Current Challenges of Digital Health Interventions in Pakistan: Mixed Methods Analysis.

BACKGROUND: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan. OBJECTIVE: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan. METHODS: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization's (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy. RESULTS: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations' inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects. CONCLUSIONS: We conclude that while digital health has a promising future in Pakistan, it is still in its infancy at the time of this study. However, due to the coronavirus disease 2019 (COVID-19) pandemic, there is an increase in demand for digital health and implementation of health outcomes following global social distancing protocols, especially in LMICs. Hence, there is a need for active involvement by public and private organizations to regulate, mobilize, and expand the digital health sector for the improvement of health care systems in countries.

TB dots strategy in District Rawalpindi: results and lessons.

BACKGROUND: Tuberculosis (TB) is one of the most ancient diseases of mankind. Despite newer modalities for diagnosis and treatment, unfortunately, people are still suffering, and TB is among the top 10 killer infectious diseases in the world. TB is a devastating disease due to its rapid transmission and high rate of mortality causing around 1.8 million deaths annually. This study was conducted to evaluate the effectiveness of the Directly Observed Therapy Short-course (DOTS) in the target population. METHODS: Two Tehsils of District Rawalpindi were selected for the study. All patients under TB treatment attending Basic Health Units (BHUs) and Rural Health Centres (RHCs) were included in the study. The patients with extra pulmonary TB and children under five years of age were excluded from the study. All patients were contacted individually and asked about the DOTS program activity using a preformed questionnaire that mainly contained questions regarding knowledge of the patients about their disease and the role of health facility in treating and following the disease. RESULTS: Out of the 224 patients who were included in the study, 87 (38.8%) were male, and 137 (61.2%) were female. Majority (48.8%) of the patients was in age group of 21-40 years and 62.5% patients had positive family history of TB. Among the patients, 51.8% were illiterate, 31.7% had studied till primary level, and only 16.5% had the educational qualification of Matric or above. In our study 69.2% of patients themselves or through their relatives reported to the health facilities to get treatment, while the rest were picked by community health workers, 62.9% were diagnosed by the public hospitals, 23.2% were diagnosed by general practitioners and 12.9% by the federal public hospitals. In our study 69.6% of the patients were not observed at all or were observed by the family members. CONCLUSION: TB is mainly a disease of the poor and illiterate people. Despite many achievements a bulk of patients are not picked by the community health providers nor are they properly observed. We need to improve the current working of the DOTS personnel. General practitioners are playing a big role in diagnosing the disease, so they need to be integrated in the DOTS to effectively diagnose and control TB.

The Influence of Person-Environment Fit on the Turnover Intention of Nurses in Jordan: The Moderating Effect of Psychological Empowerment.

There is an acute shortage of nurses worldwide, including in Jordan. The nursing shortage is considered to be a crucial and complex challenge across healthcare systems and has stretched to a warning threshold. High turnover among nurses in Jordan is an enduring problem and is believed to be the foremost cause of the nurse shortage. The purpose of this study was to investigate the multidimensional impact of the person-environment (P-E) fit on the job satisfaction (JS) and turnover intention (TI) of registered nurses. The moderating effect of psychological empowerment (PE) on the relationship between JS and TI was also investigated. Based on a quantitative research design, data were collected purposively from 383 registered nurses working at private Jordanian hospitals through self-administered structured questionnaires. Statistical Package for Social Sciences (SPSS) 25 and Smart Partial Least Squares (PLS) 3.2.8 were used to analyze the statistical data. The results showed that there is a significant relationship between person-job fit (P-J fit), person-supervisor fit (P-S fit), and JS. However, this study found an insignificant relationship between person-organization fit (P-O fit) and JS. Moreover, PE was also significantly moderate between JS and TI of nurses. This study offers an important policy intervention that helps healthcare organizations to understand the enduring issue of nurse turnover. Additionally, policy recommendations to mitigate nurse turnover in Jordan are outlined.