Adding value to outpatient heart failure services and the patient journey through digital transformation of services

Introduction Heart failure (HF) is a chronic condition affecting over 900,000 people in the UK. The management of patients with HF frequently involves regular face-to-face appointments. Digital transformation of care with telemedicine, remote monitoring and mobile applications (Apps) may help improve patient experience and relieve demand on services. The Covid-19 pandemic resulted in an acceleration in telemedicine. This thesis evaluates pre-pandemic HF services at the Royal Brompton Hospital (RBH), identifying potential areas for improving patient journeys. Methods Retrospective cohort studies including over 200 patients were used to analyse the activities and actions resulting from HF clinic appointments over 3 years. Time-and-motion studies were conducted for each of the 4 consultant-led HF clinics at RBH, where flow through hospital was analysed for 58 patients. Eight clinicians and 8 patients who had undergone telemedicine consultations were interviewed about their experiences and perceptions, with narrative data thematically analysed. Focus groups and existing educational material were used to design an educational App for HF. Results Most HF patients under long-term follow-up were followed up twice yearly. At clinic visit, worsening HF symptoms and therapy change by clinicians were uncommon (21% and 36% of appointments respectively). Patients spent a median of 103 minutes in hospital on the day of an appointment for a median 20-minute consultation. The majority of consultations ran late. Clinicians and patients found telemedicine consultations generally acceptable, but both groups identified changes in time utilisation, clinical assessment, communication, and technology. Telemedicine appointments were shorter and involved less time waiting and travelling for patients. Patients and clinicians agreed that when patients are “stable”, telemedicine is preferred. A prototype HF educational “Avatar”-based App was produced. Conclusion Digital transformation of outpatient services, including telemedicine can improve patient and clinician experience, efficiency and rationalise limited resources, thus adding value to outpatient HF care.Open Acces

Raging Pandemics and Taming Epidemics: The Role of Behaviour Change Communication in India’s Polio Eradication

This article, drawing upon the author’s past research and scholarly writings on communication strategies to prevent, contain, and mitigate pandemics and epidemics, including HIV/AIDS, analyses India’s march towards polio eradication, focusing on the relentless implementation of its macro and micro-level social and behavioural change communication strategies. It discusses the micro-targeting and messaging interventions to achieve largescale vaccine adherence and behaviour compliance, especially in the states of Uttar Pradesh and Bihar—the last sanctuaries for polio in India. It also analyses how India eradicated polio with relentless social mobilisation, involvement and engagement of local opinion leaders, and an adaptive data-driven strategy. No country, at any time, has utilised the art and science of social and behavioural communication for a greater public good as India did to wipe out polio. This article represents a modest attempt to analyse the communication-centric elements, focusing on the interpersonal and ground-based elements of the polio communication strategy, that contributed to this public health triumph of epic proportions, and represents India’s gift to the world.publishedVersio

“Picking our Oysters” and “Swimming with our Whales”: How innovative tourism practices may engender sustainable development

n an unfolding scenario of environmental gloom and doom where humans have become the key disruptors and exploiters of nature, our article presents an optimistic and hopeful approach to how humans may interact with nature on nature’s premises—with reverence. To illustrate this communicative praxis, we carry out cross-case analyses of two real-life scenarios that we label “picking our oysters” and “swimming with our whales,” revealing how human beings interacting with others and nature through locally situated tourism interventions can spark cascading interactional effects into yet newer and expanding communities of caring for nature. When such happens, we contend that it represents the kind of sustainable development that the world badly needs, especially in the present perilous times. We contend that the insights emerging from our cross-case analyses have wide-ranging implications for both scholars and practitioners of tourism and communication—that is, collaborative local interactions, actions, and interventions can cascade into emergent and resilient sustainable development practices.publishedVersio

The Basic Course as Social Change

Working as an agent of social change calls for perseverance and determination. In our work as, and with, change agents all over the world we have seen many well-meaning people working to serve populations that are often hopeless about the future, demoralized, and/or seeking quick solutions that may not address the real issues or causes of problems. At our university we often see similar characteristics in students enrolled in the basic course. That population can be similarly hopeless about the future (at least in the course), de-motivated, and dreaming of escape through the attainment of a passing grade via the path of least resistance. When the first author compares his previous work as a “change agent” in a Balkan country with his present teaching of the basic course, he realizes that the two have much in common. In many important ways, the basic course is social change

Flipping the Diffusion of Innovations Paradigm: Embracing the Positive Deviance Approach to Social Change

The classical diffusion of the innovations paradigm has faced criticism for reifying outside-in, expert-driven approaches to solving problems and for overlooking and rejecting local solutions. In this article, we argue that diffusion scholars should pay more attention to approaches such as positive deviance (PD) that enable communities to discover the wisdom they already have and then to act on it. PD is an asset-based approach that identifies what is going right in a community to amplify it, as opposed to focusing on what is going wrong in a community and fixing it with outside expertise. In the PD approach, the change is led by internal change agents who, with access to no special resources, present the social behavioural proof to their peers that problems can be solved. Given that the solutions are generated locally, they are more likely to sustain and be owned by potential adopters.acceptedVersio

Creative Content and Inclusive Classrooms to Transform Student Learning: Liberating Structures for Mathematics Educators

This article describes how K-12 teachers may significantly improve student learning, engagement, and retention of mathematical concepts by creatively designing their course content around real-world problems, and employing Liberating Structures (LS)—simple protocols to organize classrooms through different spatial arrangements, group configurations, distribution of participation, and sequencing of steps. LS-inspired classrooms allow for equitable student participation, peer-learning, and building of connections, trust, and immediacy. The teacher assumes the role of facilitator—a partner in discovering solutions

Using television drama as entertainment-education to tackle domestic violence in China

Don’t Respond to Strangers (DRTS) is the first and to date the only television drama in China that was intentionally produced to raise public consciousness about the insidious nature of domestic violence, to contribute to its elimination, and to protect and uphold the rights of women. Under the overarching framework of entertainment-education, we utilised the protection motivation theory to carry out a systematic three-part mixed-methods evaluation of DRTS. Study 1 was a qualitative content analysis of how domestic violence was portrayed in all 23 episodes of DRTS, identifying themes and scenes that could influence viewers’ threat and coping appraisal of domestic violence. In Study 2, a quantitative content analysis of 1,848 viewer posts spread over an eight-year period was carried out on DRTS’ online forum, ascertaining how they reflected the viewers’ threat and coping appraisal about domestic violence. Study 3 was an on-line survey with Chinese nationals (N=326) that tested how their threat and coping appraisal with respect to domestic violence influenced the relationships between programme exposure and three behavioural intention outcomes—i.e., victim coping, bystander intervention, and policy support. Our triangulated results suggested that, overall, DRTS was highly effective in using fear appeals to get the public’s attention on domestic violence, spur public discussions on the topic, and foster a favorable policy climate—one that culminated in 2015 in the passage of anti-domestic violence legislation.publishedVersio

Evaluation of anti-inflammatory activity of docosahexaenoic acid on carrageenan induced paw oedema in rats

Background: Inflammation is a tissue reaction to infection, irritation of foreign substance. It is a part of the host defence mechanism but if in excess it becomes harmful. Docosahexaenoic acid (DHA) is omega-3-derivative of alpha-linolenic acid. This study was conducted to determine the anti-inflammatory activity of DHA and its comparison with standard drug diclofenac.Methods: The study was carried out by using inflammatory models in male albino rats. Rats were divided into 4 groups of 6 animals of each. The anti-inflammatory activity was studied with carrageenan induced rat paw edema.  The anti-inflammatory activity of DHA was compared with standard drug diclofenac. The study parameters for acute inflammation was assessment of reduction in inflammation and the percentage inhibition of the paw edema.Results: DHA 200 mg/kg, DHA 300 mg/kg, and diclofenac 10 mg/kg showed 58%, 64%, and 67% reduction in paw volume, respectively. The DHA showed significant (p<0.05) anti-inflammatory activity in both dosages as compared to control and was dose dependent.Conclusions: DHA produced dose dependent anti-inflammatory activity which suggest its probable use in the treatment of inflammation

East Los High: Transmedia edutainment to promote the sexual and reproductive health of young Latina/o Americans

Latina/o Americans are at high risk for sexually transmitted infections and teen pregnancies. Needed urgently are innovative health promotion approaches that are engaging and culturally sensitive. East Los High, a transmedia edutainment program, was purposefully designed to embed educational messages in entertainment narratives across several digital platforms to promote sexual and reproductive health among Young Latina/o Americans. By employing analytics tracking, a viewer survey, and a lab experiment, we found that East Los High had a wide audience reach, strong audience engagement and, in general, a positive cognitive, emotional, and social impact on sexual and reproductive health communication and education. Culturally-sensitive transmedia edutainment programs represent a promising health promotion strategy for minority populations and warrant further investigation and validation

Social media fandom for health promotion? Insights from East Los High, a transmedia edutainment initiative

As digital media technologies proliferate and social media spaces expand, how does one leverage popularity and cultivate fandom to promote health? Despite the easy entry, broad reach, and interactive features of social media such as Facebook and Twitter, health promoters are unsure how to meaningfully engage users and build lasting online communities. In this article, we examined the Facebook Insights and Twitter hashtag network over a nine-month period for Season 1 of the exemplary transmedia edutainment show East Los High. Premiered on Hulu, the popular entertainment streaming site, East Los High was purposefully designed to serve Latino youths in the United States, spurring conversations and promoting healthy relationships and safe sex practices across different digital platforms. We used Facebook analytics to gauge the audience reach, engagement, and dissemination; developed a 10-indicator index to identify the most successful among the 352 Facebook posts; analysed the position of East Los High in the Facebook co-commenting network; and assessed the top word pairs from those Facebook comments in accordance with the show’s social objectives. We also studied the underlying structure of the Twitter hashtag network representing the interactions between @EastLosHighShow and its 2,136 followers with tweets that included #ELH, #ELHaddict(s), and/or #EastLosHigh. While challenges exist in initiating and maintaining user engagement on these social media platforms, our findings revealed effective and actionable strategies for health promotion by cultivating fandom and building communities on social media.publishedVersio