Assessment tools measuring health-related empowerment in psychosocially vulnerable populations: a systematic review.

BACKGROUND: Many programs are undertaken to facilitate the empowerment of vulnerable populations across the world. However, an overview of appropriate empowerment measurements to evaluate such initiatives remains incomplete to date. This systematic review aims to describe and summarise psychometric properties, feasibility and clinical utility of the available tools for measuring empowerment in psychosocially vulnerable populations. METHODS: A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was completed. A descriptive approach was used for data analysis. Papers were eligible if they explored the development, validation, cross-cultural translation or the utility of an empowerment measurement tool in the context of psychosocially vulnerable populations. RESULTS: Twenty-six included articles described twenty-six separate studies in which 16 empowerment measurement tools were developed, validated/translated, or used. There was heterogeneity in empowerment constructs, samples targeted, and psychometric properties measured. The measurement of reliability of the included instruments was satisfactory in most cases. However, the validity, responsiveness, interpretability, feasibility and clinical utility of the identified measurement tools were often not adequately described or measured. CONCLUSION: This systematic review provides a useful snapshot of the strengths as well as limitations of existing health related empowerment measurement tools used with psychosocially vulnerable populations in terms of their measurement properties, and constructs captured. It highlights significant gaps in empowerment tool measurement, development and evaluation processes. In particular, the results suggest that in addition to systematic assessments of psychometric properties, the inclusion of feasibility and clinical utility as outcome measures are important to assess relevance to clinical practice.

A call for action that cannot go to voicemail: Research activism to urgently improve Indigenous perinatal health and wellbeing.

In this call to action, a coalition of Indigenous and non-Indigenous researchers from Australia, Aotearoa New Zealand, United States and Canada argue for the urgent need for adequately funded Indigenous-led solutions to perinatal health inequities for Indigenous families in well-resourced settler-colonial countries. Authors describe examples of successful community-driven programs making a difference and call on all peoples to support and resource Indigenous-led perinatal health services by providing practical actions for individuals and different groups.

Comparing machine and human reviewers to evaluate the risk of bias in randomized controlled trials.

BACKGROUND: Evidence from new health technologies is growing, along with demands for evidence to inform policy decisions, creating challenges in completing health technology assessments (HTAs)/systematic reviews (SRs) in a timely manner. Software can decrease the time and burden by automating the process, but evidence validating such software is limited. We tested the accuracy of RobotReviewer, a semi-autonomous risk of bias (RoB) assessment tool, and its agreement with human reviewers. METHODS: Two reviewers independently conducted RoB assessments on a sample of randomized controlled trials (RCTs), and their consensus ratings were compared with those generated by RobotReviewer. Agreement with the human reviewers was assessed using percent agreement and weighted kappa (κ). The accuracy of RobotReviewer was also assessed by calculating the sensitivity, specificity, and area under the curve in comparison to the consensus agreement of the human reviewers. RESULTS: The study included 372 RCTs. Inter-rater reliability ranged from κ = -0.06 (no agreement) for blinding of participants and personnel to κ = 0.62 (good agreement) for random sequence generation (excluding overall RoB). RobotReviewer was found to use a high percentage of "irrelevant supporting quotations" to complement RoB assessments for blinding of participants and personnel (72.6%), blinding of outcome assessment (70.4%), and allocation concealment (54.3%). CONCLUSION: RobotReviewer can help with risk of bias assessment of RCTs but cannot replace human evaluations. Thus, reviewers should check and validate RoB assessments from RobotReviewer by consulting the original article when not relevant supporting quotations are provided by RobotReviewer. This consultation is in line with the recommendation provided by the developers.

Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector.

BACKGROUND: The capacity of the Indigenous primary healthcare (PHC) sector to continue playing a crucial role in meeting the health needs of Aboriginal and Torres Strait Islander Australians is in large part reliant on the skills, motivation and experience of its workforce. While exhibiting many workforce strengths, the sector faces significant challenges in building and maintaining a strong and stable workforce. Drawing on data from one Aboriginal Community Controlled Health Service (ACCHS), this study reports what is working well and what could be improved to strengthen the Indigenous PHC sector workforce. METHODS: Using grounded theory methods, interviews with 17 ACCHS staff from a range of organisational positions were transcribed, coded and analysed. This paper focuses on the strategies identified that contribute towards strengthening the Indigenous PHC workforce. RESULTS: Four overarching strategies for Indigenous PHC workforce strengthening were identified. These were Strengthening Workforce Stability, Having Strong Leadership, Growing Capacity, and Working Well Together. A range of enabling factors at the macro, community, organisational and individual levels were also identified. CONCLUSION: Indigenous PHC services are already implementing many important workforce-development strategies that are having a positive impact on the sector. There are also several persistent challenges which need to be addressed through action at organisational and structural levels. Approaches to workforce strengthening in Indigenous PHC should be tailored to local needs to ensure they address the unique workforce challenges experienced in different contexts.

Healthy Choice Rewards: A Feasibility Trial of Incentives to Influence Consumer Food Choices in a Remote Australian Aboriginal Community.

Poor diet including inadequate fruit and vegetable consumption is a major contributor to the global burden of disease. Aboriginal and Torres Strait Islander Australians experience a disproportionate level of preventable chronic disease and successful strategies to support Aboriginal and Torres Strait Islander people living in remote areas to consume more fruit and vegetables can help address health disadvantage. Healthy Choice Rewards was a mixed methods study to investigate the feasibility of a monetary incentive: store vouchers, to promote fruit and vegetable purchasing in a remote Australian Aboriginal community. Multiple challenges were identified in implementation, including limited nutrition workforce. Challenges related to the community store included frequent store closures and amended trading times, staffing issues and poor infrastructure to support fruit and vegetable promotion. No statistically significant increases in fruit or vegetable purchases were observed in the short time frame of this study. Despite this, community members reported high acceptability of the program, especially for women with children. Optimal implementation including, sufficient time and funding resources, with consideration of the most vulnerable could go some way to addressing inequities in food affordability for remote community residents.

Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults.

BACKGROUND/AIMS: Teleophthalmology is well positioned to play a key role in screening of major chronic eye diseases. Economic evaluation of cost-effectiveness of teleophthalmology, however, is lacking. This study provides a systematic review of economic studies of teleophthalmology screening for diabetic retinopathy (DR), glaucoma and macular degeneration. METHODS: Structured search of electronic databases and full article review yielded 20 cost-related articles. Sixteen articles fulfilled the inclusion criteria and were retained for a narrative review: 12 on DR, 2 on glaucoma and 2 on chronic eye disease. RESULTS: Teleophthalmology for DR yielded the most cost savings when compared with traditional clinic examination. The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates. The required patient pool size to be screened varied from 110 to 3500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilisation of the equipment. Teleophthalmology for glaucoma was more cost-effective compared with in-person examination. Similarly, increasing number of glaucoma patients targeted for screening yielded more cost savings. CONCLUSIONS: This economic review provides supportive evidence of cost-effectiveness of teleophthalmology for DR and glaucoma screening potentially increasing screening accessibility especially for rural and remote populations. Special selection of the targeted screening population will optimise the cost-effectiveness of teleophthalmology.

Promoting equitable global health research: a policy analysis of the Canadian funding landscape.

BACKGROUND: Recognising radical shifts in the global health research (GHR) environment, participants in a 2013 deliberative dialogue called for careful consideration of equity-centred principles that should inform Canadian funding polices. This study examined the existing funding structures and policies of Canadian and international funders to inform the future design of a responsive GHR funding landscape. METHODS: We used a three-pronged analytical framework to review the ideas, interests and institutions implicated in publically accessible documents relevant to GHR funding. These data included published literature and organisational documents (e.g. strategic plans, progress reports, granting policies) from Canadian and other comparator funders. We then used a deliberative approach to develop recommendations with the research team, advisors, industry informants and low- and middle-income country (LMIC) partners. RESULTS: In Canada, major GHR funders invest an estimated CA$90 M per annum; however, the post-2008 re-organization of funding structures and policies resulted in an uncoordinated and inefficient Canadian strategy. Australia, Denmark, the European Union, Norway, Sweden, the United Kingdom and the United States of America invest proportionately more in GHR than Canada. Each of these countries has a national strategic plan for global health, some of which have dedicated benchmarks for GHR funding and policy to allow funds to be held by partners outside of Canada. Key constraints to equitable GHR funding included (1) funding policies that restrict financial and cost burden aspects of partnering for GHR in LMICs; and (2) challenges associated with the development of effective governance mechanisms. There were, however, some Canadian innovations in funding research that demonstrated both unconventional and equitable approaches to supporting GHR in Canada and abroad. Among the most promising were found in the International Development Research Centre and the (no longer active) Global Health Research Initiative. CONCLUSION: Promoting equitable GHR funding policies and practices in Canada requires cooperation and actions by multiple stakeholders, including government, funding agencies, academic institutions and researchers. Greater cooperation and collaboration among these stakeholders in the context of recent political shifts present important opportunities for advancing funding policies that enable and encourage more equitable investments in GHR.

Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review.

OBJECTIVES: Frequent emergency department (ED) users are high-risk and high-resource-utilizing patients. This systematic review evaluates effectiveness of interventions targeting adult frequent ED users in reducing visit frequency and improving patient outcomes. METHODS: An a priori protocol was published in PROSPERO. Two independent reviewers screened, selected, rated quality, and extracted data. Third-party adjudication resolved disagreements. Rate ratios of post- versus pre-intervention ED visits were calculated. Data sources were from a comprehensive search that included seven databases and the gray literature. Eligibility criteria for selecting studies included experimental studies assessing the effect of interventions on frequent users' ED visits and patient-oriented outcomes. RESULTS: A total of 6,865 citations were identified and 31 studies included. Designs were noncontrolled (n = 21) and controlled (n = 4) before-after studies and randomized controlled trials (n = 6). Frequent user definitions varied considerably and risk of bias was moderate to high. Studies examined general frequent users or those with psychiatric comorbidities, chronic disease, or low socioeconomic status or the elderly. Interventions included case management (n = 18), care plans (n = 8), diversion strategies (n = 3), printout case notes (n = 1), and social work visits (n = 1). Post- versus pre-intervention rate ratios were calculated for 25 studies and indicated a significant visit decrease in 21 (84%) of these studies. The median rate ratio was 0.63 (interquartile range = 0.41 to 0.71), indicating that the general effect of the interventions described was to decrease ED visits post-intervention. Significant visit decreases were found for a majority of studies in subgroup analyses based on 6- or 12-month follow-up, definition thresholds, clinical frequent user subgroups, and intervention types. Studies reporting homelessness found consistent improvements in stable housing. Overall, interstudy heterogeneity was high. CONCLUSIONS: Interventions targeting frequent ED users appear to decrease ED visits and may improve stable housing. Future research should examine cost-effectiveness and adopt standardized definitions.

Developing a national health research system: participatory approaches to legislative, institutional and networking dimensions in Zambia.

For many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, we discuss the ongoing development of Zambia's NHRS. We reflect on our experience in the ongoing consultative development of Zambia's NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. We argue that three streams of concurrent activity are critical in developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system's boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonize, unify and strengthen the overall capacities of the research community.