Exploring people’s candidacy for mobile health–supported HIV testing and care services in rural Kwazulu-Natal, South Africa: qualitative study

BACKGROUND: The use of mobile communication technologies (mHealth: mobile health) in chronic disease management has grown significantly over the years. mHealth interventions have the potential to decentralize access to health care and make it convenient, particularly in resource-constrained settings. It is against this backdrop that we aimed to codevelop (with potential users) a new generation of mobile phone-connected HIV diagnostic tests and Web-based clinical care pathways needed for optimal delivery of decentralized HIV testing, prevention, and care in low- and middle-income countries. OBJECTIVE: The aim of this study was to understand ways in which an mHealth intervention could be developed to overcome barriers to existing HIV testing and care services and promote HIV self-testing and linkage to prevention and care in a poor, HIV hyperendemic community in rural KwaZulu-Natal, South Africa. METHODS: A total of 54 in-depth interviews and 9 focus group discussions were conducted with potential users (including health care providers) in 2 different communities. Theoretically informed by the candidacy framework, themes were identified from the interview transcripts, manually coded, and thematically analyzed. RESULTS: Participants reported barriers, such as fear of HIV identity, stigma, long waiting hours, clinic space, and health care workers' attitudes, as major impediments to effective uptake of HIV testing and care services. People continued to reassess their candidacy for HIV testing and care services on the basis of their experiences and how they or others were treated within the health systems. Despite the few concerns raised about new technology, mobile phone-linked HIV testing was broadly acceptable to potential users (particularly men and young people) and providers because of its privacy (individual control of HIV testing over health provider-initiated testing), convenience (individual time and place of choice for HIV testing versus clinic-based testing), and time saving. CONCLUSIONS: Mobile phone-connected HIV testing and Web-based clinical care and prevention pathways have the potential to support access to HIV prevention and care, particularly for young people and men. Although mHealth provides a way for individuals to test their candidacy for HIV services, the barriers that can make the service unattractive at the clinic level will also need to be addressed if potential demand is to turn into actual demand

An Updated Review of Interventions that Include Promotion of Physical Activity for Adult Men

The marked disparity in life expectancy between men and women suggests men are a vulnerable group requiring targeted health promotion programs. As such, there is an increasing need for health promotion strategies that effectively engage men with their health and/or illness management. Programs that promote physical activity could significantly improve the health of men. Although George et al. (Sports Med 42(3):281, 30) reviewed physical activity programs involving adult males published between 1990 and 2010, developments in men’s health have prompted the emergence of new sex- and gender-specific approaches targeting men. The purpose of this review was to: (1) extend and update the review undertaken by George et al. (Sports Med 42(3):281, 30) concerning the effectiveness of physical activity programs in males, and (2) evaluate the integration of gender-specific influences in the content, design, and delivery of men’s health promotion programs. A search of MEDLINE, CINAHL, ScienceDirect, Web of Science, PsycINFO, the Cochrane Library, and the SPORTDiscus databases for articles published between January 2010 and August 2014 was conducted. In total, 35 studies, involving evaluations of 31 programs, were identified. Findings revealed that a variety of techniques and modes of delivery could effectively promote physical activity among men. Though the majority of programs were offered exclusively to men, 12 programs explicitly integrated gender-related influences in male-specific programs in ways that recognized men’s interests and preferences. Innovations in male-only programs that focus on masculine ideals and gender influences to engage men in increasing their physical activity hold potential for informing strategies to promote other areas of men’s health

Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review

Reproduced by permission of Oxford University Press https://academic.oup.com Copyright © 2019 American Society for NutritionSmartphone applications are increasingly being used to support nutrition improvement in community settings. However, there is a scarcity of practical literature to support researchers and practitioners in choosing or developing health applications. This work maps the features, key content, theoretical approaches, and methods of consumer testing of applications intended for nutrition improvement in community settings. A systematic, scoping review methodology was used to map published, peer-reviewed literature reporting on applications with a specific nutrition-improvement focus intended for use in the community setting. After screening, articles were grouped into 4 categories: dietary self-monitoring trials, nutrition improvement trials, application description articles, and qualitative application development studies. For mapping, studies were also grouped into categories based on the target population and aim of the application or program. Of the 4818 titles identified from the database search, 64 articles were included. The broad categories of features found to be included in applications generally corresponded to different behavior change support strategies common to many classic behavioral change models. Key content of applications generally focused on food composition, with tailored feedback most commonly used to deliver educational content. Consumer testing before application deployment was reported in just over half of the studies. Collaboration between practitioners and application developers promotes an appropriate balance of evidence-based content and functionality. This work provides a unique resource for program development teams and practitioners seeking to use an application for nutrition improvement in community settings

Development and evaluation of a physical activity intervention for older adults

The present knowledge of factors associated with older adults’ physical activity behaviour is limited. Therefore, this study trialled an innovative physical activity program for older adults, investigating effective recruitment and retention strategies, and exploring the adults’ perceptions of physical activity. A total of 573 subjects were recruited into the quasi-randomised controlled trial, located in 30 intervention and 30 control neighbourhoods in the Perth metropolitan area. The initial response rate was 74% (260/352) in the intervention group and 82% (313/382) in the control group. Self-reported questionnaires administered at three time points (baseline, 3-months, 6-months) measured physical activity levels, personal and demographic information, including perception of financial struggle, proximity to friends, and other psychosocial data. Descriptive statistics, repeated measure analysis of variance, logistic regression and generalised estimating equations were used in the analysis. Qualitative data on the participants’ perceptions of physical activity were collected through one-on-one interviews (n=16). The results showed that: 1. This cost-effective recruitment procedure facilitated the selection of a reasonably representative sample of 65 to 74 year olds from the Perth metropolitan area. Names of 7378 older adults were obtained from the Federal Electoral Roll, then 6401 potential subjects were matched to telephone numbers and phoned with subjects meeting the screening criteria invited to join the program (n = 4209). From this sample, 573 subjects were recruited. More females (63%) than males (37%) were recruited.The study attracted a greater proportion of ‘obese’ older adults (27%) relative to state averages. 2. Over the intervention period there was a significant increase in participants’ total physical activity of 2.25 hours per week (p >.001). The General Estimating Equation analysis confirmed significant increase in physical activity from baseline to midpoint (p=.002) and to post intervention (p=.0031). Perceptions of financial struggle (p=.020) were positively correlated with physical activity time spent by participants, whereas having friends or acquaintances living nearby (p=.037) had a significant negative correlation with physical activity time. 3. At the end of the intervention, 32% of the intervention group and 25% of the control group had dropped out, resulting in an overall drop out rate of 28%. Most of the attrition occurred in the first 3 months (77%). Characteristics of individuals lost to attrition (n=86, 35%) were compared with program completers (n=162, 65%). Logistic regression analysis showed that those lost to attrition came from areas of lower socio-economic status, were overweight, were less physically active, and had a lower walking self-efficacy score and a higher loneliness score. The results suggest that to improve retention and to avoid potential bias, early assessment of these characteristics should be undertaken to identify individuals at risk of attrition. 4. Based on the finding of this research, future intervention studies should consider: the role of tertiary students as a skilled resource; the use of volunteers to contain costs; the importance of a tailored program; the appropriateness of walking as a form of physical activity for this age group; the enjoyment associated with a walking group; and the usefulness of social support.This practical program is potentially effective and sustainable for mobilizing physically inactive older people. 5. Qualitative research highlighted the need for older adults to receive more specific information on: the benefits of physical activity; the role of pain management in physical activity; and the concept that involvement in physical activity in younger years leads to involvement when older. The older adults also expressed a desire to engage in less age appropriate activities. These results suggest that the intervention was successful in recruiting older adults into and retaining them in the intervention, documenting a need for early identification of individuals at risk of attrition. The program significantly increased the participants’ weekly mean time for physical activity and identified factors that affect their commitment to physical activity programs. This program was practical and could be used as a model for physical activity programs aimed at older adults

Social Cognitive Theories and Electronic Health Design: Scoping Review

Background: There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. Objective: This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. Methods: The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. Results: Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). Conclusions: This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution

Education programs for Indigenous Australians about sexually transmitted infections and bloodborne viruses

As a group, Indigenous Australians experience poorer health outcomes than other Australians, including in the area of sexual health. Indigenous Australians have substantially higher rates of STIs, BBVs and teen pregnancy than non-Indigenous Australians, particularly for chlamydia, gonorrhoea, infectious syphilis, hepatitis B and hepatitis C. Efforts to reduce these high rates are compounded by the historical and social context of Indigenous Australians. Although many Australians may experience elements of shame and embarrassment when they access health services for STIs and BBVs, for many Indigenous Australians there also exists a mistrust of ‘mainstream’ (non-Indigenous specific) health services as a result of past injustices and racially differentiated treatment (Arabena 2006). Historically, Indigenous Australians diagnosed with an STI were segregated and placed into privately run hospitals (‘lock hospitals’) that were in poor condition (Hunter 1998)

Final Tanzania mixed methods evaluation report

e-PactThis final mixed methods report forms part of the external impact evaluation of mNutrition in Tanzania. The evaluation was conducted by a consortium of researchers from Gamos, the Institute of Development Studies (IDS) and the International Food Policy Research Institute (IFPRI) between 2016 and 2020. Mnutrition was a global initiative supported by DFID, organised by GSMA, and implemented by in-country mobile network operators (MNOs) and other providers to use mobile technology to improve the health and nutritional status of children and adults in low-income countries. In Tanzania, mNutrition was implemented through the ‘Healthy Pregnancy, Healthy Baby’ (HPHB) SMS (text messaging) programme, which is part of the Wazazi Nipendeni mHealth platform. The programme was run by the mHealth Tanzania-PPP initiated by the Ministry of Health and Social Welfare, with financial support from the US Government’s Centers for Disease Control and Prevention (CDC). Wazazi Nipendeni is targeted at pregnant women and mothers of young children, as well as their partners (husbands, etc.). It is available nationally on all phone networks. The HPHB SMS service sends free text messages in Swahili on a range of pregnancy and early childhood issues. Nutrition was a small component of the original HPHB SMS service but was extended substantially with the addition of the mNutrition content. This report summarises the final findings of the mNutrition evaluation in Tanzania drawn from across the three interlinked evaluation components (quantitative, qualitative and business model) and structured around the key overarching evaluation questions. For more details on the technical and methodological aspects of the evaluation please refer to the separate methods-specific technical reports

Lightening the Load: A Look at Four Ways That Community Schools Can Support Effective Teaching

Describes how healthcare, family involvement, and expanded food assistance programs at high-poverty community schools enhance teacher effectiveness by enabling them to focus on instruction in stable environments. Recommends policies to maximize benefits

Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review

Aim: Adolescents in low-and-middle-income countries (LMICs) are facing numerous developmental, sexual and reproductive health (SRH) challenges including exposure to multidimensional violence. Gender-based violence (GBV) specifically intimate partner violence (IPV) are both highly prevalent in LMICs and are strongly linked with poor SRH outcomes. However, GBV and IPV interventions have not yet been adequately integrated in SRH due to individual, social, cultural, service, and resource barriers. To promote long-term SRH, a more holistic approach that integrates GBV and IPV, and adolescent development needs is imperative. Digital health has the potential to address multiple service setup, provision, and addressing access barriers through designing and providing integrated SRH care. However, there are no guidelines for an integrated digital SRH and development promotion for adolescents in LMICs. Methods: An umbrella review was conducted to synthesize evidence in three inter-related areas of digital health intervention literature: (i) SRH, (ii) GBV specifically IPV as a subset, and (iii) adolescent development and health promotion. We first synthesize findings for each area of research, then further analyze the implications and opportunities to inform approaches to develop an integrated intervention that can holistically address multiple SRH needs of adolescents in LMICs. Articles published in English, between 2010 and 2020, and from PubMed were included. Results: Seventeen review articles met our review inclusion criterion. Our primary finding is that application of digital health strategies for adolescent SRH promotion is highly feasible and acceptable. Although effectiveness evidence is insufficient to make strong recommendations for interventions and best practices suggestions, some user-centered design guidelines have been proposed for web-based health information and health application design for adolescent use. Additionally, several digital health strategies have also been identified that can be used to further develop integrated GBV-IPV-SRH-informed services to improve adolescent health outcomes. We generated several recommendations and strategies to guide future digital based SRH promotion research from our review. Conclusions: Rigorous research that focuses on intervention effectiveness testing using a combination of digital health strategies and standardized albeit contextualized outcome measures would be important. Methodological improvement such as adoption of longitudinal experimental design will be crucial in generating evidence-based intervention and practice guidelines for adolescents in LMICs. Keywords: Gender-based violence, Intimate partner violence, Sexual and reproductive health, Low-and-middle - income countries, mHealth, Digital health, Adolescents Development, Revie

Injury

Background:Kenya\u2019s estimated road traffic injury (RTI) death rate is 27.8/100,000 population, which is 1.5 times the global rate. Some RTI data are collected in Kenya; however, a systematic and integrated surveillance system does not exist. Therefore, we adopted and modified the World Health Organization\u2019s injury surveillance guidelines to pilot a hospital-based RTI surveillance system in Nairobi County, Kenya.Methods:We prospectively documented all RTI cases presenting at two public trauma hospitals in Nairobi County from October 2018\u2013April 2019. RTI cases were defined as injuries involving 651 moving vehicles on public roads. Demographics, injury circumstances, and outcome information were collected using standardized case report forms. The Kampala Trauma Score (KTS) was used to assess injury severity. RTI cases were characterized with descriptive statistics.Results:Of the 1,840 RTI cases reported during the seven-month period, 73.2% were male. The median age was 29.8 years (range 1\u201389 years). Forty percent (n = 740) were taken to the hospital by bystanders. Median time for hospital arrival was 77 min. Pedestrians constituted 54.1% (n = 995) of cases. Of 400 motorcyclists, 48.0% lacked helmets. Similarly, 65.7% of bicyclists (23/35) lacked helmets. Among 386 motor vehicle occupants, 59.6% were not using seat belts (19.9% unknown). Seven percent of cases (n = 129) reported alcohol use (49.0% unknown), and 8.8% (n = 161) reported mobile phone use (59.7% unknown). Eleven percent of cases (n = 199) were severely injured (KTS <11), and 220 died.Conclusion:We demonstrated feasibility of a hospital-based RTI surveillance system in Nairobi County. Integrating information from crash scenes and hospitals can guide prevention.CC999999/ImCDC/Intramural CDC HHSUnited States