IMPACT OF MOBILE HEALTH (MHEALTH) IN DIABETIC RETINOPATHY (DR) AWARENESS AND EYE CARE BEHAVIOR AMONG INDIGENOUS WOMEN

Diabetes is increasingly prevalent among Indigenous people and diabetic retinopathy (DR) is an eye complication of diabetes, and a common cause of blindness among adults in Canada. Indigenous women have a high risk of diabetes likewise increasing their risk for DR. The study examined factors that motivate and constrain Indigenous women from adopting healthy eye care behaviors and identified the changes in DR awareness and eye care behavior as a result of a mHealth education intervention among adult Indigenous women with diabetes or at-risk of diabetes (n=78). This was a pre-post-study which adopted an embedded concurrent mixed methods approach guided by self-determination theory and the medicine wheel. Pre-intervention DR awareness and eye care behavior information were collected from participants. Thereafter, participants received daily diabetes-eye related text messages for 12 weeks. Post-intervention, the impact of mHealth promotion on DR awareness and eye care behavior was assessed. Data was collected via sharing circles and surveys and underwent thematic and statistical analysis. Pre-intervention, participants indicated limited understanding of eye care costs/payment, guidelines, and eye complications and resolve to manage diabetes-eye conditions influenced eyecare. Also, fear originating from family history of diabetes, interaction with health care practitioners, and dependence on eye glasses affected their eye care. Participants requested information-resources on complications, prevention, and management of diabetes and DR which were included in the mHealth intervention. Age, diabetes status, and education level were significantly associated with DR knowledge, attitude, and practice scores. Post-intervention, the DR knowledge, attitude, and practice scores significantly improved. The DR attitude and practice post-score for individuals with diabetes increased compared to those at risk of diabetes. Women with higher education levels had higher pre-post-change in knowledge and practice score compared to women with low education levels. Older women had lower pre-post-change in practice score compared to younger women. Participants noted that voice or text messages via various mobile platforms, the telephone number used to send messages, the tone of messages, group activities, and message content were all important when using mHealth for health information. The mHealth intervention created awareness of DR and encouraged change in diabetes-eye care behavior. mHealth has the potential to be used for health education in different populations, and motivate, provide support, and empower individuals to prevent and manage chronic conditions and reduce the risk of complications

Simulation médicale mobile pour les anesthésistes ruraux : Une étude de faisabilité

Introduction: Family practice anesthesia (FPA) providers are family physicians trained to deliver anesthesia care; they often practice in rural hospitals to facilitate surgical care. FPA providers in rural hospitals face challenges including professional isolation and limited opportunities for formal continuing education. To address needs identified by FPA providers, we piloted mobile medical simulation in rural Saskatchewan. Methods: Using a logic model framework, we evaluated feasibility of a one-day interdisciplinary mobile simulation workshop for healthcare providers in a rural Saskatchewan hospital. As part of this mixed methods pilot study, we interviewed stakeholders to explore their perceptions of human and financial resources associated with delivering medical simulations in rural locations. Multiple simulation scenarios were utilized to train participants in clinical and professional skills. Participants completed pre- and post-workshop surveys to evaluate their experience. Results: Financial and human resources included cost of renting, transportation of mannequins, and the time required to create the scenarios. Participants (n = 10) reported improved knowledge and found the experience valuable. The session prompted participants to reflect on their deficiencies in certain clinical procedures/skills and highlight learning strategies to address the gap. Discussion: Mobile medical simulation brought continuing medical education (CME) to health professionals in a rural location, but the program was expensive. Our logic model may inform educators and administrators considering mobile medical simulation for physicians in rural areas when balancing resource allocation and the organization’s commitment to CME for rural physicians.Introduction : Les anesthésistes en pratique familiale (APF) sont des médecins de famille formés pour offrir des soins d’anesthésie. Ils pratiquent souvent dans des hôpitaux ruraux pour faciliter les soins chirurgicaux. Les APF dans les hôpitaux ruraux sont confrontés à divers défis, tels l’isolement professionnel et un nombre limité d’occasions  de formation continue formelle. Pour répondre aux besoins identifiés par les APF, nous avons mené une simulation médicale mobile dans une région rurale de la Saskatchewan. Méthodes : En utilisant un cadre de modèle logique, nous avons évalué la faisabilité d’un atelier sur une simulation mobile interdisciplinaire d’un jour pour les professionnels de la santé dans un hôpital rural de la Saskatchewan. Dans le cadre de cette étude pilote basée sur des méthodes mixtes, nous avons interviewé les parties prenantes pour explorer leurs perceptions en matière de ressources humaines et financières associées à la prestation de simulations médicales dans des zones rurales. Nous avons eu recours à de multiples scénarios de simulation pour former les participants dans des compétences cliniques et professionnelles. Les participants ont rempli un questionnaire avant et après l’atelier pour évaluer leur expérience. Résultats : Les ressources financières et humaines comprenaient le coût de location, le transport de mannequins et le temps requis pour créer les scénarios. Les participants (n = 10) ont rapporté avoir amélioré leurs connaissances et que l’expérience en valait la peine. La séance incitait les participants à réfléchir sur leurs lacunes dans certaines procédures ou compétences cliniques et à préciser des stratégies d’apprentissage pour combler leurs lacunes. Discussion : La simulation médicale mobile rapproche l’éducation médicale continue des professionnels de la santé dans une zone rurale, mais le programme a coûté cher. Notre modèle logique peut informer les éducateurs et les administrateurs qui envisagent la simulation médicale mobile pour les médecins dans les zones rurales lorsqu’ils équilibrent les ressources et l’engagement de l’organisation à la formation médicale continue pour les médecins en zones rurales

Participant-reported effect of an Indigenous health continuing professional development initiative for specialists

Background: Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions. Methods: The E4E program was delivered to rheumatologists in two phases, each delivered as experiential learning workshops where participants engaged with and applied course content within an interactive format focusing on real-time feedback. The phase 1 workshop focused on skill development of E4E Framework concepts and principles. Phase 2 concentrated on building capacity for teaching of E4E content. Evaluation of the program’s effectiveness was through longitudinal responses to the Social Cultural Confidence in Care Survey (SCCCS), self-reported strategies employed to address social issues and improve therapeutic relationships, engagement with teaching others, and satisfaction with the program. Results: Two cohorts of participants have participated in the program (n = 24 Phase 1, n = 10 Phase 2). For participants completing both phases of training, statistically significant improvements were observed in exploring social factors with patients, gaining knowledge and skills related to cultural aspects of care, improved communication and relationship building, and reflections on held stereotypes. Strategies to address social issues and build therapeutic relationships remained consistent throughout participation, while the training enhanced exploration and confidence to ask about cultural and traditional practices, and stronger communication strategies for exploring beliefs, expectations, social barriers, and residential school impacts on health. Participants reported feeling prepared to teach Indigenous health concepts to others and subsequently lead teaching with residents, fellows, and allied health professionals. Satisfaction with the delivery and content of the workshops was high, and participants valued interactions with peers in learning. Conclusions: This CPD intervention had a beneficial impact on self-reported confidence and enhanced practice strategies to engage with Indigenous patients

Assessing the feasibility, acceptability, and fidelity of a tele-retinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: a protocol

Background: Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attend screening. Screening rates are even lower in immigrants to Canada including people from China, Africa, and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French-speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. // Methods: We will work with our health system and patient partners to conduct a 6-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50–150 patients and 5–10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, and we will use a survey informed by the National Institutes of Health framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention-related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. // Discussion: This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention

Participant-reported effect of an Indigenous health continuing professional development initiative for specialists

Background: Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions. Methods: The E4E program was delivered to rheumatologists in two phases, each delivered as experiential learning workshops where participants engaged with and applied course content within an interactive format focusing on real-time feedback. The phase 1 workshop focused on skill development of E4E Framework concepts and principles. Phase 2 concentrated on building capacity for teaching of E4E content. Evaluation of the program’s effectiveness was through longitudinal responses to the Social Cultural Confidence in Care Survey (SCCCS), self-reported strategies employed to address social issues and improve therapeutic relationships, engagement with teaching others, and satisfaction with the program. Results: Two cohorts of participants have participated in the program (n = 24 Phase 1, n = 10 Phase 2). For participants completing both phases of training, statistically significant improvements were observed in exploring social factors with patients, gaining knowledge and skills related to cultural aspects of care, improved communication and relationship building, and reflections on held stereotypes. Strategies to address social issues and build therapeutic relationships remained consistent throughout participation, while the training enhanced exploration and confidence to ask about cultural and traditional practices, and stronger communication strategies for exploring beliefs, expectations, social barriers, and residential school impacts on health. Participants reported feeling prepared to teach Indigenous health concepts to others and subsequently lead teaching with residents, fellows, and allied health professionals. Satisfaction with the delivery and content of the workshops was high, and participants valued interactions with peers in learning. Conclusions: This CPD intervention had a beneficial impact on self-reported confidence and enhanced practice strategies to engage with Indigenous patients.Medicine, Faculty ofNon UBCMedicine, Department ofReviewedFacult

Global Rural and Remote Patients with Rheumatoid Arthritis: A Systematic Review of Disease Epidemiology, Clinical Outcomes and Health Service Utilization

Introduction: Rural and remote patients with rheumatoid arthritis (RA) are at risk for inequities in health outcomes based on differences in physical environments and healthcare access potential compared to urban populations. The aim of this systematic review was to synthesize epidemiology, clinical outcomes and health service use reported for global populations with RA residing in rural/remote locations. Methods: Medline, EMBASE, Healthstar, CINAHL and Cochrane were searched from inception to June 2019 using librarian-developed search terms for RA and rural/remote populations. Peer-reviewed published manuscripts were included if they reported on any of an epidemiology, clinical or health service use outcomes. Results: 54 articles were included for data synthesis, representing studies from all continents. In 11 studies where there was an appropriate urban population comparator, rural/remote populations were not at increased risk for RA, 1 study reported increased and 5 studies reported decreased prevalence in rural/remote populations. Clinical characteristics of rural/remote populations in studies with an appropriate urban comparator showed no significant differences in disease activity measures or disability, but with 1 study reporting worse physical function and health-related quality of life in rural/remote populations. Studies reporting on health service use provided evidence that rural/remote residence impacts diagnostic time, ongoing follow-up, access to RA-care related practitioners and services, and with variation in medication access and use. Conclusion: This synthesis highlights that RA epidemiology and clinical outcomes are not necessarily different between rural/remote and urban populations, however rural/remote patients face greater barriers to care which increases the risk for inequities in outcomes. From a public health perspective, we need leadership to implement structures and policies to support better outcomes in rural and remote populations. Access to health services is a recognized determinant of health, which presents the opportunity for actionable strategies and approaches to resolve inequities in care delivery

Community and primary care refractive and optical service delivery models: protocol for a scoping review

Background Uncorrected refractive error is a leading cause of vision impairment which, in most cases, can be managed with the appropriate spectacle correction. A 40-percentage point increase in effective coverage of refractive error is the 2021 World Health Assembly endorsed global target to be achieved by 2030. To achieve this global target, equitable access to refractive and optical services within community and primary care settings needs to be strengthened. Objectives The overall purpose of the scoping review is to determine the range of community and primary care refractive and optical service delivery models, and the methods employed for their evaluation. This review is designed to help inform the development of technical guidance to support World Health Organization (WHO) Member States in improving refractive error coverage for their populations. Search methods We will search academic databases (Cochrane Library, MEDLINE, Embase, Global Health), grey literature, and websites and reports of relevant organizations involved in eye care delivery to identify care models for providing refractive and optical services. Selection criteria We will include all observational and interventional publications, reviews, reports of relevant organizations providing refractive and optical services, published reports, unpublished reports, abstracts, editorials, and comment articles related to delivering refractive services and optical services published within January 2002 to November 2022 for pre-school, school-aged children, and adults in community and primary care settings. Data collection and analysis Two reviewers will screen the titles/abstracts and full texts and carry out data extraction with any discrepancies resolved through discussion. Data syntheses will be conducted, and results will be presented as tables and case studies. This project will be led by the WHO Vision and Eye Care Programme and Cochrane Eyes and Vision. Conclusion The study outcomes will help guide WHO country support approaches to strengthen refractive and optical services at community and primary care levels

Self-directed learning readiness of Indian medical students: a mixed method study

Abstract Background Self-directed learning (SDL) is defined as learning on one’s own initiative, with the learner having primary responsibility for planning, implementing, and evaluating the effort. Medical education institutions promote SDL, since physicians need to be self-directed learners to maintain lifelong learning in the ever-changing world of medicine and to obtain essential knowledge for professional growth. The purpose of the study was to measure the self-directed learning readiness of medical students across the training years, to determine the perceptions of students and faculty on factors that promote and deter SDL and to identify the role of culture and curriculum on SDL at the Christian Medical College, Vellore, India. Methods Guglielmino’s SDL Readiness Scale (SDLRS) was administered in 2015 to six student cohorts (452 students) at admission, end of 1st, 2nd, 3rd and 4th year of training, and at the beginning of internship in the undergraduate medicine (MBBS) program. Analysis of variance (ANOVA) was used to compare SDL scores between years of training. 5 student focus groups and 7 interviews with instructors captured perceptions of self-direction. Transcripts were coded and analyzed thematically. Results The overall mean SDLRS score was 212.91. There was no significant effect of gender and age on SDLR scores. There was a significant drop in SDLRS scores on comparing students at admission with students at subsequent years of training. Qualitative analysis showed the prominent role of culture and curriculum on SDL readiness. Conclusions Given the importance of SDL in medicine, the current curriculum may require an increase in learning activities that promote SDL. Strategies to change the learning environment that facilitates SDL have to be considered