scholarly journals Iterative Adaptation of a Tuberculosis Digital Medication Adherence Technology to Meet User Needs: Qualitative Study of Patients and Health Care Providers Using Human-Centered Design Methods (Preprint)

2020 ◽  
Author(s):  
Devika Patel ◽  
Christopher Allen Berger ◽  
Alex Kityamuwesi ◽  
Joseph Ggita ◽  
Lynn Kunihira Tinka ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Treatment Outcomes ◽  
Health Care Providers ◽  
Design Methodology ◽  
Health Workers ◽  
Design Principles ◽  
User Needs ◽  
Local Health ◽  
Care Providers ◽  
Human Centered Design

BACKGROUND Digital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes. OBJECTIVE This study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase. METHODS 99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration. RESULTS The 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable. CONCLUSIONS We demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes.

scholarly journals Iterative Adaptation of a Tuberculosis Digital Medication Adherence Technology to Meet User Needs: Qualitative Study of Patients and Health Care Providers Using Human-Centered Design Methods

10.2196/19270 ◽  
2020 ◽  
Vol 4 (12) ◽  
pp. e19270
Author(s):  
Devika Patel ◽  
Christopher Allen Berger ◽  
Alex Kityamuwesi ◽  
Joseph Ggita ◽  
Lynn Kunihira Tinka ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Treatment Outcomes ◽  
Health Care Providers ◽  
Design Methodology ◽  
Health Workers ◽  
Design Principles ◽  
User Needs ◽  
Local Health ◽  
Care Providers ◽  
Human Centered Design

Background Digital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes. Objective This study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase. Methods 99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration. Results The 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable. Conclusions We demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes.

The Materiality of Care and Nurses’ “Attitude Problem”

2017 ◽  
Vol 43 (2) ◽  
pp. 270-301 ◽  
Author(s):  
Josiane Carine Tantchou
Keyword(s):  
Health Systems ◽  
Health Care Providers ◽  
Health Workers ◽  
Continuous Process ◽  
Local Health ◽  
Care Providers ◽  
Resource Limited ◽  
Health Initiatives ◽  
Nurses Attitude ◽  
The Impact

Health systems in Africa have been widely studied in the social sciences. Several aspects have been addressed in particular: the provision of and access to care, working conditions, the human resources crisis, and patient–provider relations, for example. In this respect, the idea of an “attitude problem,” with health-care providers offering different services for different patients, has been suggested. Recently, researchers have studied the impact of global health initiatives on local health systems, mainly in the fight against HIV/AIDS. Others have explored why some health issues have attracted more attention than others. Despite this wealth of studies, one point remains insufficiently addressed: the materiality of care and its impact on interactions (human and nonhuman) within hospital settings. In this article, I consider the heuristic value of the uses of a maternity ward in a resource-limited country (Cameroon) to understand health workers’ so-called attitude problem, specifically, the tension characteristic of patient–provider interactions. I suggest that this tension is related to a continuous process of translation and anticipation to adapt the maternity ward’s space to everyday activities. Drawing on Akrich’s description of technical objects, and Lussault’s pragmatics of space, I attempt to show that in this context, care is also an art of tinkering with unpredictable bodies in unstable hospitals’ spaces.

scholarly journals Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Maria Jennings ◽  
Joanna Morrison ◽  
Kohenour Akter ◽  
Hassan Haghparast-Bidgoli ◽  
Carina King ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Care Providers ◽  
Low Income ◽  
Diabetes Management ◽  
Local Health ◽  
Care Seeking ◽  
Care Providers ◽  
Structured Interviews ◽  
Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

scholarly journals Brazil’s Community Health Workers Practicing Narrative Medicine: Patients’ Perspectives

2021 ◽  
Author(s):  
Rogério Meireles Pinto ◽  
Rahbel Rahman ◽  
Margareth Santos Zanchetta ◽  
W. Galhego-Garcia
Keyword(s):  
Health Care ◽  
Community Health ◽  
Community Health Workers ◽  
Health Care Providers ◽  
Health Workers ◽  
Hybrid Approach ◽  
Narrative Medicine ◽  
Structured Interview ◽  
Patient Perspectives ◽  
Care Providers

Abstract Background Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. Objective To document how CHWs apply specific NM concepts in Brazil’s Family Health Strategy (FHS), the key component of Brazil’s Unified Health System. Design We used a semi-structured interview, grounded in Charon’s (2001) framework, including four types of NM relationships: provider–patient, provider–colleague, provider–society, and provider–self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. Key Results Sample: 18 females; 13 White, 12 “Pardo” (mixed races), 12 Black. We found: (1) provider–patient relationship—CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider–colleague relationship—CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider–society relationship—CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider–self relationship—patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. Conclusion This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider–colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider–self relationship. Public education on CHWs’ roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs’ personality traits may influence their ability to apply NM.

scholarly journals A Qualitative Study Exploring the Experiences and Perspectives of Australian Aboriginal Women on Oral Health during Pregnancy

2021 ◽  
Vol 18 (15) ◽  
pp. 8061
Author(s):  
Ariana Kong ◽  
Michelle Dickson ◽  
Lucie Ramjan ◽  
Mariana S. Sousa ◽  
Joanne Goulding ◽  
...  
Keyword(s):  
Oral Health ◽  
Health Care Providers ◽  
Torres Strait Islander ◽  
Health Workers ◽  
Healthcare Providers ◽  
Aboriginal Health ◽  
Health Staff ◽  
Care Providers ◽  
Aboriginal Women ◽  
Torres Strait

The aim of this study was to explore whether oral health was an important consideration for Aboriginal and Torres Strait Islander women during pregnancy, whether oral health could be promoted by Aboriginal health staff, and strategies that would be appropriate to use in a new model of care. A qualitative descriptive methodology underpinned the study. All participants in this study identified as Aboriginal, with no Torres Strait Islander participants, and were from New South Wales, Australia. The interviews were analysed using inductive thematic analysis. From the data, two themes were constructed. The first theme identified that oral health was not always the first priority for participants as poor accessibility alongside other competing commitments were challenges to accessing oral health services. The second theme highlighted how relationships with personal networks and healthcare providers were essential and could be used to support maternal oral health during pregnancy. Effective strategies to promote oral health during pregnancy for Aboriginal and Torres Strait Islander women should involve key stakeholders and health care providers, like Aboriginal Health Workers, to facilitate culturally safe support and tailored oral health advice.

Creating Academic and Health Care Partnerships that Impact Public Health

2015 ◽  
Vol 4 (4) ◽  
pp. 378-384
Author(s):  
Peter W. Grandjean ◽  
Burritt W. Hess ◽  
Nicholas Schwedock ◽  
Jackson O. Griggs ◽  
Paul M. Gordon
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Professional Training ◽  
Local Health ◽  
Care Providers ◽  
Research Partnerships ◽  
Local Health Care ◽  
Training Community ◽  
The University

Kinesiology programs are well positioned to create and develop partnerships within the university, with local health care providers, and with the community to integrate and enhance the activities of professional training, community service, public health outreach, and collaborative research. Partnerships with medical and health care organizations may be structured to fulfill accreditation standards and the objectives of the “Exercise is Medicine®” initiative to improve public health through primary prevention. Barriers of scale, location, time, human resources, and funding can be overcome so all stakeholder benefits are much greater than the costs.

Training health workers to provide person-centred maternal and newborn health care in Burkina Faso

2013 ◽  
Vol 3 (2) ◽  
pp. 154-159
Author(s):  
Janet Perkins ◽  
Aminata Bargo ◽  
Cecilia Capello ◽  
Carlo Santarelli
Keyword(s):  
Health Care ◽  
Burkina Faso ◽  
Health Care Providers ◽  
Health Workers ◽  
Healthcare Providers ◽  
Newborn Health ◽  
World Health ◽  
Maternal And Newborn Health ◽  
Care Providers ◽  
Maternal And Newborn

Assuring the provision of person-centred care is critical in maternal and newborn health (MNH). As a component of the national strategy to improve MNH, Burkina Faso Ministry of Health, supported by Enfants du Monde, La Fondation pour le Développement Communautaire/Burkina Faso and UNFPA, is implementing the World Health Organization’s (WHO) framework for Working with Individuals, Families and Communities (IFC) to improve MNH. As a first step in district implementation, participatory community assessments were conducted. These assessments consistently revealed that poor interactions with healthcare providers posed one important barrier preventing women from seeking MNH services. In order to address this barrier, healthcare providers were trained to improve their interpersonal skills and in counselling women. During 2011-12 a total of 175 personnel were trained over a 5-day course developed using a WHO manual. The course was met with enthusiasm as providers expressed their need and desire for such training. Immediate post-test results revealed an impressive increase in knowledge and anecdotal evidence suggests that training has influenced provider’s behaviours in their interactions with women. In addition, health care providers are taking concrete action to build the capabilities of women to experience pregnancy and birth safely by engaging directly with communities.  While early findings are promising, an evaluation will be necessary to measure how the training has influenced practices, whether this translates into a shift of perceptions at community level and ultimately its contribution toward promoting person-centred care in Burkina Faso.

Social media as a platform for information and support for coronavirus: analysis ofCOVID-19 Facebook groups

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Hossein Motahari-Nezhad ◽  
Maryam Shekofteh ◽  
Maryam Andalib-Kondori
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Design Methodology ◽  
Information Needs ◽  
Descriptive Statistics ◽  
Public Knowledge ◽  
Care Providers ◽  
Analysis Method ◽  
Content Type ◽  
Content Analysis Method

Purpose This study aims to investigate the characteristics, as well as the purpose and posts of the COVID-19 Facebook groups. Design/methodology/approach A systematic search for COVID-19 Facebook groups was conducted on June 1, 2020. Characteristics of the groups were examined using descriptive statistics. Mann-Whitney test was used to study the differences between groups. The study of the most popular groups’ posts was also carried out using the content analysis method. Findings The groups had a combined membership of 2,729,061 users. A total of 147,885 posts were received. There were about approximately 60% public groups. A high percentage of the groups (86.5%) had descriptions. The results showed a significant relationship between the groups’ description status and the number of members (p-value = 0.016). The majority of COVID-19 Facebook groups (56%) were created to meet their members’ information needs. The highest number of studied posts were related to vaccination (35.2%), followed by curfew rules (19.6%) and symptoms (10.6%). Originality/value Translating these insights into policies and practices will put policymakers and health-care providers in a stronger position to make better use of Facebook groups to support and enhance public knowledge about COVID-19.

scholarly journals Knowledge and attitudes of tuberculosis management in San Juan de Lurigancho district of Lima, Peru

2009 ◽  
Vol 3 (10) ◽  
pp. 783-788 ◽  
Author(s):  
Elizabeth M. Kiefer ◽  
Theresa Shao ◽  
Olveen Carrasquillo ◽  
Pamela Nabeta ◽  
Carlos Seas
Keyword(s):  
Health Care ◽  
Community Health ◽  
Community Health Workers ◽  
Health Care Providers ◽  
Health Workers ◽  
Knowledge Score ◽  
San Juan ◽  
Care Providers ◽  
Knowledge Gaps ◽  
Knowledge And Attitudes

Background: Expansion of the health care workforce in Peru to combat tuberculosis (TB) includes both professional health care providers (HCPs) such as doctors and nurses, and non-professional HCPs such as community health workers (CHWs). We describe the knowledge and attitudes of these HCPs, and identify modifiable barriers to appropriate anti-tuberculosis treatment.  Methodology: We surveyed HCPs practicing in 30 clinical settings (hospitals, community health centers, and health posts) in the San Juan de Lurigancho district of Eastern Lima, Peru. Multiple-choice questions were used to assess knowledge of TB. A five-item Likert scale was created to assess attitudes toward the community, patients, and clinics. Linear regression was used to identify predictors of mean knowledge score, and analysis of variance was used to test differences in HCP score.  Results: Of the 73 HCPs surveyed, 15% were professionals (doctors or nurses). The remaining 85% were health technicians, community health workers (CHWs) or students. The mean knowledge score was 10.0 ± 1.9 (maximum 14) with professional HCPs scoring higher than other HCPs (11.7 ± 1.1 vs. 9.7 ± 1.9), p < .01). Knowledge gaps included identification of patients at high risk for TB, assessment of treatment outcomes, and consequences of treatment failure. The most commonly cited modifiable barriers were structural, including laboratory facilities and staffing of TB clinics, with 52.1% and 62.5% of HCPs, respectively, citing these as problematic.  Conclusions: Efforts to improve knowledge of TB HCPs in Peru should focus on the specific gaps we have identified. Further research is needed to evaluate whether these knowledge gaps correlate with TB control.     

scholarly journals Generating Evidence From Contextual Clinical Research in Low- to Middle Income Countries: A Roadmap Based on Theory of Change

2021 ◽  
Vol 9 ◽  
Author(s):  
Babar S. Hasan ◽  
Muneera A. Rasheed ◽  
Asra Wahid ◽  
Raman Krishna Kumar ◽  
Liesl Zuhlke
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Theory Of Change ◽  
Health Priorities ◽  
Global Health Research ◽  
Local Health ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Ministries

Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low and Middle-Income Countries (LMICs). If diagnosed and managed in a timely manner, as in high-income countries (HICs), most children lead a healthy life and achieve adulthood. However, children with CHD in LMICs have limited care available with subsequent impact on survival. The large disparity in global health research focus on this complex disease makes it a solid paradigm to shape the debate. Despite many challenges, an essential aspect of improving research in LMICs is the realization and ownership of the problem around paucity of local evidence by patients, health care providers, academic centers, and governments in these countries. We have created a theory of change model to address these challenges at a micro- (individual patient or physician or institutions delivering health care) and a macro- (government and health ministries) level, presenting suggested solutions for these complex problems. All stakeholders in the society, from government bodies, health ministries, and systems, to frontline healthcare workers and patients, need to be invested in addressing the local health problems and significantly increase data to define and improve the gaps in care in LMICs. Moreover, interventions can be designed for a more collaborative and effective HIC-LMIC and LMIC-LMIC partnership to increase resources, capacity building, and representation for long-term productivity.

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