@Article{info:doi/10.2196/64131,
author="Dougherty, Kylie
and Tesfaye, Yihenew
and Biza, Heran
and Belew, Mulusew
and Benda, Natalie
and Gebremariam Gobezayehu, Abebe
and Cranmer, John
and Bakken, Suzanne",
title="User-Centered Design of an Electronic Dashboard for Monitoring Facility-Level Basic Emergency Obstetric Care Readiness in Amhara, Ethiopia: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="3",
volume="12",
pages="e64131",
keywords="health information technology",
keywords="design and evaluation",
keywords="Ethiopia",
keywords="usability",
keywords="nursing informatics",
keywords="user-centered design",
keywords="basic emergency obstetric care",
keywords="obstetric",
keywords="nurse",
keywords="user-centered",
keywords="design",
keywords="maternal mortality",
keywords="maternal",
keywords="develop",
keywords="sub-Saharan Africa",
keywords="Africa",
keywords="dashboard",
keywords="tracking",
keywords="emergency care",
abstract="Background: Maternal mortality remains a persistent public health concern in sub-Saharan African countries such as Ethiopia. Health information technology solutions are a flexible and low-cost method for improving health outcomes with proven benefits in low- to middle-income countries' health systems. Objective: This study aimed to develop and assess the usability of an electronic dashboard to monitor facility-level readiness to manage basic emergency obstetric care (BEmOC) in Amhara, Ethiopia. Methods: The study used three methods to iteratively refine the dashboard: (1) user-centered design sessions with individuals who interact with the BEmOC supply chain, (2) review and feedback from domain and information visualization subject matter experts (SMEs) to refine the dashboard, and (3) usability heuristic evaluation with human-computer interaction (HCI) SMEs. Results: User-centered design sessions resulted in a preliminary version of the dashboard informed by end-user preferences and perceptions, with recommendations focusing on aesthetic design, filtering and sorting, and matching with the real world. An example of an end-user recommendation included increasing font sizes on the dashboard and using a red, yellow, and green color-coding scheme. Next, domain and visualization SMEs continued the dashboard's iterative refinement, focusing on aesthetic design and navigation, by confirming design choices incorporated from the user-centered design sessions and recommending changes to enhance user experience moving through the dashboard, such as adding more filtering options. HCI SMEs rated the dashboard as highly usable (0.82 on a scale of 0-4, with 0 being no usability concern and 4 being a catastrophic usability concern). The principle with the highest usability severity scores was a match between the system and the real world with a score of 1.4. The HCI SMEs also rated the information visualization aspects of the dashboard favorably with 2 usability principles, spatial organization and information coding, scoring 0. Conclusions: Dashboards are a novel method for promoting and tracking facility capacity to manage BEmOC. By including targeted end users and SMEs in the design process, the team was able to tailor the dashboard to meet user needs, fit it into the existing government health systems, and ensure that the dashboard follows design best practices. Collectively, the novel, customized BEmOC dashboard can be used to track and improve facility-level readiness in Amhara, Ethiopia, and similar global BEmOC facilities. ",
doi="10.2196/64131",
url="https://humanfactors.jmir.org/2025/1/e64131"
}


@Article{info:doi/10.2196/63482,
author="Yew, Qian Sheng
and Trivedi, Daksha
and Adanan, Hafizah Nurul Iman
and Chew, How Boon",
title="Facilitators and Barriers to the Implementation of Digital Health Technologies in Hospital Settings in Lower- and Middle-Income Countries Since the Onset of the COVID-19 Pandemic: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="6",
volume="27",
pages="e63482",
keywords="digital health implementation",
keywords="facilitators",
keywords="barriers",
keywords="digital health classification framework",
keywords="lower- and middle-income countries",
abstract="Background: Although the implementation process of digital health technologies (DHTs) has been extensively documented in high-income countries, the factors that facilitate and prevent their implementation in lower- and middle-income countries (LMICs) may differ for various reasons. Objective: To address this gap in research, this scoping review aims to determine the facilitators and barriers to implementing DHTs in LMIC hospital settings following the onset of the COVID-19 pandemic. Additionally, the review outlined the types of DHTs that have been implemented in LMICs' hospitals during this pandemic and finally developed a classification framework to categorize the landscape of DHTs. Methods: Systematic searches were conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from March 2020 to December 2023. We extracted data on authors, publication years, study objectives, study countries, disease conditions, types of DHTs, fields of clinical medicine where the DHTs are applied, study designs, sample sizes, characteristics of the study population, study location, and data collection methods of the included studies. Both quantitative and qualitative data were utilized to conduct a thematic analysis, using a deductive method based on the Practical, Robust Implementation and Sustainability Model (PRISM), to identify facilitators and barriers to DHT implementation. Finally, all accessible DHTs were identified and organized to create a novel classification framework. Results: Twelve studies were included from 292 retrieved articles. Telemedicine (n=5) was the most commonly used DHT in LMICs' hospitals, followed by hospital information systems (n=4), electronic medical records (n=2), and mobile health (n=1). These 4 DHTs, among the other existing DHTs, allowed us to develop a novel classification framework for DHTs. The included studies used qualitative methods (n=4), which included interviews and focus groups, quantitative methods (n=5), or a combination of both (n=2). Among the 64 facilitators of DHT implementation, the availability of continuous on-the-job training (n=3), the ability of DHTs to prevent cross-infection (n=2), and positive previous experiences using DHTs (n=2) were the top 3 reported facilitators. However, of the 44 barriers to DHT implementation, patients with poor digital literacy and skills in DHTs (n=3), inadequate awareness regarding DHTs among health care professionals and stakeholders (n=2), and concerns regarding the accuracy of disease diagnosis and treatment through DHTs (n=2) were commonly reported. Conclusions: In the postpandemic era, telemedicine, along with other DHTs, has seen increased implementation in hospitals within LMICs. All facilitators and barriers can be categorized into 6 themes, namely, (1) Aspects of the Health Care System; (2) Perspectives of Patients; (3) External Environment; (4) Implementation of Sustainable Infrastructure; (5) Characteristics of Health Care Organization; and (6) Characteristics of Patients. ",
doi="10.2196/63482",
url="https://www.jmir.org/2025/1/e63482",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053793"
}


@Article{info:doi/10.2196/68720,
author="Hu, Songbo
and Oppong, Abigail
and Mogo, Ebele
and Collins, Charlotte
and Occhini, Giulia
and Barford, Anna
and Korhonen, Anna",
title="Natural Language Processing Technologies for Public Health in Africa: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="5",
volume="27",
pages="e68720",
keywords="public health",
keywords="global health",
keywords="health promotion",
keywords="essential public health functions",
keywords="Africa",
keywords="natural language processing",
keywords="artificial intelligence",
keywords="machine learning",
keywords="technology",
keywords="mobile phone",
abstract="Background: Natural language processing (NLP) has the potential to promote public health. However, applying these technologies in African health systems faces challenges, including limited digital and computational resources to support the continent's diverse languages and needs. Objective: This scoping review maps the evidence on NLP technologies for public health in Africa, addressing the following research questions: (1) What public health needs are being addressed by NLP technologies in Africa, and what unmet needs remain? (2) What factors influence the availability of public health NLP technologies across African countries and languages? (3) What stages of deployment have these technologies reached, and to what extent have they been integrated into health systems? (4) What measurable impact has these technologies had on public health outcomes, where such data are available? (5) What recommendations have been proposed to enhance the quality, cost, and accessibility of health-related NLP technologies in Africa? Methods: This scoping review includes academic studies published between January 1, 2013, and October 3, 2024. A systematic search was conducted across databases, including MEDLINE via PubMed, ACL Anthology, Scopus, IEEE Xplore, and ACM Digital Library, supplemented by gray literature searches. Data were extracted and the NLP technology functions were mapped to the World Health Organization's list of essential public health functions and the United Nations' sustainable development goals (SDGs). The extracted data were analyzed to identify trends, gaps, and areas for future research. This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines, and its protocol is publicly available. Results: Of 2186 citations screened, 54 studies were included. While existing NLP technologies support a subset of essential public health functions and SDGs, language coverage remains uneven, with limited support for widely spoken African languages, such as Kiswahili, Yoruba, Igbo, and Zulu, and no support for most of Africa's >2000 languages. Most technologies are in prototyping phases, with only one fully deployed chatbot addressing vaccine hesitancy. Evidence of measurable impact is limited, with 15\% (8/54) studies attempting health-related evaluations and 4\% (2/54) demonstrating positive public health outcomes, including improved participants' mood and increased vaccine intentions. Recommendations include expanding language coverage, targeting local health needs, enhancing trust, integrating solutions into health systems, and adopting participatory design approaches. The gray literature reveals industry- and nongovernmental organizations--led projects focused on deployable NLP applications. However, these projects tend to support only a few major languages and specific use cases, indicating a narrower scope than academic research. Conclusions: Despite growth in NLP research for public health, major gaps remain in deployment, linguistic inclusivity, and health outcome evaluation. Future research should prioritize cross-sectoral and needs-based approaches that engage local communities, align with African health systems, and incorporate rigorous evaluations to enhance public health outcomes. International Registered Report Identifier (IRRID): RR2-doi:10.1101/2024.07.02.24309815 ",
doi="10.2196/68720",
url="https://www.jmir.org/2025/1/e68720",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053738"
}


@Article{info:doi/10.2196/60811,
author="Franke, Anna Mara
and Neumann, Anne
and Nordmann, Kim
and Suleymanova, Daniela
and Ravololohanitra, Gabrielle Onja
and Emmrich, Valentin Julius
and Knauss, Samuel",
title="Impact of a Mobile Money--Based Conditional Cash Transfer Intervention on Health Care Utilization in Southern Madagascar: Mixed-Methods Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Mar",
day="3",
volume="13",
pages="e60811",
keywords="cash transfer intervention",
keywords="Madagascar",
keywords="Sub-Saharan Africa",
keywords="health care utilization",
keywords="humanitarian assistance",
keywords="Africa",
keywords="mobile",
keywords="mixed methods study",
keywords="money",
keywords="quantitative",
keywords="qualitative",
keywords="thematic analysis",
keywords="policy",
keywords="service",
keywords="delivery",
keywords="health care system",
keywords="cash",
keywords="economic",
keywords="financial",
keywords="payment",
keywords="time series",
abstract="Background: Mobile money--based cash transfer interventions are becoming increasingly utilized, especially in humanitarian settings. southern Madagascar faced a humanitarian emergency in 2021-2022, when the second wave of the COVID-19 pandemic and a severe famine affected the fragile region simultaneously. Objective: This mixed-methods study aims to analyze the impact and factors influencing the success of a mobile money--based conditional cash transfer intervention for health care utilization at 4 primary and 11 secondary facilities in Madagascar. Methods: We obtained quantitative data from 11 facility registers, detailing patient numbers per month, categorized into maternity care, surgical care, pediatric care, outpatient care, and inpatient care. An interrupted time series analysis, without a control group, was conducted using the end of the intervention in July 2022 as the cut off point. For qualitative data, 64 in-depth interviews were conducted with health care providers, NGO staff, policymakers, beneficiaries, and nonbeneficiaries of the intervention, and was interpreted by 4 independent researchers using reflexive thematic analysis to identify facilitators and barriers to implementation. Results: The interrupted time series analysis showed a significant negative impact on health care utilization, indicating a reduction in health care--seeking behavior after the end of the cash transfer intervention. The effect was stronger in the slope change of patient numbers per month (defined as P<.05), which significantly decreased in 39 of 55 (70\%) models compared to the step change at the end of the intervention, which showed a significant but lower change (P <.05) in 40\% (22/55) of models. The changes were most pronounced in surgical and pediatric care. The key factors that influenced the success of the implementation were grouped across three levels. At the community level, outreach conducted to inform potential beneficiaries about the project by community health workers and using the radio was a decisive factor for success. At participating facilities, high intrinsic staff motivation and strong digital literacy among facility staff positively influenced the intervention. Confusion regarding previous activities by the same implementing NGO and perceptions of unfair bonus payments for health care providers included in the project negatively affected the intervention. Finally, at the NGO-level, the staff present at each facility and the speed and efficiency of administrative processes during the intervention were decisive factors that influenced the intervention. Conclusions: The conditional cash transfer intervention was overarchingly successful in increasing health care utilization in southern Madagascar in a humanitarian setting. However, this success was conditional on key implementation factors at the community, facility, and NGO levels. In the future, similar interventions should proactively consider the key factors identified in this study to optimize the impact. ",
doi="10.2196/60811",
url="https://mhealth.jmir.org/2025/1/e60811"
}


@Article{info:doi/10.2196/58841,
author="Cyuzuzo, Callixte
and Dukuzimana, Josee Marie
and Muhire, Clement
and Sheldon Ames, Mathew
and Ngwakongnwi, Emmanuel",
title="Challenges to Rehabilitation Services in Sub-Saharan Africa From a User, Health System, and Service Provider Perspective: Scoping Review",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="28",
volume="12",
pages="e58841",
keywords="challenges",
keywords="users",
keywords="health system",
keywords="service providers",
keywords="Sub-Saharan Africa",
keywords="scoping review",
keywords="rehabilitation service",
abstract="Background: Rehabilitation aims to restore and optimize the functioning of impaired systems for people with disabilities. It is an integral part of universal health coverage, and access to it is a human right. Objective: We aimed to identify the key challenges to rehabilitation services in Sub-Saharan Africa from a user, health system, and service provider perspective. Methods: This scoping review was conducted in accordance with the 5-stage framework proposed by Arksey and O'Malley. A comprehensive electronic search was run to identify published articles on rehabilitation services in Sub-Saharan Africa. Of the 131 articles retrieved, 83 articles were assessed for eligibility and 15 papers that met the inclusion criteria were considered. Results: The results show that people with disabilities in Sub-Saharan Africa face multifactorial challenges to access rehabilitation services. Poor access to rehabilitation services is associated with less attention given to rehabilitation by governments, which leads to less funding, negative cultural and social beliefs, fewer rehabilitation centers, poorly equipped rehabilitation units, failure of health systems, lack of training to rehabilitation practitioners, and logistical and financial constraints. This review also reveals that digital rehabilitation reduces costs and improves access to services in hard-to-reach geographical areas. However, digital rehabilitation faces challenges as well, including connectivity issues, inaccessibility to technology, a lack of technical knowledge, a lack of privacy, and ethical concerns. Conclusions: People with disabilities face multifactorial challenges to access rehabilitation services in Sub-Saharan Africa. It is therefore critical to address these challenges to optimize patients' health outcomes and offer better rehabilitation services. ",
doi="10.2196/58841",
url="https://humanfactors.jmir.org/2025/1/e58841"
}


@Article{info:doi/10.2196/58858,
author="Muliokela, K. Rosemary
and Banda, Kuwani
and Hussen, Mohammed Abdulaziz
and Malumo, Bvulani Sarai
and Kashoka, Andrew
and Mwiche, Angel
and Chiboma, Innocent
and Barreix, Maria
and Nyirenda, Muyereka
and Sithole, Zvanaka
and Ratanaprayul, Natschja
and Endehabtu, Fikadie Berhanu
and Telake, Abayneh Hanna
and Weldeab, Adane
and Probert, M. William J.
and Tun{\c{c}}alp, ?zge
and Maya, Ernest
and Woldetsadik, Mulatu
and Tilahun, Binyam
and Guure, Chris
and Senya, Kafui
and Say, Lale
and Tamrat, Tigest",
title="Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned",
journal="JMIR Med Inform",
year="2025",
month="Feb",
day="7",
volume="13",
pages="e58858",
keywords="guidelines",
keywords="reproductive health",
keywords="maternal health",
keywords="antenatal care",
keywords="clinical decision support",
keywords="clinical decision support systems",
keywords="digital health",
keywords="HIV/AIDS",
keywords="family planning",
keywords="electronic medical records",
keywords="electronic health record",
keywords="standards",
keywords="interoperability",
keywords="system uptake",
keywords="digital health governance",
abstract="Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts. Objective: This paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs. Methods: A DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings. Implementation (Results): Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health. Conclusions: Country experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact. ",
doi="10.2196/58858",
url="https://medinform.jmir.org/2025/1/e58858"
}


@Article{info:doi/10.2196/58338,
author="Kaushik, Aprajita
and Barcellona, Capucine
and Mandyam, Kanumoory Nikita
and Tan, Ying Si
and Tromp, Jasper",
title="Challenges and Opportunities for Data Sharing Related to Artificial Intelligence Tools in Health Care in Low- and Middle-Income Countries: Systematic Review and Case Study From Thailand",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="4",
volume="27",
pages="e58338",
keywords="artificial intelligence",
keywords="data sharing",
keywords="health care",
keywords="low- and middle-income countries",
keywords="AI tools",
keywords="systematic review",
keywords="case study",
keywords="Thailand",
keywords="computing machinery",
keywords="academic experts",
keywords="technology developers",
keywords="health care providers",
keywords="internet connectivity",
keywords="data systems",
keywords="low health data literacy",
keywords="cybersecurity",
keywords="standardized data formats",
keywords="AI development",
keywords="PRISMA",
abstract="Background: Health care systems in low- and middle-income countries (LMICs) can greatly benefit from artificial intelligence (AI) interventions in various use cases such as diagnostics, treatment, and public health monitoring but face significant challenges in sharing data for developing and deploying AI in health care. Objective: This study aimed to identify barriers and enablers to data sharing for AI in health care in LMICs and to test the relevance of these in a local context. Methods: First, we conducted a systematic literature search using PubMed, SCOPUS, Embase, Web of Science, and ACM using controlled vocabulary. Primary research studies, perspectives, policy landscape analyses, and commentaries performed in or involving an LMIC context were included. Studies that lacked a clear connection to health information exchange systems or were not reported in English were excluded from the review. Two reviewers independently screened titles and abstracts of the included articles and critically appraised each study. All identified barriers and enablers were classified according to 7 categories as per the predefined framework---technical, motivational, economic, political, legal and policy, ethical, social, organisational, and managerial. Second, we tested the local relevance of barriers and enablers in Thailand through stakeholder interviews with 15 academic experts, technology developers, regulators, policy makers, and health care providers. The interviewers took notes and analyzed data using framework analysis. Coding procedures were standardized to enhance the reliability of our approach. Coded data were reverified and themes were readjusted where necessary to avoid researcher bias. Results: We identified 22 studies, the majority of which were conducted across Africa (n=12, 55\%) and Asia (n=6, 27\%). The most important data-sharing challenges were unreliable internet connectivity, lack of equipment, poor staff and management motivation, uneven resource distribution, and ethical concerns. Possible solutions included improving IT infrastructure, enhancing funding, introducing user-friendly software, and incentivizing health care organizations and personnel to share data for AI-related tools. In Thailand, inconsistent data systems, limited staff time, low health data literacy, complex and unclear policies, and cybersecurity issues were important data-sharing challenges. Key solutions included building a conducive digital ecosystem---having shared data input platforms for health facilities to ensure data uniformity and to develop easy-to-understand consent forms, having standardized guidelines for data sharing, and having compensation policies for data breach victims. Conclusions: Although AI in LMICs has the potential to overcome health inequalities, these countries face technical, political, legal, policy, and organizational barriers to sharing data, which impede effective AI development and deployment. When tested in a local context, most of these barriers were relevant. Although our findings might not be generalizable to other contexts, this study can be used by LMICs as a framework to identify barriers and strengths within their health care systems and devise localized solutions for enhanced data sharing. Trial Registration: PROSPERO CRD42022360644; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=360644 ",
doi="10.2196/58338",
url="https://www.jmir.org/2025/1/e58338"
}


@Article{info:doi/10.2196/60843,
author="Kizito, Michael
and Mugabi, Nabunjo Erina
and Ford, Sabrina
and Holtz, Bree
and Hirko, Kelly",
title="Characterizing Telehealth Barriers and Preferences to Promote Acceptable Implementation Strategies in Central Uganda: Multilevel Formative Evaluation",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="23",
volume="9",
pages="e60843",
keywords="telehealth",
keywords="telemedicine",
keywords="health care",
keywords="disparities",
keywords="technology",
keywords="barriers",
keywords="resource-limited",
keywords="preferences",
keywords="Uganda",
keywords="Africa",
keywords="barrier",
keywords="formative evaluation",
keywords="health service provider",
keywords="primary care",
keywords="satisfaction",
keywords="Sub-Saharan Africa",
keywords="survey",
keywords="utility",
abstract="Background: Telehealth approaches can address health care access barriers and improve care delivery in resource-limited settings around the globe. Yet, telehealth adoption in Africa has been limited, due in part to an insufficient understanding of effective strategies for implementation. Objective: This study aimed to conduct a multi-level formative evaluation identifying barriers and facilitators for implementing telehealth among health service providers and patients in Central Uganda. Methods: We collected surveys characterizing telehealth perceptions, barriers, and preferences from health care providers and patients seeking primary care in the Central Region of Uganda from January 2022 to July 2022. Survey development was informed by the technology acceptance model and evaluated predictors of technology acceptance (ie, perceived usefulness, ease of use, and attitudes). We used descriptive statistics to characterize telehealth perceptions and examined differences according to provider and patient characteristics using Student t tests. Results: Nearly 79\% (n=48) of 61 providers surveyed had used telehealth, and perceptions were generally favorable. While 93.4\% (n=57) reported that telehealth adds value to clinical practice, less than half (n=30, 49.2\%) felt telehealth was more efficient than in-person visits. Provider-reported barriers to telehealth included technology challenges for the patient (34/132, 26\%), low patient engagement (25/132, 19\%), and lack of implementation support (24/132, 18\%). Telehealth use was lower among the 91 surveyed patients, with only 19.8\% (n=18) having used telehealth. Although 89\% (n=81) of patients reported saving time with telehealth approaches, 33.3\% (n=30) of patients reported that telehealth made them feel uncomfortable, and 43.8\% (n=39) reported concerns about confidentiality. Over 72\% (n=66) of patients who had used telehealth previously reported satisfaction with the telehealth services they received. Several differences in perceptions of telehealth according to patient's self-reported health status were observed. Conclusions: Perceptions of telehealth were generally favorable, although higher among providers than patients. Barriers impeding telehealth use include technology challenges and the lack of infrastructure and implementation support. Findings from this study can inform the implementation of acceptable telehealth approaches to address disparities propagated by health care access barriers in Sub-Saharan Africa. ",
doi="10.2196/60843",
url="https://formative.jmir.org/2025/1/e60843"
}


@Article{info:doi/10.2196/65093,
author="Virachith, Siriphone
and Phakhounthong, Khanxayaphone
and Khounvisith, Vilaysone
and Mayxay, Mayfong
and Kounnavong, Sengchanh
and Sayasone, Somphou
and H{\"u}bschen, M. Judith
and Black, P. Antony",
title="Hepatitis B Virus Exposure, Seroprotection Status, and Susceptibility in Health Care Workers From Lao People's Democratic Republic: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Dec",
day="17",
volume="10",
pages="e65093",
keywords="hepatitis B",
keywords="hepatitis D",
keywords="health care workers",
keywords="Laos",
keywords="prevalence",
abstract="Background: Despite the high prevalence of chronic hepatitis B virus (HBV) infection in adults in Lao People's Democratic Republic (Lao PDR), Lao health care workers (HCWs) have previously been shown to have low levels of protection against infection. Furthermore, the prevalence of hepatitis D virus (HDV), which increases disease severity in individuals infected with HBV, is not known in Lao PDR. Objective: This study aimed to estimate the exposure and seroprotection against HBV, as well as exposure to HDV, in Lao HCWs from 5 provinces. Methods: In 2020, a total of 666 HCWs aged 20 to 65 years from 5 provinces of Lao PDR were recruited, and their sera were tested by enzyme-linked immunosorbent assay to determine their HBV and HDV coinfection status. Results: HBV exposure, as indicated by the presence of anti--hepatitis B core antibodies, was 40.1\% (267/666) overall and significantly higher for HCWs from Oudomxay province (21/31, 67.7\%; adjusted odds ratio 3.69, 95\% CI 1.68?8.12; P=.001). The prevalence of hepatitis B surface antigen was 5.4\% (36/666) overall and increased with age, from 3.6\% (9/248) in those aged ?30 years to 6.8\% (8/118) in those aged ?50 years. Only 28.7\% (191/666) of participants had serological indication of immunization. We could find no evidence for HDV exposure in this study. Conclusions: The study found intermediate hepatitis B surface antigen prevalence among HCWs in Lao PDR, with no evidence of HDV coinfection. Notably, a significant proportion of HCWs remains susceptible to HBV, indicating a substantial gap in seroprotection against the disease. ",
doi="10.2196/65093",
url="https://publichealth.jmir.org/2024/1/e65093"
}


@Article{info:doi/10.2196/57799,
author="Yang, Danyu
and Ma, Ling
and Cheng, Yin
and Shi, Hongjuan
and Liu, Yining
and Shi, Chao",
title="Utility of Anthropometric Indexes for Detecting Metabolic Syndrome in Resource-Limited Regions of Northwestern China: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="29",
volume="10",
pages="e57799",
keywords="metabolic syndrome",
keywords="MetS",
keywords="anthropometric indexes",
keywords="lipid accumulation product",
keywords="LAP",
keywords="waist-to-height ratio",
keywords="WHtR",
keywords="anthropometric",
keywords="adult",
keywords="aging",
keywords="NingXia",
keywords="China",
keywords="cross-sectional study",
keywords="population-based survey",
keywords="logistic regression",
keywords="waist-to-height",
keywords="threshold",
keywords="diagnosis",
keywords="public health",
abstract="Background: Anthropometric indexes offer a practical approach to identifying metabolic syndrome (MetS) and its components. However, there is a scarcity of research on anthropometric indexes tailored to predict MetS in populations from resource-limited regions. Objective: This study aimed to examine the association between 8 easy-to-collect anthropometric indexes and MetS, and determine the most appropriate indexes to identify the presence of MetS for adults in resource-limited areas. Methods: A total of 10,520 participants aged 18?85 years from Ningxia Hui Autonomous Region, China, were included in this cross-sectional study. Participants were recruited through a stratified sampling approach from January 1, 2020, to December 31, 2021. MetS was defined using the International Diabetes Federation (IDF) criteria. Eight anthropometric indexes were examined, including BMI, waist-to-height ratio (WHtR), weight-adjusted waist index (WWI), conicity index, a body shape index (ABSI), lipid accumulation products (LAP), visceral obesity index (VAI), and the triglyceride-glucose (TyG) index. Logistic regression analysis and restricted cubic splines (RCSs) were applied to identify the association between the anthropometric indexes. The receiver operating characteristic curve and the area under the curve (AUC) were analyzed to identify and compare the discriminative power of anthropometric indexes in identifying MetS. The Youden index was used to determine a range of optimal diagnostic thresholds. Logistic regression analysis was applied to identify the association between the anthropometric indexes. Results: A total of 3324 (31.60\%) participants were diagnosed with MetS. After adjusting for age, ethnicity, current residence, education level, habitual alcohol consumption, and tobacco use, all the 8 indexes were positively correlated with the risks of MetS (P<.05). LAP presented the highest adjusted odds ratios (adjOR 35.69, 95\% CI 34.59?36.80), followed by WHtR (adjOR 29.27, 95\% CI 28.00?30.55), conicity index (adjOR 11.58, 95\% CI 10.95?12.22), TyG index (adjOR 5.53, 95\% CI 5.07?6.04), BMI (adjOR 3.88, 95\% CI 3.71?4.05), WWI (adjOR 3.23, 95\% CI 3.02?3.46), VAI (adjOR 2.11, 95\% CI 2.02?2.20), and ABSI (adjOR 1.71, 95\% CI 1.62?1.80). Significantly nonlinear associations between the 8 indexes and the risk of MetS (all Pnonlinear<.001) were observed in the RCSs. WHtR was the strongest predictor of MetS for males (AUC 0.91, 95\% CI 0.90-0.92; optimal cutoff 0.53). LAP were the strongest predictor of MetS for females (AUC 0.89, 95\% CI 0.89-0.90; optimal cutoff 28.67). Statistical differences were present between WHtR and all other 7 anthropometric indexes among males and overall (all P<.05). In females, the AUC values between LAP and BMI, WWI, ABSI, conicity index, VAI, and TyG index were significantly different (P<.001). No statistical difference was observed between LAP and WHtR among females. Conclusions: According to 8 anthropometric and lipid-related indices, it is suggested that WHtR and LAP are the most appropriate indexes for identifying the presence of MetS in resource-limited areas. ",
doi="10.2196/57799",
url="https://publichealth.jmir.org/2024/1/e57799"
}


@Article{info:doi/10.2196/59545,
author="Wallenborn, T. Jordyn
and Sinantha-Hu, Miley
and Ouipoulikoune, Vattahanaphone
and Kounnavong, Sengchanh
and Siengsounthone, Latsamy
and Probst-Hensch, Nicole
and Odermatt, Peter
and Sayasone, Somphou
and Fink, G{\"u}nther",
title="Vientiane Multigenerational Birth Cohort Project in Lao People's Democratic Republic: Protocol for Establishing a Longitudinal Multigenerational Birth Cohort to Promote Population Health",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="27",
volume="13",
pages="e59545",
keywords="Lao PDR",
keywords="birth cohort",
keywords="growth and development",
keywords="mental health",
keywords="dementia",
keywords="exercise",
keywords="behavior",
keywords="aging",
keywords="intergenerational",
keywords="noncommunicable disease",
keywords="hypertension",
keywords="longitudinal cohort",
keywords="low- and middle-income countries",
keywords="maternal health",
keywords="pregnancy",
keywords="antenatal care",
keywords="peripartum",
keywords="postpartum",
keywords="child health",
keywords="infant health",
abstract="Background: Rapid global population growth and urbanization have led to an increase in urban populations in low- and middle-income countries. Although these urban areas have generally better health outcomes than lower-income rural areas, many environmental, social, and health challenges remain. Vientiane, the capital of Lao People's Democratic Republic (Lao PDR), has approximately 1.5 of the 7.5 million Laotian population (2022) and provides a unique opportunity to examine health outcomes among socioeconomically diverse populations in the rapidly urbanizing context of the country. Objective: The aim of the Vientiane multigenerational birth cohort (VITERBI) project is to (1) establish a multigenerational birth cohort in Vientiane capital, Lao PDR, which is representative of the local population, (2) serve as the basis for additional observational (ie, cross-sectional) and intervention studies that promote population health in Vientiane province, and (3) investigate the social, epidemiological, and medical problems of public health importance to Lao PDR. Methods: VITERBI is a prospective multigenerational birth cohort. The study population is structured around children born between July 1, 2022, and June 30, 2023, who reside in Chanthabuly, Sikhottabong, Sangthong, or Mayparkngum districts of Vientiane. Whenever possible, children and their mothers are enrolled during pregnancy; nonreported pregnancies are enrolled after birth. The cohort plans to enroll 3000 pregnant women and their children and the infants' fathers, grandparents, and great-grandparents for a total study population of approximately 13,000 individuals. Participants will be followed throughout the life course with a range of data collected, including demographics, behavior, diet, physical activity, physiology, neurodevelopment, health history, quality of life, environmental exposures, depression, anxiety, stress, resilience, household characteristics, obstetric history, birth outcomes, and various living and dementia scales for older adults. Biomarkers collected include height, weight, blood pressure, and hemoglobin levels. Currently, no statistical analyses are planned. Results: As of April 2024, this study has enrolled 3500 pregnant women and 4579 family members. Study participation is ongoing until May 2025 at minimum, with the goal to extend follow-up until 2050. Conclusions: The study cohort will be used as a basis for further observational (cross-sectional, longitudinal) and intervention studies. It also serves as a tool to investigate social, epidemiological, and medical problems of public health importance to Lao PDR, which will contribute to broader understanding of regional and international contexts. International Registered Report Identifier (IRRID): DERR1-10.2196/59545 ",
doi="10.2196/59545",
url="https://www.researchprotocols.org/2024/1/e59545"
}


@Article{info:doi/10.2196/47311,
author="Hasegawa, Kaede
and O'Brien, Niki
and Prendergast, Mabel
and Ajah, Agape Chris
and Neves, Luisa Ana
and Ghafur, Saira",
title="Cybersecurity Interventions in Health Care Organizations in Low- and Middle-Income Countries: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e47311",
keywords="computer security",
keywords="internet security",
keywords="network security",
keywords="digital health",
keywords="digital health technology",
keywords="cybersecurity",
keywords="health data",
keywords="global health",
keywords="security",
keywords="data science",
keywords="LMIC",
keywords="low income",
keywords="low resource",
keywords="scoping review",
keywords="review methodology",
keywords="implementation",
keywords="barrier",
keywords="facilitator",
abstract="Background: Health care organizations globally have seen a significant increase in the frequency of cyberattacks in recent years. Cyberattacks cause massive disruptions to health service delivery and directly impact patient safety through disruption and treatment delays. Given the increasing number of cyberattacks in low- and middle-income countries (LMICs), there is a need to explore the interventions put in place to plan for cyberattacks and develop cyber resilience. Objective: This study aimed to describe cybersecurity interventions, defined as any intervention to improve cybersecurity in a health care organization, including but not limited to organizational strategy(ies); policy(ies); protocol(s), incident plan(s), or assessment process(es); framework(s) or guidelines; and emergency planning, implemented in LMICs to date and to evaluate their impact on the likelihood and impact of attacks. The secondary objective was to describe the main barriers and facilitators for the implementation of such interventions, where reported. Methods: A systematic search of the literature published between January 2017 and July 2024 was performed on Ovid Medline, Embase, Global Health, and Scopus using a combination of controlled terms and free text. A search of the gray literature within the same time parameters was undertaken on the websites of relevant stakeholder organizations to identify possible additional studies that met the inclusion criteria. Findings from included papers were mapped against the dimensions of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework and presented as a narrative synthesis. Results: We included 20 studies in this review. The sample size of the majority of studies (13/20, 65\%) was 1 facility to 5 facilities, and the studies were conducted in 14 countries. Studies were categorized into the thematic dimensions of the ECHO framework, including context; governance; organizational strategy; risk management; awareness, education, and training; and technical capabilities. Few studies (6/20, 30\%) discussed cybersecurity intervention(s) as the primary focus of the paper; therefore, information on intervention(s) implemented had to be deduced. There was no attempt to report on the impact and outcomes in all papers except one. Facilitators and barriers identified were grouped and presented across national or regional, organizational, and individual staff levels. Conclusions: This scoping review's findings highlight the limited body of research published on cybersecurity interventions implemented in health care organizations in LMICs and large heterogeneity across existing studies in interventions, research objectives, methods, and outcome measures used. Although complex and challenging, future research should specifically focus on the evaluation of cybersecurity interventions and their impact in order to build a robust evidence base to inform evidence-based policy and practice. ",
doi="10.2196/47311",
url="https://www.jmir.org/2024/1/e47311"
}


@Article{info:doi/10.2196/56636,
author="Duan, Sainan
and Chen, Dongxu
and Wang, Jinping
and Paramboor, Sharooq Mohammed
and Xia, Zhen
and Xu, Wanting
and Han, Kun
and Zhu, Tao
and Jiang, Xiaoqin",
title="Digital Exclusion and Cognitive Function in Elderly Populations in Developing Countries: Insights Derived From 2 Longitudinal Cohort Studies",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="15",
volume="26",
pages="e56636",
keywords="digital exclusion",
keywords="cognition",
keywords="cohort study",
keywords="developing country",
keywords="China Health and Retirement Longitudinal Study",
keywords="CHARLS",
keywords="",
keywords="MHAS",
keywords="cognitive decline",
abstract="Background: Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. Objective: This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Methods: Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health \& Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. Results: After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81\%) and MHAS (n=12,560, 52.19\%) were included. Of these, 96.78\% (n=11,135) participants in CHARLS and 70.02\% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95\% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95\% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95\% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95\% CI 0.40-0.59; P<.001) in MHAS. Conclusions: A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations. ",
doi="10.2196/56636",
url="https://www.jmir.org/2024/1/e56636"
}


@Article{info:doi/10.2196/58140,
author="Hope, Mackline
and Kiggundu, Reuben
and Byonanebye, M. Dathan
and Mayito, Jonathan
and Tabajjwa, Dickson
and Lwigale, Fahad
and Tumwine, Conrad
and Mwanja, Herman
and Kambugu, Andrew
and Kakooza, Francis",
title="Progress of Implementation of World Health Organization Global Antimicrobial Resistance Surveillance System Recommendations on Priority Pathogen-Antibiotic Sensitivity Testing in Africa: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="15",
volume="13",
pages="e58140",
keywords="antimicrobial resistance",
keywords="antibiotic sensitivity testing",
keywords="global antimicrobial resistance surveillance system",
keywords="GLASS implementation",
keywords="AMR Surveillance",
keywords="Africa",
abstract="Background: Antimicrobial resistance (AMR) is a major global public health concern, particularly in low- and middle-income countries where resources and infrastructure for an adequate response are limited. The World Health Organization (WHO) Global Antimicrobial Resistance Surveillance System (GLASS) was introduced in 2016 to address these challenges, outlining recommendations for priority pathogen-antibiotic combinations. Despite this initiative, implementation in Africa remains understudied. This scoping review aims to assess the current state of implementing WHO GLASS recommendations on antimicrobial sensitivity testing (AST) in Africa. Objective: The primary objective of this study is to determine the current state of implementing the WHO GLASS recommendations on AST for priority pathogen-antimicrobial combinations. The review will further document if the reporting of AST results is according to ``susceptible,'' ``intermediate,'' and ``resistant'' recommendations according to GLASS. Methods: Following the methodological framework by Arksey and O'Malley, studies published between January 2016 and November 2023 will be included. Search strategies will target electronic databases, including MEDLINE, Scopus, CINAHL, and Embase. Eligible studies will document isolates tested for antimicrobial sensitivity, focusing on WHO-priority specimens and pathogens. Data extraction will focus on key study characteristics, study context, population, and adherence to WHO GLASS recommendations on AST. Descriptive statistics involving summarizing the quantitative data extracted through measures of central tendency and variation will be used. Covidence and Microsoft Excel software will be used. This study will systematically identify, collate, and analyze relevant studies and data sources based on clear inclusion criteria to provide a clear picture of the progress achieved in the implementation of the WHO GLASS recommendations. Areas for further improvement will be documented to inform future efforts to strengthen GLASS implementation for enhanced AMR surveillance in Africa. Results: The study results are expected in August 2024. Conclusions: To our knowledge, this scoping review will be the first to comprehensively examine the implementation of WHO GLASS recommendations in Africa, shedding light on the challenges and successes of AMR surveillance in the region. Addressing these issues aims to contribute to global efforts to combat AMR. International Registered Report Identifier (IRRID): PRR1-10.2196/58140 ",
doi="10.2196/58140",
url="https://www.researchprotocols.org/2024/1/e58140"
}


@Article{info:doi/10.2196/58624,
author="Reynolds, W. Christopher
and Lee, HaEun
and Sieka, Joseph
and Perosky, Joseph
and Lori, R. Jody",
title="Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Nov",
day="13",
volume="12",
pages="e58624",
keywords="mHealth",
keywords="mobile triage",
keywords="referral pathways",
keywords="Liberia",
keywords="LMIC",
keywords="low- income country",
keywords="obstetric triage",
keywords="third delay",
keywords="mobile health",
keywords="mobile application",
keywords="digital health",
keywords="digital intervention",
keywords="smartphone",
keywords="middle-income country",
abstract="Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61\%), nurses (20/62, 32\%), physicians assistants (3/62, 5\%), and physicians (1/62, 2\%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100\%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92\%), increasing health worker attentiveness (39/62, 63\%), and contributing to improved patient care (34/62, 55\%). MORES was perceived as sustainable and scalable (62/62, 100\%), particularly if technological barriers (21/62, 34\%) and staff training (19/62, 31\%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89\%), feedback mechanisms for hospitals and RHFs (48/62, 77\%), interprofessional teamwork (21/62, 34\%), longitudinal follow-up care (20/62, 32\%), creating a record of care delays (17/62, 27\%), and electronic health record infrastructure (13/62, 21\%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. ",
doi="10.2196/58624",
url="https://mhealth.jmir.org/2024/1/e58624"
}


@Article{info:doi/10.2196/57764,
author="Gebeyew, Sisay Ayenew
and Wordofa, Regasa Zegeye
and Muluneh, Alebachew Ayana
and Shibabaw, Ambachew Adamu
and Walle, Damtew Agmasie
and Tizie, Birhanu Sefefe
and Mengistie, Belachew Muluken
and Takillo, Kassaw Mitiku
and Assaye, Tilahun Bayou
and Senishaw, Fentahun Adualem
and Hailye, Gizaw
and Shimie, Worku Aynadis
and Butta, Wake Fikadu",
title="Attitudes of Health Professionals Toward Digital Health Data Security in Northwest Ethiopia: Cross-Sectional Study",
journal="Online J Public Health Inform",
year="2024",
month="Nov",
day="6",
volume="16",
pages="e57764",
keywords="health",
keywords="profession",
keywords="digital",
keywords="attitude",
keywords="security",
keywords="data",
abstract="Background: Digital health is a new health field initiative. Health professionals require security in digital places because cybercriminals target health care professionals. Therefore, millions of medical records have been breached for money. Regarding digital security, there is a gap in studies in limited-resource countries. Therefore, surveying health professionals' attitudes toward digital health data security has a significant purpose for interventions. Objective: This study aimed to assess the attitudes of health professionals toward digital health data security and their associated factors in a resource-limited country. Methods: A cross-sectional study was conducted to measure health professionals' attitudes toward digital health data security. The sample size was calculated using a single population. A pretest was conducted to measure consistency. Binary logistic regression was used to identify associated factors. For multivariable logistic analysis, a P value ?.20 was selected using Stata software (version 16; StataCorp LP). Results: Of the total sample, 95\% (402/423) of health professionals participated in the study. Of all participants, 63.2\% (254/402) were male, and the mean age of the respondents was 34.5 (SD 5.87) years. The proportion of health professionals who had a favorable attitude toward digital health data security at specialized teaching hospitals was 60.9\% (95\% CI 56.0\%?65.6\%). Educational status (adjusted odds ratio [AOR] 3.292, 95\% CI 1.16?9.34), basic computer skills (AOR 1.807, 95\% CI 1.11?2.938), knowledge (AOR 3.238, 95\% CI 2.0?5.218), and perceived usefulness (AOR 1.965, 95\% CI 1.063?3.632) were factors associated with attitudes toward digital health data security. Conclusions: This study aimed to assess health professionals' attitudes toward digital health data security. Interventions on educational status, basic computer skills, knowledge, and perceived usefulness are important for improving health professionals' attitudes. Improving the attitudes of health professionals related to digital data security is necessary for digitalization in the health care arena. ",
doi="10.2196/57764",
url="https://ojphi.jmir.org/2024/1/e57764"
}


@Article{info:doi/10.2196/59873,
author="Chaudary, Jatin
and Rawat, Shruta
and Dange, Alpana
and Golub, A. Sarit
and Kim, S. Ryung
and Chakrapani, Venkatesan
and Mayer, H. Kenneth
and Arnsten, Julia
and Patel, V. Viraj",
title="The CHALO! 2.0 mHealth-Based Multilevel Intervention to Promote HIV Testing and Linkage-to-Care Among Men Who Have Sex with Men in Mumbai, India: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="5",
volume="13",
pages="e59873",
keywords="Keywords: digital health",
keywords="HIV prevention",
keywords="social media",
keywords="stigma",
keywords="gay",
keywords="men who have sex with men",
keywords="MSM",
abstract="Background: Current programs to engage marginalized populations such as gay and bisexual individuals and other men who have sex with men (MSM) in HIV prevention interventions do not often reach all MSM who may benefit from them. To reduce the global burden of HIV, far-reaching strategies are needed to engage MSM in HIV prevention and treatment. Globally, including low- and middle-income countries, MSM are now widely using internet-based social and mobile technologies (SMTs; eg, dating apps, social media, and WhatsApp [Meta]), which provides an unprecedented opportunity to engage unreached and underserved groups, such as MSM for HIV prevention and care. Objective: This study aimed to assess the effectiveness of a multilevel mobile health (mHealth)--based intervention to improve HIV testing uptake and status neutral linkage-to-care among sexually active MSM reached through internet-based platforms in Mumbai, India. Methods: In this randomized controlled trial, we will determine whether CHALO! 2.0 (a theory-based multilevel intervention delivered in part through WhatsApp) results in increased HIV testing and linkage-to-care (prevention or treatment). This study is being conducted among 1000 sexually active MSM who are unaware of their HIV status (never tested or tested >6 months ago) and are recruited through SMTs in Mumbai, India. We will conduct a 12-week, 3-arm randomized trial comparing CHALO! 2.0 to 2 control conditions---an attention-matched SMT-based control (also including a digital coupon for free HIV testing) and a digital coupon--only control. The primary outcomes will be HIV testing and status neutral linkage-to-care by 6 months post enrollment. Participants will be followed up for a total of 18 months to evaluate the long-term impact. Results: The study was funded in 2020, with recruitment having started in April 2022 due to delays from the COVID-19 pandemic. Baseline survey data collection began in April 2022, with follow-up surveys starting in July 2022. As of April 2022, we enrolled 1004 participants in the study. The completion of follow-up data collection is expected in January 2025, with results to be published thereafter. Conclusions: While global health agencies have called for internet-based interventions to engage populations vulnerable to HIV who are not being reached, few proven effective and scalable models exist and none is in India, which has one of the world's largest HIV epidemics. This study will address this gap by testing a multicomponent mHealth intervention to reach and engage MSM at high priority for HIV interventions and link them to HIV testing and prevention or treatment. Trial Registration: ClinicalTrials.gov NCT04814654; https://clinicaltrials.gov/study/NCT04814654. Clinical Trial Registry of India CTRI/2021/03/032280 International Registered Report Identifier (IRRID): DERR1-10.2196/59873 ",
doi="10.2196/59873",
url="https://www.researchprotocols.org/2024/1/e59873"
}


@Article{info:doi/10.2196/52557,
author="Reynaud, Danielle
and Bouscaren, Nicolas
and Cartron, Emmanuelle
and Marimoutou, Catherine",
title="Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island",
journal="JMIR Pediatr Parent",
year="2024",
month="Nov",
day="1",
volume="7",
pages="e52557",
keywords="sexual health",
keywords="adolescent",
keywords="young adults",
keywords="web application",
keywords="contraception prescription",
keywords="contraception",
keywords="teleconsultation",
keywords="telemedicine",
keywords="youth",
keywords="usage",
keywords="e-consultation",
keywords="web based",
abstract="Background: Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. Objective: This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. Methods: A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. Results: A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36\%), receive an initial birth control prescription (12/22, 55\%), and inquire about condom prescriptions (2/22, 9\%). Conclusions: While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts. ",
doi="10.2196/52557",
url="https://pediatrics.jmir.org/2024/1/e52557"
}


@Article{info:doi/10.2196/57703,
author="Musheghyan, Lusine
and Harutyunyan, M. Nika
and Sikder, Abu
and Reid, W. Mark
and Zhao, Daniel
and Lulejian, Armine
and Dickhoner, W. James
and Andonian, T. Nicole
and Aslanyan, Lusine
and Petrosyan, Varduhi
and Sargsyan, Zhanna
and Shekherdimian, Shant
and Dorian, Alina
and Espinoza, C. Juan",
title="Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="30",
volume="10",
pages="e57703",
keywords="COVID-19",
keywords="remote patient monitoring",
keywords="Armenia",
keywords="web platform",
keywords="home oxygen therapy",
keywords="pandemic",
keywords="global health care",
keywords="low and middle-income countries",
keywords="health care infrastructure",
keywords="Yerevan",
keywords="home monitoring",
keywords="resource-constrained",
abstract="Background: The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. Objective: The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Methods: Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Results: Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94\% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1\% and low re-admission rate. Opportunities for operational and data quality improvements were identified. Conclusions: This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program's success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments. ",
doi="10.2196/57703",
url="https://publichealth.jmir.org/2024/1/e57703",
url="http://www.ncbi.nlm.nih.gov/pubmed/39348686"
}


@Article{info:doi/10.2196/48294,
author="Fesshaye, Berhaun
and Pandya, Shivani
and Kan, Lena
and Kalbarczyk, Anna
and Alland, Kelsey
and Rahman, Mustafizur S. M.
and Bulbul, Islam Md Mofijul
and Mustaphi, Piyali
and Siddique, Bakr Muhammad Abu
and Tanim, Alam Md Imtiaz
and Chowdhury, Mridul
and Rumman, Tajkia
and Labrique, B. Alain",
title="Quality, Usability, and Trust Challenges to Effective Data Use in the Deployment and Use of the Bangladesh Nutrition Information System Dashboard: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="30",
volume="26",
pages="e48294",
keywords="digital health",
keywords="nutrition",
keywords="data for decision-making",
keywords="health information systems",
keywords="information system",
keywords="information systems",
keywords="LMIC",
keywords="low- and middle-income countries",
keywords="nutritional",
keywords="dashboard",
keywords="experience",
keywords="experiences",
keywords="interview",
keywords="interviews",
keywords="service",
keywords="services",
keywords="delivery",
keywords="health care management",
abstract="Background: Evidence-based decision-making is essential to improve public health benefits and resources, especially in low- and middle-income countries (LMICs), but the mechanisms of its implementation remain less straightforward. The availability of high-quality, reliable, and sufficient data in LMICs can be challenging due to issues such as a lack of human resource capacity and weak digital infrastructure, among others. Health information systems (HISs) have been critical for aggregating and integrating health-related data from different sources to support evidence-based decision-making. Nutrition information systems (NISs), which are nutrition-focused HISs, collect and report on nutrition-related indicators to improve issues related to malnutrition and food security---and can assist in improving populations' nutritional statuses and the integration of nutrition programming into routine health services. Data visualization tools (DVTs) such as dashboards have been recommended to support evidence-based decision-making, leveraging data from HISs or NISs. The use of such DVTs to support decision-making has largely been unexplored within LMIC contexts. In Bangladesh, the Mukto dashboard was developed to display and visualize nutrition-related performance indicators at the national and subnational levels. However, despite this effort, the current use of nutrition data to guide priorities and decisions remains relatively nascent and underused. Objective: The goal of this study is to better understand how Bangladesh's NIS, including the Mukto dashboard, has been used and areas for improvement to facilitate its use for evidence-based decision-making toward ameliorating nutrition-related service delivery and the health status of communities in Bangladesh. Methods: Primary data collection was conducted through qualitative semistructured interviews with key policy-level stakeholders (n=24). Key informants were identified through purposive sampling and were asked questions about the experiences and challenges with the NIS and related nutrition dashboards. Results: Main themes such as trust, data usability, personal power, and data use for decision-making emerged from the data. Trust in both data collection and quality was lacking among many stakeholders. Poor data usability stemmed from unstandardized indicators, irregular data collection, and differences between rural and urban data. Insufficient personal power and staff training coupled with infrastructural challenges can negatively affect data at the input stage. While stakeholders understood and expressed the importance of evidence-based decision-making, ultimately, they noted that the data were not being used to their maximum potential. Conclusions: Leveraging DVTs can improve the use of data for evidence-based decision-making, but decision makers must trust that the data are believable, credible, timely, and responsive. The results support the significance of a tailored data ecosystem, which has not reached its full potential in Bangladesh. Recommendations to reach this potential include ensuring a clear intended user base and accountable stakeholders are present. Systems should also have the capacity to ensure data credibility and support ongoing personal power requirements. ",
doi="10.2196/48294",
url="https://www.jmir.org/2024/1/e48294",
url="http://www.ncbi.nlm.nih.gov/pubmed/39348172"
}


@Article{info:doi/10.2196/55092,
author="Rampilo, Mashudu
and Phalane, Edith
and Phaswana-Mafuya, Nancy Refilwe",
title="Piloting the Inclusion of the Key Populations Unique Identifier Code in the South African Routine Health Information Management System: Protocol for a Multiphased Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="6",
volume="13",
pages="e55092",
keywords="key populations",
keywords="unique identifier code",
keywords="biometric",
keywords="biometrics",
keywords="alphanumeric code",
keywords="routine health management information system",
keywords="health management",
keywords="management",
keywords="protocol",
keywords="mixed methods study",
keywords="South Africa",
keywords="human immunodeficiency",
keywords="immunodeficiency",
keywords="HIV",
keywords="AIDS",
keywords="transgender",
keywords="epidemiology",
keywords="data extraction",
keywords="HIV transmission",
abstract="Background: The global community has set an ambitious goal to end HIV/AIDS as a public health threat by 2030. Significant progress has been achieved in pursuing these objectives; however, concerns remain regarding the lack of disaggregated routine data for key populations (KPs) for a targeted HIV response. KPs include female sex workers, transgender populations, gay men and other men who have sex with men, people who are incarcerated, and people who use drugs. From an epidemiological perspective, KPs play a fundamental role in shaping the dynamics of HIV transmission due to specific behaviors. In South Africa, routine health information management systems (RHIMS) do not include a unique identifier code (UIC) for KPs. The purpose of this protocol is to develop the framework for improved HIV monitoring and programming through piloting the inclusion of KPs UIC in the South African RHIMS. Objective: This paper aims to describe the protocol for a multiphased study to pilot the inclusion of KPs UIC in RHIMS. Methods: We will conduct a multiphased study to pilot the framework for the inclusion of KPs UIC in the RHIMS. The study has attained the University of Johannesburg Research Ethics Committee approval (REC-2518-2023). This study has four objectives, including a systematic review, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (objective 1). Second, policy document review and in-depth stakeholder interviews using semistructured questionnaires (objective 2). Third, exploratory data analysis of deidentified HIV data sets (objective 3), and finally, piloting the framework to assess the feasibility of incorporating KPs UIC in RHIMS using findings from objectives 1, 2, and 3 (objective 4). Qualitative and quantitative data will be analyzed using ATLAS.ti (version 6; ATLAS.ti Scientific Software Development GmbH) and Python (version 3.8; Python Software Foundation) programming language, respectively. Results: The results will encompass a systematic review of literature, qualitative interviews, and document reviews, along with exploratory analysis of deidentified routine program data and findings from the pilot study. The systematic review has been registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42023440656). Data collection is planned to commence in September 2024 and expected results for all objectives will be published by December 2025. Conclusions: The study will produce a framework to be recommended for the inclusion of the KP UIC national rollout. The study results will contribute to the knowledge base around the inclusion of KPs UIC in RHIMS data. Trial Registration: PROSPERO CRD42023440656; https://tinyurl.com/msnppany International Registered Report Identifier (IRRID): PRR1-10.2196/55092 ",
doi="10.2196/55092",
url="https://www.researchprotocols.org/2024/1/e55092",
url="http://www.ncbi.nlm.nih.gov/pubmed/39240683"
}


@Article{info:doi/10.2196/58548,
author="Julian, Silva Guilherme
and Shau, Wen-Yi
and Chou, Hsu-Wen
and Setia, Sajita",
title="Bridging Real-World Data Gaps: Connecting Dots Across 10 Asian Countries",
journal="JMIR Med Inform",
year="2024",
month="Aug",
day="15",
volume="12",
pages="e58548",
keywords="Asia",
keywords="electronic medical records",
keywords="EMR",
keywords="health care databases",
keywords="health technology assessment",
keywords="HTA",
keywords="real-world data",
keywords="real-world evidence",
doi="10.2196/58548",
url="https://medinform.jmir.org/2024/1/e58548",
url="http://www.ncbi.nlm.nih.gov/pubmed/39026427"
}


@Article{info:doi/10.2196/50125,
author="Marley, Gifty
and Dako-Gyeke, Phyllis
and Nepal, Prajwol
and Rajgopal, Rohini
and Koko, Evelyn
and Chen, Elizabeth
and Nuamah, Kwabena
and Osei, Kingsley
and Hofkirchner, Hubertus
and Marks, Michael
and Tucker, D. Joseph
and Eggo, Rosalind
and Ampofo, William
and Sylvia, Sean",
title="Collective Intelligence--Based Participatory COVID-19 Surveillance in Accra, Ghana: Pilot Mixed Methods Study",
journal="JMIR Infodemiology",
year="2024",
month="Aug",
day="12",
volume="4",
pages="e50125",
keywords="information markets",
keywords="participatory disease surveillance",
keywords="collective intelligence",
keywords="community engagement",
keywords="the wisdom of the crowds",
keywords="Ghana",
keywords="mobile phone",
abstract="Background: Infectious disease surveillance is difficult in many low- and middle-income countries. Information market (IM)--based participatory surveillance is a crowdsourcing method that encourages individuals to actively report health symptoms and observed trends by trading web-based virtual ``stocks'' with payoffs tied to a future event. Objective: This study aims to assess the feasibility and acceptability of a tailored IM surveillance system to monitor population-level COVID-19 outcomes in Accra, Ghana. Methods: We designed and evaluated a prediction markets IM system from October to December 2021 using a mixed methods study approach. Health care workers and community volunteers aged ?18 years living in Accra participated in the pilot trading. Participants received 10,000 virtual credits to trade on 12 questions on COVID-19--related outcomes. Payoffs were tied to the cost estimation of new and cumulative cases in the region (Greater Accra) and nationwide (Ghana) at specified future time points. Questions included the number of new COVID-19 cases, the number of people likely to get the COVID-19 vaccination, and the total number of COVID-19 cases in Ghana by the end of the year. Phone credits were awarded based on the tally of virtual credits left and the participant's percentile ranking. Data collected included age, occupation, and trading frequency. In-depth interviews explored the reasons and factors associated with participants' user journey experience, barriers to system use, and willingness to use IM systems in the future. Trading frequency was assessed using trend analysis, and ordinary least squares regression analysis was conducted to determine the factors associated with trading at least once. Results: Of the 105 eligible participants invited, 21 (84\%) traded at least once on the platform. Questions estimating the national-level number of COVID-19 cases received 13 to 19 trades, and obtaining COVID-19--related information mainly from television and radio was associated with less likelihood of trading (marginal effect: ?0.184). Individuals aged <30 years traded 7.5 times more and earned GH {\textcent}134.1 (US \$11.7) more in rewards than those aged >30 years (marginal effect: 0.0135). Implementing the IM surveillance was feasible; all 21 participants who traded found using IM for COVID-19 surveillance acceptable. Active trading by friends with communal discussion and a strong onboarding process facilitated participation. The lack of bidirectional communication on social media and technical difficulties were key barriers. Conclusions: Using an IM system for disease surveillance is feasible and acceptable in Ghana. This approach shows promise as a cost-effective source of information on disease trends in low- and middle-income countries where surveillance is underdeveloped, but further studies are needed to optimize its use. ",
doi="10.2196/50125",
url="https://infodemiology.jmir.org/2024/1/e50125"
}


@Article{info:doi/10.2196/45242,
author="Bostan, Sarah
and Johnson, A. Owen
and Jaspersen, J. Lena
and Randell, Rebecca",
title="Contextual Barriers to Implementing Open-Source Electronic Health Record Systems for Low- and Lower-Middle-Income Countries: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="1",
volume="26",
pages="e45242",
keywords="implementation",
keywords="open source",
keywords="electronic health records",
keywords="digital health",
keywords="low- and lower-middle-income countries",
keywords="barriers",
keywords="global health care",
keywords="scoping",
keywords="review",
abstract="Background: Low- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation. Objective: This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research. Methods: We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach. Results: This review included 13 studies that examined open-source EHRs' adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes. Conclusions: While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers' experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline. ",
doi="10.2196/45242",
url="https://www.jmir.org/2024/1/e45242"
}


@Article{info:doi/10.2196/50375,
author="Yilma, Melese Tesfahun
and Taddese, Asefa
and Mamuye, Adane
and Endehabtu, Fikadie Berhanu
and Alemayehu, Yibeltal
and Senay, Asaye
and Daka, Dawit
and Abraham, Loko
and Tadesse, Rabeal
and Melkamu, Gemechis
and Wendrad, Naod
and Kaba, Oli
and Mohammed, Mesoud
and Denboba, Wubshet
and Birhan, Dawit
and Biru, Amanuel
and Tilahun, Binyam",
title="Maturity Assessment of District Health Information System Version 2 Implementation in Ethiopia: Current Status and Improvement Pathways",
journal="JMIR Med Inform",
year="2024",
month="Jul",
day="26",
volume="12",
pages="e50375",
keywords="health information system",
keywords="digital health system",
keywords="District Health Information System version 2",
keywords="DHIS2",
keywords="maturity assessment",
keywords="Stages of Continuous Improvement",
keywords="Ethiopia",
abstract="Background: Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. Objective: This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. Methods: A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. Results: The national DHIS2 implementation's maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. Conclusions: On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed. ",
doi="10.2196/50375",
url="https://medinform.jmir.org/2024/1/e50375"
}


@Article{info:doi/10.2196/55959,
author="Aisyah, Nur Dewi
and Setiawan, Heri Agus
and Lokopessy, Fawwaz Alfiano
and Faradiba, Nadia
and Setiaji, Setiaji
and Manikam, Logan
and Kozlakidis, Zisis",
title="The Information and Communication Technology Maturity Assessment at Primary Health Care Services Across 9 Provinces in Indonesia: Evaluation Study",
journal="JMIR Med Inform",
year="2024",
month="Jul",
day="18",
volume="12",
pages="e55959",
keywords="public health centers",
keywords="Puskesmas",
keywords="digital maturity",
keywords="infrastructure",
keywords="primary health care",
keywords="district health office",
keywords="primary care clinics",
keywords="Asia",
keywords="Asian",
keywords="Indonesia",
keywords="ICT",
keywords="information and communication technologies",
keywords="information and communication technology",
keywords="maturity",
keywords="adoption",
keywords="readiness",
keywords="implementation",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="cross sectional",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="primary care",
abstract="Background: Indonesia has rapidly embraced digital health, particularly during the COVID-19 pandemic, with over 15 million daily health application users. To advance its digital health vision, the government is prioritizing the development of health data and application systems into an integrated health care technology ecosystem. This initiative involves all levels of health care, from primary to tertiary, across all provinces. In particular, it aims to enhance primary health care services (as the main interface with the general population) and contribute to Indonesia's digital health transformation. Objective: This study assesses the information and communication technology (ICT) maturity in Indonesian health care services to advance digital health initiatives. ICT maturity assessment tools, specifically designed for middle-income countries, were used to evaluate digital health capabilities in 9 provinces across 5 Indonesian islands. Methods: A cross-sectional survey was conducted from February to March 2022, in 9 provinces across Indonesia, representing the country's diverse conditions on its major islands. Respondents included staff from public health centers (Puskesmas), primary care clinics (Klinik Pratama), and district health offices (Dinas Kesehatan Kabupaten/Kota). The survey used adapted ICT maturity assessment questionnaires, covering human resources, software and system, hardware, and infrastructure. It was administered electronically and involved 121 public health centers, 49 primary care clinics, and 67 IT staff from district health offices. Focus group discussions were held to delve deeper into the assessment results and gain more descriptive insights. Results: In this study, 237 participants represented 3 distinct categories: 121 public health centers, 67 district health offices, and 49 primary clinics. These instances were selected from a sample of 9 of the 34 provinces in Indonesia. Collected data from interviews and focus group discussions were transformed into scores on a scale of 1 to 5, with 1 indicating low ICT readiness and 5 indicating high ICT readiness. On average, the breakdown of ICT maturity scores was as follows: 2.71 for human resources' capability in ICT use and system management, 2.83 for software and information systems, 2.59 for hardware, and 2.84 for infrastructure, resulting in an overall average score of 2.74. According to the ICT maturity level pyramid, the ICT maturity of health care providers in Indonesia fell between the basic and good levels. The need to pursue best practices also emerged strongly. Further analysis of the ICT maturity scores, when examined by province, revealed regional variations. Conclusions: The maturity of ICT use is influenced by several critical components. Enhancing human resources, ensuring infrastructure, the availability of supportive hardware, and optimizing information systems are imperative to attain ICT maturity in health care services. In the context of ICT maturity assessment, significant score variations were observed across health care levels in the 9 provinces, underscoring the diversity in ICT readiness and the need for regionally customized follow-up actions. ",
doi="10.2196/55959",
url="https://medinform.jmir.org/2024/1/e55959"
}


@Article{info:doi/10.2196/54669,
author="Matzke, Ina
and Huhn, Sophie
and Koch, Mara
and Maggioni, Anna Martina
and Munga, Stephen
and Muma, Okoth Julius
and Odhiambo, Ochieng Collins
and Kwaro, Daniel
and Obor, David
and B{\"a}rnighausen, Till
and Dambach, Peter
and Barteit, Sandra",
title="Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="4",
volume="12",
pages="e54669",
keywords="wearables",
keywords="wearable",
keywords="tracker",
keywords="trackers",
keywords="climate",
keywords="Africa",
keywords="environment",
keywords="environmental",
keywords="heat",
keywords="weather",
keywords="exposure",
keywords="temperature",
keywords="rural",
keywords="fitness trackers",
keywords="climate change",
keywords="health",
keywords="sub-Saharan Africa",
keywords="Kenya",
keywords="outcome",
keywords="outcomes",
abstract="Background: Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. Objective: The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. Methods: We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. Results: Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1\%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8\%) out of 204 days. Despite 10 (21\%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6\%, SD 21.3\% and mean 86.1\%, SD 18.9\%, respectively), but low for heart rate (mean 7\%, SD 14\%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2\% (SD 24.5\%) completeness. Conclusions: Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change. ",
doi="10.2196/54669",
url="https://mhealth.jmir.org/2024/1/e54669",
url="http://www.ncbi.nlm.nih.gov/pubmed/38963698"
}


@Article{info:doi/10.2196/49127,
author="Fraser, F. Hamish S.
and Mugisha, Michael
and Bacher, Ian
and Ngenzi, Lune Joseph
and Seebregts, Christopher
and Umubyeyi, Aline
and Condo, Jeanine",
title="Factors Influencing Data Quality in Electronic Health Record Systems in 50 Health Facilities in Rwanda and the Role of Clinical Alerts: Cross-Sectional Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="3",
volume="10",
pages="e49127",
keywords="data quality",
keywords="electronic health record",
keywords="EHR",
keywords="electronic medical record",
keywords="EMR",
keywords="HIV",
keywords="Rwanda",
abstract="Background: Electronic health records (EHRs) play an increasingly important role in delivering HIV care in low- and middle-income countries. The data collected are used for direct clinical care, quality improvement, program monitoring, public health interventions, and research. Despite widespread EHR use for HIV care in African countries, challenges remain, especially in collecting high-quality data. Objective: We aimed to assess data completeness, accuracy, and timeliness compared to paper-based records, and factors influencing data quality in a large-scale EHR deployment in Rwanda. Methods: We randomly selected 50 health facilities (HFs) using OpenMRS, an EHR system that supports HIV care in Rwanda, and performed a data quality evaluation. All HFs were part of a larger randomized controlled trial, with 25 HFs receiving an enhanced EHR with clinical decision support systems. Trained data collectors visited the 50 HFs to collect 28 variables from the paper charts and the EHR system using the Open Data Kit app. We measured data completeness, timeliness, and the degree of matching of the data in paper and EHR records, and calculated concordance scores. Factors potentially affecting data quality were drawn from a previous survey of users in the 50 HFs. Results: We randomly selected 3467 patient records, reviewing both paper and EHR copies (194,152 total data items). Data completeness was >85\% threshold for all data elements except viral load (VL) results, second-line, and third-line drug regimens. Matching scores for data values were close to or >85\% threshold, except for dates, particularly for drug pickups and VL. The mean data concordance was 10.2 (SD 1.28) for 15 (68\%) variables. HF and user factors (eg, years of EHR use, technology experience, EHR availability and uptime, and intervention status) were tested for correlation with data quality measures. EHR system availability and uptime was positively correlated with concordance, whereas users' experience with technology was negatively correlated with concordance. The alerts for missing VL results implemented at 11 intervention HFs showed clear evidence of improving timeliness and completeness of initially low matching of VL results in the EHRs and paper records (11.9\%-26.7\%; P<.001). Similar effects were seen on the completeness of the recording of medication pickups (18.7\%-32.6\%; P<.001). Conclusions: The EHR records in the 50 HFs generally had high levels of completeness except for VL results. Matching results were close to or >85\% threshold for nondate variables. Higher EHR stability and uptime, and alerts for entering VL both strongly improved data quality. Most data were considered fit for purpose, but more regular data quality assessments, training, and technical improvements in EHR forms, data reports, and alerts are recommended. The application of quality improvement techniques described in this study should benefit a wide range of HFs and data uses for clinical care, public health, and disease surveillance. ",
doi="10.2196/49127",
url="https://publichealth.jmir.org/2024/1/e49127"
}


@Article{info:doi/10.2196/58549,
author="Soehnchen, Clarissa
and Burmann, Anja
and Henningsen, Maike
and Meister, Sven",
title="A Digital Sexual Health Education Web Application for Resource-Poor Regions in Kenya: Implementation-Oriented Case Study Using the Intercultural Research Model",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="3",
volume="8",
pages="e58549",
keywords="sexual health education",
keywords="Intercultural Research Model",
keywords="semistructured interview",
keywords="SUS analysis",
keywords="user-centered design",
abstract="Background: Developing a digital educational application focused on sexual health education necessitates a framework that integrates cultural considerations effectively. Drawing from previous research, we identified the problem and essential requirements to incorporate cultural insights into the development of a solution. Objective: This study aims to explore the Solution Room of the self-established Intercultural Research Model, with a focus on creating a reusable framework for developing and implementing a widely accessible digital educational tool for sexual health. The study centers on advancing from a low-fidelity prototype (She!Masomo) to a high-fidelity prototype (We!Masomo), while evaluating its system usability through differentiation. This research contributes to the pursuit of Sustainable Development Goals 3, 4, and 5. Methods: The research methodology is anchored in the Solution Room of the self-expanded Intercultural Research Model, which integrates cultural considerations. It uses a multimethod, user-centered design thinking approach, focusing on extensive human involvement for the open web-based application. This includes gathering self-assessed textual user feedback, conducting a System Usability Scale (SUS) analysis, and conducting 4 face-to-face semistructured expert interviews, following COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Results: Based on the identified limitations of the low-fidelity prototype, She!Masomo (SUS score 67), which were highlighted through textual user feedback (63/77) and prototype feature comparisons, iterative development and improvement were implemented. This process led to the creation of an enhanced high-fidelity prototype (We!Masomo). The improved effectiveness of the enhanced prototype was evaluated using the qualitative SUS analysis (82/90), resulting in a favorable score of 77.3, compared with the previous SUS score of 67 for the low-fidelity prototype. Highlighting the importance of accessible digital educational tools, this study conducted 4 expert interviews (4/4) and reported e-survey results following the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guideline. The digital educational platform, We!Masomo, is specifically designed to promote universal and inclusive free access to information. Therefore, the developed high-fidelity prototype was implemented in Kenya. Conclusions: The primary outcome of this research provides a comprehensive exploration of utilizing a case study methodology to advance the development of digital educational web tools, particularly focusing on cultural sensitivity and sensitive educational subjects. It offers critical insights for effectively introducing such tools in regions with limited resources. Nonetheless, it is crucial to emphasize that the findings underscore the importance of integrating culture-specific components during the design phase. This highlights the necessity of conducting a thorough requirement engineering analysis and developing a low-fidelity prototype, followed by an SUS analysis. These measures are particularly critical when disseminating sensitive information, such as sexual health, through digital platforms. International Registered Report Identifier (IRRID): RR2-10.1186/s12905-023-02839-6 ",
doi="10.2196/58549",
url="https://formative.jmir.org/2024/1/e58549"
}


@Article{info:doi/10.2196/53905,
author="Adamu, Gati Umar
and Badianyama, Marheb
and Mpanya, Dineo
and Maseko, Muzi
and Tsabedze, Nqoba",
title="The Use of Metabolomes in Risk Stratification of Heart Failure Patients: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="23",
volume="13",
pages="e53905",
keywords="metabolomes",
keywords="metabolomics",
keywords="heart failure",
keywords="risk stratification",
keywords="morbidity",
keywords="mortality",
keywords="metabolic abnormality",
keywords="scoping review protocol",
keywords="electronic database",
abstract="Background: Heart failure (HF) is a significant health problem that is often associated with major morbidity and mortality. Metabolic abnormalities occur in HF and may be used to identify individuals at risk of developing the condition. Furthermore, these metabolic changes may play a role in the pathogenesis and progression of HF. Despite this knowledge, the utility of metabolic changes in diagnosis, management, prognosis, and therapy for patients with chronic HF has not been systematically reviewed. Objective: This scoping review aims to systematically appraise the literature on metabolic changes in patients with HF, describe the role of these changes in pathogenesis, progression, and care, and identify knowledge gaps to inform future research. Methods: This review will be conducted using a strategy based on previous reports, the JBI Manual for Evidence Synthesis, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search of electronic databases (Medline, EBSCOhost, Scopus, and Web of Science) will be conducted using keywords related to HF, myocardial failure, metabolomes, metabonomics, and analytical chemistry techniques. The search will include original peer-reviewed research papers (clinical studies conducted on humans and systematic reviews with or without a meta-analysis) published between January 2010 and September 2023. Studies that include patients with HF younger than 18 years or those not published in English will be excluded. Two authors (UGA and MB) will screen the titles and abstracts independently and perform a full-text screen of the relevant and eligible papers. Relevant data will be extracted and synthesized, and a third author or group will be consulted to resolve discrepancies. Results: This scoping review will span from January 2010 to September 2023, and the results will be published in a peer-reviewed, open-access journal as a scoping review in 2024. The presentation of the findings will use the PRISMA-ScR flow diagram and descriptive and narrative formats, including tables and graphical displays, to provide a comprehensive overview of the extracted data. Conclusions: This review aims to collect and analyze the available evidence on metabolic changes in patients with HF, aiming to enhance our current understanding of this topic. Additionally, this review will identify the most commonly used and suitable sample, analytical method, and specific metabolomes to facilitate standardization, reproducibility of results, and application in the diagnosis, treatment, and risk stratification of patients with HF. Finally, it is hoped that this review's outcomes will inspire further research into the metabolomes of patients with HF in low- and middle-income countries. Trial Registration: Open Science Framework; https://osf.io/sp6xj International Registered Report Identifier (IRRID): DERR1-10.2196/53905 ",
doi="10.2196/53905",
url="https://www.researchprotocols.org/2024/1/e53905",
url="http://www.ncbi.nlm.nih.gov/pubmed/38781584"
}


@Article{info:doi/10.2196/52145,
author="Ambrosio, Graca Maria Da
and Lachman, M. Jamie
and Zinzer, Paula
and Gwebu, Hlengiwe
and Vyas, Seema
and Vallance, Inge
and Calderon, Francisco
and Gardner, Frances
and Markle, Laurie
and Stern, David
and Facciola, Chiara
and Schley, Anne
and Danisa, Nompumelelo
and Brukwe, Kanyisile
and Melendez-Torres, GJ",
title="A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="3",
volume="13",
pages="e52145",
keywords="parenting intervention",
keywords="chatbot-led public health intervention",
keywords="engagement",
keywords="implementation science",
keywords="mobile phone",
abstract="Background: Violence against children (VAC) is a serious public health concern with long-lasting adverse effects. Evidence-based parenting programs are one effective means to prevent VAC; however, these interventions are not scalable in their typical in-person group format, especially in low- and middle-income countries where the need is greatest. While digital delivery, including via chatbots, offers a scalable and cost-effective means to scale up parenting programs within these settings, it is crucial to understand the key pillars of user engagement to ensure their effective implementation. Objective: This study aims to investigate the most effective and cost-effective combination of external components to optimize user engagement with ParentText, an open-source chatbot-led parenting intervention to prevent VAC in Mpumalanga, South Africa. Methods: This study will use a mixed methods design incorporating a 2 {\texttimes} 2 factorial cluster-randomized controlled trial and qualitative interviews. Parents of adolescent girls (32 clusters, 120 participants [60 parents and 60 girls aged 10 to 17 years] per cluster; N=3840 total participants) will be recruited from the Ehlanzeni and Nkangala districts of Mpumalanga. Clusters will be randomly assigned to receive 1 of the 4 engagement packages that include ParentText alone or combined with in-person sessions and a facilitated WhatsApp support group. Quantitative data collected will include pretest-posttest parent- and adolescent-reported surveys, facilitator-reported implementation data, and digitally tracked engagement data. Qualitative data will be collected from parents and facilitators through in-person or over-the-phone individual semistructured interviews and used to expand the interpretation and understanding of the quantitative findings. Results: Recruitment and data collection started in August 2023 and were finalized in November 2023. The total number of participants enrolled in the study is 1009, with 744 caregivers having completed onboarding to the chatbot-led intervention. Female participants represent 92.96\% (938/1009) of the sample population, whereas male participants represent 7.03\% (71/1009). The average participant age is 43 (SD 9) years. Conclusions: The ParentText Optimisation Trial is the first study to rigorously test engagement with a chatbot-led parenting intervention in a low- or middle-income country. The results of this study will inform the final selection of external delivery components to support engagement with ParentText in preparation for further evaluation in a randomized controlled trial in 2024. Trial Registration: Open Science Framework (OSF); https://doi.org/10.17605/OSF.IO/WFXNE International Registered Report Identifier (IRRID): DERR1-10.2196/52145 ",
doi="10.2196/52145",
url="https://www.researchprotocols.org/2024/1/e52145",
url="http://www.ncbi.nlm.nih.gov/pubmed/38700935"
}


@Article{info:doi/10.2196/52106,
author="Jockers, Dominik
and Bakoubayi, Wimima Akila
and B{\"a}rnighausen, Kate
and Bando, P'kont{\`e}me P'tanam
and Pechar, Stefanie
and Maina, Wamuyu Teresia
and Wachinger, Jonas
and Vetter, Mark
and Djakpa, Yawovi
and Saka, Bayaki
and Gnossike, Piham
and Schr{\"o}der, Maike Nora
and Liu, Shuyan
and Gadah, Yawovi Denis Agbenyigan
and Kasang, Christa
and B{\"a}rnighausen, Till",
title="Effectiveness of Sensitization Campaigns in Reducing Leprosy-Related Stigma in Rural Togo: Protocol for a Mixed Methods Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="18",
volume="13",
pages="e52106",
keywords="audio",
keywords="community health worker",
keywords="information campaign",
keywords="knowledge, attitude, and practices",
keywords="language",
keywords="leprosy-related stigma",
keywords="qualitative and quantitative research",
keywords="stigma intervention",
keywords="Togo",
keywords="West Africa",
abstract="Background: In the global strategy to eliminate leprosy, there remains a need for early case detection to successfully interrupt transmissions. Poor knowledge about leprosy and leprosy-related stigma are key drivers of delayed diagnosis and treatment. Sensitization campaigns to inform and increase awareness among the general population are an integral part of many national neglected tropical disease programs. Despite their importance, the effectiveness of such campaigns has not been rigorously studied in the West African context. A multilingual rural setting with low health literacy in this region presents challenges to the potential impact of sensitization campaigns. Objective: The primary objective of this study is to assess the causal effect of common practice community sensitization campaigns on leprosy-related knowledge and stigma at the community level and among community health volunteers. Additionally, we will test the potential of novel educational audio tools in the 15 most prominent local languages to overcome literacy and language barriers and amplify sensitization campaigns. Methods: We will conduct a cluster randomized controlled trial using a sequential mixed methods approach in 60 rural communities across all regions of Togo, West Africa. The study features 2 intervention arms and 1 control arm, with intervention and control assignments made at the community level through randomization. Communities in intervention arm 1 will receive a sensitization campaign in line with the current Togolese national neglected tropical disease program. Communities in intervention arm 2 will receive the same sensitization campaign along with educational audio tools distributed to community households. The control arm will receive no intervention before data collection. Quantitative outcome measures on knowledge and stigma will be collected from a random sample of 1200 individuals. Knowledge will be assessed using the 9-item standardized Knowledge, Attitudes, and Practices Questionnaire. Stigma will be measured using the 7-item Social Distance Scale and the 15-item Explanatory Model Interview Catalogue Community Stigma Scale. We will estimate intention-to-treat effects at the individual level, comparing the outcomes of the intervention and control arms. In an accompanying qualitative component, we will conduct in-depth interviews with community members, community health volunteers, and health care workers in both treatment arms and the control arm to explore intervention and stigma-related experiences. Results: This paper describes and discusses the protocol for a mixed methods cluster randomized controlled trial. Data collection is planned to be completed in June 2024, with ongoing data analysis. The first results are expected to be submitted for publication by the end of 2024. Conclusions: This trial will be among the first to test the causal effectiveness of community-based sensitization campaigns and audio tools to increase knowledge and reduce leprosy-related stigma. As such, the results will inform health policy makers, decision-makers, and public health practitioners designing sensitization campaigns in rural multilingual settings. Trial Registration: German Clinical Trials Register DRKS00029355; https://drks.de/search/en/trial/DRKS00029355 International Registered Report Identifier (IRRID): DERR1-10.2196/52106 ",
doi="10.2196/52106",
url="https://www.researchprotocols.org/2024/1/e52106",
url="http://www.ncbi.nlm.nih.gov/pubmed/38635983"
}


@Article{info:doi/10.2196/54278,
author="Taye, Kefiyalew Biniam
and Gezie, Derseh Lemma
and Atnafu, Asmamaw
and Mengiste, Anagaw Shegaw
and Kaasb{\o}ll, Jens
and Gullslett, Knudsen Monika
and Tilahun, Binyam",
title="Effect of Performance-Based Nonfinancial Incentives on Data Quality in Individual Medical Records of Institutional Births: Quasi-Experimental Study",
journal="JMIR Med Inform",
year="2024",
month="Apr",
day="5",
volume="12",
pages="e54278",
keywords="individual medical records",
keywords="data quality",
keywords="completeness",
keywords="consistency",
keywords="nonfinancial incentives",
keywords="institutional birth",
keywords="health care quality",
keywords="quasi-experimental design",
keywords="Ethiopia",
abstract="Background: Despite the potential of routine health information systems in tackling persistent maternal deaths stemming from poor service quality at health facilities during and around childbirth, research has demonstrated their suboptimal performance, evident from the incomplete and inaccurate data unfit for practical use. There is a consensus that nonfinancial incentives can enhance health care providers' commitment toward achieving the desired health care quality. However, there is limited evidence regarding the effectiveness of nonfinancial incentives in improving the data quality of institutional birth services in Ethiopia. Objective: This study aimed to evaluate the effect of performance-based nonfinancial incentives on the completeness and consistency of data in the individual medical records of women who availed institutional birth services in northwest Ethiopia. Methods: We used a quasi-experimental design with a comparator group in the pre-post period, using a sample of 1969 women's medical records. The study was conducted in the ``Wegera'' and ``Tach-armacheho'' districts, which served as the intervention and comparator districts, respectively. The intervention comprised a multicomponent nonfinancial incentive, including smartphones, flash disks, power banks, certificates, and scholarships. Personal records of women who gave birth within 6 months before (April to September 2020) and after (February to July 2021) the intervention were included. Three distinct women's birth records were examined: the integrated card, integrated individual folder, and delivery register. The completeness of the data was determined by examining the presence of data elements, whereas the consistency check involved evaluating the agreement of data elements among women's birth records. The average treatment effect on the treated (ATET), with 95\% CIs, was computed using a difference-in-differences model. Results: In the intervention district, data completeness in women's personal records was nearly 4 times higher (ATET 3.8, 95\% CI 2.2-5.5; P=.02), and consistency was approximately 12 times more likely (ATET 11.6, 95\% CI 4.18-19; P=.03) than in the comparator district. Conclusions: This study indicates that performance-based nonfinancial incentives enhance data quality in the personal records of institutional births. Health care planners can adapt these incentives to improve the data quality of comparable medical records, particularly pregnancy-related data within health care facilities. Future research is needed to assess the effectiveness of nonfinancial incentives across diverse contexts to support successful scale-up. ",
doi="10.2196/54278",
url="https://medinform.jmir.org/2024/1/e54278",
url="http://www.ncbi.nlm.nih.gov/pubmed/38578684"
}


@Article{info:doi/10.2196/50337,
author="Aboye, Tadese Genet
and Simegn, Lamesgin Gizeaddis
and Aerts, Jean-Marie",
title="Assessment of the Barriers and Enablers of the Use of mHealth Systems in Sub-Saharan Africa According to the Perceptions of Patients, Physicians, and Health Care Executives in Ethiopia: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="27",
volume="26",
pages="e50337",
keywords="barriers",
keywords="chronic disease",
keywords="digital health",
keywords="eHealth",
keywords="enablers",
keywords="health care",
keywords="mHealth",
keywords="mobile health",
keywords="perspectives",
keywords="Sub-Saharan Africa",
abstract="Background: Digital technologies are increasingly being used to deliver health care services and promote public health. Mobile wireless technologies or mobile health (mHealth) technologies are particularly relevant owing to their ease of use, broad reach, and wide acceptance. Unlike developed countries, Sub-Saharan Africa experiences more challenges and obstacles when it comes to deploying, using, and expanding mHealth systems. In addition to barriers, there are enabling factors that could be exploited for the design, implementation, and scaling up of mHealth systems. Sub-Saharan Africa may require tailored solutions that address the specific challenges facing the region. Objective: The overall aim of this study was to identify the barriers and enablers for using mHealth systems in Sub-Saharan Africa from the perspectives of patients, physicians, and health care executives. Methods: Multi-level and multi-actor in-depth semistructured interviews were employed to qualitatively explore the barriers and enablers of the use of mHealth systems. Data were collected from patients, physicians, and health care executives. The interviews were audio recorded, transcribed verbatim, translated, and coded. Thematic analysis methodology was adopted, and NVivo software was used for the data analysis. Results: Through this rigorous study, a total of 137 determinants were identified. Of these determinants, 68 were identified as barriers and 69 were identified as enablers. Perceived barriers in patients included lack of awareness about mHealth systems and language barriers. Perceived enablers in patients included need for automated tools for health monitoring and an increasing literacy level of the society. According to physicians, barriers included lack of available digital health systems in the local context and concern about patients' mHealth capabilities, while enablers included the perceived usefulness in reducing workload and improving health care service quality, as well as the availability of mobile devices and the internet. As perceived by health care executives, barriers included competing priorities alongside digitalization in the health sector and lack of interoperability and complete digitalization of implemented digital health systems, while enablers included the perceived usefulness of digitalization for the survival of the highly overloaded health care system and the abundance of educated manpower specializing in technology. Conclusions: mHealth systems in Sub-Saharan Africa are hindered and facilitated by various factors. Common barriers and enablers were identified by patients, physicians, and health care executives. To promote uptake, all relevant stakeholders must actively mitigate the barriers. This study identified a promising outlook for mHealth in Sub-Saharan Africa, despite the present barriers. Opportunities exist for successful integration into health care systems, and a user-centered design is crucial for maximum uptake. ",
doi="10.2196/50337",
url="https://www.jmir.org/2024/1/e50337",
url="http://www.ncbi.nlm.nih.gov/pubmed/38536231"
}


@Article{info:doi/10.2196/47081,
author="Hailemariam, Tesfahun
and Atnafu, Asmamaw
and Gezie, Lemma
and Kaasb{\o}ll, Jens
and Klein, Jorn
and Tilahun, Binyam",
title="Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="4",
volume="11",
pages="e47081",
keywords="data capturing",
keywords="data use",
keywords="eCHIS",
keywords="electronic community health information system",
keywords="health extension worker",
keywords="HEW",
keywords="intention to use",
keywords="service provision",
keywords="Unified Theory of Acceptance and Use of Technology 2",
keywords="UTAUT2 model",
abstract="Background: IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. Objective: This study aimed to assess HEWs' intentions to use the eCHIS for health data management and service provision. Methods: A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs' intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95\% CI with a corresponding P value of <.05. Results: A total of 456 HEWs participated in the study, with a response rate of 99\%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3\%; 95\% CI 34.7\%-43.9\%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy ($\beta$=0.256; P=.007), self-expectancy ($\beta$=0.096; P=.04), social influence ($\beta$=0.203; P=.02), and hedonic motivation ($\beta$=0.217; P=.03) were significantly associated with HEWs' intention to use the eCHIS. Conclusions: HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management. ",
doi="10.2196/47081",
url="https://humanfactors.jmir.org/2024/1/e47081",
url="http://www.ncbi.nlm.nih.gov/pubmed/38437008"
}


@Article{info:doi/10.2196/47703,
author="Benda, Natalie
and Dougherty, Kylie
and Gebremariam Gobezayehu, Abebe
and Cranmer, N. John
and Zawtha, Sakie
and Andreadis, Katerina
and Biza, Heran
and Masterson Creber, Ruth",
title="Designing Electronic Data Capture Systems for Sustainability in Low-Resource Settings: Viewpoint With Lessons Learned From Ethiopia and Myanmar",
journal="JMIR Public Health Surveill",
year="2024",
month="Feb",
day="12",
volume="10",
pages="e47703",
keywords="low and middle income countries",
keywords="LMIC",
keywords="electronic data capture",
keywords="population health surveillance, sociotechnical system",
keywords="data infrastructure",
keywords="electronic data system",
keywords="health care system",
keywords="technology",
keywords="information system",
keywords="health program development",
keywords="intervention",
doi="10.2196/47703",
url="https://publichealth.jmir.org/2024/1/e47703",
url="http://www.ncbi.nlm.nih.gov/pubmed/38345833"
}


@Article{info:doi/10.2196/50371,
author="Hartinger Pena, Maria Stella
and M{\"a}usezahl, Daniel
and J{\"a}ggi, Lena
and Aguilar, Leonel
and Alvarado Llatance, Milagros
and Castellanos, Andreana
and Huaylinos Bustamante, Maria-Luisa
and Hinckley, Kristen
and Charles McCoy, Dana
and Zhang, Ce
and Fink, G{\"u}nther",
title="Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="14",
volume="12",
pages="e50371",
keywords="child development",
keywords="digital support",
keywords="parenting",
keywords="Peru",
keywords="child",
keywords="children",
keywords="childhood",
keywords="parent",
keywords="parents",
keywords="education",
keywords="support",
keywords="parental",
keywords="cost",
keywords="low income",
keywords="low resource",
keywords="digital health",
keywords="platforms",
keywords="pediatric",
keywords="pediatrics",
keywords="eHealth",
keywords="e-health",
keywords="RCT",
keywords="RCTs",
keywords="randomized",
keywords="controlled trial",
keywords="development",
keywords="scalable",
abstract="Background: Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. Objective: The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. Methods: This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna M{\'a}s) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. Results: Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. Conclusions: This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. Trial Registration: ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106 International Registered Report Identifier (IRRID): DERR1-10.2196/50371 ",
doi="10.2196/50371",
url="https://www.researchprotocols.org/2023/1/e50371",
url="http://www.ncbi.nlm.nih.gov/pubmed/38096020"
}


@Article{info:doi/10.2196/47706,
author="Fuad, Anis
and Tiara, Agi
and Kusumasari, Amalia Rizqiani
and Rimawati, Rimawati
and Murhandarwati, Herdiana E. Elsa",
title="Introducing a Regulatory Sandbox Into the Indonesian Health System Using e-Malaria as a Use Case: Participatory Action Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="5",
volume="25",
pages="e47706",
keywords="regulatory sandbox",
keywords="digital health",
keywords="disruptive technologies",
keywords="e-malaria",
keywords="participatory action research",
keywords="Indonesia",
abstract="Background: Regulatory sandboxes offer an alternative solution to address regulatory challenges in adopting disruptive technologies. Although regulatory sandboxes have been widely implemented in the financial sector across more than 50 countries, their application to the health sector remains limited. Objective: This study aims to explore stakeholders' perspectives on introducing a regulatory sandbox into the Indonesian health system using e-malaria as a use case. Methods: Using a participatory action research approach, this study conducted qualitative research, including desk reviews, focus group discussions, and in-depth interviews with stakeholders. This study sought to understand stakeholders' concerns and interests regarding the regulatory sandbox and to collaboratively develop a regulatory sandbox model to support the malaria program. Results: The study revealed that most stakeholders had limited awareness of the regulatory sandbox concept. Concerns have been raised regarding the time required to establish regulations, knowledge gaps among stakeholders, data protection issues, and limited digital infrastructure in malaria endemic areas. Existing regulations have been found to be inadequate to accommodate disruptive healthtech for malaria. Nevertheless, through a collaborative process, stakeholders successfully developed a regulatory sandbox model specifically for e-malaria, with the crucial support of the Ministry of Health. Conclusions: The regulatory sandbox holds the potential for adoption in the Indonesian health system to address the limited legal framework and to facilitate the rapid and safe adoption of disruptive healthtech in support of the malaria elimination program. Through stakeholder involvement, guidelines for implementing the regulatory sandbox were developed and innovators were successfully invited to participate in the first-ever trial of a health regulatory sandbox for e-malaria in Indonesia. Future studies should provide further insights into the challenges encountered during the e-malaria regulatory sandbox pilot study, offering a detailed account of the implementation process. ",
doi="10.2196/47706",
url="https://www.jmir.org/2023/1/e47706",
url="http://www.ncbi.nlm.nih.gov/pubmed/38051555"
}


@Article{info:doi/10.2196/47052,
author="Ye, Jiancheng
and Xiong, Shangzhi
and Wang, Tengyi
and Li, Jingyi
and Cheng, Nan
and Tian, Maoyi
and Yang, Yang",
title="The Roles of Electronic Health Records for Clinical Trials in Low- and Middle-Income Countries: Scoping Review",
journal="JMIR Med Inform",
year="2023",
month="Nov",
day="22",
volume="11",
pages="e47052",
keywords="electronic health records",
keywords="clinical trials",
keywords="low- and middle-income countries",
abstract="Background: Clinical trials are a crucial element in advancing medical knowledge and developing new treatments by establishing the evidence base for safety and therapeutic efficacy. However, the success of these trials depends on various factors, including trial design, project planning, research staff training, and adequate sample size. It is also crucial to recruit participants efficiently and retain them throughout the trial to ensure timely completion. Objective: There is an increasing interest in using electronic health records (EHRs)---a widely adopted tool in clinical practice---for clinical trials. This scoping review aims to understand the use of EHR in supporting the conduct of clinical trials in low- and middle-income countries (LMICs) and to identify its strengths and limitations. Methods: A comprehensive search was performed using 5 databases: MEDLINE, Embase, Scopus, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. We followed the latest version of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guideline to conduct this review. We included clinical trials that used EHR at any step, conducted a narrative synthesis of the included studies, and mapped the roles of EHRs into the life cycle of a clinical trial. Results: A total of 30 studies met the inclusion criteria: 13 were randomized controlled trials, 3 were cluster randomized controlled trials, 12 were quasi-experimental studies, and 2 were feasibility pilot studies. Most of the studies addressed infectious diseases (15/30, 50\%), with 80\% (12/15) of them about HIV or AIDS and another 40\% (12/30) focused on noncommunicable diseases. Our synthesis divided the roles of EHRs into 7 major categories: participant identification and recruitment (12/30, 40\%), baseline information collection (6/30, 20\%), intervention (8/30, 27\%), fidelity assessment (2/30, 7\%), primary outcome assessment (24/30, 80\%), nonprimary outcome assessment (13/30, 43\%), and extended follow-up (2/30, 7\%). None of the studies used EHR for participant consent and randomization. Conclusions: Despite the enormous potential of EHRs to increase the effectiveness and efficiency of conducting clinical trials in LMICs, challenges remain. Continued exploration of the appropriate uses of EHRs by navigating their strengths and limitations to ensure fitness for use is necessary to better understand the most optimal uses of EHRs for conducting clinical trials in LMICs. ",
doi="10.2196/47052",
url="https://medinform.jmir.org/2023/1/e47052",
url="http://www.ncbi.nlm.nih.gov/pubmed/37991820"
}


@Article{info:doi/10.2196/48234,
author="Wang, Dongqing
and Nguyen, H. Christine
and Fawzi, W. Wafaie",
title="The Effects of Antenatal Interventions on Gestational Weight Gain in Low- and Middle-Income Countries: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="8",
volume="12",
pages="e48234",
keywords="low- and middle-income countries",
keywords="pregnant women",
keywords="gestational weight gain",
keywords="maternal nutrition",
keywords="interventions",
keywords="randomized controlled trials",
keywords="systematic review",
keywords="protocols",
keywords="RCT",
keywords="maternal",
keywords="pregnant",
keywords="pregnancy",
keywords="review methodology",
keywords="nutrition",
keywords="gestational",
keywords="weight",
keywords="prenatal",
keywords="LMIC",
keywords="low income",
keywords="middle income",
abstract="Background: Gestational weight gain (GWG) is a crucial determinant of maternal and child outcomes yet remains an underused target for antenatal interventions in low- and middle-income countries (LMICs). Objective: This systematic review aims to identify and summarize educational, behavioral, nutritional, and medical interventions on GWG from randomized controlled trials conducted in LMICs. Methods: Randomized controlled trials that documented the effects of antenatal interventions on GWG in LMICs will be included. The interventions of interest will be educational, behavioral, nutritional, or medical. A systematic literature search will be conducted using PubMed, Embase, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from the inception of each database through October 2022 (with an updated search in January 2024). A total of 2 team members will independently perform the screening of studies and data extraction. A narrative synthesis of all the included studies will be provided. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The certainty of the evidence for each homogeneous group of interventions will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. A narrative synthesis of the included studies will be conducted to summarize mean differences (with 95\% CIs) for continuous outcomes and risk ratios, rate ratios, hazard ratios, or odds ratios (with 95\% CIs) for dichotomous or categorical outcomes. Available information on the costs of interventions will also be summarized to facilitate the adoption and scale-up of effective GWG interventions. Results: The development of the research questions, search strategy, and search protocol was started on September 20, 2022. The database searches and the importation of the identified records into Covidence were performed on October 7, 2022. As of September 2023, the title and abstract screening was ongoing. The target completion time of this systematic review is April 2024. Conclusions: Without effective interventions to manage GWG, the potential to improve maternal and child health through optimal GWG remains unrealized in LMICs. This systematic review will inform the design and implementation of antenatal interventions to prevent inadequate and excessive GWG in resource-limited settings. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022366354; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=366354 International Registered Report Identifier (IRRID): PRR1-10.2196/48234 ",
doi="10.2196/48234",
url="https://www.researchprotocols.org/2023/1/e48234",
url="http://www.ncbi.nlm.nih.gov/pubmed/37938874"
}


@Article{info:doi/10.2196/45715,
author="Kaburi, Benduri Basil
and Wyss, Kaspar
and Kenu, Ernest
and Asiedu-Bekoe, Franklin
and Hauri, M. Anja
and Laryea, Odai Dennis
and Klett-Tammen, J. Carolina
and Leone, Fr{\'e}d{\'e}ric
and Walter, Christin
and Krause, G{\'e}rard",
title="Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="20",
volume="7",
pages="e45715",
keywords="implementation",
keywords="Surveillance Outbreak Response Management and Analysis System",
keywords="SORMAS",
keywords="barriers",
keywords="facilitators",
keywords="digital disease surveillance",
keywords="outbreak response",
keywords="COVID-19",
keywords="pandemic",
keywords="Ghana",
keywords="mobile phone",
abstract="Background: In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. Objective: This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. Methods: Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. Results: The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. Conclusions: The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding. ",
doi="10.2196/45715",
url="https://formative.jmir.org/2023/1/e45715",
url="http://www.ncbi.nlm.nih.gov/pubmed/37862105"
}


@Article{info:doi/10.2196/48256,
author="Bediang, Georges",
title="Implementing Clinical Information Systems in Sub-Saharan Africa: Report and Lessons Learned From the MatLook Project in Cameroon",
journal="JMIR Med Inform",
year="2023",
month="Oct",
day="18",
volume="11",
pages="e48256",
keywords="implementation report",
keywords="challenges",
keywords="success factors",
keywords="Sub-Saharan Africa",
keywords="Cameroon",
keywords="healthcare",
keywords="health care",
keywords="clinical information",
keywords="information management",
keywords="clinical information systems",
keywords="hospital information systems",
keywords="data governance",
abstract="Background: Yaound{\'e} Central Hospital (YCH), located in the capital of Cameroon, is one of the leading referral hospitals in Cameroon. The hospital has several departments, including the Department of Gynecology-Obstetrics (hereinafter referred to as ``the Maternity''). This clinical department has faced numerous problems with clinical information management, including the lack of high-quality and reliable clinical information, lack of access to this information, and poor use of this information. Objective: We aim to improve the management of clinical information generated at the Maternity at YCH and to describe the challenges, success factors, and lessons learned during its implementation and use. Methods: Based on an open-source hospital information system (HIS), this intervention implemented a clinical information system (CIS) at the Maternity at YCH and was carried out using the HERMES model---the first part aimed to cover outpatient consultations, billing, and cash management of the Maternity. Geneva University Hospitals supported this project, and several outcomes were measured at the end. The following outcomes were assessed: project management, technical and organizational aspects, leadership, change management, user training, and system use. Implementation (Results): The first part of the project was completed, and the CIS was deployed in the Maternity at YCH. The main technical activities were adapting the open-source HIS to manage outpatient consultations and develop integrated billing and cash management software. In addition to technical aspects, we implemented several other activities. They consisted of the implementation of appropriate project governance or management, improvement of the organizational processes at the Maternity, promotion of the local digital health leadership and performance of change management, and implementation of the training and support of users. Despite barriers encountered during the project, the 6-month evaluation showed that the CIS was effectively used during the first 6 months. Conclusions: Implementation of the HIS or CIS is feasible in a resource-limited setting such as Cameroon. The CIS was implemented based on good practices at the Maternity at YCH. This project had successes but also many challenges. Beyond project management and technical and financial aspects, the other main problems of implementing health information systems or HISs in Africa lie in digital health leadership, governance, and change management. This digital health leadership, governance, and change management should prioritize data as a tool for improving productivity and managing health institutions, and promote a data culture among health professionals to support a change in mindset and the acquisition of information management skills. Moreover, in countries with a highly centralized political system like ours, a high-level strategic and political anchor for such projects is often necessary to guarantee their success. ",
doi="10.2196/48256",
url="https://medinform.jmir.org/2023/1/e48256",
url="http://www.ncbi.nlm.nih.gov/pubmed/37851502"
}


@Article{info:doi/10.2196/48097,
author="Layer, Erica
and Slim, Salim
and Mussa, Issa
and Al-Mafazy, Abdul-Wahid
and Besana, R. Giulia V.
and Msellem, Mwinyi
and Fulcher, Isabel
and Hornung, Heiko
and Lampariello, Riccardo",
title="The Journey of Zanzibar's Digitally Enabled Community Health Program to National Scale: Implementation Report",
journal="JMIR Med Inform",
year="2023",
month="Oct",
day="9",
volume="11",
pages="e48097",
keywords="Zanzibar",
keywords="digital health",
keywords="community health",
keywords="health systems strengthening",
keywords="maternal health",
keywords="child health",
keywords="data for decision-making",
keywords="implementation science",
keywords="health systems",
keywords="healthcare infrastructure",
keywords="health care",
keywords="implementation report",
abstract="Background: While high-quality primary health care services can meet 80\%-90\% of health needs over a person's lifetime, this potential is severely hindered in many low-resource countries by a constrained health care system. There is a growing consensus that effectively designed, resourced, and managed community health worker programs are a critical component of a well-functioning primary health system, and digital technology is recognized as an important enabler of health systems transformation. Objective: In this implementation report, we describe the design and rollout of Zanzibar's national, digitally enabled community health program--Jamii ni Afya. Methods: Since 2010, D-tree International has partnered with the Ministry of Health Zanzibar to pilot and generate evidence for a digitally enabled community health program, which was formally adopted and scaled nationally by the government in 2018. Community health workers use a mobile app that guides service delivery and data collection for home-based health services, resulting in comprehensive service delivery, access to real-time data, efficient management of resources, and continuous quality improvement. Results: The Zanzibar government has documented increases in the delivery of health facilities among pregnant women and reductions in stunting among children younger than 5 years since the community health program has scaled. Key success factors included starting with the health challenge and local context rather than the technology, usage of data for decision-making, and extensive collaboration with local and global partners and funders. Lessons learned include the significant time it takes to scale and institutionalize a digital health systems innovation due to the time to generate evidence, change opinions, and build capacity. Conclusions: Jamii ni Afya represents one of the world's first examples of a nationally scaled digitally enabled community health program. This implementation report outlines key successes and lessons learned, which may have applicability to other governments and partners working to sustainably strengthen primary health systems. ",
doi="10.2196/48097",
url="https://medinform.jmir.org/2023/1/e48097",
url="http://www.ncbi.nlm.nih.gov/pubmed/37812488"
}


@Article{info:doi/10.2196/45250,
author="Thomas, Verghese
and Kalidindi, Bharat
and Waghmare, Abijeet
and Bhatia, Abhishek
and Raj, Tony
and Balsari, Satchit",
title="The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="2",
volume="7",
pages="e45250",
keywords="community health workers",
keywords="digital health",
keywords="focus group discussions",
keywords="health care workers",
keywords="human centered design",
keywords="key informant interviews",
keywords="LMICs",
keywords="low- and middle-income countries",
keywords="mHealth",
keywords="mobile health",
keywords="qualitative research",
abstract="Background: mHealth (mobile health) systems have been deployed widely in low- and middle-income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by health care workers. A human-centered design approach to improving mHealth system use requires an exploration of users' perceptions of mHealth systems, including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration before full-scale development and deployment. Objective: To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design and, consequently, successful adoption. Methods: We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann to label, sort, and collate findings and themes into a list of questions that explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs. Results: We developed the Vinyasa Tool to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based health care workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections that unpack and explore multiple aspects of mHealth systems from the perspectives of their users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow, and adoption behavior of a system's users; the security, privacy, and interoperability afforded by a system; and the artifacts of an information system---the data, information, knowledge, algorithms, and technology that constitute the system. The tool can be deployed in whole or in part, depending on the context of the study. Conclusions: The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it to find wide application among mHealth developers, health system administrators, and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human-centered design with the goal of improving relevance, usability, and, therefore, adoption. ",
doi="10.2196/45250",
url="https://formative.jmir.org/2023/1/e45250",
url="http://www.ncbi.nlm.nih.gov/pubmed/37607881"
}


@Article{info:doi/10.2196/45224,
author="O'Brien, Niki
and Li, Edmond
and Chaibva, N. Cynthia
and Gomez Bravo, Raquel
and Kovacevic, Lana
and Kwame Ayisi-Boateng, Nana
and Lounsbury, Olivia
and Nwabufo, F. Ngnedjou Francoise
and Senkyire, Kumi Ephraim
and Serafini, Alice
and Surafel Abay, Eleleta
and van de Vijver, Steven
and Wanjala, Mercy
and Wangari, Marie-Claire
and Moosa, Shabir
and Neves, Luisa Ana",
title="Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="7",
volume="25",
pages="e45224",
keywords="digital health",
keywords="digital health technology",
keywords="telemedicine",
keywords="remote care",
keywords="primary care",
keywords="primary health carel PHC",
keywords="COVID-19",
keywords="global health",
keywords="sub-Saharan Africa",
keywords="eHealth",
abstract="Background: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers' contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle. ",
doi="10.2196/45224",
url="https://www.jmir.org/2023/1/e45224",
url="http://www.ncbi.nlm.nih.gov/pubmed/37676721"
}


@Article{info:doi/10.2196/44784,
author="Harahap, Clydea Nabila
and Handayani, Wuri Putu
and Hidayanto, Nizar Achmad",
title="Integrated Personal Health Record in Indonesia: Design Science Research Study",
journal="JMIR Med Inform",
year="2023",
month="Mar",
day="14",
volume="11",
pages="e44784",
keywords="personal health record",
keywords="integrated",
keywords="Indonesia",
keywords="design science",
keywords="mobile phone",
abstract="Background: Personal health records (PHRs) are consumer-centric tools designed to facilitate the tracking, management, and sharing of personal health information. PHR research has mainly been conducted in high-income countries rather than in low- and middle-income countries. Moreover, previous studies that proposed PHR design in low- and middle-income countries did not describe integration with other systems, or there was no stakeholder involvement in exploring PHR requirements. Objective: This study developed an integrated PHR architecture and prototype in Indonesia using design science research. We conducted the research in Indonesia, a low- to middle-income country with the largest population in Southeast Asia and a tiered health system. Methods: This study followed the design science research guidelines. The requirements were identified through interviews with 37 respondents from health organizations and a questionnaire with 1012 patients. Afterward, the proposed architecture and prototype were evaluated via interviews with 6 IT or eHealth experts. Results: The architecture design refers to The Open Group Architecture Framework version 9.2 and comprises 5 components: architecture vision, business architecture, application architecture, data architecture, and technology architecture. We developed a high-fidelity prototype for patients and physicians. In the evaluation, improvements were made to add the stakeholders and the required functionality to the PHR and add the necessary information to the functions that were developed in the prototype. Conclusions: We used design science to illustrate PHR integration in Indonesia, which involves related stakeholders in requirement gathering and evaluation. We developed architecture and application prototypes based on health systems in Indonesia, which comprise routine health services, including disease treatment and health examinations, as well as promotive and preventive health efforts. ",
doi="10.2196/44784",
url="https://medinform.jmir.org/2023/1/e44784",
url="http://www.ncbi.nlm.nih.gov/pubmed/36917168"
}


@Article{info:doi/10.2196/43772,
author="Tang, Weiming
and Xie, Yewei
and Xiong, Mingzhou
and Wu, Dan
and Ong, J. Jason
and Wi, Elvira Teodora
and Yang, Bin
and Tucker, D. Joseph
and Wang, Cheng",
title="A Pay-It-Forward Approach to Improve Chlamydia and Gonorrhea Testing Uptake Among Female Sex Workers in China: Venue-Based Superiority Cluster Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="2",
volume="9",
pages="e43772",
keywords="pay-it-forward",
keywords="chlamydia",
keywords="gonorrhea",
keywords="testing",
keywords="female sex workers",
keywords="women",
keywords="China",
keywords="cost",
keywords="stigma",
keywords="prevention",
keywords="community",
keywords="HIV",
keywords="care",
keywords="STD",
keywords="implementation",
keywords="research",
abstract="Background: Regular chlamydia and gonorrhea testing are essential for key populations, such as female sex workers (FSWs). However, testing cost, stigma, and lack of access prevent FSWs in low- and middle-income countries from receiving chlamydia and gonorrhea testing. A social innovation to address these problems is ``pay it forward,'' where an individual receives a gift (free testing) and then asks whether they would like to give a gift to another person in the community. Objective: This cluster randomized controlled trial examined the effectiveness and cost of the pay-it-forward strategy in increasing access to chlamydia and gonorrhea testing among FSWs in China. Methods: This trial integrated a pay-it-forward approach into a community-based HIV outreach service. FSWs (aged 18 years or older) were invited by an outreach team from 4 Chinese cities (clusters) to receive free HIV testing. The 4 clusters were randomized into 2 study arms in a 1:1 ratio: a pay-it-forward arm (offered chlamydia and gonorrhea testing as a gift) and a standard-of-care arm (out-of-pocket cost for testing: US \$11). The primary outcome was chlamydia and gonorrhea test uptake, as ascertained by administrative records. We conducted an economic evaluation using a microcosting approach from a health provider perspective, reporting our results in US dollars (at 2021 exchange rates). Results: Overall, 480 FSWs were recruited from 4 cities (120 per city). Most FSWs were aged ?30 years (313/480, 65.2\%), were married (283/480, 59\%), had an annual income <US \$9000 (301/480, 62.7\%), and had never been tested for chlamydia (401/480, 83.5\%) or gonorrhea (397/480, 82.7\%). Chlamydia and gonorrhea test uptake in the pay-it-forward and standard-of-care arms were 82\% (197/240) and 4\% (10/240), respectively, with an adjusted proportion difference of 76.7\% (lower bound 95\% CI 70.8\%). All those who tested positive were referred to and received treatment at local sexually transmitted infection clinics. This finding was consistent when adjusting for marital status, income, inconsistent condom use during commercial sex in the last 3 months, and HIV testing history. Among 197 women who received tests in the pay-it-forward arm, 99 (50.3\%) donated money, with a median donation of US \$1.54 (IQR 0.77-1.54). The economic cost per person tested was US \$568.71 for standard of care and US \$43.20 for pay it forward. Conclusions: The pay-it-forward strategy has the potential to enhance chlamydia and gonorrhea testing for Chinese FSWs and may be useful for scaling up preventive services. Further implementation research is needed to inform the transition of pay-it-forward research into practice. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000037653; https://www.chictr.org.cn/showprojen.aspx?proj=57233 ",
doi="10.2196/43772",
url="https://publichealth.jmir.org/2023/1/e43772",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862485"
}


@Article{info:doi/10.2196/41892,
author="Pandey, Kumar Anuj
and Raushan, Ravi Mukesh
and Gautam, Diksha
and Neogi, Bandyopadhyay Sutapa",
title="Alarming Trends of Cesarean Section---Time to Rethink: Evidence From a Large-Scale Cross-sectional Sample Survey in India",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="13",
volume="25",
pages="e41892",
keywords="cesarean section",
keywords="surgical obstetric procedure",
keywords="abdominal delivery",
keywords="reproductive health service",
keywords="women health services",
keywords="obstetrics",
keywords="health promotion",
abstract="Background: Cesarean section (CS) delivery rate has increased significantly both globally and in India, thereby posing a burden on overstretched health systems. Objective: This study plans to understand the factors associated with CS rate with an objective to (1) analyze the trends of CS delivery from 1998-99 to 2019-21 and (2) understand the proximate determinants of CS deliveries in India. Methods: Analysis of secondary data (National Family Health Survey) of a nationally representative sample of 230,870 women (year 2019-21) was undertaken to explore the trends, distribution, and determinants of CS deliveries in India and within states. Multivariable analyses were performed to determine the proximate variables associated with CS and elective CS. The relative interaction effect of confounding factors, such as number of antenatal care (ANC) visits, place of residence, and wealth status, on cesarean delivery was assessed. A composite index was generated using trust, support, and intimate partner violence variables (termed the partner human capital index [PHI]) to study its influence on CS deliveries, with a low PHI indicating abusive partner and a high PHI indicating supportive partner. Statewise spatial distribution of the most significantly associated factors, namely, wealth quintile and ANC checkups, were also analyzed. Results: The overall prevalence of CS was 21.50\% (49,634/230,870) which had risen from 16.72\% (2312/13,829) in 1998-99. The adjusted odds of CS deliveries were significantly higher among women who were highly educated (odds ratio [OR] 7.30, 95\% CI 7.02-7.60; P<.001), had 4 or more ANC visits (OR 2.28, 95\% CI 2.15-2.42; P<.001), belonging to the high-wealth quintile (OR 7.87, 95\% CI 7.57-8.18; P<.001), and from urban regions. Increasing educational level of the head of the household (OR 3.05, 95\% CI 2.94-3.16; P<.001) was also found to be a significant determinant of CS deliveries. The odds of selection of elective and emergency CS were also significantly higher among women from richer families (OR 1.66, 95\% CI 1.25-2.21; P<.001) and those belonging to Christian religion (OR 1.67, 95\% CI 1.14-2.43; P=.008). Adjusting the cesarean delivery by PHI, the odds of outcome were significantly higher among women with moderate and high PHI compared with those with low PHI (OR 1.46, 95\% CI 1.36-1.56 and OR 1.61, 95\% CI 1.49-1.74, respectively; P<.001 for both). The interaction effect result reiterates that women with more than 4 ANC checkups, high PHI, and belonging to the richer wealth quintile were more likely to undergo cesarean delivery (OR 22.22, 95\% CI 14.99-32.93; P<.001) compared with those with no ANC visit, low PHI, and poorest women. Conclusions: The increasing trend of CS deliveries across India is raising concerns. Better education, wealth, and good support from the partner have been incriminated as the contributory factors. There is a need to institute proper monitoring mechanisms to assess the need for CS, especially when performed electively. ",
doi="10.2196/41892",
url="https://www.jmir.org/2023/1/e41892/"
}


@Article{info:doi/10.2196/44308,
author="Bhana, Sindeep
and Naidoo, Poobalan
and Pillay, Somasundram
and Variava, Ebrahim
and Naidoo, Kiolan
and Rohitlall, Neeresh
and Sekhuthe, Lauren
and Pauly, Bruno",
title="Health Care Resource Utilization in Adults Living With Type 1 Diabetes Mellitus in the South African Public Health Sector: Protocol for a 1-Year Retrospective Analysis With a 5-, 10-, and 25-Year Projection",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="13",
volume="12",
pages="e44308",
keywords="type 1 diabetes mellitus",
keywords="South African public health care system",
keywords="health care resource utilization",
keywords="pharmacoeconomics",
keywords="diabetes",
keywords="adults",
keywords="insulin",
keywords="essential",
keywords="policy makers",
abstract="Background: Type 1 diabetes mellitus (T1DM) is less common than type 2 diabetes mellitus but is increasing in frequency in South Africa. It tends to affect younger individuals, and upon diagnosis, exogenous insulin is essential for survival. In South Africa, the health care system is divided into private and public health care systems. The private system is well resourced, whereas the public sector, which treats more than 80\% of the population, has minimal resources. There are currently no studies in South Africa, and Africa at large, that have evaluated the immediate and long-term costs of managing people living with T1DM in the public sector. Objective: The primary objective was to quantify the cost of health care resource utilization over a 12-month period in patients with controlled and uncontrolled T1DM in the public health care sector. In addition, we will project costs for 5, 10, and 25 years and determine if there are cost differences in managing subsets of patients who achieve glycemic control (hemoglobin A1c [HbA1c] <7\%) and those who do not. Methods: The study was performed in accordance with Good Epidemiological Practice. Ethical clearance and institutional permissions were acquired. Clinical data were collected from 2 tertiary hospitals in South Africa. Patients with T1DM, who provided written informed consent, and who satisfied the inclusion criteria were enrolled in the study. Data collection included demographic and clinical characteristics, acute and chronic complications, hospital admissions, and so on. We plan to perform a cost-effectiveness analysis to quantify the costs of health care utilization in the preceding 12 months. In addition, we will estimate projected costs over the next 10 years, assuming that study participants maintain their current HbA1c level. The cost-effectiveness analysis will be modeled using the IQVIA CORE Diabetes Model. The primary outcome measures are incremental quality-adjusted life years, incremental costs, incremental cost-effectiveness ratios, and incremental life years. Results: Ethical clearance and institutional approval were obtained (reference number 200407). Enrollment began on February 9, 2021, and was completed on August 24, 2021, with 224 participants. A database lock was performed on October 29, 2021. The statistical analysis and clinical study report were completed in January 2022. Conclusions: At present, there are no data assessing the short- and long-term costs of managing patients with T1DM in the South African public sector. It is hoped that the findings of this study will help policy makers optimally use limited resources to reduce morbidity and mortality in people living with T1DM. International Registered Report Identifier (IRRID): RR1-10.2196/44308 ",
doi="10.2196/44308",
url="https://www.researchprotocols.org/2023/1/e44308",
url="http://www.ncbi.nlm.nih.gov/pubmed/36780227"
}


@Article{info:doi/10.2196/25361,
author="Verma, Neha
and Lehmann, Harold
and Alam, Afroz Amal
and Yazdi, Youseph
and Acharya, Soumyadipta",
title="Development of a Digital Assistant to Support Teleconsultations Between Remote Physicians and Frontline Health Workers in India: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="2",
volume="10",
pages="e25361",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="community health workers",
keywords="frontline health workers",
keywords="digital health assistant",
keywords="task shifting",
abstract="Background: Many low- and middle-income countries have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with physicians in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographical barriers, these health worker--to-physician telemedicine programs have the potential to increase health care quality, expand the specialties available to patients, and reduce the time and cost required to deliver care. Objective: We aimed to identify, validate, and prioritize unmet needs in the health care space of health worker--to-physician telemedicine programs and develop and refine a solution that addresses those needs. Methods: We collected information regarding user needs through ethnographic research, direct observation, and semistructured interviews with 37 stakeholders (n=5, 14\% physicians; n=1, 3\% public health program manager; n=12, 32\% community health workers; and n=19, 51\% patients) at 2 telemedicine clinics in rural West Bengal, India. We used the Spiral-Iterative Innovation Model to design and develop a prototype solution to meet these needs. Results: We identified 74 unmet needs through our immersion in health worker--to-physician telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in low- and middle-income countries often requires shifting tasks such as history taking and physical examination from high-skilled remote physicians to FHWs. To meet this need, we developed a prototype digital assistant that would allow FHWs to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, physicians, and health organizations) were incorporated into the design and features of the task-shifting tool. The final prototype was shared with the health workers, physicians, and public health program managers who expressed that the tool would be useful and valuable. Conclusions: The final prototype that was developed was released as an open-source digital public good and may improve the quality and efficiency of care delivery in health worker--to-physician telemedicine programs. ",
doi="10.2196/25361",
url="https://humanfactors.jmir.org/2023/1/e25361",
url="http://www.ncbi.nlm.nih.gov/pubmed/36729578"
}


@Article{info:doi/10.2196/38213,
author="Obase, Ngemani Bekindaka
and Francis, Zeukeng
and Forgu, Livo Esemu
and Honore, Awanakam
and Bigoga, Daiga Jude
and Nsagha, S. Dickson",
title="The Effects of HIV Infection on the Immune Response to Malaria Among Pregnant Women in Kumba, Southwest Cameroon: Protocol for a Cross-sectional Study",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="24",
volume="12",
pages="e38213",
keywords="malaria",
keywords="HIV",
keywords="co-infection",
keywords="pregnancy",
keywords="prevalence",
keywords="allele",
keywords="immunity",
keywords="antibodies",
keywords="cytokines",
keywords="Cameroon",
abstract="Background: Malaria and HIV, 2 of the world's deadliest diseases, share a lot of territory in sub-Saharan Africa. Objective: This study seeks to investigate the effect of HIV on the immune response to malaria infection among pregnant women in Kumba in the southwest region (SWR) of Cameroon. The study aims to determine the prevalence of malaria infection, assess the occurrence of Plasmodium falciparum genetic diversity, and evaluate the antibody (immunoglobulin [Ig]G and IgM: apical membrane antigen-1 [AMA1], merozoite surface protein [MSP]1, MSP2, MSP3, and erythrocyte-binding antigen [EBA]175) and cytokine (interleukin [IL]-10, tumor necrosis factor alpha [TNF-$\alpha$], and interferon gamma [IFN$\gamma$]) response to malaria infection among pregnant women with and without HIV in Kumba. Methods: The study will be a hospital-based cross-sectional design that will run from March 2022 to February 2023. It will recruit pregnant women with and without HIV who are in their third trimester of pregnancy. The study will be carried out in 5 health institutions in Kumba: General Hospital Kumba, Presbyterian Hospital Kumba, District Hospital Kumba-town, Kossala Integrated Health Center Kumba, and Catholic Hospital Kumba. About 3 mL of the mother's venous blood, placental blood, and baby cord blood will be collected from each pregnant women at the point of delivery. Microscopy, rapid diagnostic tests (RDTs), and nested polymerase chain reaction (PCR) will be performed to identify the malaria parasite in all the samples, and nested PCR targeting the different genetic diversity markers for P. falciparum will also be performed. Furthermore, sequencing will be performed to study the nucleotide sequence of different alleles, and the genetic diversity of the alleles responsible for malaria infection among pregnant women will be assessed. A multiplex assay will be conducted to analyze the peripheral blood plasma and cord blood plasma for the cytokine and total antibody response to malaria infection among pregnant women with and without HIV. The questionnaire for data collection will be pretested at the Kumba District Hospital, and ethical clearance will be obtained from the University of Buea and the Regional Delegation of Public Health for the SWR. Data will be analyzed using SPSS Statistics and STATA. All P values <.05 will be considered statistically significant. BioEdit 7.0.0 software will be used to align the nucleotide sequences of different genes after sequencing. Phylogenetic tree searching will be conducted using the maximum-likelihood (ML) method in MEGA V6.0. Results: The project started in March 2022 and will end in February 2023. Presently, three-fourth of the project funding has been disbursed to date. A total of 218 participants have been enrolled: 193 (88.5\%) women without HIV and 25 (11.5\%) women with HIV. Between February 2023 and March 2024, the following results will be ready for publication: maternal-neonatal malaria prevalence among pregnant women and babies in Kumba, the effect of HIV on (1) P. falciparum genetic diversity among pregnant women in Kumba, (2) the maternal and neonatal immune response to MSP1, MSP2, and EBA175 IgG antibody response to P. falciparum--caused malaria infection among pregnant women, and (3) the maternal and neonatal pro-inflammatory and anti-inflammatory cytokine response to malaria infection. Conclusions: HIV infection increases the prevalence of malaria infection among pregnant women and also influences the genetic diversity of P. falciparum, with MSP1 alleles being the most prevalent. HIV infection also reduces the antibody response to malaria infection, as well as altering the level of pro-inflammatory and anti-inflammatory responses to malaria infection. International Registered Report Identifier (IRRID): DERR1-10.2196/38213 ",
doi="10.2196/38213",
url="https://www.researchprotocols.org/2023/1/e38213",
url="http://www.ncbi.nlm.nih.gov/pubmed/36692923"
}


@Article{info:doi/10.2196/40721,
author="Tegegne, Derese Masresha
and Wubante, Maru Sisay
and Kalayou, Hayelom Mulugeta
and Melaku, Sharew Mequannent
and Tilahun, Binyam
and Yilma, Melese Tesfahun
and Dessie, Simane Hiwote",
title="Electronic Medical Record System Use and Determinants in Ethiopia: Systematic Review and Meta-Analysis",
journal="Interact J Med Res",
year="2023",
month="Jan",
day="11",
volume="12",
pages="e40721",
keywords="electronic medical record system",
keywords="health professional",
keywords="utilization",
keywords="determinants",
keywords="Ethiopia",
keywords="medical record",
keywords="EMR",
keywords="EHR",
keywords="electronic health record",
keywords="health information technology",
keywords="systematic review",
abstract="Background: The strategic plan of the Ethiopian Ministry of Health recommends an electronic medical record (EMR) system to enhance health care delivery and streamline data systems. However, only a few exhaustive systematic reviews and meta-analyses have been conducted on the degree of EMR use in Ethiopia and the factors influencing success. This will emphasize the factors that make EMR effective and increase awareness of its widespread use among future implementers in Ethiopia. Objective: This study aims to determine the pooled estimate of EMR use and success determinants among health professionals in Ethiopia. Methods: We developed a protocol and searched PubMed, Web of Sciences, African Journals OnLine, Embase, MEDLINE, and Scopus to identify relevant studies. To assess the quality of each included study, we used the Joanna Briggs Institute quality assessment tool using 9 criteria. The applicable data were extracted using Microsoft Excel 2019, and the data were then analyzed using Stata software (version 11; StataCorp). The presence of total heterogeneity across included studies was calculated using the index of heterogeneity I2 statistics. The pooled size of EMR use was estimated using a random effect model with a 95\% CI. Results: After reviewing 11,026 research papers, 5 papers with a combined total of 2439 health workers were included in the evaluation and meta-analysis. The pooled estimate of EMR usage in Ethiopia was 51.85\% (95\% CI 37.14\%-66.55\%). The subgroup study found that the northern Ethiopian region had the greatest EMR utilization rate (58.75\%) and that higher (54.99\%) utilization was also seen in publications published after 2016. Age groups <30 years, access to an EMR manual, EMR-related training, and managerial support were identified factors associated with EMR use among health workers. Conclusions: The use of EMR systems in Ethiopia is relatively low. Belonging to a young age group, accessing an EMR manual, receiving EMR-related training, and managerial support were identified as factors associated with EMR use among health workers. As a result, to increase the use of EMRs by health care providers, it is essential to provide management support and an EMR training program and make the EMR manual accessible to health professionals. ",
doi="10.2196/40721",
url="https://www.i-jmr.org/2023/1/e40721",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630161"
}


@Article{info:doi/10.2196/41132,
author="Mbwogge, Mathew
and Kumar, Pratyush
and Abhishek, Kumar",
title="A Metasynthesis and Meta-analysis of the Impact and Diagnostic Safety of COVID-19 Symptom Agnostic Rapid Testing in Low- and Middle-Income Countries: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="5",
volume="12",
pages="e41132",
keywords="SARS-CoV-2",
keywords="2019-nCoV",
keywords="rapid test",
keywords="diagnostic accuracy",
keywords="meta-analysis",
keywords="metasynthesis",
keywords="COVID-19",
keywords="low- and middle-income countries",
abstract="Background: Amid all public health measures to contain COVID-19, the most challenging has been how to break the transmission chain. This has been even more challenging in low- and middle-income countries (LMICs). A public health emergency warrants a public health perspective, which comes down to prevention. Rapid mass testing has been advocated throughout the pandemic as a way to promptly deal with asymptomatic infections, but its usefulness in LMICs is yet to be fully understood. Objective: The study objectives of this paper are to (1) investigate the impact of the different rapid mass testing options for SARS-CoV-2 that have been delivered at point of care in LMICs and (2) evaluate the diagnostic safety (accuracy) of rapid mass testing for SARS-CoV-2 in LMICs. Methods: This review will systematically search records in PubMed, EBSCOhost, Cochrane library, Global Index Medicus COVID-19 Register, and Scopus. Records will be managed using Mendeley reference manager and SWIFT-Review. Risk of bias for randomized controlled trials will be assessed using the RoB 2 assessment tool, while nonrandomized interventions will be assessed using the tool developed by the Evidence Project. A narrative approach will be used to synthesize data under the first objective, and either a meta-analysis or synthesis without meta-analysis for the second objective. Tables, figures, and textual descriptions will be used to present findings. The overall body of evidence for the first objective will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation--Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach, and for the second objective using GRADE. Results: The screening of records has been finalized. We hope to finalize the synthesis by the end of February 2023 and to prepare the manuscript for publication by April 2023. The study will be reported in accordance with standard guidelines for the reporting of systematic reviews. Review results will be disseminated through conferences and their peer-reviewed publication in a relevant journal. Conclusions: This review highlights the role of a preventive approach in infection control using rapid mass testing. It also flags the overriding need to involve users and providers in the evaluation of such tests in the settings for which they are intended. This will be the first review to the best of our knowledge to generate both qualitative and quantitative evidence regarding rapid mass testing specific to LMICs. Trial Registration: PROSPERO CRD42022283776; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=283776 International Registered Report Identifier (IRRID): PRR1-10.2196/41132 ",
doi="10.2196/41132",
url="https://www.researchprotocols.org/2023/1/e41132",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602849"
}


@Article{info:doi/10.2196/41586,
author="Kikuchi, Kimiyo
and Islam, Rafiqul
and Sato, Yoko
and Nishikitani, Mariko
and Izukura, Rieko
and Jahan, Nusrat
and Yokota, Fumihiko
and Ikeda, Subaru
and Sultana, Nazneen
and Nessa, Meherun
and Nasir, Morshed
and Ahmed, Ashir
and Kato, Kiyoko
and Morokuma, Seiichi
and Nakashima, Naoki",
title="Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="15",
volume="11",
number="12",
pages="e41586",
keywords="telehealth care",
keywords="continuum of care",
keywords="maternal, newborn, and child health",
keywords="portable health clinic",
keywords="parenting",
keywords="prenatal",
keywords="pediatrics",
abstract="Background: Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. Objective: Our study will examine the telehealth care system's effectiveness in improving women's and infants' care uptake and detecting their health problems. Methods: A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (?16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants' health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants' health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention's effectiveness. Results: Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. Conclusions: Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women's and infants' health status. Trial Registration: ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621 International Registered Report Identifier (IRRID): DERR1-10.2196/41586 ",
doi="10.2196/41586",
url="https://www.researchprotocols.org/2022/12/e41586",
url="http://www.ncbi.nlm.nih.gov/pubmed/36520523"
}


@Article{info:doi/10.2196/38628,
author="Xiao, Ting
and Ou, Chun-Quan
and Yang, Jun
and Wang, Chunhua
and Yang, Mei
and Yu, Tingyu
and Shen, Liang
and Xu, Xiaohan
and Xing, Hui",
title="The Risk Factors for Cervical Cytological Abnormalities Among Women Infected With Non-16/18 High-Risk Human Papillomavirus: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Dec",
day="8",
volume="8",
number="12",
pages="e38628",
keywords="non-16/18 high-risk human papillomavirus",
keywords="cervical cytological abnormalities",
keywords="risk factors",
keywords="logistic regression",
keywords="cervical cancer",
keywords="screening",
keywords="rural",
keywords="pelvic examination",
keywords="education",
keywords="gravidity",
abstract="Background: High-risk human papillomavirus (hrHPV) infection is a necessary cause of almost all cervical cancers. Relative to hrHPV 16/18 infection, non-16/18 hrHPV infection is of less concern. However, the increasing prevalence of non-16/18 hrHPV infections has become an important public health issue. The early identification and treatment of cervical cytological abnormalities in women infected with non-16/18 hrHPV reduces the incidence of cervical cancer. To date, no study has examined the risk factors for cytological abnormalities in this high-risk population. Objective: This population-based, cross-sectional study aimed to identify the risk factors for cervical cytological abnormalities in women infected with non-16/18 hrHPV. Methods: A total of 314,587 women from the general population were recruited for cervical cancer screening at 136 primary care hospitals in Xiangyang, China. Of these, 311,604 women underwent HPV genotyping, and 17,523 non-16/18 hrHPV--positive women were referred for cytological screening according to the screening program. A logistic regression model was used to assess the risk factors for cytological abnormalities among these non-16/18 hrHPV--positive women. A separate analysis was performed to determine the factors influencing high-grade cytological abnormalities. Results: The non-16/18 hrHPV infection rate was 5.88\% (18,323/311,604), which was 3-fold higher than that of hrHPV 16/18 (6068/311,604, 1.95\%). Among the non-16/18 hrHPV--positive women who underwent ThinPrep cytologic test, the overall prevalence rates of cervical cytological abnormalities and high-grade cytological abnormalities were 13.46\% (2359/17,523) and 1.18\% (206/17,523), respectively. Multivariate logistic regression analysis revealed that women with middle or high school educational attainment were at a higher risk of having cytological abnormalities than those who received primary education (odds ratio [OR] 1.31, 95\% CI 1.17-1.45; P<.001, and OR 1.32, 95\% CI 1.14-1.53; P<.001, respectively). Living in rural areas (OR 2.58, 95\% CI 2.29-2.90; P<.001), gravidity ?3 (OR 2.77, 95\% CI 1.19-6.45; P=.02), cervix abnormalities detected in pelvic examination (OR 1.22, 95\% CI 1.11-1.34; P<.001), and having a cervical cancer screening 3 years ago (OR 0.79, 95\% CI 0.62-1.00; P=.048) were associated with cytological abnormalities. The risk factors for high-grade cytological abnormalities included middle school education (OR 1.45, 95\% CI 1.07-1.98; P=.02), living in rural regions (OR 1.52, 95\% CI 1.10-2.10; P=.01), and cervix abnormality (OR 1.72, 95\% CI 1.30-2.26; P<.001). Conclusions: The dominant epidemic of non-16/18 hrHPV infection is revealed in Chinese women. Multiple risk factors for cervical cytological abnormalities have been identified in women infected with non-16/18 hrHPV. These findings can provide important information for clinically actionable decisions for the screening, early diagnosis, intervention, and prevention of cervical cancer in non-16/18 hrHPV--positive women. ",
doi="10.2196/38628",
url="https://publichealth.jmir.org/2022/12/e38628",
url="http://www.ncbi.nlm.nih.gov/pubmed/36480259"
}


@Article{info:doi/10.2196/35176,
author="Koumamba, Patrice Aim{\'e}
and Ngoungou, Brice Edgard
and Engohang-Ndong, Jean
and Ibinga, Euloge
and Ondzigue Mbenga, Raymond
and Diallo, Gayo",
title="From Real-world Individuals' Data to National Health Indicators: Multiphase Pilot Study in Gabon",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="7",
volume="6",
number="10",
pages="e35176",
keywords="health data quality",
keywords="decision support information system",
keywords="low- and middle-income countries",
keywords="LMICs",
keywords="mobile phone",
abstract="Background: Achieving health goals requires informed decision-making supported by transparent, reliable, and relevant health information. This helps decision makers, such as health managers, to better understand the functioning of their health system and improve their ability to respond quickly to health demands. To achieve this, the health system needs to be supported by a digitized decision-making information system. In Sub-Saharan African countries, inadequate digital infrastructure, including limited internet connectivity and insufficient access to appropriate computer software, makes it difficult to collect, process, and analyze data for health statistics. The processing of data is done manually in this case; however, this situation affects the quality of the health statistics produced and compromises the quality of health intervention choices in these countries. Objective: This study aimed to describe the conceptual approach of a data production and dissemination platform model proposed and implemented in Gabon. More precisely, it aimed to present the approach applied for the multidimensional analysis of the data production and dissemination process in the existing information system and present the results of an evaluation of the proposed model implemented in a real context. Methods: The research was carried out in 3 phases. First, a platform was designed and developed based on the examination of the various data production and indicator generation procedures. Then, the platform was implemented in chosen health facilities in Gabon. Finally, a platform evaluation was carried out with actual end users. Results: A total of 14 users with 12 years of average experience in health data management were interviewed. The results show that the use of the proposed model significantly improved the completeness, timeliness, and accuracy of data compared with the traditional system (93\% vs 12\%, P<.001; 96\% vs 18\%, P<.001; and 100\% vs 18\%, P<.001; respectively). Conclusions: The proposed model contributes significantly to the improvement of health data quality in Gabon. ",
doi="10.2196/35176",
url="https://formative.jmir.org/2022/10/e35176",
url="http://www.ncbi.nlm.nih.gov/pubmed/36206045"
}


@Article{info:doi/10.2196/33402,
author="Mar{\'e}, Adele Irma
and Kramer, Beverley
and Hazelhurst, Scott
and Nhlapho, Dorcus Mapule
and Zent, Roy
and Harris, A. Paul
and Klipin, Michael",
title="Electronic Data Capture System (REDCap) for Health Care Research and Training in a Resource-Constrained Environment: Technology Adoption Case Study",
journal="JMIR Med Inform",
year="2022",
month="Aug",
day="30",
volume="10",
number="8",
pages="e33402",
keywords="electronic data capture",
keywords="implementation science",
keywords="Research Electronic Data Capture",
keywords="REDCap",
keywords="biomedical informatics",
keywords="South Africa",
abstract="Background: Electronic data capture (EDC) in academic health care organizations provides an opportunity for the management, aggregation, and secondary use of research and clinical data. It is especially important in resource-constrained environments such as the South African public health care sector, where paper records are still the main form of clinical record keeping. Objective: The aim of this study was to describe the strategies followed by the University of the Witwatersrand Faculty of Health Sciences (Wits FHS) during the period from 2013 to 2021 to overcome resistance to, and encourage the adoption of, the REDCap (Research Electronic Data Capture; Vanderbilt University) system by academic and clinical staff. REDCap has found wide use in varying domains, including clinical studies and research projects as well as administrative, financial, and human resource applications. Given REDCap's global footprint in >5000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of importance to others using the system, particularly in resource-constrained settings. Methods: The strategies to support users and encourage adoption included top-down organizational support; secure and reliable application, hosting infrastructure, and systems administration; an enabling and accessible REDCap support team; regular hands-on training workshops covering REDCap project setup and data collection instrument design techniques; annual local symposia to promote networking and awareness of all the latest software features and best practices for using them; participation in REDCap Consortium activities; and regular and ongoing mentorship from members of the Vanderbilt University Medical Center. Results: During the period from 2013 to 2021, the use of the REDCap EDC system by individuals at the Wits FHS increased, respectively, from 129 active user accounts to 3447 active user accounts. The number of REDCap projects increased from 149 in 2013 to 12,865 in 2021. REDCap at Wits also supported various publications and research outputs, including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system. Conclusions: By providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap EDC system at the Wits FHS and its associated academic medical centers. We believe that the increase in the use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and health care organizations in resource-constrained environments planning to implement EDC technology. ",
doi="10.2196/33402",
url="https://medinform.jmir.org/2022/8/e33402",
url="http://www.ncbi.nlm.nih.gov/pubmed/36040763"
}


@Article{info:doi/10.2196/33491,
author="Adedeji, Taiwo
and Fraser, Hamish
and Scott, Philip",
title="Implementing Electronic Health Records in Primary Care Using the Theory of Change: Nigerian Case Study",
journal="JMIR Med Inform",
year="2022",
month="Aug",
day="11",
volume="10",
number="8",
pages="e33491",
keywords="theory of change",
keywords="electronic health records",
keywords="maternal and child health",
keywords="primary health center",
keywords="success criteria",
abstract="Background: Digital health has been a tool of transformation for the delivery of health care services globally. An electronic health record (EHR) system can solve the bottleneck of paper documentation in health service delivery if it is successfully implemented, but poor implementation can lead to a waste of resources. The study of EHR system implementation in low- and middle-income countries (LMICs) is of particular interest to health stakeholders such as policy makers, funders, and care providers because of the efficiencies and evidence base that could result from the appropriate evaluation of such systems. Objective: We aimed to develop a theory of change (ToC) for the implementation of EHRs for maternal and child health care delivery in LMICs. The ToC is an outcomes-based approach that starts with the long-term goals and works backward to the inputs and mediating components required to achieve these goals for complex programs. Methods: We used the ToC approach for the whole implementation's life cycle to guide the pilot study and identify the preconditions needed to realize the study's long-term goal at Festac Primary Health Centre in Lagos, Nigeria. To evaluate the maturity of the implementation, we adapted previously defined success factors to supplement the ToC approach. Results: The initial ToC map showed that the long-term goal was an improved service delivery in primary care with the introduction of EHRs. The revised ToC revealed that the long-term change was the improved maternal and child health care delivery at Festac Primary Health Center using EHRs. We proposed a generic ToC map that implementers in LMICs can use to introduce an optimized EHR system, with assumptions about sustainability and other relevant factors. The outcomes from the critical success factors were sustainability: the sustained improvements included trained health care professionals, a change in mindset from using paper systems toward digital health transformation, and using the project's laptops to collect aggregate data for the District Health Information System 2--based national health information management system; financial: we secured funding to procure IT equipment, including servers, laptops, and networking, but the initial cost of implementation was high, and funds mainly came from the funding partner; and organizational: the health professionals, especially the head of nursing and health information officers, showed significant commitment to adopting the EHR system, but certain physicians and midwives were unwilling to use the EHR system initially until they were persuaded or incentivized by the management. Conclusions: This study shows that the ToC is a rewarding approach to framing dialogue with stakeholders and serves as a framework for planning, evaluation, learning, and reflection. We hypothesized that any future health IT implementation in primary care could adapt our ToC approach to their contexts with necessary modifications based on inherent characteristics. ",
doi="10.2196/33491",
url="https://medinform.jmir.org/2022/8/e33491",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969461"
}


@Article{info:doi/10.2196/34741,
author="Dinh, Nhi
and Agarwal, Smisha
and Avery, Lisa
and Ponnappan, Priya
and Chelangat, Judith
and Amendola, Paul
and Labrique, Alain
and Bartlett, Linda",
title="Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya: Observational Analysis",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="20",
volume="6",
number="6",
pages="e34741",
keywords="newborn",
keywords="neonatal health",
keywords="maternal health",
keywords="intrapartum care",
keywords="labor and delivery",
keywords="Kenya",
keywords="digital clinical decision support",
keywords="health information systems",
keywords="digital health",
keywords="implementation research",
abstract="Background: iDeliver, a digital clinical support system for maternal and neonatal care, was developed to support quality of care improvements in Kenya. Objective: Taking an implementation research approach, we evaluated the adoption and fidelity of iDeliver over time and assessed the feasibility of its use to provide routine Ministry of Health (MOH) reports. Methods: We analyzed routinely collected data from iDeliver, which was implemented at the Transmara West Sub-County Hospital from December 2018 to September 2020. To evaluate its adoption, we assessed the proportion of actual facility deliveries that was recorded in iDeliver over time. We evaluated the fidelity of iDeliver use by studying the completeness of data entry by care providers during each stage of the labor and delivery workflow and whether the use reflected iDeliver's envisioned function. We also examined the data completeness of the maternal and neonatal indicators prioritized by the Kenya MOH. Results: A total of 1164 deliveries were registered in iDeliver, capturing 45.31\% (1164/2569) of the facility's deliveries over 22 months. This uptake of registration improved significantly over time by 6.7\% (SE 2.1) on average in each quarter-year (P=.005), from 9.6\% (15/157) in the fourth quarter of 2018 to 64\% (235/367) in the third quarter of 2020. Across iDeliver's workflow, the overall completion rate of all variables improved significantly by 2.9\% (SE 0.4) on average in each quarter-year (P<.001), from 22.25\% (257/1155) in the fourth quarter of 2018 to 49.21\% (8905/18,095) in the third quarter of 2020. Data completion was highest for the discharge-labor summary stage (16,796/23,280, 72.15\%) and lowest for the labor signs stage (848/5820, 14.57\%). The completion rate of the key MOH indicators also improved significantly by 4.6\% (SE 0.5) on average in each quarter-year (P<.001), from 27.1\% (69/255) in the fourth quarter of 2018 to 83.75\% (3346/3995) in the third quarter of 2020. Conclusions: iDeliver's adoption and data completeness improved significantly over time. The assessment of iDeliver' use fidelity suggested that some features were more easily used because providers had time to enter data; however, there was low use during active childbirth, which is when providers are necessarily engaged with the woman and newborn. These insights on the adoption and fidelity of iDeliver use prompted the team to adapt the application to reflect the users' culture of use and further improve the implementation of iDeliver. ",
doi="10.2196/34741",
url="https://formative.jmir.org/2022/6/e34741",
url="http://www.ncbi.nlm.nih.gov/pubmed/35723911"
}


@Article{info:doi/10.2196/32964,
author="Downie, Andrew
and Mashanya, Titus
and Chipwaza, Beatrice
and Griffiths, Frances
and Harris, Bronwyn
and Kalolo, Albino
and Ndegese, Sylvester
and Sturt, Jackie
and De Valliere, Nicole
and Pemba, Senga",
title="Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="14",
volume="6",
number="6",
pages="e32964",
keywords="remote consultation",
keywords="mobile consulting",
keywords="digital health",
keywords="telehealth",
keywords="mHealth",
keywords="eHealth",
keywords="mobile health",
keywords="health care",
keywords="cascade",
keywords="train the trainer",
keywords="low- and middle-income countries",
keywords="rural areas",
keywords="Tanzania",
keywords="Kirkpatrick",
keywords="consultation",
keywords="training",
keywords="low- and middle-income",
keywords="rural",
keywords="COVID-19",
abstract="Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania's rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17\%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8\%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97\%) completed the cascaded training. Of the 10 (83\%) tier 1 trainees who completed the survey, 9 (90\%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees' behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings. ",
doi="10.2196/32964",
url="https://formative.jmir.org/2022/6/e32964",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507772"
}


@Article{info:doi/10.2196/34298,
author="Schmude, Marcel
and Salim, Nahya
and Azadzoy, Hila
and Bane, Mustafa
and Millen, Elizabeth
and O'Donnell, Lisa
and Bode, Philipp
and T{\"u}rk, Ewelina
and Vaidya, Ria
and Gilbert, Stephen",
title="Investigating the Potential for Clinical Decision Support in Sub-Saharan Africa With AFYA (Artificial Intelligence-Based Assessment of Health Symptoms in Tanzania): Protocol for a Prospective, Observational Pilot Study",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="7",
volume="11",
number="6",
pages="e34298",
keywords="differential diagnosis",
keywords="artificial intelligence",
keywords="clinical decision support systems",
keywords="decision support",
keywords="diagnostic decision support systems",
keywords="diagnosis",
keywords="Africa",
keywords="low income",
keywords="middle income",
keywords="user centred design",
keywords="user centered design",
keywords="symptom assessment",
keywords="chatbot",
keywords="health app",
keywords="prototype",
abstract="Background: Low- and middle-income countries face difficulties in providing adequate health care. One of the reasons is a shortage of qualified health workers. Diagnostic decision support systems are designed to aid clinicians in their work and have the potential to mitigate pressure on health care systems. Objective: The Artificial Intelligence--Based Assessment of Health Symptoms in Tanzania (AFYA) study will evaluate the potential of an English-language artificial intelligence--based prototype diagnostic decision support system for mid-level health care practitioners in a low- or middle-income setting. Methods: This is an observational, prospective clinical study conducted in a busy Tanzanian district hospital. In addition to usual care visits, study participants will consult a mid-level health care practitioner, who will use a prototype diagnostic decision support system, and a study physician. The accuracy and comprehensiveness of the differential diagnosis provided by the diagnostic decision support system will be evaluated against a gold-standard differential diagnosis provided by an expert panel. Results: Patient recruitment started in October 2021. Participants were recruited directly in the waiting room of the outpatient clinic at the hospital. Data collection will conclude in May 2022. Data analysis is planned to be finished by the end of June 2022. The results will be published in a peer-reviewed journal. Conclusions: Most diagnostic decision support systems have been developed and evaluated in high-income countries, but there is great potential for these systems to improve the delivery of health care in low- and middle-income countries. The findings of this real-patient study will provide insights based on the performance and usability of a prototype diagnostic decision support system in low- or middle-income countries. Trial Registration: ClinicalTrials.gov NCT04958577; http://clinicaltrials.gov/ct2/show/NCT04958577 International Registered Report Identifier (IRRID): DERR1-10.2196/34298 ",
doi="10.2196/34298",
url="https://www.researchprotocols.org/2022/6/e34298",
url="http://www.ncbi.nlm.nih.gov/pubmed/35671073"
}


@Article{info:doi/10.2196/33025,
author="M Selvarajah, Thinakaran
and Yamamoto, Eiko
and Saw, Mon Yu
and Kariya, Tetsuyoshi
and Hamajima, Nobuyuki",
title="Satisfaction With Health Care Services at the Pediatric Specialist Clinic of the National Referral Center in Malaysia: Cross-sectional Study of Caregivers' Perspectives",
journal="JMIRx Med",
year="2022",
month="May",
day="25",
volume="3",
number="2",
pages="e33025",
keywords="pediatrics",
keywords="caregivers",
keywords="health care services",
keywords="public hospital",
keywords="Malaysia",
keywords="public-private-partnership",
keywords="children",
abstract="Background: The concept of customer satisfaction is gaining hold in all corporate sectors worldwide, and a satisfaction survey is used as a tool to discover service problems and as a chance for customers to rate their experience with health care services. A high degree of patient satisfaction with the services given has been found in numerous studies conducted in Malaysian public health care facilities. However, there is limited information available on caregiver satisfaction with pediatric clinics run by the Ministry of Health (MoH) of Malaysia. Objective: This was the first research performed at a public hospital's pediatric clinic, which was the first hospital to adopt the public-private-partnership model under the MoH, with the aim of discovering the prevalence and factors affecting the satisfaction of caregivers at the national referral center. Methods: Cross-sectional research using the standard self-administered SERVQUAL questionnaire was conducted among caregivers accompanying their children to the clinic. The questionnaire consists of 16 paired statements to evaluate their expectations and experiences with the clinic services. Results: A total of 459 caregivers were involved in this study with a majority aged between 30 and 39 years (n=254, 55.4\%). Caregivers from the Indian community (adjusted odds ratio [AOR] 2.91, 95\% CI 1.37-6.18) and lower income groups (AOR 2.94, 95\% CI 1.87-4.64), and those with lower educational backgrounds (AOR 3.58, 95\% CI 1.19-10.72) were more likely to be satisfied with the quality of pediatric clinic services. Housewives/househusbands (AOR 0.48, 95\% CI 0.25-0.90), on the other hand, appeared less likely to be satisfied with the services provided during their visit to the clinic. Looking at overall patient satisfaction, 50.5\% (n=232) of caregivers demonstrated satisfaction with the quality of services, compared to 49.5\% (n=227) of dissatisfied respondents. Conclusions: This paper suggests that, although most caregivers are satisfied with the services, greater emphasis must be placed on delivering reliable service in response to the MoH's mission to provide quality and integrated people-centered health services in Malaysia. ",
doi="10.2196/33025",
url="https://med.jmirx.org/2022/2/e33025",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725531"
}


@Article{info:doi/10.2196/29469,
author="Simba, Daudi
and Sukums, Felix
and Kumalija, Claud
and Asiimwe, Eden Sarah
and Pothepragada, Kumar Sai
and Githendu, Warui Patrick",
title="Perceived Usefulness, Competency, and Associated Factors in Using District Health Information System Data Among District Health Managers in Tanzania: Cross-sectional Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="23",
volume="6",
number="5",
pages="e29469",
keywords="DHIS2",
keywords="Tanzania",
keywords="health information system",
keywords="health management information system",
keywords="perception",
keywords="competency",
keywords="usefulness",
abstract="Background: Tanzania introduced District Health Information Software (version 2; DHIS2) in 2013 to support existing health management information systems and to improve data quality and use. However, to achieve these objectives, it is imperative to build human resource capabilities to address the challenges of new technologies, especially in resource-constrained countries. Objective: This study aimed to determine the perceived usefulness, competency, and associated factors in using DHIS2 data among district health managers (DHMs) in Tanzania. Methods: This descriptive cross-sectional study used a quantitative approach, which involved using a self-administered web-based questionnaire. This study was conducted between April and September 2019. We included all core and co-opted members of the council or district health management teams (DHMTs) from all 186 districts in the country. Frequency and bivariate analyses were conducted, and the differences among categories were measured by using a chi-square test. P values of <.05 were considered significant. Results: A total of 2667 (77.96\%) of the expected 3421 DHMs responded, of which 2598 (97.41\%) consented and completed the questionnaires. Overall, the DHMs were satisfied with DHIS2 (2074/2596, 79.83\%) because of workload reduction (2123/2598, 81.72\%), the ease of learning (1953/2598, 75.17\%), and enhanced data use (2239/2598, 86.18\%). Although only half of the managers had user accounts (1380/2598, 53.12\%) and were trained on DHIS2 data analysis (1237/2598, 47.61\%), most claimed to have average to advanced skills in data validation (1774/2598, 68.28\%), data visualization (1563/2598, 60.16\%), and DHIS2 data use (1321/2598, 50.85\%). The biggest challenges facing DHMs included the use of a paper-based system as the primary data source (1890/2598, 72.75\%) and slow internet speed (1552/2598, 59.74\%). Core members were more confident in using DHIS2 compared with other members (P=.004), whereas program coordinators were found to receive more training on data analysis and use (P=.001) and were more confident in using DHIS2 data compared with other DHMT members (P=.001). Conclusions: This study showed that DHMs have appreciable competencies in using the DHIS2 and its data. However, their skill levels have not been commensurate with the duration of DHIS2 use. This study recommends improvements in the access to and use of DHIS2 data. More training on data use is required and should involve using cost-effective approaches to include both the core and noncore members of the DHMTs. Moreover, enhancing the culture and capacity of data use will ensure the better management and accountability of health system performance. ",
doi="10.2196/29469",
url="https://formative.jmir.org/2022/5/e29469",
url="http://www.ncbi.nlm.nih.gov/pubmed/35604763"
}


@Article{info:doi/10.2196/34021,
author="Venkateswaran, Mahima
and Nazzal, Zaher
and Ghanem, Buthaina
and Khraiwesh, Reham
and Abbas, Eatimad
and Abu Khader, Khadija
and Awwad, Tamara
and Hijaz, Taghreed
and Isbeih, Mervett
and M{\o}rkrid, Kjersti
and Rose, James Christopher
and Fr{\o}en, Frederik J.",
title="eRegTime---Time Spent on Health Information Management in Primary Health Care Clinics Using a Digital Health Registry Versus Paper-Based Documentation: Cluster-Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="May",
day="13",
volume="6",
number="5",
pages="e34021",
keywords="time-motion study",
keywords="clinical workflow",
keywords="digital health intervention",
keywords="eRegistry",
keywords="antenatal care",
keywords="cluster-randomized controlled trial",
keywords="digital health",
keywords="child health registry",
keywords="primary care",
keywords="health information",
abstract="Background: Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine. Objective: In the eRegTime study, we compared time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system. Methods: Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random subsample of primary health care clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits and on client care using mixed-effects linear regression. Results: In total, 22 of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. A total of 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups, respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 5.72 minutes versus 8.10 minutes in control clinics (adjusted relative time 0.69, 95\% CI 0.60-0.79; P<.001), and 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95\% CI 0.61-1.50; P=.85) for booking visits. The average time spent on documentation, a subcategory of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68, 95\% CI 0.56-0.83; P<.001). While the average time spent on client care was 5.01 minutes in eRegistry clinics versus 4.91 minutes in control clinics, some uncertainty remains, and the CI was consistent with eRegistry clinics using less, the same, or more time on client care compared to those that use paper (adjusted relative time 0.85, 95\% CI 0.64-1.13; P=.27). Conclusions: The eRegistry captures digital data at point of care during client consultations and generates automated routine reports based on the clinical data entered. Markedly less time (plausibly a saving of at least 18\%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires lesser repetitive documentation work than paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce health care resources. Trial Registration: ISRCTN registry ISRCTN18008445; https://doi.org/10.1186/ISRCTN18008445 International Registered Report Identifier (IRRID): RR2-10.2196/13653 ",
doi="10.2196/34021",
url="https://formative.jmir.org/2022/5/e34021",
url="http://www.ncbi.nlm.nih.gov/pubmed/35559792"
}


@Article{info:doi/10.2196/34485,
author="Ng, Wen Sock
and Hwong, Yea Wen
and Husin, Masliyana
and Ab Rahman, Norazida
and Nasir, Hairizan Nazrila
and Juval, Kawselyah
and Sivasampu, Sheamini",
title="Assessing the Availability of Teleconsultation and the Extent of Its Use in Malaysian Public Primary Care Clinics: Cross-sectional Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="9",
volume="6",
number="5",
pages="e34485",
keywords="teleconsultation",
keywords="telemedicine",
keywords="video consultation",
keywords="telephone consultation",
keywords="virtual clinic",
keywords="primary care",
keywords="cross-sectional",
keywords="virtual care",
keywords="Asia",
abstract="Background: The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries. Objective: The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics. Methods: A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic. Results: In total, 97.6\% (249/255) of the clinics responded. Out of these clinics, 45.8\% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5\%) provided only telephone consultation, while 24.6\% (28/114) of the clinics offered video and telephone consultation, and 14.9\% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5\% (20/114) and 16.7\% (19/114) of the clinics were from two larger states; other states comprised less than 10\% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93\%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50\% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97). Conclusions: Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service. ",
doi="10.2196/34485",
url="https://formative.jmir.org/2022/5/e34485",
url="http://www.ncbi.nlm.nih.gov/pubmed/35532973"
}


@Article{info:doi/10.2196/32305,
author="Fraser, F. Hamish S.
and Mugisha, Michael
and Remera, Eric
and Ngenzi, Lune Joseph
and Richards, Janise
and Santas, Xenophon
and Naidoo, Wayne
and Seebregts, Christopher
and Condo, Jeanine
and Umubyeyi, Aline",
title="User Perceptions and Use of an Enhanced Electronic Health Record in Rwanda With and Without Clinical Alerts: Cross-sectional Survey",
journal="JMIR Med Inform",
year="2022",
month="May",
day="3",
volume="10",
number="5",
pages="e32305",
keywords="electronic health record",
keywords="eHealth",
keywords="HIV/AIDS",
keywords="survey",
keywords="Rwanda",
keywords="implementation science",
abstract="Background: Electronic health records (EHRs) have been implemented in many low-resource settings but lack strong evidence for usability, use, user confidence, scalability, and sustainability. Objective: This study aimed to evaluate staff use and perceptions of an EHR widely used for HIV care in >300 health facilities in Rwanda, providing evidence on factors influencing current performance, scalability, and sustainability. Methods: A randomized, cross-sectional, structured interview survey of health center staff was designed to assess functionality, use, and attitudes toward the EHR and clinical alerts. This study used the associated randomized clinical trial study sample (56/112, 50\% sites received an enhanced EHR), pulling 27 (50\%) sites from each group. Free-text comments were analyzed thematically using inductive coding. Results: Of the 100 participants, 90 (90\% response rate) were interviewed at 54 health centers: 44 (49\%) participants were clinical and 46 (51\%) were technical. The EHR top uses were to access client data easily or quickly (62/90, 69\%), update patient records (56/89, 63\%), create new patient records (49/88, 56\%), generate various reports (38/85, 45\%), and review previous records (43/89, 48\%). In addition, >90\% (81/90) of respondents agreed that the EHR made it easier to make informed decisions, was worth using, and has improved patient information quality. Regarding availability, (66/88) 75\% said they could always or almost always count on the EHR being available, whereas (6/88) 7\% said never/almost never. In intervention sites, staff were significantly more likely to update existing records (P=.04), generate summaries before (P<.001) or during visits (P=.01), and agree that ``the EHR provides useful alerts, and reminders'' (P<.01). Conclusions: Most users perceived the EHR as well accepted, appropriate, and effective for use in low-resource settings despite infrastructure limitation in 25\% (22/88) of the sites. The implementation of EHR enhancements can improve the perceived usefulness and use of key functions. Successful scale-up and use of EHRs in small health facilities could improve clinical documentation, care, reporting, and disease surveillance in low- and middle-income countries. ",
doi="10.2196/32305",
url="https://medinform.jmir.org/2022/5/e32305",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503526"
}


@Article{info:doi/10.2196/28965,
author="Tilahun, Binyam
and Endehabtu, F. Berhanu
and Gashu, D. Kassahun
and Mekonnen, A. Zeleke
and Animut, Netsanet
and Belay, Hiwot
and Denboba, Wubshet
and Alemu, Hibret
and Mohammed, Mesoud
and Abate, Biruk",
title="Current and Future Needs for Human Resources for Ethiopia's National Health Information System: Survey and Forecasting Study",
journal="JMIR Med Educ",
year="2022",
month="Apr",
day="12",
volume="8",
number="2",
pages="e28965",
keywords="forecasting",
keywords="human resources",
keywords="health information system",
keywords="workforce",
keywords="Ethiopia",
keywords="health informatics",
keywords="healthcare professionals",
abstract="Background: Strengthening the national health information system is one of Ethiopia's priority transformation agendas. A well-trained and competent workforce is the essential ingredient to a strong health information system. However, this workforce has neither been quantified nor characterized well, and there is no roadmap of required human resources to enhance the national health information system. Objective: We aimed to determine the current state of the health information system workforce and to forecast the human resources needed for the health information system by 2030. Methods: We conducted a survey to estimate the current number of individuals employed in the health information system unit and the turnover rate. Document review and key-informant interviews were used to collect current human resources and available health information system position data from 110 institutions, including the Ministry of Health, federal agencies, regional health bureaus, zonal health departments, district health offices, and health facilities. The Delphi technique was used to forecast human resources required for the health information system in the next ten years: 3 rounds of workshops with experts from the Ministry of Health, universities, agencies, and regional health bureaus were held. In the first expert meeting, we set criteria, which was followed by expert suggestions and feedback. Results: As of April 2020, there were 10,344 health information system professionals working in the governmental health system. Nearly 95\% (20/21) of district health offices and 86.7\% (26/30) of health centers reported that the current number of health information system positions was inadequate. In the period from June 2015 to June 2019, health information technicians had high turnover (48/244, 19.7\%) at all levels of the health system. In the next ten years, we estimate that 50,656 health information system professionals will be needed to effectively implement the Ethiopia's national health information system. Conclusions: Current health information system--related staffing levels were found to be inadequate. To meet the estimated need of 50,656 multidisciplinary health information system professionals by 2030, the Ministry of Health and regional health bureaus, in collaboration with partners and academic institutions, need to work on retaining existing and training additional health information system professionals. ",
doi="10.2196/28965",
url="https://mededu.jmir.org/2022/2/e28965",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412469"
}


@Article{info:doi/10.2196/33848,
author="Ashworth, Henry
and Ebrahim, Senan
and Ebrahim, Hassaan
and Bhaiwala, Zahra
and Chilazi, Michael",
title="A Free, Open-Source, Offline Digital Health System for Refugee Care",
journal="JMIR Med Inform",
year="2022",
month="Feb",
day="11",
volume="10",
number="2",
pages="e33848",
keywords="electronic health record",
keywords="mHealth",
keywords="refugee",
keywords="displaced population",
keywords="digital health",
keywords="COVID-19",
keywords="health care",
abstract="Background: Rise of conflict, extreme weather events, and pandemics have led to larger displaced populations worldwide. Displaced populations have unique acute and chronic health needs that must be met by low-resource health systems. Electronic health records (EHRs) have been shown to improve health outcomes in displaced populations, but need to be adapted to meet the constraints of these health systems. Objective: The aim of this viewpoint is to describe the development and deployment of an EHR designed to care for displaced populations in low-resource settings. Methods: Using a human-centered design approach, we conducted in-depth interviews and focus groups with patients, health care providers, and administrators in Lebanon and Jordan to identify the essential EHR features. These features, including modular workflows, multilingual interfaces, and offline-first capabilities, led to the development of the Hikma Health EHR, which has been deployed in Lebanon and Nicaragua. Results: We report the successes and challenges from 12 months of Hikma Health EHR deployment in a mobile clinic providing care to Syrian refugees in Bekaa Valley, Lebanon. Successes include the EHR's ability to (1) increase clinical efficacy by providing detailed patient records, (2) be adaptable to the threats of COVID-19, and (3) improve organizational planning. Lessons learned include technical fixes to methods of identifying patients through name or their medical record ID. Conclusions: As the number of displaced people continues to rise globally, it is imperative that solutions are created to help maximize the health care they receive. Free, open-sourced, and adaptable EHRs can enable organizations to better provide for displaced populations. ",
doi="10.2196/33848",
url="https://medinform.jmir.org/2022/2/e33848",
url="http://www.ncbi.nlm.nih.gov/pubmed/35147509"
}


@Article{info:doi/10.2196/30755,
author="John, Oommen
and Sarbadhikari, Nath Suptendra
and Prabhu, Thanga
and Goel, Ashvini
and Thomas, Alexander
and Shroff, Sunil
and Allaudin, Fazilah
and Weerabaddana, Chaminda
and Alhuwail, Dari
and Koirala, Udaya
and Johnrose, Jayalal
and Codyre, Patricia
and Bleaden, Andy
and Singh, Shubnum
and Bajaj, Shuchin",
title="Implementation and Experiences of Telehealth: Balancing Policies With Practice in Countries of South Asia, Kuwait, and the European Union",
journal="Interact J Med Res",
year="2022",
month="Feb",
day="8",
volume="11",
number="1",
pages="e30755",
keywords="telehealth policy and practice",
keywords="implementation lessons",
keywords="challenges in scaling up",
keywords="capacity building of human resources",
keywords="data privacy",
keywords="telehealth",
keywords="health policy",
keywords="telemedicine",
keywords="implementation",
keywords="challenges",
keywords="human resources",
keywords="digital health",
keywords="data security",
doi="10.2196/30755",
url="https://www.i-jmr.org/2022/1/e30755",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133279"
}


@Article{info:doi/10.2196/30040,
author="Chukwu, Emeka
and Garg, Lalit
and Foday, Edward
and Konomanyi, Abdul
and Wright, Royston
and Smart, Francis",
title="Electricity, Computing Hardware, and Internet Infrastructures in Health Facilities in Sierra Leone: Field Mapping Study",
journal="JMIR Med Inform",
year="2022",
month="Feb",
day="3",
volume="10",
number="2",
pages="e30040",
keywords="digital health",
keywords="mHealth",
keywords="eHealth infrastructure",
keywords="health ICT",
keywords="SpaceX",
keywords="connectivity",
keywords="Sierra Leone",
keywords="rural-urban divide",
keywords="rural areas",
keywords="internet",
abstract="Background: Years of health information system investment in many countries have facilitated service delivery, surveillance, reporting, and monitoring. Electricity, computing hardware, and internet networks are vital for health facility--based information systems. Availability of these infrastructures at health facilities is crucial for achieving national digital health visions. Objective: The aim of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample. Methods: Stratified sampling of 72 (out of 1284) health facilities distributed in all districts of Sierra Leone was performed, factoring in the rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over a 2-week period. Results: Among the 72 surveyed health facilities, 59 (82\%) do not have institutionally provided internet. Among the 15 Maternal and Child Health Posts, as a type of primary health care unit (PHU), 9 (60\%) use solar energy as their only electricity source and the other 6 (40\%) have no electricity source. Similarly, among the 13 hospitals, 5 (38\%) use a generator as a primary electricity source. All hospitals have at least one functional computer, although only 7 of the 13 hospitals have four or more functional computers. Similarly, only 2 of the 59 (3\%) PHUs have one computer each, and 37 (63\%) of the PHUs have one tablet device each. We consider this health care computing infrastructure mapping to be representative with a 95\% confidence level within an 11\% margin of error. Two-thirds of the PHUs have only alternate solar electricity, only 10 of the 72 surveyed health facilities have functional official internet, and most use suboptimal computing hardware. Overall, 43\% of the surveyed health facilities believe that inadequate electricity is the biggest threat to digitization. Similarly, 16 (22\%) of the 72 respondents stated that device theft is a primary hindrance to digitization. Conclusions: Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. The current trend where GSM (Global System for Mobile Communication) service providers provide the internet to all health facilities may change to other promising alternatives. This study provides evidence of the critical infrastructure gaps in health facilities in Sierra Leone. ",
doi="10.2196/30040",
url="https://medinform.jmir.org/2022/2/e30040",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113026"
}


@Article{info:doi/10.2196/29012,
author="Bin, Jia Kaio
and Melo, Ribeiro Adler Araujo
and da Rocha, Franco Jos{\'e} Guilherme Moraes
and de Almeida, Pivi Renata
and Cobello Junior, Vilson
and Maia, Liebhart Fernando
and de Faria, Elizabeth
and Pereira, Jos{\'e} Antonio
and Battistella, Rizzo Linamara
and Ono, Kioko Suzane",
title="The Impact of Artificial Intelligence on Waiting Time for Medical Care in an Urgent Care Service for COVID-19: Single-Center Prospective Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="1",
volume="6",
number="2",
pages="e29012",
keywords="COVID-19",
keywords="artificial intelligence",
keywords="robotic process automation",
keywords="digital health",
keywords="health care management",
keywords="pandemic",
keywords="waiting time",
keywords="queue",
keywords="nonvalue-added activities",
abstract="Background: To demonstrate the value of implementation of an artificial intelligence solution in health care service, a winning project of the Massachusetts Institute of Technology Hacking Medicine Brazil competition was implemented in an urgent care service for health care professionals at Hospital das Cl{\'i}nicas of the Faculdade de Medicina da Universidade de S{\~a}o Paulo during the COVID-19 pandemic. Objective: The aim of this study was to determine the impact of implementation of the digital solution in the urgent care service, assessing the reduction of nonvalue-added activities and its effect on the nurses' time required for screening and the waiting time for patients to receive medical care. Methods: This was a single-center, comparative, prospective study designed according to the Public Health England guide ``Evaluating Digital Products for Health.'' A total of 38,042 visits were analyzed over 18 months to determine the impact of implementing the digital solution. Medical care registration, health screening, and waiting time for medical care were compared before and after implementation of the digital solution. Results: The digital solution automated 92\% of medical care registrations. The time for health screening increased by approximately 16\% during the implementation and in the first 3 months after the implementation. The waiting time for medical care after automation with the digital solution was reduced by approximately 12 minutes compared with that required for visits without automation. The total time savings in the 12 months after implementation was estimated to be 2508 hours. Conclusions: The digital solution was able to reduce nonvalue-added activities, without a substantial impact on health screening, and further saved waiting time for medical care in an urgent care service in Brazil during the COVID-19 pandemic. ",
doi="10.2196/29012",
url="https://formative.jmir.org/2022/2/e29012",
url="http://www.ncbi.nlm.nih.gov/pubmed/35103611"
}


@Article{info:doi/10.2196/30106,
author="Silenou, C. Bernard
and Nyirenda, Z. John L.
and Zaghloul, Ahmed
and Lange, Berit
and Doerrbecker, Juliane
and Schenkel, Karl
and Krause, G{\'e}rard",
title="Availability and Suitability of Digital Health Tools in Africa for Pandemic Control: Scoping Review and Cluster Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="23",
volume="7",
number="12",
pages="e30106",
keywords="mobile applications",
keywords="mHealth",
keywords="epidemiological surveillance",
keywords="communicable diseases",
keywords="outbreak response",
keywords="health information management",
keywords="public health",
keywords="review",
keywords="transmission network",
abstract="Background: Gaining oversight into the rapidly growing number of mobile health tools for surveillance or outbreak management in Africa has become a challenge. Objective: The aim of this study is to map the functional portfolio of mobile health tools used for surveillance or outbreak management of communicable diseases in Africa. Methods: We conducted a scoping review by combining data from a systematic review of the literature and a telephone survey of experts. We applied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching for articles published between January 2010 and December 2020. In addition, we used the respondent-driven sampling method and conducted a telephone survey from October 2019 to February 2020 among representatives from national public health institutes from all African countries. We combined the findings and used a hierarchical clustering method to group the tools based on their functionalities (attributes). Results: We identified 30 tools from 1914 publications and 45 responses from 52\% (28/54) of African countries. Approximately 13\% of the tools (4/30; Surveillance Outbreak Response Management and Analysis System, Go.Data, CommCare, and District Health Information Software 2) covered 93\% (14/15) of the identified attributes. Of the 30 tools, 17 (59\%) tools managed health event data, 20 (67\%) managed case-based data, and 28 (97\%) offered a dashboard. Clustering identified 2 exceptional attributes for outbreak management, namely contact follow-up (offered by 8/30, 27\%, of the tools) and transmission network visualization (offered by Surveillance Outbreak Response Management and Analysis System and Go.Data). Conclusions: There is a large range of tools in use; however, most of them do not offer a comprehensive set of attributes, resulting in the need for public health workers having to use multiple tools in parallel. Only 13\% (4/30) of the tools cover most of the attributes, including those most relevant for response to the COVID-19 pandemic, such as laboratory interface, contact follow-up, and transmission network visualization. ",
doi="10.2196/30106",
url="https://publichealth.jmir.org/2021/12/e30106",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941551"
}


@Article{info:doi/10.2196/28958,
author="Jaafa, Kasiiti Noah
and Mokaya, Benard
and Savai, Muhindi Simon
and Yeung, Ada
and Siika, Mosigisi Abraham
and Were, Martin",
title="Implementation of Fingerprint Technology for Unique Patient Matching and Identification at an HIV Care and Treatment Facility in Western Kenya: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="22",
volume="23",
number="12",
pages="e28958",
keywords="biometrics",
keywords="patient matching",
keywords="fingerprints",
keywords="unique patient identification",
keywords="electronic medical record systems",
keywords="low- and middle-income countries (LMICs)",
abstract="Background: Unique patient identification remains a challenge in many health care settings in low- and middle-income countries (LMICs). Without national-level unique identifiers for whole populations, countries rely on demographic-based approaches that have proven suboptimal. Affordable biometrics-based approaches, implemented with consideration of contextual ethical, legal, and social implications, have the potential to address this challenge and improve patient safety and reporting accuracy. However, limited studies exist to evaluate the actual performance of biometric approaches and perceptions of these systems in LMICs. Objective: The aim of this study is to evaluate the performance and acceptability of fingerprint technology for unique patient matching and identification in the LMIC setting of Kenya. Methods: In this cross-sectional study conducted at an HIV care and treatment facility in Western Kenya, an open source fingerprint application was integrated within an implementation of the Open Medical Record System, an open source electronic medical record system (EMRS) that is nationally endorsed and deployed for HIV care in Kenya and in more than 40 other countries; hence, it has potential to translate the findings across multiple countries. Participants aged >18 years were conveniently sampled and enrolled into the study. Participants' left thumbprints were captured and later used to retrieve and match records. The technology's performance was evaluated using standard measures: sensitivity, false acceptance rate, false rejection rate, and failure to enroll rate. The Wald test was used to compare the accuracy of the technology with the probabilistic patient-matching technique of the EMRS. Time to retrieval and matching of records were compared using the independent samples 2-tailed t test. A survey was administered to evaluate patient acceptance and satisfaction with use of the technology. Results: In all, 300 participants were enrolled; their mean age was 36.3 (SD 12.2) years, and 58\% (174/300) were women. The relevant values for the technology's performance were sensitivity 89.3\%, false acceptance rate 0\%, false rejection rate 11\%, and failure to enroll rate 2.3\%. The technology's mean record retrieval speed was 3.2 (SD 1.1) seconds versus 9.5 (SD 1.9) seconds with demographic-based record retrieval in the EMRS (P<.001). The survey results revealed that 96.3\% (289/300) of the participants were comfortable with the technology and 90.3\% (271/300) were willing to use it. Participants who had previously used fingerprint biometric systems for identification were estimated to have more than thrice increased odds of accepting the technology (odds ratio 3.57, 95\% CI 1.0-11.92). Conclusions: Fingerprint technology performed very well in identifying adult patients in an LMIC setting. Patients reported a high level of satisfaction and acceptance. Serious considerations need to be given to the use of fingerprint technology for patient identification in LMICs, but this has to be done with strong consideration of ethical, legal, and social implications as well as security issues. ",
doi="10.2196/28958",
url="https://www.jmir.org/2021/12/e28958",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941557"
}


@Article{info:doi/10.2196/26381,
author="Were, Chieng Martin
and Savai, Simon
and Mokaya, Benard
and Mbugua, Samuel
and Ribeka, Nyoman
and Cholli, Preetam
and Yeung, Ada",
title="mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="14",
volume="23",
number="12",
pages="e26381",
keywords="mobile health",
keywords="electronic medical records",
keywords="developing countries",
keywords="digital divide",
keywords="digital health",
keywords="global health",
abstract="Background: The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide. Objective: We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS). Methods: The ``Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)'' checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima's architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems. Results: mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO's Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas. Conclusions: Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains. ",
doi="10.2196/26381",
url="https://www.jmir.org/2021/12/e26381",
url="http://www.ncbi.nlm.nih.gov/pubmed/34904952"
}


@Article{info:doi/10.2196/27988,
author="Schroeder, Kristin
and Maiarana, James
and Gisiri, Mwitasrobert
and Joo, Emma
and Muiruri, Charles
and Zullig, Leah
and Masalu, Nestory
and Vasudevan, Lavanya",
title="Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="8",
volume="4",
number="4",
pages="e27988",
keywords="mHealth",
keywords="literacy",
keywords="smartphone use",
keywords="developing countries",
keywords="pediatric cancer",
keywords="cancer",
keywords="pediatrics",
keywords="children",
keywords="parents",
keywords="caregivers",
keywords="mobile health",
keywords="smartphone",
keywords="SMS",
keywords="education",
keywords="knowledge transfer",
keywords="communication",
abstract="Background: There is a 60\% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. Objective: The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. Methods: In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. Results: All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85\%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98\%), receiving laboratory results (n=37, 93\%), receiving reminders for upcoming appointments (n=38, 95\%), and receiving educational information on cancer (n=35, 88\%). Although only 9\% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74\% (25/34) self-reported they could view and read SMS text messages. Conclusions: To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone--based education and communication strategy suggests that a mobile phone--based intervention, particularly one that utilizes SMS technology, could be feasible in this setting. ",
doi="10.2196/27988",
url="https://pediatrics.jmir.org/2021/4/e27988",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889763"
}


@Article{info:doi/10.2196/27626,
author="Al kalali, Ahmed Fadwa Salem
and Mahyoub, Essam
and Al-Hammadi, Abdulbary
and Anam, Labiba
and Khader, Yousef",
title="Evaluation of the National Tuberculosis Surveillance System in Sana'a, Yemen, 2018: Observational Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="30",
volume="7",
number="11",
pages="e27626",
keywords="evaluation",
keywords="surveillance system",
keywords="tuberculosis",
keywords="Yemen",
abstract="Background: Tuberculosis remains a public problem that is considered one of the top causes of morbidity and mortality worldwide. The National Tuberculosis Control Program in Yemen was established in 1970 and included in the national health policy under the leadership of the Ministry of Public Health and Population to monitor tuberculosis control. The surveillance system must be evaluated periodically to produce recommendations for improving performance and usefulness. Objective: This study aims to assess the usefulness and the performance of the tuberculosis surveillance system attributes and to identify the strengths and weaknesses of the system. Methods: A quantitative and qualitative evaluation of the national tuberculosis surveillance system was conducted using the Centers for Disease Control and Prevention's updated guidelines. The study was carried out in 10 districts in Sana'a City. A total of 28 public health facilities providing tuberculosis services for the whole population in their assigned catchment areas were purposively selected. All participants were interviewed based on their involvement with key aspects of tuberculosis surveillance activities. Results: The tuberculosis surveillance system was found to have an average performance in usefulness (57/80, 71\%), flexibility (30/40, 75\%), acceptability (174/264, 66\%), data quality (4/6, 67\%), and positive predictive value (78/107, 73\%), and poor performance in simplicity (863/1452, 59\%) and stability (15\%, 3/20). In addition, the system also had a good performance in sensitivity (78/81, 96\%). Conclusions: The tuberculosis surveillance system was found to be useful. The flexibility, positive predictive value, and data quality were average. Stability and simplicity were poor. The sensitivity was good. The main weaknesses in the tuberculosis surveillance system include a lack of governmental financial support, a paper-based system, and a lack of regular staff training. Developing an electronic system, securing governmental finances, and training the staff on tuberculosis surveillance are strongly recommended to improve the system performance. ",
doi="10.2196/27626",
url="https://publichealth.jmir.org/2021/11/e27626",
url="http://www.ncbi.nlm.nih.gov/pubmed/34851294"
}


@Article{info:doi/10.2196/29755,
author="Ginsburg, Sarah Amy
and Kinshella, Woo Mai-Lei
and Naanyu, Violet
and Rigg, Jessica
and Chomba, Dorothy
and Coleman, Jesse
and Hwang, Bella
and Ochieng, Roseline
and Ansermino, Mark J.
and Macharia, M. William",
title="Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="28",
volume="23",
number="10",
pages="e29755",
keywords="infants",
keywords="Africa",
keywords="medical technology design",
keywords="user perspectives",
keywords="in-depth interviews",
keywords="direct observations",
abstract="Background: Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization. Objective: This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting. Methods: We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software. Results: Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies. Conclusions: Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-035184 ",
doi="10.2196/29755",
url="https://www.jmir.org/2021/10/e29755",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709194"
}


@Article{info:doi/10.2196/25777,
author="Chirambo, Baxter Griphin
and Thompson, Matthew
and Hardy, Victoria
and Ide, Nicole
and Hwang, H. Phillip
and Dharmayat, Kanika
and Mastellos, Nikolaos
and Heavin, Ciara
and O'Connor, Yvonne
and Muula, S. Adamson
and Andersson, Bo
and Carlsson, Sven
and Tran, Tammy
and Hsieh, Chen-Ling Jenny
and Lee, Hsin-Yi
and Fitzpatrick, Annette
and Joseph Wu, Tsung-Shu
and O'Donoghue, John",
title="Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="20",
volume="23",
number="10",
pages="e25777",
keywords="community case management",
keywords="mobile health",
keywords="pediatrics",
keywords="childhood infection",
keywords="mobile phone",
abstract="Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ?2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited---49.11\% (3421/6965) in the control phase and 50.88\% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95\% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95\% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95\% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission). Conclusions: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345 ",
doi="10.2196/25777",
url="https://www.jmir.org/2021/10/e25777",
url="http://www.ncbi.nlm.nih.gov/pubmed/34668872"
}


@Article{info:doi/10.2196/26918,
author="Rahman, Anisur
and Friberg, K. Ingrid
and Dolphyne, Akuba
and Fjeldheim, Ingvild
and Khatun, Fatema
and O'Donnell, Brian
and Pervin, Jesmin
and Rahman, Monjur
and Rahman, Qaiyum A. M.
and Nu, Tin U.
and Sarker, Krishna Bidhan
and Venkateswaran, Mahima
and Fr{\o}en, Frederik J.",
title="An Electronic Registry for Improving the Quality of Antenatal Care in Rural Bangladesh (eRegMat): Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="6",
volume="10",
number="7",
pages="e26918",
keywords="quality of care",
keywords="antenatal care",
keywords="maternal and newborn health",
keywords="eHealth",
keywords="digital health interventions",
keywords="eRegistries",
keywords="health information systems",
keywords="Bangladesh",
abstract="Background: Digital health interventions (DHIs) can alleviate several barriers to achieving better maternal and child health. The World Health Organization's guideline recommendations for DHIs emphasize the need to integrate multiple DHIs for maximizing impact. The complex health system of Bangladesh provides a unique setting for evaluating and understanding the role of an electronic registry (eRegistry) for antenatal care, with multiple integrated DHIs for strengthening the health system as well as improving the quality and utilization of the public health care system. Objective: The aim of this study is to assess the effect of an eRegistry with DHIs compared with a simple digital data entry tool without DHIs in the community and frontline health facilities. Methods: The eRegMat is a cluster-randomized controlled trial conducted in the Matlab North and Matlab South subdistricts in the Chandpur district, Bangladesh, where health facilities are currently using the eRegistry for digital tracking of the health status of pregnant women longitudinally. The intervention arm received 3 superimposed data-driven DHIs: health worker clinical decision support, health worker feedback dashboards with action items, and targeted client communication to pregnant women. The primary outcomes are appropriate screening as well as management of hypertension during pregnancy and timely antenatal care attendance. The secondary outcomes include morbidity and mortality in the perinatal period as well as timely first antenatal care visit; successful referrals for anemia, diabetes, or hypertension during pregnancy; and facility delivery. Results: The eRegistry and DHIs were co-designed with end users between 2016 and 2018. The eRegistry was implemented in the study area in July 2018. Recruitment for the trial started in October 2018 and ended in June 2020, followed by an 8-month follow-up period to capture outcome data until February 2021. Trial results will be available for publication in June 2021. Conclusions: This trial allows the simultaneous assessment of multiple integrated DHIs for strengthening the health system and aims to provide evidence for its implementation. The study design and outcomes are geared toward informing the living review process of the guidelines for implementing DHIs. Trial Registration: ISRCTN Registry ISRCTN69491836; https://www.isrctn.com/ISRCTN69491836 International Registered Report Identifier (IRRID): DERR1-10.2196/26918 ",
doi="10.2196/26918",
url="https://www.researchprotocols.org/2021/7/e26918",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255723"
}


@Article{info:doi/10.2196/27603,
author="Mekonnen, Abebaw Zeleke
and Gelaye, Alemu Kassahun
and Were, Martin
and Tilahun, Binyam",
title="Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="15",
volume="9",
number="6",
pages="e27603",
keywords="mHealth",
keywords="eHealth",
keywords="mobile phone",
keywords="text message",
keywords="short message service",
keywords="reminder",
keywords="immunization",
keywords="vaccination",
keywords="Ethiopia",
abstract="Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message--based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8\% vs 185/213, 86.9\%, respectively; P<.001), measles (195/213, 91.5\% vs 169/213, 79.3\%, respectively; P<.001), and full vaccination (176/213, 82.6\% vs 151/213, 70.9\%, respectively; P=.002; risk ratio 1.17, 95\% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7\% vs 128/185, 69.2\%, respectively; P<.001), measles (170/195, 87.1\% vs 116/169, 68.6\%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3\% vs 85/213, 39.9\%, respectively; P<.001; risk ratio 1.59, 95\% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7\%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 ",
doi="10.2196/27603",
url="https://mhealth.jmir.org/2021/6/e27603",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128813"
}


@Article{info:doi/10.2196/23350,
author="Rossman, H. Andrea
and Reid, W. Hadley
and Pieters, M. Michelle
and Mizelle, Cecelia
and von Isenburg, Megan
and Ramanujam, Nimmi
and Huchko, J. Megan
and Vasudevan, Lavanya",
title="Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research",
journal="J Med Internet Res",
year="2021",
month="May",
day="27",
volume="23",
number="5",
pages="e23350",
keywords="cervical cancer",
keywords="digital health",
keywords="mobile phones",
keywords="low- and middle-income countries",
keywords="colposcopy",
keywords="uterine cervical neoplasms",
keywords="telemedicine or mobile apps",
keywords="cell phones",
keywords="developing countries",
abstract="Background: Nearly 90\% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system--level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. Objective: We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation. Methods: A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. Results: In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions. Conclusions: Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies. ",
doi="10.2196/23350",
url="https://www.jmir.org/2021/5/e23350",
url="http://www.ncbi.nlm.nih.gov/pubmed/34042592"
}


@Article{info:doi/10.2196/27268,
author="Fatima, Munaza
and Kumar, Santosh
and Hussain, Mudassar
and Memon, Masood Naveed
and Vighio, Anum
and Syed, Asif Muhammad
and Chaudhry, Ambreen
and Hussain, Zakir
and Baig, Iqbal Zeeshan
and Baig, Amir Mirza
and Asghar, Jawad Rana
and Ikram, Aamer
and Khader, Yousef",
title="Morbidity and Mortality Associated with Typhoid Fever Among Hospitalized Patients in Hyderabad District, Pakistan, 2017-2018: Retrospective Record Review",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="17",
volume="7",
number="5",
pages="e27268",
keywords="antimicrobial resistance",
keywords="complications",
keywords="control drug resistance",
keywords="extensive drug resistance",
keywords="hospitalization",
keywords="Hyderabad",
keywords="ileal perforation",
keywords="medical records",
keywords="microbiological",
keywords="morbidity",
keywords="mortality",
keywords="Pakistan",
keywords="prevention",
keywords="typhoid",
abstract="Background: Hyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited. Objective: To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan. Methods: We reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths. Results: A total of 1452 culture-confirmed typhoid cases, including 947 (66\%) XDR typhoid cases and 505 (34\%) non-XDR typhoid cases, were identified. Overall, ?1 complications were reported in 360 (38\%) patients with XDR typhoid and 89 (18\%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23\%) and patients with non-XDR typhoid (n=71, 14\%) (P<.001). Overall, mortality was documented among 17 (1.8\%) patients with XDR S Typhi infections and 3 (0.6\%) patients with non-XDR S Typhi infections (P=.06). Conclusions: As this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures. ",
doi="10.2196/27268",
url="https://publichealth.jmir.org/2021/5/e27268",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999000"
}


@Article{info:doi/10.2196/23951,
author="Kanfe, G. Shuma
and Endehabtu, F. Berhanu
and Ahmed, H. Mohammedjud
and Mengestie, D. Nebyu
and Tilahun, Binyam",
title="Commitment Levels of Health Care Providers in Using the District Health Information System and the Associated Factors for Decision Making in Resource-Limited Settings: Cross-sectional Survey Study",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="4",
volume="9",
number="3",
pages="e23951",
keywords="commitment",
keywords="district health information system",
keywords="decision making",
keywords="performance monitoring",
keywords="health facilities",
keywords="information use",
abstract="Background: Changing the culture of information use, which is one of the transformation agendas of the Ministry of Health of Ethiopia, cannot become real unless health care providers are committed to using locally collected data for evidence-based decision making. The commitment of health care providers has paramount influence on district health information system 2 (DHIS2) data utilization for decision making. Evidence is limited on health care providers' level of commitment to using DHIS2 data in Ethiopia. Therefore, this study aims to fill this evidence gap. Objective: This study aimed to assess the levels of commitment of health care providers and the factors influencing their commitment levels in using DHIS2 data for decision making at public health care facilities in the Ilu Aba Bora zone of the Oromia national regional state, Ethiopia in 2020. Methods: The cross-sectional quantitative study supplemented by qualitative methods was conducted from February 26, 2020 to April 17, 2020. A total of 264 participants were approached. SPSS version 20 software was used for data entry and analysis. Descriptive and analytical statistics, including bivariable and multivariable analyses, were performed. Thematic analysis was conducted for the qualitative data. Results: Of the 264 respondents, 121 (45.8\%, 95\% CI 40.0\%-52.8\%) respondents showed high commitment levels to use DHIS2 data. The variables associated with the level of commitment to use DHIS2 data were found to be provision of feedback for DHIS2 data use (adjusted odds ratio [AOR] 1.85, 95\% CI 1.02-3.33), regular supervision and managerial support (AOR 2.84, 95\% CI 1.50-5.37), information use culture (AOR 1.92, 95\% CI 1.03-3.59), motivation to use DHIS2 data (AOR 1.80, 95\% CI 1.00-3.25), health needs (AOR 3.96, 95\% CI 2.11-7.41), and competency in DHIS2 tasks (AOR 2.41, 95\% CI 1.27-4.55). Conclusions: In general, less than half of the study participants showed high commitment levels to use DHIS2 data for decision making in health care. Providing regular supportive supervision and feedback and increasing the motivation and competency of the health care providers in performing DHIS2 data tasks will help in promoting their levels of commitment that can result in the cultural transformation of data use for evidence-based decision making in health care. ",
doi="10.2196/23951",
url="https://medinform.jmir.org/2021/3/e23951",
url="http://www.ncbi.nlm.nih.gov/pubmed/33661133"
}


@Article{info:doi/10.2196/23335,
author="Elhadi, Muhammed
and Msherghi, Ahmed
and Elhadi, Ahmed
and Ashini, Aimen
and Alsoufi, Ahmed
and Bin Alshiteewi, Fatimah
and Elmabrouk, Amna
and Alsuyihili, Ali
and Elgherwi, Alsafa
and Elkhafeefi, Fatimah
and Abdulrazik, Sarah
and Tarek, Ahmed",
title="Utilization of Telehealth Services in Libya in Response to the COVID-19 Pandemic: Cross-sectional Analysis",
journal="JMIR Med Inform",
year="2021",
month="Feb",
day="26",
volume="9",
number="2",
pages="e23335",
keywords="COVID-19",
keywords="cross-sectional study",
keywords="resource-limited countries",
keywords="SARS-CoV-2",
keywords="telehealth",
keywords="telemedicine",
keywords="transitional countries",
keywords="usability",
abstract="Background: Health care systems in transitional countries have witnessed unprecedented challenges related to adequate and continuous health care provision during the COVID-19 pandemic. In many countries, including Libya, institutions and organizations have begun to implement telehealth technology for the first time. This serves to establish an alternative modality for direct physician-patient interviews to reduce the risk of COVID-19 transmission. Objective: This study aimed to assess the usability of telehealth services in Libya and to provide an overview of the current COVID-19 scenario. Methods: In this cross-sectional study, an anonymous web-based survey was administered to Libyan residents between April and May 2020. Participants were contacted through text messaging, emails, and social media. The survey items yielded information on the sociodemographic characteristics, availability and accessibility of health care services, effects of the COVID-19 pandemic on health care services, mental health status, and the feasibility and application of the telehealth system. Results: We obtained 2512 valid responses, of which 1721 (68.5\%) were from females. The participants were aged 28.2 (SD 7.6) years, of whom 2333 (92.9\%) were aged <40 years, and 1463 (58.2\%) were single. Regarding the health care services and their accessibility, 786 (31.1\%) participants reported having a poor health status in general, and 492 (19.6\%) reported having a confirmed diagnosis of at least one chronic disease. Furthermore, 498 (19.9\%) participants reported varying degrees of difficulty in accessing health care centers, and 1558 (62.0\%) could not access their medical records. Additionally, 1546 (61.6\%) participants experienced problems in covering medical costs, and 1429 (56.9\%) avoided seeking medical care owing to financial concerns. Regarding the feasibility of the telehealth system, approximately half of the participants reported that telehealth services were useful during the COVID-19 pandemic, and 1545 (61.5\%) reported that the system was an effective means of communication and of obtaining health care services. Furthermore, 1435 (57.1\%) participants felt comfortable using the telehealth system, and 1129 (44.9\%) felt that they were able to express themselves effectively. Moreover, 1389 (55.3\%) participants found the system easy to understand, and 1354 (53.9\%) reported having excellent communication with physicians through the telehealth system. However, only 1018 (40.5\%) participants reported that communication was better with the telehealth system than with traditional methods. Conclusions: Our study revealed high levels of usability and willingness to use the telemedicine system as an alternative modality to in-person consultations among the Libyan residents in this study. This system is advantageous because it helps overcome health care costs, increases access to prompt medical care and follow-up evaluation, and reduces the risk of COVID-19 transmission. However, internet connectivity and electricity issues could be a substantial barrier for many resource-limited communities, and further studies should address such obstacles. ",
doi="10.2196/23335",
url="https://medinform.jmir.org/2021/2/e23335",
url="http://www.ncbi.nlm.nih.gov/pubmed/33606654"
}


@Article{info:doi/10.2196/18899,
author="Walcott-Bryant, Aisha
and Ogallo, William
and Remy, L. Sekou
and Tryon, Katherine
and Shena, Winnie
and Bosker-Kibacha, Marloes",
title="Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="17",
volume="23",
number="2",
pages="e18899",
keywords="hypertension",
keywords="health information systems",
keywords="mobile phone",
keywords="private sector",
keywords="Kenya",
abstract="Background: Hypertension is a major risk factor of cardiovascular disease and a leading cause of morbidity and mortality globally. In Kenya, the rise of hypertension strains an already stretched health care system that has traditionally focused on the management of infectious diseases. Health care provision in this country remains fragmented, and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private health care sector. Objective: The aim of this study is to assess stakeholders' perspectives on the challenges associated with the management of hypertension in the Kenyan private health care sector and to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension. Methods: We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads, and direct observations at 18 private health care institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions to support the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity. Results: The management of hypertension in the Kenyan private health care sector is characterized by challenges such as high cost of care, limited health care literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patients' care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision support, and patient-mediated data sharing with privacy preservation, auditability, and trust enabled by blockchain technology. Conclusions: The Kenyan private health care sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring that care providers have a holistic view of the patient during any encounter. ",
doi="10.2196/18899",
url="http://www.jmir.org/2021/2/e18899/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33595446"
}


@Article{info:doi/10.2196/14405,
author="Baker, Kevin
and Maurel, Alice
and Ward, Charlotte
and Getachew, Dawit
and Habte, Tedila
and McWhorter, Cindy
and LaBarre, Paul
and Karlstr{\"o}m, Jonas
and Petzold, Max
and K{\"a}llander, Karin",
title="Automated Respiratory Rate Counter to Assess Children for Symptoms of Pneumonia: Protocol for Cross-Sectional Usability and Acceptability Studies in Ethiopia and Nepal",
journal="JMIR Res Protoc",
year="2020",
month="Mar",
day="30",
volume="9",
number="3",
pages="e14405",
keywords="community health worker",
keywords="pneumonia",
keywords="child",
keywords="respiratory rate",
keywords="Nepal",
keywords="Ethiopia",
abstract="Background: Manually counting a child's respiratory rate (RR) for 60 seconds using an acute respiratory infection timer is the World Health Organization (WHO) recommended method for detecting fast breathing as a sign of pneumonia. However, counting the RR is challenging and misclassification of an observed rate is common, often leading to inappropriate treatment. To address this gap, the acute respiratory infection diagnostic aid (ARIDA) project was initiated in response to a call for better pneumonia diagnostic aids and aimed to identify and assess automated RR counters for classifying fast breathing pneumonia when used by front-line health workers in resource-limited community settings and health facilities. The Children's Automated Respiration Monitor (ChARM), an automated RR diagnostic aid using accelerometer technology developed by Koninklijke Philips NV, and the Rad-G, a multimodal RR diagnostic and pulse oximeter developed by Masimo, were the two devices tested in these studies conducted in the Southern Nations, Nationalities, and Peoples' Region in Ethiopia and in the Karnali region in Nepal. Objective: In these studies, we aimed to understand the usability of two new automated RR diagnostic aids for community health workers (CHWs; health extension workers [Ethiopia] and female community health volunteers [Nepal]) and their acceptability to CHWs in Ethiopia and Nepal, first-level health facility workers (FLHFWs) in Ethiopia only, and caregivers in both Ethiopia and Nepal. Methods: This was a prospective, cross-sectional study with a mixed methods design. CHWs and FLHFWs were trained to use both devices and provided with refresher training on all WHO requirements to assess fast breathing. Immediately after training, CHWs were observed using ARIDA on two children. Routine pneumonia case management consultations for children aged 5 years and younger and the device used for these consultations between the first and second consultations were recorded by CHWs in their patient log books. CHWs were observed a second time after 2 months. Semistructured interviews were also conducted with CHWs, FLHFWs, and caregivers. The proportion of consultations with children aged 5 years and younger where CHWs using an ARIDA and adhered to all WHO requirements to assess fast breathing and device manufacturer instructions for use after 2 months will be calculated. Qualitative data from semistructured interviews will be analyzed using a thematic framework approach. Results: The ARIDA project was funded in November 2015, and data collection was conducted between April and December 2018. Data analysis is currently under way and the first results are expected to be submitted for publication in 2020. Conclusions: This is the first time the usability and acceptability of automated RR counters in low-resource settings have been evaluated. Outcomes will be relevant for policy makers and are important for future research of this new class of diagnostic aids for the management of children with suspected pneumonia. International Registered Report Identifier (IRRID): DERR1-10.2196/14405 ",
doi="10.2196/14405",
url="http://www.researchprotocols.org/2007/3/e14405/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32224491"
}


@Article{info:doi/10.2196/12949,
author="Mauco, Leonard Kabelo
and Scott, Ernest Richard
and Mars, Maurice",
title="Development of an eHealth Readiness Assessment Framework for Botswana and Other Developing Countries: Interview Study",
journal="JMIR Med Inform",
year="2019",
month="Aug",
day="22",
volume="7",
number="3",
pages="e12949",
keywords="eHealth",
keywords="eHealth readiness",
keywords="frameworks",
keywords="Botswana",
keywords="developing countries",
abstract="Background: Electronic health (eHealth) readiness has been defined as the preparedness of health care institutions or communities for the anticipated change brought about by programs related to information and communication technology use. To ascertain the degree of such preparedness, an eHealth readiness assessment (eHRA) is needed. Literature on the existing eHRA frameworks and tools shows high inconsistency in content, definitions, and recommendations, and none have been found to be entirely suitable for assessing eHealth readiness in the context of developing countries. To develop an informed eHRA framework and tools with applicability to Botswana and similar developing countries, insight was sought from a broad spectrum of eHealth key informants in Botswana to identify and inform relevant issues, including those not specifically addressed in available eHRA tools. Objective: The aim of this study was to evaluate key informant (local expert) opinions on aspects that need to be considered when developing an eHRA framework suitable for use in developing countries. Methods: Interviews with 18 purposively selected key informants were recorded and transcribed. Thematic analysis of transcripts involved the use of an iterative approach and NVivo 11 software. The major themes, as well as subthemes, emerging from the thematic analysis were then discussed and agreed upon by the authors through consensus. Results: Analysis of interviews identified four eHealth readiness themes (governance, stakeholder issues, resources, and access), with 33 subthemes and 9 sub-subthemes. A major finding was that these results did not directly correspond in content or order to those previously identified in the literature. The results highlighted the need to perform exploratory research before developing an eHRA to ensure that those topics of relevance and importance to the local setting are first identified and then explored in any subsequent eHRA using a locally relevant framework and stakeholder-specific tools. In addition, seven sectors in Botswana were found to play a role in ensuring successful implementation of eHealth projects and might be targets for assessment. Conclusions: Insight obtained from this study will be used to inform the development of an evidence-based eHealth readiness assessment framework suitable for use in developing countries such as Botswana. ",
doi="10.2196/12949",
url="http://medinform.jmir.org/2019/3/e12949/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31441429"
}


@Article{info:doi/10.2196/13359,
author="Lalaye, Didier
and de Bruijn, E. Mirjam
and de Jong, PVM Tom",
title="Prevalence of Schistosoma Haematobium Measured by a Mobile Health System in an Unexplored Endemic Region in the Subprefecture of Torrock, Chad",
journal="JMIR Public Health Surveill",
year="2019",
month="Jun",
day="18",
volume="5",
number="2",
pages="e13359",
keywords="Schistosoma haematobium",
keywords="prevalence",
keywords="Chad",
keywords="neglected tropical diseases",
keywords="mobile health",
abstract="Background: Schistosoma haematobium is a parasitic digenetic trematode responsible for schistosomiasis (also known as bilharzia). The disease is caused by penetration of the skin by the parasite, spread by intermediate host molluscs in stagnant waters, and can be treated by administration of praziquantel. Schistosomiasis is considered to be an important but neglected tropical disease. Objective: The aim of this pilot study was to investigate the prevalence of schistosomiasis in the subprefecture of Torrock, an endemic area in Chad where no earlier investigation had been conducted and no distribution system for pharmacotherapy has ever existed. Methods: This study examined 1875 children aged 1 to 14 years over a period of 1 year. After centrifugation, urine examination was performed by a direct microscopic investigation for eggs. The investigation was conducted with a mobile health (mHealth) approach, using short message service (SMS) for communication among parents, local health workers, a pharmacist, and a medical doctor. An initial awareness campaign requested parents to have their children examined for schistosomiasis. Urine was then collected at home by the parents following the SMS request. Urine results that proved positive were sent to a medical doctor by SMS, who in turn ordered a pharmacist by SMS to distribute praziquantel to the infected children. Results: Direct microscopic examination of urine found 467 positive cases (24.9\% of the total sample). Of all male and female samples, 341 (34\%) and 127 (14.4\%) samples were positive, respectively. The infection rate was equally distributed over age groups. The newly developed mHealth system had a limited level of participation (8\%) from an estimated total of 25,000 children in the target group. Conclusions: The prevalence of schistosomiasis in children in the subprefecture of Torrock is moderately high. Efforts will be required to enhance the awareness of parents and to reach a larger percentage of the population. Systematic governmental measures should be put in place as soon as possible to increase awareness in the area and to diagnose and treat cases of schistosomiasis. ",
doi="10.2196/13359",
url="http://publichealth.jmir.org/2019/2/e13359/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31215519"
}


@Article{info:doi/10.2196/cancer.9798,
author="Camail, Roxane
and Kenfack, Bruno
and Tran, Lien Phuong
and Viviano, Manuela
and Tebeu, Pierre-Marie
and Temogne, Liliane
and Akaaboune, Mohamed
and Tincho, Eveline
and Mbobda, Joel
and Catarino, Rosa
and Vassilakos, Pierre
and Petignat, Patrick",
title="Benefit of Watching a Live Visual Inspection of the Cervix With Acetic Acid and Lugol Iodine on Women's Anxiety: Randomized Controlled Trial of an Educational Intervention Conducted in a Low-Resource Setting",
journal="JMIR Cancer",
year="2019",
month="May",
day="13",
volume="5",
number="1",
pages="e9798",
keywords="cervical cancer",
keywords="papillomavirus infections",
keywords="acetic acid",
keywords="Lugol's iodine",
keywords="anxiety",
abstract="Background: Women undergoing pelvic examination for cervical cancer screening can experience periprocedural anxiety. Objective: The aim of this study was to assess the anxiety level experienced by women undergoing a visual inspection with acetic acid and Lugol iodine (VIA and VILI) examination, with or without watching the procedure on a digital screen. Methods: This prospective randomized study took place in the district of Dschang, Cameroon. A previous cervical cancer screening campaign tested women aged between 30 and 49 years for human papillomavirus (HPV). HPV-positive women were invited for the 12-month follow-up control visit, including a VIA/VILI examination. During that visit, we recruited women to participate in this study. Before the examination, participants were randomized in a 1:1 ratio to a control group (CG) and an intervention group (IG). Women in both groups underwent a pelvic examination and were verbally informed about the steps undertaken during the gynecological examination. The IG could also?watch it live on a tablet screen. Women's anxiety was assessed before and immediately after the examination, using the Spielberger State-Trait Anxiety Inventory (STAI). A paired t test was used to compare the mean STAI score for each question before and after VIA/VILI while a nonpaired, 2-sided t test was used to compare the mean differences of the STAI score between the 2 study groups. Results: A total of 122 women were randomized in the study; 4 of them were excluded as they did not undergo the pelvic examination, did not answer to the second STAI questionnaire because of personal reasons, or the cervix could not be properly visualized. Thus, the final sample size consisted of 118 patients of whom 58 women were assigned to the CG and 60 to the IG. The mean age was 39.1 (SD 5.2) years. Before the examination, the mean (SD) STAI score was 33.6 (SD 10.9) in the CG and 36.4 (SD 11.8) in the IG (P=.17). The STAI score after pelvic examination was significantly reduced for both groups (CG: 29.3 [SD 11.2]; IG: 28.5 [SD 12.0]). Overall, the difference of the STAI scores before and after the pelvic examination was lower in the CG (4.2 [SD 9.0]) than in the IG (7.9 [SD 14.3]), although the difference was not significant (P=.10). However, the women's emotional state, such as I feel secure and I feel strained, was improved in the IG as compared with the CG (CG: P=.01; IG: P=.007). Conclusions: Watching the VIA/VILI procedure in real time improved the women's emotional state but did not reduce the periprocedural anxiety measured by the STAI score. Furthermore, larger studies should assess women's satisfaction with watching their pelvic examination in real time to determine whether this tool could be included in VIA/VILI routine practice. Trial Registration: ClinicalTrials.gov NCT02945111; http://clinicaltrials.gov/ct2/show/NCT02945111 ",
doi="10.2196/cancer.9798",
url="http://cancer.jmir.org/2019/1/e9798/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094335"
}


@Article{info:doi/10.2196/humanfactors.9317,
author="Kavuma, Michael",
title="The Usability of Electronic Medical Record Systems Implemented in Sub-Saharan Africa: A Literature Review of the Evidence",
journal="JMIR Hum Factors",
year="2019",
month="Feb",
day="25",
volume="6",
number="1",
pages="e9317",
keywords="review",
keywords="computer systems",
keywords="delivery of health care",
keywords="sub-Saharan Africa",
abstract="Background: Electronic medical record (EMR) systems hold the exciting promise of accurate, real-time access to patient health care data and great potential to improve the quality of patient care through decision support to clinicians. This review evaluated the usability of EMR systems implemented in sub-Saharan Africa based on a usability evaluation criterion developed by the Healthcare Information and Management Systems Society (HIMSS). Objective: This review aimed to evaluate EMR system implementations in sub-Saharan Africa against a well-defined evaluation methodology and assess their usability based on a defined set of metrics. In addition, the review aimed to identify the extent to which usability has been an enabling or hindering factor in the implementation of EMR systems in sub-Saharan Africa. Methods: Five key metrics for evaluating EMR system usability were developed based on the methodology proposed by HIMSS. These were efficiency, effectiveness, ease of learning, cognitive load, and user satisfaction. A 5-point rating system was developed for the review. EMR systems in 19 reviewed publications were scored based on this rating system. It awarded 5 points per metric to any EMR system that was identified as excellent, 4 points for good, 3 points for fair, 2 points for poor, and 1 point for bad. In addition, each of the 5 key metrics carried a maximum weighted score of 20. The percentage scores for each metric were then computed from the weighted scores from which the final overall usability score was derived. Results: In possibly contributing to the usability of implemented EMR systems, ease of learning obtained the highest percentage score of 71\% (SD 1.09) followed by cognitive load in second place with a score of 68\% (SD 1.62). Effectiveness followed closely in third place at 67\% (SD 1.47) and efficiency was in fourth place at 64\% (SD 1.04). User satisfaction came in last at 63\% (SD 1.70). The overall usability score for all systems was calculated to be 66\%. Conclusions: The usability of EMR systems implemented in sub-Saharan Africa has been good with ease of learning possibly being the biggest positive contributor to this rating. Cognitive load and effectiveness have also possibly positively influenced the usability of EMR systems, whereas efficiency and user satisfaction have perhaps contributed least to positively influencing EMR system usability. ",
doi="10.2196/humanfactors.9317",
url="http://humanfactors.jmir.org/2019/1/e9317/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30801251"
}


@Article{info:doi/10.2196/12385,
author="Lee, Seohyun
and Lee, Youngji
and Lee, Sangmi
and Islam, Shariful Sheikh Mohammed
and Kim, Sun-Young",
title="Toward Developing a Standardized Core Set of Outcome Measures in Mobile Health Interventions for Tuberculosis Management: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="19",
volume="7",
number="2",
pages="e12385",
keywords="mHealth",
keywords="tuberculosis",
keywords="outcome measures",
keywords="evidence synthesis",
keywords="low-and middle-income countries",
abstract="Background: Tuberculosis (TB) management can be challenging in low- and middle-income countries (LMICs) not only because of its high burden but also the prolonged treatment period involving multiple drugs. With rapid development in mobile technology, mobile health (mHealth) interventions or using a mobile device for TB management has gained popularity. Despite the potential usefulness of mHealth interventions for TB, few studies have quantitatively synthesized evidence on its effectiveness, presumably because of variability in outcome measures reported in the literature. Objective: The aim of this systematic review was to evaluate the outcome measures reported in TB mHealth literature in LMICs. Methods: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched to identify mHealth intervention studies for TB (published up to May 2018) that reported any type of outcome measures. The extracted information included the study setting, types of mHealth technology used, target population, study design, and categories of outcome measures. Outcomes were classified into 13 categories including treatment outcome, adherence, process measure, perception, technical outcome, and so on. The qualitative synthesis of evidence focused on the categories of outcome measures reported by the type of mHealth interventions. Results: A total of 27 studies were included for the qualitative synthesis of evidence. The study designs varied widely, ranging from randomized controlled trials to economic evaluations. A total of 12 studies adopted short message service (SMS), whereas 5 studies used SMS in combination with additional technologies or mobile apps. The study populations were also diverse, including patients with TB, patients with TB/HIV, health care workers, and general patients attending a clinic. There was a wide range of variations in the definition of outcome measures across the studies. Among the diverse categories of outcome measures, treatment outcomes have been reported in 14 studies, but only 6 of them measured the outcome according to the standard TB treatment definitions by the World Health Organization. Conclusions: This critical evaluation of outcomes reported in mHealth studies for TB management suggests that substantial variability exists in reporting outcome measures. To overcome the challenges in evidence synthesis for mHealth interventions, this study can provide insights into the development of a core set of outcome measures by intervention type and study design. ",
doi="10.2196/12385",
url="http://mhealth.jmir.org/2019/2/e12385/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30777847"
}


@Article{info:doi/10.2196/medinform.9291,
author="Agarwal, Kumar Rajat
and Sedai, Amit
and Ankita, Kumari
and Parmar, Lalith
and Dhanya, Rakesh
and Dhimal, Sunil
and Sriniwas, Reshma
and Gowda, Ashwini
and Gujjal, Pooja
and H, Pushpa
and Jain, Suman
and Ramaiah, Dasaratha J.
and Jali, Sujata
and Tallur, Rayappa Neelavva
and Ramprakash, Stalin
and Faulkner, Lawrence",
title="Information Technology--Assisted Treatment Planning and Performance Assessment for Severe Thalassemia Care in Low- and Middle-Income Countries: Observational Study",
journal="JMIR Med Inform",
year="2019",
month="Jan",
day="23",
volume="7",
number="1",
pages="e9291",
keywords="$\beta$-thalassemia major",
keywords="health information technologies",
keywords="health planning",
keywords="patient outcome assessment",
abstract="Background: Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessity. Severe thalassemia is one of the most common life-threatening noncommunicable diseases of children globally. Objective: The aim was to study the impact of ICT on quality of care for severe thalassemia patients in LMIC. Methods: A total of 1110 patients with severe thalassemia from five centers in India were followed over a 1-year period. The impact of consistent use of a Web-based platform designed to assist comprehensive management of severe thalassemia (ThalCare) on key indicators of quality of care such as minimum (pretransfusion) hemoglobin, serum ferritin, liver size, and spleen size were assessed. Results: Overall improvements in initial hemoglobin, ferritin, and liver and spleen size were significant (P<.001 for each). For four centers, the improvement in mean pretransfusion hemoglobin level was statistically significant (P<.001). Four of five centers achieved reduction in mean ferritin levels, with two displaying a significant drop in ferritin (P=.004 and P<.001). One of the five centers did not record liver and spleen size on palpation, but of the remaining four centers, two witnessed a large drop in liver and spleen size (P<.01), one witnessed moderate drop (P=.05 for liver; P=.03 for spleen size), while the fourth witnessed a moderate increase in liver size (P=.08) and insignificant change in spleen size (P=.12). Conclusions: Implementation of computer-assisted treatment planning and performance assessment consistently and positively impacted indexes reflecting effective delivery of care to patients suffering from severe thalassemia in LMIC. ",
doi="10.2196/medinform.9291",
url="http://medinform.jmir.org/2019/1/e9291/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30672740"
}


@Article{info:doi/10.2196/medinform.9495,
author="He, Cui
and Zhou, Qiru
and Chen, Wei
and Tian, Junzhang
and Zhou, Lihua
and Peng, Hong
and Luan, Shuo
and Wang, Shengfei",
title="Using an Internet-Based Hospital to Address Maldistribution of Health Care Resources in Rural Areas of Guangdong Province, China: Retrospective and Descriptive Study",
journal="JMIR Med Inform",
year="2018",
month="Dec",
day="21",
volume="6",
number="4",
pages="e51",
keywords="telemedicine",
keywords="health care delivery",
keywords="prescription",
keywords="cost",
keywords="patient satisfaction",
keywords="patient compliance",
abstract="Background: Health care maldistribution is a long-term problem in China. Telemedicine is an efficient way to deliver medical resources to remote areas; however, there are few studies on the effectiveness and challenges in providing health care from rural to urban areas in China. Objective: The objective was to describe the effectiveness and challenges of telemedicine for providing health care from Guangzhou to rural areas in Guangdong Province. Methods: We designed surveys and conducted them immediately after the consultation and 2-4 weeks later. Data were collected from June 2015 to May 2016 including patients' demographic features, patient satisfaction, medicine effect, patient compliance, acceptability of prescription expenses, patients' desire to revisit the department, the top 10 diseases, and self-reported difficulties in telemedicine experience. The monthly average prescription expense was described using a line chart. The monthly consultation and prescription, as well as monthly prescriptions of Western medicines and herbs, were described using a bar chart. Results: Women comprised majority (45,386/67,740, 67.00\%) of participants and men comprised the minority (22,354/67,740, 33.00\%). The top 3 diseases were upper respiratory diseases (12,371/36,311, 34.07\%), laryngopharyngitis (4938/36,311, 13.60\%), and menstrual disorders (4669/36,311, 12.86\%). The monthly prescription for Western medicine was much more than that for Chinese herbs. The annual average medicine expense per prescription was 62.9 {\textyen}. The participants' perception of expense was acceptable (8775/12,450, 70.48\%), mostly acceptable (2497/12,450, 20.01\%), accepted but somewhat expensive (980/12,450, 7.9\%), and unacceptable because of high cost (198/12,450, 1.6\%). The surveys on patient satisfaction demonstrated very satisfied (55,687/67,740, 82.21\%), satisfied (5891/67,740, 8.70\%), basic satisfaction (3561/67,740, 5.26\%), dissatisfaction (1454/67,740, 2.15\%), and no comment (1147/67,740, 1.69\%). Participants reported their treatment outcome as follows: full recovery (5008/12,450, 40.22\%), recovering (4873/12,450, 39.14\%), no effect (2153/12,450, 17.29\%), or worsening (416/12,450, 3.3\%). Approximately 89.01\% (20,240/22,740) of participants will revisit the department, whereas 10.99\% (2500/22,740) will not. Most patients complied with the doctors' advice completely (5430/10,290, 52.77\%), whereas the rest reported partial compliance (3684/10,290, 35.80\%) or no compliance at all (1176/10,290, 11.43\%). The participants reported poor computer skills (4980/22,740, 21.90\%), transportation inconvenience (4670/22,740, 20.50\%), unstable internet connection (3820/22,740, 16.80\%), language barriers (3708/22,740, 16.30\%), medication and medical hardware shortage (2459/22,740, 10.82\%), tiring commute (2068/22,740, 9.08\%), family care burdens (679/22,740, 3.0\%), and other unclassified difficulties (356/22,740, 1.6\%) as difficulties in using telemedicine. Conclusions: Telemedicine has a wide disease spectrum, similar to ordinary medicine in China. It saves costs, has high patient satisfaction and price acceptability, and can relieve disease and syndromes. However, certain problems need to be resolved. Telemedicine could be a feasible approach to address the health care maldistribution in rural China. This study may provide useful information for policy making and guidance for further telemedicine practice in China and other developing countries. ",
doi="10.2196/medinform.9495",
url="http://medinform.jmir.org/2018/4/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578195"
}


@Article{info:doi/10.2196/11541,
author="White, B. Elizabeth
and Meyer, J. Amanda
and Ggita, M. Joseph
and Babirye, Diana
and Mark, David
and Ayakaka, Irene
and Haberer, E. Jessica
and Katamba, Achilles
and Armstrong-Hough, Mari
and Davis, Lucian John",
title="Feasibility, Acceptability, and Adoption of Digital Fingerprinting During Contact Investigation for Tuberculosis in Kampala, Uganda: A Parallel-Convergent Mixed-Methods Analysis",
journal="J Med Internet Res",
year="2018",
month="Nov",
day="15",
volume="20",
number="11",
pages="e11541",
keywords="biometrics",
keywords="mHealth",
keywords="mobile phone",
keywords="tuberculosis",
abstract="Background: In resource-constrained settings, challenges with unique patient identification may limit continuity of care, monitoring and evaluation, and data integrity. Biometrics offers an appealing but understudied potential solution. Objective: The objective of this mixed-methods study was to understand the feasibility, acceptability, and adoption of digital fingerprinting for patient identification in a study of household tuberculosis contact investigation in Kampala, Uganda. Methods: Digital fingerprinting was performed using multispectral fingerprint scanners. We tested associations between demographic, clinical, and temporal characteristics and failure to capture a digital fingerprint. We used generalized estimating equations and a robust covariance estimator to account for clustering. In addition, we evaluated the clustering of outcomes by household and community health workers (CHWs) by calculating intraclass correlation coefficients (ICCs). To understand the determinants of intended and actual use of fingerprinting technology, we conducted 15 in-depth interviews with CHWs and applied a widely used conceptual framework, the Technology Acceptance Model 2 (TAM2). Results: Digital fingerprints were captured for 75.5\% (694/919) of participants, with extensive clustering by household (ICC=.99) arising from software (108/179, 60.3\%) and hardware (65/179, 36.3\%) failures. Clinical and demographic characteristics were not markedly associated with fingerprint capture. CHWs successfully fingerprinted all contacts in 70.1\% (213/304) of households, with modest clustering of outcomes by CHWs (ICC=.18). The proportion of households in which all members were successfully fingerprinted declined over time ($\rho$=.30, P<.001). In interviews, CHWs reported that fingerprinting failures lowered their perceptions of the quality of the technology, threatened their social image as competent health workers, and made the technology more difficult to use. Conclusions: We found that digital fingerprinting was feasible and acceptable for individual identification, but problems implementing the hardware and software lead to a high failure rate. Although CHWs found fingerprinting to be acceptable in principle, their intention to use the technology was tempered by perceptions that it was inconsistent and of questionable value. TAM2 provided a valuable framework for understanding the motivations behind CHWs' intentions to use the technology. We emphasize the need for routine process evaluation of biometrics and other digital technologies in resource-constrained settings to assess implementation effectiveness and guide improvement of delivery. ",
doi="10.2196/11541",
url="http://www.jmir.org/2018/11/e11541/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30442637"
}


@Article{info:doi/10.2196/11402,
author="Alkhalifah, Shahad
and Aldhalaan, Hesham",
title="Telehealth Services for Children With Autism Spectrum Disorders in Rural Areas of the Kingdom of Saudi Arabia: Overview and Recommendations",
journal="JMIR Pediatr Parent",
year="2018",
month="Nov",
day="15",
volume="1",
number="2",
pages="e11402",
keywords="autism spectrum disorders",
keywords="intervention",
keywords="Saudi Arabia",
keywords="telehealth",
doi="10.2196/11402",
url="http://pediatrics.jmir.org/2018/2/e11402/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518306"
}


@Article{info:doi/10.2196/pediatrics.9618,
author="Endehabtu, Berhanu
and Weldeab, Adane
and Were, Martin
and Lester, Richard
and Worku, Abebaw
and Tilahun, Binyam",
title="Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia: Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2018",
month="Oct",
day="17",
volume="1",
number="2",
pages="e9",
keywords="mHealth",
keywords="mobile phone",
keywords="pregnant women",
keywords="SMS",
keywords="willingness",
keywords="Ethiopia",
keywords="antenatal care",
keywords="maternal health",
abstract="Background: Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition. Objective: The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)--based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa. Methods: A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95\% CI was used to identify factors associated with the willingness to receive a text message--based mHealth intervention. Results: A total of 416 respondents (response rate 98.6\%, 416/422) were included in the analysis. About 76.7\% (319/416) of respondents owned a mobile phone and 71.2\% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6\% (120/319) were having smartphones. Of all women with mobile phones, 89.7\% (286/319) described that they are the primary holders of these phones and among them, 85.0\% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0\% (287/319) described that they could read and 86.8\% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3\% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95\% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95\% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95\% CI 0.141-0.718). Conclusions: A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message--based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message--based mHealth interventions. ",
doi="10.2196/pediatrics.9618",
url="http://pediatrics.jmir.org/2018/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518334"
}


@Article{info:doi/10.2196/formative.9658,
author="Liang, Li
and Wiens, O. Matthew
and Lubega, Phaisal
and Spillman, Ian
and Mugisha, Samuel",
title="A Locally Developed Electronic Health Platform in Uganda: Development and Implementation of Stre@mline",
journal="JMIR Formativ Res",
year="2018",
month="Sep",
day="24",
volume="2",
number="2",
pages="e20",
keywords="electronic health record",
keywords="locally developed technology",
keywords="appropriate technology",
keywords="eHealth in low-resource settings",
abstract="Background: Electronic health records (EHRs) are especially important in low-resource settings due to their potential to address unique challenges such as a high number of patients requiring long-term treatments who are lost to follow-up, the frequent shortages of essential drugs, poor maintenance and storage of records, and inefficient clinical triaging. However, there is a lack of affordable and practical EHR solutions. Stre@mline is an EHR platform that has been locally developed by Ugandan clinicians and engineers in Southwestern Uganda. It is tailored to the specific context and needs of low-resource hospitals. It operates without internet access, incorporates locally relevant standards and key patient safety features, has a medication inventory management component, has local technical support available, and is economically sustainable without funding from international donors. Stre@mline is currently used by over 60,000 patients at 2 hospitals, with plans to expand across Uganda. Objective: The purpose of this article is to describe the key opportunities and challenges in EHR development in sub-Saharan Africa and to summarize the development and implementation of a ``Made-for-Africa'' EHR, Stre@mline, and how it has led to improved care for over 60,000 vulnerable patients in a rural region of Southwestern Uganda. Methods: A quantitative user survey consisting of a set of 33 questions on usability and performance was conducted at Kisiizi Hospital. Users responded to each question through a Likert scale with the values of strongly disagree, disagree, agree, and strongly agree. Through purposive sampling, 30 users were identified and 28 users completed the survey. Results: We found that users were generally very satisfied with the ease of use of Stre@mline, with 96\% (27/28) finding it easy to learn and 100\% (28/28) finding it easy to use. Users found that Stre@mline was helpful in improving both clinical efficiency and enhancing patient care. Conclusions: The partnership of local clinicians and developers is crucial to the design and adoption of user-centered technologies tailored to the specific needs of low-resource settings. The EHR described here could serve as a model for the development of future technologies suitable for developing countries. ",
doi="10.2196/formative.9658",
url="http://formative.jmir.org/2018/2/e20/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684419"
}


@Article{info:doi/10.2196/mhealth.9725,
author="Wexler, Catherine
and Brown, Melinda
and Hurley, A. Emily
and Ochieng, Martin
and Goggin, Kathy
and Gautney, Brad
and Maloba, May
and Lwembe, Raphael
and Khamadi, Samoel
and Finocchario-Kessler, Sarah",
title="Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Aug",
day="22",
volume="6",
number="8",
pages="e169",
keywords="early infant diagnosis (EID)",
keywords="HIV/AIDS",
keywords="eHealth",
keywords="mHealth",
keywords="implementation science",
keywords="Kenya",
abstract="Background: Literature suggests that electronic health (eHealth) interventions can improve the efficiency and accuracy of health service delivery and improve health outcomes and are generally well received by patients; however, there are limited data on provider experiences using eHealth interventions in resource-limited settings. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants. Objective: We aimed to compare provider experiences with standard EID and HITSystem implementation at 6 Kenyan hospitals and 3 laboratories. The objective of this study was to better understand provider experiences implementing and using the HITSystem in order to assess facilitators and barriers that may impact adoption and sustainability of this eHealth intervention. Methods: As part of a randomized controlled trial to evaluate the HITSystem, we conducted semistructured interviews with 17 EID providers at participating intervention and control hospitals and laboratories. Results: Providers emphasized the perceived usefulness of the HITSystem, including improved efficiency in sample tracking and patient follow-up, strengthened communication networks among key stakeholders, and improved capacity to meet patient needs compared to standard EID. These advantages were realized from an intervention that providers saw as easy to use and largely compatible with workflow. However, supply stock outs and patient psychosocial factors (including fear of HIV status disclosure and poverty) provided ongoing challenges to EID service provision. Furthermore, slow or sporadic internet access and heavy workload prevented real-time HITSystem data entry for some clinicians. Conclusions: Provider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals. To maximize implementation success, care should be taken in intervention design and implementation to ensure that end users see clear advantages to using the technology and to account for variations in workflows, patient populations, and resource levels by allowing flexibility to suit user needs. Trial Registration: ClinicalTrials.gov NCT02072603; https://clinicaltrials.gov/ct2/show/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm) ",
doi="10.2196/mhealth.9725",
url="http://mhealth.jmir.org/2018/8/e169/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30135052"
}


@Article{info:doi/10.2196/10725,
author="Balsari, Satchit
and Fortenko, Alexander
and Blaya, A. Joaqu{\'i}n
and Gropper, Adrian
and Jayaram, Malavika
and Matthan, Rahul
and Sahasranam, Ram
and Shankar, Mark
and Sarbadhikari, N. Suptendra
and Bierer, E. Barbara
and Mandl, D. Kenneth
and Mehendale, Sanjay
and Khanna, Tarun",
title="Reimagining Health Data Exchange: An Application Programming Interface--Enabled Roadmap for India",
journal="J Med Internet Res",
year="2018",
month="Jul",
day="13",
volume="20",
number="7",
pages="e10725",
keywords="health information exchange",
keywords="India",
keywords="health APIs",
doi="10.2196/10725",
url="http://www.jmir.org/2018/7/e10725/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30006325"
}


@Article{info:doi/10.2196/medinform.8403,
author="Muinga, Naomi
and Magare, Steve
and Monda, Jonathan
and Kamau, Onesmus
and Houston, Stuart
and Fraser, Hamish
and Powell, John
and English, Mike
and Paton, Chris",
title="Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study",
journal="JMIR Med Inform",
year="2018",
month="Apr",
day="18",
volume="6",
number="2",
pages="e22",
keywords="electronic health records",
keywords="software",
keywords="medical records",
keywords="Kenya",
keywords="open source",
abstract="Background: The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. Objective: We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. Methods: We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results: This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Conclusions: Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. ",
doi="10.2196/medinform.8403",
url="http://medinform.jmir.org/2018/2/e22/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29669709"
}


@Article{info:doi/10.2196/jmir.8485,
author="Cherrez Ojeda, Ivan
and Vanegas, Emanuel
and Torres, Michell
and Calder{\'o}n, Carlos Juan
and Calero, Erick
and Cherrez, Annia
and Felix, Miguel
and Mata, Valeria
and Cherrez, Sofia
and Simancas, Daniel",
title="Ecuadorian Cancer Patients' Preference for Information and Communication Technologies: Cross-Sectional Study",
journal="J Med Internet Res",
year="2018",
month="Feb",
day="20",
volume="20",
number="2",
pages="e50",
keywords="social media",
keywords="telemedicine",
keywords="cancer",
keywords="Web 2.0",
keywords="mHealth",
abstract="Background: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. Objective: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients. Methods: We conducted an anonymous cross-sectional survey study in 500 Ecuadorian cancer patients. This questionnaire consisted of 22 items about demographic and clinical data, together with the preferences of people who use ICTs. Chi-square, crude, and adjusted logistic regressions were performed. Results: Of the total, 43.2\% (216/500) of participants reported that they had access to the Internet, and 25.4\% (127/500) reported that they neither owned a cell phone nor did they have access to the Internet. The Internet constituted the highest usage rate as a source of information about malignant diseases (74.3\%, 162/218) regardless of age (P<.001). With regard to the preferences on how patients would like to use ICTs to receive information about diseases, WhatsApp (66.5\%, 145/218) and short message service (SMS) text messaging (61.0\%, 133/218) were widely reported as interesting communication channels. Similarly, WhatsApp (72.0\%, 157/218) followed by SMS (63.8\%, 139/218) were reported as the preferred ICTs through which patients would like to ask physicians about diseases. Adjusted regression analysis showed that patients aged between 40 and 64 years were more likely to be interested in receiving information through SMS (odds ratio, OR 5.09, 95\% CI 1.92-13.32), as well as for asking questions to physicians through this same media (OR 9.78, CI 3.45-27.67) than the oldest group. Conclusions: WhatsApp, SMS, and email are effective and widely used ICTs that can promote communication between cancer patients and physicians. According to age range, new ICTs such as Facebook are still emerging. Future studies should investigate how to develop and promote ICT-based resources more effectively to engage the outcomes of cancer patients. The widespread use of ICTs narrows the gap between cancer patients with restricted socioeconomic conditions and those with wealth and easily available technological means, thereby opening up new possibilities in low-income countries. ",
doi="10.2196/jmir.8485",
url="http://www.jmir.org/2018/2/e50/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29463492"
}


@Article{info:doi/10.2196/medinform.7380,
author="Li, Peiyao
and Xie, Chen
and Pollard, Tom
and Johnson, William Alistair Edward
and Cao, Desen
and Kang, Hongjun
and Liang, Hong
and Zhang, Yuezhou
and Liu, Xiaoli
and Fan, Yong
and Zhang, Yuan
and Xue, Wanguo
and Xie, Lixin
and Celi, Anthony Leo
and Zhang, Zhengbo",
title="Promoting Secondary Analysis of Electronic Medical Records in China: Summary of the PLAGH-MIT Critical Data Conference and Health Datathon",
journal="JMIR Med Inform",
year="2017",
month="Nov",
day="14",
volume="5",
number="4",
pages="e43",
keywords="electronic health record",
keywords="datathon",
keywords="database",
keywords="intensive care units",
doi="10.2196/medinform.7380",
url="http://medinform.jmir.org/2017/4/e43/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29138126"
}


@Article{info:doi/10.2196/medinform.8131,
author="Syzdykova, Assel
and Malta, Andr{\'e}
and Zolfo, Maria
and Diro, Ermias
and Oliveira, Luis Jos{\'e}",
title="Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review",
journal="JMIR Med Inform",
year="2017",
month="Nov",
day="13",
volume="5",
number="4",
pages="e44",
keywords="electronic health record",
keywords="EHR",
keywords="software",
keywords="eHealth",
keywords="open source",
abstract="Background: Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas. Objective: The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings. Methods: First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings. Results: The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code-based language, (17) development activity, (18) modularity, (19) user interface, (20) community support, and (21) customization. The quality of each feature is discussed for each of the evaluated solutions and a final comparison is presented. Conclusions: There is a clear demand for open-source, reliable, and flexible EHR systems in low-resource settings. In this study, we have evaluated and compared five open-source EHR systems following a multidimensional methodology that can provide informed recommendations to other implementers, developers, and health care professionals. We hope that the results of this comparison can guide decision making when needing to adopt, install, and maintain an open-source EHR solution in low-resource settings. ",
doi="10.2196/medinform.8131",
url="http://medinform.jmir.org/2017/4/e44/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29133283"
}


@Article{info:doi/10.2196/jmir.7881,
author="Oza, Shefali
and Jazayeri, Darius
and Teich, M. Jonathan
and Ball, Ellen
and Nankubuge, Alexandra Patricia
and Rwebembera, Job
and Wing, Kevin
and Sesay, Amara Alieu
and Kanter, S. Andrew
and Ramos, D. Glauber
and Walton, David
and Cummings, Rachael
and Checchi, Francesco
and Fraser, S. Hamish",
title="Development and Deployment of the OpenMRS-Ebola Electronic Health Record System for an Ebola Treatment Center in Sierra Leone",
journal="J Med Internet Res",
year="2017",
month="Aug",
day="21",
volume="19",
number="8",
pages="e294",
keywords="Ebola virus disease",
keywords="electronic health records",
keywords="eHealth",
keywords="health information systems",
keywords="disease outbreaks",
keywords="disasters",
keywords="West Africa",
keywords="Sierra Leone",
abstract="Background: Stringent infection control requirements at Ebola treatment centers (ETCs), which are specialized facilities for isolating and treating Ebola patients, create substantial challenges for recording and reviewing patient information. During the 2014-2016 West African Ebola epidemic, paper-based data collection systems at ETCs compromised the quality, quantity, and confidentiality of patient data. Electronic health record (EHR) systems have the potential to address such problems, with benefits for patient care, surveillance, and research. However, no suitable software was available for deployment when large-scale ETCs opened as the epidemic escalated in 2014. Objective: We present our work on rapidly developing and deploying OpenMRS-Ebola, an EHR system for the Kerry Town ETC in Sierra Leone. We describe our experience, lessons learned, and recommendations for future health emergencies. Methods: We used the OpenMRS platform and Agile software development approaches to build OpenMRS-Ebola. Key features of our work included daily communications between the development team and ground-based operations team, iterative processes, and phased development and implementation. We made design decisions based on the restrictions of the ETC environment and regular user feedback. To evaluate the system, we conducted predeployment user questionnaires and compared the EHR records with duplicate paper records. Results: We successfully built OpenMRS-Ebola, a modular stand-alone EHR system with a tablet-based application for infectious patient wards and a desktop-based application for noninfectious areas. OpenMRS-Ebola supports patient tracking (registration, bed allocation, and discharge); recording of vital signs and symptoms; medication and intravenous fluid ordering and monitoring; laboratory results; clinician notes; and data export. It displays relevant patient information to clinicians in infectious and noninfectious zones. We implemented phase 1 (patient tracking; drug ordering and monitoring) after 2.5 months of full-time development. OpenMRS-Ebola was used for 112 patient registrations, 569 prescription orders, and 971 medication administration recordings. We were unable to fully implement phases 2 and 3 as the ETC closed because of a decrease in new Ebola cases. The phase 1 evaluation suggested that OpenMRS-Ebola worked well in the context of the rollout, and the user feedback was positive. Conclusions: To our knowledge, OpenMRS-Ebola is the most comprehensive adaptable clinical EHR built for a low-resource setting health emergency. It is designed to address the main challenges of data collection in highly infectious environments that require robust infection prevention and control measures and it is interoperable with other electronic health systems. Although we built and deployed OpenMRS-Ebola more rapidly than typical software, our work highlights the challenges of having to develop an appropriate system during an emergency rather than being able to rapidly adapt an existing one. Lessons learned from this and previous emergencies should be used to ensure that a set of well-designed, easy-to-use, pretested health software is ready for quick deployment in future. ",
doi="10.2196/jmir.7881",
url="http://www.jmir.org/2017/8/e294/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28827211"
}


@Article{info:doi/10.2196/medinform.6959,
author="Balikuddembe, S. Michael
and Tumwesigye, M. Nazarius
and Wakholi, K. Peter
and Tyllesk{\"a}r, Thorkild",
title="Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review",
journal="JMIR Med Inform",
year="2017",
month="Jun",
day="15",
volume="5",
number="2",
pages="e14",
keywords="childbirth",
keywords="obstetric labor",
keywords="fetal monitoring",
keywords="medical informatics applications",
keywords="systematic review",
abstract="Background: Proper monitoring of labor and childbirth prevents many pregnancy-related complications. However, monitoring is still poor in many places partly due to the usability concerns of support tools such as the partograph. In 2011, the World Health Organization (WHO) called for the development and evaluation of context-adaptable electronic health solutions to health challenges. Computerized tools have penetrated many areas of health care, but their influence in supporting health staff with childbirth seems limited. Objective: The objective of this scoping review was to determine the scope and trends of research on computerized labor monitoring tools that could be used by health care providers in childbirth management. Methods: We used key terms to search the Web for eligible peer-reviewed and gray literature. Eligibility criteria were a computerized labor monitoring tool for maternity service providers and dated 2006 to mid-2016. Retrieved papers were screened to eliminate ineligible papers, and consensus was reached on the papers included in the final analysis. Results: We started with about 380,000 papers, of which 14 papers qualified for the final analysis. Most tools were at the design and implementation stages of development. Three papers addressed post-implementation evaluations of two tools. No documentation on clinical outcome studies was retrieved. The parameters targeted with the tools varied, but they included fetal heart (10 of 11 tools), labor progress (8 of 11), and maternal status (7 of 11). Most tools were designed for use in personal computers in low-resource settings and could be customized for different user needs. Conclusions: Research on computerized labor monitoring tools is inadequate. Compared with other labor parameters, there was preponderance to fetal heart monitoring and hardly any summative evaluation of the available tools. More research, including clinical outcomes evaluation of computerized childbirth monitoring tools, is needed. ",
doi="10.2196/medinform.6959",
url="http://medinform.jmir.org/2017/2/e14/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28619702"
}


@Article{info:doi/10.2196/jmir.7326,
author="Ali, Joseph
and Labrique, B. Alain
and Gionfriddo, Kara
and Pariyo, George
and Gibson, G. Dustin
and Pratt, Bridget
and Deutsch-Feldman, Molly
and Hyder, A. Adnan",
title="Ethics Considerations in Global Mobile Phone-Based Surveys of Noncommunicable Diseases: A Conceptual Exploration",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e110",
keywords="ethics",
keywords="mobile phone survey",
keywords="mHealth",
keywords="noncommunicable diseases",
keywords="research ethics",
keywords="bioethics",
doi="10.2196/jmir.7326",
url="http://www.jmir.org/2017/5/e110/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476723"
}


@Article{info:doi/10.2196/mhealth.7185,
author="Adepoju, Omolade Ibukun-Oluwa
and Albersen, Antonia Bregje Joanna
and De Brouwere, Vincent
and van Roosmalen, Jos
and Zweekhorst, Marjolein",
title="mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Mar",
day="23",
volume="5",
number="3",
pages="e38",
keywords="mHealth",
keywords="decision support systems, clinical",
keywords="sub-Saharan Africa",
keywords="clinical decision-making",
abstract="Background: In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established. Objective: The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa. Methods: A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA. Results: We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training. Conclusions: The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings. ",
doi="10.2196/mhealth.7185",
url="http://mhealth.jmir.org/2017/3/e38/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28336504"
}


@Article{info:doi/10.2196/medinform.4106,
author="Tilahun, Binyam
and Fritz, Fleur",
title="Comprehensive Evaluation of Electronic Medical Record System Use and User Satisfaction at Five Low-Resource Setting Hospitals in Ethiopia",
journal="JMIR Med Inform",
year="2015",
month="May",
day="25",
volume="3",
number="2",
pages="e22",
keywords="electronic medical record",
keywords="evaluation",
keywords="low-resource settings",
keywords="Ethiopia",
keywords="DeLone and MacLean model",
abstract="Background: Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective: The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional's satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods: A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results: Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2\% response rate). Out of the respondents, 76.1\% (309/406) started to use the system immediately after implementation and user training, but only 31.7\% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4\% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4\% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95\% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95\% CI 3.23-17.01). Conclusions: Health professionals' use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock. ",
doi="10.2196/medinform.4106",
url="http://medinform.jmir.org/2015/2/e22/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26007237"
}


@Article{info:doi/10.2196/jmir.3859,
author="Siedner, J. Mark
and Santorino, Data
and Haberer, E. Jessica
and Bangsberg, R. David",
title="Know Your Audience: Predictors of Success for a Patient-Centered Texting App to Augment Linkage to HIV Care in Rural Uganda",
journal="J Med Internet Res",
year="2015",
month="Mar",
day="24",
volume="17",
number="3",
pages="e78",
keywords="telemedicine",
keywords="text messaging",
keywords="randomized controlled trial",
keywords="Uganda",
keywords="HIV",
abstract="Background: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. Objective: We sought to (1) identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda and (2) evaluate the efficacy of various short message service (SMS) text message formats to optimize the balance between confidentiality and accessibility. Methods: The trial evaluated the efficacy of a SMS text messaging app to notify PLWH of their laboratory results and request return to care for those with abnormal test results. Participants with a normal laboratory result received a single SMS text message indicating results were normal. Participants with an abnormal test result were randomized to 1 of 3 message formats designed to evaluate trade-offs between clarity and privacy: (1) an SMS text message that stated results were abnormal and requested return to clinic (``direct''), (2) the same message protected by a 4-digit PIN code (``PIN''), and (3) the message ``ABCDEFG'' explained at enrollment to indicate abnormal results (``coded''). Outcomes of interest were (1) self-reported receipt of the SMS text message, (2) accurate identification of the message, and (3) return to care within 7 days (for abnormal results) or on the date of the scheduled appointment (for normal results). We fit regression models for each outcome with the following explanatory variables: sociodemographic characteristics, CD4 count result, ability to read a complete sentence, ability to access a test message on enrollment, and format of SMS text message. Results: Seventy-two percent (234/385) of participants successfully receiving a message, 87.6\% (219/250) correctly identified the message format, and 60.8\% (234/385) returned to clinic at the requested time. Among participants with abnormal tests results (138/385, 35.8\%), the strongest predictors of reported message receipt were the ability to read a complete sentence and a demonstrated ability to access a test message on enrollment. Participants with an abnormal result who could read a complete sentence were also more likely to accurately identify the message format (AOR 4.54, 95\% CI 1.42-14.47, P=.01) and return to clinic appropriately (AOR 3.81, 95\% CI 1.61-9.03, P=.002). Those who were sent a PIN-protected message were less likely to identify the message (AOR 0.11, 95\% CI 0.03-0.44, P=.002) or return within 7 days (AOR 0.26, 95\% CI 0.10-0.66, P=.005). Gender, age, and socioeconomic characteristics did not predict any outcomes and there were no differences in outcomes between those receiving direct or coded messages. Conclusions: Confirmed literacy at the time of enrollment was a robust predictor of SMS text message receipt, identification, and appropriate response for PLWH in rural Uganda. PIN-protected messages reduced odds of clinic return, but coded messages were as effective as direct messages and might augment privacy. Trial Registration: Clinicaltrials.gov NCT 01579214; https://clinicaltrials.gov/ct2/show/NCT01579214 (Archived by WebCite at http://www.webcitation.org/6Ww8R4sKq). ",
doi="10.2196/jmir.3859",
url="http://www.jmir.org/2015/3/e78/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25831269"
}


@Article{info:doi/10.2196/mhealth.3854,
author="Nhavoto, Ant{\'o}nio Jos{\'e}
and Gr{\"o}nlund, {\AA}ke
and Chaquilla, Ponce Walter",
title="SMSa{\'u}de: Design, Development, and Implementation of a Remote/Mobile Patient Management System to Improve Retention in Care for HIV/AIDS and Tuberculosis Patients",
journal="JMIR mHealth uHealth",
year="2015",
month="Mar",
day="09",
volume="3",
number="1",
pages="e26",
keywords="mobile health",
keywords="text messaging",
keywords="SMS system",
keywords="patient management",
keywords="design science research",
keywords="Mozambique",
abstract="Background: The widespread and low cost of mobile phones and the convenience of short message service (SMS) text messaging suggest potential suitability for use with alternative strategies for supporting retention in care and adherence to the treatment of various chronic diseases, such as HIV and tuberculosis (TB). Despite the growing body of literature reporting positive outcomes of SMS text message-based communication with patients, there is yet very little research about the integration of communication technologies and electronic medical records or electronic patient tracking systems. Objective: To design, develop, and implement an integrated mobile phone text messaging system used to follow up with patients with HIV and TB in treatment in Mozambique. Methods: Following the design science research methodology, we developed a Web-based system that provides support to patients. A case study involving three health care sites in Mozambique was a basis for discussing design issues for this kind of system. We used brainstorming techniques to solicit usability requirements, focus group meetings to discuss and define system architecture, and prototyping to test in real environments and to improve the system. Results: We found six sets of system requirements that need to be addressed for success: data collection, telecommunication costs, privacy and data security, text message content, connectivity, and system scalability. A text messaging system was designed and implemented in three health facilities. These sites feed data into a central data repository, which can be used for analysis of operations and decision support. Based on the treatment schedule, the system automatically sent SMS text message appointment reminders, medication reminders, as well as motivational and educational messages to patients enrolled in antiretroviral therapy and TB treatment programs. Conclusions: We successfully defined the requirements for, designed, and implemented a mobile phone text messaging system to support HIV and TB treatments. Implementation of this system could improve patients' self-management skills and strengthen communication between patients and health care providers. ",
doi="10.2196/mhealth.3854",
url="http://mhealth.jmir.org/2015/1/e26/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25757551"
}


@Article{info:doi/10.2196/mhealth.3704,
author="Kaewkungwal, Jaranit
and Apidechkul, Tawatchai
and Jandee, Kasemsak
and Khamsiriwatchara, Amnat
and Lawpoolsri, Saranath
and Sawang, Surasak
and Sangvichean, Aumnuyphan
and Wansatid, Peerawat
and Krongrungroj, Sarinya",
title="Application of Mobile Technology for Improving Expanded Program on Immunization Among Highland Minority and Stateless Populations in Northern Thailand Border",
journal="JMIR mHealth uHealth",
year="2015",
month="Jan",
day="14",
volume="3",
number="1",
pages="e4",
keywords="expanded program on immunization",
keywords="EPI",
keywords="hill tribes",
keywords="stateless",
keywords="behavioral change communication",
keywords="mobile technology",
abstract="Background: Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. Objective: The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. Methods: The ``StatelessVac'' project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention.  With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. Results: This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend.  Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. Conclusions: The mobile technology has proven to be an effective mechanism in improving a children's immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country. ",
doi="10.2196/mhealth.3704",
url="http://mhealth.jmir.org/2015/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25589367"
}