Challenges experienced by community health workers and their motivation to attend a self-management programme

Background: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.Aim: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.Setting: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa.Methods: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis.Results: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective.Conclusion: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.

Onset of Weight Gain and Health Concerns for Men: Findings from the TAP Programme

With shown reticence by men to engage with dietary interventions for weight loss, investigations that provide detail on men’s perceptions for the causes of weight gain and subsequent concerns over health and image are important. Such discoveries have potential to make a valuable contribution to male gendered programme design aimed at tackling weight gain and promoting good health. Connecting to men to health using their hobbies and interests, this study deployed semi-structured interviews of eight male participants (age > 35 years) enrolled on The Alpha Programme (TAP). TAP is a 12-week football and weight management intervention delivered in local community venues. Results captured men’s lived experiences and feelings of being overweight, their attempts at dietary modification, health and causes of weight gain. Results signify externalized attribution for weight gain, entrenched habitual intake practices, despondency related to weight stigmatization, self-objectification and low self-worth. Moreover, this study outlines the processes for capturing this information using a male friendly approach and setting. Outcomes have potential for shaping bespoke men’s weight management and health improvement interventions in the future.

The Impact of COVID-19 on Travelers’ Travel Behavior

The purpose of this paper is to investigate the impact of a global pandemic, Coronavirus (COVID-19), on travel behavior by integrating crisis management with other behavior variables. Online surveys via the Amazon Mechanical Turk website were used for data collection. A total of 1978 responses were collected from 19 countries (September, 2020); 1607 valid cases were undertaken for the data analysis. The results suggest that crisis management intervention was the most influential factor impacting travel behavior during the COVID-19 pandemic. Non-pharmaceutical interventions followed as the second most influencing predictor. . Personal traits were the only variable that recorded a negative relationship with travel behavior. This study has significant practical and theoretical implications since it adopted the extended model of goal-directed behavior while including crisis management intervention, which is a unique approach.  Although attitudes generally strongly influence travel behavior, in a pandemic situation, such relationships weaken. In terms of practical implications, it has become apparent that firms and governments should implement integrated risk management and crisis management strategies. Travelers need to be reassured that these tourist destinations have become safe again. This will likely decrease the risk factor, therefore influencing them to travel to this region. This study contributes to understanding how a global pandemic influences travel behavior It will be invaluable in predicting the early reflections of travelers as the pandemic ends.

Consumers’ Perception of The Cost of Credit Default in The Vehicle Finance Industry in South Africa

The risk that a borrower may not fulfil his/her borrowing obligation presents credit owner (lender) a default risk management opportunity to maximize the risk-adjusted rate of return and to maintain minimum exposure to default associated cost. This paper investigated respondents’ perception of the cost of credit default and examines requirements for default risk management (DRM) in the vehicle finance industry in South Africa. It is noted that with an increased level of consumer indebtedness, unstable economy, high unemployment, opportunistic risks like health pandemics, vehicle financing faces a higher probability of default from borrowers. This descriptive investigation utilised quantitative approach using a survey method to collect data from 381 purposive randomly selected respondents who are vehicle finance customers in South Africa, Cape Town specifically. Data collection took place in the Western Cape over a nine-month period, utilising personal interview, and emails to administer questionnaires to vehicle finances’ customers as data collection instruments. Responses received were codified and quantitative data were analysed using the Statistical Packages for Social Sciences (SPSS version 25) The paper found mixed and variable respondents’ perception of the cost of credit default. In conclusion, it is perceived that South Africa debt would become more costly with credit default. It can be recommended that a default risk management intervention be applied to manage credit default risk within the context of the unified credit assessment policy in South Africa.

‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study

Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents’ experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.

Liraglutide (Saxenda)

CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec. This review assesses liraglutide 6 mg/mL (Saxenda). Indication under review : Indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial BMI of: 30 kg/m2 or greater (obesity), or 27 kg/m2 or greater (overweight) in the presence of at least 1 weight-related comorbidity (e.g., hypertension, type 2 diabetes, or dyslipidemia) and who have failed a previous weight management intervention.

Effects of Virtual Reality-Based Relaxation Techniques on Psychological, Physiological, and Biochemical Stress Indicators

Various relaxation techniques could benefit from merging with virtual reality (VR) technologies, as these technologies are easily applicable, involving, and user-friendly. To date, it is unclear which relaxation technique using biofeedback combined with VR technology is the most effective. The study aimed to compare the effectiveness of brief VR-based biofeedback-assisted relaxation techniques including electroencephalographic biofeedback, mindfulness-based biofeedback, galvanic skin response biofeedback, and respiratory biofeedback. Forty-three healthy volunteers (age 34.7 ± 7.2 years), comprising 28 (65%) women and 15 (35%) men, were enrolled in the study. All the participants were exposed to four distinct relaxation sessions according to a computer-generated random sequence. The efficacy of relaxation methods was evaluated by examining psychological, physiological, and biochemical stress indicators. All VR-based relaxation techniques reduced salivary steroid hormone (i.e., cortisol, cortisone, and total glucocorticoid) levels and increased galvanic skin response values. Similarly, all interventions led to a significantly reduced subjectively perceived psychological strain level. Three out of the four interventions (i.e., electroencephalographic, respiratory, and galvanic skin response-based biofeedback relaxation sessions) resulted in a decreased self-reported fatigue level. We suggest that newly developed VR-based relaxations techniques are potential tools for stress reduction and might be particularly suitable for individuals who are not capable of adhering to a strict and time-consuming stress management intervention schedule.

Taking Charge After Stroke: A novel, community-based intervention to improve the lives of people with stroke

<p>Background and aims: Stroke is the third leading cause of disability worldwide. Despite the recent development of hyper-acute therapies for stroke, outcomes for people with stroke and types of rehabilitation interventions have remained unchanged. Rehabilitation in New Zealand is largely therapy-based and uses goal setting as a main component, but evidence for effectiveness of these methods is weak. Attempts to enhance the effects of rehabilitation using a stroke liaison officer or a caregiver to lead rehabilitation at home have had no effect on outcomes. However, self-management interventions have shown some promise. The Take Charge session is a novel, community-based, self-management intervention, which was shown to significantly improve both independence and health-related quality of life at 12 months following stroke in Māori and Pacific New Zealanders. We formalised the components of the Take Charge session, based upon Self Determination Theory and qualitative research about the importance of Taking Charge in recovery. This allowed us to retest the intervention in a different population of people with stroke. We hypothesised that: (1) the beneficial effect of the Take Charge session would be reproducible in a larger cohort of non-Māori, non-Pacific people with stroke, and (2) that two Take Charge sessions would have a greater positive effect on health-related quality of life than one alone. Methods: We randomised 400 people within 16 weeks of acute stroke who had been discharged to community living at seven centres in New Zealand to either a single Take Charge session (TCS 1, n = 132), two Take Charge sessions (TCS 2, n = 138), or a control intervention (n = 130). The primary outcome was the Physical Component Summary score (PCS) of the Short Form 36 (SF-36) at 12 months following index stroke, comparing any Take Charge session exposure to control. Secondary outcomes included the PCS of the Short Form 12 (SF-12) at six months, participation measured by the Frenchay Activities Index at six and 12 months, and activities measured by the Barthel Index at six and 12 months. Outcome measures were performed by an assessor masked to allocation. Results: At 12 months following stroke, participants in either of the Take Charge groups (TCS 1 + TCS 2) scored 2.9 (95% CI 0.95 to 4.9, p = 0.004) points higher (better) than control on the SF-36 PCS. This difference was statistically and clinically significant. The effect size remained significant when we adjusted for pre-specified baseline variables, including age, gender, and baseline stroke severity. Furthermore, SF-12 PCS at six months showed improvement in similar direction and effect size, and improvement in participation was statistically significant at 12 months. There was a positive dose effect with each exposure to the Take Charge session predicting a 1.9 (95% CI 0.8 to 3.1, p < 0.001) point increase in the 12-month SF-36 PCS. Subsequently, we conducted an individual patient meta-analysis of the Take Charge session, pooling data with the initial Māori and Pacific Stroke Study. The pooled effect of any exposure to the Take Charge session was 3.74 (95% CI 1.96 to 5.51) points greater than control. Conclusion: The Take Charge session – a simple, self-management intervention, improved healthrelated quality of life and participation at 12 months. This thesis provides evidence for implementing such an intervention into routine, post-stroke care, to improve the quality of life of people with stroke in the long term.</p>