Health insurance and contraceptive use, Indonesian Family Planning Census 2021.

Objective: To assess the association between health insurance coverage and sociodemographic characteristics, and the use of modern contraception in Indonesia. Method: We used data from the 2021 Indonesian family planning census which included 38 408 597 couples. Contraception is covered by the national health insurance scheme: members are non-contributory (for poor families who do not make any monetary contribution) or contributory (for better-off families who pay for the insurance). We used regression analyses to examine the correlation between each type of health insurance (non-contributory, contributory, private or none) and contraceptive use and type of contraceptive used. Findings: The prevalence of the use of modern contraceptives in Indonesia was 57.0% (21 897 319/38 408 597). Compared with not having health insurance, having health insurance was associated with a greater likelihood of contraceptive use, odds ratio (OR): 1.14 (95% confidence intervals, CI: 1.13-1.14) and OR: 1.01 (95% CI: 1.01-1.01) for women with non-contributory and contributory health insurance, respectively. Having private health insurance was associated with lower use of modern contraceptives (OR: 0.94; 95% CI: 0.94-0.94). Intrauterine devices, lactational amenorrhoea and tubal ligation were the most common forms of contraceptive used by women. Conclusion: The prevalence of modern contraceptive use in Indonesia is lower than the 75% target of the 2030 sustainable development goals. As national health insurance positively correlated with modern contraceptive use, extending its coverage on remote Indonesian islands is recommended to increase the use of such contraceptive methods in those areas.

Trajectories of self-reported hearing and their associations with cognition: evidence from the United Kingdom and United States of America.

OBJECTIVE: This study aimed to investigate the relationships between trajectories of change in self-reported hearing over eight years with subsequent effects on cognition, measured using episodic memory. METHODS: Data were drawn from 5 waves (2008-2016) of the English Longitudinal Study of England (ELSA) and the Health and Retirement Study (HRS), involving 4,875 individuals aged 50+ at the baseline in ELSA and 6,365 in HRS. The latent growth curve modelling was used to identify trajectories of hearing over eight years, and linear regression models were performed to investigate the relationship between hearing trajectory memberships and episodic memory scores, controlling for confounding factors. RESULTS: Five trajectories of hearing (stable very good, stable fair, poor to fair/good, good to fair, and very good to good) were retained in each study. Individuals whose hearing remains suboptimal and those whose hearing deteriorates within suboptimal levels throughout eight years have significantly poorer episodic memory scores at follow-up than those with stable very good hearing. Conversely, individuals whose hearing declines but is within an optimal category at baseline do not see significantly poorer episodic memory scores than those with consistently optimal hearing. There was no significant relationship between individuals whose hearing improved from suboptimal baseline levels to optimal by follow-up and memory in ELSA. However, analysis using HRS data shows a significant improvement for this trajectory group (-1.260, P < 0.001). CONCLUSIONS: Either stable fair or deterioration in hearing is associated with worse cognitive function, both stable good or improving hearing is associated with better cognitive function specifically episodic memory.

A prospective analysis examining frailty remission and the association with future falls risk in older adults in England.

BACKGROUND: Previous research has shown older adults experience dynamic changes in frailty status. This study aimed to determine the occurrence of sustained frailty remission and how remission is associated with falls risk. METHODS: Participants who contributed data to the analysis were in the English Longitudinal Study of Ageing from Waves 1 to 8 (2002-2017). Frailty was defined across waves using the frailty index and categorised into robust, pre-frail and frail. We classified participants who improved their frailty category from Wave 1 (2002) to Wave 2 (2004) and sustained/improved category again into Wave 3 (2006) and compared them with those who were either robust or frail across Waves 1-3. Cox proportional hazard modelling was used to determine the risk of incident falls reported at Waves 4-8, with results expressed as hazard ratios and 95% confidence intervals. RESULTS: Of 2,564 participants, 389 (15·2%) improved frailty category and sustained this during Waves 2-3, 1,489 (58·1%) remained robust and 686 (26·8%) remained frail during Waves 1-3. During the 10-year period (Waves 4-8), a total of 549 participants reported a fall. Compared with those who remained frail during Waves 1-3, those who with sustained frailty remission had a lower risk of future falls (HR 0·41; 95% CI = 0·36-0·45). CONCLUSIONS: Frailty remission is possible and can be sustained across 5 years. There is a lower risk of future falls in those who sustain frailty remission compared with those who remain frail.

Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15 years (2002-2017).

BACKGROUND: frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. OBJECTIVE: to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. DESIGN: population-based cohort study. SETTING: communities in England. SUBJECTS: in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. METHODS: multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. RESULTS: the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0-34.6%] and 11.7 (11.1-12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2-1.3) and 2.2 (95% CI = 2.1-2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. CONCLUSIONS: in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.

Performance-based incentives and community health workers' outputs, a systematic review.

OBJECTIVE: To review the evidence on the impact on measurable outcomes of performance-based incentives for community health workers (CHWs) in low- and middle-income countries. METHODS: We conducted a systematic review of intervention studies published before November 2020 that evaluated the impact of financial and non-financial performance-based incentives for CHWs. Outcomes included patient health indicators; quality, utilization or delivery of health-care services; and CHW motivation or satisfaction. We assessed risk of bias for all included studies using the Cochrane tool. We based our narrative synthesis on a framework for measuring the performance of CHW programmes, comprising inputs, processes, performance outputs and health outcomes. FINDINGS: Two reviewers screened 2811 records; we included 12 studies, 11 of which were randomized controlled trials and one a non-randomized trial. We found that non-financial, publicly displayed recognition of CHWs' efforts was effective in improved service delivery outcomes. While large financial incentives were more effective than small ones in bringing about improved performance, they often resulted in the reallocation of effort away from other, non-incentivized tasks. We found no studies that tested a combined package of financial and non-financial incentives. The rationale for the design of performance-based incentives or explanation of how incentives interacted with contextual factors were rarely reported. CONCLUSION: Financial performance-based incentives alone can improve CHW service delivery outcomes, but at the risk of unincentivized tasks being neglected. As calls to professionalize CHW programmes gain momentum, research that explores the interactions among different forms of incentives, context and sustainability is needed.

Hearing and vision health for people with dementia in residential long term care: Knowledge, attitudes and practice in England, South Korea, India, Greece, Indonesia and Australia.

OBJECTIVES: Up to 90% of people with dementia in long term care (LTC) have hearing and/or vision impairment. Hearing/vision difficulties are frequently under-recognised or incompletely managed. The impacts of hearing/vision impairment include more rapid cognitive decline, behavioural disturbances, reduced quality of life, and greater care burden. This research investigated LTC staff knowledge, attitudes and practice regarding hearing/vision care needs for residents with dementia. METHODS: A survey of staff in LTC facilities in England, South Korea, India, Greece, Indonesia and Australia. Respondents used a five-point scale to indicate agreement or YES/NO response to questions regarding sensory-cognitive care knowledge (what is known); attitudes (what is thought); practice (what is done). RESULTS: Respondents reported high awareness of hearing/vision care needs, although awareness of how to identify hearing/vison difficulties or refer for assessment was low. Most felt that residents were not able to use hearing/vision devices effectively due to poor fit, being poorly tolerated or lost or broken devices. A substantial minority of respondents reported low confidence in supporting use of assistive hearing/vision devices, with lack of training the main reason. Most staff did not undertake routine checking of hearing/vision devices, and it was rare for facilities to have designated staff responsible for sensory needs. Variation among countries was not significant after accounting for staff experience and having received dementia training. CONCLUSIONS: There is a need to improve sensory support for people with dementia in LTC facilities internationally. Practice guidelines and training to enhance sensory-cognitive knowledge, attitudes and practice in professional care teams is called for.

Healthcare system performance and socioeconomic inequalities in hearing and visual impairments in 17 European countries.

BACKGROUND: Socioeconomic status is associated with health status among older adults, including hearing and vision impairments, and healthcare system performance is an important consideration in examining that association. We explored the link between a country's healthcare system performance and the hearing and visual impairments of its people in Europe. METHODS: This study enrolled 65 332 individuals aged 50+ from 17 countries participating in the Survey of Health, Ageing and Retirement in Europe Wave 6. We used latent class analysis to identify groups of countries based on six domains of healthcare system performance. We then performed multiple logistic regressions to quantify the association between socioeconomic status and hearing and visual impairments adjusted for demographic and other co-variates; finally, we compared the patterns of observed associations in each of the country groups. RESULTS: The latent class analysis separated countries into three groups based on the performance of their healthcare systems: poor, moderate and high. Respondents in countries with moderate and poor healthcare performance were more likely to experience hearing and visual impairment than those in countries with high healthcare performance. With respect to hearing and visual impairments, wealth gradients at the individual level varied among countries in different healthcare performance groups, with less wealth associated with worse hearing and seeing only in the countries with moderate and poor healthcare performance. CONCLUSION: The relationships between wealth and hearing and visual impairments differ among countries with different healthcare performance.

Longitudinal sleep efficiency in the elderly and its association with health.

The relationships between older age and sleep efficiency have traditionally been assessed using cross-sectional studies that ignore changes within individuals as they age. This research examines the determinants of sleep efficiency, the heterogeneity in an individual's sleep efficiency trajectory across a period of up to 27 years in later life and its associations with health. The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age cohort (n = 6,375; age 42-94 years) was used in this study. Depression and health data were collected using self-report validated instruments (Cornell Medical Index, Beck Depression Inventory and Geriatric Depression Scale). Longitudinal sleep and sociodemographic data were collected using a study-specific self-report questionnaire. A mixed-effect model was performed for sleep efficiency with adjustments for time-invariant and time-variant predictors. Latent class analysis was used to demonstrate subgroups of sleep efficiency trajectories and associations between sleep efficiency clusters and health history of the participants were investigated. Older adults have decreased sleep efficiency over time, with 18.6% decline between 40 and 100 years of age. Three sleep efficiency trajectory clusters were identified: high (32%), medium (50%) and low sleep efficiency (18%). Belonging to the high sleep efficiency cluster was associated with having lower prevalence of hypertension, circulatory problems, general arthritis, breathing problems and recurrent episodes of depression compared to the low efficiency cluster. Overall, ageing decreases sleep efficiency. However, there are detectable subgroups of sleep efficiency that are related to prevalence of different diseases.

Childhood Socioeconomic Status and Cognitive Function Later in Life: Evidence From a National Survey in Indonesia.

INTRODUCTION: Social and economic conditions in childhood have been found to predict cognitive ability in midlife and old age in high-income countries. This study examines the long-term effect of childhood conditions on cognition among a nationally representative sample of older adults in a low- and middle-income country. MATERIALS AND METHODS: Data were obtained from the 2014 to 2015 Indonesia Family Life Survey Wave 5 (6676 respondents, aged 50 years and older). Cognitive function was assessed based on total score on a series of tests adapted from the Telephone Interview for Cognitive Status. Retrospective information was collected on childhood poverty, with questions including whether respondents ever experienced hunger before age 15, whether basic facilities were available, and the number of books in the childhood home. We used linear regression to examine the association between childhood conditions and cognitive function in later life. RESULTS: The findings show that the numbers of facilities and books available in childhood homes are substantially associated with cognition in later life after taking adulthood characteristics into account. Childhood hunger has no significant association with cognitive ability in later life. Belonging to an older birth cohort and living in a rural area were shown to have negative associations with cognitive ability in Indonesia. CONCLUSIONS: Our findings suggest that childhood poverty, birth cohort, and living in a rural area may contribute to cognitive aging in Indonesia. Policies and interventions that target childhood poverty in developing countries may also recognize the rural-urban divide in access to educational and other socioeconomic resources.

Socio-economic inequalities in C-reactive protein levels: Evidence from longitudinal studies in England and Indonesia.

OBJECTIVE: The levels of health enjoyed by individuals vary according to socio-economic status, and inflammation has been proposed as one pathway through which socio-economic status influences health in high-income countries. However, little is known regarding the social determinants of inflammation in low- and middle-income countries. This study investigated the association between socio-economic status and C-reactive protein (CRP) in England and Indonesia. METHODS: This study used data from 4923 respondents aged 50+ in the English Longitudinal Study of Ageing and from 1812 respondents from the Indonesian Family Life Survey at baseline. The sources of information on individuals' education attainment, wealth, CRP and other covariates were ELSA Waves 2, 4 and 6, and IFLS Waves 4 and 5. Linear mixed models were performed to identify the longitudinal relationships between socio-economic status and CRP, and joint models were used to deal with bias in longitudinal ageing surveys due to attrition. RESULTS: Respondents with high school education (ß = -0.036, p < 0.01) or college degree or higher (ß = -0.127, p < 0.01) in England had lower CRP levels. Being wealthy is correlated with lower CRP levels in England (middle: ß = -0.073, p < 0.01; wealthiest: ß = -0.133, p < 0.01). Being wealthy and having higher education were related with higher level of CRP in Indonesia. However, those significant relationships vanished when health behaviour and health status were included in the analysis. CONCLUSIONS: The relationships between socio-economic status and CRP proved to be different in England and Indonesia. Encouraging healthy lifestyles among older adults with low socio-economic status may be the main focus of efforts toward healthy ageing in England and other developed countries. However, in Indonesia and other developing countries, attention is also required to older adults in wealthier socio-economic groups.

Hearing Impairment, Loneliness, Social Isolation, and Cognitive Function: Longitudinal Analysis Using English Longitudinal Study on Ageing.

OBJECTIVE: This study examines the relationships between hearing impairment and cognitive function among older adults, and whether that association is mediated by loneliness and social isolation. METHODS: Data were drawn from English Longitudinal Study of Ageing (ELSA) wave two (2004/2005) until wave seven (2014/2015). The study sample consisted of 8,199 individuals aged 50 years or older. Cognitive function was measured using episodic memory. We performed analysis using a generalized structural equation modeling (GSEM) technique. RESULTS: GSEM analysis shows that the direct effect of hearing impairment on episodic memory was negative and significant (ß = -0.29, p <0.001). Loneliness and social isolation mediated that effect. Hearing impairment was positively associated with loneliness (ß = 0.10, p <0.001) and social isolation (ß = 0.04, p <0.001). Loneliness (ß = -0.08, p <0.001) and social isolation (ß = -0.09, p = 0.001) were significantly associated with lower memory scores. CONCLUSION: The link between hearing impairment and episodic memory was partly mediated by loneliness and social isolation. Interventions to improve the social networks of older adults with hearing impairment are likely to be beneficial in preventing cognitive decline. Thus, the importance of maintaining social relationships among older adults, especially those with hearing impairment is highlighted.

Visual and hearing impairments are associated with cognitive decline in older people.

INTRODUCTION: highly prevalagent hearing and vision sensory impairments among older people may contribute to the risk of cognitive decline and pathological impairments including dementia.This study aims to determine whether single and dual sensory impairment (hearing and/or vision) are independently associated with cognitive decline among older adults and to describe cognitive trajectories according to their impairment pattern. MATERIAL AND METHODS: we used data from totals of 13,123, 11,417 and 21,265 respondents aged 50+ at baseline from the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE), respectively. We performed growth curve analysis to identify cognitive trajectories, and a joint model was used to deal with attrition problems in longitudinal ageing surveys. RESULTS: respondents with a single sensory impairment had lower episodic memory score than those without sensory impairment in HRS (ß = -0.15, P < 0.001), ELSA (ß = -0.14, P < 0.001) and SHARE (ß = -0.26, P < 0.001). The analysis further shows that older adults with dual sensory impairment in HRS (ß = -0.25, P < 0.001), ELSA (ß = -0.35, P < 0.001) and SHARE (ß = -0.68, P < 0.001) remembered fewer words compared with those with no sensory impairment. The stronger associations between sensory impairment and lower episodic memory levels were found in the joint model which accounted for attrition. CONCLUSIONS: hearing and/or vision impairments are a marker for the risk of cognitive decline that could inform preventative interventions to maximise cognitive health and longevity. Further studies are needed to investigate how sensory markers could inform strategies to improve cognitive ageing.

Trajectories of allostatic load among older Americans and Britons: longitudinal cohort studies.

BACKGROUND: Difference in life expectancy between males and females has been suggested to rest on sex difference in physiological dysregulation. But allostatic load, a physiological index, has not been carefully examined for an extended period beyond middle age. We aim to draw longitudinal trajectories of allostatic load in a national sample of older Americans and Britons; also to examine sex-based trajectories and factors behind their differences. METHODS: We studied men and women aged ≥50 years participating in the Health and Retirement Study Waves 8-11, 2006-2012 (N = 15,583 person-years) and the English Longitudinal Study of Ageing Waves 2, 4 and 6, 2004-2012 (N = 14,765 person-years). Because of the difference in provenance, we included different number of biomarkers to calculate allostatic load in HRS and ELSA. In HRS we used 8 biomarkers (systolic and diastolic blood pressure, haemoglobin A1c, high-density lipoprotein, total cholesterol, waist circumference, cystatin C, and C-reactive protein), while ELSA allostatic load was constructed from 10 biomarkers (systolic and diastolic blood pressure, haemoglobin A1c, high-density lipoprotein, total cholesterol, waist circumference, BMI, triglyceride, fibrinogen and C-reactive protein). A growth curve model was fitted to repeated observations of allostatic load, demographic characteristics, socioeconomic position, comorbidities and health behaviours (smoking, drinking, and physical exercise). To account for attrition, a joint model was applied. RESULTS: The analysis showed that allostatic load increases linearly with age in the U.S. However, there are different levels for males and females. In England allostatic load follows such different paths that their trajectories cross in later life. CONCLUSIONS: Sex-based trajectories of allostatic load showed distinct female advantage and are mostly consistent with female advantage in life expectancy.

Determinants of immunization status among 12- to 23-month-old children in Indonesia (2008-2013): a multilevel analysis.

BACKGROUND: Immunization is one of the most cost-effective public health interventions to prevent children from contracting vaccine-preventable diseases. Indonesia launched the Expanded Program for Immunization (EPI) in 1977. However, immunization coverage remains far below the United Nations International Children's Emergency Fund (UNICEF) and World Health Organization (WHO) target of 80%. This study aims to investigate the determinants of complete immunization status among children aged 12-23 months in Indonesia. METHODS: We used three waves of the Indonesian National Socioeconomic Survey (2008, 2011, and 2013) and national village censuses from the same years. Multilevel logistic regression was used to conduct the analysis. RESULTS: The number of immunized children increased from 47.48% in 2008 to 61.83% in 2013. The presence of health professionals, having an older mother, and having more educated mothers were associated with a higher probability of a child's receiving full immunization. Increasing the numbers of hospitals, village health posts, and health workers was positively associated with children receiving full immunization. The MOR (median odds ratio) showed that children's likelihood of receiving complete immunization varied significantly among districts. CONCLUSIONS: Both household- and district-level determinants were found to be associated with childhood immunization status. Policy makers may take these determinants into account to increase immunization coverage in Indonesia.

When Did Old Age Stop Being Depressing? Depression Trajectories of Older Americans and Britons 2002-2012.

OBJECTIVE: This study aims to investigate the implications of the heterogeneous cohort composition on depression trajectories of older adults in the United States and England. METHODS: Using growth curve models to identify depressive symptom trajectories and data spanning six waves over 10 years (2002-2012) from the U.S. Health Retirement Study and the English Longitudinal Study of Ageing, community-dwelling Americans and Britons aged 50 years and older were studied. Depressive symptoms were measured using the eight-item Center for Epidemiologic Studies Depression Scale. RESULTS: The sample included 11,919 respondents (7,095 women [59.53%]) in the United States and 10,606 respondents (5,802 women [54.7%]) in England aged 50 and older. Older cohorts were shown to have higher depressive symptoms than younger cohorts in the United States and England. The trajectories of depression of older cohorts, particularly those of the prewar cohorts in both countries and the war cohort in England, followed a U-shape. Conversely, the trajectories of depression of the younger cohort, particularly those of the postwar cohorts in both countries and the war cohort in the United States, took an inverted U-shape. CONCLUSION: The trajectories of depression in later life between cohorts took different shapes. This finding may lead to the development of more cost-effective policies for treating depression in later life.

Vision and Hearing Difficulties and Life Expectancy Without ADL/IADL Limitations: Evidence From the English Longitudinal Study of Ageing and the Health and Retirement Study.

BACKGROUND: Hearing and vision difficulties are some of the most common deficits experienced by older adults. Having either visual or hearing difficulties increases the risk of comorbidity, disability, and poor quality of life. So far, however, few studies have examined the association between vision and hearing difficulties on life expectancy without activities of daily living (ADL) or instrumental ADL (IADL) limitations (LEWL). METHODS: Data came from the English Longitudinal Study of Ageing and the Health and Retirement Study in the United States from 2002 to 2013. The outcome was defined as reporting 2+ limitations with ADL/IADL. Life expectancy was estimated by discrete-time multistate life table models for hearing and vision difficulties separately as well as for combined vision and hearing difficulties by sex and age. RESULTS: Thirteen percent of men in England and the United States had ADL/IADL limitations, whereas, for women, it was 16% and 19% in England and the United States. At all ages, either vision or hearing difficulty was associated with shorter LEWL compared to no difficulties. Dual sensory difficulty (vision and hearing) reduced LEWL by up to 12 years in both countries. At the ages of 50 and 60 in England, hearing difficulty was associated with fewer years lived without ADL/IADL limitations than vision difficulty. In contrast, in the United States, vision difficulty led to fewer years lived without ADL/IADL limitations than hearing difficulty. CONCLUSIONS: The implementation of strategies to reduce the prevalence and incidence of vision and hearing difficulties has the potential to increase the number of years spent without ADL/IADL limitations.

Implementation of mobile-health technology is associated with five-year survival among individuals in rural areas of Indonesia.

There is an urgent need to focus on implementing cost-effective health interventions and policies to reduce the burden of cardiovascular disease in Indonesia. This study aims to evaluate whether a mobile technology-supported primary health care intervention, compared with usual care, would reduce the risk of all-cause mortality among people in rural Indonesia. Data were collected from 11,098 participants in four intervention villages and 10,981 participants in four control villages in Malang district, Indonesia. The baseline data were collected in 2016. All the participants were followed for five years, and the mortality data were recorded. Cox proportional hazard model was used to examine the association between the intervention and the risk of all-cause mortality, adjusted for the covariates, including age, gender, educational attainment, employment and marital status, obesity and the presence of diabetes mellitus. During the five-year follow-up, 275 participants died in intervention villages, compared with 362 in control villages. Participants residing in intervention villages were at 18% (95%CI = 4 to 30) lower risk of all-cause mortality. Higher education attainment and being married are associated with lower risks of all-cause mortality among respondents who lived in the control villages, but not among those living in the intervention villages. A mobile technology-supported primary health care intervention had the potential to improve the five-year survival among people living in villages in an upper-middle income country.

How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review.

Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.

Is knowledge about COVID-19 associated with willingness to receive vaccine, vaccine uptake, and vaccine booster uptake in rural Malang, Indonesia?

Background: Lack of knowledge regarding the coronavirus disease (COVID-19) and COVID-19 vaccines is a key barrier to COVID-19 vaccine uptake in low- and middle-income countries (LMICs). Aims: To examine factors associated with knowledge about COVID-19 and the association between knowledge of COVID-19, willingness to receive a COVID-19 vaccine, and vaccine uptake in Malang, East Java, Indonesia. Method: A cross-sectional study among individuals aged 15-99 years was conducted in Malang, Java Timur, Indonesia between November 2022 and January 2023. Of 10,050 potential respondents, 10,007 were able to complete the survey. The main independent variable was knowledge about COVID-19, which was assessed using a six-item questionnaire. The dependent variables were COVID-19 vaccine uptake and COVID-19 booster vaccine uptake. The mediating variable was respondent's willingness to receive a COVID-19 vaccine. Linear regression was used to examine factors associated with knowledge about COVID-19. Logistic regression was employed to examine the association of knowledge about COVID-19 with vaccine uptake. Generalized structural equation modeling (GSEM) was performed to examine whether willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccination uptake. Findings: The percentage of respondents who reported having received at least one dose of a COVID-19 vaccine was 94.8%, while the percentage of those who reported having received at least three doses was 88.5%. These numbers are higher than the national average for COVID-19 vaccine and booster vaccine uptake. Most respondents answered about four of six knowledge items correctly (M = 4.60, SD = 1.1). Among respondents who had not received a vaccine, 83.1% expressed willingness to receive a vaccine when it became available to them. Older, more educated, employed respondents, and those with higher economic status, demonstrated more accurate knowledge about COVID-19 than younger, less educated, unemployed respondents and those with lower economic status. Respondents who demonstrated more accurate knowledge about COVID-19 were more likely to have received a vaccine (OR = 1.528, 95% CI = 1.428-1.634) and a booster vaccine (OR = 1.260, 95% CI = 1.196-1.328). Willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccine uptake (coef. = 0.426, 95% CI = 0.379-0.473). Implications: Interventions and public health programs aiming to improve knowledge about COVID-19 can be implemented to improve individual willingness to receive COVID-19 vaccination and to improve COVID-19 vaccine uptake among the general population.

Facilitators and barriers to the adoption of mHealth apps for COVID-19 contact tracing: a systematic review of the literature.

Background: Despite the enormous potential of mobile health (mHealth) apps for COVID-19 contact tracing, the adoption rate in most countries remains low. Thus, the objective of the current study is to identify facilitators and barriers of mHealth apps adoption for COVID-19 contact tracing based on existing studies. Methods: We conducted a systematic review of mHealth studies before December 2021 that evaluate facilitators and barriers associated with the adoption of mHealth apps for COVID-19 contact tracing. We assessed the risk of bias for all included studies using the Cochrane tool. We based our narrative synthesis on the facilitators-barriers to the adoption of mHealth framework comprising seven key factors. Results: A total of 27 articles were reviewed from 16 countries representing high income countries (France, German, Italy, United Kingdom, United States, Australia, Singapore, Belgium, Republic Ireland, Netherland, Poland, and Japan), middle-income countries (Fiji), and low-middle income countries (India). We identified the main facilitators of mHealth adoption: perceived risks to COVID-19, trust, perceived benefit, social norm, and technology readiness. The main barriers of mHealth adoption were data privacy/security concerns. Among sociodemographic factors, females, lower education, lower-income, and older individual are barriers to adoption in low-middle income countries, while most of those factors were not significantly associated with adoption in a high-income country. Conclusion: The findings imply that resolving data privacy/security issues while developing trust, perceived benefits, social norms, and technology preparedness could be effective strategies for increasing adoption intentions and app use among the general public. In low-middle-income countries, addressing digital divide is critical to the app's adoption.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249500, identifier RD42021249500 (PROSPERO).