-experimental design will then be used to assess the impact of the revised tools. Eligible clinics will be randomized to a control group or potential intervention group; clinics will be recruited from the potential intervention group in random order until 6 are enrolled in the study. Intervention clinics will have access to the CDS tools in their EHR, will receive minimal implementation support, and will be followed for 18 months to evaluate tool adoption and the impact of tool use on patient blood pressure and glucose control. Results: This study was funded in January 2020 by the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Formative activities will take place from April 2020 to July 2021, the CDS tools will be developed between May 2021 and November 2022, the pilot study will be conducted from August 2021 to July 2022, and the main trial will occur from December 2022 to May 2024. Study data will be analyzed, and the results will be disseminated in 2024. Conclusions: Patients' social risk information must be presented to care teams in a way that facilitates social risk--informed care. To our knowledge, this study is the first to develop and test EHR-embedded CDS tools designed to support the provision of social risk--informed care. The study results will add a needed understanding of how to use social risk data to improve health outcomes and reduce disparities. International Registered Report Identifier (IRRID): PRR1-10.2196/31733 ", doi="10.2196/31733", url="https://www.researchprotocols.org/2021/10/e31733", url="http://www.ncbi.nlm.nih.gov/pubmed/34623308" } @Article{info:doi/10.2196/23204, author="Mauka, Wilhellmuss and Mbotwa, Christopher and Moen, K{\aa}re and Lichtwarck, Ochieng Hanne and Haaland, Inga and Kazaura, Method and Leyna, H. Germana and Leshabari, T. Melkizedeck and Mmbaga, J. Elia", title="Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach", journal="JMIR Form Res", year="2021", month="Oct", day="7", volume="5", number="10", pages="e23204", keywords="mHealth application", keywords="participatory design", keywords="HIV", keywords="pre-exposure prophylaxis", keywords="Africa", keywords="female sex workers", keywords="sex and gender minorities", abstract="Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app's design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570 ", doi="10.2196/23204", url="https://formative.jmir.org/2021/10/e23204", url="http://www.ncbi.nlm.nih.gov/pubmed/34617904" } @Article{info:doi/10.2196/30947, author="Larkin, Celine and Wijesundara, Jessica and Nguyen, L. Hoa and Ha, Anh Duc and Vuong, Anh and Nguyen, Kieu Cuong and Amante, Daniel and Ngo, Quy Chau and Phan, Thu Phuong and Pham, Le Quyen Thi and Nguyen, Ngoc Binh and Nguyen, Phuong Anh Thi and Nguyen, Thu Phuong Thi and Person, Sharina and Allison, J. Jeroan and Houston, K. Thomas and Sadasivam, Rajani", title="mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam", journal="JMIR Res Protoc", year="2021", month="Oct", day="7", volume="10", number="10", pages="e30947", keywords="tobacco cessation", keywords="smoking cessation", keywords="mHealth", keywords="global health", keywords="Vietnam", keywords="randomized controlled trial", abstract="Background: Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. Objective: The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. Methods: We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. Results: Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3\%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. Conclusions: This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. Trial Registration: ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. International Registered Report Identifier (IRRID): DERR1-10.2196/30947 ", doi="10.2196/30947", url="https://www.researchprotocols.org/2021/10/e30947", url="http://www.ncbi.nlm.nih.gov/pubmed/34617915" } @Article{info:doi/10.2196/26980, author="Farah, Mohamed Alinoor and Nour, Yousuf Tahir and Obsiye, Muse and Aden, Akil Mowlid and Ali, Moeline Omar and Hussein, Arab Muktar and Budul, Bedel Abdullahi and Omer, Muktar and Getnet, Fentabil", title="Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study", journal="JMIR Form Res", year="2021", month="Oct", day="1", volume="5", number="10", pages="e26980", keywords="COVID-19", keywords="knowledge", keywords="attitude", keywords="practice", keywords="health care workers", keywords="Eastern Ethiopia", abstract="Background: On March 13, 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already-fragile health care delivery system and reduce the availability of essential health services. This analysis of data from the Somali Region of Eastern Ethiopia on health care workers' (HCWs) knowledge, attitudes, and practices regarding the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease. Objective: This study aimed to investigate the knowledge, attitudes, and practices of HCWs regarding COVID-19 infection. Methods: This cross-sectional study was conducted among HCWs in three public health facilities in the Somali Region, Eastern Ethiopia. A self-administered questionnaire was shared with all HCWs working at the public health facilities. A total of 15 knowledge questions were scored as 1 or 0 for correct or incorrect responses, respectively. A total of 14 practice questions were scored on a 3-point scale from 1 (``always'') to 3 (``never''). A total of six attitude questions were rated on a 5-point Likert scale, in a negative dimension, as follows: 1 (``strongly agree''), 2 (``agree''), 3 (``neutral''), 4 (``disagree''), and 5 (``strongly disagree''). Mean scores were calculated and used as a cut point to dichotomize the outcome variables (>13.7 indicated good knowledge, <18.8 indicated good practices, and ?10.5 indicated favorable attitudes). We used t tests and analyses of variance (ie, F tests) to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores. Results: Of the 686 HCWs approached, a total of 434 HCWs responded (63.3\% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5\%). The mean knowledge score was 13.7 (SD 2.6), and 73.3\% (318/434) of participants had sufficient knowledge. The mean attitude score was 10.5 (SD 4.1), and 54.8\% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 18.8 (SD 5.8), and 61.5\% (267/434) of the participants practiced precautionary measures to prevent COVID-19. There was a negative correlation between knowledge and attitude scores (r=--0.295, P<.001) and between knowledge and practice scores (r=--0.298, P<.001). Conclusions: The overall levels of knowledge and practice were relatively better than the attitude level. This highlights the need to implement strategies that enhance the positive attitudes and safe practices of the HCWs for better containment of the pandemic and supporting of essential health care services. ", doi="10.2196/26980", url="https://formative.jmir.org/2021/10/e26980", url="http://www.ncbi.nlm.nih.gov/pubmed/34477559" } @Article{info:doi/10.2196/24272, author="Lillie, Tiffany and Boyee, Dorica and Kamariza, Gloriose and Nkunzimana, Alphonse and Gashobotse, Dismas and Persaud, Navindra", title="Increasing Testing Options for Key Populations in Burundi Through Peer-Assisted HIV Self-Testing: Descriptive Analysis of Routine Programmatic Data", journal="JMIR Public Health Surveill", year="2021", month="Sep", day="30", volume="7", number="9", pages="e24272", keywords="HIV", keywords="HIV self-testing", keywords="key populations", keywords="case finding", keywords="ART initiation", keywords="Burundi", abstract="Background: In Burundi, given the low testing numbers among key populations (KPs), peer-assisted HIV self-testing (HIVST) was initiated for female sex workers (FSWs), men who have sex with men (MSM), and transgender people to provide another testing option. HIVST was provided by existing peer outreach workers who were trained to provide support before, during, and after the administration of the test. People who screened reactive were referred and actively linked to confirmatory testing, and those confirmed positive were linked to treatment. Standard testing included HIV testing by clinical staff either at mobile clinics in the community or in facilities. Objective: This study aims to improve access to HIV testing for underserved KPs, improve diagnoses of HIV serostatus among key populations, and link those who were confirmed HIV positive to life-saving treatment for epidemic control. Methods: A descriptive analysis was conducted using routine programmatic data that were collected during a 9-month implementation period (June 2018 to March 2019) for peer-assisted HIVST among FSWs, MSM, and transgender people in 6 provinces where the US Agency for International Development--and US President's Emergency Plan for AIDS Relief--funded LINKAGES (Linkage across the Continuum of HIV Services for KP Affected by HIV) Burundi project was being implemented. Chi-square tests were used to compare case-finding rates among individuals who were tested through HIVST versus standard testing. Multivariable logistic regression was performed to assess factors that were independently associated with HIV seropositivity among FSWs and MSM who used HIVST kits. Results: A total of 2198 HIVST kits were administered (FSWs: 1791/2198, 81.48\%; MSM: 363/2198, 16.52\%; transgender people: 44/2198, 2\%). HIV seropositivity rates from HIVST were significantly higher than those from standard testing for FSWs and MEM and nonsignificantly higher than those from standard testing for transgender people (FSWs: 257/1791, 14.35\% vs 890/9609, 9.26\%; P<.001; MSM: 47/363, 12.95\% vs 90/2431, 3.7\%; P<.001; transgender people: 10/44, 23\% vs 6/36, 17\%; P=.50). Antiretroviral therapy initiation rates were significantly lower among MSM who were confirmed to be HIV positive through HIVST compared to those among MSM who were confirmed to be HIV positive through standard testing (40/47, 85\% vs 89/90, 99\%; P<.001). No significant differences in antiretroviral therapy initiation rates were found between the FSW and transgender groups. Multivariable analyses among FSWs who used HIVST kits showed that being aged ?25 years (adjusted odds ratio 1.9, 95\% CI 1.4-2.6) and having >8 clients per week (adjusted odds ratio 1.3, 95\% CI 1.0-1.8) were independently associated with HIV seropositivity. Conclusions: The results demonstrate the potential effectiveness of HIVST in newly diagnosing underserved KPs and linking them to treatment. ", doi="10.2196/24272", url="https://publichealth.jmir.org/2021/9/e24272", url="http://www.ncbi.nlm.nih.gov/pubmed/34591018" } @Article{info:doi/10.2196/31236, author="Greenleaf, R. Abigail and Mwima, Gerald and Lethoko, Molibeli and Conkling, Martha and Keefer, George and Chang, Christiana and McLeod, Natasha and Maruyama, Haruka and Chen, Qixuan and Farley, M. Shannon and Low, Andrea", title="Participatory Surveillance of COVID-19 in Lesotho via Weekly Calls: Protocol for Cell Phone Data Collection", journal="JMIR Res Protoc", year="2021", month="Sep", day="27", volume="10", number="9", pages="e31236", keywords="COVID-19", keywords="cell phones", keywords="mHealth", keywords="Africa south of the Sahara", keywords="surveillance", abstract="Background: The increase in cell phone ownership in low- and middle-income countries (LMIC) has created an opportunity for low-cost, rapid data collection by calling participants on their cell phones. Cell phones can be mobilized for a myriad of data collection purposes, including surveillance. In LMIC, cell phone--based surveillance has been used to track Ebola, measles, acute flaccid paralysis, and diarrheal disease, as well as noncommunicable diseases. Phone-based surveillance in LMIC is a particularly pertinent, burgeoning approach in the context of the COVID-19 pandemic. Participatory surveillance via cell phone could allow governments to assess burden of disease and complements existing surveillance systems. Objective: We describe the protocol for the LeCellPHIA (Lesotho Cell Phone PHIA) project, a cell phone surveillance system that collects weekly population-based data on influenza-like illness (ILI) in Lesotho by calling a representative sample of a recent face-to-face survey. Methods: We established a phone-based surveillance system to collect ILI symptoms from approximately 1700 participants who had participated in a recent face-to-face survey in Lesotho, the Population-based HIV Impact Assessment (PHIA) Survey. Of the 15,267 PHIA participants who were over 18 years old, 11,975 (78.44\%) consented to future research and provided a valid phone number. We followed the PHIA sample design and included 342 primary sampling units from 10 districts. We randomly selected 5 households from each primary sampling unit that had an eligible participant and sampled 1 person per household. We oversampled the elderly, as they are more likely to be affected by COVID-19. A 3-day Zoom training was conducted in June 2020 to train LeCellPHIA interviewers. Results: The surveillance system launched July 1, 2020, beginning with a 2-week enrollment period followed by weekly calls that will continue until September 30, 2022. Of the 11,975 phone numbers that were in the sample frame, 3020 were sampled, and 1778 were enrolled. Conclusions: The surveillance system will track COVID-19 in a resource-limited setting. The novel approach of a weekly cell phone--based surveillance system can be used to track other health outcomes, and this protocol provides information about how to implement such a system. International Registered Report Identifier (IRRID): DERR1-10.2196/31236 ", doi="10.2196/31236", url="https://www.researchprotocols.org/2021/9/e31236", url="http://www.ncbi.nlm.nih.gov/pubmed/34351866" } @Article{info:doi/10.2196/17913, author="Nowaskie, Z. Dustin", title="Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers", journal="JMIR Form Res", year="2021", month="Sep", day="22", volume="5", number="9", pages="e17913", keywords="cultural competency", keywords="disparities", keywords="e-health", keywords="healthcare", keywords="internet", keywords="LGBTQ+", keywords="online platform", keywords="providers", keywords="resources", keywords="eHealth", keywords="health care", abstract="Background: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. Objective: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health---a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform---was created. Methods: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. Results: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83\% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. Conclusions: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population. ", doi="10.2196/17913", url="https://formative.jmir.org/2021/9/e17913", url="http://www.ncbi.nlm.nih.gov/pubmed/34550083" } @Article{info:doi/10.2196/28005, author="Qaisieh, Rami and Al-Tamimi, Mohammad and El-Hammuri, Naser and Shalabi, Marwan and Kilani, M. Muna and Taha, Hana and Al-Muhtaseb, Abdallah and Alfarrajin, Ibrahim and Abu Shaqra, Marwan and Hamdan, Almothana", title="Clinical, Laboratory, and Imaging Features of COVID-19 in a Cohort of Patients: Cross-Sectional Comparative Study", journal="JMIR Public Health Surveill", year="2021", month="Sep", day="21", volume="7", number="9", pages="e28005", keywords="COVID-19", keywords="gender", keywords="clinical", keywords="laboratory", keywords="imaging", keywords="SARS-CoV2", keywords="Jordan", abstract="Background: The clinical, laboratory, and imaging features of COVID-19 disease are variable. Multiple factors can affect the disease progression and outcome. Objective: This study aimed to analyze the clinical, laboratory, and imaging features of COVID-19 in Jordan. Methods: Clinical, laboratory, and imaging data were collected for 557 confirmed COVID-19 patients admitted to Prince Hamzah Hospital (PHH), Jordan. Analysis was performed using appropriate statistical tests with SPSS version 24. Results: Of the 557 COVID-19 polymerase chain reaction (PCR)-positive cases admitted to PHH, the mean age was 34.4 years (SD 18.95 years; range 5 weeks to 87 years), 86.0\% (479/557) were male, 41\% (29/70) were blood group A+, and 57.1\% (93/163) were overweight or obese. Significant past medical history was documented in 25.9\% (144/557), significant surgical history in 12.6\% (70/557), current smoking in 14.9\% (83/557), and pregnancy in 0.5\% (3/557). The mean duration of hospitalization was 16.4 (SD 9.3; range 5 to 70) days; 52.6\% (293/557) were asymptomatic, and 12.9\% (72/557) had more than 5 symptoms, with generalized malaise and dry cough the most common symptoms. Only 2.5\% (14/557) had a respiratory rate over 25 breaths/minute, and 1.8\% (10/557) had an oxygen saturation below 85\%. Laboratory investigations showed a wide range of abnormalities, with lymphocytosis and elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer the most common abnormalities. Ground glass opacity was the most common imaging finding. Men had a significantly higher frequency of symptoms, incidence of smoking, reduced hemoglobin, increased monocyte \%, elevated creatinine levels, and intensive care unit admissions compared with women (P<.05). Hospitalization duration was associated with increased age, male gender, symptom score, history of smoking, elevated systolic blood pressure, elevated respiratory rate, and elevated monocyte \%, CRP, ESR, creatinine, and D-dimer (P<.05). Conclusions: Most COVID-19 cases admitted to PHH were asymptomatic. Variabilities in symptoms, signs, laboratory results, and imaging findings should be noted. Increased age, male gender, smoking history, and elevated inflammatory markers were significantly associated with longer duration of hospitalization. ", doi="10.2196/28005", url="https://publichealth.jmir.org/2021/9/e28005", url="http://www.ncbi.nlm.nih.gov/pubmed/34081600" } @Article{info:doi/10.2196/26602, author="Nida, Kedir Esmael and Bekele, Sisay and Geurts, Luc and Vanden Abeele, Vero", title="Acceptance of a Smartphone-Based Visual Field Screening Platform for Glaucoma: Pre-Post Study", journal="JMIR Form Res", year="2021", month="Sep", day="17", volume="5", number="9", pages="e26602", keywords="mHealth acceptance", keywords="UTAUT", keywords="glaucoma screening", keywords="mhealth for eye care", keywords="mhealth", keywords="glaucoma", keywords="visual", keywords="eye", keywords="ophthalmology", keywords="ophthalmic", keywords="mobile phone", abstract="Background: Glaucoma, the silent thief of sight, is a major cause of blindness worldwide. It is a burden for people in low-income countries, specifically countries where glaucoma-induced blindness accounts for 15\% of the total incidence of blindness. More than half the people living with glaucoma in low-income countries are unaware of the disease until it progresses to an advanced stage, resulting in permanent visual impairment. Objective: This study aims to evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising a smartphone, a stereoscopic virtual reality headset, and a gaming joystick. Methods: A mixed methods study that included 24 eye care professionals from 4 hospitals in Southwest Ethiopia was conducted to evaluate the acceptability of GES. A pre-post design was used to collect perspectives before and after using the GES by using questionnaires and semistructured interviews. A Wilcoxon signed-rank test was used to determine the significance of any change in the scores of the questionnaire items (two-tailed, 95\% CI; $\alpha$=.05). The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology. Results: Positive results were obtained both before and after use, suggesting the acceptance of mobile health solutions for conducting glaucoma screening by using a low-cost headset with a smartphone and a game controller. There was a significant increase (two-tailed, 95\% CI; $\alpha$=.05) in the average scores of 86\% (19/22) of postuse questionnaire items compared with those of preuse questionnaire items. Ophthalmic professionals perceived GES as easy to use and as a tool that enabled the conduct of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on the accuracy of the tool. Moreover, ophthalmologists voiced the need to limit the tool to screening only (ie, not for making diagnoses). Conclusions: This study supports the feasibility of using a mobile device in combination with a low-cost virtual reality headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness caused by glaucoma. However, further assessment of its sensitivity and specificity is required. ", doi="10.2196/26602", url="https://formative.jmir.org/2021/9/e26602", url="http://www.ncbi.nlm.nih.gov/pubmed/34533462" } @Article{info:doi/10.2196/31930, author="Barkia, Abdelaziz and Laamrani, Hammou and Belalia, Abdelmounaim and Benmamoun, Abderrahman and Khader, Yousef", title="Morocco's National Response to the COVID-19 Pandemic: Public Health Challenges and Lessons Learned", journal="JMIR Public Health Surveill", year="2021", month="Sep", day="17", volume="7", number="9", pages="e31930", keywords="COVID-19", keywords="public health", keywords="challenges", keywords="prevention", keywords="control", keywords="infectious disease", doi="10.2196/31930", url="https://publichealth.jmir.org/2021/9/e31930", url="http://www.ncbi.nlm.nih.gov/pubmed/34388104" } @Article{info:doi/10.2196/27799, author="Wang, Xin Jonathan and Somani, Sulaiman and Chen, H. Jonathan and Murray, Sara and Sarkar, Urmimala", title="Health Equity in Artificial Intelligence and Primary Care Research: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2021", month="Sep", day="17", volume="10", number="9", pages="e27799", keywords="artificial intelligence", keywords="health information technology", keywords="health informatics", keywords="electronic health records", keywords="big data", keywords="data mining", keywords="primary care", keywords="family medicine", keywords="decision support", keywords="diagnosis", keywords="treatment", keywords="scoping review", keywords="health equity", keywords="health disparity", abstract="Background: Though artificial intelligence (AI) has the potential to augment the patient-physician relationship in primary care, bias in intelligent health care systems has the potential to differentially impact vulnerable patient populations. Objective: The purpose of this scoping review is to summarize the extent to which AI systems in primary care examine the inherent bias toward or against vulnerable populations and appraise how these systems have mitigated the impact of such biases during their development. Methods: We will conduct a search update from an existing scoping review to identify studies on AI and primary care in the following databases: Medline-OVID, Embase, CINAHL, Cochrane Library, Web of Science, Scopus, IEEE Xplore, ACM Digital Library, MathSciNet, AAAI, and arXiv. Two screeners will independently review all abstracts, titles, and full-text articles. The team will extract data using a structured data extraction form and synthesize the results in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: This review will provide an assessment of the current state of health care equity within AI for primary care. Specifically, we will identify the degree to which vulnerable patients have been included, assess how bias is interpreted and documented, and understand the extent to which harmful biases are addressed. As of October 2020, the scoping review is in the title- and abstract-screening stage. The results are expected to be submitted for publication in fall 2021. Conclusions: AI applications in primary care are becoming an increasingly common tool in health care delivery and in preventative care efforts for underserved populations. This scoping review would potentially show the extent to which studies on AI in primary care employ a health equity lens and take steps to mitigate bias. International Registered Report Identifier (IRRID): PRR1-10.2196/27799 ", doi="10.2196/27799", url="https://www.researchprotocols.org/2021/9/e27799", url="http://www.ncbi.nlm.nih.gov/pubmed/34533458" } @Article{info:doi/10.2196/31389, author="Bhawra, Jasmin and Skinner, Kelly and Favel, Duane and Green, Brenda and Coates, Ken and Katapally, Reddy Tarun", title="The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness", journal="JMIR Res Protoc", year="2021", month="Sep", day="15", volume="10", number="9", pages="e31389", keywords="food security", keywords="food sovereignty", keywords="food equity", keywords="mental health", keywords="solastalgia", keywords="climate change impacts", keywords="climate change preparedness", keywords="digital health", keywords="digital dashboards", keywords="Indigenous health", keywords="mobile phone", abstract="Background: Despite having the tools at our disposal to enable an adequate food supply for all people, inequities in food acquisition, distribution, and most importantly, food sovereignty, worsen food insecurity. The detrimental impact of climate change on food systems and mental health is further exacerbated by a lack of food sovereignty. We urgently require innovative solutions to enable food sovereignty, minimize food insecurity, and address climate change--related mental distress (ie, solastalgia). Indigenous communities have a wealth of Traditional Knowledge for climate change adaptation and preparedness to strengthen food systems. Traditional Knowledge combined with Western methods can revolutionize ethical data collection, engagement, and knowledge mobilization. Objective: The Food Equity and Environmental Data Sovereignty (FEEDS) Project takes a participatory action, citizen science approach for early detection and warning of climate change impacts on food sovereignty, food security, and solastalgia. The aim of this project is to develop and implement a sustainable digital platform that enables real-time decision-making to mitigate climate change--related impacts on food systems and mental well-being. Methods: Citizen science enables citizens to actively contribute to all aspects of the research process. The FEEDS Project is being implemented in five phases: participatory project planning, digital climate change platform customization, community-led evaluation, digital platform and project refinement, and integrated knowledge translation. The project is governed by a Citizen Scientist Advisory Council comprising Elders, Traditional Knowledge Keepers, key community decision makers, youth, and FEEDS Project researchers. The Council governs all phases of the project, including coconceptualizing a climate change platform, which consists of a smartphone app and a digital decision-making dashboard. Apart from capturing environmental and health-related big data (eg, weather, permafrost degradation, fire hazards, and human movement), the custom-built app uses artificial intelligence to engage and enable citizens to report on environmental hazards, changes in biodiversity or wildlife, and related food and mental health issues in their communities. The app provides citizens with valuable information to mitigate health-related risks and relays big data in real time to a digital dashboard. Results: This project is currently in phase 1, with the subarctic M{\'e}tis jurisdiction of {\^I}le-{\`a}-la-Crosse, Saskatchewan, Canada. Conclusions: The FEEDS Project facilitates Indigenous Peoples' self-determination, governance, and data sovereignty. All citizen data are anonymous and encrypted, and communities have ownership, access, control, and possession of their data. The digital dashboard system provides decision makers with real-time data, thereby increasing the capacity to self-govern. The participatory action research approach, combined with digital citizen science, advances the cocreation of knowledge and multidisciplinary collaboration in the digital age. Given the urgency of climate change, leveraging technology provides communities with tools to respond to existing and emerging crises in a timely manner, as well as scientific evidence regarding the urgency of current health and environmental issues. International Registered Report Identifier (IRRID): PRR1-10.2196/31389 ", doi="10.2196/31389", url="https://www.researchprotocols.org/2021/9/e31389", url="http://www.ncbi.nlm.nih.gov/pubmed/34524106" } @Article{info:doi/10.2196/27855, author="Wharton-Smith, Alexandra and Baker, Kevin and Roca-Feltrer, Arantxa and Rodrigues, Maria and Richardson, Sol and Bonnington, A. Craig and Rassi, Christian and Marasciulo, Madeleine and Enosse, Sonia and Saute, Francisco and Aide, Pedro and Macete, Eusebio and Candrinho, Baltazar", title="Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study", journal="JMIR Res Protoc", year="2021", month="Sep", day="15", volume="10", number="9", pages="e27855", keywords="malaria", keywords="seasonal malaria chemoprevention", keywords="sulfadoxine-pyrimethamine amodiaquine", keywords="resistance", keywords="children under five", keywords="implementation research", keywords="Mozambique", keywords="Africa", keywords="mobile phone", abstract="Background: Malaria is a significant cause of morbidity and mortality in children aged under 5 years in Mozambique. The World Health Organization recommends seasonal malaria chemoprevention (SMC), the administration of four monthly courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ), to children aged 3-59 months during rainy season. However, as resistance to SP is widespread in East and Southern Africa, SMC has so far only been implemented across the Sahel in West Africa. Objective: This protocol describes the first phase of a pilot project that aims to assess the protective effect of SP and AQ when used for SMC and investigate the levels of molecular markers of resistance of Plasmodium falciparum to antimalarial medicines in the study districts. In addition, it is important to understand whether SMC is a feasible and acceptable intervention in the context of Nampula Province, Mozambique. Methods: This study will adopt a hybrid effectiveness-implementation design to conduct a mixed methods evaluation with six objectives: a molecular marker study, a nonrandomized controlled trial, an analysis of reported malaria morbidity indicators, a documentation exercise of the contextual SMC adaptation, an acceptability and feasibility assessment, and a coverage and quality assessment. Results: Ethical approval for this study was granted by the Mozambican Ministry of Health National Bioethics Committee on September 15, 2020. Data collection began in October 2020, and data analysis is expected to be completed by August 2021. Conclusions: This research will make a unique contribution to our understanding of whether the combination of SP and AQ, when used for SMC, can confer a protective effect against malaria in children aged 3-59 months in a region where malaria transmission is seasonal and SP resistance is expected to be high. If the project is successful, subsequent phases are expected to provide a more comprehensive assessment of the effectiveness and sustainability of SMCs. International Registered Report Identifier (IRRID): DERR1-10.2196/27855 ", doi="10.2196/27855", url="https://www.researchprotocols.org/2021/9/e27855", url="http://www.ncbi.nlm.nih.gov/pubmed/34524109" } @Article{info:doi/10.2196/31211, author="Fung, Po-Lun Kenneth and Vahabi, Mandana and Moosapoor, Masoomeh and Akbarian, Abdolreza and Jing-Wen Liu, Jenny and Wong, Pui-Hing Josephine", title="Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol", journal="JMIR Res Protoc", year="2021", month="Sep", day="13", volume="10", number="9", pages="e31211", keywords="migrant live-in caregiver", keywords="women", keywords="mental health", keywords="acceptance commitment therapy", keywords="resiliency", keywords="empowerment", abstract="Background: Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status. Objective: The Women Empowerment - Caregiver Acceptance \& Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants' satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined. Methods: A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale -- Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program. Results: WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021. Conclusions: WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations. International Registered Report Identifier (IRRID): DERR1-10.2196/31211 ", doi="10.2196/31211", url="https://www.researchprotocols.org/2021/9/e31211", url="http://www.ncbi.nlm.nih.gov/pubmed/34515642" } @Article{info:doi/10.2196/25405, author="Ramos, C. Lili M. and Delgadillo, Joseline and V{\'e}lez, Sarah and Dauria, Emily and Salas, Jamie and Tolou-Shams, Marina", title="Collecting Social Media Information in a Substance Use Intervention Trial With Adolescent Girls With Lifetime Substance Use History: Observational Study", journal="JMIR Form Res", year="2021", month="Sep", day="10", volume="5", number="9", pages="e25405", keywords="adolescent girls", keywords="legal involvement", keywords="substance use", keywords="social media", keywords="health intervention", abstract="Background: Adolescents with juvenile legal system contact face numerous barriers to participation in behavioral health intervention research, including housing disruption, legal privacy concerns, and systems mistrust. Technology, such as social media, may be a novel and developmentally appropriate adolescent research study engagement and retention tool. Objective: We examined data on social media information collected for study retention purposes from adolescents participating in a substance use intervention trial. Methods: Data were collected as part of a randomized controlled trial determining efficacy of a group-based substance use intervention for girls and young women (12-24 years) with substance use histories referred from legal and school systems in the United States. Baseline demographic and social media information was analyzed from the subset of 114 adolescent girls (mean age 15.7 years; range 13-18 years), of whom 31.6\% (36/114) were legally involved, 87.7\% (100/114) belonged to minoritized racial/ethnic groups, and 32.5\% (37/114) received public assistance. Results: Most girls (74/114, 64.9\%) provided at least one social media account (Instagram, 95\% [70/74]; Facebook, 27\% [20/74]; and Twitter, 11\% [8/74]) during study enrollment. Legally involved girls were significantly less likely to provide social media information than school-referred girls (44\% [16/36] versus 74\% [58/78]; $\chi$21 [N=114]=9.68, P=.002). Conclusions: Obtaining social media information for study retention purposes from adolescent girls with lifetime substance use appears possible; however, particular subgroups (ie, legally involved girls) may be less likely to provide accounts. Factors shaping legally involved girls' willingness to provide social media information, including mistrust and privacy concerns, and the impact of researcher's access to social media information on study retention are critical directions for future research. Trial Registration: ClinicalTrials.gov NCT02293057; https://clinicaltrials.gov/ct2/show/NCT02293057 ", doi="10.2196/25405", url="https://formative.jmir.org/2021/9/e25405", url="http://www.ncbi.nlm.nih.gov/pubmed/34505833" } @Article{info:doi/10.2196/24377, author="Haroz, E. Emily and Grubin, Fiona and Goklish, Novalene and Pioche, Shardai and Cwik, Mary and Barlow, Allison and Waugh, Emma and Usher, Jason and Lenert, C. Matthew and Walsh, G. Colin", title="Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers", journal="JMIR Public Health Surveill", year="2021", month="Sep", day="2", volume="7", number="9", pages="e24377", keywords="suicide prevention", keywords="machine learning", keywords="Native American health", keywords="implementation", abstract="Background: Machine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied. Objective: This study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations. Methods: Participants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways. Results: Case managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers' clinical judgment would help increase sensitivity. Conclusions: Suicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting. ", doi="10.2196/24377", url="https://publichealth.jmir.org/2021/9/e24377", url="http://www.ncbi.nlm.nih.gov/pubmed/34473065" } @Article{info:doi/10.2196/31072, author="Baggett, M. Kathleen and Davis, Betsy and Sheeber, Lisa and Miller, Katy and Leve, Craig and Mosley, A. Elizabeth and Landry, H. Susan and Feil, G. Edward", title="Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting", journal="JMIR Res Protoc", year="2021", month="Aug", day="18", volume="10", number="8", pages="e31072", keywords="maternal depression", keywords="parenting", keywords="infant social-emotional and social-communication development", keywords="mobile intervention", keywords="remote coaching", keywords="trial protocol", keywords="mobile phone", abstract="Background: Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. Objective: The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. Methods: This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. Results: The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)--approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. Conclusions: Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. Trial Registration: ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630 International Registered Report Identifier (IRRID): DERR1-10.2196/31072 ", doi="10.2196/31072", url="https://www.researchprotocols.org/2021/8/e31072", url="http://www.ncbi.nlm.nih.gov/pubmed/34406122" } @Article{info:doi/10.2196/23360, author="Ashrafi, Agaah and Tabatabaee, Maryam and Sharifi, Vandad", title="Development and Evaluation of Acceptability and Feasibility of a Web-Based Intervention for Patients With Bipolar Disorder in Iran: Implementation Study", journal="JMIR Form Res", year="2021", month="Aug", day="17", volume="5", number="8", pages="e23360", keywords="bipolar disorder", keywords="psychoeducation", keywords="web-based intervention", keywords="feasibility", keywords="acceptability", abstract="Background: Psychoeducation for bipolar disorder has a significant impact on symptoms and treatment adherence. In Iran, as a low-resource setting, infrastructural barriers, such as inadequate mental health professionals, difficulties in transportation, and costs of care, may hinder optimum delivery of this evidence-based intervention to patients. Objective: This study sought to explore the acceptability and feasibility of a web-based intervention for bipolar patients in Iran. Methods: A website has been developed as a platform for providing psychoeducational content about bipolar disorder. Patients were chosen via a convenient sampling method in 2018-2019. The main component of the intervention included streaming 7 weekly video clips after attending a single in-person meeting, as well as a medication self-monitoring application. Information was collected about the feasibility and acceptability of the intervention. Results: We invited 45 patients from the day center and the outpatient clinic of Roozbeh psychiatric hospital and some private clinics in Tehran. Of the 23 patients (51\%) who attended the first in-person session and provided informed consent, 14 patients dropped out during the study. While 9 patients completed the course (attended 4 or more online sessions), only 5 watched all the video sessions. The rate of adherence to the intervention and frequency of exposure to the website were much higher for those recruited from the private and outpatient clinics. Conclusions: This web-based intervention can be feasible and acceptable only for a subgroup of patients with specific educational status and socioeconomic level. ", doi="10.2196/23360", url="https://formative.jmir.org/2021/8/e23360", url="http://www.ncbi.nlm.nih.gov/pubmed/34402794" } @Article{info:doi/10.2196/29309, author="Pisani, Elizabeth and Hasnida, Amalia and Rahmi, Mawaddati and Kok, Olivier Maarten and Harsono, Steven and Anggriani, Yusi", title="Substandard and Falsified Medicines: Proposed Methods for Case Finding and Sentinel Surveillance", journal="JMIR Public Health Surveill", year="2021", month="Aug", day="16", volume="7", number="8", pages="e29309", keywords="substandard drugs", keywords="falsified medicine", keywords="counterfeit medicine", keywords="medicine quality", keywords="sentinel surveillance", keywords="public health surveillance", keywords="substandard", keywords="pharmaceuticals", keywords="surveillance", keywords="public health", doi="10.2196/29309", url="https://publichealth.jmir.org/2021/8/e29309", url="http://www.ncbi.nlm.nih.gov/pubmed/34181563" } @Article{info:doi/10.2196/28148, author="Swain, Dharitri and Begum, Jasmina and Parida, Prangnan Swayam", title="Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Aug", day="16", volume="10", number="8", pages="e28148", keywords="preconception care", keywords="maternal nutritional status", keywords="birth outcome", keywords="paternal preconception health", keywords="childbirth", keywords="birth outcomes", keywords="maternal and child health", keywords="maternal health", keywords="maternal and child nutrition", keywords="health education", keywords="pediatrics", abstract="Background: The provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures. Objective: The goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India's low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications. Methods: A nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed. Results: The proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024. Conclusions: Through preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes. Trial Registration: Clinical Trials Registry--India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239\&EncHid=\&userName=CTRI/2021/04/032836 International Registered Report Identifier (IRRID): PRR1-10.2196/28148 ", doi="10.2196/28148", url="https://www.researchprotocols.org/2021/8/e28148", url="http://www.ncbi.nlm.nih.gov/pubmed/34398798" } @Article{info:doi/10.2196/26565, author="Nies, Sarah and Patel, Shae and Shafer, Melissa and Longman, Laura and Sharif, Iman and Pina, Paulo", title="Understanding Physicians' Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study", journal="JMIR Form Res", year="2021", month="Aug", day="13", volume="5", number="8", pages="e26565", keywords="telemedicine", keywords="federally qualified health care center", keywords="primary care", keywords="COVID-19", keywords="telehealth", keywords="physician", keywords="doctor", keywords="preference", keywords="perspective", keywords="dissemination", keywords="appropriate", keywords="cross-sectional", keywords="survey", abstract="Background: In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine. Objective: We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. Methods: We used an anonymous cross-sectional survey including closed- and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t tests to compare age between those who would versus would not use telemedicine. We then used logistic regression to test whether age and specialty were both correlated with the desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future and to describe the situations for which they felt telemedicine would be appropriate. Results: Of 272 health care providers who were sent the electronic survey, 157 (58\%) responded within the 2-week survey time frame. The mean age of providers was 45 (range 28-75) years. Overall, 80\% (126/157) stated they would use telemedicine in the future. Compared to the family medicine, internal medicine, behavioral health, dental, and obstetrics and gynecology specialties, providers from pediatrics, med-peds, subspecialties, and surgery (protelemedicine specialties) were more likely to believe telemedicine would be useful post pandemic (61/67 [91\%] vs 65/90 [72\%]; P<.001). Providers who reported they would use telemedicine in the future were younger (mean age 44, range 42-46 years vs mean age 50, range 46-55 years; P=.048). In the regression analysis, both protelemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future (prospecialties: odds ratio 5.2, 95\% CI 1.7-16.2; younger age: odds ratio 1.05, 95\% CI 1.01-1.08). Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow-up visits, medication refills, urgent care, patient convenience, and specific conditions such as behavioral health, dermatology visits, and chronic care management. Conclusions: The majority of health providers in this resource-limited setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over. ", doi="10.2196/26565", url="https://formative.jmir.org/2021/8/e26565", url="http://www.ncbi.nlm.nih.gov/pubmed/34227993" } @Article{info:doi/10.2196/28156, author="Ariff, Shabina and Habib, Atif and Memon, Zahid and Arshad, Tayyaba and Samejo, Tariq and Maznani, Ikram and Umer, Muhammad and Hussain, Amjad and Rizvi, Arjumand and Ahmed, Imran and Soofi, Bashir Sajid and Bhutta, A. Zulfiqar", title="Effect of Community-Based Kangaroo Mother Care Package on Neonatal Mortality Among Preterm and Low Birthweight Infants in Rural Pakistan: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Aug", day="10", volume="10", number="8", pages="e28156", keywords="community kangaroo mother care", keywords="low birth weight", keywords="KMC champions", keywords="neonatal mortality", keywords="RCT protocol", keywords="Pakistan", abstract="Background: Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim to implement and evaluate the effectiveness of a community-based KMC package to reduce neonatal morbidity and mortality among preterm and low birthweight (LBW) infants, which will provide evidence for policy development and the large-scale implementation of KMC across the country. Objective: The primary objective of this trial is to reduce neonatal mortality among preterm and LBW infants. The secondary objectives are growth (measured as weight gain), reduced incidence of possible serious bacterial infection, and increased exclusive breastfeeding and continued breastfeeding practices. Methods: We designed a community-based cluster randomized controlled trial in one rural district of Pakistan. Stable, LBW babies (weighing 1200 grams to 2500 grams) are included in the study. The community KMC package, consisting of the KMC kit, information and counseling material, and community mobilization through KMC champions (village volunteers), was designed after preliminary research in the same geographical location and implemented in intervention clusters. The standard essential newborn care is offered in the control clusters. Infants are recruited and followed up by independent teams of data collectors. Data are collected on the duration of skin-to-skin contact, growth, breastfeeding practices, morbidities, neonatal mortality, and neurodevelopment status. Data analysis will be conducted based on the intention to treat principle. The Cox regression model will be used to assess the primary outcome of neonatal mortality. The secondary outcomes will be evaluated using linear or logistic regression. Results: The Ethics Review Committee of Aga Khan University, Pakistan, approved the study protocol in February 2017. Data collection began in August 2019 and will be completed in December 2021. Data analyses are yet to be completed. Conclusions: This intervention may be effective in preventing sepsis and subsequently improve survival in LBW newborns in Pakistan and other low-income and middle-income countries worldwide. Trial Registration: clinicaltrials.gov NCT03545204; https://clinicaltrials.gov/ct2/show/NCT03545204 International Registered Report Identifier (IRRID): DERR1-10.2196/28156 ", doi="10.2196/28156", url="https://www.researchprotocols.org/2021/8/e28156", url="http://www.ncbi.nlm.nih.gov/pubmed/34170839" } @Article{info:doi/10.2196/28573, author="Zola Matuvanga, Tr{\'e}sor and Johnson, Ginger and Larivi{\`e}re, Ynke and Esanga Longomo, Emmanuel and Matangila, Junior and Maketa, Vivi and Lapika, Bruno and Mitashi, Patrick and Mc Kenna, Paula and De Bie, Jessie and Van Geertruyden, Jean-Pierre and Van Damme, Pierre and Muhindo Mavoko, Hypolite", title="Use of Iris Scanning for Biometric Recognition of Healthy Adults Participating in an Ebola Vaccine Trial in the Democratic Republic of the Congo: Mixed Methods Study", journal="J Med Internet Res", year="2021", month="Aug", day="9", volume="23", number="8", pages="e28573", keywords="biometric identification", keywords="iris recognition", keywords="vaccine trial", keywords="participants' visits", keywords="acceptability", keywords="feasibility", keywords="Democratic Republic of the Congo", keywords="mixed methods", keywords="Ebola", abstract="Background: A partnership between the University of Antwerp and the University of Kinshasa implemented the EBOVAC3 clinical trial with an Ebola vaccine regimen administered to health care provider participants in Tshuapa Province, Democratic Republic of the Congo. This randomized controlled trial was part of an Ebola outbreak preparedness initiative financed through Innovative Medicines Initiative-European Union. The EBOVAC3 clinical trial used iris scan technology to identify all health care provider participants enrolled in the vaccine trial, to ensure that the right participant received the right vaccine at the right visit. Objective: We aimed to assess the acceptability, accuracy, and feasibility of iris scan technology as an identification method within a population of health care provider participants in a vaccine trial in a remote setting. Methods: We used a mixed methods study. The acceptability was assessed prior to the trial through 12 focus group discussions (FGDs) and was assessed at enrollment. Feasibility and accuracy research was conducted using a longitudinal trial study design, where iris scanning was compared with the unique study ID card to identify health care provider participants at enrollment and at their follow-up visits. Results: During the FGDs, health care provider participants were mainly concerned about the iris scan technology causing physical problems to their eyes or exposing them to spiritual problems through sorcery. However, 99\% (85/86; 95\% CI 97.1-100.0) of health care provider participants in the FGDs agreed to be identified by the iris scan. Also, at enrollment, 99.0\% (692/699; 95\% CI 98.2-99.7) of health care provider participants accepted to be identified by iris scan. Iris scan technology correctly identified 93.1\% (636/683; 95\% CI 91.2-95.0) of the participants returning for scheduled follow-up visits. The iris scanning operation lasted 2 minutes or less for 96.0\% (656/683; 95\% CI 94.6-97.5), and 1 attempt was enough to identify the majority of study participants (475/683, 69.5\%; 95\% CI 66.1-73.0). Conclusions: Iris scans are highly acceptable as an identification tool in a clinical trial for health care provider participants in a remote setting. Its operationalization during the trial demonstrated a high level of accuracy that can reliably identify individuals. Iris scanning is found to be feasible in clinical trials but requires a trained operator to reduce the duration and the number of attempts to identify a participant. Trial Registration: ClinicalTrials.gov NCT04186000; https://clinicaltrials.gov/ct2/show/NCT04186000 ", doi="10.2196/28573", url="https://www.jmir.org/2021/8/e28573", url="http://www.ncbi.nlm.nih.gov/pubmed/34378545" } @Article{info:doi/10.2196/24112, author="Derksen, E. Marloes and Jaspers, WM Monique and van Strijp, Sander and Fransen, P. Mirjam", title="Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study", journal="JMIR Form Res", year="2021", month="Aug", day="4", volume="5", number="8", pages="e24112", keywords="think aloud", keywords="heuristic evaluation", keywords="usability", keywords="mHealth", keywords="game elements", keywords="smoking prevention", keywords="user-centered design", keywords="mobile phone", abstract="Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. ", doi="10.2196/24112", url="https://formative.jmir.org/2021/8/e24112", url="http://www.ncbi.nlm.nih.gov/pubmed/34346895" } @Article{info:doi/10.2196/25795, author="Kimmie-Dhansay, Faheema and Barrie, Robert and Naidoo, Sudeshni and Roberts, Sharon Tina", title="Prevalence of Early Childhood Caries in South Africa: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2021", month="Aug", day="3", volume="10", number="8", pages="e25795", keywords="dmft", keywords="prevalence", keywords="dental caries", keywords="South Africa", keywords="early childhood caries", abstract="Background: Young children are at the highest risk of developing dental caries as they have a lack of autonomy over their diet and oral hygiene practices. Dental caries develops over time due to demineralization of tooth substance (enamel), which results from acid production during sugar metabolism by bacteria. Early onset of dental caries often results in asymptomatic presentation, but if left untreated, it can result in severe pain, infection, and dentoalveolar abscesses. Early childhood caries (ECC) is defined as dental caries in children aged 6 years and younger and is a significant public health problem in South Africa. According to the Global Burden of Disease study, untreated dental caries of primary teeth affects 532 million children. Untreated dental caries has many detrimental effects which can affect the physical development and reduce the quality of life of affected children. Furthermore, long-term untreated dental caries can result in school absenteeism, low BMI, and poor educational outcomes. Objective: The purpose of this study was to determine the prevalence and severity of ECC in South Africa in children under the age of 6 years. Methods: All cross-sectional studies documenting the prevalence and severity of dental disease (decayed, missing, and filled teeth scores) will be included. Various databases will be searched for eligible studies. Only studies conducted on South African children aged 6 years and under will be included. There will be no restriction on the time or language of publication. The quality of all eligible studies will be analyzed by a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be conducted. Results: The protocol is registered with PROSPERO. The literature search was initially conducted in November 2018 and was repeated in November 2020. Conclusions: The results of this study will be used to advise stakeholders of the prevalence and severity of dental disease in children under 6 years of age in South Africa. Trial Registration: PROSPERO CRD42018112161; International Registered Report Identifier (IRRID): DERR1-10.2196/25795 ", doi="10.2196/25795", url="https://www.researchprotocols.org/2021/8/e25795", url="http://www.ncbi.nlm.nih.gov/pubmed/34342587" } @Article{info:doi/10.2196/28147, author="Oakley-Girvan, Ingrid and Watterson, L. Jessica and Jones, Cheryl and Houghton, C. Lauren and Gibbons, P. Marley and Gokal, Kajal and Magsamen-Conrad, Kate", title="Use of Social Media for Cancer Prevention Through Neighborhood Social Cohesion: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2021", month="Jul", day="30", volume="10", number="7", pages="e28147", keywords="social cohesion", keywords="mothers", keywords="neighborhood", keywords="physical activity", keywords="social media", keywords="social", keywords="behavior", keywords="health outcomes", keywords="socioeconomic status", keywords="community health", keywords="chronic disease", keywords="social network", keywords="feasibility", keywords="wellbeing", keywords="cancer", abstract="Background: Social cohesion is associated with healthier behaviors and better health outcomes, and therefore may offer a mechanism for promoting better health. Low socioeconomic status (SES) communities face higher rates of chronic disease due to both community- and individual-level factors. Objective: The aim of this study is to leverage social cohesion to promote healthier behaviors and prevent chronic disease in a low SES community. This protocol outlines the methodology for a pilot study to assess the feasibility of an intervention (Free Time For Wellness [FT4W]) using a social networking platform (Nextdoor) with mothers living in an urban, low-income community to improve social cohesion and promote healthy behaviors. Methods: The study will involve three phases: (I) co-designing the intervention with mothers in the neighborhoods of interest, (II) implementing the intervention with community leaders through the social networking platform, and (III) evaluating the intervention's feasibility. Phase I of the study will include qualitative data collection and analysis from in-depth, semistructured interviews and a co-design group session with mothers. Phases II and III of the study include a pre- and postintervention survey of participating mothers. Neighborhood-level data on social cohesion will also be collected to enable comparison of outcomes between neighborhoods with higher and lower baseline social cohesion. Results: As of March 2021, recruitment and data collection for this study are complete. This protocol outlines our original study plan, although the final enrollment numbers and intervention implementation deviated from our initial planned methodology that is outlined in this protocol. These implementation learnings will be shared in subsequent publications of our study results. Conclusions: Ultimately, this study aims to: (1) determine the barriers and facilitators to finding free time for wellness among a population of low-income mothers to inform the co-design process, and (2) implement and study the feasibility of an intervention that leverages social cohesion to promote physical activity in a community of low-income mothers. The results of this study will provide preliminary feasibility evidence to inform a larger effectiveness trial, and will further our understanding of how social cohesion might influence well-being. International Registered Report Identifier (IRRID): RR1-10.2196/28147 ", doi="10.2196/28147", url="https://www.researchprotocols.org/2021/7/e28147", url="http://www.ncbi.nlm.nih.gov/pubmed/34328445" } @Article{info:doi/10.2196/28255, author="Lehlewa, Mahdi Asaad and Khaleel, Abdulghafoor Hanan and Lami, Faris and Hasan, Falah Saif Aldeen and Malick, Asmail Hasanain and Mohammed, Hashim Razzaq and Abdulmottaleb, Abdulazziz Qais", title="Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study", journal="JMIRx Med", year="2021", month="Jul", day="30", volume="2", number="3", pages="e28255", keywords="cutaneous leishmaniasis", keywords="outbreak", keywords="Iraq", keywords="risk factors", keywords="risk", keywords="disease", keywords="infectious disease", keywords="disease prevention", keywords="prevention", abstract="Background: In 2018, an outbreak of cutaneous leishmaniasis (CL) occurred in Diyala Province in Iraq. Several risk factors of CL were identified in a prior study; however, the impact of removing modifiable risk factors on the occurrence of the disease was not measured. Objective: The aim of this study is to measure the impact of removing modifiable risk factors of CL on the occurrence of the disease. Methods: We conducted a population-based unmatched case-control study in two conveniently selected districts in Diyala Province. All cases of CL were included. Controls were chosen preferentially according to the site where the cases occurred. A structured questionnaire was used to collect data. The unadjusted odds ratios (ORs) and 95\% confidence intervals for each risk factor were calculated using binary logistic regression. We also calculated the attributable fractions and 95\% confidence intervals of the modifiable risk factors. A P value <.05 was considered statistically significant. Results: Data from 844 persons (432 cases, 51.2\%) were analyzed. Cases were more likely than controls to report a history of previous displacement (OR 5.18, 95\% CI 3.84-6.98), electricity supply for less than 12 hours per day (OR 1.94, 95\% CI 1.47-2.55), living in a rural area (OR 1.91, 95\% CI 1.45-2.51), living in a clay house (OR 2.41, 95\% CI 1.59-3.66), having an unpainted indoor living space (OR 2.14, 95\% CI 1.51-3.02), having rodents inside the house (OR 5.15, 95\% CI 3.56-7.47), having chickens, sheep, or both (OR 3.44, 95\% CI 2.48-4.75), having a mixture of dogs and sheep or of dogs and chickens within a distance of less than 100 meters (OR 3.92, 95\% CI 2.59-5.94), fogging (OR 2.11, 95\% CI 1.40-3.19), bed net use (OR 1.72, 95\% CI 1.08-2.72), and sleeping outside or a mixture of inside and outside (OR 4.01, 95\% CI 1.32-12.19). The data show that the exposure of approximately 70\% to 80\% of cases was associated with displacement, the presence of rodents inside the house, the presence of animals within 100 meters of the house, the presence of animals (chickens/sheep/both or a mixture of dogs and sheep or of dogs and chickens), and sleeping outside. Approximately 40\%-50\% of the cases reported living in a clay house, living in a rural area, having an unpainted indoor space, having an electricity supply for less than 12 hours, and using a bed net. Conclusions: Prevention and control of CL requires a multifaceted approach that relies on changing environmental conditions, housing conditions, and human behavior. Fogging and bed net use were not effective because the underlying housing characteristics and human behavior provided a good culture for the disease. We recommend conducting a study to identify the species, reservoirs, and vectors of CL in Iraq; studying vector behaviors before applying environmental control measures; and educating the public on how and when to use bed nets as well as how to accompany their use with behavioral changes. ", doi="10.2196/28255", url="https://med.jmirx.org/2021/3/e28255", url="http://www.ncbi.nlm.nih.gov/pubmed/37725543" } @Article{info:doi/10.2196/25947, author="Yousef, Hind and Al-Sheyab, Nihaya and Al Nsour, Mohannad and Khader, Yousef and Al Kattan, Malika and Bardus, Marco and Alyahya, Mohammad and Taha, Hana and Amiri, Mirwais", title="Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives", journal="J Med Internet Res", year="2021", month="Jul", day="28", volume="23", number="7", pages="e25947", keywords="family planning", keywords="mobile apps", keywords="social media", keywords="digital technology", keywords="contraceptives", abstract="Background: Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices. Objective: The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services. Methods: We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis. Results: Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women's empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional. Conclusions: As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices. ", doi="10.2196/25947", url="https://www.jmir.org/2021/7/e25947", url="http://www.ncbi.nlm.nih.gov/pubmed/34319250" } @Article{info:doi/10.2196/25548, author="Bermon, Anderson and Uribe, Fernanda Ana and P{\'e}rez-Rivero, Fernanda Paula and Prieto-Merino, David and Saaibi, Federico Jose and Silva, Arturo Federico and Canon, Ivonne Diana and Castillo-Gonzalez, Melissa Karol and C{\'a}ceres-Rivera, Isabel Diana and Guio, Elizabeth and Meneses-Castillo, Janneth Karen and Castillo-Meza, Alberto and Atkins, Louise and Horne, Robert and Murray, Elizabeth and Serrano, Cecilia Norma and Free, Caroline and Casas, Pablo Juan and Perel, Pablo", title="Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Jul", day="28", volume="9", number="7", pages="e25548", keywords="randomized controlled trial", keywords="Colombia", keywords="text messaging", keywords="cardiovascular disease", keywords="secondary prevention", abstract="Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. Objective: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. Methods: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. Results: Of the 930 randomized patients, 805 (86.5\%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. Conclusions: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. Trial Registration: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028017 ", doi="10.2196/25548", url="https://mhealth.jmir.org/2021/7/e25548", url="http://www.ncbi.nlm.nih.gov/pubmed/34319247" } @Article{info:doi/10.2196/28905, author="Kagawa, Nantamu Mike and Chipamaunga, Shalote and Prozesky, Detlef and Kafumukache, Elliot and Gwini, Rudo and Kandawasvika, Gwendoline and Katowa-Mukwato, Patricia and Masanganise, Rangarirai and Pretorius, Louise and Wessels, Quenton and Dithole, S. Kefalotse and Marimo, Clemence and Mubuuke, Gonzaga Aloysius and Mbalinda, Nalugo Scovia and van der Merwe, Lynette and Nyoni, N. Champion", title="Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach", journal="JMIR Res Protoc", year="2021", month="Jul", day="28", volume="10", number="7", pages="e28905", keywords="Africa", keywords="COVID-19", keywords="emergency remote teaching", keywords="formal online learning", keywords="pandemic", abstract="Background: The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask--wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. Objective: This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. Methods: A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. Results: Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. Conclusions: This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. International Registered Report Identifier (IRRID): DERR1-10.2196/28905 ", doi="10.2196/28905", url="https://www.researchprotocols.org/2021/7/e28905", url="http://www.ncbi.nlm.nih.gov/pubmed/34254943" } @Article{info:doi/10.2196/29463, author="Kumwichar, Ponlagrit and Chongsuvivatwong, Virasakdi and Prappre, Tagoon", title="Development of a Video-Observed Therapy System to Improve Monitoring of Tuberculosis Treatment in Thailand: Mixed-Methods Study", journal="JMIR Form Res", year="2021", month="Jul", day="27", volume="5", number="7", pages="e29463", keywords="app", keywords="mixed-methods analysis", keywords="remote monitoring", keywords="therapy", keywords="tuberculosis", keywords="user experience", keywords="video directly observed therapy", keywords="video-enhanced therapy", keywords="video-observed therapy", abstract="Background: Directly observed therapy programs for monitoring tuberculosis (TB) treatment in Thailand are unsustainable, especially during the COVID-19 pandemic. The current video-observed therapy (VOT) system, the Thai VOT (TH VOT), was developed to replace the directly observed therapy program. Objective: This study aimed to describe the VOT system design and identify the potential for system improvements. Methods: This pilot study was conducted in Na Yong district, a small district in Trang province, south of Thailand. The TH VOT system consists of a smartphone app for patients, a secured web-based platform for staff, items used, and standard operating procedures. There were three groups of users: observers who were TB staff, healthy volunteers as simulated patients, and patients with active TB. All participants were trained to follow the standard operating procedures. After 2-week usage, VOT session records were analyzed to measure the compliance of the patients and observers. The User Experience Questionnaire was used to lead the participant users to focus on 6 standard dimensions of usability, and was supplemented with an in-depth interview to identify potential system improvements from users' experience. Results: Only 2 of 16 patients with currently active TB had a usable smartphone. Sixty of 70 drug-taking sessions among 2 patients and 3 simulated patients in 2 weeks were recorded and uploaded. Only 37 sessions were inspected by the observers within 24 hours. All participants needed a proper notification system. An audit system was also requested. Conclusions: Before upscaling, the cost of smartphone lending, audit management, and notification systems should be elucidated. ", doi="10.2196/29463", url="https://formative.jmir.org/2021/7/e29463", url="http://www.ncbi.nlm.nih.gov/pubmed/34313602" } @Article{info:doi/10.2196/25926, author="Mhende, Josephine and Bell, A. Sharrill and Cottrell-Daniels, Cherell and Luong, Jackie and Streiff, Micah and Dannenfelser, Mark and Hayat, J. Matthew and Spears, Adams Claire", title="Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Jul", day="23", volume="5", number="7", pages="e25926", keywords="acceptability", keywords="addiction", keywords="African American", keywords="cessation", keywords="COVID-19", keywords="feasibility", keywords="income", keywords="low socioeconomic status", keywords="mHealth", keywords="mindfulness", keywords="minority", keywords="smoking", keywords="SMS", keywords="text messaging", keywords="treatment", abstract="Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program ``iQuit Mindfully'' was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8\%) were female, 19 (82.6\%) were African American, and 18 (78.3\%) had an annual income of