Understanding the convergence of social enterprise, digital health, and citizen engagement for co-producing integrated Person-Centred health services: A critical review and theoretical framework.

INTRODUCTION: To achieve Universal Health Coverage and the United Nations' (UN) Sustainable Development Goals (SDGs) agenda for 2030, the World Health Organisation (WHO) recommended the use of social enterprise, digital technology, and citizen engagement in the delivery of Integrated People-Centred Health Services (IPCHS) as part of its strategic vision for 21st century primary care. METHODS: We conducted a hermeneutic review of frameworks, models and theories on social enterprise, digital health, citizen engagement and IPCHS. This involved multiple iterative cycles of (i) searching and acquisition, followed by (ii) critical analysis and interpretation of literature to assemble arguments and evidence for conceptual relationships until information saturation was reached. This process identified a set of constructs which we synthesised into a testable framework. RESULTS: Several interdisciplinary frameworks, models and theories explain how social enterprises could use digital technology, and citizen engagement to enable the technical and social integration required to facilitate people-centred primary care. Innovative approaches can be used to maintain financial sustainability while delivering IPCHS at lower cost to vulnerable and marginalised populations in both developed and developing countries. CONCLUSION: This framework provides a theoretical grounding to guide empirical inquiry into how social enterprises use digital technology to engage citizens in co-producing IPCHS.

Integrated Management Systems (IMS) to Support and Sustain Quality One Health Services: International Lessons from the COVID-19 Pandemic by the IMIA Primary Care Working Group.

OBJECTIVES: One Health considers human, animal and environment health as a continuum. The COVID-19 pandemic started with the leap of a virus from animals to humans. Integrated management systems (IMS) should provide a coherent management framework, to meet reporting requirements and support care delivery. We report IMS deployment during, and retention post the COVID-19 pandemic, and exemplar One Health use cases. METHODS: Six volunteer members of the International Medical Association's (IMIA) Primary Care Working Group provided data about any IMS and One Health use to support the COVID-19 pandemic initiatives. We explored how IMS were: (1) Integrated with organisational strategy; (2) Utilised standardised processes, and (3) Met reporting requirements, including public health. Selected contributors provided Unified Modelling Language (UML) use case diagram for a One Health exemplar. RESULTS: There was weak evidence of synergy between IMS and health system strategy to the COVID-19 pandemic. However, there were rapid pragmatic responses to COVID-19, not citing IMS. All health systems implemented IMS to link COVID test results, vaccine uptake and outcomes, particularly mortality and to provide patients access to test results and vaccination certification. Neither proportion of gross domestic product alone, nor vaccine uptake determined outcome. One Health exemplars demonstrated that animal, human and environmental specialists could collaborate. CONCLUSIONS: IMS use improved the pandemic response. However, IMS use was pragmatic rather than utilising an international standard, with some of their benefits lost post-pandemic. Health systems should incorporate IMS that enables One Health approaches as part of their post COVID-19 pandemic preparedness.

A Systematic Review with Framework Synthesis of the Ways That Urban Environments Influence Opportunities for Healthy and Sustainable Mobility in Older Age.

Supporting older people's use of sustainable transport is important for both population health and sustainable development, especially in the context of global population ageing. This systematic review identifies individual and environmental factors that influence older people's sustainable transport use and synthesises findings using a framework approach. Factors influencing older people's walking (n = 10 studies), bus use (n = 11), community transport use (n = 1), bicycling (n = 1), and e-bicycling (n = 1) were found to be physical, geographical, facility-based, economic, time-based, fear-based, space-based, information-based, or interpersonal. Many factors were common across transport modes. One reason for this is that environmental features designed to facilitate the use of one particular transport mode also influenced the use of other modes (e.g., bus shelters influence not only bus use but also walking as they provide pedestrian seating). Thus, environments need to be considered from the perspective of multiple, different types of road users. Another reason is that many factors related to the ways individuals experienced their environment (e.g., finding information guiding behaviour in public spaces to be unclear), regardless of any specific transport mode. This review highlights the important need for greater cross-sectoral action and input from older people.

From telehealth to virtual primary care in Australia? A Rapid scoping review.

OBJECTIVE: The COVID-19 pandemic and its socio-economic impacts have disrupted our health systems and society. We sought to examine informatics and digital health strategies that supported the primary care response to COVID-19 in Australia. Specifically, the review aims to answer: how Australian primary health care responded and adapted to COVID-19, the facilitators and inhibitors of the Primary care informatics and digital health enabled COVID-19 response and virtual models of care observed in Australia. METHODS: We conducted a rapid scoping review complying with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews guidelines. Two reviewers independently performed the literature search, data extraction, and synthesis of the included studies. Any disagreement in the eligibility screening, data extraction or synthesis was resolved through consensus meeting and if required. was referred to a third reviewer. Evidence was synthesised, summarised, and mapped to several themes that answer the research question s of this review. RESULTS: We identified 377 papers from PubMed, Scopus, Web of Science and Embase. Following title, abstract and full-text screening, 29 eligible papers were included. The majority were "perspectives" papers. The dearth of original research into digital health and COVID-19 in primary care meant limited evidence on effectiveness, access, equity, utility, safety, and quality. Data extraction and evidence synthesis identified 14 themes corresponding to 3 research questions. Telehealth was the key digital health response in primary care, together with mobile applications and national hotlines, to enable the delivery of virtual primary care and support public health. Enablers and barriers such as workforce training, digital resources, patient experience and ethical issues, and business model and management issues were identified as important in the evolution of virtual primary care. CONCLUSIONS: COVID-19 has transformed Australian primary care with the rapid adaptation of digital technologies to complement "in-person" primary care with telehealth and virtual models of care. The pandemic has also highlighted several literacy, maturity/readiness, and micro, meso and macro-organisational challenges with adopting and adapting telehealth to support integrated person-centred health care. There is a need for more research into how telehealth and virtual models of care can improve the access, integration, safety, and quality of virtual primary care.

Quality assessment of real-world data repositories across the data life cycle: A literature review.

OBJECTIVE: Data quality (DQ) must be consistently defined in context. The attributes, metadata, and context of longitudinal real-world data (RWD) have not been formalized for quality improvement across the data production and curation life cycle. We sought to complete a literature review on DQ assessment frameworks, indicators and tools for research, public health, service, and quality improvement across the data life cycle. MATERIALS AND METHODS: The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Databases from health, physical and social sciences were used: Cinahl, Embase, Scopus, ProQuest, Emcare, PsycINFO, Compendex, and Inspec. Embase was used instead of PubMed (an interface to search MEDLINE) because it includes all MeSH (Medical Subject Headings) terms used and journals in MEDLINE as well as additional unique journals and conference abstracts. A combined data life cycle and quality framework guided the search of published and gray literature for DQ frameworks, indicators, and tools. At least 2 authors independently identified articles for inclusion and extracted and categorized DQ concepts and constructs. All authors discussed findings iteratively until consensus was reached. RESULTS: The 120 included articles yielded concepts related to contextual (data source, custodian, and user) and technical (interoperability) factors across the data life cycle. Contextual DQ subcategories included relevance, usability, accessibility, timeliness, and trust. Well-tested computable DQ indicators and assessment tools were also found. CONCLUSIONS: A DQ assessment framework that covers intrinsic, technical, and contextual categories across the data life cycle enables assessment and management of RWD repositories to ensure fitness for purpose. Balancing security, privacy, and FAIR principles requires trust and reciprocity, transparent governance, and organizational cultures that value good documentation.

Community health alliances as social enterprises that digitally engage citizens and integrate services: A case study in Southwestern Sydney (protocol).

South Western Sydney (SWS) is one of the fastest growing regions in the state of New South Wales (Australia). Much of the population live in local government areas (LGAs) with levels of disadvantage higher than the state average, with a predominance of non-communicable and chronic diseases that are typically associated with age-related and behavioural factors. This necessitates the management of social determinants of health through the integrated provision of primary and social care. The SWS Local Health District and Primary Health Network is exploring the potential of community health alliances (CHAs) as an innovative approach to support the provision of integrated health services. CHAs are a population health approach for addressing health challenges faced by people who share a common area of residence, sociocultural characteristic or health need, and are characterised by a shared mission, shared resource needs and acquiring/developing necessary organisational knowledge and skills. We explore how CHAs operate as social enterprises that utilise digital health and citizen engagement to deliver integrated people-centred health services (IPCHS) by conducting two case studies of CHAs operating in SWS: in Wollondilly and Fairfield LGAs. Using this approach, we aim to unpack the conceptual convergence that enables social enterprises to utilise digital health interventions and citizen engagement strategies to co-produce IPCHS with a view to developing theory and a framework for engaging digital citizens in integrated primary health care via social enterprise.

The built environment and health: fostering interprofessional collaboration for better policy recommendations.

This paper describes the initiation and proceedings of a national consultation organized to appraise issues in the local built environment affecting public health, using an interprofessional and intersectoral approach. The consultation was hosted as a part of the onsite session of an international fellowship program in interprofessional education and practice, organized by the Manipal FAIMER Institute for Leadership in Interprofessional Education, India. One hundred and eight delegates from across academic disciplines including the health professions, management, public health, architecture, and engineering, participated in this event. Plenary lectures and case studies highlighted the theoretical basics of built environment. Participants were also introduced to fundamental parameters for evaluating health-related aspects of the built environment. Delegates were then grouped into 18 teams and assigned to visit predetermined locations which they appraised and provided recommendations for. These were then thematically coded and synthesized for communication to relevant local municipal authorities. The consultation scope was limited by involving only academics in the appraisal process, and next steps include the engagement of local citizens and policy-makers to ensure the implementation of recommendations. This event illustrates how engaging interprofessional stakeholders can facilitate knowledge-driven development for promoting health equity, through action on the social determinants of health.

Debating evidence-based health policy in an interprofessional classroom: an exploratory study.

Model United Nations (MUN) debates enable students to engage in policy debate in simulated UN councils, and are regularly held in schools and colleges, globally. In developing countries where leadership and teamwork in 'evidence-based policy and practice' is needed to overcome health inequities and strengthen health systems, few curricula teach these skills using simulation-based, participatory learning approaches. Do MUN debates have something to offer for health professions education in low-resource settings? Since MUN debates are novel in health profession education, we aimed to identify the skill domains for selection of outcome measures in future evaluations. We employed an exploratory, qualitative approach to identify relevant competency domains. The 8 students (4 medical, 1 dental, and 3 pre-med) who volunteered to participate in the MedMUN initiative were interviewed, responses were thematically analyzed and a conceptual framework was developed. Leadership (subthemes: confidence and public-speaking), teamwork (subthemes: student integration and interprofessional education), and social responsibility (subthemes: democracy and a global outlook) were dominant themes. MUN debates are useful, interprofessional simulation exercises for providing students a window into global health policy, while engendering leadership and teamwork skills.

A protocol for a systematic review of economic evaluation studies conducted on neonatal systemic infections in South Asia.

BACKGROUND: Neonatal systemic infections and their consequent impairments give rise to long-lasting health, economic and social effects on the neonate, the family and the nation. Considering the dearth of consolidated economic evidence in this important area, this systematic review aims to critically appraise and consolidate the evidence on economic evaluations of management of neonatal systemic infections in South Asia. METHODS: Full and partial economic evaluations, published in English, associated with the management of neonatal systemic infections in South Asia will be included. Any intervention related to management of neonatal systemic infections will be eligible for inclusion. Comparison can include a placebo or alternative standard of care. Interventions without any comparators will also be eligible for inclusion. Outcomes of this review will include measures related to resource use, costs and cost-effectiveness. Electronic searches will be conducted on PubMed, CINAHL, MEDLINE (Ovid), EMBASE, Web of Science, EconLit, the Centre for Reviews and Dissemination Library (CRD) Database, Popline, IndMed, MedKnow, IMSEAR, the Cost Effectiveness Analysis (CEA) Registry and Pediatric Economic Database Evaluation (PEDE). Conference proceedings and grey literature will be searched in addition to performing back referencing of bibliographies of included studies. Two authors will independently screen studies (in title, abstract and full-text stages), extract data and assess risk of bias. A narrative summary and tables will be used to summarize the characteristics and results of included studies. DISCUSSION: Neonatal systemic infections can have significant economic repercussions on the families, health care providers and, cumulatively, the nation. Pediatric economic evaluations have focused on the under-five age group, and published consolidated economic evidence for neonates is missing in the developing world context. To the best of our knowledge, this is the first review of economic evidence on neonatal systemic infections in the South Asian context. Further, this protocol provides an underst anding of the methods used to design and evaluate economic evidence for methodological quality, transparency and focus on health equity. This review will also highlight existing gaps in research and identify scope for further research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017047275.

Risk factors and barriers to case management of neonatal pneumonia: protocol for a pan-India qualitative study of stakeholder perceptions.

INTRODUCTION: India accounted for more neonatal deaths (estimated at 696 000) than any other country, as of 2015. Of these , most neonatal deaths due to infections can be attributed to pneumonia which accounts for 16% of all neonatal mortalities (2010). Despite simple, inexpensive case management strategies being available, pneumonia continues to cause significant mortality and morbidity among neonates. Understanding the perceptions and experiences of stakeholders of neonatal care can help find solutions to barriers to care and design tailored strategies for controlling neonatal pneumonia. METHODS AND ANALYSIS: A pan-India qualitative study will be conducted. Participants include healthcare providers, programme officers, academicians, representatives of non-governmental organisations/bilateral agencies and policy makers. They will be recruited purposively from rural and urban, public and private, and facility and community healthcare settings across six Indian regions. Within each region, a minimum of one state will be selected. Districts will be based on neonatal mortality indicators, and will be subject to feasibility at the time of conducting the study. We plan to conduct in-depth interviews (IDI) and focus group discussions focusing on (a) burden, (b) risk factors, (c) case management, (d) treatment guidelines, (e) barriers to case management, (f) recommendations. The number of interviews will depend on the information saturation. Interviews will be audio-recorded with prior written consent and transcribed verbatim. Principles of thematic analysis will be applied for qualitative data analysis using R package for Qualitative Data Analysis (RQDA). ETHICS AND DISSEMINATION: The protocol has been approved by the Health Ministry Screening Committee, Government of India and the Institutional Ethics Committee at the host institution. Confidentiality and privacy of the participants will be maintained. The findings of the study will be shared with all stakeholders of this research including the participants. Knowledge dissemination workshops will be conducted to ultimately transfer the evidence tailored to the stakeholders' need.