Chatbots in Healthcare Interventions: A systematic review of randomized controlled trials v (Preprint)

BACKGROUND Chatbot or virtual conversational agent is a typical programme of utilizing AI technology in mimicking human interactions. More robust and high-quality clinical trials have been conducted to test the effectiveness of chatbot-based interventions, however, there was a lack of a synthesis of the best available evidence. OBJECTIVE To examine the best available evidence of the application of chatbot-based interventions in the healthcare context. METHODS Seven databases were searched from inception until October 2021. Two reviewers independently selected the studies, extracted data from the included studies, and assessed the risk of bias. Study qualities were assessed by the RoB 2.0 tool. Silberg Scale was used to evaluate the quality of the chatbots systems utilized in the reviewed studies. RESULTS Twenty-one studies were included in the data synthesis. Studies of using chatbot-based interventions are feasible and an average moderate to a high level of participants acceptability of the intervention was reported. The intervention approaches mainly included cognitive-behavioural interventions, health education/counselling, storytelling acceptance and commitment therapy, and coping skills training. Findings indicate significant improvements in participants’ physical activity and physical function, healthy lifestyle modifications, symptoms/knowledge of the diseases, as well as mental health and psychosocial outcomes. The overall quality varies among the included studies as assessed by the RoB 2.0 tool. The average Silberg score was 5.4 with an SD of 1.6, out of the 9 points. CONCLUSIONS Our review findings indicate that chatbot-based interventions are feasible, acceptability and have positive effects on a variety of healthcare outcomes. Chatbots can provide low threshold access to healthcare services, and they can serve as a medical assistant to support patients’ recovery or health education/promotion needs before or after medical treatment without location restrictions. Also, the chatbot interventions can play an adjunct role and be integrated into the current health systems, which could improve the comprehensiveness of the healthcare services as well as save physicians’ time to see more patients or give more intensive care. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews No.CRD42021262512.

Context Matters in Evidence Implementation Globally; Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis"

Context influences the effectiveness of healthcare interventions and should be considered to inform their implementation. However, context remains poorly defined in the knowledge translation (KT) literature. The paper by Squires and colleagues constitutes a valuable contribution to the field of KT as it provides the basis for a comprehensive framework to assess the influence of context on implementation success. In their study, Squires et al. identified 66 context features, grouped into 16 attributes. Their findings highlight a great convergence in the context features mentioned by stakeholders across countries, experience levels and roles in KT. Thus, the proposed framework could eventually transfer to several implementation settings. However, all study participants were from high-income countries. It would therefore be important to replicate this research in low- and middle-income countries. A common understanding of what context means is essential to assessing its influence on the implementation of healthcare interventions globally.

Measuring and applying motivational constructs in a brief intervention for reducing harmful alcohol use in ED patients in Moshi, Tanzania (Preprint)

BACKGROUND Self Determination Theory (SDT) conceptualizes human motivation in terms of a spectrum. However, literature is scarce on how to measure self-determination in different languages or how self-determination can influence the effectiveness of healthcare interventions. OBJECTIVE The aim of this study was to translate and culturally adapt a psychometric questionnaire on self-determination (TSRQ) as well as SMS booster messages for a Brief Negotiational Intervention (BNI) aimed at reducing harmful alcohol use among injury patients presenting at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. METHODS A mixed-methods approach was used to evaluate the psychometric properties of the TSRQ and SMS booster messages. Likert-scale surveys were administered to expert panels to assess translation quality and adherence to theory. RESULTS Quantitative analyses confirmed that the Swahili translation of the TSRQ accurately reflected SDT constructs. Exploratory Factor Analysis (EFA) revealed a two-domain model had a better fit than the original three-domain TSRQ. Expert panel surveys indicated that the SMS booster messages maintained strong connections to tenets of SDT. CONCLUSIONS This was the first study to conduct a cross-cultural validation of the TSRQ in Tanzania and Tanzanian Swahili and the first to implement and assess motivational constructs in SMS booster messages for a BNI to promote safe alcohol use. The TSRQ is a valid, clinically useful scale, but could be improved with more items. SMS booster messages touch on many SDT constructs, affirming their motivational utility.

Hemophilia Patient Experience in a Physical Therapy-Guided Health Education Intervention: A Mixed-Method Design

People with hemophilia usually have negative joint consequences due to their illness. Evidence suggests that exercise and therapeutic education bring some benefits. An important factor that affects health interventions was the experience and degree of satisfaction. Thus, it is relevant to analyze qualitative and quantitative data to obtain a complete view of the patient’s experience. As a result, a concurrent nested mixed method with quantitative predominance study design was carried out. Nine people with hemophilia of Hemoaralar with a homogeneous environment participated in this study. The items evaluated were the level of satisfaction through the GCPC-UN-ESU survey and the experience with healthcare interventions through a focus group. A high level of satisfaction was obtained, but some divergences between quantitative and qualitative data were found. Further research about physical therapy and this type of intervention in people with hemophilia should be considered to better address the impact of living with the disease.

Caregiving During COVID-19: A Multi-State Qualitative Study of Family Caregiver Experiences and Decision Making

COVID-19 poses unique challenges to family caregivers. This study explores how family caregivers for older adults with cognitive impairments experience and make decisions about caregiving during a global pandemic. Using purposive sampling, 63 family caregivers across eight states participated in open-ended qualitative interviews (2019-2020), until thematic saturation was reached. Questions broadly examined caregivers’ experiences and decisions, focusing on decisions made around type of care setting. Questions about responses to the Pandemic were added as events unfolded. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long-term services and supports expenditures. Family caregivers experienced significant concern about COVID-19 itself, and about the indirect consequences of caregiving caused by the pandemic. Caregivers also displayed flexibility and adaptability in ceasing selected services, contingently continuing services, and utilizing telemedicine and other remote healthcare interventions to protect their loved ones. Many family caregivers utilized remote health care tools such telemedicine, no-contact prescription and grocery delivery. Such measures improved service access and reduced caregiver workload. Given the persistent challenges posed by COVID-19, long-term service organizations have an opportunity to enhance their policies to meet the needs of caregivers and those they care for. There is a need to expand telemedicine and other remote healthcare tools, while adapting these technologies to the needs of families. Also, procedures are needed for safe pathways to utilize HCBS and nursing care during a pandemic including communication supports, sufficient PPE, increased staffing, and utilization of evidence-based protocols.

A guide to systems-level, participatory, theory-informed implementation research in global health

Implementation research is a multidisciplinary field that addresses the complex phenomenon of how context influences our ability to deliver evidence-informed healthcare. There is increasing realisation of the importance of applying robust implementation research to scale-up life-saving interventions that meet health-related sustainable development goals. However, the lack of high-quality implementation research is impeding our ability to meet these targets, globally. Within implementation research, theory refers to the proposed hypothesis and/or explanation of how an intervention is expected to interact with the local context and actors to bring about change. Although there is increasing interest in applying theory to understand how and why implementation programmes work in real-world settings, global health actors still tend to favour impact evaluations conducted in controlled environments. This may, in part, be due to the relative novelty as well as methodological complexity of implementation research and the need to draw on divergent disciplines, including epidemiology, implementation science and social sciences. Because of this, implementation research is faced with a particular set of challenges about how to reconcile different ways of thinking and constructing knowledge about healthcare interventions. To help translate some of the ambiguity surrounding how divergent theoretical approaches and methods contribute to implementation research, we draw on our multidisciplinary expertise in the field, particularly in global health. We offer an overview of the different theoretical approaches and describe how they are applied to continuously select, monitor and evaluate implementation strategies throughout the different phases of implementation research. In doing so, we offer a relatively brief, user-focused guide to help global health actors implement and report on evaluation of evidence-based and scalable interventions, programmes and practices.

Information systems in support of public health in high-income countries

Public health activities are dependent on the availability of information and ability to disseminate information to clinicians/healthcare providers, individuals, and communities. The increasing computerization of healthcare systems can offer opportunities to improve these activities. Databases of electronic healthcare records are used for disease surveillance and monitoring healthcare interventions. The quality and quantity of reporting of notifiable diseases may be improved by regular review of the electronic healthcare records. Randomized trials that recruit patients at the point of care and use electronic healthcare records for collection of follow-up information can be used to test the effectiveness of healthcare intervention in routine clinical practice. Cluster trials that randomize different clinics or regions can compare different public health policies and improve the evidence base for the pragmatic use of public health interventions. Data generated within clinical information systems can be used to provide feedback and guidance to clinicians and patients as part of clinical care. Better information systems providing data on risks and benefits of healthcare interventions will provide an important impetus to evidence-based public health.

Private Healthcare Expenditure in China: A Regional Comparative Analysis

Private (out-of-pocket) healthcare expenditure (PHCE) is a complex phenomenon that is shaped by many different factors. In this paper, we analyzed the influencing factors of PHCE in China, with a specific focus on regional differences. We found that old-age dependency ratio, income, and education have significant impacts on PHCE in all regions, whereas public HCE, number of beds in medical institutions, and economic development levels have significant impacts only in some regions. The results indicate that the government should pay attention to regional inequality and implement targeted adjustments for improving the health service system. In particular, we recommend: (1) monitoring regional inequality in PHCE and other healthcare issues to unmask geographical differences in healthcare interventions; (2) adopting regional-specific policy measures—the government should divert some resources from eastern to western and central regions to increasing the support for public health undertakings and improve the quality of the local health services while providing matching medical resources by targeting the needs of the residents; (3) paying more attention to the healthcare demand of the elderly population; and (4) improving the education level of residents to improve public health and avoid high PHCE.