Users' views on the use of a smartwatch app to collect daily symptom data in individuals with multiple long-term conditions (Multimorbidity): A qualitative study.

Introduction: Long-term conditions are a major burden on health systems. One way to facilitate more research and better clinical care among patients with long-term conditions is to collect accurate data on their daily symptoms (patient-generated health data) using wearable technologies. Whilst evidence is growing for the use of wearable technologies in single conditions, there is less evidence of the utility of frequent symptom tracking in those who have more than one condition. Aims: To explore patient views of the acceptability of collecting daily patient-generated health data for three months using a smartwatch app. Methods: Watch Your Steps was a longitudinal study which recruited 53 patients to track over 20 symptoms per day for a 90-day period using a study app on smartwatches. Semi-structured interviews were conducted with a sub-sample of 20 participants to explore their experience of engaging with the app. Results: In a population of older people with multimorbidity, patients were willing and able to engage with a patient-generated health data app on a smartwatch. It was suggested that to maintain engagement over a longer period, more 'real-time' feedback from the app should be available. Participants did not seem to consider the management of more than one condition to be a factor in either engagement or use of the app, but the presence of severe or chronic pain was at times a barrier. Conclusion: This study has provided preliminary evidence that multimorbidity was not a major barrier to engagement with patient-generated health data via a smartwatch symptom tracking app.

Beliefs About Pain in Pediatric Inflammatory and Noninflammatory Chronic Musculoskeletal Conditions: A Scoping Review.

OBJECTIVE: The Common Sense Self-Regulatory Model posits that beliefs about pain influence coping behaviors and subsequent physical and mental health outcomes in children/young people with chronic musculoskeletal conditions. It was unclear how and what beliefs had been investigated in this population, and whether there were similarities and differences in beliefs held about pain by those experiencing inflammatory versus noninflammatory musculoskeletal conditions. This scoping review addressed this gap. METHODS: A systematic search was conducted using four databases (MEDLINE, PsycINFO, Embase, and CINAHL) in November 2021. Primary studies exploring key stakeholders' (including children, parents, and/or healthcare professionals) beliefs about pain underlying pediatric chronic musculoskeletal conditions were synthesized. RESULTS: Eighteen articles were identified. Cross-sectional designs were predominantly used to explore beliefs (n = 6). The majority used questionnaires to assess beliefs (n = 12). Beliefs common across musculoskeletal conditions were that children/young people felt their pain was not understood by others, and pain affected their physical functioning. Differences included children/young people and parents thinking they had some ability to control pain, and causal beliefs relating to underlying disease activity. These pain beliefs were more likely to be held in relation to inflammatory diagnoses. In contrast, children/young people and parents were more likely to view pain as uncontrollable, with more uncertainty regarding underlying causes, relating to noninflammatory diagnoses. CONCLUSIONS: Methods used to explore pain beliefs were inconsistent. Studies identified similarities and differences which appear to be closely related to the underlying diagnosis. Findings justify further exploration to identify potentially modifiable targets to improve pain outcomes in this population.

Feasibility and acceptability to use a smartphone-based manikin for daily longitudinal self-reporting of chronic pain.

Background: As management of chronic pain continues to be suboptimal, there is a need for tools that support frequent, longitudinal pain self-reporting to improve our understanding of pain. This study aimed to assess the feasibility and acceptability of daily pain self-reporting using a smartphone-based pain manikin. Methods: For this prospective feasibility study, we recruited adults with lived experience of painful musculoskeletal condition. They were asked to complete daily pain self-reports via an app for 30 days. We assessed feasibility by calculating pain report completion levels, and investigated differences in completion levels between subgroups. We assessed acceptability via an end-of-study questionnaire, which we analysed descriptively. Results: Of the 104 participants, the majority were female (n = 87; 84%), aged 45-64 (n = 59; 57%), and of white ethnic background (n = 89; 86%). The mean completion levels was 21 (± 7.7) pain self-reports. People who were not working (odds ratio (OR) = 1.84; 95% confidence interval (CI), 1.52-2.23) were more likely, and people living in less deprived areas (OR = 0.77; 95% CI, 0.62-0.97) and of non-white ethnicity (OR = 0.45; 95% CI, 0.36-0.57) were less likely to complete pain self-reports than their employed, more deprived and white counterparts, respectively. Of the 96 participants completing the end-of-study questionnaire, almost all participants agreed that it was easy to complete a pain drawing (n = 89; 93%). Conclusion: It is feasible and acceptable to self-report pain using a smartphone-based manikin over a month. For its wider adoption for pain self-reporting, the feasibility and acceptability should be further explored among people with diverse socio-economic and ethnic backgrounds.

Conducting a systematic review and evaluation of commercially available mobile applications (apps) on a health-related topic: the TECH approach and a step-by-step methodological guide.

OBJECTIVES: To provide an overview of the methodological considerations for conducting commercial smartphone health app reviews (mHealth reviews), with the aim of systematising the process and supporting high-quality evaluations of mHealth apps. DESIGN: Synthesis of our research team's experiences of conducting and publishing various reviews of mHealth apps available on app stores and hand-searching the top medical informatics journals (eg, The Lancet Digital Health, npj Digital Medicine, Journal of Biomedical Informatics and the Journal of the American Medical Informatics Association) over the last five years (2018-2022) to identify other app reviews to contribute to the discussion of this method and supporting framework for developing a research (review) question and determining the eligibility criteria. RESULTS: We present seven steps to support rigour in conducting reviews of health apps available on the app market: (1) writing a research question or aims, (2) conducting scoping searches and developing the protocol, (3) determining the eligibility criteria using the TECH framework, (4) conducting the final search and screening of health apps, (5) data extraction, (6) quality, functionality and other assessments and (7) analysis and synthesis of findings. We introduce the novel TECH approach to developing review questions and the eligibility criteria, which considers the Target user, Evaluation focus, Connectedness and the Health domain. Patient and public involvement and engagement opportunities are acknowledged, including co-developing the protocol and undertaking quality or usability assessments. CONCLUSION: Commercial mHealth app reviews can provide important insights into the health app market, including the availability of apps and their quality and functionality. We have outlined seven key steps for conducting rigorous health app reviews in addition to the TECH acronym, which can support researchers in writing research questions and determining the eligibility criteria. Future work will include a collaborative effort to develop reporting guidelines and a quality appraisal tool to ensure transparency and quality in systematic app reviews.

Exploring the Cross-cultural Acceptability of Digital Tools for Pain Self-reporting: Qualitative Study.

BACKGROUND: Culture and ethnicity influence how people communicate about their pain. This makes it challenging to develop pain self-report tools that are acceptable across ethnic groups. OBJECTIVE: We aimed to inform the development of cross-culturally acceptable digital pain self-report tools by better understanding the similarities and differences between ethnic groups in pain experiences and self-reporting needs. METHODS: Three web-based workshops consisting of a focus group and a user requirement exercise with people who self-identified as being of Black African (n=6), South Asian (n=10), or White British (n=7) ethnicity were conducted. RESULTS: Across ethnic groups, participants shared similar lived experiences and challenges in communicating their pain to health care professionals. However, there were differences in beliefs about the causes of pain, attitudes toward pain medication, and experiences of how stigma and gender norms influenced pain-reporting behavior. Despite these differences, they agreed on important aspects for pain self-report, but participants from non-White backgrounds had additional language requirements such as culturally appropriate pain terminologies to reduce self-reporting barriers. CONCLUSIONS: To improve the cross-cultural acceptability and equity of digital pain self-report tools, future developments should address the differences among ethnic groups on pain perceptions and beliefs, factors influencing pain reporting behavior, and language requirements.

Charting a Course for Smartphones and Wearables to Transform Population Health Research.

The use of data from smartphones and wearable devices has huge potential for population health research, given the high level of device ownership; the range of novel health-relevant data types available from consumer devices; and the frequency and duration with which data are, or could be, collected. Yet, the uptake and success of large-scale mobile health research in the last decade have not met this intensely promoted opportunity. We make the argument that digital person-generated health data are required and necessary to answer many top priority research questions, using illustrative examples taken from the James Lind Alliance Priority Setting Partnerships. We then summarize the findings from 2 UK initiatives that considered the challenges and possible solutions for what needs to be done and how such solutions can be implemented to realize the future opportunities of digital person-generated health data for clinically important population health research. Examples of important areas that must be addressed to advance the field include digital inequality and possible selection bias; easy access for researchers to the appropriate data collection tools, including how best to harmonize data items; analysis methodologies for time series data; patient and public involvement and engagement methods for optimizing recruitment, retention, and public trust; and methods for providing research participants with greater control over their data. There is also a major opportunity, provided through the linkage of digital person-generated health data to routinely collected data, to support novel population health research, bringing together clinician-reported and patient-reported measures. We recognize that well-conducted studies need a wide range of diverse challenges to be skillfully addressed in unison (eg, challenges regarding epidemiology, data science and biostatistics, psychometrics, behavioral and social science, software engineering, user interface design, information governance, data management, and patient and public involvement and engagement). Consequently, progress would be accelerated by the establishment of a new interdisciplinary community where all relevant and necessary skills are brought together to allow for excellence throughout the life cycle of a research study. This will require a partnership of diverse people, methods, and technologies. If done right, the synergy of such a partnership has the potential to transform many millions of people's lives for the better.

Examining the variability of multiple daily symptoms over time among individuals with multiple long-term conditions (MLTC-M/multimorbidity): An exploratory analysis of a longitudinal smartwatch feasibility study.

Introduction: People living with multiple long-term conditions (MLTC-M) (multimorbidity) experience a range of inter-related symptoms. These symptoms can be tracked longitudinally using consumer technology, such as smartphones and wearable devices, and then summarised to provide useful clinical insight. Aim: We aimed to perform an exploratory analysis to summarise the extent and trajectory of multiple symptom ratings tracked via a smartwatch, and to investigate the relationship between these symptom ratings and demographic factors in people living with MLTC-M in a feasibility study. Methods: 'Watch Your Steps' was a prospective observational feasibility study, administering multiple questions per day over a 90 day period. Adults with more than one clinician-diagnosed long-term condition rated seven core symptoms each day, plus up to eight additional symptoms personalised to their LTCs per day. Symptom ratings were summarised over the study period at the individual and group level. Symptom ratings were also plotted to describe day-to-day symptom trajectories for individuals. Results: Fifty two participants submitted symptom ratings. Half were male and the majority had LTCs affecting three or more disease areas (N = 33, 64%). The symptom rated as most problematic was fatigue. Patients with increased comorbidity or female sex seemed to be associated with worse experiences of fatigue. Fatigue ratings were strongly correlated with pain and level of dysfunction. Conclusion: In this study we have shown that it is possible to collect and descriptively analyse self reported symptom data in people living with MLTC-M, collected multiple times per day on a smartwatch, to gain insights that might support future clinical care and research.

Exploring the links between indoor air pollutants and health outcomes in South Asian countries: a systematic review.

Indoor air pollution (IAP) has adverse effects on the health of people, globally. The objective of this systematic review was to present the range of health problems studied in association with indoor air pollutants in South Asian countries. We searched five databases, including PubMed, Web of Science, Scopus, Google Scholar, and CAB Direct for articles published between the years 2000 and 2020. We retrieved 5,810 articles, out of which we included 90 articles in our review. Among South Asian countries, only five countries have published results related to relationship between indoor air pollutants and adverse health conditions. All studies have shown adversity of indoor air pollutants on human's health. We found indoor solid fuel burning as a key source of indoor air pollution in the included studies, while women and children were most affected by their exposure to solid fuel burning. More than half of the studies accounted particulate matter responsible for indoor air pollution bearing negative health effects. In the included studies, eyes and lungs were the most commonly affected body organs, exhibiting common symptoms like cough, breathing difficulty and wheezing. This might have developed into common conditions like respiratory tract infection, chronic obstructive pulmonary diseases and eye cataract. In addition to promote research in South Asian countries, future research should focus on novel digital ways of capturing effects of indoor air pollutants among vulnerable segments of the population. As a result of this new knowledge, public health agencies should develop and test interventions to reduce people's exposure levels and prevent them to develop adverse health outcomes.

Adoption of Digital Pain Manikins for Research Data Collection: A Systematic Review.

Chronic pain is common and disabling. Researchers need robust methods to collect pain data in large populations to enhance knowledge on pain prevalence, causes and treatment. Digital pain manikins address this by enabling self-reporting of location-specific pain. However, it is unknown to what extent pain studies adopted digital manikins for data collection. Therefore, we systematically searched the literature. We included 17 studies. Most were published after 2017, collected pain data cross-sectionally in ≥50 participants, and reported pain distribution and pain extent as manikin-derived summary metrics. Across the studies, 13 unique manikins were used, of which four had been evaluated. Our review shows that adoption of digital pain manikins in research settings has been slow. Harnessing the digital nature of manikins, enabling use of personal devices, and assessing and improving the reliability, validity and responsiveness of digital manikins will expedite their adoption as digital data collection tools for pain research.

Engagement with consumer smartwatches for tracking symptoms of individuals living with multiple long-term conditions (multimorbidity): A longitudinal observational study.

INTRODUCTION: People living with multiple long-term conditions (multimorbidity) (MLTC-M) experience an accumulating combination of different symptoms. It has been suggested that these symptoms can be tracked longitudinally using consumer technology, such as smartphones and wearable devices. AIM: The aim of this study was to investigate longitudinal user engagement with a smartwatch application, collecting survey questions and active tasks over 90 days, in people living with MLTC-M. METHODS: 'Watch Your Steps' was a prospective observational study, administering multiple questions and active tasks over 90 days. Adults with more than one clinician-diagnosed long-term conditions were loaned Fossil® Sport smartwatches, pre-loaded with the study app. Around 20 questions were prompted per day.Daily completion rates were calculated to describe engagement patterns over time, and to explore how these varied by patient characteristics and question type. RESULTS: Fifty three people with MLTC-M took part in the study. Around half were male ( = 26; 49%) and the majority had a white ethnic background (n = 45; 85%). About a third of participants engaged with the smartwatch app nearly every day. The overall completion rate of symptom questions was 45% inter-quartile range (IQR 23-67%) across all study participants. Older patients and those with greater MLTC-M were more engaged, although engagement was not significantly different between genders. CONCLUSION: It was feasible for people living with MLTC-M to report multiple symptoms per day over 3 months. User engagement appeared as good as other mobile health studies that recruited people with single health conditions, despite the higher daily data entry burden.

Public health practitioners' perspective on the sustainability of the tuberculosis control programme at primary health care level in Pakistan.

BACKGROUND: In resource-limited settings, national tuberculosis (TB) control programmes are highly dependent on external funds, which may pose a challenge to programme sustainability. There is a recognized need for developing guidance around sustainable programming of current TB control initiatives. AIMS: The aim of this study was to explore public health practitioners' perspectives on the sustainability of TB control initiatives in Pakistan at the primary health care (PHC) level. METHODS: Guided by an interpretive epistemology, online in-depth interviews were conducted with 10 public health practitioners who had experience as resource planners in the TB control programme in Pakistan. Thematic content analysis was employed to the textual data as the analytical approach. RESULTS: Three themes were inductively derived from the thematic analysis: community involvement, stakeholder engagement and efficient use of the PHC system. Community involvement was a determinant in sustaining TB control initiatives. This was attributed to the nature of the disease and prevalent health seeking behaviour. Stakeholder engagement was associated with funding arrangements between public and private partners and considered important in how new initiatives can be made part of the routine structure. Overall, having an efficient PHC system was deemed critical in sustaining current TB control initiatives at the PHC level in Pakistan. CONCLUSION: Fostering an enabling operational environment through regulations, supporting the utilization of existing resources, expanding the network of providers, inclusive planning, increasing spending on research and cost-effective testing are pivotal for sustaining the TB control initiatives.

Sticky apps, not sticky hands: A systematic review and content synthesis of hand hygiene mobile apps.

OBJECTIVE: The study sought to identify smartphone apps that support hand hygiene practice and to assess their content, technical and functional features, and quality. A secondary objective was to make design and research recommendations for future apps. MATERIALS AND METHODS: We searched the UK Google Play and Apple App stores for hand hygiene smartphone apps aimed at adults. Information regarding content, technical and functional features was extracted and summarized. Two raters evaluated each app, using the IMS Institute for Healthcare Informatics functionality score and the Mobile App Rating Scale (MARS). RESULTS: A total of 668 apps were identified, with 90 meeting the inclusion criteria. Most (96%) were free to download. The majority (78%) intended to educate or inform or remind users to hand wash (69%), using behavior change techniques such as personalization and prompting practice. Only 20% and 4% named a best practice guideline or had expert involvement in development, respectively. Innovative means of engagement were used in 42% (eg, virtual or augmented reality or geolocation-based reminders). Apps included an average of 2.4 out of 10 of the IMS functionality criteria (range, 0-8). The mean MARS score was 3.2 ± 0.5 out of 5, and 68% had a minimum acceptability score of 3. Two had been tested or trialed. CONCLUSIONS: Although many hand hygiene apps exist, few provide content on best practice. Many did not meet the minimum acceptability criterion for quality or were formally trialed or tested. Research should assess the feasibility and effectiveness of hand hygiene apps (especially within healthcare settings), including when and how they "work." We recommend that future apps to support hand hygiene practice are developed with infection prevention and control experts and align with best practice. Robust research is needed to determine which innovative methods of engagement create "sticky" apps.

Digital manikins to self-report pain on a smartphone: A systematic review of mobile apps.

BACKGROUND: Chronic pain is the leading cause of disability. Improving our understanding of pain occurrence and treatment effectiveness requires robust methods to measure pain at scale. Smartphone-based pain manikins are human-shaped figures to self-report location-specific aspects of pain on people's personal mobile devices. METHODS: We searched the main app stores to explore the current state of smartphone-based pain manikins and to formulate recommendations to guide their development in the future. RESULTS: The search yielded 3,938 apps. Twenty-eight incorporated a pain manikin and were included in the analysis. For all apps, it was unclear whether they had been tested and had end-user involvement in the development. Pain intensity and quality could be recorded in 28 and 13 apps, respectively, but this was location specific in only 11 and 4. Most manikins had two or more views (n = 21) and enabled users to shade or select body areas to record pain location (n = 17). Seven apps allowed personalising the manikin appearance. Twelve apps calculated at least one metric to summarise manikin reports quantitatively. Twenty-two apps had an archive of historical manikin reports; only eight offered feedback summarising manikin reports over time. CONCLUSIONS: Several publically available apps incorporated a manikin for pain reporting, but only few enabled recording of location-specific pain aspects, calculating manikin-derived quantitative scores, or generating summary feedback. For smartphone-based manikins to become adopted more widely, future developments should harness manikins' digital nature and include robust validation studies. Involving end users in the development may increase manikins' acceptability as a tool to self-report pain. SIGNIFICANCE: This review identified and characterised 28 smartphone apps that included a pain manikin (i.e. pain drawings) as a novel approach to measure pain in large populations. Only few enabled recording of location-specific pain aspects, calculating quantitative scores based on manikin reports, or generating manikin feedback. For smartphone-based manikins to become adopted more widely, future studies should harness the digital nature of manikins, and establish the measurement properties of manikins. Furthermore, we believe that involving end users in the development process will increase acceptability of manikins as a tool for self-reporting pain.

Remote symptom monitoring integrated into electronic health records: A systematic review.

OBJECTIVE: People with long-term conditions require serial clinical assessments. Digital patient-reported symptoms collected between visits can inform these, especially if integrated into electronic health records (EHRs) and clinical workflows. This systematic review identified and summarized EHR-integrated systems to remotely collect patient-reported symptoms and examined their anticipated and realized benefits in long-term conditions. MATERIALS AND METHODS: We searched Medline, Web of Science, and Embase. Inclusion criteria were symptom reporting systems in adults with long-term conditions; data integrated into the EHR; data collection outside of clinic; data used in clinical care. We synthesized data thematically. Benefits were assessed against a list of outcome indicators. We critically appraised studies using the Mixed Methods Appraisal Tool. RESULTS: We included 12 studies representing 10 systems. Seven were in oncology. Systems were technically and functionally heterogeneous, with the majority being fully integrated (data viewable in the EHR). Half of the systems enabled regular symptom tracking between visits. We identified 3 symptom report-guided clinical workflows: Consultation-only (data used during consultation, n = 5), alert-based (real-time alerts for providers, n = 4) and patient-initiated visits (n = 1). Few author-described anticipated benefits, primarily to improve communication and resultant health outcomes, were realized based on the study results, and were only supported by evidence from early-stage qualitative studies. Studies were primarily feasibility and pilot studies of acceptable quality. DISCUSSION AND CONCLUSIONS: EHR-integrated remote symptom monitoring is possible, but there are few published efforts to inform development of these systems. Currently there is limited evidence that this improves care and outcomes, warranting future robust, quantitative studies of efficacy and effectiveness.

Satisfaction Level of Tuberculosis Patients Regarding Their Access to TB Care and Prevention Services, Delivered Through a Public-Private Mix Model in Pakistan.

OBJECTIVE: The private healthcare providers (PHCP) are believed to improve access to healthcare services in public-private mix (PPM) projects, as they are considered first point of contact for healthcare. The purpose of this study was to determine the satisfaction level of tuberculosis (TB) patients. DESIGN: A questionnaire-based, cross-sectional study was carried out during November and December 2017 for 572 under-treatment patients registered with PHCPs in the PPM project. Lot quality assurance sampling technique was used to randomly select 19 districts from a sample frame of 75 districts. In each selected district, the data collector retrieved a TB register of 8 months (January-August 2017) and systematically selected patients by fixed periodic interval. SPSS version 24.0 (IBM Corp, Amonk, NY, USA) was used to analyze the data. RESULTS: This study included 53% (n = 301) males and 47% (n = 271) females, with mean age of 38 years (SD, ±18). Almost half of the participants were illiterate (51%, n = 289), and 64% (n = 365) were non-earning members of the family. In practice, most of the participants visit private providers (71%, n = 407), including private hospitals/clinics (44%) and traditional practitioners (27%; n = 153); 55% of participants visited their current doctor because of the clinic's proximity to their residence. Of the participants, 82% (n = 469) were satisfied with TB care services and 85% (n = 488) said that they would recommend this clinic to others. Conclusion: PHCPs are preferred providers for individuals, which is consistent with findings of other studies. Though they are satisfied with TB care and services, interventions should be introduced to reduce the financial burden on the patient. Partnering PHCP is a way forward to ensure universal health coverage and better health outcomes of the population.

Leveraging Digital Technology to Challenge Mental Health Stigma in West Bengal: A Protocol.

Mental health related stigma is a pernicious phenomenon that permeates and pervades our world. As stigma continues to evolve so too must our approach to reduce it. This paper outlines a protocol that leverages the power of virtual contact and digital technology to challenge mental health related stigma in West Bengal, India.

3Ts of low cure rate: taxonomy, themes and theory of low cure rate in Pakistan's TB control programme and gathering a 360-degree perspective through qualitative, in-depth interviewing approach.

OBJECTIVE: WHO recommends cure of tuberculosis (TB) as the best prevention strategy; however, information about factors associated with low cure rate in patients with drug-susceptible TB is limited in Pakistan. Therefore, the purpose of this study was to explore the factors that account for low TB cure rate. METHODOLOGY: The present qualitative study recruited diverse informants through purposive sampling to explore low cure rate situation in Badin between March and June 2017. Data were collected from clinicians, paramedics, lab technicians, district field supervisors, patients and treatment supporters through indepth and face-to-face interviews. Interviews were conducted in local languages (Urdu and Sindhi) and transcribed into English. Coding structure was developed inductively and applied on textual data to draw output at the levels of taxonomy, themes and theory, as proposed by Bradley et al. FINDINGS: Thirty-seven individuals consented to participate in this study and provided detailed account of the subject under enquiry. Review of interview data collected from a variety of informants resulted in the identification of four broad factors (taxonomy) that contributed to the situation of low cure rate in one of the districts implementing the public-private mix intervention. These factors were (1) health-seeking behaviour, (2) technical capacity of the healthcare provider, (3) managerial capacity of the healthcare provider, and (4) access to healthcare facility and services. Each factor is deconstructed into key dimensions (themes) that emerged from the dialogue between the interviewer and the respondents. Moreover, dimensions were exemplified through underlying concepts that correspond to theories for low cure rate. CONCLUSION: Change in programme reporting requirement has demeaned the significance of having cure as treatment outcome. Therefore, returning the focus to achieving cure status for TB cases will be beneficial for assessing the effectiveness of TB control efforts. In parallel to the care delivery system, a mechanism for disseminating disease-related and treatment-related information should be introduced.

Effective uses of social media in public health and medicine: a systematic review of systematic reviews.

INTRODUCTION: Research examining the effective uses of social media (SM) in public health and medicine, especially in the form of systematic reviews (SRs), has grown considerably in the past decade. To our knowledge, no comprehensive synthesis of this literature has been conducted to date. AIMS AND METHODS: To conduct a systematic review of systematic reviews of the benefits and harms ("effects") of SM tools and platforms (such as Twitter and Facebook) in public health and medicine. To perform a synthesis of this literature and create a 'living systematic review'. RESULTS: Forty-two (42) high-quality SRs were examined. Overall, evidence of SM's effectiveness in public health and medicine was judged to be minimal. However, qualitative benefits for patients are seen in improved psychosocial support and psychological functioning. Health professionals benefited from better peer-to-peer communication and lifelong learning. Harms on all groups include the impact of SM on mental health, privacy, confidentiality and information reliability. CONCLUSIONS: A range of negatives and positives of SM in public health and medicine are seen in the SR literature but definitive conclusions cannot be made at this time. Clearly better research designs are needed to measure the effectiveness of social technologies. For ongoing updates, see the wiki "Effective uses of social media in health: a living systematic review of systematic reviews". http://hlwiki.slais.ubc.ca/index.php/Effective_uses_of_social_media_in_healthcare:_a_living_systematic_review_of_reviews.

Loss-to-follow-up and delay to treatment initiation in Pakistan's national tuberculosis control programme.

BACKGROUND: Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. METHODS: This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. RESULTS: One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). CONCLUSION: Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested.

Measuring management's perspective of data quality in Pakistan's Tuberculosis control programme: a test-based approach to identify data quality dimensions.

BACKGROUND: Data quality is core theme of programme's performance assessment and many organizations do not have any data quality improvement strategy, wherein data quality dimensions and data quality assessment framework are important constituents. As there is limited published research about the data quality specifics that are relevant to the context of Pakistan's Tuberculosis control programme, this study aims at identifying the applicable data quality dimensions by using the 'fitness-for-purpose' perspective. RESULTS: Forty-two respondents pooled a total of 473 years of professional experience, out of which 223 years (47%) were in TB control related programmes. Based on the responses against 11 practical cases, adopted from the routine recording and reporting system of Pakistan's TB control programme (real identities of patient were masked), completeness, accuracy, consistency, vagueness, uniqueness and timeliness are the applicable data quality dimensions relevant to the programme's context, i.e. work settings and field of practice. CONCLUSION: Based on a 'fitness-for-purpose' approach to data quality, this study used a test-based approach to measure management's perspective and identified data quality dimensions pertinent to the programme and country specific requirements. Implementation of a data quality improvement strategy and achieving enhanced data quality would greatly help organizations in promoting data use for informed decision making.