Culturally adapted training for community volunteers to improve their knowledge, attitude and practice regarding non-communicable diseases in Vietnam.

BACKGROUND: The burden of non-communicable diseases is becoming unmanageable by primary healthcare facilities in low- and middle-income countries. Community-based approaches are promising for supporting healthcare facilities. In Vietnam, community health volunteers are trained in providing health promotion and screening in a culturally adapted training. This study aims to assess the change in knowledge, attitude and practice regarding NCD prevention and management after a culturally adapted training, and the potential mechanisms leading to this change. METHODS: The Knowledge Attitude and Practice survey was assessed before and after an initial training, and before and after a refresher training (n = 37). We used a focus group discussion with community health volunteers (n = 8) to map potential mechanisms of the training and applying learned knowledge in practice. Data were collected in the districts Le Chan and An Duong of Hai Phong, Vietnam, in November 2021 and May 2022. RESULTS: We found that knowledge increased after training (mean = 5.54, 95%-confidence interval = 4.35 to 6.74), whereas attitude and practice did not improve. Next, knowledge decreased over time (m=-12.27;-14.40 to -10.11) and did not fully recover after a refresher training (m=-1.78;-3.22 to -0.35). As potential mechanisms for change, we identified the use of varying learning methods, enough breaks, efficient coordination of time located for theory and practice, handout materials, large group size and difficulty in applying a digital application for screening results. CONCLUSION: Culturally adapted trainings can improve knowledge among community health volunteers which is important for the support of primary healthcare in low- and middle-income countries. Using a digital screening application can be a barrier for the improvement of knowledge, attitude and practice and we suggest using an intergenerational or age-friendly approach, with the supervision of primary healthcare professionals. Future research on behavioral change should include additional components such as self-efficacy and interrelationships between individuals.

The implementation of community-based programs in Vietnam is promising in promoting health.

Background: Low-and middle-income countries mostly have ageing populations with many unmet economic, social, or health-related needs, Vietnam being an example. Community-based support in Vietnam, organized as Intergenerational Self-Help Clubs (ISHCs) based on the Older People Associations (OPA) model, can help to meet these needs by the provision of services for various aspects of life. This study aims to assess the implementation of the ISHCs and whether successful implementation is associated with more member-reported positive health. Methods: We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the implementation using multiple data sources: ISHC board surveys (n = 97), ISHC member surveys (n = 5,080 in 2019 and n = 5,555 in 2020), focus group discussions (6; n = 44), and interviews with members and board leaders (n = 4). Results: Reach ranged between 46 and 83% of ISHCs reaching target groups, with a majority of women and older people participating. Regarding Effectiveness, members indicated high satisfaction with the ISHCs. Adoption scores were high, with 74%-99% for healthcare and community support activities, and in 2019, higher adoption scores were associated with more members reporting good positive health. In 2020, reported positive health slightly decreased, probably due to the influence of the COVID-19 pandemic. A total of 61 ISHCs had consistent or improving Implementation from 2019 to 2020, and confidence in Maintenance was high. Conclusion: The implementation of the OPA model in Vietnam is promising regarding its promotion of health and may help to tackle the needs of an ageing population. This study further shows that the RE-AIM framework helps to assess community health promotion approaches.

Co-occurrence of behavioural risk factors for non-communicable diseases among 40-year and above aged community members in three regions of Myanmar.

Background: Risky behaviours such as smoking, alcohol consumption, physical inactivity and inadequate consumption of fruits and vegetables are known contributing factors for non-communicable diseases (NCDs) which account for 74% of global mortality. Such behavioural risk factors co-occur frequently resulting in synergistic action for developing NCD related morbidity and mortality. This study aims to assess the existence of multiple risk behaviours and determine the socio-economic and demographic factors associated with co-occurrence of behavioural risks among Myanmar adult population. Method: Data were collected, in the context of the SUNI-SEA project (Scaling Up NCD interventions in Southeast Asia), from 660 community members aged 40 years and above of both sexes, residing in selected urban and rural areas from Ayeyawaddy, Yangon and Mandalay regions of Myanmar. The co-occurrence of behavioural risk factors was presented as percentage with 95% CI and its determinants were identified by multinomial logistic regression. Results: The co-occurrence of two risk behaviours and three or four risk behaviours were found in 40% (95% CI: 36.2%, 43.9%) and 10.8% (95% CI: 8.5%, 13.4%) respectively. Urban residents, men, participants without formal schooling and unemployed persons were more likely to exhibit co-occurrence of two risk behaviors and three or four risk behaviours. Conclusion: The current study shows high prevalence of co-occurrence of behavioural risk factors among Myanmar adults in the study area. NCD prevention and control programs emphasizing management of behavioural risks should be intensively promoted, particularly directed towards multiple behavioural risk factors, and not focused on individual factors only.

Risky behaviours such as smoking, alcohol consumption, physical inactivity and inadequate consumption of fruits and vegetables are known contributing factors for non-communicable diseases (NCDs) which account for 74% of global mortality. Such behavioural risk factors co-occur frequently resulting in synergistic action for developing NCD related morbidity and mortality. This study aims to assess the existence of multiple risk behaviours and determine the socio-economic and demographic factors associated with co-occurrence of behavioural risks among the Myanmar adult population. Data were collected from 660 community members aged 40 years and above of both sexes, residing in selected urban and rural areas from Ayeyawaddy, Yangon and Mandalay Regions of Myanmar. The current study shows substantial proportion of study adults had co-occurrence of behavioural risk factors (at least two risk factors), contributing to 50.8%. Urban residents, men, participants without formal schooling and unemployed persons were more likely to present co-occurrence of two risk behaviors and three or four risk behaviours, compared with their counterparts. Based on the study findings, the research team highly recommends that NCD prevention and control programs emphasizing management of behavioural risks should be intensively promoted, particularly directed towards multiple behavioural risk factors, and not focused on single risk factor only.

Clinical stance on response initiation in autistic adults: co-creating an integrative approach based on theory and lived experiences to act from language, via motor movement to wellbeing.

Getting 'stuck', literally and figuratively, is a common experience for autistic people. Literally 'stuck' means exhibiting limited response initiation due to immobility with tense muscles and inability to move. Figuratively 'stuck' means loneliness, passivity or captivity in activities that do not offer long-term satisfaction. To further conceptualize this complex phenomenon of limited response initiation in autistic individuals, we performed qualitative interviews and focus groups with autistic people and their family members, followed by brainstorm sessions and a Delphi study with input from a larger panel of experts from multiple backgrounds. We aimed to co-create the outline of an integrative approach to support autistic people in moving away from this 'stuck state' to more flexible, limber 'supple states' in order to live freer, more meaningful, satisfying and peaceful lives. Over time, in interaction with all participants, our shared insight grew. Based on this, we here stipulate a conceptual framework, in which the described 'stuck state' at the micro-level of the muscles/behavior of one individual, probably is caused by feeling/being 'stuck' or 'cramped' at several overarching (i.e., meso and macro) levels. For instance, stuck in relationships with unhealthy dynamics, stuck at home creating short-term calm, trance-like states (e.g., gaming), stuck at an educational level that might fit the individuals' current social-emotional state rather than their potential cognitive level, stuck in a job that pays the bills but does not feel meaningful, nor contributes to a satisfying life with opportunities for personal development. Stuck in a mental/public health care system where ever ongoing changes in policies hinder sustained support to suit care-needs. Stuck in a regulated societal system making it likely to repeatedly get stuck. Is this phenomenon specific to autism? Formally we have only conducted interviews with this population, but in another smaller, related project we also spoke to people from the general population with careers that are considered successful in the general society. These people actually voiced similar experiences. Therefore, we hypothesize that this numbing state of being or feeling 'stuck' may be a prevalent phenomenon that needs to be addressed. In this article, we discuss several types of interventive approaches (i.e., language-based talking therapies, affective experiential expressive therapies, physical therapies and systemic therapies), prevention as well as intervention programs, directed at different primary stakeholders, that can complement and enrich each other in an integrative policy, that leads to tailor-made, personalized trajectories of interdisciplinary support to enable people to live satisfying, meaningful, dignified and peaceful lives.

[Experience of first COVID-19 patients in Northern part of the Netherlands: Information provision, source investigation, contact tracing and home isolation]. / Eerste covid-19-patiënten in Noord-Nederland.

OBJECTIVE: The aim of this study was to investigate how patients experience the information, the source investigation and contact tracing and the measures in isolation at the start of a pandemic. DESIGN: Secondary analysis of semi-structured interviews was conducted as part of a larger exploratory mixed-methods study on COVID-19 patient experiences. METHODS: Semi-structured interviews were conducted with 29 people from Friesland and Groningen who tested positive for SARS-CoV-2 between 9 March and 3 April 2020, recruited via maximum variation sampling. Thematic analysis was used. RESULTS: The following themes emerged from the analysis: 1) Information: Conflicting information by different advisors led to a lack of clarity. Patients admitted to hospital usually felt uninformed about the rules of home isolation after discharge. 2) Investigation into the source of infection: For most it was unclear whether and how this investigation took place. Some expected feedback on their suggestions. 3) Informing contacts: Not everyone felt able to inform the right contacts. Some felt stigmatized. 4) Living with the measures in home isolation: The recommended living rules were often not fully applied. Some patients felt insufficiently supported. CONCLUSION: Our study shows that not all COVID-19 patients felt well cared for at the start of the outbreak. Scaling down monitoring by the public health service can mean that questions about source and contact investigation and isolation remain unanswered or are answered by others. This leads to conflicting information and non-compliance with measures. The supervision of patients in isolation should be better guarded.

Perceptions on Home-Administration of Biologics in the Context of Severe Asthma: An International Qualitative Study.

BACKGROUND: Biologics are an effective therapy for severe asthma. Home administration of biologics by patients is likely to facilitate their accessibility. Yet little is known about patients' and health care providers' (HCPs) perceptions regarding home administration of biologics. OBJECTIVE: The aim of this study is to create more insight into the perceptions and experiences of patients and HCPs regarding home administration of biologics in the context of the treatment of severe asthma. METHODS: A qualitative international study was performed in the Netherlands, United States, Australia, and United Kingdom. In each country, 2 focus groups were held with potential/recent and long-term users of biologics at home. Prior to the focus groups, patients were prompted with themes on online forums. For triangulation purposes, interviews were held with HCPs to discuss salient findings from forums and focus groups. Data were analyzed with qualitative content analysis. RESULTS: In total, 75 patients participated in the forums, of which 40 participated in the focus groups. Furthermore, 12 HCPs were interviewed. The following overarching themes were identified: living with severe asthma; practical aspects of using biologics; the role of HCPs regarding biologics; social support from family, friends, and others; effectiveness of biologics and other treatments; side effects of biologics. CONCLUSIONS: This study showed that, for those using biologics for severe asthma, the benefits of home administration of biologics usually outweigh inconvenience and side effects. Guided practice, accessible support contact, and monitoring including social support should be central in the transition from hospital to home administration of asthma biologics.