scholarly journals Developing and Evaluating Culturally and Literacy Appropriate Cancer Patient Education Materials for Haiti

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 55s-56s
Author(s):  
Lauren E. Schleimer ◽  
Peter-Gens Desameau ◽  
Ruth Damuse ◽  
Maia Olsen ◽  
Veronica Manzo ◽  
...  
Keyword(s):  
Patient Education ◽  
Focus Group ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Conflicts Of Interest ◽  
Public Awareness ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Setting ◽  
Written Materials

Abstract 21 Background: New efforts are being made to bring modern cancer medicine to patients in low- resource settings, where limited public awareness of cancer and health literacy pose significant challenges. Partners In Health (PIH) launched its first cancer program in Haiti in collaboration with Dana-Farber Cancer Institute and Brigham and Women's Hospital; however, no patient education materials appropriate for Haiti existed. Global Oncology has developed written educational materials based on cancer patient needs in low-resource settings. Objectives are to: 1) Adapt Global Oncology's patient education materials to be culturally and literacy appropriate for Haiti; 2) Assess the effectiveness of written materials for cancer patient education in a low-resource setting. Methods: Feedback from staff at the PIH-affiliated Hôpital Universitaire de Mirebalais (HUM) was incorporated into the pilot materials. We recruited 33 chemotherapy patients at HUM for interviews (n=20) and two focus groups (n=13). Patients were presented the booklet by the Oncology social worker, and pre- and post-counseling tests were administered. Qualitative data regarding booklet design and content was collected through observation of counseling sessions, interview questions and focus group discussions. Providers were surveyed with a questionnaire and proposed modifications to the booklet were discussed during a provider focus group. Results: Patients across all levels of education significantly increased their knowledge from pre-test (m=49.2%, sd= 19.5%) to post-test (m=87.9% sd = 8.9%; t(19)=10.07, p<0.0001). Patients felt reassured by the booklet. Many wanted to share the booklet with family and friends to teach them about cancer. Patients valued hearing about the side effects of chemotherapy and the precautions to take during treatment, but they also wanted more information about the causes of cancer and whether a cure is possible. Providers expressed a desire for the materials to include a definition of palliative versus curative treatment and to improve the explanation of cancer as a disease. Conclusion: Written patient education materials designed for low-resource settings enhance discussions between patients and providers, and can be a tool for disseminating information beyond the hospital to the family, friends and caregivers of cancer patients. Incorporating patient and provider feedback is essential to ensure written materials are culturally and literacy appropriate for the local patient population. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Lauren E. Schleimer No relationship to disclose Peter-Gens Desameau No relationship to disclose Ruth Damuse No relationship to disclose Maia Olsen No relationship to disclose Veronica Manzo No relationship to disclose Rachael Guay No relationship to disclose Ami S. Bhatt No relationship to disclose Carlos Cardenas No relationship to disclose Franklin W. Huang Stock or Other Ownership: GlaxoSmithKline, Abbvie Lawrence N. Shulman No relationship to disclose

scholarly journals Actions of a Brazilian public telehealth service to help coping with the new coronavirus

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L B Silva ◽  
L A P Sousa ◽  
R E Resende ◽  
A A Fortini ◽  
C G Pessoa ◽  
...  
Keyword(s):  
Public Health ◽  
General Population ◽  
Health Professionals ◽  
Large Scale ◽  
Ventilatory Support ◽  
Medical Specialties ◽  
Low Resource Settings ◽  
Low Resource ◽  
Telehealth Service ◽  
Resource Setting

Abstract Background In January/2020 the respiratory disease caused by the new coronavirus was declared as an international public health emergency. In Brazil, until June 22nd there were 1,11 million confirmed cases. In this context, the Telehealth Network of Minas Gerais (TNMG), a large-scale public telehealth service, acted quickly to assist professionals and the population in coping with the disease, mainly in low resource settings. Aim To report the experience of a Brazilian public telehealth service in actions to manage COVID-19 and its impacts. Methods Experience report. Results The TNMG developed 15 infographics and 16 web lectures for health professionals and general population about key themes, such as respiratory syndromes, personal care and ventilatory support. Two of them were live, seen in real time by 13,422 professionals, mainly nurses (63.8%) and doctors (31.1%), from 45 medical specialties (most family physicians-34.0%), in all Brazilian states, especially the Southeast region (58.5%). All lectures were uploaded on TNMG's Youtube channel, each one reaching 5,300 viewers on average. Specific to support health professionals: 2 guidelines were developed - one for primary care units and other to emergency/intensive care; a category for offline (second opinion) teleconsultations was created for doubts about coronavirus; and a list with 39 Frequently Asked Questions (FAQs) was developed. For the general population: 65 FAQs were developed; a health team from a low resource setting was trained to provide online teleconsultations; and a chatbot was released to automatically answer COVID-19 related doubts and/or evaluate a user's health condition, indicating if emergency medical care was needed. All resources are freely available on TNMG's website and on its social networks. Conclusions Telehealth tools had a notable acceptance and were shown to be an effective way to disseminate information for professionals and lay population throughout the country. Key messages Telehealth tools have been proven to be an effective strategy to promote health education, for both professionals and the general population. Telemedicine plays a fundamental role on dealing with public health issues, especially on low resource settings.

scholarly journals Cardiac Specialists’ Perspectives on Barriers to Cardiac Rehabilitation Referral and Participation in a Low-Resource Setting

2020 ◽  
Vol 9 ◽  
pp. 117957272093664
Author(s):  
Mahdieh Ghanbari-Firoozabadi ◽  
Masoud Mirzaei ◽  
Khadijeh Nasiriani ◽  
Mozhgan Hemati ◽  
Jamal Entezari ◽  
...  
Keyword(s):  
Focus Group ◽  
Focus Groups ◽  
Cardiac Rehabilitation ◽  
Cultural Beliefs ◽  
Cultural Factors ◽  
Similar Process ◽  
Patient Factors ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

Background: Cardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively. Aim: This study investigated cardiac specialists’ perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral. Methods: In this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n = 9 and n = 10, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group. Results: Four themes emerged: “physician factors,” “center factors,” “patient factors,” and “cultural factors.” Regarding “physician factors,” most participants mentioned shortage of time. Regarding “center factors,” most participants mentioned poor physician-patient-center coordination. In “patient factors,” the subcategories that arose were socioeconomic challenges and clinical condition of the patients. “Cultural factors” related to lack of belief in behavioral/preventive medicine. Conclusions: Barriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.

scholarly journals Cash transfers may increase the no-show rate for surgical patients in low-resource settings: A randomized trial

2021 ◽  
Author(s):  
Mark G Shrime ◽  
Elizabeth A Harter ◽  
Becky Handforth ◽  
Christine L Phillips ◽  
Hendrika W C Bos ◽  
...  
Keyword(s):  
Conditional Cash Transfer ◽  
Cash Transfers ◽  
Cash Transfer ◽  
Surgical Patients ◽  
Control Group ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Setting ◽  
Transfer Group ◽  
Unconditional Cash Transfer

Background: Over two-thirds of the world's population cannot access surgery when needed. Interventions to address this gap have primarily focused on surgical training and ministry-level surgical planning. However, patients more commonly cite cost--rather than governance or surgeon availability--as their primary access barrier. We undertook a randomized, controlled trial (RCT) to evaluate the effect on compliance with scheduled surgical appointments of addressing this barrier through a cash transfer. Methods: 453 patients who were deemed surgical candidates by a nursing screening team in Guinea, West Africa, were randomized into three study arms: control, conditional cash transfer, and labeled unconditional cash transfer. Arrival to a scheduled surgical appointment was the primary outcome. The study was performed in conjunction with Mercy Ships. Results: The overall no-show rate was five-fold lower in Guinea than previously published estimates, leading to an underpowered study. In a post-hoc analysis, which included non-randomized patients, patients in the control group and the conditional cash transfer group demonstrated no effect from the cash transfer. Patients in the unconditional cash transfer group were significantly less likely to arrive for their scheduled appointment. Subgroup analysis suggested that actual receipt of the unconditional cash transfer, instead of a lapse in the transfer mechanism, was associated with failure to show. Conclusion: We find that cash transfers are feasible for surgical patients in a low-resource setting, but that unconditional transfers may have negative effects on compliance. Although demand-side barriers are large for surgical patients in low-resource settings, interventions to address them must be designed with care.

scholarly journals Depth of Necrosis Using Different Ablation Techniques in Healthy Cervical Tissue

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 4s-5s
Author(s):  
Miriam Cremer ◽  
Karla Alfaro ◽  
Mauricio Maza ◽  
Philip E. Castle ◽  
Albert Zevallos ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Conflicts Of Interest ◽  
Low Cost ◽  
A Priori ◽  
Intraepithelial Neoplasia ◽  
Cost Effective ◽  
Care Providers ◽  
Cervical Tissue ◽  
Low Resource Settings ◽  
Low Resource

Abstract 22 Background: Screening followed by treatment has been a key contributor to the reduction of cervical cancer in industrialized countries and is critical to reduce its burden in low-resource countries. Screening technologies that are appropriate for low-resource settings have advanced considerably; however, treatment technologies have lagged. Treatment methods that are used in developing countries must be low cost, effective, and adaptable for areas with limited infrastructure and health care providers. This study was performed to determine the depth of necrosis in cervical tissue achieved with three treatment devices: conventional cryotherapy with CO2, the CryoPen (CryoPen, Corpus Christi, TX) adapted for low-resource settings, and the thermocoagulator. Methods: One hundred twenty-five women who were scheduled for hysterectomy for indications other than cervical pathology were randomly assigned to one of five treatment arms: single-freeze arms and double-freeze arms for both conventional cryotherapy and the adapted CryoPen, and a single application of thermoablation at 100° C for 40 seconds. Treatment was administered 12 to 24 hours before hysterectomy. Depth of necrosis in cervical specimens was measured by pathologists who were blinded to the treatment modality. Results: A total of 119 women have been enrolled to date, and 114 specimens have been reviewed. Mean depth of necrosis is 5.1 mm (0.9 to 8.5 mm) for single-freeze cryotherapy, 5.6 mm (3.8 to 10.5 mm) for double-freeze cryotherapy, 4.9 mm (3.5 to 8.5 mm) for single-freeze adapted CryoPen; 4.5 mm (3.0 to 7.3 mm) for double-freeze adapted CryoPen, and 3.7 mm (1.9 to 5.5 mm) for the thermoablation ( Table 1 ). Conclusion: The depths of necrosis achieved with the three different ablation modalities are competitive and surpass the targeted depth of 3.5 mm established a priori. Results thus far have demonstrated that devices that are optimized for use in low-resource settings can be as effective as conventional cryotherapy in treating cervical intraepithelial neoplasia. [Table: see text] AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Miriam Cremer Honoraria: Merck Speakers' Bureau: Merck Travel, Accommodations, Expenses: Merck Other Relationship: Basic Health International Karla Alfaro No relationship to disclose Mauricio Maza No relationship to disclose Philip E. Castle No relationship to disclose Albert Zevallos No relationship to disclose Ana Cecilia Diaz de Uriarte No relationship to disclose Manuel Alvarez No relationship to disclose Manuel Salinas No relationship to disclose Ana Sofia Ore No relationship to disclose Luis Taxa No relationship to disclose Juan Felix Expert Testimony: Johnson & Johnson, Philip Morris

scholarly journals Ethical issues raised by cluster randomised trials conducted in low-resource settings: identifying gaps in the Ottawa Statement through an analysis of the PURE Malawi trial

2019 ◽  
Vol 45 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Tiwonge K Mtande ◽  
Charles Weijer ◽  
Mina C Hosseinipour ◽  
Monica Taljaard ◽  
Mitch Matoga ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Health Workers ◽  
National Standards ◽  
Guidance Document ◽  
Randomised Trials ◽  
Low Resource Settings ◽  
Low Resource ◽  
Cluster Randomised Trials ◽  
Cluster Randomised ◽  
Resource Setting

The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomised Trials is the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in the Ottawa Statement relevant to cluster trials conducted in low-resource settings. Our method is (1) to analyse a prototypical cluster trial conducted in a low-resource setting (PURE Malawi trial) with the Ottawa Statement; (2) to identify ethical issues in the design or conduct of the trial not captured adequately and (3) to make recommendations for issues needing attention in forthcoming revisions to the Ottawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of the Ottawa Statement should provide additional guidance on these issues: (1) streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; (2) the classification of lay health workers who deliver study interventions as health providers or research participants; (3) the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; (4) the timing of gatekeeper engagement, particularly when researchers face funding constraints; (5) providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and (6) defining vulnerable participants needing protection in low-resource settings.

Context

2020 ◽  
pp. 1-20
Author(s):  
Tom Bashford ◽  
Julian Gore-Booth ◽  
Jo James ◽  
Stephen Pickering ◽  
Becky Paris ◽  
...  
Keyword(s):  
Local Context ◽  
Technical Aspects ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Clinical Background ◽  
Developmental Principles ◽  
The Way

The chapter provides the reader with information on the non-clinical background to working as an anaesthetist in a low-resource setting. It concentrates on important concepts that should inform the way you practise and teach, rather than technical aspects of anaesthesia. Although technical aspects of delivering anaesthesia are usually uppermost in the minds of anaesthetists new to working in low-resource settings, it is often the case that adapting successfully to the local context proves the more challenging aspect. Topics covered include humanitarian and developmental principles, teaching anaesthesia, looking after your own health, being a good visitor, and how to adapt your practice.

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

2021 ◽  
Vol 6 (6) ◽  
pp. e005190
Author(s):  
Chanel van Zyl ◽  
Marelise Badenhorst ◽  
Susan Hanekom ◽  
Martin Heine
Keyword(s):  
Content Analysis ◽  
Scoping Review ◽  
Qualitative Content Analysis ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low Middle Income Countries

IntroductionThe 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.MethodsA 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.ResultsA 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.ConclusionThe 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.

scholarly journals Outcomes of Treatment With CHOP and EPOCH in Patients With HIV Associated NHL in a Low Resource Setting

2020 ◽  
Author(s):  
Clement Dove Okello ◽  
Abrahams Omoding ◽  
Henry Ddungu ◽  
Yusuf Mulumba ◽  
Jackson Orem
Keyword(s):  
Retrospective Study ◽  
Adverse Events ◽  
Overall Response Rate ◽  
Survival Rates ◽  
Curative Intent ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
One Year

Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done. Results: One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5-24.9 kg/m2, (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP=13, 12%; DA-EPOCH=2, 17%), anaemia (CHOP=12, 12%; DA-EPOCH=1, 8%), thrombocytopenia (CHOP=7, 6%; DA-EPOCH=0), sepsis (CHOP=1), treatment related death (DA-EPOCH=1) and hepatic encephalopathy (CHOP=1). Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with >50% one year survival.

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