Pregnant and breastfeeding women are priority targets for COVID-19 vaccination due to adverse maternal and fetal consequences of perinatal COVID-19 infection and the opportunity for protecting infants through maternal antibodies. Saheli (‘female friend’) is a WhatsApp-deployed chatbot providing evidence-based guidance on COVID-19 for pregnant and breastfeeding women.
To understand the feasibility and acceptability of Saheli and its impact on COVID-19 vaccination.
We pilot-tested Saheli among pregnant and breastfeeding participants of pre-existing WhatsApp educational groups led by a community-based non-governmental organisation in Haryana, India from January to March 2022 using a pre/post design.
829 unique participants completed precommunity surveys or postcommunity surveys; 238 completed both. 829 individuals used Saheli, including 88% postintervention survey participants. Users reported Saheli was easy to engage with (79%), easy to understand (91%), quick (83%) and met their information needs (97%). 89% indicated it improved their COVID-19 knowledge a lot, 72% recommended it to others and 88% shared chatbot-derived information with others. Most participants received ≥1 COVID-19 vaccine (86% vs 88%, preintervention to postintervention); full vaccination was 55% and 61%, respectively. Vaccination over time increased marginally for ≥1 dose (OR 1.15, 95% CI 0.99 to 1.36) and significantly for 2 doses (OR 1.21, 95% CI 1.09 to 1.34), and increases were significant among pregnant (≥1 dose) and breastfeeding participants (2 doses). Vaccine hesitancy was low. Chatbot use was high, yet individual chatbot engagement did not alter COVID-19 vaccination.
Chatbots are a promising health education strategy due to high acceptability and deployment potential. Interpreting community chatbot impact must acknowledge the co-occurring constellation of multilevel interventions, community and pandemic factors.
Affordable surgical innovations (ASIs) provide simple, safe and equitable solutions in resource-limited settings. Effective dissemination is needed for widespread adoption and uptake of ASIs in low and middle-income countries (LMICs). However, surgical systems in these settings face challenges with adoption and uptake of ASIs, which remain unknown and/or unused even after supporting evidence is published. A surgery-specific, implementation science-informed framework can provide a roadmap delineating the actions needed to achieve this goal; however, none exist currently. This prompted the development of a well-defined roadmap for this purpose.
The roadmap was developed after several rounds of structured brainstorming discussions among the authors, who are LMIC-based experts in academic surgery, ASIs, global health and implementation science.
The proposed ‘DISSEMINATE’ roadmap presents 18 non-sequential domains to be considered in a comprehensive approach to equitable accessibility for surgical innovations: Design of the innovation; Innovate by combining the IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) surgical innovation framework with local multidisciplinary expertise; Substantiate available evidence; Scale up application of evidence in surgical practice; Share knowledge on multidisciplinary platforms; Sustainability; Endorsement of the innovation by local catalysts; Media promotion; Identify early adopters; Improve and refine the innovation; Improvise during setbacks; Implementation science methods; Navigate through barriers; Aspirational affordability; Advocacy for the value of ASIs; Tools for scalability and adoption; Evaluate impact of dissemination; and Extend use of the innovation to resource-rich settings. This surgery-specific roadmap provides structure for effective dissemination to help in overcoming know-do gaps in the use of ASIs in LMICs.
To identify the barriers and facilitators for uptake of telemedicine services in low-income and middle-income countries (LMICs).
The rapid review approach to identify the barriers and facilitators for the uptake/delivery of telemedicine in health system from both the provider and the patient’s perspective. A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form.
A search on PubMed (NCBI), Embase (Ovid), the Cochrane Library (Wiley), Scopus (Elsevier) and the WHO Global Index Medicus was conducted.
Studies published between 1 January 2012 and 1 July 2022 on barriers and facilitators for uptake of telemedicine services in LMICs were included.
Database search identified a total of 2829 citations. After removing 1069 duplicates, 1760 were taken forward for title and abstract screening. A total of 43 articles were included at full text stage and 8 articles were included in this overview for narrative synthesis. Barriers and facilitators to telemedicine adoption and use were categorised under four subheadings, namely organisational and environmental, individual and cultural barriers, financial barriers and technological barriers. Providers, patient and health policy-makers perspectives were captured.
Any development of telemedicine services should engage the primary users such as patients and their family caregivers to design people-centred digital health systems and services. Usability studies must be commissioned by the governments and host agencies to enhance the interaction experience pending which investments would remain futile. Future research should employ mixed methods or multi methods approaches to understand the interaction between patients and providers.
Globally, 5 billion people lack access to safe surgery and annually, only 6% of surgeries occur in low-income countries. Surgical frugal innovations can reduce cost and optimise the function for the context; however, there is limited evidence about what enables success.
A systematic literature review (SLR) was performed to understand the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries (LMICs).
Web of Science, PubMed, Embase at Ovid, Google Scholar and EThOs were searched.
Inclusion criteria were original research in English containing a frugal surgical innovation. Research must be focused on LMICs. Studies were excluded if the content was not focused on LMICs or did not pertain to barriers and facilitators. 26 studies from 2006 to 2021 were included. The GRADE tool was used to assess overall review quality.
Results were analysed using the modified consolidated framework for implementation research. The lack of formal evidence regarding frugal innovation in LMICs was the most reported barrier. The adaptability of frugal innovations to the context was the most reported facilitator. The limitations of this study were that most frugal innovations are not included in formal literature and that only English studies were included.
Frugal surgical innovations that are highly adaptable to the local context hold significant potential to scale and positively affect healthcare access and outcomes. Furthermore, supporting formal research about frugal innovations is important when aiming to innovate for health equity.
Medial tibial stress syndrome (MTSS) is common and often difficult to treat. The purpose of this study was to examine the effect of a lower leg brace on MTSS symptoms compared to a placebo.
A pilot of a prospective double-blinded randomised placebo-controlled trial conducted in two private sports medicine practices. Included were those with symptomatic MTSS lasting 6 weeks or more. Excluded were those with other lower limb pathologies. Fourteen participants formed the study cohort who wore the brace or placebo. The brace applied counterforce pressure to the musculotendinous junctions of the soleus, compressed periosteum at the distal third of the posteromedial tibia and applied inferomedial torsion to the soleus muscle. Additional treatment modalities were recorded. Participants completed a standardised MTSS Severity Score at 0–6, 8, 12 and 24 weeks and recorded return to full activity.
The brace group demonstrated a significantly reduced MTSS severity score from 5 to 24 weeks (p<0.03) and had returned to full activity within 5 weeks. MTSS score in the placebo group remained unchanged (p >0.05), all participants experienced MTSS recurrence and none returned to full activity over 24 weeks.
The lower leg brace demonstrated a reduction in MTSS symptoms from 5 weeks that was sustained over 6 months with a lower rate of MTSS recurrence compared with the placebo. If similar results are seen in a larger cohort, it has potential to benefit patients with MTSS as an adjunct to current treatment modalities. Further investigation regarding efficacy is needed.
ACTRN12620000906954.