scholarly journals Mobile Technology Integrated into a Large-Scale Nutrition Program Enables Age-Appropriate Home Visits and Counseling for Mothers of Infants in India

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 886-886
Author(s):  
Sumeet Patil ◽  
Sneha Nimmagadda ◽  
Lakshmi Gopalakrishnan ◽  
Rasmi Avula ◽  
Sumati Bajaj ◽  
...  
Keyword(s):  
Large Scale ◽  
Program Effectiveness ◽  
Health Workers ◽  
Life Stage ◽  
Intervention Group ◽  
Home Visits ◽  
Small Scale ◽  
Post Intervention ◽  
Mhealth Intervention ◽  
Age Appropriate

Abstract Objectives An mHealth job aid and real time monitoring tool currently targets over 1 million community health workers in India (Anganwadi workers – AWWs). Previous studies have shown that mHealth interventions can be effective at a small scale. In this study, we evaluate whether this at-scale mHealth intervention improved the quantity and quality of AWW home visits and counseling. We also examined whether these improvements led to better infant and young child feeding (IYCF) practices among beneficiaries. Methods The mHealth intervention (Common Application Software – CAS) is currently being used by 581,282 AWWs across India. We conducted a village-matched, quasi-experimental design to examine program effectiveness across 428 villages in Madhya Pradesh (MP) and Bihar (BH). Repeated cross-sectional surveys were completed 17–24 months apart with AWWs (n = 1344) and mothers of children < 12 m (n = 6635). We compared post-intervention outcomes between matched groups, controlling for average baseline outcome levels and other covariates to correct for imbalances and improve precision. Program effects were assessed separately within each state. Results In both states, mothers in the intervention group were more likely to receive adequate number of home visits (MP: control = 42%; ß = 9.1%; P < 0.05; BH: control = 24%; ß = 7.7%; P < 0.05). A larger proportion of mothers in the intervention group could recall at least half the life-stage appropriate counseling messages (MP: control = 28.1%; ß = 11.8%. BH: control = 9.5%; ß = 7.7%). However, no improvements in IYCF practices were associated with the intervention. Conclusions mHealth interventions like CAS can support gains in immediate term service delivery outcomes by enabling more age-appropriate home-visits and counseling. However, impacts on nutrition and health behaviors will require a longer-term evaluation and parallel efforts to improve a range of other outcomes, including structural poverty, gender norms, and larger socio-economic and political factors. Funding Sources The Bill and Melinda Gates Foundation.

Lifestyle knowledge and preferences in preschool children: Evaluation of the Get up and Grow healthy lifestyle education programme

2016 ◽  
Vol 75 (8) ◽  
pp. 1012-1024 ◽  
Author(s):  
Nicola Wiseman ◽  
Neil Harris ◽  
Patricia Lee
Keyword(s):  
Preschool Children ◽  
Healthy Lifestyle ◽  
Life Stage ◽  
Intervention Group ◽  
Education Programme ◽  
Control Group ◽  
Lifestyle Interventions ◽  
Post Intervention ◽  
Lifestyle Behaviours ◽  
Age Appropriate

Objective: Early childhood is considered a window of opportunity for lifestyle interventions, as this is a critical life-stage at which children accumulate knowledge and skills around behaviours such as eating and physical activity. This study examined how exposure to a settings-based healthy lifestyle programme influences knowledge and preference of food and physical play in preschool children. Design: Quasi-experimental, pre–post intervention design. Methods: Pre- and post-impact evaluation of a healthy lifestyle intervention using an innovative computerised photo-pair food and exercise questionnaire and an age-appropriate test of executive function. The study included 82 children aged 3–5 years and was structured with an intervention and a control group. Quantitative data were analysed using SPSS v22. Results: For the intervention group, there was a significant improvement in overall knowledge of healthy lifestyle behaviours post-intervention, particularly in the identification of healthy and unhealthy food choices. There was no associated change in behavioural preferences. Conclusion: The study highlighted that age-appropriate lifestyle interventions with preschool-aged children can lead to improved knowledge of healthy lifestyle choices. However, improvement in knowledge of healthy lifestyle behaviours does not necessarily lead to positive changes in food and activity preferences that inform choices.

scholarly journals REaCH-Resiliency Engagement and Care in Health; A Telephone Befriending Intervention to Address The Psycho-Social Challenges of Vulnerable Population in The Context of COVID-19 Pandemic: An Exploratory Trial in India

2020 ◽  
Author(s):  
M D Saju ◽  
Lorane Scaria ◽  
KK Shaju ◽  
Natania Cheguvera ◽  
MK Joseph ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Large Scale ◽  
Central Government ◽  
Health Workers ◽  
Intervention Group ◽  
Development Project ◽  
Telephone Intervention ◽  
Clinical Trial Registry ◽  
Exploratory Trial

Abstract Background Observational evidence suggests that befriending interventions provided by the lay mental health workers, when trained and supervised by experts, are effective in enhancing social support, wellbeing and reducing depression. We carried out a telephone intervention for youth, recruited from DDUGKY (Deen Dayal Upadhyaya Grameen Kaushalya Yojana), a central government funded skill development project in India.Methods We performed an exploratory trial in Kerala, India, between 29th July, 2020 and 26th August, 2020 with pass out students of DDUGKY. From a total of 1036 students, 498 fulfilled the criteria and were recruited for the program. We randomized the participants via a computer generated randomization list. Out of 498 eligible participants, 251 were randomized to the intervention group and 247 to the general enquiry call group. Total of 439 (89%) participants, (251 (100%) = intervention arm and 188 (76%) = control arm), completed follow-up assessment after one month. The primary outcomes of the study included depression, measured by Patient Health Questionnaire (PHQ-9) and wellbeing, using WHO Wellbeing Index; while secondary outcomes included social support from friends and family.Results Analysis was done for 439 pass out students who completed one-month intervention. Befriending intervention was effective in increasing the wellbeing (p=0.000) and social support (p=0.008) in the intervention group. Regression analysis revealed that befriending intervention is associated with notable changes in support from significant others (OR: 2.91, P=0.005), support from family (OR: 2.47, P=0.013) and support from friends (OR: 2.52, P=0.007).Conclusion Befriending intervention was found successful in improving overall wellbeing and social support among student participants of the programme. Large-scale transformational efforts to secure country’s mental health service pipeline is possible by integrating this intervention into existing DDU-GKY institutional and program eco-systems. Task shifting and sharing strategies can be effectively employed to improve the mental health outcomes of the people especially during a community crisis. Trial Registration Clinical Trial Registry India; ICMR-NIMS (Registration Number: CTRI/2020/07/026834), prospectively registered (Registration date: 27th July 2020) , http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=45953&EncHid=&userName=CTRI/2020/07/026834

scholarly journals Classroom-based cognitive behavioural therapy: a large-scale non-randomised controlled trial of the ‘Journey of the Brave’

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuko Urao ◽  
Ikuyo Ohira ◽  
Takako Koshiba ◽  
Shin-ichi Ishikawa ◽  
Yasunori Sato ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Large Scale ◽  
Controlled Trial ◽  
Intervention Group ◽  
Behavioural Therapy ◽  
Anxiety Score ◽  
Small Scale ◽  
Control Group ◽  
Cognitive Behavioural

Abstract Background In Japan, ‘Journey of the Brave’, a cognitive behavioural therapy (CBT)-based anxiety preventive education programme, was previously developed and its effectiveness examined in two small-scale controlled trials. These studies had some limitations, including a small number of participants and not having regular classroom teachers as programme facilitators. Therefore, we conducted a large-scale controlled trial, with teachers as programme implementers. Methods Twenty-seven elementary schools participated: 1622 and 1123 children were allocated to the intervention and control groups, respectively. The intervention group received a programme comprising ten 45-min sessions, while the control group underwent the regular school curriculum. Anxiety symptoms among participants were assessed using the Spence Children’s Anxiety Scale (SCAS) at three stages (pre-intervention, post-intervention, and follow-up). Results Following primary analysis, estimated mean changes in SCAS from baseline to follow-up were − 4.91 (95% CI − 5.91, − 3.90) in the intervention group and − 2.53 (95% CI − 3.52, − 1.54) in the control group; the group difference was 2.37 (95% CI 1.42, 3.33, p < 0.0001). Children in the intervention group showed significant reduction in their anxiety score versus children in the control group. Conclusions The results showed a statistically significant anxiety score reduction in the intervention group, thus verifying the programme’s effectiveness. Trial registration The University Hospital Medical Information Network (UMIN): UMIN000032517. Registered 10 May 2018—Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037083

scholarly journals Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025774 ◽  
Author(s):  
Sneha Nimmagadda ◽  
Lakshmi Gopalakrishnan ◽  
Rasmi Avula ◽  
Diva Dhar ◽  
Nadia Diamond-Smith ◽  
...  
Keyword(s):  
Public Health ◽  
Service Delivery ◽  
Pregnant Women ◽  
Large Scale ◽  
Health Workers ◽  
Matched Pair ◽  
Mhealth Intervention ◽  
Health And Nutrition ◽  
Public Health Programmes ◽  
Health Programmes

IntroductionMillions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children <6 years and their mothers. However, major gaps exist in ICDS service delivery. The government is currently strengthening ICDS through an mHealth intervention called Common Application Software (ICDS-CAS) installed on smart phones, with accompanying multilevel data dashboards. This system is intended to be a job aid for frontline workers, supervisors and managers, aims to ensure better service delivery and supervision, and enable real-time monitoring and data-based decision-making. However, there is little to no evidence on the effectiveness of such large-scale mHealth interventions integrated with public health programmes in resource-constrained settings on the service delivery and subsequent health and nutrition outcomes.Methods and analysisThis study uses a village-matched controlled design with repeated cross-sectional surveys to evaluate whether ICDS-CAS can enable more timely and appropriate services to pregnant women, children <12 months and their mothers, compared with the standard ICDS programme. The study will recruit approximately 1500 Anganwadi workers and 6000+ mother-child dyads from 400+ matched-pair villages in Bihar and Madhya Pradesh. The primary outcomes are the proportion of beneficiaries receiving (a) adequate number of home visits and (b) appropriate level of counselling by the Anganwadi workers. Secondary outcomes are related to improvements in other ICDS services, and knowledge and practices of the Anganwadi workers and beneficiaries.Ethics and disseminationEthical oversight is provided by the Committee for the Protection of Human Subjects at the University of California at Berkeley, and the Suraksha Independent Ethics Committee in India. The results will be published in peer-reviewed journals and analysis data will be made public.Trial registration numberISRCTN83902145

scholarly journals Factors Affecting Motivation among Key Populations to Engage with Tuberculosis Screening and Testing Services in Northwest Tanzania: A Mixed-Methods Analysis

2021 ◽  
Vol 18 (18) ◽  
pp. 9654
Author(s):  
Rabia Abeid Khaji ◽  
Venance Muzuka Kabwebwe ◽  
Annasia Goodluck Mringo ◽  
Thomas Faustine Nkwabi ◽  
Jacob Bigio ◽  
...  
Keyword(s):  
Sex Workers ◽  
Large Scale ◽  
Health Workers ◽  
Qualitative Interviews ◽  
Small Scale ◽  
Key Populations ◽  
Health Seeking ◽  
Tuberculosis Screening ◽  
Mining Areas ◽  
Community Stakeholders

In northwest Tanzania, many artisanal small-scale miners (ASMs) and female sex workers (FSWs) live in informal communities surrounding mines where tuberculosis (TB) is highly prevalent. An active case finding (ACF) intervention to increase TB case notification was undertaken in two districts. Alongside this, a study was implemented to understand engagement with the intervention through: (1) quantitative questionnaires to 128 ASMs and FSWs, who either engaged or did not engage in the ACF intervention, to assess their views on TB; (2) qualitative interviews with 41 ASMs and FSWs, 36 community health workers (CHWs) and 30 community stakeholders. The mean perceived severity of TB score was higher in the engaged than in the non-engaged group (p = 0.01). Thematic analysis showed that health-seeking behaviour was similar across both groups but that individuals in the non-engaged group were more reluctant to give sputum samples, often because they did not understand the purpose. CHWs feared contracting TB on the job, and many noted that mining areas were difficult to access without transportation. Community stakeholders provided various recommendations to increase engagement. This study highlights reasons for engagement with a large-scale ACF intervention targeting key populations and presents insights from implementers and stakeholders on the implementation of the intervention.

scholarly journals AM Versus PM Postoperative Administration of Warfarin With a Mechanical Mitral Valve

2020 ◽  
pp. 875512252097361
Author(s):  
Justin R. Harris ◽  
Rachel Hatch ◽  
Prashanth Vallabhajosyula ◽  
Yancy Lo ◽  
Danielle Mowery ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Large Scale ◽  
Intervention Group ◽  
Mechanical Valve ◽  
International Normalized Ratio ◽  
Post Intervention ◽  
Thrombotic Complications ◽  
Administration Timing ◽  
Evening Administration

Background: Currently, there are no guidelines regarding the optimal daily timing of inpatient warfarin administration. Objective: The purpose of this study was to determine whether dosing warfarin in the morning will have a significant impact on therapeutic international normalized ratio (INR) achievement compared with evening administration in mechanical mitral valve patients initiated on warfarin following cardiac surgery. Methods: This was a single-center, pre- and post-retrospective cohort conducted between 2014 and 2018. One-hundred fifty-four adult patients who underwent a mechanical mitral valve replacement or alternative cardiac surgery with a history of a mechanical mitral valve were enrolled. The primary outcome was achievement of therapeutic INR at any time point after initiation of warfarin. Pre-intervention administration timing was 6 pm and post-intervention timing was 10 am. Results: Baseline characteristics including age, sex, and race were similar between the 2 groups ( P = NS for each characteristic). Therapeutic INR achievement was significantly improved at all time points following 10 am warfarin administration compared with 6 pm (hazard ratio = 1.69; P = .005). Mean time-to-therapeutic INR was 7.37 days in the post-intervention group and 8.39 days in the pre-intervention group ( P = .073). There were no significant differences in INR >4, bleeding, or thrombotic complications between groups. Conclusion and Relevance: This retrospective analysis suggests that there may be a postoperative benefit in therapeutic INR achievement in mechanical valve patients when dosing warfarin in the morning compared with evening administration. Large-scale studies should be conducted to further elucidate the potential benefit across more heterogeneous populations.

scholarly journals Effectiveness of a health education intervention on the use of long-lasting insecticidal nets for the prevention of malaria in pregnant women of Pakistan: a quasi-experimental study

2020 ◽  
Author(s):  
Ramesh Kumar ◽  
Midhat Farzeen ◽  
Assad Hafeez ◽  
Baseer Khan Achakzai ◽  
Muskan Vankwani ◽  
...  
Keyword(s):  
Experimental Study ◽  
Health Education ◽  
Pregnant Women ◽  
Health Workers ◽  
Intervention Group ◽  
Educational Interventions ◽  
Bed Nets ◽  
Control Group ◽  
Post Intervention ◽  
Quasi Experimental

Abstract Background About one quarter of pregnant women in the population of Pakistan are using long-lasting insecticide-treated bed nets (LLINs) for prevention of malaria. Past research reported that adequate information and education would act as mediator to change behaviour among patients for prevention of malaria infection. The effective use of LLINs would contribute to reduction of disease burden caused by malaria. The aim of this study was to determine the effectiveness of health education on the adoption of LLINs among pregnant women living in Tharparkar, a remote district in Sindh Province, Pakistan.Methods A quasi-experimental study design with control and intervention groups was conducted with 200 pregnant women (100 in each group). Women in the intervention group were provided with health education sessions on malaria for 12 weeks, while those in the control group obtained routine information from lady health workers (LHWs). Pre- and post-intervention assessment was done of knowledge about malaria and use of LLIN, which was statistically analysed using descriptive statistics and difference in difference (DID) multivariable regression analysis to test effectiveness of the intervention.Results Baseline was conducted with 200 pregnant women. Demographic characteristics were similar in both groups with slight differences in age, education, income, type of latrine, and source of drinking water. There were no significant differences between mean knowledge and use of LLINs scores between groups at baseline. However, the estimated DID value after the intervention was 4.170 (p <0.01) and represents an increase in scores of knowledge in the intervention group compared to control. Similarly DID value of 3.360 (p <0.05) showed an increase in use of LLINs score after the intervention which was significant, showing that the intervention had a positive effect.Conclusions Results proved that health education could be an effective intervention for improving knowledge and usage of LLINs among pregnant women for the prevention of malaria. Such educational interventions have a positive potential to be implemented at larger scale by incorporating them into routine health sessions provided by health workers.

scholarly journals Community health workers at the dawn of a new era: 7. Recent advances in supervision

2021 ◽  
Vol 19 (S3) ◽  
Author(s):  
Carey Westgate ◽  
David Musoke ◽  
Lauren Crigler ◽  
Henry B. Perry
Keyword(s):  
Community Health ◽  
Case Studies ◽  
Community Health Workers ◽  
Large Scale ◽  
Health Workers ◽  
Local Context ◽  
Small Scale ◽  
Exploratory Research ◽  
New Era ◽  
Over Time

Abstract Background Supervision is essential for optimizing performance and motivation of community health workers (CHWs). This paper, the seventh in our series, “Community health workers at the dawn of a new era”, supplements the existing evidence on CHW supervision in low- and middle-income countries by reviewing what supervision approaches are employed in specific contexts, identifying potential facilitators of CHW supervision including mobile health (mHealth) interventions, and noting challenges of supervision including the relationship between supervision and other CHW programme elements. Methods For this exploratory research study on CHW supervision, we reviewed the supervisory interventions described in a compendium of 29 case studies of large-scale CHW programmes, performed an electronic search of multiple databases to identify articles related to CHW supervision published between 15 June 2017 and 1 December 2020, and from those articles followed additional references that appeared to be relevant for our results. Results We reviewed 55 case studies, academic articles, and grey literature resources as part of this exploratory research. A variety of supervision approaches have been adapted over time, which we grouped into five categories: external supervision, community supervision, group supervision, peer supervision, and dedicated supervision. These approaches are frequently used in combination. Digital (mHealth) technologies are being explored as potential facilitators of CHW supervision in both small- and large-scale programmes; however, evidence of their effectiveness remains limited to date. Inadequate support for supervisors is a major challenge, particularly given the numerous and varied roles they are expected to fulfil, spanning administrative, clinical, and supportive activities. Supervisors can help CHWs acquire other critical elements needed from the health system for them to perform more effectively: incentives to foster motivation, clarity of roles and tasks, adequate tools and supplies, appropriate knowledge and skills, and a safe work environment. Conclusion In the absence of a universal “best approach” for CHW supervision, our recommendation is that countries and programmes prioritize homegrown evolution over time to suit the local context. In some cases, this may involve scaling up novel approaches that have proven effective at small scale or testing approaches that have worked in other countries.

scholarly journals Differences in composition of territories in relation to behaviour, stage, and depth of the three-spot damselfish, Stegastes planifrons, in Caribbean coral reefs

SURG Journal ◽  
2013 ◽  
Vol 6 (1) ◽  
pp. 52-57
Author(s):  
Maria J. Arroyo Gerez
Keyword(s):  
Coral Reef ◽  
Coral Reefs ◽  
Large Scale ◽  
Life Stage ◽  
Small Scale ◽  
Fish Behaviour ◽  
Short Term ◽  
Algal Diversity ◽  
Stegastes Planifrons

Coral reef diversity is correlated with the depth at which the reefs are found, the energy available for biological processes, and the species’ roles and presence throughout the food chain. Can a specific species activity alter the whole ecosystem? Can a small-scale, short-term activity such as fish behaviour have a long-term effect on a larger scale, that of the reef? Can the life stage of a species mediate substrate competition? The three-spot damselfish (Stegastes planifrons) is hypothesized to regulate competition between substrate coverage by actively farming – protecting from herbivores and weeding – in order to regulate the algal species composition and percent coverage of the reef. This behaviour is observed in both juvenile and adult fish. Deeper patches are predicted to have less coral diversity and higher algal diversity; juvenile fish are predicted to have less diversity in their patches than adults. Coral and algal diversity are hypothesized to be negatively correlated. In this study, behaviour of the S. planifrons was classified into one of four categories (active patrolling, passing patrolling, farming, and hiding) and palatable algae surface area coverage was digitized from photographs; life stage was either juvenile or adult. Coral and algal genus diversity were measured along a depth gradient of 0-16 m where the diversity of the reef was thought to be the highest. A three-way ANCOVA was performed to test whether fish behaviour (a small-scale, short-term process), depth, or fish development stage (juvenile or adult) had a significant effect on coral or algal diversity (a large-scale, long-term process). Results showed a significant effect of fish behaviour category on algal genera diversity, and a significant effect of depth on both algal and coral genera diversity. Farming yielded significantly more algal coverage than hiding. This study shows that small-scale, short-term behaviours by S. planifrons can have an effect on algal genera diversity on coral reefs in Utila, Honduras. Keywords: Stegastes planifrons (three-spotted damselfish); behaviours (short-term, small-scale); stage of development (juvenile, adult); depth; coral reef and algal diversity (long-term, large-scale); damselfish territories

scholarly journals Development and acceptability of a peer-paired, cross-cultural and cross-generational storytelling HPV intervention for Korean American college women

2019 ◽  
Vol 34 (5) ◽  
pp. 483-494 ◽  
Author(s):  
Minjin Kim ◽  
Haeok Lee ◽  
Peter Kiang ◽  
Jeroan Allison
Keyword(s):  
Cervical Cancer ◽  
College Women ◽  
Large Scale ◽  
Comparison Group ◽  
Hpv Vaccination ◽  
Intervention Group ◽  
Korean American ◽  
Cross Cultural ◽  
Post Intervention ◽  
The Impact

Abstract Although Korean American women have a higher risk of developing cervical cancer, currently there are limited culturally relevant intervention strategies for improving primary prevention of cervical cancer by promoting HPV vaccination in this population. This study reports the development of a cross-cultural, cross-generational storytelling HPV intervention using a peer-paired method, in which two storytellers interactively share their stories, as a particular innovation that might resonate with Korean American young women. The acceptability of the intervention was assessed by self-reported satisfaction and endorsement with the intervention in a pilot randomized control trial (RCT). We compared participants’ responses to the intervention by their generation and cultural identity. One hundred and four Korean college women between the ages of 18–26 were recruited from the Northeastern US Participants randomized to the intervention group received a storytelling video (n = 54); the comparison group received written information (n = 50). The acceptability of the intervention was measured immediately post-intervention. The intervention group had significantly greater satisfaction than the comparison group (P < 0.05). Participants reported greater endorsement for videos that reflected their cultural and generational experiences. Future study is needed to examine the impact of such interventions on objective follow-up on HPV vaccination in a large-scale RCT.

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