Development of a diabetes self-management + mHealth program: tailoring the intervention for a pilot study in a low-income setting in Mexico

Background: Rapid expansion of mobile technology has resulted in the development of many mobile health (“mHealth”) platforms for health monitoring and support. However, applicability, desirability, and extent of tailoring of these platforms for pregnant women, particularly in populations who experience the greatest health inequities—such as women with diabetes mellitus (DM) and/or those with greater socioeconomic barriers—remains unknown. The objective is to understand low-income pregnant women’s experiences and preferences for mHealth tools to support DM health and improve DM self-management during pregnancy. Methods: Low-income pregnant and postpartum women were included in individual interviews or focus groups; women with type 2 DM, gestational DM, or no DM were included. Analysis was performed with the constant comparison method. Results: In this population of 45 ( N=37 with DM) low-income, largely minority, pregnant and postpartum women, 100% reported access to smartphones and prior experience with apps. Interest in mHealth to support health and engagement during pregnancy was high. Preferences for general mHealth features included education that reduces uncertainty, support communities, visualizing progress, convenient access to information, and support for better management of pregnancy-related tasks. Preferred design elements included personalization, interactive features, and integrated graphics. Women with DM expressed multiple additional DM-specific needs, including support tools for DM self-management and self-regulation tasks. Conclusion: Pregnant and postpartum women, especially those with DM, desire mHealth technology to support engagement and to adapt lifestyle guidelines and treatment requirements for a healthy pregnancy. Further work to develop mHealth interventions tailored for target populations remains a key step in reducing health inequities and promoting access to evidence-based perinatal health interventions.

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83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

Age and Ageing ◽

10.1093/ageing/afab030.44 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

C Yang ◽

Z Hui ◽

S Zhu ◽

X Wang ◽

G Tang ◽

...

Keyword(s):

Medication Adherence ◽

Pilot Study ◽

Older People ◽

Intervention Group ◽

Self Management ◽

Control Group ◽

Medication Knowledge ◽

Management Intervention ◽

Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P < 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

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The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-020-00866-8 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Giorgia Gon ◽

Abdunoor M. Kabanywanyi ◽

Petri Blinkhoff ◽

Simon Cousens ◽

Stephanie J. Dancer ◽

...

Keyword(s):

Pilot Study ◽

Study Design ◽

Low Income ◽

High Volume ◽

Surface Cleaning ◽

Low Income Countries ◽

Training Period ◽

Future Research ◽

Environmental Hygiene ◽

The Impact

Abstract Background Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. Methods This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. Results Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. Conclusions The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.

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Albuminuria Testing in Low-Income Setting

Journal of Primary Care & Community Health ◽

10.1177/21501327211009703 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110097

Author(s):

Megha Nataraj

Keyword(s):

Low Income ◽

Low Income Setting

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Validity of a point-of-care viral load test for hepatitis B in a low-income setting

Journal of Virological Methods ◽

10.1016/j.jviromet.2020.114057 ◽

2021 ◽

Vol 289 ◽

pp. 114057

Author(s):

Gezahegn Mekonnen Woldemedihn ◽

Corina Silvia Rueegg ◽

Hailemichael Desalegn ◽

Hanna Aberra ◽

Nega Berhe ◽

...

Keyword(s):

Viral Load ◽

Hepatitis B ◽

Low Income ◽

Point Of Care ◽

Load Test ◽

Viral Load Test ◽

Low Income Setting

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At what cost is performance-based financing implemented? Novel evidence from Malawi

Health Policy and Planning ◽

10.1093/heapol/czz030 ◽

2019 ◽

Vol 34 (4) ◽

pp. 282-288 ◽

Cited By ~ 1

Author(s):

Manuela De Allegri ◽

Chris Makwero ◽

Aleksandra Torbica

Keyword(s):

Low Income ◽

Economic Cost ◽

Personnel Cost ◽

Cost Category ◽

Implementation Phase ◽

Personnel Costs ◽

Performance Based Financing ◽

Implementation Costs ◽

The Cost ◽

Low Income Setting

Abstract Our study estimated the full economic cost of implementing performance-based financing [PBF, the Support for Service Delivery Integration Performance-Based Incentives (SSDI-PBI) programme], as a means of first introducing strategic purchasing in a low-income setting, Malawi. Our analysis distinguished design from implementation costs and traces costs across personnel and non-personnel cost categories over the 2012–15 period. The full cost of the SSDI-PBI programme amounted to USD 3 402 187, equivalent to USD 6.46 per targeted beneficiary. The design phase accounted for about one-third (USD 1 161 332) of the total costs, while the incentives (USD 1 140 436) represented about one-third of the total cost of the intervention and about half the cost of the implementation phase. With a cost of USD 1 605 178, personnel costs represented the dominant cost category. Our study indicated that the introduction of PBF entailed consumption of a substantial amount of resources, hence representing an important opportunity cost for the health system.

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Vescicovaginal fistula management in low-income setting: a complicated case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz198 ◽

2019 ◽

Vol 2019 (6) ◽

Author(s):

Igor Vaz ◽

Lenny Starforth ◽

Damiano Pizzol ◽

Anna Claudia Colangelo

Keyword(s):

Case Report ◽

Low Income ◽

Complicated Case ◽

Low Income Setting

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