Chronic disease prevention and screening outcomes for patients with and without financial difficulty: a secondary analysis of the BETTER WISE cluster randomised controlled trial.

OBJECTIVE: Building on Existing Tools To improvE chronic disease pRevention and screening in primary care Wellness of cancer survIvorS and patiEnts (BETTER WISE) was designed to assess the effectiveness of a cancer and chronic disease prevention and screening (CCDPS) programme. Here, we compare outcomes in participants living with and without financial difficulty. DESIGN: Secondary analysis of a cluster-randomised controlled trial. SETTING: Patients of 59 physicians from 13 clinics enrolled between September 2018 and August 2019. PARTICIPANTS: 596 of 1005 trial participants who responded to a financial difficulty screening question at enrolment. INTERVENTION: 1-hour CCDPS visit versus usual care. OUTCOME MEASURES: Eligibility for a possible 24 CCDPS actions was assessed at baseline and the primary outcome was the percentage of eligible items that were completed at 12-month follow-up. We also compared the change in response to the financial difficulty screening question between baseline and follow-up. RESULTS: 55 of 265 participants (20.7%) in the control group and 69 of 331 participants (20.8%) in the intervention group reported living with financial difficulty. The primary outcome was 29% (95% CI 26% to 33%) for intervention and 23% (95% CI 21% to 26%) for control participants without financial difficulty (p=0.01). Intervention and control participants with financial difficulty scored 28% (95% CI 24% to 32%) and 32% (95% CI 27% to 38%), respectively (p=0.14). In participants who responded to the financial difficulty question at both time points (n=302), there was a net decrease in the percentage of participants who reported financial difficulty between baseline (21%) and follow-up (12%, p<0.001) which was similar in the control and intervention groups. The response rate to this question was only 51% at follow-up. CONCLUSION: The BETTER intervention improved uptake of CCDPS manoeuvres in participants without financial difficulty, but not in those living with financial difficulty. Improving CCDPS for people living with financial difficulty may require a different clinical approach or that social determinants be addressed concurrently with clinical and lifestyle needs or both. TRIAL REGISTRATION NUMBER: ISRCTN21333761.

AHP and TOPSIS based flood risk assessment- a case study of the Navsari City, Gujarat, India.

Flooding is one of the major natural catastrophic disasters that causes massive environmental and socioeconomic destruction. The magnitude of losses due to floods has prompted researchers to focus more on robust and comprehensive modeling approaches for alleviating flood damages. Recently developed multi-criteria decision making (MCDM) methods are being widely used to construct decision-making process more participatory, rational, and efficient. In this study, two statistical MCDM approaches, namely the analytical hierarchy process (AHP) and the technique for order preference by similarity to ideal solution (TOPSIS), have been employed to generate flood risk maps together with hazard and vulnerability maps in a GIS framework for Navsari city in Gujarat, India, to identify the vulnerable areas that are more susceptible to inundation during floods. The study area was divided into 10 sub areas (i.e., NC1 to NC10) to appraise the degree of flood hazard, vulnerability and risk intensities in terms of areal coverage and categorized under 5 intensity classes, viz., very low, low, moderate, high, and very high. A total of 14 flood indicators, seven each for hazard (i.e., elevation, slope, drainage density, distance to river, rainfall, soil, and flow accumulation) and vulnerability (i.e., population density, female population, land use, road network density, household, distance to hospital, and literacy rate) were considered for evaluating the flood risk. Flood risk coverage evaluated from the two approaches were compared with the flood extent computed from the actual flood data collected at 36 random locations. Results revealed that the TOPSIS approach estimated more precise flood risk coverage than the AHP approach, yielding high R2 values, i.e., 0.78 to 0.95 and low RMSE values, i.e., 0.95 to 0.43, for all the 5 risk intensity classes. The sub areas identified under "very high" and "high" risk intensity classes (i.e., NC1, NC4, NC6, NC7, NC8, and NC10) call for immediate flood control measures with a view to palliate the extent of flood risk and consequential damages. The study demonstrates the potential of AHP and TOPSIS integrated with GIS towards precise identification of flood-prone areas for devising effective flood management strategies.