wow-inequalities/02-data/intermediate/wos_sample/7383cda5e3b4f88e0ad1e0683bef95e8-steinman-lesley-and/info.yaml

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2023-09-28 14:46:10 +00:00
abstract: 'Background: The burden of non-communicable diseases (NCDs) is increasing
in low-and middle-income countries (LMICs) where NCDs cause 4:5 deaths,
disproportionately affect poorer populations, and carry a large economic
burden. Digital interventions can improve NCD management for these
hard-to-reach populations with inadequate health systems and high
cell-phone coverage; however, there is limited research on whether
digital health is reaching this potential. We conducted a process
evaluation to understand challenges and successes from a digital health
intervention trial to support Cambodians living with NCDs in a peer
educator (PE) program. Methods: MoPoTsyo, a Cambodian non-governmental
organization (NGO), trains people living with diabetes and/or
hypertension as PEs to provide self-management education, support, and
healthcare linkages for better care management among underserved
populations. We partnered with MoPoTsyo and InSTEDD in 2016-2018 to test
tailored and targeted mHealth mobile voice messages and eHealth tablets
to facilitate NCD management and clinical-community linkages. This
cluster randomized controlled trial (RCT) engaged 3,948 people and 75
PEs across rural and urban areas. Our mixed methods process evaluation
was guided by RE-AIM to understand impact and real-world implications of
digital health. Data included patient (20) and PE interviews (6),
meeting notes, and administrative datasets. We triangulated and analyzed
data using thematic analysis, and descriptive and complier average
causal effects statistics (CACE). Results: Reach: intervention
participants were more urban (66\% vs. 44\%), had more PE visits (39 vs.
29), and lower uncontrolled hypertension {[}12\% and 7\% vs. 23\% and
16\% uncontrolled systolic blood pressure (SBP) and diastolic blood
pressure (DBP)]. Adoption: patients were sent mean {[}standard deviation
(SD)] 30 {[}14] and received 14 {[}8] messages; 40\% received no
messages due to frequent phone number changes. Effectiveness: CACE found
clinically but not statistically significant improvements in blood
pressure and sugar for mHealth participants who received at least one
message vs. no messages. Implementation: main barriers were limited
cellular access and that mHealth/eHealth could not solve structural
barriers to NCD control faced by people in poverty. Maintenance: had the
intervention been universally effective, it could be paid for from
additional revolving drug fund revenue, new agreements with mobile
networks, or the government. Conclusions: Evidence for digital health to
improve NCD outcomes in LMICs are limited. This study suggests digital
health alone is insufficient in countries with low resource health
systems and that high cell phone coverage did not translate to access.
Adding digital health to an NCD peer network may not significantly
benefit an already effective program; mHealth may be better for
hard-to-reach populations not connected to other supports. As long as
mHealth remains an individual-level intervention, it will not address
social determinants of health that drive outcomes. Future digital health
research and practice to improve NCD management in LMICs requires
engaging government, NGOs, and technology providers to work together to
address barriers.'
affiliation: 'Steinman, L (Corresponding Author), Univ Washington, Hlth Promot Res
Ctr, UW Box 354804, Seattle, WA 98105 USA.
Steinman, Lesley, Univ Washington, Sch Publ Hlth, Dept Hlth Serv, Seattle, WA 98105
USA.
van Pelt, Maurits; Hen, Heang, MoPoTsyo Patient Informat Ctr, Phnom Penh, Cambodia.
Chhorvann, Chhea; Te, Vannarath, Natl Inst Publ Hlth, Phnom Penh, Cambodia.
Lan, Channe Suy, InSTEDD, Phnom Penh, Cambodia.
LoGerfo, James; Fitzpatrick, Annette L., Univ Washington, Sch Publ Hlth, Dept Global
Hlth, Seattle, WA 98105 USA.
LoGerfo, James, Univ Washington, Dept Med, Seattle, WA 98105 USA.
Fitzpatrick, Annette L., Univ Washington, Sch Med, Dept Family Med, Seattle, WA
98105 USA.
Fitzpatrick, Annette L., Univ Washington, Sch Publ Hlth, Dept Epidemiol, Seattle,
WA 98105 USA.'
article-number: '40'
author: Steinman, Lesley and van Pelt, Maurits and Hen, Heang and Chhorvann, Chhea
and Lan, Channe Suy and Te, Vannarath and LoGerfo, James and Fitzpatrick, Annette
L.
author-email: lesles@uw.edu
author_list:
- family: Steinman
given: Lesley
- family: van Pelt
given: Maurits
- family: Hen
given: Heang
- family: Chhorvann
given: Chhea
- family: Lan
given: Channe Suy
- family: Te
given: Vannarath
- family: LoGerfo
given: James
- family: Fitzpatrick
given: Annette L.
da: '2023-09-28'
doi: 10.21037/mhealth-19-249
eissn: 2306-9740
files: []
journal: MHEALTH
keywords: Diabetes; hypertension; mHealth; Cambodia; implementation science
keywords-plus: 'NONCOMMUNICABLE DISEASE; PREVENTION; INTERVENTION; TECHNOLOGY;
ADHERENCE; PROGRAM; SERVICE; BURDEN; IMPACT'
language: English
month: OCT
number: '4'
number-of-cited-references: '82'
papis_id: 50b3f52055b82213f72fbc7bb57feeb5
ref: Steinman2020canmhealth
times-cited: '7'
title: Can mHealth and eHealth improve management of diabetes and hypertension in
a hard-to-reach population? -lessons learned from a process evaluation of digital
health to support a peer educator model in Cambodia using the RE-AIM framework br
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000850208600007
usage-count-last-180-days: '2'
usage-count-since-2013: '6'
volume: '6'
web-of-science-categories: Health Care Sciences \& Services; Medical Informatics
year: '2020'