Factors Influencing Rural End-Users' Acceptance of e-Health in Developing Countries: A study on Portable Health Clinic in Bangladesh.

BACKGROUND: Existing studies regarding e-health are mostly focused on information technology design and implementation, system architecture and infrastructure, and its importance in public health with ancillaries and barriers to mass adoption. However, not enough studies have been conducted to assess the end-users' reaction and acceptance behavior toward e-health, especially from the perspective of rural communities in developing countries. OBJECTIVE: The objective of this study is to explore the factors that influence rural end users' acceptance of e-health in Bangladesh. METHODS: Data were collected between June and July 2016 through a field survey with structured questionnaire form 292 randomly selected rural respondents from Bheramara subdistrict, Bangladesh. Technology Acceptance Model was adopted as the research framework. Logistic regression analysis was performed to test the theoretical model. RESULTS: The study found social reference as the most significantly influential variable (Coef. = 2.28, odds ratio [OR] = 9.73, p < 0.01) followed by advertisement (Coef. = 1.94, OR = 6.94, p < 0.01); attitude toward the system (Coef. = 1.52, OR = 4.56, p < 0.01); access to cellphone (Coef. = 1.37, OR = 3.92, p < 0.05), and perceived system effectiveness (Coef. = 0.74, OR = 2.10, p < 0.01). Among demographic variables, age, gender, and education were found significant while we did not find any significant impact of respondents' monthly family expenditure on their e-health acceptance behavior. The model explains 54.70% deviance (R2 = 0.5470) in the response variable with its constructs. The "Hosmer-Lemeshow" goodness-of-fit score (0.539) is also above the standard threshold (0.05), which indicates that the data fit well with the model. CONCLUSION: The study provides guidelines for the successful adoption of e-health among rural communities in developing countries. This also creates an opportunity for e-health technology developers and service providers to have a better understanding of their end users.

Factors Affecting Rural Patients' Primary Compliance with e-Prescription: A Developing Country Perspective.

Background:The electronic prescription system has emerged to reduce the ambiguity and misunderstanding associated with handwritten prescriptions. The opportunities and challenges of e-prescription system, its impact on reducing medication error, and improving patient's safety have been widely studied. However, not enough studies were conducted to explore and quantify the factors that affect rural patients' compliance with e-prescription, especially from the perspective of Asian developing countries where most of the world's population resides.Objective:The objective of this study is to explore and assess the factors that affect rural patients' primary compliance with e-prescription in Bangladesh.Methods:Data were collected from 95 randomly selected rural patients who received e-prescription through a field survey with a structured questionnaire from Bheramara subdistrict, Bangladesh, during June and July 2016. Logistic regression analysis was performed to test the research hypotheses.Results:The study found patients' gender as the most significantly influential factor (regression coefficient [Coef.] = 2.02, odds ratio [OR] = 7.51, p < 0.05) followed by visiting frequency (Coef. = 0.99, OR = 2.70, p < 0.05); education (Coef. = 0.92, OR = 2.51, p < 0.05); and distance to healthcare facility (Coef. = 0.82, OR = 2.26, p < 0.01). However, patients' age, monthly family expenditure, and use of cell phone were found insignificant. The model explains 59.40% deviance (R2 = 0.5940) in the response variable with its constructs. And the "Hosmer-Lemeshow" goodness-of-fit score (0.99) is also above the standard threshold (0.05), which indicates the data fit well with the model.Conclusions:The findings of this study are expected to be helpful for e-health service providers to gain a better understanding of the factors that influence their patients to comply with e-prescriptions.

Performance Evaluation of the Commonly-Used Portable Cholesterol Sensors for Telehealth Services in the Unreached Communities.

Portable medical sensors play an important role in healthcare services, especially in rural communities. Many telehealth systems use these devices for providing patients' vital information from a distance to remote doctors. Erroneous data will not only mislead the remote doctor for correct diagnosis but it will cause health threats to these unreached community people. Therefore, it is very important to identify good sensors with an acceptable level of accuracy but within the affordable price of the available sensors in the market. This study aims to identify quality portable cholesterol sensors with high accuracy with the reference of the Japanese clinical pathology laboratory as a gold standard. We have considered cholesterol sensors that measure total cholesterol for this study that are commonly used in the developing countries of Asia. We found that out of four, three of them were very much erroneous and cannot be recommended even for primary healthcare.

Portable health clinic COVID-19 system for remote patient follow-up ensuring clinical safety.

Background: A developing country like Bangladesh suffers very much from the sudden appearance of the COVID-19 pandemic due to the shortage of medical facilities for testing and follow-up treatment. The Portable Health Clinic (PHC) system has developed the COVID-19 module with a triage system for the detection of COVID-19 suspects and the follow-up of the home quarantined COVID-19 patients to reduce the workload of the limited medical facilities. Methods: The PHC COVID-19 system maintains a questionnaire-based triage function using the experience of the Japanese practice of diseases management for early detection of suspected COVID-19 patients who may need a confirmation test. Then only the highly suspected patients go for testing preventing the unnecessary crowd from the confirmation PCR test centers and hospitals. Like the basic PHC system, it also has the features for patients' treatment and follow-up for the home quarantined COVID-19 positive and suspect patients using a telemedicine system. This COVID-19 system service box contains 4 self-checking medical sensors, namely, (1) thermometer, (2) pulse oximeter, (3) blood pressure machine, and (4) glucometer for patient's health monitoring including a tablet PC installed with COVID-19 system application for communication between patient and doctor for tele-consultancy. Results: This study conducted a COVID-19 triage among 300 villagers and identified 220 green, 45 light-yellow, 2 yellow, 30 orange, and 3 red patients. Besides the 3 red patients, the call center doctors also referred another 13 patients out of the 30 orange patients to health facilities for PCR tests as suspect COVID-19 positive, and to go under their follow-up. Out of these (3 + 13 =) 16 patients, only 4 went for PCR test and 3 of them had been tested positive. The remaining orange, yellow and light-yellow patients were advised home quarantine under the follow-up of the PHC health workers and got cured in 1-2 weeks. Conclusions: This system can contribute to the community healthcare system by ensuring quality service to the suspected and 80% or more tested COVID-19 positive patients who are usually in the moderate or mild state and do not need to be hospitalized. The PHC COVID-19 system provides services maintaining social distance for preventing infection and ensuring clinical safety for both the patients and the health workers.

Women's health status before and during the COVID-19 pandemic in rural Bangladesh: A prospective longitudinal study.

The coronavirus disease (COVID-19) pandemic has widely spread worldwide since 2020. Several countries have imposed lockdown or stay-at-home policies to prevent the infection. Bangladesh experienced a lockdown from March 2020 to May 2020, and internal travel was restricted. Such long and strict confinement may impact women's health. Herein, we aimed to assess the impact of the COVID-19 pandemic on women's health by comparing their health status before and during the pandemic. We conducted a prospective longitudinal study in two zones in the Chhaygaon union, rural district Shariatpur, Bangladesh. The study population comprised non-pregnant women aged 15-49 years. We visited the household of all eligible women and invited them for health checkups. The survey staff examined their health status at the checkup camps and conducted questionnaire interviews. In total, 121 non-pregnant women received health checkups both from June 2019 to July 2019 and in October 2020, before and during the COVID-19 pandemic, respectively. Compared with those during the 2019 health checkup, the medians of body mass index, systolic blood pressure, and diastolic blood pressure were significantly higher (22.7 kg/m2 to 23.6 kg/m2; 110.0 mmHg to 111.0 mmHg; and 73.0 mmHg to 75.0 mmHg, respectively, p<0.05) during the 2020 health checkup. In contrast, urine glucose levels were significantly lower (10.1% to 3.4%, p = 0.021). The lack of physical activity and other inconvenience accumulation caused by the prolonged confinement might have affected their health status. This necessitates local health workers to promote physical activity to prevent health deterioration during the pandemic.

Standardization of Personal Health Records in the Portable Health Clinic System.

A personal health record (PHR) is not only a collection of personal health data but also a personal healthcare and disease management tool for individual patients. Recently, PHRs have been considered indispensable tools for patient engagement in the area of noncommunicable diseases (NCDs) and have gained a special importance. Unfortunately, similar to several other developing countries, Bangladesh remains far behind in establishing a standard PHR system for the country despite the fact that the growth of NCDs is extremely high and accounts for approximately 70% of the total diseases experienced in the country. The Portable Health Clinic system, which has a PHR feature, was established in Bangladesh in 2010. This PHR system requires standardization for each country. The objective of this research is to standardize this PHR system with reference to the PHR system proposed by the Japanese Clinical Societies, which is a pioneer of work in this field in Asia.

Portable Health Clinic System for Maternal and Child Health Care in COVID-19 Pandemic Situation.

Rural women in developing countries do not have any option but to visit the distant city to see the obstetricians and gynecologists in case of any maternal and child health issues. However, it becomes more difficult to travel during the COVID-19 pandemic situation. Thus, the telehealth service using the Portable Health Clinic can be very effective for maternal and child health care services. Since the PHC system provides home delivery services through the local health workers, the rural women can avail regular continuum of care services. This study found a 300% increase in participation in the continuum of care. This is not because they receive the service at home but also because they can receive consultancy from urban specialist doctors without travel during the pandemic situation.

Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study.

BACKGROUND: Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. OBJECTIVE: Our study will examine the telehealth care system's effectiveness in improving women's and infants' care uptake and detecting their health problems. METHODS: A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (≥16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants' health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants' health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention's effectiveness. RESULTS: Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. CONCLUSIONS: Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women's and infants' health status. TRIAL REGISTRATION: ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41586.

Maternal and Child Healthcare Service by Portable Health Clinic System Using a Triage Protocol.

The number of deaths of a mother and child caused by maternal and child healthcare (MCH) issues has been greatly decreased recently, but still, the number is extremely high especially in developing countries. Although the governments have been given a priority in this issue, the lack of financial and human resources brings a limit. Thus, the use of low-cost but appropriate technology is required. Portable Health Clinic (PHC), a telemedicine system developed for providing primary healthcare, is such a technology. This study aimed to address this MCH issue with the aid of a low-cost PHC service involving a continuum-of-care protocol to the rural communities of Bangladesh. Moreover, this study introduces a triage protocol to distinguish high-risk patients from the early stage of the continuum of care who need special care and refer to specialized physicians to prevent unwanted deaths.

Portable health clinic for sustainable care of mothers and newborns in rural Bangladesh.

BACKGROUND AND OBJECTIVE: Regular health checkups are important for mothers and newborns to detect health problems at an early stage; however, this is often difficult in resource-limited settings. Therefore, the portable health clinic (PHC) for maternal and child health (MCH), a telemedicine health checkup system, was introduced as an intervention study in a rural area in Bangladesh. The aim of this research project was to report findings that we had observed at a mid-point of the intervention period. METHODS: This was an intervention study conducted in Shariatpur, Bangladesh. The study population included pregnant/parturient women aged 15-49 years and their newborns. With the help of the newly created PHC for MCH, health workers, with a set of sensor devices in an attaché case, visited mothers and newborns at home to examine their health status. Their health status was triaged into four categories using a data management application, and in cases of affected or emergent health status, they were placed on remote video consultation with a doctor. RESULTS: In total, 94 women were included in the PHC for MCH intervention. The rate of participants who received antenatal care at least four times or postnatal care at least once increased (from 29% to 51%, and from 27% to 78%, respectively) compared with before introducing PHC for MCH. Using the PHC for MCH, we detected health problems in pregnant/parturient women; a relatively high percentage had anemia (45-54%) and/or abnormal pulse rate (20-40%). Moreover, after introducing the PHC for MCH, more than 40% of women who received multiple antenatal care or postnatal care checkups improved their health status. CONCLUSIONS: The PHC for MCH could be an effective system to improve the health of mothers and newborns by increasing the availability of care. In the future, this system is expected to be used as a primary resource for maternity healthcare, not only in rural areas but also in other social environments.

A Predictive Model for Height Tracking in an Adult Male Population in Bangladesh to Reduce Input Errors.

The advancement of ICT and affordability of medical sensors enable healthcare data to be obtained remotely. Remote healthcare data is erroneous in nature. Detection of errors for remote healthcare data has not been significantly studied. This research aims to design and develop a software system to detect and reduce such healthcare data errors. Enormous research efforts produced error detection algorithms, however, the detection is done at the server side after a substantial amount of data is archived. Errors can be efficiently reduced if the suspicious data can be detected at the source. We took the approach to predict acceptable range of anthropometric data of each patient. We analyzed 40,391 records to monitor the growth patterns. We plotted the anthropometric items e.g., Height, Weight, BMI, Waist and Hip size for males and females. The plots show some patterns based on different age groups. This paper reports one parameter, height of males. We found three groups that can be classified with similar growth patterns: Age group 20-49, no significant change; Age group 50-64, slightly decremented pattern; and Age group 65-100, a drastic height loss. The acceptable range can change over time. The system estimates the updated trend from new health records.

Blood Uric Acid Prediction With Machine Learning: Model Development and Performance Comparison.

BACKGROUND: Uric acid is associated with noncommunicable diseases such as cardiovascular diseases, chronic kidney disease, coronary artery disease, stroke, diabetes, metabolic syndrome, vascular dementia, and hypertension. Therefore, uric acid is considered to be a risk factor for the development of noncommunicable diseases. Most studies on uric acid have been performed in developed countries, and the application of machine-learning approaches in uric acid prediction in developing countries is rare. Different machine-learning algorithms will work differently on different types of data in various diseases; therefore, a different investigation is needed for different types of data to identify the most accurate algorithms. Specifically, no study has yet focused on the urban corporate population in Bangladesh, despite the high risk of developing noncommunicable diseases for this population. OBJECTIVE: The aim of this study was to develop a model for predicting blood uric acid values based on basic health checkup test results, dietary information, and sociodemographic characteristics using machine-learning algorithms. The prediction of health checkup test measurements can be very helpful to reduce health management costs. METHODS: Various machine-learning approaches were used in this study because clinical input data are not completely independent and exhibit complex interactions. Conventional statistical models have limitations to consider these complex interactions, whereas machine learning can consider all possible interactions among input data. We used boosted decision tree regression, decision forest regression, Bayesian linear regression, and linear regression to predict personalized blood uric acid based on basic health checkup test results, dietary information, and sociodemographic characteristics. We evaluated the performance of these five widely used machine-learning models using data collected from 271 employees in the Grameen Bank complex of Dhaka, Bangladesh. RESULTS: The mean uric acid level was 6.63 mg/dL, indicating a borderline result for the majority of the sample (normal range <7.0 mg/dL). Therefore, these individuals should be monitoring their uric acid regularly. The boosted decision tree regression model showed the best performance among the models tested based on the root mean squared error of 0.03, which is also better than that of any previously reported model. CONCLUSIONS: A uric acid prediction model was developed based on personal characteristics, dietary information, and some basic health checkup measurements. This model will be useful for improving awareness among high-risk individuals and populations, which can help to save medical costs. A future study could include additional features (eg, work stress, daily physical activity, alcohol intake, eating red meat) in improving prediction.

Personal Health Record (PHR) System in Portable Health Clinic.

Personal Health Record (PHR) is not just the collection of personal health data but also a personal healthcare and disease management tool for the individual patient as well as a communication tool with the medical staff. Moreover, recently PHR has been considered an indispensable tool for patient engagement in the area of non-communicable diseases (NCDs) and has gained importance. Like many other developing countries, the growth of NCDs is very high in Bangladesh. Portable Health Clinic (PHC) system has been developed there with a focus on NCDs and PHR is there from the beginning. This study for the standardization of PHR system of PHC with the reference of the PHR proposed by Japanese Clinical Societies could be a reference work for the national PHR system development in the country.

Redesigning Portable Health Clinic Platform as a Remote Healthcare System to Tackle COVID-19 Pandemic Situation in Unreached Communities.

Medical staff carry an inordinate risk of infection from patients, and many doctors, nurses, and other healthcare workers are affected by COVID-19 worldwide. The unreached communities with noncommunicable diseases (NCDs) such as chronic cardiovascular, respiratory, endocrine, digestive, or renal diseases became more vulnerable during this pandemic situation. In both cases, Remote Healthcare Systems (RHS) may help minimize the risk of SARS-CoV-2 transmission. This study used the WHO guidelines and Design Science Research (DSR) framework to redesign the Portable Health Clinic (PHC), an RHS, for the containment of the spread of COVID-19 as well as proposed corona logic (C-Logic) for the main symptoms of COVID-19. Using the distributed service platform of PHC, a trained healthcare worker with appropriate testing kits can screen high-risk individuals and can help optimize triage to medical services. PHC with its new triage algorithm (C-Logic) classifies the patients according to whether the patient needs to move to a clinic for a PCR test. Through modified PHC service, we can help people to boost their knowledge, attitude (feelings/beliefs), and self-efficacy to execute preventing measures. Our initial examination of the suitability of the PHC and its associated technologies as a key contributor to public health responses is designed to "flatten the curve", particularly among unreached high-risk NCD populations in developing countries. Theoretically, this study contributes to design science research by introducing a modified healthcare providing model.

Interventions integrating non-communicable disease prevention and reproductive, maternal, newborn, and child health: A systematic review.

Reproductive, maternal, newborn, and child health (RMNCH) care services could be critical entry points for preventing non-communicable diseases in women and children. In high-income countries, non-communicable diseases screening has been integrated into both the medical and public health systems. To integrate these services in low- and middle-income countries, it is necessary to closely examine its effectiveness and feasibility. In this systematic review, we evaluated the effectiveness of integrating gestational and non-gestational non-communicable diseases interventions and RMNCH care among women and children in low- and middle-income countries. This systematic review included randomized and quasi-randomized controlled trials published from 2000 to 2015. Participants included reproductive-age women, children < 5 years old, and RMNCH care providers. The included interventions comprised packaged care/services that integrated RMNCH services with non-communicable disease care. The outcomes were maternal and/or infant mortality and complications, as well as health care service coverage. We analyzed six studies from 7,949 retrieved articles. Yoga exercise (p < 0.01) and nutritional improvements (p < 0.05) were effective in reducing gestational hypertension and diabetes. Additionally, integrating cervical cancer and RMNCH services was useful for identifying potential cervical cancer cases. Interventions that integrate non-communicable disease care/screening and RMNCH care may positively impact the health of women and children in low- and middle-income countries. However, as primary evidence is scarce, further research on the effectiveness of integrating non-communicable disease prevention and RMNCH care is warranted. (Review Registration: PROSPERO International prospective register of systematic reviews (CRD42015023425).).

Postnatal care could be the key to improving the continuum of care in maternal and child health in Ratanakiri, Cambodia.

In South-East Asia, the maternal and child mortality rate has declined over the past decades; however, it varies among and within the countries in the region, including Cambodia. The continuum of care is an integrated series of care that women and children are required to avail continuously from pregnancy to the child/motherhood period. This study aimed to assess the completion rate of the continuum of care and examine the factors associated with the continuum of care in Ratanakiri, Cambodia. A cross-sectional study was conducted in Ratanakiri. Overall, 377 women were included, and data were collected via face-to-face interviews using a semi-structured questionnaire. Among them, 5.0% completed the continuum of care (antenatal care at least four times, delivery by skilled birth attendant, and postnatal care at least once). Meanwhile, 18.8% did not receive any care during pregnancy, delivery, and after birth. The highest discontinuation rate was at the postnatal care stage (73.6%). Not receiving any perinatal care was associated with neonatal complications at 6 weeks after birth (adjusted odds ratio [AOR]: 3.075; 95% confidence interval [CI]: 1.310-7.215). Furthermore, a long distance to the health center was negatively associated with completion of the continuum of care (AOR: 0.877; 95% CI: 0.791-0.972). This study indicates the need for efforts to reduce the number of women who discontinue from the continuum of care, as well as who do not receive any care to avoid neonatal complications. Since the discontinuation rate was highest at the postnatal care, postnatal care needs to be promoted more through the antenatal care and delivery services. Furthermore, given that long distance to health facilities was a barrier for receiving the care continuously, our findings suggest the need for a village-based health care system that can provide the basic continuum of care in remote areas.

Substance use and sexual behaviors among Japanese tourists, students, and temporary workers in Honolulu, Hawaii.

A total of 249 Japanese nationals - tourists (n = 107), students (n = 98), and temporary workers (n = 44) - were recruited at the targeted community venues in Honolulu, Hawaii, and completed a structured survey questionnaire. Reported lifetime sexually transmitted diseases, or STDs infection (10% male and 20% female participants), and HIV infection rates (7%, 2 out of 31 persons tested) were high. Male participants were more likely to practice safe sex with female sex workers than with steady and casual female partners both in Japan and Hawaii. More than 80% of the participants reported having had sex under the influence of alcohol. Multivariate analysis revealed that positive attitudes toward drug use and negative attitudes toward condom use were significantly correlated with the frequency of sex under the influence of drugs with steady partners in the past 12 months. Future HIV/STD prevention intervention programs must target Japanese youths who are planning to visit Hawaii or elsewhere abroad, as well as Japanese high-risk groups (e.g., temporary workers in Hawaii), and provide information about HIV/STD prevention in relation to substance use.

Sex behaviour of male Japanese tourists in Bangkok, Thailand.

This paper explores why Japanese men engage in potentially risky commercial sexual behaviours while on holiday in Thailand. Semi-structured, in-depth interviews were conducted with 30 heterosexual male Japanese tourists, aged 19-36, who paid for sex with Thai women. Study participants were recruited at guesthouses in Bangkok. Analysis revealed eight main factors that encourage participation in commercial sex: a sense of freedom and anonymity during "time-out" spent travelling in a foreign country; a sense that there are permissive norms governing commercial sex in Thailand; the perceived sexual desirability of Thai women, a sense of economic and racial superiority relative to Thai women; a sense of loneliness or feeling in need of companionship; peer influence; the widespread availability of inexpensive sexual services in Thailand; and sexual desire or need. Findings indicate that Japanese male sexual conduct reflects individual drives while on holiday, in the context of interactions among Japanese peers, shaped by Thailand's socio-cultural environment.