Using a knowledge-based approach: the way healthy communities make decisions

The planning for Knowledge Cities faces significant challenges due to the lack of effective information tools. These challenges are magnified while planning healthy communities. The Australian Health Information Council (AHIC) concluded in its last report that health information needs to be shared more effectively (AHIC, 2008). Some research justifies the use of Decision Support Systems (DSS) as an E-planning tool, particularly in the context of healthy communities. However, very limited research has been conducted in this area to date, especially in terms of evaluating the impact of these tools on decision-makers within the health planning practice. The paper presents the methodological instruments which were developed to measure the impact of the E-planning tool (i.e., Health Decision Support System [HDSS])) on a group of health planners, namely, the Logan Beaudesert Health Coalition (LBHC). The paper is focused on the culture in which decisions were made before and after the intervention of the HDSS. Subsequently, the paper presents the observed impact of the HDSS tool, to facilitate a knowledge-based decision-making approach. This study is an attempt to make some contribution to the Knowledge Cities literature in the context of planning healthy communities by adopting E-planning tools

Building Healthier Communities: Value Co-Creation within the Chronic Care Model for Rural Under-Resourced Areas

Chronic disease is a worldwide epidemic that disproportionately affects low- to middle-income countries and regions [1]. The Chronic Care Model (CCM) is intended to address the significant societal costs and health burdens of chronic disease through redesign of the health care system and has raised awareness of the need for integration of clinical services and public health resources. To complement this descriptive, a-theoretical framework, we develop a theory-driven research model rooted in service-dominant logic (S-D logic). Our model conceptualizes improved chronic disease health outcomes as co-created value and focuses on triadic actor-to-actor-to actor (patients, family/friends and health care providers) resource integration and service exchange. We illustrate the model’s utility for policy and intervention design and for research on diabetes self-management programs in low-income, rural communities, in which patients’ social capital resources can be integrated with health IT and healthcare expertise in CCM program design.

Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: An interview study

Objective To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Design Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. Setting 21 haemodialysis centres across Australia. Participants 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. Results Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). Conclusions Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient-clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis

Development of IT-enabled Chronic Care Management for the Medically Underserved: A Contextualist Framework

While efforts to address the management of chronic diseases in the context of large, urban hospitals are underway, the literature is silent on how to facilitate such efforts in the community clinics that provide services to many chronic-care patients who are medically underserved. We offer a contextualist framework for developing IT-enabled chronic care management in community clinics. To understand and support the required collaboration between diverse stakeholders located across institutional boundaries, the framework adapts Pettigrew’s Contextual Inquiry as the overarching analytical lens. The framework focuses on the context of community clinics, including patients, clinicians, administrators, technology providers, and institutional partnerships; it considers the content of developing IT-support based on the Chronic Care Model, and, as basis for the development process, it adapts Holtzblatt and Beyer’s Contextual Design principles. We demonstrate the workings of the framework through a case study of how IT-enabled support for chronic care management was designed and implemented into a community clinic in the Southeast U.S. over a three-year period, and, finally, we discuss its theoretical and practical implications in relation to extant literature

The Global Burden and Perspectives on Non-Communicable Diseases (NCDs) and the Prevention, Data Availability and Systems Approach of NCDs in Low-resource Countries

The burden of non-communicable diseases (NCDs) is growing swiftly in low-resourced countries resulting in deleterious health resembling the NCDs burden in high-resourced countries. Despite the availability of information on the escalating adverse economic and health effects of NCDs globally, specific strategies designed to address the growing burden of NCDs in low-resourced countries remain substandard. Research engines like EBSCOhost, Science Citation Index, CINAHL database, PsycINFO, Cochrane Database of Systematic Reviews, published and unpublished abstracts and a hand search of reference lists and table of contents of relevant journals and books were searched from January 2011 to June 2019. In total, 84 studies met the inclusion criteria. Most studies confirm that low-resourced countries compared with high-resourced countries battle to implement NCDs prevention strategies; fail to record data on the risk factors of NCDs; medical records and surveillance data are unavailable. Due to a lack of knowledge and skill, low-resourced countries show no urgency to implement a systems approach for NCDs management. The findings confirm disparities between high-resourced and low-resourced countries regarding NCDs prevention, availability of quality data, and strategies to prevent and manage NCDs through a systems approach that can assist healthcare institutions in reducing the damaging effect of NCDs globally

Mobile phone use among patients and health workers to enhance primary healthcare : a qualitative study in rural South Africa

Mobile phones have the potential to improve access to healthcare information and services in low-resourced settings. This study investigated the use of mobile phones among patients with chronic diseases, pregnant women, and health workers to enhance primary healthcare in rural South Africa. Qualitative research was undertaken in Mpumalanga in 2014. Semi structured in-depth interviews were conducted with 113 patients and 43 health workers from seven primary healthcare clinics and one district hospital. Data were thematically analysed. We found that some health workers and patients used their own mobile phones for healthcare, bearing the cost themselves. Patients used their mobile phones to remind themselves to take medication or attend their clinic visits, and they appreciated receiving voice call reminders. Some patients and health workers accessed websites and used social media to gather health information, but lacked web search strategies. The use of the websites and social media was intermittent due to lack of financial ability to afford airtime among these patients and health workers. Many did not know what to search for and where to search. Doctors have developed their own informal mobile health solutions in response to their work needs and lack of resources due to their rurality. Physical and social factors influence the usability of mobile phones for healthcare, and this can shape communication patterns such as poor eyesight. The bottom-up use of mobile phones has been evolving to fill the gaps to augment primary care services in South Africa; however, barriers to access remain, such as poor digital infrastructure and low digital literacy

Framework for better living with HIV in England

1 Introduction and overview 1.1 The goal, purpose and scope of the framework This framework is the first of its kind in the UK. It describes the shared aspirations of a group of agencies for the lives of people diagnosed with HIV in England. The overarching goal of the framework is: All people with HIV are enabled to have the maximum level of health, well-being, quality of life and social integration. This is no less than the majority of people in the country expect for themselves. However, numerous obstacles prevent people with HIV from achieving this goal. These obstacles are not about having the virus but about how people with the virus are treated. This overarching goal is the situation we want to bring about. We detail this goal in seventeen subsidiary goals (what we want to happen). Each of these has a number of related aims and target groups (what we want individuals and groups to do to bring about the goal). The framework starts with the individual and seeks to bring about the conditions most favourable to individual self-determination and self-empowerment. The purpose of the framework is to: • Promote and protect the rights and well-being of all people with HIV in England. • Maximise the capacity of individuals and groups of people with HIV to care for, advocate and represent themselves effectively. • Improve and protect access to appropriate, effective and sufficient information, social support and social care services. • Minimise social, economic, governmental and judicial change detrimental to the rights and well-being of people with HIV. • Build consensus among those with a responsibility for promoting the well-being and rights of people with HIV. • Provide benchmarks against which the activities of a range of key stakeholders can be assessed, critiqued and coordinated. The framework does not describe all the activities of the organisations represented in the Framework Development Group (see section 1.4). Nor can these organisations undertake all the interventions necessary within the framework. Rather, the framework seeks to mobilise and coordinate the actions of a broad range of individuals and groups, from people with HIV themselves to government ministers. The framework primarily seeks to benefit people with diagnosed HIV infection. It is concerned with the health and well-being of those diagnosed with HIV and not those with undiagnosed HIV or those who might become infected (HIV prevention).As we are concerned with the lives of people with HIV after diagnosis, this framework is not focused on increasing HIV testing or HIV diagnosis nor does it attend to the needs of the broader population affected by HIV except where they relate to people with diagnosed HIV

New research directions on disparities in obesity and type 2 diabetes

Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and lowâ income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scalingâ up successful interventions and reaching atâ risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.This report discusses a workshop convened by the National Institutes of Health to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154507/1/nyas14270_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154507/2/nyas14270.pd

The Role of the Health Care Sector in Expanding Economic Opportunity

This report provides an overview and critical assessment of the ways in which multinational pharmaceutical companies currently participate in expanding economic opportunities in developing countries. As pharmaceutical companies become more involved in both business and philanthropic activities in developing countries, it will be important for each company to identify the best strategies available to it to create new economic opportunities and to leverage the benefits of activities already underway. While the primary focus of the industry is, and will most likely continue to be, on increasing access to health care, the potential for expanding economic opportunities through its activities should not be overlooked as a significant outcome. The analysis and case studies contained in the report highlight companies' contributions to economic opportunity expansion through job creation, training and capacity building, and shaping public policy. The report also offers recommendations for future work to increase economic opportunities. This paper is part of the Economic Opportunity Series published by the CSR Initiative at Harvard University Kennedy School