scholarly journals Feasibility, Acceptability, and Adoption of Digital Fingerprinting During Contact Investigation for Tuberculosis in Kampala, Uganda: A Parallel-Convergent Mixed-Methods Analysis

10.2196/11541 ◽  
2018 ◽  
Vol 20 (11) ◽  
pp. e11541 ◽  
Author(s):  
Elizabeth B White ◽  
Amanda J Meyer ◽  
Joseph M Ggita ◽  
Diana Babirye ◽  
David Mark ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Digital Fingerprinting ◽  
Contact Investigation

scholarly journals Feasibility, acceptability, and adoption of fingerprint scanning during contact investigation for tuberculosis in Kampala, Uganda: A parallel-convergent, mixed-methods analysis

2018 ◽  
Author(s):  
Elizabeth B White ◽  
Amanda J Meyer ◽  
Joseph M Ggita ◽  
Diana Babirye ◽  
David Mark ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Technology Acceptance ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Monitoring And Evaluation ◽  
Resource Constrained ◽  
Patient Identification ◽  
Digital Fingerprinting ◽  
Contact Investigation

Background: In resource-constrained settings, challenges with unique patient identification may limit continuity of care, monitoring and evaluation, and data integrity. Biometrics offer an appealing but understudied potential solution. Methods: We conducted a mixed-methods study to understand feasibility, acceptability, and adoption of digital fingerprinting for patient identification in a study of household TB contact investigation in Kampala, Uganda. We tested associations between demographic, clinical, and temporal characteristics and failure to capture a digital fingerprint. We used generalized estimating equations and a robust covariance estimator to account for clustering. We evaluated clustering of outcomes by household and community health worker by calculating intra-class correlation coefficients. To understand determinants of intended and actual use of fingerprinting technology, we conducted fifteen in-depth interviews with community health workers and applied a widely used conceptual framework, the Technology Acceptance Model 2. Results: Digital fingerprints were captured in 74% of participants, with extensive clustering by household (ICC = 0.99) arising from hardware (36%) and software (60%) failures. Clinical and demographic characteristics were not significantly associated with fingerprint capture. Community health workers successfully fingerprinted all contacts in 70% of households, with modest clustering of outcomes by CHW (ICC = 0.18). Fingerprinting success at the household level declined over time (Spearman’s rho = 0.30, P < 0.001). In interviews, CHWs reported that fingerprinting non-capture events lowered their own perception of the quality of the technology, threatened their social image, and made the technology more difficult to use. Conclusions: We found digital fingerprinting to be feasible and acceptable for indvidual identification, but problems implementing the hardware and software led to a high failure rate. Although CHWs found fingerprinting to be acceptable in principle, their intention to use the technology was tempered by perceptions that it was inconsistent and of questionable value. We emphasize the need for routine process evaluation of biometrics and other digital technologies during implementation in resource-constrained settings.

scholarly journals Feasibility, Acceptability, and Adoption of Digital Fingerprinting During Contact Investigation for Tuberculosis in Kampala, Uganda: A Parallel-Convergent Mixed-Methods Analysis (Preprint)

2018 ◽  
Author(s):  
Elizabeth B White ◽  
Amanda J Meyer ◽  
Joseph M Ggita ◽  
Diana Babirye ◽  
David Mark ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Technology Acceptance ◽  
Health Workers ◽  
Intraclass Correlation ◽  
Monitoring And Evaluation ◽  
Individual Identification ◽  
Resource Constrained ◽  
Patient Identification ◽  
Digital Fingerprinting ◽  
Contact Investigation

BACKGROUND In resource-constrained settings, challenges with unique patient identification may limit continuity of care, monitoring and evaluation, and data integrity. Biometrics offers an appealing but understudied potential solution. OBJECTIVE The objective of this mixed-methods study was to understand the feasibility, acceptability, and adoption of digital fingerprinting for patient identification in a study of household tuberculosis contact investigation in Kampala, Uganda. METHODS Digital fingerprinting was performed using multispectral fingerprint scanners. We tested associations between demographic, clinical, and temporal characteristics and failure to capture a digital fingerprint. We used generalized estimating equations and a robust covariance estimator to account for clustering. In addition, we evaluated the clustering of outcomes by household and community health workers (CHWs) by calculating intraclass correlation coefficients (ICCs). To understand the determinants of intended and actual use of fingerprinting technology, we conducted 15 in-depth interviews with CHWs and applied a widely used conceptual framework, the Technology Acceptance Model 2 (TAM2). RESULTS Digital fingerprints were captured for 75.5% (694/919) of participants, with extensive clustering by household (ICC=.99) arising from software (108/179, 60.3%) and hardware (65/179, 36.3%) failures. Clinical and demographic characteristics were not markedly associated with fingerprint capture. CHWs successfully fingerprinted all contacts in 70.1% (213/304) of households, with modest clustering of outcomes by CHWs (ICC=.18). The proportion of households in which all members were successfully fingerprinted declined over time (ρ=.30, P<.001). In interviews, CHWs reported that fingerprinting failures lowered their perceptions of the quality of the technology, threatened their social image as competent health workers, and made the technology more difficult to use. CONCLUSIONS We found that digital fingerprinting was feasible and acceptable for individual identification, but problems implementing the hardware and software lead to a high failure rate. Although CHWs found fingerprinting to be acceptable in principle, their intention to use the technology was tempered by perceptions that it was inconsistent and of questionable value. TAM2 provided a valuable framework for understanding the motivations behind CHWs’ intentions to use the technology. We emphasize the need for routine process evaluation of biometrics and other digital technologies in resource-constrained settings to assess implementation effectiveness and guide improvement of delivery.

scholarly journals Feasibility, acceptability, and adoption of fingerprint scanning during contact investigation for tuberculosis in Kampala, Uganda: A parallel-convergent, mixed-methods analysis

2018 ◽  
Author(s):  
Elizabeth B White ◽  
Amanda J Meyer ◽  
Joseph M Ggita ◽  
Diana Babirye ◽  
David Mark ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Technology Acceptance ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Monitoring And Evaluation ◽  
Resource Constrained ◽  
Patient Identification ◽  
Digital Fingerprinting ◽  
Contact Investigation

Background: In resource-constrained settings, challenges with unique patient identification may limit continuity of care, monitoring and evaluation, and data integrity. Biometrics offer an appealing but understudied potential solution. Methods: We conducted a mixed-methods study to understand feasibility, acceptability, and adoption of digital fingerprinting for patient identification in a study of household TB contact investigation in Kampala, Uganda. We tested associations between demographic, clinical, and temporal characteristics and failure to capture a digital fingerprint. We used generalized estimating equations and a robust covariance estimator to account for clustering. We evaluated clustering of outcomes by household and community health worker by calculating intra-class correlation coefficients. To understand determinants of intended and actual use of fingerprinting technology, we conducted fifteen in-depth interviews with community health workers and applied a widely used conceptual framework, the Technology Acceptance Model 2. Results: Digital fingerprints were captured in 74% of participants, with extensive clustering by household (ICC = 0.99) arising from hardware (36%) and software (60%) failures. Clinical and demographic characteristics were not significantly associated with fingerprint capture. Community health workers successfully fingerprinted all contacts in 70% of households, with modest clustering of outcomes by CHW (ICC = 0.18). Fingerprinting success at the household level declined over time (Spearman’s rho = 0.30, P < 0.001). In interviews, CHWs reported that fingerprinting non-capture events lowered their own perception of the quality of the technology, threatened their social image, and made the technology more difficult to use. Conclusions: We found digital fingerprinting to be feasible and acceptable for indvidual identification, but problems implementing the hardware and software led to a high failure rate. Although CHWs found fingerprinting to be acceptable in principle, their intention to use the technology was tempered by perceptions that it was inconsistent and of questionable value. We emphasize the need for routine process evaluation of biometrics and other digital technologies during implementation in resource-constrained settings.

scholarly journals ‘Something so hard': a mixed-methods study of home sputum collection for tuberculosis contact investigation in Uganda

2018 ◽  
Vol 22 (10) ◽  
pp. 1152-1159 ◽  
Author(s):  
M. Armstrong-Hough ◽  
J. Ggita ◽  
P. Turimumahoro ◽  
A. J. Meyer ◽  
E. Ochom ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Contact Investigation

scholarly journals Uptake of home-initiated tuberculosis evaluation during household contact investigation in Kampala, Uganda: A mixed-methods study

2017 ◽  
Author(s):  
Mari Armstrong-Hough ◽  
Joseph Ggita ◽  
Patricia Turimumahoro ◽  
Amanda Meyer ◽  
Emmanuel Ochom ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Interviews ◽  
Linkage To Care ◽  
Index Patient ◽  
Household Contact ◽  
Mixed Methods Design ◽  
Worker Training ◽  
Home Based ◽  
Contact Investigation ◽  
Household Contact Investigation

Background Home-initiated tuberculosis (TB) evaluation could improve test uptake and linkage to care among at-risk contacts of active TB index patients. However, there is a need to systematically explore why contacts accept, decline, or are unable to complete these services. We sought to describe the barriers to home-based sputum collection as part of enhanced household contact investigation for TB in Kampala, Uganda. Methods Using a parallel convergent mixed-methods design, we collected quantitative data describing home sputum collection among 82 household contacts of active TB patients and qualitative interviews from a sub-sample of 19 of those contacts. Data were analyzed in parallel to produce a more complete picture of the underlying barriers to home sputum collection. Results Men were significantly more likely than women to provide sputum when eligible (p=0.04). Contacts who reported risk factors for or symptoms of TB but no active cough where significantly less likely to provide sputum (p=0.05). Education level was not associated with differences in home sputum collection success. In interviews, contacts pointed to support from and for the index patient as a facilitator. Contacts were particularly enthusiastic about the convenience of home-based sputum collection compared to visiting a clinic. Lost or insufficient sputum containers, difficulty producing sputum on demand, and shame emerged as barriers to collecting sputum at home. Conclusions Uptake of sputum collection might be improved by addressing opportunity barriers prior to the visit, possibly through equipment checklists and improved community health worker training. More research is needed on the effects of TB stigma on willingness to produce sputum, even in the privacy of one’s own home.

scholarly journals Integrating home HIV counselling and testing into household TB contact investigation: a mixed-methods study

2018 ◽  
Vol 8 (2) ◽  
pp. 72-78 ◽  
Author(s):  
E. Ochom ◽  
A. J. Meyer ◽  
M. Armstrong-Hough ◽  
S. Kizito ◽  
I. Ayakaka ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Contact Investigation ◽  
Hiv Counselling And Testing

scholarly journals Contact Investigation of Multidrug-Resistant Tuberculosis Patients: A Mixed-Methods Study from Myanmar

2019 ◽  
Vol 5 (1) ◽  
pp. 3
Author(s):  
Aye Mon Phyo ◽  
Ajay M. V. Kumar ◽  
Kyaw Thu Soe ◽  
Khine Wut Yee Kyaw ◽  
Aung Si Thu ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Care Providers ◽  
Multidrug Resistant ◽  
Mixed Methods Study ◽  
Care Providers ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Contact Investigation ◽  
Mdr Tb

There is no published evidence on contact investigation among multidrug-resistant tuberculosis (MDR-TB) patients from Myanmar. We describe the cascade of contact investigation conducted in 27 townships of Myanmar from January 2018 to June 2019 and its implementation challenges. This was a mixed-methods study involving quantitative (cohort analysis of programme data) and qualitative components (thematic analysis of interviews of 8 contacts and 13 health care providers). There were 556 MDR-TB patients and 1908 contacts, of whom 1134 (59%) reached the health centres for screening (chest radiography and symptoms). Of the latter, 344 (30%) had presumptive TB and of them, 186 (54%) were investigated (sputum microscopy or Xpert MTB/RIF®). A total of 27 TB patients were diagnosed (six bacteriologically-confirmed including five with rifampicin resistance). The key reasons for not reaching township TB centres included lack of knowledge and lack of risk perception owing to wrong beliefs among contacts, financial constraints related to loss of wages and transportation charges, and inconvenient clinic hours. The reasons for not being investigated included inability to produce sputum, health care providers being unaware of or not agreeing to the investigation protocol, fixed clinic days and times, and charges for investigation. The National Tuberculosis Programme needs to note these findings and take necessary action.

scholarly journals Uptake of home-initiated tuberculosis evaluation during household contact investigation in Kampala, Uganda: A mixed-methods study

2017 ◽  
Author(s):  
Mari Armstrong-Hough ◽  
Joseph Ggita ◽  
Patricia Turimumahoro ◽  
Amanda Meyer ◽  
Emmanuel Ochom ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Interviews ◽  
Linkage To Care ◽  
Index Patient ◽  
Household Contact ◽  
Mixed Methods Design ◽  
Worker Training ◽  
Home Based ◽  
Contact Investigation ◽  
Household Contact Investigation

Background Home-initiated tuberculosis (TB) evaluation could improve test uptake and linkage to care among at-risk contacts of active TB index patients. However, there is a need to systematically explore why contacts accept, decline, or are unable to complete these services. We sought to describe the barriers to home-based sputum collection as part of enhanced household contact investigation for TB in Kampala, Uganda. Methods Using a parallel convergent mixed-methods design, we collected quantitative data describing home sputum collection among 82 household contacts of active TB patients and qualitative interviews from a sub-sample of 19 of those contacts. Data were analyzed in parallel to produce a more complete picture of the underlying barriers to home sputum collection. Results Men were significantly more likely than women to provide sputum when eligible (p=0.04). Contacts who reported risk factors for or symptoms of TB but no active cough where significantly less likely to provide sputum (p=0.05). Education level was not associated with differences in home sputum collection success. In interviews, contacts pointed to support from and for the index patient as a facilitator. Contacts were particularly enthusiastic about the convenience of home-based sputum collection compared to visiting a clinic. Lost or insufficient sputum containers, difficulty producing sputum on demand, and shame emerged as barriers to collecting sputum at home. Conclusions Uptake of sputum collection might be improved by addressing opportunity barriers prior to the visit, possibly through equipment checklists and improved community health worker training. More research is needed on the effects of TB stigma on willingness to produce sputum, even in the privacy of one’s own home.

Determining Emotional Tone and Verbal Behavior in Patients With Tinnitus and Hyperacusis: An Exploratory Mixed-Methods Study

2019 ◽  
Vol 28 (3) ◽  
pp. 660-672
Author(s):  
Suzanne H. Kimball ◽  
Toby Hamilton ◽  
Erin Benear ◽  
Jonathan Baldwin
Keyword(s):  
Mixed Methods ◽  
Verbal Behavior ◽  
Coping Strategies ◽  
Mixed Methods Study ◽  
Self Report ◽  
Anxiety And Depression ◽  
Negative Consequences ◽  
Emotional Tone ◽  
Explanatory Mixed Methods ◽  
Quantitative Results

Purpose The purpose of this study was to evaluate the emotional tone and verbal behavior of social media users who self-identified as having tinnitus and/or hyperacusis that caused self-described negative consequences on daily life or health. Research Design and Method An explanatory mixed-methods design was utilized. Two hundred “initial” and 200 “reply” Facebook posts were collected from members of a tinnitus group and a hyperacusis group. Data were analyzed via the LIWC 2015 software program and compared to typical bloggers. As this was an explanatory mixed-methods study, we used qualitative thematic analyses to explain, interpret, and illustrate the quantitative results. Results Overall, quantitative results indicated lower overall emotional tone for all categories (tinnitus and hyperacusis, initial and reply), which was mostly influenced by higher negative emotion. Higher levels of authenticity or truth were found in the hyperacusis sample but not in the tinnitus sample. Lower levels of clout (social standing) were indicated in all groups, and a lower level of analytical thinking style (concepts and complex categories rather than narratives) was found in the hyperacusis sample. Additional analysis of the language indicated higher levels of sadness and anxiety in all groups and lower levels of anger, particularly for initial replies. These data support prior findings indicating higher levels of anxiety and depression in this patient population based on the actual words in blog posts and not from self-report questionnaires. Qualitative results identified 3 major themes from both the tinnitus and hyperacusis texts: suffering, negative emotional tone, and coping strategies. Conclusions Results from this study suggest support for the predominant clinical view that patients with tinnitus and hyperacusis have higher levels of anxiety and depression than the general population. The extent of the suffering described and patterns of coping strategies suggest clinical practice patterns and the need for research in implementing improved practice plans.

Monitoring von Pflegekontextfaktoren – Erste deskriptive Studienresultate einer Querschnittserhebung der schweizerischen DRG Begleitforschung Pflege vor Einführung der SwissDRG

Pflege ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 93-107 ◽  
Author(s):  
Michael Kleinknecht-Dolf ◽  
Elisabeth Spichiger ◽  
Irena Anna Frei ◽  
Marianne Müller ◽  
Jacqueline S. Martin ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Design

Hintergrund: Mit der Einführung der DRG-basierten Finanzierung erhalten Spitäler einen kleineren finanziellen Spielraum, was Prozessoptimierungen notwendig macht. Internationale Erfahrungen zeigen, dass solche Restrukturierungen Einfluss auf für die Pflege notwendige Kontextfaktoren haben können. Dadurch können auch Pflegequalität und Patientensicherheit beeinträchtigt werden. Ziel: Ziel der «DRG Begleitforschung Pflege» ist, ein Monitoringmodell samt dazugehörenden Instrumenten zur kontinuierlichen Überwachung des Einflusses der DRG-Finanzierung auf zentrale Pflegekontextfaktoren zu entwickeln. Methode: Die vorliegenden deskriptiven quantitativen Resultate wurden im Rahmen der in einem Mixed-Methods-Design durchgeführten Untersuchung mittels einer Online-Befragung erhoben, an der sich Pflegefachpersonen aus fünf Spitälern beteiligten. Ergebnisse: Die Resultate zeigen, dass die untersuchten Pflegekontextfaktoren «Komplexität der Pflege», «Arbeitsumgebungsqualität», «Führungsverhalten», «Moralischer Stress» und «Zufriedenheit mit der Arbeitsstelle» in allen Fachbereichen hinsichtlich der Arbeitsumgebung und Leistungserbringung der Pflege relevant sind. Es lassen sich Muster erkennen, die im Einklang mit der Literatur stehen, und die Hinweise auf die im Modell angenommenen Beziehungen zwischen diesen Kontextfaktoren geben. Schlussfolgerungen: Die Studie hat einerseits für die beteiligten Betriebe nützliche Daten geliefert, auf deren Basis sie Maßnahmen zur Sicherung der Qualität und Entwicklung der Pflege diskutieren können, andererseits konnten wichtige Informationen zur Weiterentwicklung des Modells und zu den eingesetzten Instrumenten gesammelt werden.

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