scholarly journals Participatory Design and Process Testing to Optimize Utility, Usability, and Acceptability of a Mobile Game for Promoting Evidence-Driven Public Health Decision-Making in Resource-Constrained Settings

2022 ◽  
Vol 3 ◽  
Author(s):  
James Douglas Sinnatwah ◽  
Hajah Kenneh ◽  
Alvan A. Coker ◽  
Wahdae-Mai Harmon-Gray ◽  
Joelyn Zankah ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Low Income ◽  
Participatory Design ◽  
End Users ◽  
Low Income Countries ◽  
Design Team ◽  
Training Methods ◽  
Design Development ◽  
Mobile Game

Innovative game-based training methods that leverage the ubiquity of cellphones and familiarity with phone-based interfaces have the potential to transform the training of public health practitioners in low-income countries such as Liberia. This article describes the design, development, and testing of a prototype of the Figure It Out mobile game. The prototype game uses a disease outbreak scenario to promote evidence-based decision-making in determining the causative agent and prescribing intervention measures to minimize epidemiological and logistical burdens in resource-limited settings. An initial prototype of the game developed by the US team was playtested and evaluated by focus groups with 20 University of Liberia Masters of Public Health (UL MPH) students. Results demonstrate that the learning objectives—improving search skills for identifying scientific evidence and considering evidence before decision-making during a public health emergency—were considered relevant and important in a setting that has repeatedly and recently experienced severe threats to public health. However, some of the game mechanics that were thought to enhance engagement such as trial-and-error and choose-your-own-path gameplay, were perceived by the target audience as distracting or too time-consuming, particularly in the context of a realistic emergency scenario. Gameplay metrics that mimicked real-world situations around lives lost, money spent, and time constraints during public health outbreaks were identified as relatable and necessary considerations. Our findings reflect cultural differences between the game development team and end users that have emphasized the need for end users to have an integral part of the design team; this formative evaluation has critically informed next steps in the iterative development process. Our multidisciplinary, cross-cultural and cross-national design team will be guided by Liberia-based public health students and faculty, as well as community members who represent our end user population in terms of experience and needs. These stakeholders will make key decisions regarding game objectives and mechanics, to be vetted and implemented by game design experts, epidemiologists, and software developers.

scholarly journals COVID-19 pandemic: the implications of the natural history, challenges of diagnosis and management for care in sub-Saharan Africa

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Lawrence Omo-Aghoja ◽  
Emuesiri Goodies Moke ◽  
Kenneth Kelechi Anachuna ◽  
Adrian Itivere Omogbiya ◽  
Emuesiri Kohworho Umukoro ◽  
...  
Keyword(s):  
Public Health ◽  
Natural History ◽  
Low Income ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Diagnosis And Management ◽  
Severe Acute Respiratory Infection ◽  
Identification Technique ◽  
Sub Saharan ◽  
Policies And Programs

Abstract Background Coronavirus disease (COVID-19) is a severe acute respiratory infection which has afflicted virtually almost all nations of the earth. It is highly transmissible and represents one of the most serious pandemics in recent times, with the capacity to overwhelm any healthcare system and cause morbidity and fatality. Main content The diagnosis of this disease is daunting and challenging as it is dependent on emerging clinical symptomatology that continues to increase and change very rapidly. The definitive test is the very expensive and scarce polymerase chain reaction (PCR) viral identification technique. The management has remained largely supportive and empirical, as there are no officially approved therapeutic agents, vaccines or antiviral medications for the management of the disease. Severe cases often require intensive care facilities and personnel. Yet there is paucity of facilities including the personnel required for diagnosis and treatment of COVID-19 in sub-Saharan Africa (SSA). It is against this backdrop that a review of key published reports on the pandemic in SSA and globally is made, as understanding the natural history of a disease and the documented responses to diagnosis and management is usually a key public health strategy for designing and improving as appropriate, relevant interventions. Lead findings were that responses by most nations of SSA were adhoc, paucity of public health awareness strategies and absence of legislations that would help enforce preventive measures, as well as limited facilities (including personal protective equipment) and institutional capacities to deliver needed interventions. Conclusion COVID-19 is real and has overwhelmed global health care system especially low-income countries of the sub-Sahara such as Nigeria. Suggestions for improvement of healthcare policies and programs to contain the current pandemic and to respond more optimally in case of future pandemics are made herein.

scholarly journals Design, development, and public health

2018 ◽  
Vol 15 (1) ◽  
pp. 62-74
Author(s):  
Traci Rose Rider ◽  
Margaret Van Bakergem ◽  
Jinoh Park ◽  
Xi Wang ◽  
J. Aaron Hipp
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Real Estate ◽  
Private Investment ◽  
Robert Wood Johnson Foundation ◽  
Design Development ◽  
Interview Protocol ◽  
Early Adopters ◽  
Standard Design ◽  
Decision Making Processes

As awareness of the built environment’s impact on individual and community health spreads through design and construction, different stakeholders are engaging in conversations of strategies and metrics. This paper explores the structure, methodology, and findings of research supported by the Robert Wood Johnson Foundation addressing how multifamily developers conceptualize, discuss and implement health strategies in their projects. Framed in a Critical Theory perspective, this research first explores the traditional multifamily development decision-making process, specifically targeting how early adopters in multifamily development are discussing health and wellness in their projects. By unpacking the discussions around health and wellbeing in design, real estate development, and public health, aligned concepts are identified to operationalize these concepts for further exploration. Using a comparative case study strategy addressing how and why (Yin 2017), five developers positioned as early adopters were engaged to better understand how they each conceptualize, implement and measure health strategies in their multifamily projects. Two-day in-depth interviews were held in two initial developers’ home offices, addressing their standard design and decision-making processes and evolving into specific consideration of various health strategies. Four additional developers were engaged either over the phone or in person. Interview protocol ensured that discussion topics were standardized at the outset, with the following topics addressed with each partner: (1) company mission, (2) organizational structure, (3) differentiation in the market, (4) company evaluation metrics, (5) assessment scales, (6) decision-making processes, (7) market trends, (8) use of evidence-based data, (9) internal health discussions, and (10) investor relationships. Cyclical data collection, transcription, and analysis allowed the interview protocol to be modified for emergent topics. Site visits, website analysis, and clicks through national online real estate databases also contributed to a holistic perspective of this complex problem. Findings indicate that multifamily developers are focusing on upfront, marketable strategies that are likely to foster mental and social health, but with little regard of applying any form of evaluative metrics. Rating systems addressing health are of little help. When asked directly about choices to influence the health of residents, participants heavily cited (1) location, emphasizing access to community amenities; (2) place making, for community building and social and mental wellbeing; and (3) physical fitness opportunities through fitness spaces. Even those developers viewed as early adopters are uncomfortable discussing health strategies using a public health lens. This research intends to highlight interdisciplinary conversations surrounding health in multifamily real estate, contributing to more rigorous adoption of health strategies in this challenging building type. These findings can be valuable to stakeholders in design, development, private investment, property management, public health, community design, and policy.   

scholarly journals Factors that influence the scale up of new interventions in low-income settings: a qualitative case study of the introduction of chlorhexidine cleansing of the umbilical cord in Bangladesh

2020 ◽  
Vol 35 (4) ◽  
pp. 440-451
Author(s):  
Jennifer A Callaghan-Koru ◽  
Munia Islam ◽  
Marufa Khan ◽  
Ardy Sowe ◽  
Jahrul Islam ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Umbilical Cord ◽  
Low Income ◽  
Qualitative Case Study ◽  
National Level ◽  
Scale Up ◽  
New Drugs ◽  
Low Income Countries

Abstract There is a well-recognized need for empirical study of processes and factors that influence scale up of evidence-based interventions in low-income countries to address the ‘know-do’ gap. We undertook a qualitative case study of the scale up of chlorhexidine cleansing of the umbilical cord (CHX) in Bangladesh to identify and compare facilitators and barriers for the institutionalization and expansion stages of scale up. Data collection and analysis for this case study were informed by the Consolidated Framework for Implementation Research (CFIR) and the WHO/ExpandNet model of scale up. At the national level, we interviewed 20 stakeholders involved in CHX policy or implementation. At the district level, we conducted interviews with 31 facility-based healthcare providers in five districts and focus group discussions (FGDs) with eight community-based providers and eight programme managers. At the community level, we conducted 7 FGDs with 53 mothers who had a baby within the past year. Expanded interview notes were thematically coded and analysed following an adapted Framework approach. National stakeholders identified external policy and incentives, and the engagement of stakeholders in policy development through the National Technical Working Committee for Newborn Health, as key facilitators for policy and health systems changes. Stakeholders, providers and families perceived the intervention to be simple, safe and effective, and more consistent with family preferences than the prior policy of dry cord care. The major barriers that delayed or decreased the public health impact of the scale up of CHX in Bangladesh’s public health system related to commodity production, procurement and distribution. Bangladesh’s experience scaling up CHX suggests that scale up should involve early needs assessments and planning for institutionalizing new drugs and commodities into the supply chain. While the five CFIR domains were useful for categorizing barriers and facilitators, additional constructs are needed for common health systems barriers in low-income settings.

scholarly journals Return to Treatment in the Formal Health Care Sector: Evidence from Tanzania

2015 ◽  
Vol 7 (3) ◽  
pp. 29-57 ◽  
Author(s):  
Achyuta Adhvaryu ◽  
Anant Nyshadham
Keyword(s):  
Public Health ◽  
Health Care ◽  
Low Income ◽  
Health Care Sector ◽  
Health Facilities ◽  
Low Income Countries ◽  
Formal Sector ◽  
Health Goal ◽  
Public Health Goal ◽  
Formal Health Care

Improving access to the formal health care sector is a primary public health goal in many low-income countries. But the returns to this access are unclear, given that the quality of care at public health facilities is often considered inadequate. We exploit temporal and geographic variation in the cost of traveling to formal sector health facilities to show that treatment at these facilities improves short-term health outcomes for acutely ill children in Tanzania. Our results suggest that these improvements are driven in part by more timely receipt of and better adherence to antimalarial treatment. (JEL I11, I12, I15, I18, J13, O15)

scholarly journals Economic support, education and sexual decision making among female adolescents in Zambia: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. Milimo ◽  
J. M. Zulu ◽  
J. Svanemyr ◽  
E. Munsaka ◽  
O. Mweemba ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomised Controlled Trial ◽  
Low Income ◽  
Controlled Trial ◽  
Community Support ◽  
Female Adolescents ◽  
Low Income Countries ◽  
Sexual Decision Making ◽  
Economic Support ◽  
Randomised Controlled

Abstract Background The importance of educating female adolescents has been recognized as critical to the development of any country. However, in low income countries like Zambia they often drop out of school due to poverty, early pregnancy and early marriages. Some studies indicate that economic support such as Social Cash Transfers (SCTs) can mitigate the effects of poverty on female adolescents by improving their school participation and helping postpone pregnancy and marriage. This study aimed to explore the role of economic support in influencing education and sexual decision making among female adolescents in a randomised controlled trial in Zambia. Methods The study adopted a qualitative approach. It utilized purposive and convenient sampling. Data were collected from 6 schools using 18 in-depth interviews (IDIs) and 4 focus group discussions (FGDs) comprising 48 school-going female adolescents in grade 8 aged 14 to 17. All participants received economic support in form of SCTs and payment of school fees as part of the Research Initiative to Support the Empowerment of Girls (RISE), a Cluster Randomised Controlled Trial. Data were analyzed using thematic analysis. Results Findings suggested several benefits of the economic support for the female adolescents such as economic independence and empowerment; increased assertiveness and autonomy; reduced desire for sexual relationships with boys in exchange for cash and gifts; increased motivation for school; enhanced parental and community support for female adolescents’ education and; reduced school dropouts. However, they also experienced jealousy from those who did not benefit from the economic support. Conclusion Economic support played a significant role in influencing both educational and sexual decision making among female adolescents. Trial registration ISRCTN Registry: ISRCTN12727868, (4 March 2016).

scholarly journals Curtailing Covid-19 on a Dollar-a-Day in Malawi: Implications for the Ongoing Pandemic

2021 ◽  
Author(s):  
Iliana V. Kohler ◽  
Fabrice Kämpfen ◽  
Alberto Ciancio ◽  
James Mwera ◽  
Victor Mwapasa ◽  
...  
Keyword(s):  
Public Health ◽  
Low Income ◽  
Population Based ◽  
Community Leadership ◽  
Pivotal Role ◽  
Low Income Countries ◽  
Effective Response ◽  
Trust In Institutions ◽  
Primary Prevention Strategy ◽  
Sub Saharan

AbstractUtilizing population-based data from the Covid-19 phone survey (N = 2, 262) of the Malawi Longitudinal Study of Families and Health (MLSFH) collected during June 2nd–August 17th, 2020, we investigate behavioral, economic and social responses to Covid-19 and focus on the crucial role that community leadership and trust in institutions play towards shaping these responses. We argue that the effective response of Malawi to limit the spread of the virus was facilitated by the engagement of local leaders to mobilize communities to adapt and adhere to Covid-19 prevention strategies. Village heads (VHs) played pivotal role in shaping individual’s knowledge about the pandemic and the adaption of preventive health behaviors and were crucial for mitigating the negative economic and health consequences of the pandemic. We further show that trust in institutions is of particular importance in shaping individuals’ behavior during the pandemic, and these findings highlight the pivotal role of community leadership in fostering better compliance and adoption of public health measures essential to contain the virus. Overall, our findings point to distinctive patterns of pandemic response in a low-income sub-Saharan African rural population that emphasized local leadership as mediators of public health messages and policies. These lessons from the first pandemic wave remain relevant as in many low-income countries behavioral responses to Covid-19 will remain the primary prevention strategy for a foreseeable future.

scholarly journals Counseling at all contacts for postpartum contraceptive use: can paper-based tools help community health workers improve continuity of care? A qualitative study from Ethiopia

2019 ◽  
Vol 3 ◽  
pp. 1652 ◽  
Author(s):  
Muluneh Yigzaw Mossie ◽  
Anne Pfitzer ◽  
Yousra Yusuf ◽  
China Wondimu ◽  
Eva Bazant ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Community Health ◽  
Low Income ◽  
Health Workers ◽  
Continuum Of Care ◽  
Low Income Countries ◽  
Health Extension Workers ◽  
Pregnancy Risk ◽  
The Continuum

Background: Globally, there has been a resurgence of interest in postpartum family planning (PPFP) to advance reproductive health outcomes. Few programs have systematically utilized all contacts a woman and her baby have with the health system, from pregnancy through the first year postpartum, to promote PPFP. Nested into a larger study covering two districts, this study assessed the use, acceptability, and feasibility of tools for tracking women’s decision-making and use of PPFP in the community health system in Oromia region, Ethiopia. Community-level tracking tools included a modified Integrated Maternal and Child Health (IMCH) card with new PPFP content, and a newly developed tool for pregnant and postpartum women for use by Women Development Armies (WDAs). Proper completion of the tools was monitored during supervision visits. Methods: In-depth interviews and focus group discussions were conducted with health officials, health extension workers, and volunteers. A total of 34 audio-files were transcribed and translated into English, double-coded using MAXQDA, and analyzed using a thematic approach. Results: The results describe how HEWs used the modified IMCH card to track women’s decision making through the continuum of care, to assess pregnancy risk and to strengthen client-provider interaction. Supervision data demonstrated how well HEWs completed the modified IMCH card. The WDA tool was intended to promote PPFP and encourage multiple contacts with facilities from pregnancy to extended postpartum period. HEWs have reservations about the engagement of WDAs and their use of the WDA tool. Conclusions: To conclude, the IMCH card improves counseling practices through the continuum of care and is acceptable and feasible to apply. Some elements have been incorporated into a revised national tool and can serve as example for other low-income countries with similar community health systems. Further study is warranted to determine how to engage WDAs in promoting PPFP.

scholarly journals COVID-19 and Its Implications in Dental Care

2020 ◽  
pp. 53-57
Author(s):  
H. Inegbenosun ◽  
E. P. Ofiri ◽  
C. C. Azodo
Keyword(s):  
Public Health ◽  
Low Income ◽  
Dental Care ◽  
Public Health Problem ◽  
Low Income Countries ◽  
Dental Procedures ◽  
The World ◽  
Huge Impact ◽  
Dental Practices ◽  
The Government

COVID-19 was first reported in Wuhan, Hubei Province of China a few months ago (December 2019) and had since become a major challenging public health problem for not only China but also many countries around the world. It was on March 11, 2020, characterized by WHO as a pandemic. The pandemic so far has killed more than 526,465 people and infected more than 11,046,917 people around the world as of 05 July 2020. Nigeria currently has 28,167 confirmed COVID-19 cases with 11,462 (40%) discharged, 16,071 (57%) currently receiving treatment at designated facilities across the country and unfortunately 634 (3%) deaths as at the time of writing this manuscript. As far as the authors are aware, there are little or no work carried out on the implications of COVID-19 on dental practices in Nigeria. Recently, COVID-19 was identified in saliva of infected patients and so transmission via aerosols and splatter generated during dental procedures is sure. To limit exposure, there was a need to avoid scheduling patients except for emergency dental care during this outbreak. This limitation on activities of the dental sector has a very huge impact on the economy of the sector as it has already resulted in serious monetary implications for dental practices worldwide. While dental practices in the high-income countries are getting help from their respective Government, those in the middle and low-income countries like Nigeria have been left to wallow in bankruptcy without support. The authors highly recommend that the Government of these neglected countries, step up and support dental practices that are on the brink of closing down due to the low turnout of patients to their practice during this outbreak.

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