From Information Seeking to Empowerment: Using Large Language Model Chatbot in Supporting Wheelchair Life in Low Resource Settings

BackgroundStroke remains a major global health burden, with high recurrence rates despite preventability through standardized interventions. Mobile health (mHealth) interventions show promise in stroke recurrence prevention, yet mHealth implementation varies significantly across different resource settings. This study aimed to investigate implementation determinants and strategy alignment patterns in mHealth interventions for recurrent stroke prevention between low and high resource settings.MethodsSix databases [PubMed, Web of Science, Cochrane Library, Scopus, CNKI (China National Knowledge Infrastructure), and Wanfangdata] were searched for the publication period from January 2013 to December 2023. We included empirical studies and evidence syntheses of mHealth interventions for secondary stroke prevention with implementation descriptions, excluding those using specialized medical devices, robot-assisted interventions, or involving participants with significant comorbidities. Implementation determinants were coded using the Consolidated Framework for Implementation Research (CFIR) constructs, and implementation strategies were mapped using Expert Recommendations for Implementing Change (ERIC) taxonomy. Strategy-barrier alignment was summarized by comparing implemented versus expert-recommended strategies across settings. Statistical significance was assessed using non-parametric tests and bootstrap analyses, with sensitivity analyses accounting for study quality.ResultsFifty-five studies were included, with 52.7% conducted in low resource settings. 74.5% were published between 2019–2023, with randomized controlled trials (RCTs) being the most common study design (49.1%). Interventions primarily utilized smartphone applications (APPs) (49.1%) and instant messaging systems (IMS) (25.5%). Key CFIR determinants differed between resource settings. “Relative Advantage” (9/29 vs. 4/23) and “Access to knowledge & information” (11/29 vs. 5/23) were emphasized in low resource settings, while “Design Quality & Packaging” (2/29 vs. 9/23) and “Reflecting & Evaluating” (1/29 vs. 6/23) were highlighted in high resource settings. There was a higher adoption of recommended strategies in low resource settings compared to high resource settings (9.40 vs. 7.16 matches per study) as well as more gaps in reported strategies (9.53 vs. 8.00 gaps per study). Mann-Whitney U tests showed marginally significant differences in strategy adoption, with bootstrap analysis confirming it [mean difference =2.20, 95% confidence interval (CI): 0.36–4.12]. Implementation gaps showed no significant difference between settings (P=0.34).ConclusionsImplementation determinants and strategy adoption vary between low and high resource settings. Low-resource settings demonstrate significantly greater adoption of ERIC strategies. Context-tailored policies are critical to bridge know-do gaps in implementing stroke prevention intervention globally.

Not available.

BackgroundThe global prevalence of chronic obstructive pulmonary disease (COPD) has increased markedly in recent decades. Given the scarcity of resources available to address global health challenges and respiratory medicine being relatively under-invested in, it is important to define research priorities for COPD globally. In this paper, we aim to identify a ranked set of COPD research priorities that need to be addressed in the next 10 years to substantially reduce the global impact of COPD.MethodsWe adapted the Child Health and Nutrition Research Initiative (CHNRI) methodology to identify global COPD research priorities.Results62 experts contributed 230 research ideas, which were scored by 34 researchers according to six pre-defined criteria: answerability, effectiveness, feasibility, deliverability, burden reduction, and equity. The top-ranked research priority was the need for new effective strategies to support smoking cessation. Of the top 20 overall research priorities, six were focused on feasible and cost-effective pulmonary rehabilitation delivery and access, particularly in primary/community care and low-resource settings. Three of the top 10 overall priorities called for research on improved screening and accurate diagnostic methods for COPD in low-resource primary care settings. Further ideas that drew support involved a better understanding of risk factors for COPD, development of effective training programmes for health workers and physicians in low resource settings, and evaluation of novel interventions to encourage physical activity.ConclusionsThe experts agreed that the most pressing feasible research questions to address in the next decade for COPD reduction were on prevention, diagnosis and rehabilitation of COPD, especially in low resource settings. The largest gains should be expected in low- and middle-income countries (LMIC) settings, as the large majority of COPD deaths occur in those settings. Research priorities identified by this systematic international process should inform and motivate policymakers, funders, and researchers to support and conduct research to reduce the global burden of COPD.

Low birth-weight is a major risk factor for perinatal death in sub-Saharan Africa, but the relative contribution of determinants of birth-weight are difficult to disentangle in low resource settings. We sought to delineate the relationship between birth-weight and maternal pre-eclampsia across gestation in a low-resource obstetric setting. Prospective cohort study in a tertiary referral centre in urban Uganda, including 971 pre-eclampsia cases and 1461 control pregnancies between 28 and 42weeks gestation. Nonlinear modeling of birth-weight versus maternal pre-eclampsia status across gestation. Models were adjusted for maternal-fetal characteristics including maternal age, parity, HIV status, and socio-economic status. Propensity score matching was used to control for the severity of pre-eclampsia at different gestational ages. Mean birth-weight for pre-eclampsia cases was 2.48kg (±0.81SD) compared to 3.06kg (±0.46SD) for controls (p<0.001). At 28weeks, the mean birth-weight difference between pre-eclampsia cases and controls was 0.58kg (p<0.05), narrowing to 0.17kg at 39weeks (p<0.01). Controlling for pre-eclampsia severity only partially explained this gestational difference in mean birth-weight between pre-eclampsia cases and controls. Holding gestational age constant, pre-eclampsia status predicted 7.1-10.5% of total variation in birth-weight, compared to 0.05-0.7% for all other maternal-fetal characteristics combined. Pre-eclampsia is the dominant predictor of birth-weight in low-resource settings and hence likely to heavily influence perinatal survival. The impact of pre-eclampsia on birth-weight is smaller with advancing gestational age, a difference that is not fully explained by controlling for pre-eclampsia severity.

With rapid urbanization, hazardous environmental exposures such as air, noise, plastic, soil and water pollution have emerged as a major threat to urban health. Recent studies show that 9 out of 10 people worldwide breathe contaminated air contributing to over 7 million premature deaths annually. Internet of Things (IoT) and Artificial Intelligence (AI)-based environmental sensing and modelling systems have potential for contributing low-cost and effective solutions by providing timely data and insights to inform mitigation and management actions. While low and middleincome countries are among those most affected by environmental health risks, the appropriateness and deployment of IoT and AI systems in low-resource settings is least understood. Motivated by this knowledge gap, this paper presents a design space for a custom environmental sensing and management system designed and developed to fill the data gaps in low-resource urban settings with a particular focus on African cities. The paper presents the AirQo system, which is the first instance of the design space requirements. The AirQo system includes: (1) autonomous AirQo sensors designed and customised to be deployed in resource constrained environments (2) a distributed sensor network that includes over 120 static and mobile nodes for air quality sensing (3) AirQo network manager tool for tracking and management of installation and maintenance of nodes, (4) AirQo platform that provides calibration, data access and analytics tools to support usage among policy makers and citizens. Case studies from African cities that are using the data and insights for education, awareness and policy are presented. The paper provides a template for designing and deploying a technology-driven solution for cities in low resource settings.

Caregiver-infant interactions shape infants' early visual experience; however, there is limited work from low-and middle-income countries (LMIC) in characterizing the visual cognitive dynamics of these interactions. Here, we present an innovative dyadic visual cognition pipeline using machine learning methods which captures, processes, and analyses the visual dynamics of caregiver-infant interactions across cultures. We undertake two studies to examine its application in both low (rural India) and high (urban UK) resource settings. Study 1 develops and validates the pipeline to process caregiver-infant interaction data captured using head-mounted cameras and eye-trackers. We use face detection and object recognition networks and validate these tools using 12 caregiver-infant dyads (4 dyads from a 6-month-old UK cohort, 4 dyads from a 6-month-old India cohort, and 4 dyads from a 9-month-old India cohort). Results show robust and accurate face and toy detection, as well as a high percent agreement between processed and manually coded dyadic interactions. Study 2 applied the pipeline to a larger data set (25 6-month-olds from the UK, 31 6-month-olds from India, and 37 9-month-olds from India) with the aim of comparing the visual dynamics of caregiver-infant interaction across the two cultural settings. Results show remarkable correspondence between key measures of visual exploration across cultures, including longer mean look durations during infant-led joint attention episodes. In addition, we found several differences across cultures. Most notably, infants in the UK had a higher proportion of infant-led joint attention episodes consistent with a child-centered view of parenting common in western middle-class families. In summary, the pipeline we report provides an objective assessment tool to quantify the visual dynamics of caregiver-infant interaction across high- and low-resource settings.

ES13.05 The Ethics of International Research

IntroductionDiabetes is largely a self-managed disease; thus, care outcomes are closely linked to self-management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa.AimWe sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD).Research design and methodsA convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enumeration, consecutive sampling, purposive and judgemental sampling. Multivariable regression models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants’ experiences and context, to complement the quantitative findings.ResultsIn total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-management knowledge score was 40% ((IQR 20–60). For every one unit increase in diabetes self-management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%-9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial constraints, conflicting messages, beliefs, and stigma were the themes underpinning self-management behaviour.ConclusionsThe DSME interventions studied were under-resourced, and unstructured. Diabetes self-management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incorporate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.

BackgroundSeveral frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description.MethodsWe used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions.ResultsWe reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components.ConclusionsOur experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process.Trial registrationThe trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386; 28/12/2012); Pan Africa Trial Register (PACTR201411000724141; 14/12/2013); ClinicalTrials.gov (NCT02019823; 24/12/2013).

Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self-management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa. We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD). A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enumeration, consecutive sampling, purposive and judgemental sampling. Multivariable regression models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants' experiences and context, to complement the quantitative findings. In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-management knowledge score was 40% ((IQR 20-60). For every one unit increase in diabetes self-management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%-9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial constraints, conflicting messages, beliefs, and stigma were the themes underpinning self-management behaviour. The DSME interventions studied were under-resourced, and unstructured. Diabetes self-management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incorporate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.

Hypertension is one of the most important risk factors for cardiovascular disease. The Global Burden of Disease Study in 2010 described hypertension as the leading risk factor for global disease burden, accounting for 18% of all deaths and 7% of global disability-adjusted life years.1 Furthermore, hypertension is responsible for 45% of deaths caused by ischemic heart disease and 51% of deaths caused by stroke.2 As the leading risk for death and disability, hypertension requires a global response. Reducing uncontrolled blood pressure (BP) by 25% is one of nine United Nations targets to reduce noncommunicable diseases (NCDs) by 2025.3 To that end, hypertension was the feature of World Health Day in 2013.2 The effort to reduce uncontrolled BP is based on two distinct, but integrated, approaches. One is to lower population BP through efforts such as reducing the amount of salt consumed, and the other is to identify people at risk for vascular disease and to clinically manage their hypertension to reduce global cardiovascular risk.4 The task of clinically managing increased BP globally is daunting. In 2008, 40% of the global population older than 25 years had hypertension, representing approximately 1 billion people.5 Further, the burden of hypertension is greatest where resources are the lowest.6 For example, the African region has a hypertension prevalence rate of 46% in adults older than 25 years, compared with the Americas, which have a prevalence rate of 35%.4 In Haiti, the prevalence rate of hypertension in men and women older than 40 years is 69.1% and 67.2%, respectfully.7 Despite the high burden, awareness, and treatment, control rates are suboptimal in most developing countries, which are disproportionately impacted by hypertension. This also underlines the “know-do gap” in terms of transfer of evidence to policy and practice. Simplistically, the sequential steps to the clinical management of hypertension are: (1) the identification of people whose BP is high; (2) behavioral lifestyle counseling; (3) assessing vascular risk to identify those in whom pharmacologic interventions are cost-effective; (4) prescribing the indicated pharmacologic therapies to reduce vascular risk; and (5) titrating pharmacologic and lifestyle behavior therapy to achieve recommended risk target levels.8, 9 In most low-resource settings (LRS), the current major initial barrier is the identification of people whose BP is high.2 BP screening programs are the first step in identifying a large number of people with hypertension,10 especially in LRS where many people are unaware and do not have adequate access to a health care system. Systematic reviews of the literature have recommended BP screening.11, 12 Both the Canadian Task Force on Preventative Health Care (CTFPHC) and the US Preventive Task Force (USPSTF) have recommended screening for hypertension in adults aged 18 years or older.10, 11 These systematic reviews demonstrate substantial indirect evidence that BP screening can identify adults at increased cardiovascular risk, that diagnosis of hypertension leads to treatment, and that treatment leads to improved cardiovascular outcomes.10, 11 Hypertension control can thus be a gateway to manage other vascular and metabolic risks linked to NCDs. In a randomized controlled trial, Kaczorowski and colleagues demonstrated that a community-based BP screening program that included cardiovascular risk assessment and education sessions reduced cardiovascular morbidity and mortality.13 Additionally, there is evidence to suggest that once high BP is controlled in screened individuals, there is improvement in quality of life and work absenteeism.14-16 However, there are no standardized approaches to assist in the development of community-based BP screening programs in LRS. The systematic reviews from the CTFPHC and USPSTF found scant literature on screening programs in LRS.10, 11 While describing the Canadian landscape, Lindsay and colleagues5 demonstrated a higher prevalence of hypertension and cardiovascular disease among aboriginal populations, who also have reduced access to preventative health care, and called on practitioners to screen people who have infrequent access to health care. John and colleagues17 describes the success of a BP screening program in rural India, which uses trained primary care workers to screen older adults who do not have access to clinic-based screening. Similarly, Strogatz and colleagues demonstrate the utility of a hypertension screening program in rural North Carolina.18 Furthermore, Deepa and colleagues19 demonstrated that the “rule of halves” is still applicable in a large South Indian population, where approximately half of the individuals with hypertension are undetected, that half of those detected are not treated, and that half of those treated are not controlled. Indeed, LRS may require innovative and region-specific approaches to tackle the immense challenge of hypertension diagnosis and control.20-23 Successful approaches in LRS have been described by Kenerson with the implementation of the Haiti Hypertension Program24 and by Ordunez-Garcia with the Cuban Hypertension Program.25 These examples underline the immense need for creation and sustainability of valid BP screening programs in LRS. In order to begin addressing this gap, a World Hypertension League (WHL) committee was established on “Blood Pressure Screening Programs in Low Resource Settings” to create and disseminate comprehensive and easy-to-use resources to aid in the development and sustainability of hypertension screening programs. To that end, the WHL has developed a standard set of resources to guide the development of BP screening programs in LRS. The recommendations and resources are outlined in this manuscript and can be found at http://www.whleague.org/index.php/j-stuff/blood-pressure-assessment-train-the-trainer. In addition, supporting videos on BP screening can be found at http://www.whleague.org/index.php/j-stuff/resource-center. It is noted that the WHL BP screening committee is pilot testing these resources with the intent to refine the recommendations and resources. The “Train the Trainer” module consists of a standard set of six resources followed by a quality-improvement feedback resource evaluation form intended to provide a practical framework on how to create, sustain, and evaluate BP screening programs in LRS. The resources are intended to be used by experts. Hence, perhaps the first need is for low-resource regions of the world and national hypertension organizations to develop “Train the Trainer” workshops to increase capacity to utilize the resources. The first meeting of the Pan-African Society of Hypertension in Cameroon, December 2014, hosted such a session. Resource 1 introduces the critical components of a successful screening program. All adults older than 18 years old should be screened for hypertension.5, 6 However, if resources are scarce, most efforts should concentrate on more vulnerable individuals such as older adults. Key components of a successful BP screening program include training to accurately measure BP, use of accurate equipment, providing education on the meaning and health impact of hypertension, and adequate follow-up and access to health care for people with high BP. Other key issues described in this resource include the importance of assessing global cardiovascular risk in people with hypertension and locating the screening program in areas frequented by those at highest risk for hypertension. Resource 2 describes the importance of appropriate selection of BP devices. In LRS, a semi-automated device that has passed international standards for accuracy is recommended. A link to approved devices is provided. We describe the challenges of LRS settings, including intermittent electricity, and offer potential solutions. We recognize that many centers use manual devices; however, they are not recommended because they are rarely used appropriately and require ongoing training and assessment. The WHL is currently involved in facilitating the field testing of automated BP devices. Resource 3 and 3a describe a comprehensive algorithm on how to organize a BP screening training program. Key messages include selection of appropriate staff to oversee and conduct the screening. The program should include training on the risks of hypertension and nonpharmacologic treatment recommendations, such as the Dietary Approaches to Stop Hypertension (DASH) diet.26 BP attendants should know how to accurately select cuff size, measure BP, interpret BP readings, and refer to health care professionals when needed. BP training should be formally evaluated through a standardized form (Resource 3a). Resource 4 describes the recommended technique for measuring BP using a semi- or fully automated device in a screening program. Key components include selection of an appropriate device (semi- or fully automated when available), patient preparation, measurement technique, and recording on a data collection form. A picture illustrates the appropriate technique and patient preparation. The WHL Web site features a video illustrating the recommended BP measurement technique to aid in training and will be available in several languages (https://www.youtube.com/watch?v=egBmUw0Y0IE). Resource 5 describes the appropriate interpretation of BP readings and dissemination of this knowledge to patients. A BP reading of <140/90 mm Hg is interpreted as normal and annual BP check is recommended. A BP reading of 140 mm Hg to 179/90–109 mm Hg is considered elevated and follow-up with a health care professional within a few weeks is recommended. Shorter follow-up is recommended with BPs that are in the higher range. A BP reading >180 mm Hg to 199/110 mm Hg is considered significantly elevated and follow-up with a health care professional as soon as possible is recommended. If a patient demonstrates evidence of end-organ effects, such as chest pain, shortness of breath, or visual changes, immediate hospital referral is recommended. Resource 5 also includes a sample letter given to the patient that explains his/her BP, follow-up instruction, and lifestyle modifications to lower cardiovascular risk. Resource 6 describes a BP data collection form to be used at screening programs. It is important not only to measure BP, but also to record BP readings in a standardized manner. These data are useful in assessment of the utility of a screening program. This serves to further enhance program development and research within communities and regions. The clinical impact of undiagnosed hypertension in LRS has substantially increased on a global scale over the past few decades and is projected to increase further. NCDs are projected to be a significant barrier to economic development in LRS.4 BP screening programs provide a cost-effective and WHL-endorsed intervention to improve the rates of hypertension detection, control, and treatment, with the goal of reducing cardiovascular morbidity and mortality. WHL resources provide comprehensive and practical tools to establish and sustain a successful BP screening program. In the upcoming year there will be ongoing pilot testing of these resources in LRS. We call on national hypertension and cardiovascular organizations to make use of these resources in the development of BP screening programs. These resources will be updated regularly with ongoing feedback and field-testing results. Drs Mangat, Campbell, Mohan, Khalsa, Berbari, Jean-Charles, Kenerson, Lemogoum, Orias, Veiga, and Zhang report no specific funding in relation to this research and have no conflicts of interest to declare. Dr Niebylski is a paid contractor for the World Hypertension League but has no other conflicts to declare. Lyne Cloutier has received funding for the pilot projects from the Agence Universitaire de la Francophonie and has no conflicts of interest to declare. The World Hypertension League is grateful for the assistance of people listed here and the nations of Cameroon, Brazil, and Haiti, where pilot testing of the resources will be initiated.

In low resource settings, with very few hours of training data, state-of-the-art speech recognition systems that require large amounts of task specific training data perform very poorly. We address this issue by building data-driven speech recognition front-ends on significant amounts of task independent data from different languages and genres collected in similar acoustic conditions as the data in the low resource scenario. We show that features derived from these trained front-ends perform significantly better and can alleviate the effect of reduced task specific training data in low resource settings. The proposed features provide a absolute improvement of about 12% (18% relative) in an low-resource LVCSR setting with only one hour of training data. We also demonstrate the usefulness of these features for zero-resource speech applications like spoken term discovery, which operate without any transcribed speech to train systems. The proposed features provide significant gains over conventional acoustic features on various information retrieval metrics for this task.

The objective of this study was to establish scientific causality and to devise criteria to implicate intrapartum hypoxia in cerebral palsy (CP) in low-resource settings, where there is potential for an increase in damaging medicolegal claims against obstetric caregivers, as is currently the situation in South Africa. For the purposes of this narrative review, an extensive literature search was performed, including any research articles, randomised controlled trials, observational studies, case reports or expert or consensus statements pertaining to CP in low-resource settings, medicolegal implications, causality, and criteria implicating intrapartum hypoxia. In terms of causation, there are differences between high-income countries (HICs) and low-resource settings. While intrapartum hypoxia accounts for 10 - 14% of CP in HICs, the figure is higher in low-resource settings (20 - 46%), indicating a need for improved intrapartum care. Criteria implicating intrapartum hypoxia presented for HICs may not apply to low-resource settings, as cord blood pH testing, neonatal brain magnetic resonance imaging (MRI) and placental histology are frequently not available, compounded by incomplete clinical notes and missing cardiotocography tracings. Revised criteria in an algorithm for low-resource settings to implicate intrapartum hypoxia in neonatal encephalopathy (NE)/ CP are presented. The algorithm relies first on specialist neurological assessment of the child, determination of the occurrence of neonatal encephalopathy (by documented or verbal accounts) and findings on childhood MRI, and second on evidence of antepartum and intrapartum contributors to the apparent hypoxia-related CP. The review explores differences between low-resource settings and HICs in trying to establish causation in NE/CP and presents a revised scientific approach to causality in the context of low-resource settings for reaching appropriate legal judgments.

In low-resource settings, working age adults suffer a disproportionately higher mental health burden due to precarious work environments; yet access to evidence-based worksite mental health promotion programs remains severely limited due to the lack of professional service providers. Alternative mental wellness programs that are affordable, accessible and help build resilience to deal with the daily demands of work and life need to be introduced in workplaces of low-resource contexts. Such programs should however be acceptable and of social importance to the targeted contexts. Acceptance-based approaches meet these criteria but have mainly been implemented and evaluated in high-income countries. Gauging the appropriateness of such programs for low-resource workplace settings before wide-scale implementation is necessary. We engaged n = 14 mental health providers living and working in Kampala-Uganda in a one-day workshop focused on using acceptance and commitment training in the workplace. During in-depth interviews, these providers shared feedback on the social importance of the program's goals and effects, and acceptability of the program's procedures to Ugandan society. A deductive thematic approach was used to analyze data (codes organized according to a priori thematic categories that aligned with the Social Validity Framework). Findings showed that the program's goals and effects were gauged as socially significant and the training process was acceptable. However, key adjustments were recommended, including introducing communal values into the program, reducing session load, integrating mental health awareness strategies, and adding contextually relevant metaphors. These adjustments are likely to enhance the appropriateness of this type of acceptance-based worksite mental health promotion program for use in Uganda.

In low-resource settings, working age adults suffer a disproportionately higher mental health burden due to precarious work environments; yet access to evidence-based worksite mental health promotion programs remains severely limited due to the lack of professional service providers. Alternative mental wellness programs that are affordable, accessible and help build resilience to deal with the daily demands of work and life need to be introduced in workplaces of low-resource contexts. Such programs should however be acceptable and of social importance to the targeted contexts. Acceptance-based approaches meet these criteria but have mainly been implemented and evaluated in high-income countries. Gauging the appropriateness of such programs for low-resource workplace settings before wide-scale implementation is necessary. We engaged n = 14 mental health providers living and working in Kampala-Uganda in a one-day workshop focused on using acceptance and commitment training in the workplace. During in-depth interviews, these providers shared feedback on the social importance of the program’s goals and effects, and acceptability of the program’s procedures to Ugandan society. A deductive thematic approach was used to analyze data (codes organized according to a priori thematic categories that aligned with the Social Validity Framework). Findings showed that the program’s goals and effects were gauged as socially significant and the training process was acceptable. However, key adjustments were recommended, including introducing communal values into the program, reducing session load, integrating mental health awareness strategies, and adding contextually relevant metaphors. These adjustments are likely to enhance the appropriateness of this type of acceptance-based worksite mental health promotion program for use in Uganda.