Technicity as a Quality Indicator of Excellence in Gynaecology

Objectives: The objective of this study was to calculate the technicity index (TI) for hysterectomies at a tertiary care university hospital in Oman. Methods: This is a retrospective chart review of patients who had hysterectomies at Sultan Qaboos University Hospital (SQUH), a tertiary care university hospital. Profiles were reviewed for all patients who had hysterectomies at SQUH in the period 2003–2009. The cumulative frequencies for all types of hysterectomies were tallied and the year-specific TI was calculated. Results: Overall, we enumerated a total of 258 hysterectomies, of which 6 (2.3%) were laparoscopic assisted hysterectomies, 42 (16.3%) vaginal hysterectomies, and 208 (80.6%) total abdominal hysterectomies. The average TI was 19% (48/258), and it ranged from 11% to 24%. The trend of change fluctuated over the years starting with 16% (2003) and increasing gradually during 2004–2006, but then declining again during 2007–2008 (trend P value 0.02). This low and fluctuating trend was mainly attributed to the inconsistency in the availability of trained surgeons and laparoscopic equipment. Conclusion: TI at our institution can be improved by increasing the number of minimally invasive hysterectomies through providing more trained surgeons and laparoscopic equipment

Development and Validation of a Culturally-Tailored Breast Cancer Health Education Programme for Arab Women

Objectives: This study aimed to develop and validate a health education programme to encourage breast cancer awareness and early detection behaviours among Arab women. Methods: This study took place between December 2015 and March 2016. The Enabling Systems Raising Awareness model was used to develop a breast cancer health education programme which was subsequently implemented by trained health educators at three female-only fitness clubs in Muscat, Oman. Breast cancer knowledge among 53 women was assessed using the breast module of the Cancer Awareness Measure before and after each health education session. Overall pre- and post-session knowledge scores were then compared. Additionally, three focus group discussions were conducted with 10 participants from each location. Thematic analysis was used to analyse the transcribed discussions and collect feedback on the programme. Results: The health education sessions resulted in a statistically significant increase in overall mean knowledge scores (P <0.001). Participants also reported significantly improved intentions to undertake early detection practices (P <0.001). The focus group discussions yielded distinct themes and valuable feedback which can be utilised in the future to create an improved version of the programme. Conclusion: While the health education programme significantly improved breast cancer and early detection knowledge among a cohort of Arab women, it still required critical improvements in terms of structure and administration. Additional studies are required in order to evaluate long-term behavioural outcomes resulting from the improved programme

Go Lean, Get Leaner: The application of lean management in Omani healthcare

Editoria

Profile of Mental and Behavioral Disorders Among Preschoolers in a Tertiary Care Hospital in Oman: A Retrospective Study

Objectives Early diagnosis and prompt treatment of mental and behavioral disorders in preschoolers is critical for a better prognosis, ultimately leading to improved quality of life for both the child and the family. Our study investigated the clinical profile of mental and behavioral disorders in children < 7 years of age, seeking consultation at Sultan Qaboos University Hospital, Muscat, Oman, between 1 June 2006 and 31 December 2010. The objective was to explore demographic variables, intervention types, and annual trends. Methods This retrospective, descriptive study was conducted by reviewing the electronic records of preschoolers seeking consultation on mental and behavioral disorders at the Department of Behavioral Medicine. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Results The total number of cases was 466, the majority (77.9%) being boys. The cumulative frequencies and annual hospital-based prevalence rates were estimated for each category of mental and behavioral disorders. Our findings showed increased service utilization among preschoolers, as reflected in the annual trend and case-specific prevalence rates. While comorbidity was common, the most frequent disorders encountered were attention deficit hyperactivity disorder (70.8%), developmental language disorder (23.6%), autism spectrum disorders (20.2%), and disruptive behavior disorders (11.6%). The most commonly prescribed drugs/supplementation were risperidone (18.7%), atomoxetine (9.7%), omega-3 (8.8%), and methylphenidate (6.2%). Conclusions Consultations for mental and behavioral disorders are being sought for Omani preschoolers. Beside pharmacotherapy, other interventions, which are an integral part of a much desired multidisciplinary approach should be introduced. Readdressing the missing needs is essential for a comprehensive approach to managing mental and behavioral disorders.H.M. Sultan Qaboos Gran

Changes in Self-Efficacy and Social Support after an Intervention to Increase Physical Activity Among Adults with Type 2 Diabetes in Oman:A 12-month follow-up of the MOVEdiabetes trial

Objectives: This study aimed to describe changes in self-efficacy (SE) and social support (SS) 12 months after the MOVEdiabetes trial, an intervention designed to increase physical activity (PA) among adults with type 2 diabetes mellitus in Oman. Methods: The original MOVEdiabetes trial was conducted between April 2016 and June 2017 in Muscat, Oman. The intervention group (IG) received personalised PA consultations, pedometers and monthly messages using a web-based application, while the comparison group received usual care. Self-reported SE and SS from family and friends were assessed using validated psychosocial scales. Results: Of the 232 original participants in the trial, a total of 174 completed the 12 months follow-up study period (response rate: 75%). However, based on intention-to-treat analysis with several imputation procedures for missing data at 3 and/or 12 months, there was a significant increase in SE scores in the IG (+10.3, 95% confidence interval [CI]: 7.1–13.5; P &lt;0.001); however, the correlation with PA levels was weak (+4.2, 95% CI: 2.7–5.7; P &lt;0.001). Higher SE scores were noted in those without comorbidities (+12.2, 95% CI: 6.8–17.6; P &lt;0.001) and with high income levels (+9.7, 95% CI: 5.2–14.2; P &lt;0.001). Additionally, SS scores increased significantly among those in the IG who received support from friends (+2.3, 95% CI: 1.1–3.7; P &lt;0.001), but not family (+1.2, 95% CI: −0.4–2.8; P = 0.110). The reliability of the scales was acceptable for SE and SS from family, but poor for SS from friends (Cronbach’s alpha coefficients = 0.82, 0.82 and 0.40, respectively). Conclusion: The PA intervention was associated with positive changes in SE and SS from friends. However, further tools for assessing psychosocial influences on PA are needed in Arab countries.   KEYWORDS Physical Activity; Type 2 Diabetes Mellitus; Self-Management; Health Behaviors; Social Support, Self-Efficacy; Primary Healthcare; Oman

Study Protocol for "MOVEdiabetes":A Trial to Promote Physical Activity for Adults with Type 2 Diabetes in Primary Health Care in Oman

Abstract Background Benefits of physical activity in the management of diabetes are well documented. However, evidence on the effectiveness of interventions integrating physical activity in diabetes care is sparse especially in the countries of the Gulf Cooperation Council. The results from this study will increase our understanding of the use of multi-component interventions aimed at increasing physical activity levels in inactive adults with type 2 diabetes in primary health care in Oman. Methods/design The study is a one year 1:1 cluster randomized controlled trial of the MOVEdiabetes programme (intervention) versus usual care in eight primary health care centres in Oman. The MOVEdiabetes programme utilizes face to face physical activity consultations promoting 150 min of moderate to vigorous physical activity per week (≥600MET-mins/week), pedometers to self-monitor step counts and monthly telephone WhatsApp messages for follow up support. Inactive adults with type 2 diabetes and no contraindication to physical activity will be recruited over a two months period, and followed up for 12 months. To demonstrate a 50% between group difference in physical activity levels (MET-mins/week) over 12 months, (at a power of 80%, and significance level of 5%), 128 participants would be required to complete the study (64 in each arm). Based on a drop-out rate of 20%, 154 participants would require to be recruited (77 in each arm). Assuming a recruitment rate of 70%, 220 potential eligible participants would need to be approached. The primary outcome is change in levels of physical activity measured by the Global Physical Activity Questionnaire. In addition, accelerometers will be used in a sub group to objectively assess physical activity. Secondary outcomes include changes in metabolic and cardiovascular biomarkers, change in self-reported health, social support, self-efficacy for physical activity, and perceived acceptability of the program. All intervention delivery and support costs will be monitored. Discussion This study will contribute to the evidence on the feasibility, cultural acceptability and efficacy of interventional approaches for increasing physical activity in primary care for persons with type 2 diabetes in Oman. Trial registration International Standard Randomised Controlled Trials No: ISRCTN14425284 . Registered 12 April 2016

Perceived barriers to leisure time physical activity in adults with type 2 diabetes attending primary healthcare in Oman:a cross-sectional survey

Objectives: Physical activity is fundamental in diabetes management for good metabolic control. This study aimed to identify barriers to performing leisure time physical activity and explore differences based on gender, age, marital status, employment, education, income and perceived stages of change in physical activity in adults with type 2 diabetes in Oman.Design: Cross-sectional study using an Arabic version of the “Barriers to Being Active” 27 item questionnaire.Setting: Seventeen primary health centres randomly selected in Muscat.Participants: Individuals &gt;18 years with type 2 diabetes, attending diabetes clinic for &gt; 2 years and with no contraindications to performing physical activity.Primary and secondary outcome measures: Participants were asked to rate how far different factors influenced their physical activity, under the following categories: fear of injury, lack of time, social support, energy, willpower, skills, resources, religion and environment. On a scale of 0-9, barriers were considered important if scored ≥5.Results: A total of 305 questionnaires were collected. Most (96%) reported at least one barrier to performing leisure time physical activity. Lack of willpower (44.4%), lack of resources (30.5%) and lack of social support (29.2%) were the most frequently reported barriers. Using chi-square test, lack of willpower was significantly different in individuals with low vs high income (54.2% vs 40%, P=0.002) and in those reporting inactive vs active stages of change for physical activity (50.7% vs 34.7%, P=0.029), lack of resources was significantly different in those with low vs high income (40% vs 24.3%, P=0.004) and married vs unmarried (33.8% vs 18.5%, P=0.018). Lack of social support was significant in females vs males (35.4% vs 20.8%, P=0.005).Conclusions: The findings can inform the design on physical activity intervention studies by testing the impact of strategies which incorporate ways to address reported barriers including approaches that enhance self-efficacy and social support

Health professionals’ perceptions about physical activity promotion in diabetes care within primary health care settings in Oman

Background: As part of formative work to inform an interventional design to increase physical activity (PA) in patients with type 2 diabetes in Oman, this qualitative study aimed to determine health professionals’ perception of barriers and opportunities, personnel responsibilities and plausible PA promotional approaches. Methods: Four focus group discussions were carried out with groups of health care professionals (family physicians, dieticians and health educators, managers and general practitioners). All discussions were audio recorded and transcribed. Responses were analysed using a thematic analysis. Results: Barriers to PA reported by participants (n = 29) were identified at three levels: health care system (e.g. deficient PA guidelines); individual (e.g. obstructive social norms) and community (e.g. lack of facilities). Participants felt that a multilevel approach is needed to address perceived barriers and to widen current opportunities. In the presence of various diabetes primary care providers, the potential for dieticians to include individualised PA consultations as part of their role was highlighted. Participants felt that consultations should be augmented by approaches within the community (volunteer support and/or appropriate facilities). However, despite lack of experience with technology supported approaches and motivational tools, the telephone application “WhatsApp” and use of pedometers were considered potentially suitable. The need for training in behaviour change techniques and clearly communicated intervention guidelines was emphasised. Conclusions: A multi-component approach including PA consultations, possibly led by trained dieticians, technological routes for providing support along with community mapping for resources appear to offer promising approaches for further PA intervention studies within diabetes primary health care