How WhatsApp is transforming health communication among frontline health workers: a mixed-method study among midwives in India.

BACKGROUND: Limited literature exists in India on WhatsApp use for health communication among frontline health workers like Auxiliary Nurse Midwives (ANM). We conducted this study to assess the adoption of WhatsApp among ANMs and identify factors influencing its adoption. In addition, the study explored the perceptions of ANMs on WhatsApp use for sharing health information. METHODS: We employed a mixed-method sequential explanatory design. We surveyed 259 ANMs, followed by in-depth interviews with 19 purposively sampled ANMs. We conducted multinomial logistic regression to identify factors associated with WhatsApp adoption and employed thematic analysis to analyze interviews. RESULTS: 257 ANMs responded to the survey questionnaire, of which 18.3%, 48.2%, and 33.5% had low, mid, and high levels of WhatsApp adoption, respectively. Education (AOR = 2.87 [95% CI = 1.20-6.85]), motivation (AOR = 6.31 [95% CI = 1.43-27.80]), and technical awareness (AOR = 2.91 [95% CI = 1.11-7.62]) were significantly associated with WhatsApp adoption. Thematic analysis of the interviews resulted in six themes describing perceptions and experiences of ANMs on WhatsApp use. They are: (i) a way of instant communication, (ii) provision for multimedia messaging, (iii) a quick fix tool for queries and concerns, (iv) make attendance and reporting easy (v) a way of reaching higher officials, and (vi) a cost-saving mechanism. CONCLUSION: WhatsApp facilitated ANMs' communication and service delivery at the grassroots level. Measures to improve motivation, technical awareness, and digital education will likely improve WhatsApp adoption among health workers.

Quality of COVID-19 information, education and communication materials in India: A content analysis.

Objective: This study examined the characteristics and quality of publicly available COVID-19 information education and communication (IEC) materials in India between March and December 2020. Design: An explanatory sequential mixed-method design was employed to examine the characteristics and quality of 265 purposefully selected IEC materials. Setting: The IEC materials analysed were those published between March and December 2020 on the Ministry of Health and Family Welfare website, Government of India. Methods: A checklist was utilised to examine the quality and characteristics of the materials. Thereafter, qualitative analysis provided insights into the contents of the materials with specific focus on the 'COVID-19 continuum of care'. Results: The majority (73.96%, n = 196) of the selected materials were directed towards the general public and had a focus on prevention (67.55 %, n = 179). Despite COVID-19-associated stigma, only 56 (21.13%) of the materials addressed this issue. However, most (95.47%, n = 253) of the materials adhered to quality standards for contents, readability and aesthetics. This qualitative analysis focused on the contents of selected IEC materials using the concept of 'continuum of care'. The analysis identified three important themes: prevention to early diagnosis and treatment; mitigation of stigma and discrimination surrounding COVID-19; and addressing the infodemic caused by COVID-19. Conclusion: The quality of materials was mostly satisfactory and appropriate to the emergent requirements. Strengthening audience engagement and attractiveness of the materials might enhance readability and actionability. A bottom-up approach to the development of future IEC materials, involving the community might widen the coverage of vulnerable populations in future crisis events.

Lived Experiences of Newly Diagnosed Type 1 Diabetes Mellitus Children and Adolescents in Uganda.

Introduction: The first-year post-diagnosis is the most challenging and stressful period in the lifetime of a young child and adolescent living with diabetes, given the adjustments that are meant to be adopted. Therefore, psychosocial factors affecting newly diagnosed children and adolescents need to be well understood and children supported to improve treatment adherence. However, evidence concerning psychosocial experiences among young patients with diabetes is scant in Uganda. This study explores the perceptions and experiences of newly diagnosed children and adolescents in Uganda. Methods: A qualitative exploratory design was employed. We recruited participants aged 6 to <18 years diagnosed within twelve months from three study sites: Mulago National Referral Hospital, Wakiso HCIV, and St Francis Nsambya Hospital. Twenty in-depth interviews were conducted, and textual data were analysed thematically using a framework approach. Results: We identified five themes: battling with symptoms, emotions at diagnosis, challenges in coping with diabetes management, changes I have made, and positive outcomes registered. The analysis found that young people living with diabetes experience a new world of adjustments, including insulin therapy, routine blood glucose monitoring, and dietary changes that are often difficult to deal with, especially in the first year after diagnosis. Discussion: Continuous psychosocial support to newly diagnosed young children and adolescents with T1DM is vital. Addressing psychosocial challenges may improve adherence to treatment regimens. Conclusion: Our findings have demonstrated the mixed experiences of newly diagnosed young children and adolescents living with diabetes, from anxiety and stigmatization to independence.

What is Stopping Primary Health Centers to Go Digital? Findings of a Mixed-method Study at a District Level Health System in Southern India.

INTRODUCTION: Electronic medical records (EMRs) are computerized medical information systems that collect, store, and display patient information and essential for the achievement of primary health-care goals. This study explores the availability and utilization of EMR and analyzed the barriers inhibiting their implementation at primary health centers (PHCs) in Nalgonda district of Telangana, India. METHODS: The research employed a sequential mixed-method design. Quantitative data were collected using a questionnaire by conducting facility surveys across 75 PHCs and in-depth interviews with district health authorities were conducted using a predesigned guide. Quantitative data were analyzed using descriptive statistics and thematic analysis of interviews resulted in four themes focusing on the factors inhibiting PHCs to use EMR. RESULTS: The availability of EMR facility was low (19.14%) and they are routinely used for maintaining immunization data in 83% of the PHCs. In contrast, none of the PHCs used EMR for prescribing medications to patients. Budgetary constraints, unavailability of dedicated information technology staff, gaps in technical knowledge, and perceptions about EMR as a time-consuming system were the commonly reported barriers inhibiting PHCs to go digital. CONCLUSION: The availability and utilization of EMR keeping was low across PHCs of Nalgonda district. The study identified multiple barriers which hinder the implementation of EMR facilities at PHCs. Addressing these barriers is crucial for the successful implementation of EMR.

How Indians responded to the Arogya Setu app?

The mHealth app Arogya Setu can substantially contribute to the containment and management of COVID-19. This study explores the experiences and expectations of Arogya Setu app users by conducting a combined content analysis of their reviews. Five hundred and three most relevant reviews were analyzed using the descriptive statistics and thematic analysis. The reviews are primarily posted in the areas of user acceptance (80%), app usefulness (72.8%), and app features (62.2%). The thematic analysis resulted in four themes: user acceptance, app usefulness, promptness of the Indian Government in bringing the app on time, and concerns and cautions raised by the users. These help in strengthening the app features enabling the real-time data capture and analytics and providing timely information to authorities for better decision-making.

Building tobacco control research in Thailand: meeting the need for innovative change in Asia.

INTRODUCTION: In low- and middle-income countries (LMICs) over the past two decades locally relevant tobacco control research has been scant. Experience shows that tobacco control measures should be based on sound research findings to ensure that measures are appropriate for local conditions and that they are likely to have an impact. Research should also be integrated within tobacco control measures to ensure ongoing learning and the production of knowledge. Thailand, a middle-income country, has a public health community with a record of successful tobacco control and a longstanding commitment to research. Thailand's comprehensive approach includes taxation; bans on tobacco advertising, sponsorship and promotion; smoke-free areas; graphic cigarette pack warnings; social marketing campaigns; cessation counseling; and an established tobacco control research program. The purpose of this study was to document and analyze the development of tobacco control research capacity in Thailand and the impact of research on Thai tobacco control measures. METHOD: We used mixed methods including review of historical documentation and policy reports, qualitative interviews with key members of Thailand's tobacco control community, and an analysis of research productivity. FINDINGS: In Thailand, tobacco control research has evolved through three phases: (1) discovery of the value of research in the policymaking arena, (2) development of a structure to support research capacity building through international collaborations supported by foreign funding agencies, and (3) delivery of locally relevant research made possible largely through substantial stable funding from a domestic health promotion foundation. Over two decades, Thai tobacco control advocates have constructed five steppingstones to success: (1) adapting foreign research to inform policymaking and lobbying for more support for domestic research; (2) attracting foreign funding agencies to support small-scale research and capacity building; (3) participating in multi-country research and capacity building programs; (4) using collaborative experiences to demonstrate the need for domestic support of locally relevant research; and (5) maintaining an unwavering commitment to research while being vigilant to ensure continued research support. CONCLUSION: The evolution of tobacco control research in Thailand provides examples of steppingstones that LMICs may be able to use to construct their own tobacco control research pathways.