Recruiting hard-to-reach populations via respondent driven sampling for mobile phone surveys in Colombia: a qualitative study.

BACKGROUND: Uptake of mobile phone surveys (MPS) is increasing in many low- and middle-income countries, particularly within the context of data collection on non-communicable diseases (NCDs) behavioural risk factors. One barrier to collecting representative data through MPS is capturing data from older participants.Respondent driven sampling (RDS) consists of chain-referral strategies where existing study subjects recruit follow-up participants purposively based on predefined eligibility criteria. Adapting RDS strategies to MPS efforts could, theoretically, yield higher rates of participation for that age group. OBJECTIVE: To investigate factors that influence the perceived acceptability of a RDS recruitment method for MPS involving people over 45 years of age living in Colombia. METHODS: An MPS recruitment strategy deploying RDS techniques was piloted to increase participation of older populations. We conducted a qualitative study that drew from surveys with open and closed-ended items, semi-structured interviews for feedback, and focus group discussions to explore perceptions of the strategy and barriers to its application amongst MPS participants. RESULTS: The strategy's success is affected by factors such as cultural adaptation, institutional credibility and public trust, data protection, and challenges with mobile phone technology. These factors are relevant to individuals' willingness to facilitate RDS efforts targeting hard-to-reach people. Recruitment strategies are valuable in part because hard-to-reach populations are often most accessible through their contacts within their social network who can serve as trust liaisons and drive engagement. CONCLUSIONS: These findings may inform future studies where similar interventions are being considered to improve access to mobile phone-based data collection amongst hard-to-reach groups.

Improving COVID-19 vaccine uptake: a message co-design process for a national mHealth intervention in Colombia.

BACKGROUND: COVID-19 vaccination is a global priority. Latin American countries have some of the highest COVID-19 death rates worldwide with vaccination hampered by a variety of reasons, including mis- and disinformation, vaccine hesitancy, and vaccine supply constraints. Addressing vaccine hesitancy through effective messages has been found to help increase vaccine uptake. Participatory processes could be used to co-design health messages for this purpose. OBJECTIVE: This article describes the methodology used to co-design evidence-based audio messages to be deployed in a cohort of individuals through an interactive voice response (IVR) mobile phone survey intervention, aimed towards increasing vaccination uptake in an adult population in Colombia. METHODS: Participants of the COVID-19 vaccination message co-design process included a sample of the general population of the country, representatives of the funder organisation, and research team members. The co-design process consisted of four phases: (1) formative quantitative and qualitative research, (2) message drafting based on the results of the formative research, (3) message content evaluation, and (4) evaluation of the voices to deliver the audio messages; and was informed by reflexive meetings. RESULTS: Three categories of evidence-based audio messages were co-designed, each corresponding to an arm of the mHealth intervention: (1) factual messages, (2) narrative messages, and (3) mixed messages. An additional fourth arm with no message was proposed for control. The iterative co-design process ended with a total of 14 audio messages recorded to be deployed via the intervention. CONCLUSIONS: Co-developing health messages in response to health emergencies is possible. Adopting more context-relevant, participatory, people-centred, and reflexive multidisciplinary approaches could help develop solutions that are more responsive to the needs of populations and public health priorities. Investing resources in message co-design is deemed to have a greater potential for influencing behaviours and improving health outcomes.

Examination of the demographic representativeness of a cross-sectional mobile phone survey in collecting health data in Colombia using random digit dialling.

OBJECTIVES: As mobile phone ownership becomes more widespread in low-income and middle-income countries, mobile phone surveys (MPSs) present an opportunity to collect data on health more cost-effectively. However, selectivity and coverage biases in MPS are concerns, and there is limited information about the population-level representativeness of these surveys compared with household surveys. This study aims at comparing the sociodemographic characteristics of the respondents of an MPS on non-communicable disease risk factors to a household survey in Colombia. DESIGN: Cross-sectional study. We used a random digit dialling method to select the samples for calling mobile phone numbers. The survey was conducted using two modalities: computer-assisted telephone interviews (CATIs) and interactive voice response (IVR). The participants were assigned randomly to one of the survey modalities based on a targeted sampling quota stratified by age and sex. The Quality-of-Life Survey (ECV), a nationally representative survey conducted in the same year of the MPS, was used as a reference to compare the sample distributions by sociodemographic characteristics of the MPS data. Univariate and bivariate analyses were performed to evaluate the population representativeness between the ECV and the MPSs. SETTING: The study was conducted in Colombia in 2021. PARTICIPANTS: Population at least 18 years old with a mobile phone. RESULTS: We completed 1926 and 2983 interviews for CATI and IVR, respectively. We found that the MPS data have a similar (within 10% points) age-sex data distribution compared with the ECV dataset for some subpopulations, mainly for young populations, people with none/primary and secondary education levels, and people who live in urban and rural areas. CONCLUSIONS: This study shows that MPS could collect similar data to household surveys in terms of age, sex, high school education level and geographical area for some population categories. Strategies are needed to improve representativeness of the under-represented groups.

Built environment interventions and physical activity levels: A systematic review. / Intervenciones en el ambiente construido y niveles de actividad física: una revisión sistemática

INTRODUCTION: Non-communicable diseases are the leading cause of death worldwide and physical activity is a key preventive strategy to reduce them. There is a relationship between the built environment and the practice of physical activity, but little evidence as to whether those built environment interventions not initially designed for promoting physical activity actually have an impact on promoting the behavior. OBJECTIVE: To identify whether such built environment interventions were able to change physical activity in adults. MATERIALS AND METHODS: We conducted a systematic review of interventions targeting modifications to the built environment changes in urban areas. RESULTS: Out of 5,605 articles reviewed, only seven met our inclusion criteria. The seven studies found higher levels of physical activity after the interventions. CONCLUSIONS: We recommend greater specificity regarding the study design, the timeline of interventions implementation and post-intervention measurements, as well as the use of more objective measures. Finally, we point out the need to make more explicit the mechanisms of change related to the interventions assessed.

Introducción. Las enfermedades no transmisibles son la principal causa de muerte en todo el mundo y la actividad física es una estrategia preventiva clave para reducirlas. Hay una relación entre el entorno construido y la práctica de actividad física, pero poca evidencia de si las intervenciones no diseñadas en principio para promoverla, realmente tienen un impacto en ese sentido. Objetivo. Determinar si tales intervenciones en el entorno urbano pudieron cambiar la práctica de actividad física en adultos. Materiales y métodos. Se hizo una revisión sistemática de las intervenciones que apuntaban a modificar el entorno construido en zonas urbanas. Resultados. De 5.605 artículos considerados, solo siete cumplieron con nuestros criterios de inclusión y en todos ellos aumentó la actividad física después de la intervención. Conclusiones. Se recomienda que el diseño del estudio, el cronograma de implementación de las intervenciones y las mediciones posteriores sean más específicas, de manera que las medidas obtenidas sean más objetivas. Asimismo, se argumenta la necesidad de hacer más explícitos los mecanismos de cambio relacionados con las intervenciones evaluadas.

Saving lives through road safety risk factor interventions: global and national estimates.

Global road mortality is a leading cause of death in many low-income and middle-income countries. Data to support priority setting under current resource constraints are urgently needed to achieve Sustainable Development Goal (SDG) 3.6. This Series paper estimates the potential number of lives saved if each country implemented interventions to address risk factors for road injuries. We did a systematic review of all available evidence-based, preventive interventions for mortality reduction that targeted the four main risk factors for road injuries (ie, speeding, drink driving, helmet use, and use of seatbelt or child restraint). We used literature review variables and considered three key country-level variables (gross domestic product per capita, population density, and government effectiveness) to generate country-specific estimates on the potential annual attributable number of lives that would be saved by interventions focusing on these four risk factors in 185 countries. Our results suggest that the implementation of evidence-based road safety interventions that target the four main road safety risk factors could prevent between 25% and 40% of all fatal road injuries worldwide. Interventions addressing speed could save about 347 258 lives globally per year, and at least 16 304 lives would be saved through drink driving interventions. The implementation of seatbelt interventions could save about 121 083 lives, and 51 698 lives could be saved by helmet interventions. We identify country-specific estimates of the potential number of lives saved that would be attributable to these interventions. Our results show the potential effectiveness of the implementation and scaling of these interventions. This paper presents key evidence for priority setting on road safety interventions and shows a path for reaching SDG 3.6.

Built environment interventions and physical activity levels: A systematic review / Intervenciones en el ambiente construido y niveles de actividad física: una revisión sistemática

Introduction: Non-communicable diseases are the leading cause of death worldwide and physical activity is a key preventive strategy to reduce them. There is a relationship between the built environment and the practice of physical activity, but little evidence as to whether those built environment interventions not initially designed for promoting physical activity actually have an impact on promoting the behavior. Objective: To identify whether such built environment interventions were able to change physical activity in adults. Materials and methods: We conducted a systematic review of interventions targeting modifications to the built environment changes in urban areas. Results: Out of 5,605 articles reviewed, only seven met our inclusion criteria. The seven studies found higher levels of physical activity after the interventions. Conclusions: We recommend greater specificity regarding the study design, the timeline of interventions implementation and post-intervention measurements, as well as the use of more objective measures. Finally, we point out the need to make more explicit the mechanisms of change related to the interventions assessed.

Introducción. Las enfermedades no transmisibles son la principal causa de muerte en todo el mundo y la actividad física es una estrategia preventiva clave para reducirlas. Hay una relación entre el entorno construido y la práctica de actividad física, pero poca evidencia de si las intervenciones no diseñadas en principio para promoverla, realmente tienen un impacto en ese sentido. Objetivo. Determinar si tales intervenciones en el entorno urbano pudieron cambiar la práctica de actividad física en adultos. Materiales y métodos. Se hizo una revisión sistemática de las intervenciones que apuntaban a modificar el entorno construido en zonas urbanas. Resultados. De 5.605 artículos considerados, solo siete cumplieron con nuestros criterios de inclusión y en todos ellos aumentó la actividad física después de la intervención. Conclusiones. Se recomienda que el diseño del estudio, el cronograma de implementación de las intervenciones y las mediciones posteriores sean más específicas, de manera que las medidas obtenidas sean más objetivas. Asimismo, se argumenta la necesidad de hacer más explícitos los mecanismos de cambio relacionados con las intervenciones evaluadas.

Using an Intervention Mapping Approach to Develop a Program for Preventing High Blood Pressure in a Marginalized Afro-Colombian Population: A Community-Based Participatory Research.

The prevention of high blood pressure (HBP) is an important public health initiative worldwide, since HBP is the main risk factor for cardiovascular diseases and increases the damage caused by coronavirus disease 2019 (COVID-19). We designed, implemented, and evaluated a program to identify effective and sustainable interventions for preventing HBP in a marginalized black population. Our study was conducted in Quibdó, a city in Colombia with the highest poverty rate and located in the Pacific coast, a subregion in Colombia with the highest prevalence of HBP. We followed an intervention mapping framework using a community-based participatory research approach. Focus groups, photovoice, literature reviews, and cross-sectional quantitative surveys were used for data collection. The community chose the time, place, and type of physical activity; led the physical activities; and strengthened their skills in seeking resources in their community to sustain the program. The evaluation was aimed at determining whether the interventions were able to achieve the program's primary aim. We used a before (September 2016) and after (December 2017) design for the evaluation. To decrease the selection bias and allow comparisons between homogeneous groups, we used a propensity score matching technique. The steps required to create a self-sustaining physical activity program were provided in detail. The pre-post test showed a decrease of the HBP (systolic, 13.4% points; p = 0.018; diastolic, 6.5% points; p = 0.002). The program may be an effective and self-sustaining intervention, and it can be replicated by policymakers and implemented in other population groups.

Evaluation of the implementation of the Framework Convention on Tobacco Control (FCTC) in Colombia.

Evidence-based interventions recommended in the Framework Convention on Tobacco Control of the World Health Organization (WHO FCTC) are subject to implementation factors that might affect their actual effectiveness. The Colombian law enacting key commitments from WHO's FCTC was signed in 2009. This study aims at evaluating the potential impact of the enactment and implementation of these WHO FCTC on four outcomes for tobacco consumption (last-year cigarette smoking prevalence, prevalence of heavy smokers, prevalence of lower-intensity smokers and monthly smoking incidence). We used data from the National Psychoactive Substances Consumption Survey (NPSCS) in 2008 (n = 29 164) and 2013 (n = 32 605), and assessed changes in these four outcomes WHO FCTC using propensity score matching (PSM). Propensity scores were obtained using key socio-demographic variables and by matching through a 'Kernel' estimation. Matching quality tests were performed. The common support for both survey samples was 60 793. Sub-analyses were conducted using a governance index to assess the effect of heterogeneous governance levels, proxying implementation, over the country. We found that cigarette year-prevalence and cigarette month-incidence decreased after matching around 8 and 1.2 percentage points between 2008 and 2013, respectively. Consumption might have shifted, at least partially, from heavy smoking towards lower-intensity smoking. Departments with a higher governance index showed larger reductions of tobacco use, possibly associated to a stronger WHO FCTC implementation. This study highlights the impact that the WHO FCTC had on tobacco consumption in a middle-income country and shows the importance of governance strength as a mediating mechanism for WHO FCTC impact. These results advance current knowledge on the effectiveness of WHO FCTC and shed light on the relevance of governance as a key factor in the WHO FCTC implementation.

Chronic stress as a mediator of the relationship between socioeconomic status and pharmacological adherence in hypertensive patients / [El estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico de pacientes hipertensos].

Introduction: High blood pressure is a public health problem worldwide. In Colombia, its prevalence is 25% with a high mortality rate. The psychosocial factors affecting pharmacological adherence among patients have not been sufficiently studied and despite international evidence on their impact, in Colombia, there is a paucity of research on the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence. Objective: To examine the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence in hypertensive patients aged 45 to 70 years old in three Colombian cities between 2015 and 2016. Materials and methods: We conducted a cross-sectional study in a population of hypertensive patients. Data for this study came from the first wave of longitudinal study aimed at examining social factors associated with the control of hypertension in Bogotá, Medellín, and Quibdó. Patients with hypertension were selected randomly from a sample of those participating in the hypertension control program De todo corazón. For the statistical analysis of the data, we used factorial analysis and multivariate regressions. Results: We found a positive association between socioeconomic status and the degree of pharmacological adherence and a negative one with chronic stress. Besides, evidence was found that stress has a negative association with the degree of adherence. Conclusions: The results suggest that stress is not a likely mediator between socioeconomic status and the pharmacological adherence of hypertensive patients in Colombia. Additional studies are required to confirm these relationships with a larger sample.

Introducción. La hipertensión arterial sistémica es un problema de salud pública en el mundo. En Colombia, su prevalencia es del 25 % y la mortalidad es alta. Los factores psicosociales que afectan el cumplimiento del tratamiento farmacológico no han sido estudiados suficientemente. En otros países, se ha estudiado el papel del estrés crónico en la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo. Objetivo. Examinar el papel del estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico, en pacientes hipertensos de 45 a 70 años en el 2015 y el 2016. Materiales y métodos. Se hizo un estudio transversal de una población de pacientes hipertensos. Los datos provienen de la muestra seleccionada para el programa "De todo corazón" en Bogotá, Medellín y Quibdó. El análisis estadístico de los datos se hizo mediante análisis factorial y regresiones multivariadas. Resultados. Los resultados confirmaron una asociación positiva entre la posición socioeconómica y el grado de cumplimiento del tratamiento farmacológico, y una relación negativa entre la primera y el estrés crónico. Además, se evidenció que el estrés tiene una asociación negativa con el grado de cumplimiento. Conclusiones. Los resultados sugieren que el estrés no es un mediador entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo en Colombia. Se requieren estudios adicionales para confirmar estas relaciones con una muestra más amplia.

El estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico de pacientes hipertensos / Chronic stress as a mediator of the relationship between socioeconomic status and pharmacological adherence in hypertensive patients

Introducción. La hipertensión arterial sistémica es un problema de salud pública en el mundo. En Colombia, su prevalencia es del 25 % y la mortalidad es alta. Los factores psicosociales que afectan el cumplimiento del tratamiento farmacológico no han sido estudiados suficientemente. En otros países, se ha estudiado el papel del estrés crónico en la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo. Objetivo. Examinar el papel del estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico, en pacientes hipertensos de 45 a 70 años en el 2015 y el 2016. Materiales y métodos. Se hizo un estudio transversal de una población de pacientes hipertensos. Los datos provienen de la muestra seleccionada para el programa "De todo corazón" en Bogotá, Medellín y Quibdó. El análisis estadístico de los datos se hizo mediante análisis factorial y regresiones multivariadas. Resultados. Los resultados confirmaron una asociación positiva entre la posición socioeconómica y el grado de cumplimiento del tratamiento farmacológico, y una relación negativa entre la primera y el estrés crónico. Además, se evidenció que el estrés tiene una asociación negativa con el grado de cumplimiento. Conclusiones. Los resultados sugieren que el estrés no es un mediador entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo en Colombia. Se requieren estudios adicionales para confirmar estas relaciones con una muestra más amplia.

Introduction: High blood pressure is a public health problem worldwide. In Colombia, its prevalence is 25% with a high mortality rate. The psychosocial factors affecting pharmacological adherence among patients have not been sufficiently studied and despite international evidence on their impact, in Colombia, there is a paucity of research on the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence. Objective: To examine the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence in hypertensive patients aged 45 to 70 years old in three Colombian cities between 2015 and 2016. Materials and methods: We conducted a cross-sectional study in a population of hypertensive patients. Data for this study came from the first wave of longitudinal study aimed at examining social factors associated with the control of hypertension in Bogotá, Medellín, and Quibdó. Patients with hypertension were selected randomly from a sample of those participating in the hypertension control program De todo corazón. For the statistical analysis of the data, we used factorial analysis and multivariate regressions. Results: We found a positive association between socioeconomic status and the degree of pharmacological adherence and a negative one with chronic stress. Besides, evidence was found that stress has a negative association with the degree of adherence. Conclusions: The results suggest that stress is not a likely mediator between socioeconomic status and the pharmacological adherence of hypertensive patients in Colombia. Additional studies are required to confirm these relationships with a larger sample.

Interventions to increase the pharmacological adherence on arterial hypertension in Latin America: a systematic review.

OBJECTIVES: This review aims to summarize evidence on the effectiveness of interventions to improve antihypertensive drug adherence in Latin America and the Caribbean. METHODS: A systematic search from January 2000 to October 2018 was conducted through LILACS, SciELO, MEDLINE, Health Evidence, Cochrane Library and Embase. Search terms were in English, Portuguese and Spanish through the MeSH and DECS. RESULTS: Seven articles were included in the study. The main discoveries indicate that implemented interventions to increase the adherence are very varied. Likewise, a high variability in levels of adherence was found (46-94%) and we could evidence that indirect measurements were used. Lastly, it was evidenced that the obstacles for adherence were mainly associated with the adverse effects of antihypertensive medication, the dosage and forgetfulness of the medication intake given the age of the patients. CONCLUSIONS: There is no single strategy to increase pharmacological adherence in Latin America since the studies used different strategies. Additional efforts are required to standardize cost-effective interventions to increase pharmacological adherence in Latin America.