Stories From the Field: The Use of Information and Communication Technologies to Address the Health Needs of Underserved Populations in Latin America and the Caribbean.

BACKGROUND: As their availability grew exponentially in the last 20 years, the use of information and communication technologies (ICT) in health has been widely espoused, with many emphasizing their potential to decrease health inequities. Nonetheless, there is scarce availability of information regarding ICT as tools to further equity in health, specifically in Latin American and Caribbean settings. OBJECTIVE: Our aim was to identify initiatives that used ICT to address the health needs of underserved populations in Latin America and Caribbean. Among these projects, explore the rationale behind the selection of ICT as a key component, probe perceptions regarding contributions to health equity, and describe the challenges faced during implementation. METHODS: We conducted an exploratory qualitative study. Interviews were completed via Skype or face-to-face meetings using a semistructured interview guide. Following participant consent, interviews were audio recorded and verbatim transcriptions were developed. All transcriptions were coded using ATLASti7 software. The text was analyzed for patterns, shared themes, and diverging opinions. Emerging findings were reviewed by all interviewers and shared with participants for feedback. RESULTS: We interviewed representatives from eight organizations in six Latin American and Caribbean countries that prominently employed ICT in health communication, advocacy, or surveillance projects. ICT expanded project's geographic coverage, increased their reach into marginalized or hard-to-reach groups, and allowed real-time data collection. Perceptions of contributions to health equity resided mainly in the provision of health information and linkage to health services to members of groups experiencing greater morbidity because of poverty, remote place of residence, lack of relevant public programs, and/or stigma and discrimination, and in more timely responses by authorities to the health needs of these groups as a result of the increased availability of strategic information on morbidity and its social determinants. Most projects faced initial resistance to implementation because of lack of precedents. Their financial and technical sustainability was threatened by reliance on external funding and weak transitional structures amidst key staff changes. Projects often experienced challenges in establishing meaningful communication with target audience members, mainly because of divergent motivations behind ICT use between projects and its target audience and the lack of access or familiarity with ICT among the most underserved members of such audiences. CONCLUSIONS: ICT can benefit projects focusing on the health needs of underserved populations by expanding the breadth and depth of target audience coverage and improving data management. Most projects tended to be small, short-term pilot interventions with limited engagement with the formal health sector and did not include health equity as an explicit component. Collaborative projects with government institutions, particularly those with health surveillance objectives, seemed to be the most optimistic about long-term sustainability.

Toronto's 2-1-1 healthcare services for immigrant populations.

BACKGROUND: Although access to information on health services is particularly important for recent immigrants, numerous studies have shown that their use of information and referral services is limited. This study explores the role played by 2-1-1 Toronto in supporting recent immigrants. PURPOSE: The study objectives were to (1) understand whether 2-1-1 Toronto is reaching and supporting recent immigrants and (2) gain a better appreciation of the information needs of this population group. METHODS: A phone survey was conducted in 2005-2006 to collect information on 2-1-1 users' characteristics and levels of satisfaction. Survey data were compared (in 2006) with census data to assess their representativeness. To achieve Objective 2, semistructured qualitative interviews were conducted and analyzed in 2006-2007, with a subset of Spanish-speaking callers. RESULTS: Recent immigrants were overrepresented among 2-1-1 callers. However, the survey population was substantially younger and had higher levels of formal education than the general population. Health-related queries represented almost one third of the total. The survey showed very high levels of satisfaction with the service. Many interviewees described their first experiences with the Canadian healthcare system negatively. Most of them had relied on disjointed, low-quality information sources. They trusted 2-1-1 but had discovered it late. CONCLUSIONS: Results are mixed in terms of 2-1-1's support to immigrants. A significant percentage of users do not take full advantage of the service. The service could become the information "entry point" for recent immigrants if it was able to reach them early in the resettlement process. Proactive, community-oriented work and a more creative use of technology could help.

Collaborative authoring: a case study of the use of a wiki as a tool to keep systematic reviews up to date.

BACKGROUND: Systematic reviews are recognized as the most effective means of summarizing research evidence. However, they are limited by the time and effort required to keep them up to date. Wikis present a unique opportunity to facilitate collaboration among many authors. The purpose of this study was to examine the use of a wiki as an online collaborative tool for the updating of a type of systematic review known as a scoping review. METHODS: An existing peer-reviewed scoping review on asynchronous telehealth was previously published on an open, publicly available wiki. Log file analysis, user questionnaires and content analysis were used to collect descriptive and evaluative data on the use of the site from 9 June 2009 to 10 April 2010. Blog postings from referring sites were also analyzed. RESULTS: During the 10-month study period, there were a total of 1222 visits to the site, 3996 page views and 875 unique visitors from around the globe. Five unique visitors (0.6% of the total number of visitors) submitted a total of 6 contributions to the site: 3 contributions were made to the article itself, and 3 to the discussion pages. None of the contributions enhanced the evidence base of the scoping review. The commentary about the project in the blogosphere was positive, tempered with some skepticism. INTERPRETATIONS: Despite the fact that wikis provide an easy-to-use, free and powerful means to edit information, fewer than 1% of visitors contributed content to the wiki. These results may be a function of limited interest in the topic area, the review methodology itself, lack of familiarity with the wiki, and the incentive structure of academic publishing. Controversial and timely topics in addition to incentives and organizational support for Web 2.0 impact metrics might motivate greater participation in online collaborative efforts to keep scientific knowledge up to date.

Leveling the playing field: the personal coach program as an innovative approach to assess and address the supportive care needs of underserved cancer patients.

Supportive care addresses informational, social, emotional, spiritual, physical, and practical needs that impact the lives of patients and their families. Accessing supportive care services is particularly challenging for patients facing significant financial and social barriers. This report discusses the Personal Coach Program (PCP), which provides specially trained coach navigators of supportive care for cancer patients, with special focus on those facing the above-mentioned barriers. The PCP was piloted with 63 patients treated at the Princess Margaret Hospital in Toronto, Ontario, Canada. Patients faced barriers of language, poverty, culture, social isolation, and literacy. Triangulation was used to compare and contrast multiple sources of quantitative and qualitative evaluation data. Identifying appropriate patients for referral to the PCP was a major challenge. Six categories of unmet needs were identified: practical factors related to daily living, cancer information, emotional support, interaction with the healthcare team, problems with physical health,and factors related to family and friends. Many significant barriers to supportive care and unmet needs are not identified by time-pressured clinical staff in cancer clinics. The PCP helped to identify needs and to improve ability to access services. Participants were highly satisfied with the program and believed it had positive implications for both physical and emotional health. Based on these results, a demonstration model for a supportive-care program is proposed as an integral component of care for all cancer patients, including those at risk for underservice.

Neighbourhood recent immigration and hospitalization in Toronto, Canada.

Recent immigrants to Canada tend to initially settle in low-income urban core areas. The relationships among immigration, neighbourhood effects and health are poorly understood. This study explored the risk of hospitalization in high recent-immigration areas in Toronto compared to other Toronto neighbourhoods. The study used 1996 hospitalization and census data. Regression was used to examine the effects of recent immigration on neighbourhood hospitalization rates. Most hospitalization categories showed significantly higher rates of admission as the proportion of recent immigrants increased. Income was also significantly associated with all categories of hospitalization except surgical admissions. Average household income was almost 60% lower (dollar 36,122) in the highest versus the lowest immigration areas (dollar 82,641) suggesting that, at the neighbourhood level, the effects of immigration and income may be difficult to disentangle. These findings have important implications for health care planning, delivery, and policy.

Hospitals in a globalized world: a view from Canada.

Globalization is a complex, multidimensional phenomenon that has already influenced the way hospitals operate and will increasingly impact the healthcare landscape and patients' experience worldwide. This paper briefly analyzes the direct and indirect effects of globalization on healthcare systems and services, mainly focusing on the experience of academic health sciences centres. Building their analysis on the belief that globalization is neither negative nor positive in itself, the authors compare alternative definitions of globalization, suggest possible ways in which it could impact health systems, examine how the role of large teaching and research institutions could evolve over the next decade or so, and put forward some fundamental questions faced by healthcare institutions. In the first part of the paper, the complex and multidimensional nature of globalization is analyzed and the highly polarized debate on the nature of this phenomenon briefly summarized. The second part focuses on the effects of globalization on health and healthcare. A pre-existing conceptual framework is used to analyze the complex linkages between globalization and health, and alternative scenarios are presented to illustrate the current and potential effects of international trade policies and regulations on health systems. In the third part, changes in hospitals' structure, organization and functions triggered by globalization and the introduction of new information and communication technologies are examined. The analysis is built around five main elements: patients, human resources, capital, information and funding. Finally, the paper highlights some of the most fundamental challenges, both practical and ethical, that healthcare institutions have to face in the transition to a new era of globalized health services.

Guia de supervision monitoreo y evaluacion para los programas de atencion materna y perinatal:I y II niveles de atencion / x

Camino de la sobrevivencia materna y perinatal. Supervision capacitante en comunicacion interpersonal y orientacion. Estrategia de supervision en cascada. Monitoreo. Experiencia de monitoreo en los programas materno perinatales. Indicadores de monitoreo y fuentes. Instrumentos de monitoreo. Evaluacion. Instrumentos de evaluacion.

Informe técnico proyecto: "Análisis de impacto del desayuno escolar en salud y nutrición de niños beneficiarios del PAIE / sss

Los programas de desayuno escolar no han sido suficientemente estudiados, no se ha desarrollado una evaluación completa sobre el estado nutricional por tanto el propósito de la presente investigación es contribuir con conocimientos útiles a la futura planificación de actividades de apoyo de programas de intervención nutricional y orientar a focalizar la problemática de salud del niño en edad escolar