Design, development and usability of an educational AI chatbot for People with Haemophilia in Senegal.

INTRODUCTION: Gaps in the disease knowledge of People with Haemophilia (PWH) in Senegal are important barriers to the effective management of haemophilia. Digital health systems for chronic diseases in low- and middle-income countries are suggested to improve education and self-management. Artificial Intelligence (AI) chatbots could improve knowledge and support symptom monitoring. AIM: Development process and usability testing of an AI chatbot to assess its future adoption in Senegal. METHODS: An AI chatbot prototype was designed based on a multilingual conversational engine using Natural Language Processing. A sequential mixed method was used including a co-creative design process with a task force made up of PWH and medical doctors. Usability was assessed through the System Usability Scale (SUS) questionnaire. RESULTS: An AI chatbot in French and Wolof, named Saytù Hemophilie, was developed for Android and Apple iOS devices. It was assessed as a very usable system with a SUS score of 81.7, above average. 42% would prefer to use the Wolof version even if they were very satisfied with the French version. The level of Wolof in the app did not always correspond to users' levels. Participants praised its accessibility and reliability, and its ability to enhance self-learning. CONCLUSIONS: Findings suggest that a culturally adapted digital conversational agent is likely to be used by PWH in Senegal and their families to improve education and self-management of haemophilia. Relevance and impact are foreseen for other communities in Africa and beyond.

iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations.

BACKGROUND: Implementation of digital health technologies has grown rapidly, but many remain limited to pilot studies due to challenges, such as a lack of evidence or barriers to implementation. Overcoming these challenges requires learning from previous implementations and systematically documenting implementation processes to better understand the real-world impact of a technology and identify effective strategies for future implementation. OBJECTIVE: A group of global experts, facilitated by the Geneva Digital Health Hub, developed the Guidelines and Checklist for the Reporting on Digital Health Implementations (iCHECK-DH, pronounced "I checked") to improve the completeness of reporting on digital health implementations. METHODS: A guideline development group was convened to define key considerations and criteria for reporting on digital health implementations. To ensure the practicality and effectiveness of the checklist, it was pilot-tested by applying it to several real-world digital health implementations, and adjustments were made based on the feedback received. The guiding principle for the development of iCHECK-DH was to identify the minimum set of information needed to comprehensively define a digital health implementation, to support the identification of key factors for success and failure, and to enable others to replicate it in different settings. RESULTS: The result was a 20-item checklist with detailed explanations and examples in this paper. The authors anticipate that widespread adoption will standardize the quality of reporting and, indirectly, improve implementation standards and best practices. CONCLUSIONS: Guidelines for reporting on digital health implementations are important to ensure the accuracy, completeness, and consistency of reported information. This allows for meaningful comparison and evaluation of results, transparency, and accountability and informs stakeholder decision-making. i-CHECK-DH facilitates standardization of the way information is collected and reported, improving systematic documentation and knowledge transfer that can lead to the development of more effective digital health interventions and better health outcomes.

Correction: iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations.

[This corrects the article DOI: 10.2196/46694.].

Development and Evaluation of an e-Learning Module for Low- and Middle-Income Countries on the Safe Handling of Chemotherapy Drugs.

Despite the growing use of chemotherapy drugs in resource-constrained settings, training opportunities on safe handling practices are lacking. This study's objectives were to develop and evaluate an e-learning training module on the safe handling of chemotherapy drugs to strengthen knowledge and practices in low- and middle-income countries (LMICs). The module's curriculum was developed using the Six-Step Approach for Curriculum Development for Medical Education. Asynchronous, self-paced, e-learning lessons within the module were created and uploaded onto a free online platform, Pharm-Ed. The study ran online from January to April 2021. Participant recruitment was done using convenience sampling through various channels (social media, communities of practice). Training module effectiveness was evaluated using knowledge assessments (a pre-test and post-test study design) and participant satisfaction. We developed a comprehensive e-learning module on the safe handling of chemotherapy drugs comprising 11 asynchronous, self-paced, e-learning lessons. Eighty-two participants (68% pharmacists and 17% pharmacy students) from 17 countries completed at least one lesson, with a total of 259 lessons completed. Evaluation of the different lessons showed significant improvements in theoretical knowledge (p < 0.01) in all except one lesson and a high degree of participant satisfaction. As the use of anti-cancer drugs in LMICs will continue to increase, this e-learning module is an effective means to address the lack of training opportunities on the safe handling of chemotherapies for healthcare workers in these countries. The module could be integrated into a multi-modal approach aimed at reducing occupational exposure and increasing patient safety in cancer care centers.

The safe handling of chemotherapy drugs in low- and middle-income countries: An overview of practices.

INTRODUCTION: The rising burden of cancer in low- and middle-income countries (LMICs) has led to substantial efforts to improve access to chemotherapy. The present study's objectives were to obtain an overview of the safe handling practices implemented in LMICs' healthcare facilities when dealing with chemotherapy drugs and to prioritize opportunities for improving them. METHODS: We conducted an online survey, from June 2018 to April 2019, among LMIC healthcare facilities dealing with chemotherapy drugs. Facilities were asked to self-assess their chemotherapy handling processes using Cyto-SAT, a self-assessment tool incorporating 134 items organized into 10 domains (management, personnel, logistics, prescription, preparation, administration, incident management, waste management, cleaning, and patient counselling). Data were recorded on an online platform (www.datapharma.ch/cyto-SAT). RESULTS: The survey enrolled 53 healthcare facilities (15 from low-income, 26 from lower-middle-income, and 12 from upper-middle-income countries). The median level of implementation of safe practices was 63% (Q1:39%-Q3:77%). Facilities in low-income countries (LICs) reported lower median levels of safe practices than middle-income countries (MICs) [LICs: 32% (Q1:24%-Q3:62%), Lower-MICs: 63% (Q1:49%-Q3:70%), Upper-MICs: 85% (Q1:77%-Q3:93%)]. The biggest differences between country categories were observed in the domains related to personnel, preparation processes, and incident management. CONCLUSION: This overview of practices highlighted a large variability and major gaps in the safe handling of chemotherapy drugs in LMICs. Improvement strategies are needed to increase patient and staff safety and limit environmental contamination, especially in LICs. Safe handling programs should be part of continuing efforts to improve access to quality cancer drugs and should be integrated into national cancer control programs.

Cyto-SAT: A self-assessment tool for the safe handling of cytotoxic drugs adapted for use in low- and middle-income countries.

INTRODUCTION: The handling of cytotoxic medicines is a high-risk process for human and environmental health. Considering the rising burden of cancer in low- and middle-income countries (LMICs), we aimed to develop, validate, and pilot test a self-assessment tool to support the implementation of safe handling practices and promote continuous quality improvement for cytotoxic drug management in LMICs. METHODS: First, the self-assessment tool Cyto-SAT was developed and validated. Key sources on the safe handling of cytotoxic medicines were reviewed to derive items addressing safety and quality aspects at every stage of the process. A two-round online Delphi survey was conducted to validate and prioritize the items. The validation rules in the first and second rounds were defined as ≥65% and ≥75% agreement, respectively. Then, intended users in healthcare facilities in LMICs evaluated the Cyto-SAT tool in a pilot test. They were asked to fill out an online evaluation questionnaire. RESULTS: Twenty-seven experts from 13 high-income countries and LMICs participated in the Delphi survey. Final expert consensus was achieved for 134/137 (97.8%) items. Consensus on priority was achieved for 52 of 134 (38.8%) items. The final Cyto-SAT tool comprises 134 items in 10 domains and 28 subdomains covering the whole cytotoxic drug handling process (https://pharmed.datapharma.ch/cyto-sat_en/). Staff from 34 institutions in 28 LMICs completed the Cyto-SAT evaluation. Almost all of them reported total agreement or agreement with its usefulness (96%), applicability (94%), usability (98%), and acceptability (97%). CONCLUSION: Cyto-SAT is the first self-assessment tool designed to assist professionals in LMICs in the safe handling of cytotoxic drugs. The pilot test revealed that Cyto-SAT is a useful and highly appreciated tool that supports practice improvement in LMICs. Cyto-SAT will be used in an international survey to obtain a global overview of handling practices in various LMIC settings.

Unravelling the knowledge, beliefs, behaviours and concerns of Persons with Haemophilia and their carriers in Senegal.

INTRODUCTION: In many sub-Saharan countries, haemophilia exists in an environment of poor knowledge and poor access to treatment. To improve the quality of life of Persons with Haemophilia (PWH), understanding their unmet needs and the socio-cultural realities is essential. AIM: This study aims to explore disease knowledge, beliefs, behaviours and concerns of PWH and carriers as a way to find adapted solutions to address the unmet needs. METHODS: Based on an interview guide, we performed a qualitative study with in-depth interviews of 26 PWH and 14 carriers. RESULTS: Eighty per cent of adult PWH were able to name the severity of haemophilia, but only 32% could describe with accuracy the mode of transmission of haemophilia. Only 23% of carriers were able to inform the severity of the disease. All carriers and adult PWH acknowledged at least one visit to a traditional healer. Acceptance of the disease through religion is the dominant coping strategy observed. High costs of treatment, fear of social rejection, difficulty of management of pain and bleeding at home were the main concerns. CONCLUSIONS: Results demonstrate important gaps in knowledge, especially within the carrier population, mothers in Africa playing particularly an important role in the survival and empowerment of PWH. Findings also indicate the important weight of cultural determinants in disease management and behaviours of PWH and thus their important role in the development of educational materials taking into account these determinants.

SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon (TB-SMS Cameroon): a randomised controlled trial.

BACKGROUND: In Cameroon, the National Tuberculosis Control Program that applies selective directly observed treatments faces difficulties in its implementation for a lack of resources, leading to only 65% of patients with sputum smear-positive pulmonary tuberculosis being cured after 6 months of treatment. This study aimed to evaluate the effectiveness of daily Short Message Service reminders to increase adherence and the proportion of adult tuberculosis patients cured after 6 months of treatment. METHODS: A simple blinded, randomised controlled, multicentre study carried out in 12 Treatment and Diagnostic Centres of Yaoundé. The patients included were randomly assigned to two groups: patients in the intervention group received daily SMS reminders in addition to the usual treatment; those in the control group received the usual treatment only. The primary outcomes were the number and proportion of treatment success at 5 months, and the number and proportion of patients cured at 6 months. Data analysis was by intention to treat. RESULTS: Two hundred and seventy-nine participants were randomized into intervention group (n = 137) and control group (n = 142). At five months, there were 111 treatment success (81%) in the intervention group and 106 (74.6%) in the control group (OR = 1.45 [0.81, 2.56]; p = 0.203). At 6 months, there were 87 patients cured (63.5%) in the intervention group and 88 (62%) in the control group (OR = 1.06 [0.65, 1.73]; p = 0.791). The number of drop-outs at 6 months was 47 (34.3%) in intervention group, and 46 (32.4%) in the control group. 48.9% (23/47) and 39.1% (18/46) of these drop-outs were sputum-negative at 5 months. At three different appointments, there were no significant differences between the two groups in any secondary outcomes. Very high and similar satisfaction was found for general management of patients in both groups: 99.5 and 99.2% (p = 0.41). CONCLUSIONS: Our study suggests that SMS reminders do not increase treatment success and cure proportions. However, the low proportion of patients cured at 6 month may be an underestimation due to a high dropout rate between the fifth and the sixth months of treatment. Future trials should focus on reducing the dropout rate. TRIAL REGISTRATION: The trial was registered on the Pan-African Clinical Trials Registry ( PACTR201307000583416 of 22 July 2013) and the protocol was published.

Applications of Space Technologies to Global Health: Scoping Review.

BACKGROUND: Space technology has an impact on many domains of activity on earth, including in the field of global health. With the recent adoption of the United Nations' Sustainable Development Goals that highlight the need for strengthening partnerships in different domains, it is useful to better characterize the relationship between space technology and global health. OBJECTIVE: The aim of this study was to identify the applications of space technologies to global health, the key stakeholders in the field, as well as gaps and challenges. METHODS: We used a scoping review methodology, including a literature review and the involvement of stakeholders, via a brief self-administered, open-response questionnaire. A distinct search on several search engines was conducted for each of the four key technological domains that were previously identified by the UN Office for Outer Space Affairs' Expert Group on Space and Global Health (Domain A: remote sensing; Domain B: global navigation satellite systems; Domain C: satellite communication; and Domain D: human space flight). Themes in which space technologies are of benefit to global health were extracted. Key stakeholders, as well as gaps, challenges, and perspectives were identified. RESULTS: A total of 222 sources were included for Domain A, 82 sources for Domain B, 144 sources for Domain C, and 31 sources for Domain D. A total of 3 questionnaires out of 16 sent were answered. Global navigation satellite systems and geographic information systems are used for the study and forecasting of communicable and noncommunicable diseases; satellite communication and global navigation satellite systems for disaster response; satellite communication for telemedicine and tele-education; and global navigation satellite systems for autonomy improvement, access to health care, as well as for safe and efficient transportation. Various health research and technologies developed for inhabited space flights have been adapted for terrestrial use. CONCLUSIONS: Although numerous examples of space technology applications to global health exist, improved awareness, training, and collaboration of the research community is needed.

[A relational approach to partnership between patients and professionals : design and implementation]. / Démarche relationnelle du partenariat entre patients et professionnels : conception et implémentation.

To implement an institutional culture of the partnership, the University Hospitals of Geneva (HUG) first studied existing collaborations between patients and professionals. The engaged professionals, their positions, and patient involvement form the structure of the relational approach. This approach relies on a foundation of consideration for others, their expertise and mutual respect. The Patient Partners Platform networks partners and their actions, supports initiatives and educates about partnership. Exchanges between patients and healthcare professionals are sustained (67 meetings and 510 patient involvements in 2 years) ; each party reaps benefits. This implementation strategy facilitates partner involvement, encourages partnership and is easily transferable to all healthcare institutions.

Pour implémenter la culture institutionnelle du partenariat, les Hôpitaux universitaires de Genève (HUG) ont d'abord étudié les collaborations existant entre patients et professionnels. Les professionnels engagés, leurs positions et l'implication des patients sont la structure de la démarche relationnelle. Elle repose sur la considération de l'autre, de son expertise et sur le respect mutuel. La Plateforme Patients partenaires met en réseau les partenaires et leurs actions, soutient les initiatives et éduque au partenariat. Les échanges entre patients et professionnels se pérennisent (67 rencontres et 510 implications de patients en deux ans); chaque partie en retire des bénéfices. Cette stratégie d'implémentation facilite l'adhésion des partenaires, encourage le partenariat et est facilement transposable à tous les établissements de soins.

[Moving towards patient-centered care using a mobile application : the Concerto project].

The benefits of patient empowerment are more and more recognized, and digital technologies have an important potential to favor it. The mobile application Concerto, prototyped during a hackathon, was co-created by caregivers, developers and patients by using a user-centered design and an agile development methodology. It uses the information available in the hospital information system to provide patients with an up-to-date schedule of care, targeted medical and practical information, a presentation of the care team and a tool promoting interactions with caregivers. The project is currently in experimental phase in 4 care units, and regularly improved through continuous evaluation and integration of new modules.

Les bénéfices de l'engagement des patients dans leurs soins sont de plus en plus reconnus et les technologies numériques disposent d'un potentiel important pour le favoriser. L'application mobile Concerto, prototypée lors d'un hackathon, a été cocréée par des soignants, des développeurs et des patients en utilisant une méthodologie de développement agile, basée sur les besoins utilisateurs. Elle utilise les informations présentes dans le système d'information hospitalier pour proposer au patient un agenda de soins mis à jour en temps réel, une information médicale et pratique adaptée, une présentation de l'équipe soignante et un outil de préparation aux interactions patient-soignant. Actuellement en phase pilote dans quatre unités, le projet poursuit son amélioration sur la base d'une évaluation continue et d'intégration de nouveaux modules.

[Real-time tele-training for obstetrical ultrasonography in Congo Brazzaville]. / Télémédecine au Congo Brazzaville : formation continue à l'échographie obstétricale par supervision en direct.

The Republic of Congo is facing a shortage of specialists and an unequal distribution of healthcare professionals between urban and rural areas, limiting access to diagnostic ultrasonography. Besides other issues this project aims at establishing the feasibility of remote training by live teleconsultation in obstetrical ultrasonography, as a mechanism to support isolated care by untrained staff. The project includes abdominal ultrasound testing for women during all stages of pregnancy. The first results have shown that the transmission of dynamic images, at a low cost internet connection, offers the possibility of distance training of peripheral health professionals, with the real-time remote support of gynecologists.

La République du Congo fait face à une pénurie de spécialistes et leur répartition est inégale entre la capitale et les zones périphériques. La précarité financière des femmes enceintes et les difficultés logistiques engendrées par un déplacement à la capitale constituent un frein au suivi médical de la grossesse. Ce projet démontre la faisabilité d'une formation à distance à l'échographie obstétricale de professionnels de la santé grâce à une téléconsultation en direct par des gynécologues obstétriciens de Brazzaville. Le projet est encore en cours et les premiers résultats sur le terrain sont très encourageants et en démontrent la pertinence. En effet, la transmission d'images dynamiques permet à ce jour de former des professionnels de santé de périphérie en leur assurant un soutien en temps réel dans la prise en charge des patientes, grâce à des connexions internet à bas coût.

Reverse innovation experiences from the RAFT e-learning and telemedicine network.

Available infrastructure, resources, and provided services in low-and middle-income countries differ significantly from high-income countries. In healthcare for example, the uneven distribution of health professionals and lack of human resources are real barriers to equitable access to quality health care and services in most developing countries and particularly in Sub-Saharan Africa. As available resources are lower and infrastructure is les developed many services and tools that have been developed for a high-income context cannot be used or are not sustainably affordable in a low-income environment, which led to the development of tools and services that are affordable and appropriate for this context. This ranges from concepts of blended learning, over tools for distance education and diagnostic to hardware like affordable and robust ultrasound machines and services like mobile payment. Many of these solutions and tools also have a great potential to be utilized in a different context and some of them have been deployed in high-income countries.

A call for a moratorium on the .health generic top-level domain: preventing the commercialization and exclusive control of online health information.

In just a few weeks, the Internet could be expanded to include a new .health generic top-level domain name run by a for-profit company with virtually no public health credentials - unless the international community intervenes immediately. This matters to the future of global public health as the "Health Internet" has begun to emerge as the predominant source of health information for consumers and patients. Despite this increasing use and reliance on online health information that may have inadequate quality or reliability, the Internet Corporation for Assigned Names and Numbers (ICANN) recently announced it intends to move forward with an auction to award the exclusive, 10 year rights to the .health generic top-level domain name. This decision is being made over the protests of the World Medical Association, World Health Organization, and other stakeholders, who have called for a suspension or delay until key questions can be resolved. However, rather than engage in constructive dialogue with the public health community over its concerns, ICANN chose the International Chamber of Commerce-a business lobbying group for industries to adjudicate the .health concerns. This has resulted in a rejection of challenges filed by ICANN's own independent watchdog and others, such that ICANN's Board decided in June 2014 that there are "no noted objections to move forward" in auctioning the .health generic top-level domain name to the highest bidder before the end of the year. This follows ICANN's award of several other health-related generic top-level domain names that have been unsuccessfully contested. In response, we call for an immediate moratorium/suspension of the ICANN award/auction process in order to provide the international public health community time to ensure the proper management and governance of health information online.

Consensus standards for introductory e-learning courses in human participants research ethics.

This paper reports the results of a workshop held in January 2013 to begin the process of establishing standards for e-learning programmes in the ethics of research involving human participants that could serve as the basis of their evaluation by individuals and groups who want to use, recommend or accredit such programmes. The standards that were drafted at the workshop cover the following topics: designer/provider qualifications, learning goals, learning objectives, content, methods, assessment of participants and assessment of the course. The authors invite comments on the draft standards and eventual endorsement of a final version by all stakeholders.

Medical and economic benefits of telehealth in low- and middle-income countries: results of a study in four district hospitals in Mali.

BACKGROUND: The aim of this study was to evaluate the impact of telehealth on 1) the diagnosis, and management in obstetrics and cardiology, 2) health care costs from patients' perspectives, 3) attendance at health centres located in remote areas of Mali. METHODS: The impact of telehealth on health care utilization, quality, and costs was assessed using a five-point Likert-scale based questionnaire consisting of three dimensions. It was completed by health care professionals in four district hospitals. The role of telehealth on attendance at health centres was also assessed based on data collected from the consultations logs before and during the project, between project sites and control sites. Referrals specific to the activities of the research study were also evaluated using a questionnaire to measure the real share of telehealth tools in increasing attendance at project sites. Finally, the cost savings achieved was estimated using the transport and lodging costs incurred if patients were to travel to the capital city for the same tests or care. RESULTS: The telehealth activities contributed to improving medical diagnoses in cardiology and obstetrics (92.6%) and the patients' management system on site (96.2%). The attendance records at health centres increased from 8 to 35% at all project sites during the study period. Patients from project sites saved an average of 12380 XOF (CFA Francs) or 25 USD (American dollar) and a maximum of 35000 XOF or 70 USD compared to patients from neighbouring sites, who must go to the capital city to receive the same care. CONCLUSION: We conclude that in Mali, enhanced training in ultrasound / electrocardiography and the introduction of telehealth have improved the health system in remote areas and resulted in high levels of appropriate diagnosis and patient management in the areas of obstetrics and cardiology. Telehealth can also significantly reduce the cost to the patient.

E-Health, another mechanism to recruit and retain healthcare professionals in remote areas: lessons learned from EQUI-ResHuS project in Mali.

BACKGROUND: The aim of this study was to evaluate the perceived influence of telehealth on recruitment and retention of healthcare professionals in remote areas in Mali. METHODS: After 15 months of diagnosis imaging training and telehealth activities at four project sites in remote Mali, between May 2011 and August 2012, a 75-item questionnaire was administered to healthcare professionals to assess the various factors related to Information and Communication Technologies (ICT), especially telehealth, and their influence on health personnel recruitment and retention. Questions assessing perceived impact of telehealth on recruitment and retention of healthcare professionals were rated on a five-point Likert scale. Dependent variables were perceived influence of ICT on recruitment and retention and independent variables were access to ICT, ICT training, ICT use, perceived benefits and drawbacks of telehealth, and perceived barriers to recruitment and retention. A multiple linear regression was performed to identify variables explaining the respondents' perceptions regarding telehealth influence on recruitment and retention. RESULTS: Data analysis showed that professionals in remote areas have very positive perceptions of telehealth in general. Many benefits of telehealth for recruitment and retention were highlighted, with perceived benefits of ICT (p = 0.0478), perceived effects of telehealth on recruitment (p = 0.0018), telehealth training (0.0338) and information on telehealth (0.0073) being the strongest motivators for recruitment, while the perceived effects of telehealth on retention (p = 0.0018) was the only factor significantly associated with retention. CONCLUSIONS: Based on our study results, telehealth could represent a mechanism for recruiting and retaining health professionals in remote areas and could reduce the isolation of these professionals through networking opportunities.