Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries—A Qualitative Systematic Review with Meta-Synthesis

From MDPI via Jisc Publications RouterHistory: accepted 2021-11-06, pub-electronic 2021-11-15Publication status: PublishedPhysical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context

Outlining a "low-resource setting" in the context of rehabilitation to facilitate health equity

Thesis (MScPhysio)--Stellenbosch University, 2020.ENGLISH SUMMARY : Background: Global health systems are under constant pressure due to demographic transitions, epidemiological trends and limited resources. Access to rehabilitation, an acknowledged holistic intervention for anyone with a condition that limits their ability to function, appears most limited in health systems in resource-constrained settings. The resource constraints, specific to the setting, that limit access to and availability of rehabilitation, are unclear. A lack of understanding of what constitutes a “low-resource setting” may limit evidence synthesis, knowledge transfer, and rehabilitation program implementation. The aim of this thesis is to unravel the concept of “low-resource settings”, in the context of rehabilitation, to facilitate health equity. Methods: A systematic scoping review was undertaken to identify published articles in the field of rehabilitation medicine, that were conducted in a self-reported “low-resource setting”. Four electronic databases were accessed and searched from their inception to 24 June 2019: PubMed, Africa Wide, Web of Science and Scopus. Qualitative content analysis through an inductive approach, using in vivo and descriptive coding, was employed to analyse the data. Codes were grouped into content categories, guided by the use of a socio-ecological framework. These content categories were subsequently grouped to identify major themes relating to the term “low-resource setting” in the included studies. The findings informed the development of a case study, detailing the intersection of two methodological approaches to unravel a broad concept in existing, published literature. The case study aims to provide a detailed account and critical reflection on the methods used to answer the research question. Results: A total of 48 studies were included in the systematic scoping review. Following the qualitative content analysis, a total of 410 codes were grouped into 63 content categories, which helped identify nine major themes relating to the term ”low-resource setting” in the context of rehabilitation. These themes include (i) financial pressure, (ii) suboptimal healthcare service delivery, (iii) underdeveloped infrastructure, (iv) paucity of knowledge, (v) research challenges and considerations, (vi) restricted social resources, (vii) geographical and environmental factors, (viii) human resource limitations and (ix) the influence of beliefs and practices. Conclusion: Healthcare administrators, clinicians and researchers now have the opportunity to actively engage with the nine themes developed in this thesis when planning, designing and implementing rehabilitation interventions in “low-resource settings”. Moreover, these themes may provide a breeding ground for future research activities to support greater transparency (e.g. framework development) in reporting of research conducted in “low-resource settings”. Greater transparency may alleviate barriers in knowledge translation, across settings, and assist in reducing the unmet needs for rehabilitation, globally. Using qualitative content analysis as a means to unravel complicated constructs derived from a scoping review of existing literature, relative to the research inquiry, is a valuable intersection of methods that could be utilised more often.AFRIKAANSE OPSOMMING : Agtergrond: Wêreldwye gesondheidstelsels is onder konstante druk as gevolg van demografiese oorgange, epidemiologiese tendense en beperkte hulpbronne. Toegang tot rehabilitasie, 'n erkende holistiese ingryping vir enige iemand met 'n toestand wat hul vermoë om te funksioneer beperk, blyk om meer beperkend te wees in gesondheidstelsels met verminderde hulpbronne. Die hulpbronbeperkings, spesifiek tot die omgewing, wat toegang tot en beskikbaarheid van rehabilitasie beperk, is onduidelik. 'n Gebrek aan begrip van wat 'n “verminderde hulpbroninstelling” is, kan die sintese en oordrag van kennis, en implementering van rehabilitasieprogramme beperk. Die doel van hierdie tesis is om die konsep van “verminderde hulpbroninstellings”, in die konteks van rehabilitasie, te ontrafel en om sodoende, gesondheidsgelykheid te verbeter. Metodes: ‘n Stelselmatige literatuuroorsig is uitgevoer om gepubliseerde artikels, in die rehabilitasiegeneeskunde veld, te identifiseer wat uitgevoer is in 'n self-gerapporteerde “verminderde hulpbroninstelling”. Vier elektroniese databasisse is hiervoor gebruik en daar is gesoek vir gepubliseerde artikels vanaf elke databasis se ontstaan tot 24 Junie 2019: PubMed, Africa Wide, Web of Science en Scopus. Kwalitatiewe inhoudsontleding, deur middel van 'n induktiewe benadering, met hulp van “in vivo” en beskrywende kodering, is gebruik om die data te ontleed. 'n Sosio-ekologiese raamwerk is gebruik om kodes in inhoudskategorieë op te deel. Hierdie kategorieë is verder gegroepeer om belangrike temas te identifiseer wat verband hou met die term "verminderde hulpbroninstelling” in die ingeslote studies. Die bevindings het die ontwikkeling van 'n gevallestudie ingelig en die kruising van twee metodologiese benaderings uiteengesit om 'n breë konsep in bestaande, gepubliseerde literatuur te ontrafel. Die gevallestudie het ten doel gehad om gedetailleerde verslag te gee, en krities te besin, oor die metodes wat gebruik word om die navorsingsvraag te beantwoord. Resultate: Altesaam is 48 studies by die stelselmatige literatuuroorsig ingesluit. Na die kwalitatiewe inhoudsanalise is 410 kodes in 63 inhoudskategorieë gegroepeer, wat gehelp het om nege hooftemas te identifiseer wat verband hou met die term “verminderde hulpbroninstelling”, in die konteks van rehabilitasie. Hierdie temas sluit in (i) finansiële druk, (ii) suboptimale gesondheidsorgdienslewering, (iii) onderontwikkelde infrastruktuur, (iv) gebrek aan kennis, (v) navorsingsuitdagings en oorwegings, (vi) beperkte sosiale hulpbronne, (vii) geografiese en omgewingsfaktore, (viii) beperkings op menslike hulpbronne en (ix) die invloed van oortuigings en praktyke. Gevolgtrekking: Administrateurs van gesondheidsorg, klinici en navorsers het nou die geleentheid om aktief betrokke te raak by die nege temas wat in hierdie tesis ontwikkel is, tydens die beplanning, ontwerp en implementering van rehabilitasie-intervensies in "verminderde hulpbroninstellings". Boonop dit, kan hierdie temas 'n teelaarde bied vir toekomstige navorsingsaktiwiteite om groter deursigtigheid (bv. raamwerkontwikkeling) te ondersteun in verslagdoening oor navorsing wat in 'n “verminderde hulpbroninstelling” uitgevoer word. Groter deursigtigheid kan hindernisse in die oordra van kennis, in verskillende instellings, verbeter, en help om wêreldwyd die onvervulde behoeftes vir rehabilitasie te verminder. Die gebruik van kwalitatiewe inhoudsanalise as 'n middel om ingewikkelde konstruksies, afkomstig vanaf 'n stelselmatige literatuurorsig, te ontrafel, relatief tot die navorsingsondersoek, is 'n kragtige kruising van metodes wat meer gereeld gebruik kan word.Master

Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis

Introduction The effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as ‘low-to-middle-income countries’ or ‘developing countries’, are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings.Methods A systematic scoping review was undertaken to start unravelling the term ‘low-resource setting’. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to ‘low-resource setting’ and ‘rehabilitation’. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used.Results A total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term ‘low-resource setting’. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices.Conclusion The emerging themes may assist with (1) the groundwork needed to unravel ‘low-resource settings’ in health-related research, (2) moving away from assumptive umbrella terms like ‘low-to-middle-income countries’ or ‘low/middle-income countries’ and (3) promoting effective knowledge transfer between settings

Unravelling € low-resource settings': A systematic scoping review with qualitative content analysis

Introduction The effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as € low-to-middle-income countries' or € developing countries', are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings. Methods A systematic scoping review was undertaken to start unravelling the term € low-resource setting'. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to € low-resource setting' and € rehabilitation'. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used. Results A total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term € low-resource setting'. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices. Conclusion The emerging themes may assist with (1) the groundwork needed to unravel € low-resource settings' in health-related research, (2) moving away from assumptive umbrella terms like € low-to-middle-income countries' or € low/middle-income countries' and (3) promoting effective knowledge transfer between settings

Patient-Reported Outcome Measures in Key Sub-Saharan African Languages to Promote Diversity: A Scoping Review

Objectives: Sub-Saharan Africa is a world region rich and diverse in cultures and languages; yet, it is also challenged with regard to resources that may facilitate the cultural adaptation or development of patient-reported outcome measures (PROMs). Systematic exclusion of patients’ “voices,” because of gaps in the availability of PROMs, may perpetuate health inequity. Hence, the objective is to describe the availability of PROMs in the non-English, sub-Saharan African languages. Methods: A scoping review was conducted to identify PROMs that had been translated, validated, or developed for use in 32 selected, non-English, sub-Saharan African languages pertaining to health outcomes. Four databases were searched (May 7, 2021), and additional articles were identified through reference screening and via corresponding authors. Data were extracted in terms of country, language, population, construct, and PROM characteristics (eg, number of items). Results: A total of 220 unique articles were included from 7451 records, leading to the identification of 126 unique PROMs. Most studies were conducted in either Ethiopia, Nigeria, or South Africa. As such, prevalent languages included Amharic, Yoruba, and non-English languages common to South Africa (eg, Setswana, Xhosa, and Zulu). No PROMs were identified in any of the languages for 27 sub-Saharan African countries or 10 of the 32 included languages. Conclusions: There are significant gaps in the availability of PROMs across the non-English African languages included. Nevertheless, the PROMs that were identified largely align with core outcome sets relevant to the prevalent disease burden in this world region. Consensus-based priority setting may inform the most pertinent gaps to be addressed

Patient-reported outcome measures in key African languages to promote diversity in research and clinical practice (PROUD)—protocol for a systematic review of measurement properties

CITATION: Heine, M., et al. 2021. Patient-reported outcome measures in key African languages to promote diversity in research and clinical practice (PROUD)—protocol for a systematic review of measurement properties. Trials, 22:380, doi:10.1186/s13063-021-05328-z.The original publication is available at https://trialsjournal.biomedcentral.comPublication of this article was funded by the Stellenbosch University Open Access FundIntroduction: Sub-Saharan Africa is a subcontinent with a proud cultural richness and diversity, yet inexplicably also a region with severe health care challenges and inequity. To challenge this health equity gap and reduce the burden of disease, the patient’s voice in monitoring and evaluation of health and health care interventions is paramount. The aim of this two-phased review is to map the availability of patient-reported outcome measures (PROMs) in a selection of non-English, African Languages, and systematically evaluate the measurement properties of the PROMs that were identified. Methods: This systematic review will be conducted in two phases. In phase 1, we will scope the literature for patientreported outcome measures (PROMs), either developed from scratch or through translation and validation in a sub-Saharan African country and a selection of non-English, African languages (n = 31; spoken in > 10 million people and/or a national language). The availability of PROMs will be mapped against the previously reported burden of disease in the respective countries included. Subsequently, in phase 2, we systematically evaluate the measurement properties of these PROMs using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for systematic reviews on PROMs. To ensure rigour, secondary searches will be developed to specifically locate articles that report on the measurement properties of the PROMs identified during phase 1. The evidence will be graded using the modified GRADE approach. Discussion: This review will provide a comprehensive overview and quality appraisal of PROMs developed in non-English, African languages. Consequently, this review when concluded may be an important first step in promoting access to these PROMs for use in clinical practice and research, as well as facilitate identification and prioritization of key knowledge gaps.https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05328-zPublisher's versio

Developing a complex understanding of physical activity in cardiometabolic disease from low-to-middle-income countries—a qualitative systematic review with meta-synthesis

Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context