An alternative to the ‘light touch’ digital health remote study: The Stress and Recovery in Frontline COVID-19 Healthcare Workers Study (Preprint)

BACKGROUND Background: Several app-based studies share similar characteristics of a ‘light touch’ approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks, while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies reporting low retention and adherence. OBJECTIVE To describe an alternative to a ‘light touch’ digital health study that involved a participant centric design including high friction app-based assessments, semi-continuous passive data from wearable sensors and a digital engagement strategy centered on providing knowledge and support to participants. METHODS The Stress and Recovery in Frontline COVID-19 Healthcare Workers Study included US frontline healthcare workers followed between May-November 2020. The study comprised 3 main components: 1) active and passive assessments of stress and symptoms from a smartphone app; 2) objective measured assessments of acute stress from wearable sensors; and 3) a participant co-driven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10-15 minutes. Retention and adherence are described both quantitatively and qualitatively. RESULTS Results: 365 participants enrolled and started the study and 81.0% (297/365) of them completed the study for a total study duration of 4 months. Average wearable sensor usage was 90.6% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18%, 68.37%, 72.86% of the time, respectively. CONCLUSIONS Conclusions: This study found evidence for feasibility and acceptability of a participant centric digital health study approach that involved building trust and respect with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected that is often missing from ‘light touch’ digital health studies. CLINICALTRIAL Clinicaltrials.Gov (NCT04713111)

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Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/20420188211054688 ◽

2021 ◽

Vol 12 ◽

pp. 204201882110546

Author(s):

Patrick Ngassa Piotie ◽

Paola Wood ◽

Elizabeth M. Webb ◽

Johannes F.M. Hugo ◽

Paul Rheeder

Keyword(s):

South Africa ◽

Type 2 Diabetes ◽

Primary Care ◽

Healthcare Workers ◽

Digital Health ◽

Complex Interventions ◽

Community Healthcare ◽

Community Healthcare Workers ◽

Project Intervention

Background: In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. Methods: We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. Results: This intervention is an innovative, nurse-driven and app-enabled intervention called ‘the Tshwane Insulin Project intervention’. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. Conclusion: The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.

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The Development of an Electronic Clinical Decision and Support System to Improve the Quality of Antenatal Care in Rural Tanzania: Lessons Learned Using Intervention Mapping

Frontiers in Public Health ◽

10.3389/fpubh.2021.645521 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sandra van Pelt ◽

Karlijn Massar ◽

Laura Shields-Zeeman ◽

John B. F. de Wit ◽

Lisette van der Eem ◽

...

Keyword(s):

Antenatal Care ◽

Support System ◽

Healthcare Workers ◽

Digital Health ◽

Intervention Mapping ◽

Clinical Decision ◽

Lessons Learned ◽

Maternal Deaths ◽

Nurse Assistant

It is widely recognised that high quality antenatal care is a key element in maternal healthcare. Tanzania has a very high maternal mortality ratio of 524 maternal deaths per 100,000 live births. Most maternal deaths are due to preventable causes that can be detected during pregnancy, and antenatal care therefore plays an important role in reducing maternal morbidity and mortality. Unfortunately, quality of antenatal care in Tanzania is low: Research has shown that healthcare workers show poor adherence to antenatal care guidelines, and the majority of pregnant women miss essential services. Digital health tools might improve the performance of healthcare workers and contribute to improving the quality of antenatal care. To this end, an electronic clinical decision and support system (the Nurse Assistant App) was developed and implemented in Tanzania in 2016 to provide digital assistance during antenatal care consultations to healthcare workers. The current study systematically evaluated the development and implementation process of the Nurse Assistant App in Magu District, Tanzania, with the aim of informing future programme planners about relevant steps in the development of a digital health intervention. Desk research was combined with semi-structured interviews to appraise the development process of the digital health tool. We employed the criteria stipulated by Godin et al., which are based on the six steps of Intervention Mapping [IM; Bartholomew Eldredge et al.]. Findings indicated that five of the six steps of IM were completed during the development and implementation of the Nurse Assistant App. Tasks related to community engagement, adjustment to local context, implementation in the practical context in collaboration with local partners, and rigorous evaluation were accomplished. However, tasks related to identifying theory-based behaviour change methods were not accomplished. Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to (1) engage the community and listen to their insights, (2), focus on clear programme goals and the desired change, (3), consult or involve a behaviour change specialist, and (4), anticipate potential problems in unexpected circumstances.

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“The nurse assistant app” to improve healthcare worker performance during antenatal care in Tanzania

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.041 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S van Pelt ◽

K Massar ◽

L van der Eem ◽

L Shields-Zeeman ◽

J B F de Wit ◽

...

Keyword(s):

Antenatal Care ◽

Healthcare Workers ◽

Digital Health ◽

Intervention Mapping ◽

Sub Saharan Africa ◽

Systematic Evaluation ◽

Future Research ◽

Change Models ◽

Nurse Assistant

Abstract Background The Nurse Assistant App (NAA) was developed to improve the quality of antenatal care in Magu District Tanzania by providing digital assistance to healthcare workers. The NAA guides healthcare workers step by step through all necessary antenatal care interventions and provides tailored advice and suggestions for follow-up actions. We used the Intervention Mapping framework to retrospectively evaluate the development of the NAA. Methods Desk research into the content, evidence base, and development of the NAA was performed combined with semi-structured interviews with two initial developers to fill in a planning tool consisting of 40 criteria for systematic evaluation of the data. Results Findings showed that the NAA was developed based on existing literature on antenatal care guidelines as well as the knowledge and experience of a broad variety of stakeholders and that five of the six steps of Intervention Mapping were performed. However, the development of the NAA lacked a theoretical foundation on behaviour change models. Future research will focus on the experiences of healthcare workers providing antenatal care using the NAA. Conclusions The NAA was developed in collaboration with relevant stakeholders and took practical matters as well as evidence from existing literature into account. However, we recommend that the responsibility and ownership of the NAA should be shared with the local government to increase the potential and sustainability of the NAA. Key messages The NAA was developed to improve the quality of antenatal care in rural Tanzania targeting healthcare workers. The current evaluation informs future digital health tool developers in sub-Saharan Africa about elements to take into account during the development phase such as systematic mapping of the process.

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Blockchain Enabled Tracking of Physician Burnout and Stressors During the COVID-19 Pandemic

Frontiers in Blockchain ◽

10.3389/fbloc.2020.586742 ◽

2021 ◽

Vol 3 ◽

Author(s):

Vikram Dhillon ◽

Tailong Xu ◽

Chirag Parikh

Keyword(s):

Mental Health ◽

Hot Spots ◽

Healthcare Workers ◽

Hot Spot ◽

Digital Health ◽

The Novel ◽

Physician Burnout ◽

Health Technologies ◽

Hospital Systems ◽

Novel Coronavirus

With more than 54 million cases worldwide, the novel coronavirus disease 2019 (COVID-19) has disrupted every aspect of public life and poses an ever-growing burden on an already strained healthcare system. The emergence of new COVID-19 hot-spots and super-spreader events are placing an immense amount of stress on hospital systems responding to the increased influx of critically ill patients. Healthcare workers and frontline physicians disproportionately bear the additional physical and psychological burdens associated with the appearance of a new hot-spot. However, the mental health implications of COVID-19 for physicians are not well understood. In this perspective piece, we discuss widespread effects of the ongoing pandemic on physician mental health and how blockchain infrastructure can enable digital health technologies in supporting data-driven fatigue mitigation interventions. This is particularly applicable to simplifying physician workflows in newly emerging hot-spots.

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Cybersecurity in health is an urgent patient safety concern: We can learn from existing patient safety improvement strategies to address it

Journal of Patient Safety and Risk Management ◽

10.1177/2516043520975926 ◽

2021 ◽

Vol 26 (1) ◽

pp. 5-10

Author(s):

Niki O’Brien ◽

Saira Ghafur ◽

Mike Durkin

Keyword(s):

Patient Safety ◽

Healthcare Workers ◽

Safety Concern ◽

Digital Health ◽

Scale Up ◽

Cyber Attacks ◽

Lessons Learned ◽

Patient Death ◽

Ensure Patient Safety ◽

Frontline Healthcare Workers

Introduction Cybersecurity is a patient safety concern. Recent cyberattacks on healthcare institutions around the world have shown the risks to patients: from delayed treatment as hospitals and clinics are shutdown, to the threat of harm from the theft of personal data, to patient death. The recent Covid-19 pandemic has further increased cyber-attacks on health organisations. In low- and middle-income countries (LMICs) digital health, including the use of health informatics systems and electronic health records, is an increasing part of the health agenda as national governments move to scale up healthcare on the path to achieving Universal Health Coverage. Frontline healthcare workers are often warned of the dangers of data mismanagement and are advised to take precautions to ensure data is safe. However, as many workers are already overstretched with conflicting administrative priorities, cybersecurity risks are going unnoticed. Discussion In this commentary we argue that future education and training interventions for frontline healthcare workers on cybersecurity in LMICs can benefit from lessons learned from other areas of patient safety. Validated interventions, including education and awareness programmes and other simple tools, exist which can offer guidance on how cybersecurity awareness and education may be scaled up in frontline healthcare facilities, without adding an unacceptable burden to staff. Conclusions Efforts to develop frontline interventions on cybersecurity that can be easily implemented and sustained are essential to ensure patient safety is a top priority in a digitally reliant health system.

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Healthcare workers’ and pregnant women’s perceptions of digital tools to improve antenatal care

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.904 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S van Pelt ◽

K Massar ◽

L van der Eem ◽

M van der Pijl ◽

L Shields-Zeeman ◽

...

Keyword(s):

Quality Of Care ◽

Antenatal Care ◽

Pregnant Women ◽

Healthcare Workers ◽

Digital Health ◽

Quality Of Healthcare ◽

Care Services ◽

Rural Tanzania ◽

Women’S Perceptions

Abstract Background To reduce maternal mortality in rural Tanzania, the need to improve antenatal care remains an urgent priority. Digital health tools are seen as a promising instrument to increase the quality of healthcare in developing countries, but it remains unclear to what extent they are perceived as beneficial during the antenatal care visit. Therefore, the aim of this research was to identify factors that could improve the quality of antenatal care in rural Tanzania, and whether digital health tools would change healthcare workers' and pregnant women's perceptions of quality of care. Methods Semi-structured in-depth interviews were conducted with sixteen healthcare workers and nineteen pregnant women, recruited from various health facilities in Magu District, Tanzania. Results Both healthcare workers and pregnant women possess a positive attitude towards antenatal care and acknowledge its importance. However, they also expressed a need for (structural) improvements in antenatal care services, particularly increased availability of diagnostic tests, and increased performance and motivation of healthcare workers. In addition, healthcare workers indicated a need for more training and better supervision. While both groups expected quality of care to increase should a digital health tool be implemented, they placed more focus on investing in health infrastructure, like the availability of medication and other materials, than investments in digital health. Conclusions Infrastructural improvements, including better communication between healthcare workers and pregnant women, as well as training opportunities and supportive leadership, are necessary before a digital health tool can be expected to increase the quality of antenatal care. Key messages Both healthcare workers and pregnant women acknowledged the need for higher quality antenatal care. Both groups suggested a number of infrastructural improvements, among which the use of a digital health tool.

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