Experience of nurses with using eHealth in Gilgit-Baltistan, Pakistan: a qualitative study in primary and secondary healthcare

Background: To improve the quality of health care in remote parts of Pakistan, a research project was initiated in the mountainous region of Gilgit-Baltistan using information and communication technology to improve patient care and support continuing education of health providers (eHealth). This paper describes the experience of nurses in using eHealth in their routine practices. Methods: All health centres of Gilgit-Baltistan, Pakistan using eHealth as part of this study, were taken as a single case. These include four primary healthcare centres, three secondary care centres and one medical centre. In-depth interviews were conducted using semi-structured interview guide to study nurses’ perspective about using eHealth, and its perceived impact on their professional lives. Results: According to the respondents, eHealth enhanced access to care for remote communities, and improved quality of health services by providing opportunities for continuing learning. Nurses also appreciated eHealth for reducing their professional isolation, and providing exposure to new knowledge through teleconsultations and eLearning. The responses categorized under six major headings include: gaps in health services prior to eHealth; role of eHealth in addressing these gaps; benefits of eHealth; challenges in eHealth implementation; community’s perception about eHealth; and future recommendations. Conclusions: Low-cost and simple eHealth solutions have shown to benefit nurses, and the communities in the remote mountainous regions of Pakistan

Building networks for eHealth research : PAN Asian Collaboration for Evidence-based e-Health Adoption and Application (PANACeA), a success story in the Asian context

The article reviews work by PANACeA to identify partners from countries in Central, South, and South East Asia, to work together to identify eight projects to generate evidence for the adoption of technologically, economically and socio-culturally sound eHealth applications in multiple countries. PANACeA Common Thematic Activities (PCTAs) are being investigated in the Asian context, to support the eHealth initiatives. The PCTAs will not only impact the implementation of research projects, but also influence the development of eHealth in the participating countries. PANACeA offers a unique way of developing evidence in a local context to generate communities of practice within Asia

PANACeA Formative Network evaluation report

This formative evaluation of PANACeA Network (PAN Asian Collaborative for Evidence-based eHealth Adoption and Application) employs the Utilization Focused Evaluation (UFE) approach to develop evaluation capacity in Information Communication Technology for development (ICT4D). UFE directs users of the evaluation to focus on utilization of the findings right from the start of the process. Some findings from the UFE process indicate that PANACeA enhanced partners’ capacity in research design, improved eHealth infrastructure, and increased their readiness for conducting independent eHealth projects, while building members’ capacity in knowledge management and dissemination

Conceptual framework for development of comprehensive e-Health evaluation tool

Objective: The main objective of this study was to develop an ehealth evaluation tool based on a conceptual framework including relevant theories for evaluating use of technology in health programs. This article presents the development of an evaluation framework for e-health programs. Materials and Methods: The study was divided into three stages: Stage 1 involved a detailed literature search of different theories and concepts on evaluation of e-health, Stage 2 plotted e-health theories to identify relevant themes, and Stage 3 developed a matrix of evaluation themes and stages of e-health programs. Results: The framework identifies and defines different stages of e-health programs and then applies evaluation theories to each of these stages for development of the evaluation tool. This framework builds on existing theories of health and technology evaluation and presents a conceptual framework for developing an e-health evaluation tool to examine and measure different factors that play a definite role in the success of e-health programs. The framework on the horizontal axis divides e-health into different stages of program implementation, while the vertical axis identifies different themes and areas of consideration for e-health evaluation. Conclusions: The framework helps understand various aspects of e-health programs and their impact that require evaluation at different stages of the life cycle. The study led to the development of a new and comprehensive e-health evaluation tool, named the Khoja–Durrani–Scott Framework for e-Health Evaluation

Facilitators and barriers to NCD prevention in Pakistanis-invincibility or inevitability: a qualitative research study.

Background: Non-communicable diseases (NCD) are the leading causes of death globally. In Pakistan, they are among the top ten causes of mortality, especially in the productive age group (30–69 years). Evidence suggests that health perceptions and beliefs strongly influence the health behavior of an individual. We performed focus group interviews to delineate the same so as to design the user interface of a non-invasive stroke risk monitoring device. Methods: It was a qualitative study, designed to explore how health perceptions and beliefs influence behavior for NCD prevention. Four focus group discussions (FGD) were conducted with 30 stable participants who had diabetes mellitus, ischemic heart disease, blood pressure, and stroke. The data was collected using a semi-structured interview guide designed to explore participants’ perceptions of their illnesses, self-management behaviors and factors affecting them. The interviews were transcribed and content analysis was done using steps of content analysis by Morse and Niehaus [10]. Results: Medication adherence, self-monitoring of blood sugars and blood pressures, and medical help seeking were the commonly performed self-management behaviors by the participants. Personal experience of illness, familial inheritance of disease, education and fear of premature death when life responsibilities were unfulfilled, emerged as strong facilitators of self-management behaviors. A sense of personal invincibility, Fatalism or inevitability, lack of personal threat realization, limited knowledge, inadequate health education, health care and financial constraints appeared as key barriers to the self-management of chronic disease in participants. Conclusions: Behavioural interventional messaging will have to engender a sense of personal vulnerability and yet empower self-efficacy solutions at the individual level to deal with both invincibility and inevitability barriers to adoption of healthy behavior

A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study.

Background: The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan. Methods: This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition to usual care, received reminder SMS for 2 months that contained a) Personalized, prescription tailored daily medication reminder(s) b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle. Results: Two hundred participants were enrolled. 38 participants were lost to follow-up. After 2 months, the mean medication score was 7.4 (95 % CI: 7.2–7.6) in the intervention group while 6.7 (95 % CI: 6.4–7.02) in the control group. The adjusted mean difference (Δ) was 0.54 (95 % CI: 0.22–0.85). The mean diastolic blood pressure in the intervention group was 2.6 mmHg (95 % CI; −5.5 to 0.15) lower compared to the usual care group. Conclusion: A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure in stroke survivors with complex medication regimens living in resource poor areas