Built environment assessment: Multidisciplinary perspectives.

Context:As obesity has become increasingly widespread, scientists seek better ways to assess and modify built and social environments to positively impact health. The applicable methods and concepts draw on multiple disciplines and require collaboration and cross-learning. This paper describes the results of an expert team׳s analysis of how key disciplinary perspectives contribute to environmental context-based assessment related to obesity, identifies gaps, and suggests opportunities to encourage effective advances in this arena. Evidence acquisition:A team of experts representing diverse disciplines convened in 2013 to discuss the contributions of their respective disciplines to assessing built environments relevant to obesity prevention. The disciplines include urban planning, public health nutrition, exercise science, physical activity research, public health and epidemiology, behavioral and social sciences, and economics. Each expert identified key concepts and measures from their discipline, and applications to built environment assessment and action. A selective review of published literature and internet-based information was conducted in 2013 and 2014. Evidence synthesis:The key points that are highlighted in this article were identified in 2014-2015 through discussion, debate and consensus-building among the team of experts. Results focus on the various disciplines׳ perspectives and tools, recommendations, progress and gaps. Conclusions:There has been significant progress in collaboration across key disciplines that contribute to studies of built environments and obesity, but important gaps remain. Using lessons from interprofessional education and team science, along with appreciation of and attention to other disciplines׳ contributions, can promote more effective cross-disciplinary collaboration in obesity prevention

Development and validation of a brief screener to measure the Health Literacy Responsiveness of Primary Care Practices (HLPC)

Background: The evolving approach of health literate health care organizations (HLHO) receives considerable support from health policy makers. Up to now, there are no performance measures available to assess the application of health literacy strategies by health care professionals in the primary care setting. This paper describes the development and validation of the Health Literate Primary Care Practice screener (HLPC). The screener can be used as a self-assessment tool for primary care organizations (PCO) that aim to elucidate the health literacy responsiveness of their organization. Methods: The HLPC is a 4-item screener developed in a multi-level process following a theory-driven approach including a literature review, consultations with scientists and cognitive tests with patients in PCO. The screener was applied in a national random sample of N = 1125 adults living in Germany. Item and psychometric properties were analyzed by determining item discrimination and reliability as well as performing a confirmatory factor analysis (CFA) to test the instruments unidimensionality. Criterion validity was investigated by performing bivariate correlations between the HLPC score and heath care quality measures. Results: The HLPC scale demonstrated good item discrimination and internal consistency (a = 0.86). CFA verified a one-factor structure of the scale and analysis on the criterion validity revealed a significant correlation between the HLPC score and patients satisfaction with the general practitioner, accessibility of the PCO and support in care-coordination received in the PCO. Conclusions: The HLPC is a valid screener to provide insights in the extent of the utilization of health literacy strategies in primary care practices

Developing and evaluating a smartphone application for tuberculosis amongst private sector academic clinicians in India

Contexte : La tuberculose est la première cause de mortalité au monde et parmi les 10,4 millions de cas de tuberculose par année, 2,8 millions proviennent de l’Inde. De ce fait, il est considéré comme le pays ayant le plus haut taux d’incidence de la tuberculose au monde. Une manque de qualité des soins est une cause majeure pour l’épidémie de la tuberculose en Inde. Le secteur privé, qui n’est pas réglementé, prend soin de 50% des patients ayant la tuberculose. Des études précédentes indiquent le mauvais diagnostic ou le mauvais traitement comme des facteurs qui sont présents dans le secteur privé. Ce secteur comprend plusieurs types de médecins, dont ceux qui ont un diplôme en médecine et ceux qui n’ont pas de diplôme en médecine mais pratiquent la médicine. Une amélioration dans l’éducation des cliniciens utilisant les technologies mobiles, dont les applications mobiles, pourrait être une solution pour améliorer et assurer la qualité des soins des patients ayant la tuberculose. Toutefois, il existe peu d’études sur les technologies mobiles pour la tuberculose en Inde. Objectifs : Ce mémoire vise à évaluer l’expérience de l’usager et l’acceptabilité d’une application mobile (LearnTB) parmi les cliniciens académiques du secteur privé en Inde. Méthodes: L’étude a utilisé une approche à deux étapes. Cinq cliniciens (étape 1) et 101 cliniciens (étape 2) ont été contactés à Kasturba Hospital Manipal, Manipal, Inde entre février et mars 2017. L’expérience des participants était évaluée par le System Usability Scale. L’acceptabilité était évaluée par un questionnaire adopté du Technology Assessment Model. Les résultats étaient analysés à l’aide des statistiques descriptives, la régression linéaire multiple ainsi que la régression logistique. Résultats : Des taux de réponse de 100% et 99% ont été obtenus pour la première et deuxième partie respectivement. L’expérience de l’usager était vraiment positive. En ce qui concerne l’acceptabilité, une analyse de cheminement a confirmé la relation directe entre l’utilité perçue et l’intention d’utilisation, et la relation indirecte entre la facilité d’utilisation perçue et l’intention d’utilisation. La régression logistique a permis de cibler les items qui influencent fortement l’intention d’utilisation. Conclusion : L’expérience de l’usager pour LearnTB était vraiment positive, et l’utilité perçue a le plus grand impact sur l’intention d’utilisation (acceptabilité). Cette étude permet d’avoir une analyse préliminaire de l’acceptabilité des cliniciens concernant les technologies mobiles pour la tuberculose en Inde. D’autres recherches dans ce domaine sont requises afin d’assurer l’implantation optimale de ces technologies.Background: Tuberculosis (TB) is the leading infectious killer, and India accounts for 2.8 of the 10.4 million TB cases that occur each year, making it the highest TB burden country worldwide. Poor quality of TB care is a major driver of the epidemic in India. India’s large private, unregulated health sector manages over 50% of the TB patients, with studies showing suboptimal diagnosis and treatment in the private sector. This sector comprises of health professionals who are medically trained, and those who are not medically trained but are practicing medicine. Better education of doctors using mobile health (mHealth) applications is a possible solution. However, little is known about mHealth around TB in India. Objective: This masters thesis aimed to evaluate the user experience and acceptability of a smartphone application for TB (LearnTB) amongst private sector academic clinicians in India. Methods: This study adopted a two part approach. Five clinicians (part 1) and 101 clinicians (part 2) were contacted at Kasturba Hospital Manipal, Manipal, India between February and March 2017. The user experience of participants (part 1) was evaluated based on the System Usability Scale (SUS). Acceptability (part 2) was evaluated based on the Technology Acceptance Model (TAM). Data were analyzed using descriptive statistics, multiple linear regression as well as logistic regression analysis. Results: Response rates of 100% and 99% were achieved for part 1 and part 2, respectively. User experience was very positive. Regarding acceptability, a path analysis confirmed the direct relationship between perceived usefulness and intention to use, and the indirect relationship between perceived ease of use and intention to use. Logistic regression analysis helped target items strongly influencing intention to use. Conclusion: The user experience with LearnTB was very positive, and perceived usefulness has the highest impact on intention to use (acceptability). This study provides a preliminary analysis of mHealth interventions for TB in India, and emphasizes the need for future research in this domain

Improving Urban Accessibility: A Methodology for Urban Dynamics Analysis in Smart, Sustainable and Inclusive Cities

Despite the improvisations of current urban accessibility regulations and their application in urban systems, it is a fact that our cities are not accessible. Both, the assessment of the effectiveness of urban accessibility and its maintenance over time are issues that require a more consistent approach. In order to address these aspects, it is necessary to have an accurate awareness of the existing condition of urban accessibility. Therefore, the way this information is transformed into specific data, which must be collected, stored and assessed, is one of the main challenges that smart cities face. This research helps implement an integrated system for urban accessibility analysis, combining the latest advances in the Information and Communication Technologies, such as RF & GPS positioning, smart sensing and cloud computing. The main goal of this research is to develop a reliable and effective method to assess public space accessibility with special focus on people with disabilities, by eliciting from users personal experiences. Consequently, the data obtained will enable a better design for improving pedestrian mobility. As a result, a computational architecture for urban dynamics analysis has been designed. Finally, technology and data processing have been validated as an effective system for data collection, and, as a first approach to users’ real experience, it has been proposed to have a testing scenario at the University of Alicante