Co-Designing an Integrated Model of Care for Delivering a Comprehensive Self-Management Intervention for People with Multimorbid COPD in Rural Nepal

Background The existing models of care developed to comprehensively address the needs of people with multimorbid chronic obstructive pulmonary disease (COPD) may not be directly applicable to low- and middle-income countries (LMICs) like Nepal. Therefore, this research sought to co-design, with end-users and stakeholders, an integrated model of care to deliver a comprehensive self-management intervention to people with multimorbid COPD in rural Nepal. Methods This research was conducted in two stages: i) a parallel mixed-method descriptive research to understand self-management practices (SMPs), health literacy (HL) and patient activation (PA), along with their barriers and facilitators; and ii) Evaluation of the feasibility and acceptability of a co-design process used to develop a model of care. The descriptive research included a survey of 238 people with multimorbid COPD and qualitative explorations using in-depth interviews (IDIs) of selected stakeholders. The evaluation included qualitative analysis of IDIs, video recordings from co-design workshops and observation notes. Data were collected between September 2018 and December 2019 in the Sunsari district, Nepal. Results More than two-thirds of participants had low levels of SMPs and HL and were less activated. Qualitative exploration identified inadequate family support, inadequate infrastructure and resources at primary care, limited skills of primary level providers and lack of educational materials for COPD, as barriers for SMPs. These findings guided the ideation of an integrated model of care, which was later refined in the prototype stage. This model of care included screening the community for people with COPD and morbidities within primary health care, establishing referral pathways and establishing a community-based support system. Evaluation of the co-design process showed that the approach was well accepted and feasible. A co-design evaluation framework was developed. Conclusion The descriptive research findings suggest that SMPs, HL and PA among the participants were low and had several barriers that an integrated model could address. The evaluation of the co-design approach revealed that the co-design process was feasible and acceptable to end-users and government agencies in Nepal. This has important practice, policy and research implications for the application of co-design in LMICs and for delivering self-management intervention targeting people with multimorbid COPD in Nepal or settings of similar context

Perceived fear of COVID-19 and its associated factors among Nepalese older adults in eastern Nepal : a cross-sectional study

Coronavirus disease 2019 (COVID-19) has affected all age groups worldwide, but older adults have been affected greatly with an increased risk of severe illness and mortality. Nepal is struggling with the COVID-19 pandemic. The normal life of older adults, one of the vulnerable populations to COVID-19 infection, has been primarily impacted. The current evidence shows that the COVID-19 virus strains are deadly, and non-compliance to standard protocols can have serious consequences, increasing fear among older adults. This study assessed the perceived fear of COVID-19 and associated factors among older adults in eastern Nepal. Methods A cross-sectional study was conducted between July and September 2020 among 847 older adults (?60 years) residing in three districts of eastern Nepal. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S). Multivariate logistic regression identified the factors associated with COVID-19 fear. Results The mean score of the FCV-19S was 18.1 (SD = 5.2), and a sizeable proportion of older adults, ranging between 12%-34%, agreed with the seven items of the fear scale. Increasing age, Dalit ethnicity, remoteness to the health facility, and being concerned or overwhelmed with the COVID-19 were associated with greater fear of COVID-19. In contrast, preexisting health conditions were inversely associated with fear. Conclusion Greater fear of the COVID-19 among the older adults in eastern Nepal suggests that during unprecedented times such as the current pandemic, the psychological needs of older adults should be prioritized. Establishing and integrating community-level mental health support as a part of the COVID-19 preparedness and response plan might help to combat COVID-19 fear among them

The Role of Family Support in the Self-Rated Health of Older Adults in Eastern Nepal: Findings from a Cross-Sectional Study

BACKGROUND: Nepal\u27s low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults. METHODS: A community-based cross-sectional survey in eastern Nepal\u27s two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health. RESULTS: Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support. CONCLUSIONS: Given the important role of family support in Nepali older adults\u27 health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults\u27 care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies

Review of gynaecological cancer among Aboriginal and/or Torres Strait Islander people in Australia

Gynaecological cancers bear a significant burden on the health of Australians. Whilst Australia has made great strides in reducing the overall gynaecological cancer burden nationally, Aboriginal and/or Torres Strait Islander women continue to experience disproportionately high rates of gynaecological cancers. This review focuses on the social, cultural, and historical contexts that contribute to inequitable gynaecological cancer rates among Aboriginal and/or Torres Strait Islander women. An in-depth discussion on cervical cancer, ovarian cancer, and uterine cancer are described; including the incidence, mortality, survival, and management of these diseases for Aboriginal and/or Torres Strait Islander women. It highlights both the persistent barriers and facilitators relating to Aboriginal and/or Torres Strait Islander women’s uptake of preventative measures and treatments, including their use of services and programs relating to the management of gynaecological cancers. This review summarises past and current policies and strategies implemented by the Australian Government and other cancer related peak bodies that aim to address this health issue. It recommends that critical attention be given to risk reduction, participation in cancer screening programs, and improved access to culturally appropriate, high quality primary health care and tertiary specialist services. This would address inequitable differences faced by Aboriginal and/or Torres Strait Islander people and reduce the overall burden of gynaecological cancers

Prevalence and correlates of depressive symptoms among Rohingya (forcibly displaced Myanmar nationals or FDMNs) older adults in Bangladesh amid the COVID-19 pandemic

BACKGROUND: Depression is globally a crucial communal psychiatric disorder, which is more common in older adults. The situation is considerably worse among millions of older (forcibly displaced Myanmar nationals or FDMNs) Rohingya adults, and the coronavirus disease-2019 (COVID-19) pandemic may exacerbate the already existing precarious situation. The present study investigated depressive symptoms and their associated factors in older adult Rohingya FDMNs in Cox Bazar, Bangladesh, during the COVID-19 pandemic. METHOD: A total of 416 older adults aged 60 years and above residing in Rohingya camps situated in the South Eastern part of Bangladesh were interviewed using a 15-item Geriatric Depression Scale (GDS-15) in Bengali language. Chi-square test was performed to compare the prevalence of depressive symptoms within different categories of a variable and a binary logistic regression model was performed to determine the factors associated with depressive symptoms. RESULTS: More than 41% of Rohingya older adults had depressive symptoms (DS). Socio-demographic and economic factors such as living alone, dependency on family for living, poor memory, feelings of being left out, difficulty in getting medicine and routine medical care during COVID-19, perception that older adults are at highest risk of COVID-19 and pre-existing non-communicable chronic conditions were found to be significantly associated with developing DS. Higher DS was also evident among older female Rohingya FDMNs. CONCLUSION: DS are highly prevalent in older Rohingya FDMNs during COVID-19. The findings of the present study call for immediate arrangement of mental health care services and highlight policy implications to ensure the well-being of older FDMNs

Factors associated with mobile phone usage to access maternal and child healthcare among women of urban slums in Dhaka, Bangladesh: a cross-sectional study.

INTRODUCTION: With the acute shortage of human resources and infrastructure, mobile phones can be a critical tool for accessing health services and strengthening health systems in Bangladesh. Yet, there is a scarcity of evidence on the use of mobile phones in this context for accessing health services. In this study, we sought to explore the current use of mobile phones for accessing maternal and child healthcare and its determinants among recently delivered women in urban slums of Bangladesh. METHODS: The data were collected through interviewing 800 recently delivered women from eight slums of Dhaka city of Bangladesh during May and June 2018. The study followed a cross-sectional design and a two-stage cluster random sampling procedure was followed. A pretested structured questionnaire was employed to collect information. Chi square tests were performed for descriptive analyses and a multilevel binary logistic regression model was executed to explore the determinants of mobile phone usage for accessing maternal and childcare among the participants. RESULTS: Overall, 73.8% of study participants used mobile phones for accessing maternal and child healthcare. After adjusting for potential confounders, participants' age, husband's occupation, sex of household head, women's ownership of mobile phones and household wealth status were found to be significantly associated with higher odds of using mobile phones to access maternal and child healthcare. CONCLUSION: The study highlighted the possibility of implementing large-scale mobile health (mHealth) interventions in slum settlements for accessing maternal and child healthcare and is a sustainable mitigation strategy for the acute health worker crisis in Bangladesh. The findings of this study are particularly crucial for policymakers and practitioners while they revise the health policy to incorporate mHealth interventions as highlighted in the recently initiated Digital Health Strategy of Bangladesh

Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries

The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond

A comparative study on self-esteem among tribal and non-tribal students in Udupi Taluk, Karnataka, India

Self esteem is defined as the positive or negative attitude about self, the degree of liking or satisfaction within self, and owns feeling of perceived worth as compared with others. Healthy self-esteem is important to be successful and happy throughout one’s life. The aim of this study was to compare the self esteem among tribal and non-tribal student in Udupi Taluk. A descriptive cross sectional study was conducted in November 2012 in government school of Brahmavar, Udupi Taluk. Study participants were students of class eight, nine and ten. One school was randomly selected from the list of government schools in Brahmavar. The size of the sample was 76 which includes 38 from tribal category and 38 from general category and the sampling design was purposive sampling. Rosenberg’s scale was used to assess the self esteem of students. Questionnaires were self administered. Permission was taken from the principle of school. Data was entered and analyzed using SPSS version 15. Results are reported as frequency and proportion. Independent t test was used to compare the self esteem of tribal and non tribal student. Study found that more than two third of the tribal student had low self esteem. There was statistically significant difference (p<0.001) in self esteem between tribal and non tribal students

Prevalence and determinants of frailty in the absence of disability among older population: a cross sectional study from rural communities in Nepal

BACKGROUND: Longevity and frailty have significant implications for healthcare delivery. They increase demands for healthcare service and surge risk of hospitalization. Despite gaining global attention, determinants of frailty have remained unmeasured in the rural community settings in Nepal. This study aimed to address this gap by accessing the prevalence and determinants of frailty in the absence of disability among older population living in rural communities in eastern Nepal. METHODS: We conducted a cross-sectional analytical study of 794 older adults aged ≥60 living in the rural part of Sunsari and Morang district of eastern Nepal between January and April in 2018. Multi-stage cluster sampling was applied to recruit the study participants. Study measures included socio-demographics; Frail Non-disabled scale (FiND) measuring frailty, Barthel\u27s Index measuring basic activities of daily living and Geriatric depression scale. Determinants of frailty in the absence of disability were identified using generalized estimating equation (GEE). RESULTS: About 65% of the participants self-reported the presence of frailty in the absence of disability. In the adjusted models, those from underprivileged ethnic groups, lack of daily physical exercise, presence of depressive symptoms and those not getting enough social support from family were found to be significantly associated with frailty among older participants. CONCLUSIONS: The prevalence of frailty in the absence of disability was high among rural community old population living in eastern Nepal. Our findings suggest that need of frailty awareness (both for clinicians and general public), so as to avoid negative consequences. To reduce the healthcare burden early screening frailty in primary care has potentials to prevent implications of frailty in Nepal