Capacity building and community of practice for women community health workers in low-resource settings: long-term evaluation of the Mobile University For Health (MUH).

Background: Lebanon has been facing a series of crises, significantly increasing health challenges, and straining its healthcare infrastructure. This caused deficiencies in the system's ability to attend to population health needs, and it profoundly impacted vulnerable and refugee communities who face additional challenges accessing healthcare services. In response, the Global Health Institute at the American University of Beirut designed and implemented the Mobile University for Health (MUH), which promotes task-shifting through capacity building complemented by communities of practice (CoP). The program aimed to prepare vulnerable women to assume the role of community health workers (CHW) within their communities, and to promote positive health knowledge and behaviours. Methods: A mixed-methods approach was used to evaluate MUHs' three certificates (women's health, mental health and psychosocial support, and non-communicable diseases). Implementation took place between 2019 and 2022, with 83 CHWs graduating from the program. Short-term data including knowledge assessments, course evaluations, and community member feedback surveys were collected. 93 semi-structured interviews with CHWs and 14 focus group discussions with community members were conducted to evaluate the long-term impact of the capacity building and CoP components. Results: Data revealed multiple strengths of the initiative, including increased access to education for the community, effectiveness of blended learning modality, successful planning and delivery of CoP sessions, and improved knowledge, skills, and health behaviours over time. The supplementary CoP sessions fostered trust in CHWs, increased community empowerment, and increased leadership skills among CHWs. However, some challenges persisted, including limited access to healthcare services, implementation logistical issues, difficulties with some aspects of the learning modality, and some resistance within the communities. Conclusion: MUH promoted and improved positive health knowledge and behaviours within targeted vulnerable populations in Lebanon. The supplementary CoP component proved instrumental in empowering CHWs and enhancing their impact within their communities. The study highlights the need for ongoing training and support for CHWs and underscores the importance of continued investment and adaptation of such initiatives through a gendered lens. This evaluation provides evidence on the successes of a capacity building model that has strong potential for scale and replication across health topics in conflict-affected contexts.

Automation of the Timed Up and Go Test Using a Doppler Radar System for Gait and Balance Analysis in Elderly People.

The timed up and go (TUG) test is a simple, valid, and reliable clinical tool that is widely used to assess mobility in elderly people. Several research studies have been conducted to automate the TUG test using wearable sensors or motion-tracking systems. Despite their promising results, the adopted technological systems present inconveniences in terms of acceptability and privacy protection. In this work, we propose to overcome these problems by using a Doppler radar system set into the backrest of a chair in order to automate the TUG test and extract additional information from its phases (i.e., transfer, walk, and turn). We intend to segment its phases and extract spatiotemporal gait parameters automatically. Our methodology is mainly based on a multiresolution analysis of radar signals. We proposed a segmentation technique based on the extraction of limbs oscillations signals through a semisupervised machine learning approach, on the one hand, and the application of the DARC algorithm on the other hand. Once the speed signals of torso and limbs oscillations were detected, we suggested estimating 14 gait parameters. All our approaches were validated by comparing outcomes to those obtained from a reference Vicon system. High correlation coefficients were obtained by comparing the speed signals of the torso (ρ=0.8), the speed signals of limbs oscillations (ρ=0.91), the initial and final indices of TUG phases (ρ=0.95), and the extracted parameters (percentage error < 4.8) obtained after radar signal processing to those obtained from the Vicon system.

A Systematic Review of Thirty-One Assessment Tests to Evaluate Mobility in Older Adults.

Assessments of gait, balance, and transfer in elderly people play a valuable role in maintaining healthy aging and preventing a decline in mobility. Several evaluation tools have been proposed; however, clinicians should select the most accurate ones wisely, based on numerous criteria. This systematic review aims to identify all applicable elderly mobility assessment tests and show their measurement properties with as much detail as possible. Initially, a broad search was performed. Articles were screened based on their titles and abstracts, and only studies published in English were considered. Based on our inclusion and exclusion criteria, 31 assessment tests evaluating the mobility of healthy elderly people were found. Then, further searches were completed to identify the measurement properties of each test. These characteristics include the origin and year of establishment, several practicality factors, and validity. The analysis of our outcomes illustrates the similarities and differences between the identified tests.

Gait Speed Measurement using a Doppler Radar Sensor for In-Home Functional Capacity Tests.

Gait speed is a simple physical function measure associated with key outcomes in the elderly population. Several tests are realized in order to assess the functional capacity of people. For an in-home monitoring of the functional capacity, we propose to use a Doppler radar sensor in order to continuously measure the gait speed of elderly people. We discuss at first how the gait speed is evaluated using the Doppler radar. We note three different phases in the gait speed, namely an acceleration zone, a measured-gait zone, and a deceleration zone. We thus provide a segmentation of the walking in order to automatically distinguish these zones. Experiments are conducted on ten subjects with three different paces in a total of 180 walking patterns. The gait speed obtained by the radar sensor is validated using a Vicon motion-capture system, with a correlation equal to 0.9788. We report an enhancement of 20% in measuring the gait speed as compared to traditional techniques, while removing the need for acceleration and deceleration zones.

Reliability of the Balance Quality Tester (BQT) for balance quality measurement.

Balance quality measurement is a key element in the evaluation of numerous conditions, including frailty. Four parameters were extracted from the balance quality assessment for older subjects: Rising Rate (RR), Duration of the stabilization segment (ZD), Stabilogram Area (SA) and Average Velocity of the Trajectory (TV). These are then scored and weighted, thus creating an overall indicator of balance quality. The reliability, the absolute reliability and the minimum difference of the four parameters were evaluated using the intra-class correlation coefficient (ICC), the standard error measurement (SEM) and the Minimal Detectable Change (MDC), respectively. Reproducibility was very high, with ICC values of 0.83, 0.85, 0.88 and 0.95 for RR, ZD, SA and TV, respectively. These results revealed that the parameters are a reliable measure for evaluating balance quality measurement.

Doppler Radar System for In-Home Gait Characterization using Wavelet Transform Analysis.

The evaluation of walking speed plays an important role in gerontology as it reflects the health and functional status of older people. In this paper, we propose the use of a Doppler radar system with continuous wavelet transform (CWT) analysis for in-home gait characterization. A methodology based on an accurate 3D motion-capture camera system (Vicon) has been developed in order to validate the suitable mother wavelet. The CWT analysis with several mother wavelets has been applied to our experimental Doppler radar signals. The Pearson Correlation coefficient (ρ) has been computed between the gait speed signals obtained from the radar and those obtained from the Vicon system. Our outcomes suggest the use of Daubechies5 and Symlets7 wavelets giving a ρ values of 0.86 and 0.85 respectively with a mean square error value less than 0.05 m/s in comparison with the correct gait speed value.