Implementing a web-based application for men’s health screening in a primary care setting during the Covid-19 pandemic: a mixed-methods pilot study

Men’s use of health screening remains low globally. This was more evident during the Covid-19 pandemic as most non-urgent services in the clinic were halted, including health screening. Technology can be used to overcome barriers to screening by improving accessibility, motivating and reminding individuals to get screened. ScreenMen is a web-based application that was developed to increase the uptake of men's health screening. This study was a process evaluation of the implementation of ScreenMen in a primary care setting. This study was conducted in a government health clinic using a mixed-method explanatory sequential design driven by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. We used a tailored intervention including: mandate change, provide education and training, identify and prepare champions, use of information and communication technology, and audit and provide feedback. Participants were staff and patients. We used Google Analytics to monitor patient uptake of ScreenMen for 5 months and conducted staff interviews to understand the implementation process. We used template analysis based on the RE-AIM framework. A total of 75 patients accessed the app. Access was higher as implementation started but subsequently dropped, and increased again towards the end of the period. The majority (51%) of patients accessed the app through QR codes. In qualitative analysis we found that access was lower than expected because of decreased patients in the clinic during the pandemic. The later increase in access was related to champion activity. Bunting promotes access due to its size and strategic placement. Staff found that mandated change was not useful as an implementation strategy. Making patients access the app in the clinic and using bunting were reported to be effective in implementing ScreenMen while mandate change was found to be least helpful

Prevalence And Factors Associated With Internet Addiction Among Adolescents In Malaysia

Aims / Background: Internet addiction (IA) among adolescents has become an important health problem as it is associated with many negative consequences if not prevented early. The adolescence is a vulnerable subgroup as they are digital natives with wide exposure to the internet and are at high risk of initiation of addictive behaviour. Therefore, early detection of IA in this subgroup is important for early intervention. The objective of this study was to determine the prevalence and factors associated with IA among adolescents in the primary care setting in Malaysia. Methodology: This was a cross-sectional study done among adolescents aged 10 to 19 years of age in 15 primary care clinics throughout Malaysia using the validated Malay version of Internet Addiction Test (IAT). Sampling was done using systematic random sampling method. IA is defined as IAT score test of more or equal to 43 points. Respondents that score less than 43 points are classified as non-internet addicts. Results: A total of 921 participants were included in this study. The male population was 49.5% (n=456) with mean age of 16.38±2.38 years. The prevalence of IA was 56.4% (n=519). The significant predictors of IA were age (p < 0.001;CI 1.09-1.29), mother’s high education level (p = 0.001;CI 1.61-5.99) and having a smartphone (p = 0.012;CI 1.23-5.25). Conclusion: This study showed that there is a high prevalence of IA among adolescents in Malaysia

How to disseminate a health screening mobile app to men? A qualitative study

Background: Mobile health is increasingly being used to improve healthcare. There is a potential of using health-related mobile apps to reach out to “difficult to reach” populations, including young working men, to improve their health, particularly in health screening. However, few studies have been done on how to implement a health screening mobile app from the perspective of men. The aim of this study was to explore men's preferred strategies on how a mobile app can be disseminated to them. It was part of a bigger study to develop, evaluate and implement a mobile app to increase the uptake of screening in men. Methods: We conducted in-depth interviews and focus group discussions with 31 men from a banking institution in Kuala Lumpur, the capital city of Malaysia in 2015. The participants were purposively sampled according to their job position, age, ethnicity and screening status. We stopped the recruitment once data saturation was achieved. The audio-recorded interviews were transcribed verbatim and thematic approach was used for analysis. Findings: Men proposed a range of dissemination strategies that they preferred including: mass media (television and radio), printed media (banners and men’s magazines), online platforms (website, social media and emails), health events and recommendations from doctors and friends. The most often cited dissemination strategies were online platforms and mass media. Facebook was highlighted by participants because most participants have a Facebook account thus enabling the mobile app to reach them through the platform. WhatsApp was also mentioned as it enabled users to easily send ‘links’ of the mobile app to other users, thus facilitating the dissemination of the app. Television and radio was also cited as a facilitator to the dissemination of the mobile app as most men had access to these media. Implications for D&I Research: This study highlighted that, for men, social media platforms and mass media were important strategies to disseminate the mobile app because these two platforms were very much part of everyday life of men in this region. These two strategies should be considered when disseminating health screening mobile app to men

Knowledge and practice of colorectal cancer screening in an urban setting : cross-sectional survey of primary care physicians in government clinics in Malaysia.

INTRODUCTION: Colorectal cancer (CRC) was the third most commonly diagnosed cancer worldwide in 2008 (1.23 million cases, 9.7%). CRC screening was shown to be effective in reducing 70% of CRC mortality. However, the screening rate for CRC remains poor. METHODS: A cross-sectional survey was conducted among primary care physicians (PCPs) in public primary care clinics in Kuala Lumpur, Malaysia. A 30-item self-administered questionnaire was used to assess the knowledge and practice of CRC screening. RESULTS: The response rate was 86.4% (n = 197/228). Less than half (39.1%) of respondents answered correctly for all risk stratification scenarios. Mean knowledge score on CRC screening modalities was 48.7% ± 17.7%. The knowledge score was positively associated with having postgraduate educational qualification and usage of screening guidelines. Overall, 69.9% of PCPs reported that they practised screening. However, of these, only 20.7% of PCPs screened over 50% of all eligible patients and only 5.2% of PCPs screened over 75% of all eligible patients. PCPs who agreed that screening was cost-effective (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.69-6.59) and those who agreed that they had adequate resources in their locality (OR 1.92, 95% CI 1.01-3.68) were more likely to practise screening. Knowledge score was not associated with the practice of screening (p = 0.185). CONCLUSION: Knowledge and practice of CRC screening was inadequate among PCPs. Knowledge of screening did not translate into its practice. PCPs' perceptions about cost-effectiveness of screening and adequate resources were important determinants of the practice of screening

Implementation strategies for web-based applications for screening: a scoping review

1. Chor Yau Ooi, Chirk Jenn Ng, Anne E. Sales, & Lim, H. M

Implementation strategies for web-based applications for screening : a scoping review

Introduction: Screening is an effective primary prevention strategy in healthcare. However, uptake of screening remains low. Many strategies have been developed and found to be effective in increasing uptake of screening including using web-based applications (web-apps). However, not much is known about effective implementation of web-apps for screening in the real-world setting. Objectives: This scoping review aimed to identify (1) implementation strategies to implement web-apps for screening; (2) implementation frameworks used for implementing web-apps for screening; (3) outcome measures of implementation strategies and (4) implementation strategies that were effective. Method: This scoping review was conducted based on Arksey O’Malley’s framework. After identifying the review question, two researchers independently screened and selected relevant literature from PubMed, Embase, Cochrane, CINAHL, PsycINFO, ISRCTN registry, OpenGrey, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform and Web of Science. This was followed by charting of the data using a standardized form. Finally, a researcher collated, summarised, and reported the results quantitatively and qualitatively based on the review objectives. Results: 16476 studies were retrieved where 5669 were duplicates. From a total of 10807 studies, 10784 studies were excluded based on screening of title and abstract. Twenty-three full-text articles were reviewed and 4 articles were included in the final analysis. Many studies were excluded because they did not focus on implementation of web-apps. Facilitation was the most cited implementation strategy used followed by reminders, clinical champions, educational meetings and materials. Only 2 studies used implementation frameworks to guide the evaluation of their studies. Common outcome measures for implementation strategies were feasibility, fidelity and penetration. Implementation strategies reported to be effective were quality improvement meetings, facilitation, educational meetings and clinical champions. Discussion/ Conclusion: There is a dearth of literature on implementation of web-apps for screening and therefore there is a need to conduct more research in development and evaluation of implementation of web-apps screening interventions

Implementation Strategies for Web-Based Apps for Screening: Scoping Review

Background: Screening is an effective primary prevention strategy in health care, as it enables the early detection of diseases. However, the uptake of such screening remains low. Different delivery methods for screening have been developed and found to be effective in increasing the uptake of screening, including the use of web-based apps. Studies have shown that web-based apps for screening are effective in increasing the uptake of health screening among the general population. However, not much is known about the effective implementation of such web-based apps in the real-world setting. Implementation strategies are theory-based methods or techniques used to enhance the adoption, implementation, and sustainability of evidence-based interventions. Implementation strategies are important, as they allow us to understand how to implement an evidence-based intervention. Therefore, a scoping review to identify the various implementation strategies for web-based apps for screening is warranted. Objective: This scoping review aims to identify (1) strategies used to implement web-based apps for health screening, (2) frameworks used for implementing web-based apps for health screening, (3) outcome measures of implementation strategies, and (4) effective implementation strategies. Methods: This scoping review was conducted based on Arksey and O’Malley’s framework. After identifying the review question, two researchers independently screened and selected relevant literature from PubMed, Embase, Cochrane, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, International Standard Randomised Controlled Trial Number Registry, OpenGrey, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and Web of Science. This was followed by charting the data using a standardized form. Finally, we collated, summarized, and reported the results quantitatively and qualitatively based on the review objectives. Results: A total of 16,476 studies were retrieved, of which 5669 were duplicates. From a total of 10,807 studies, 10,784 studies were excluded based on their titles and abstracts. There were 23 full-text articles reviewed, and 4 articles were included in the final analysis. Many studies were excluded because they focused on the effectiveness and not on the implementation of web-based apps. Facilitation was the most cited implementation strategy used, followed by reminders, clinical champions, and educational meetings and materials. Only 2 studies used implementation frameworks to guide the evaluation of their studies. Common outcome measures for implementation strategies were feasibility, fidelity, and penetration. Implementation strategies reported to be effective were quality improvement meetings, facilitation, educational meetings, and clinical champions. Conclusions: There is a dearth of literature on the implementation of web-based apps for health screening. Implementation strategies were developed without any reported use of implementation theories or frameworks in most studies. More research on the development and evaluation of web-based screening app implementations is needed

Comparison of Icare Rebound Tonometer and Perkins Applanation Tonometer in Community Eye Screening

Purpose: To compare the measurement of intraocular pressure (IOP) of Icare rebound tonometer and Perkins applanation tonometer (PAT) during community eye screening and to assess the agreement between these 2 instruments. Design: A cross-sectional, non-interventional study. Methods: The IOP measurements by handheld Icare rebound tonometer (Finland) were first performed by a primary care physician. Then the IOP was measured using Perkins Mk3 applanation tonometer (Haag-Streit, UK) by an ophthalmologist who was masked to previous readings from the Icare rebound tonometer. The mean IOP measured by each tonometer was compared. Pearson correlation coefficient was used to explore the correlation between the IOP measurements of the 2 instruments. The level of agreement between them was assessed using the Bland and Altman method. Results: A total of 420 left eyes were examined. The mean age of subjects was 38.6 ± 18.2 years. Approximately 67% of subjects were female. The mean IOP was 16.3 ± 4.0 mm Hg using Icare and 13.4 ± 2.3 mm Hg using PAT. Pearson correlation coefficient showed a moderate positive correlation between the 2 methods (r = +0.524, P < 0.001). Linear regression analysis revealed a slope of 0.28 with R2 of 0.255. The mean difference between the 2 methods was 2.90 ± 3.5 mm Hg and the sample t-test revealed a statistically significant mean difference from 0 (P < 0.001). The 95% limits of agreement between the 2 methods were between −9.73 and 3.93 mm Hg. Conclusions: The handheld Icare rebound tonometer is a reasonably acceptable screening tool in community practices. However, Icare overestimated IOP with a mean of 2.90 mm Hg higher than the PAT. Thus, using Goldmann applanation tonometer as a confirmatory measurement tool of IOP is suggested

Experience of mothers learning and doing infant massage

Experience of mothers learning and doing infant massage The practice of infant massage has been reported to give relaxation and enjoyment to mothers and babies. Objective: this study aimed to explore mothers’ experience with learning and doing infant massage. Methodology: Mothers of babies four to six weeks old were taught the adapted baby massage program over four sessions by a certified infant massage instructor in selected health centres. They were asked to do infant massage for 15 minutes twice a day. As part of a main study, nine of the mothers were recruited as study participants at the end of the teaching sessions using a purposive sampling procedure. In-depth interviews were conducted to explore their experience with learning and doing baby massage. Findings: Mothers’ experience with baby’s relaxation and sleep, baby-mother bonding, new learning in term of a helpful baby-care skill, responding to baby cues, establishing new care routine, gaining spousal and other mothers’ supports apparently contributed to their positive experience related to learning and doing massage with their babies. Findings supplement the evidence base which could influence practice change related to service provision to include infant massage as part of the maternal an