User Groups Research Articles

Designing visual hierarchies for the communication of health data.

Visual hierarchy underlies all visual design decisions related to information presentation. This manuscript describes the experience of a multidisciplinary health data visualization and software design team in using visual hierarchy to redesign a hereditary colorectal cancer lab report. A series of interviews with representative users were conducted to identify target user groups and determine information hierarchy for each user type. Visual elements (eg, size, color, contrast, etc.) were then assigned to mirror the information hierarchy and workflow for each user type. User research identified 2 distinct user groups as consumers of the redesigned lab report. An interactive design employing a 2-level page hierarchy was developed, which stratified the content to support the needs of each user type. The challenges related to displaying the complex nature of digital and personal health data can be addressed by applying foundational design methods such as visual hierarchy. Visual hierarchy, a foundational design principle, can be used by visualization teams to clearly and efficiently present complex datasets associated with healthcare.

EXPRESS: Antihistamine and COVID-19 outcomes in outpatients.

The World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) pandemic on March 11, 2020. Since then, researchers have been investigating the efficacy and side effects of its medication, up until now. From the viewpoint of Persian medicine, some medications such as antihistamines that cause retention of secretions may lead to exacerbation and spread of the disease in the body. This prospective cohort study was designed to investigate the relationship between the use of antihistamines and the severity of COVID-19 symptoms. 300 patients with a diagnosis of COVID-19 were included in the study in Shiraz, Iran from December 4, 2021 until January 24, 2022. The interviews were conducted via phone call by a single interviewer. Patients were followed weekly for four weeks. We collected information by using a data collection form, containing demographic information, underlying disease, COVID-19 symptoms, treatment methods, medications, and a list of antihistamines and herbs that might have been used. Generalized estimating equations were applied to assess the relationship between the severity of COVID-19 and the use of antihistamines, taking into account potential confounding factors such as time and herbal consumption. The difference in the severity of COVID-19 disease in antihistamine users compared to non-users was not significant in 4 weeks. The comparison of two groups of antihistamine users and non-users showed that there was a significant difference (P-value=0.001) regarding the use of herbal medicines. The severity of COVID-19 in antihistamine users compared to non-users was not different within 4 weeks.

Development and preliminary evaluation of a genetics education booklet for retinoblastoma.

Parents and survivors of retinoblastoma often hold misconceptions about the disease and desire more extensive and detailed information about its genetic nature. The aim of this study was to co-develop and evaluate a genetic education booklet for retinoblastoma. A human-centered design approach was employed, in which the study team consulted with clinician and patient knowledge user groups to design, produce, and refine an educational booklet. Over three phases of consultation, the study team met with each knowledge user group to review booklet prototypes and collect feedback for its further refinement. A preliminary evaluation using quantitative and qualitative methods was completed with six mothers of children with retinoblastoma. The iterative, phased design process produced an educational booklet rich in images and stories, with complex genetic topics described in simplified terms. The preliminary evaluation showed an average improvement in knowledge between pre- and post-test questionnaire of 10%. Participants were satisfied with content and comprehensiveness of the information included in the booklet. A novel educational tool for families affected by retinoblastoma was developed through collaboration with health care and patient knowledge users. Preliminary evaluation results indicate it is feasible to implement and study the booklet in a prospective, pragmatic trial to evaluate its efficacy.

You Are Not Alone! Care Professionals‘ Acceptance of Telemedicine in Nursing Homes Comparing Pre- and Post-Implementation Evaluations

A lack of personnel in care institutions and high proportions of older people in need of care pose central challenges for today’s aging society, often resulting in the hospitalization of geriatric patients. In many cases, these hospitalizations are not medically necessary and cause deterioration of health. Applying telemedicine in nursing homes represents one approach aimed at a reduction of unnecessary hospitalizations of geriatric patients and supporting care personnel in medically uncertain situations. For a sustainable and successful implementation of technical innovations such as telemedical consultations, the care personnel’s perspectives and acceptance are especially essential. The Optimal@NRW project implemented telemedical consultations in 24 nursing homes in Germany, investigating medical and economic efficiency and in particular also the social acceptance of digital care in nursing homes. This paper presents quantitative results comparing the acceptance evaluations before (PRE: N = 130) and after (POST: N = 87) the implementation of the telemedical consultations in the nursing homes from the perspective of care professionals. The results showed positive evaluations of the telemedical consultations in both evaluation phases: POST evaluations especially showed a lower evaluation of perceived barriers of using telemedical consultations in nursing homes. This study’s insights enable one to derive guidelines and recommendations regarding the communication and information of telemedical applications considering the needs and wishes of care personnel as a central user group.

Development of an Alokon Stock Management Information System Using a Lean Development Approach

This study explores the development of an Alokon Stock Management Information System using the Lean Development approach to enhance the efficiency and effectiveness of stock management for contraceptive devices and drugs (alokon) distributed by the Women's Empowerment, Child Protection, and Family Planning Service in Indonesia. Alokon plays a critical role in family planning and reproductive health services. The research aims to address challenges such as inaccurate stock data, distribution delays, and the inability to meet demand promptly, which can disrupt health services. The Lean Development approach, emphasizing principles such as eliminating waste, strengthening learning, and delivering results quickly, was employed to create a responsive and adaptive system tailored to user needs. The resulting system incorporates features for managing alokon data, monitoring stock levels, and generating reports to ensure adequate stock availability and timely distribution. Evaluation of the system's usability was conducted using the System Usability Scale (SUS), involving ten respondents from the primary user groups. The average SUS score was 75, indicating a good level of usability. Users reported the system as comfortable and easy to use, although feedback highlighted areas for further improvement.

Tracking Census Online Self-Completion Using Twitter Posts

From the start of data collection for the 2020 US Census, official and celebrity users tweeted about the importance of everyone being counted in the Census and urged followers to complete the questionnaire (so-called social media campaign.) At the same time, social media posts expressing skepticism about the Census became increasingly common. This study distinguishes between different prototypical Twitter user groups and investigates their possible impact on (online) self-completion rate for the 2020 Census, according to Census Bureau data. Using a network analysis method, Community Detection, and a clustering algorithm, Latent Dirichlet Allocation (LDA), three prototypical user groups were identified: “Official Government Agency,” “Census Advocate,” and “Census Skeptic.” The prototypical Census Skeptic user was motivated by events about which an influential person had tweeted (e.g., “Republicans in Congress signal Census cannot take extra time to count”). This group became the largest one over the study period. The prototypical Census Advocate was motivated more by official tweets and was more active than the prototypical Census Skeptic. The Official Government Agency user group was the smallest of the three, but their messages—primarily promoting completion of the Census—seemed to have been amplified by Census Advocate, especially celebrities and politicians. We found that the daily size of the Census Advocate user group—but not the other two—predicted the 2020 Census online self-completion rate within five days after a tweet was posted. This finding suggests that the Census social media campaign was successful in promoting completion, apparently due to the help of Census Advocate users who encouraged people to fill out the Census and amplified official tweets. This finding demonstrates that a social media campaign can positively affect public behavior regarding an essential national project like the Decennial Census.

Alcohol consumption among older adults in the United States amidst the COVID-19 pandemic: an analysis of the 2017-2021 Behavioral Risk Factor Surveillance System.

Alcohol consumption is responsible for numerous life-threatening diseases, including liver cirrhosis, heart disease, and various cancers. During the pandemic, alcohol-related deaths increased from 2019 to 2021, topping out at approximately 108,000 deaths related to alcohol. This trendalso introduced the question whether heavy alcohol consumption and binge drinking increased during the pandemic, particularly in those 65 and older. The objective of this study is to determine whether heavy alcohol consumption and binge drinking increased during the pandemic in older adults in the United States. We performed a cross-sectional analysis of the Behavioral Risk Factor Surveillance System (BRFSS) to determine whether rates of overall alcohol consumption, heavy consumption, or binge drinking deviated from 2017 through 2021. We utilized chi-square tests to determine changes in rates over the included years. Our findings show that the overall rate of alcohol use in populations 65 and older from 2017 through 2021 wasapproximately 42.1 %, which peaked in 2017 at 43.7 % and declined each year, resulting in the lowest rate (41.3 %) in 2021 (χ 2 =8.96, p<0.0001). Binge and heavy drinking rates were 5.1 % and 4.2 % overall during this time frame, respectively, and the annual changes were not statistically significant. The impact of COVID-19 on the drinking behavior of older US adults was minimal in terms of binge orheavy drinking, although the overall rates of alcohol consumption among this group declined. Reports among other US age groups showed increased consumption and deaths from alcohol use. Future research is needed to determine the causes for the overall decrease in consumption or adaptive measures that this group may have taken, which led tominimal changes in binge or heavy drinking in contrast toyounger populations.

The effects of internet use on the cultivation of non-timber forest products

Cultivating Non-Timber Forest Products (NTFPs) serves as a crucial means to increase the income of impoverished households in remote areas, while also providing an important avenue towards achieving equitable economic development and environmental preservation. This paper explores the impact of the internet use on households' NTFPs cultivation practices. Based on the available dataset of 641 valid questionnaire responses collected through field research conducted by the research team, this study employs an in-depth analysis utilizing endogenous transformation models. Furthermore, the study recognizes the importance of considering heterogeneity among different user groups and purposes. The results indicate that households who use the internet with the proportion of NTFPs in their forest land being 8.863 % higher than others. Households who use the internet for sales having a proportion of NTFPs in their forest land that is 12.083 % higher than that of non-internet-using households, while households who use it for production only has a 6.971 % increase. Further analysis reveals that internet use increases households' social capital levels, thereby promoting NTFP cultivation, which is attributable to the rise of special e-commerce models such as WeChat business. Furthermore, the use of the internet to some extent reduces the supply of agricultural labor.

A novel affordable user interface for robotic surgery training: design, development and usability study

IntroductionThe use of robotic systems in the surgical domain has become groundbreaking for patients and surgeons in the last decades. While the annual number of robotic surgical procedures continues to increase rapidly, it is essential to provide the surgeon with innovative training courses along with the standard specialization path. To this end, simulators play a fundamental role. Currently, the high cost of the leading VR simulators limits their accessibility to educational institutions. The challenge lies in balancing high-fidelity simulation with cost-effectiveness; however, few cost-effective options exist for robotic surgery training.MethodsThis paper proposes the design, development and user-centered usability study of an affordable user interface to control a surgical robot simulator. It consists of a cart equipped with two haptic interfaces, a VR visor and two pedals. The simulations were created using Unity, which offers versatility for expanding the simulator to more complex scenes. An intuitive teleoperation control of the simulated robotic instruments is achieved through a high-level control strategy.Results and DiscussionIts affordability and resemblance to real surgeon consoles make it ideal for implementing robotic surgery training programs in medical schools, enhancing accessibility to a broader audience. This is demonstrated by the results of an usability study involving expert surgeons who use surgical robots regularly, expert surgeons without robotic surgery experience, and a control group. The results of the study, which was based on a traditional Peg-board exercise and Camera Control task, demonstrate the simulator’s high usability and intuitive control across diverse user groups, including those with limited experience. This offers evidence that this affordable system is a promising solution for expanding robotic surgery training.

Accessibility in Human Computer Interaction and Human Robot Interaction: A brief review on definitions, developers guidelines, laws and regulations

This paper presents an exploratory study of accessibility in both Human Computer Interaction and Human Robot Interaction focusing on its intersection with interrelated concepts such as usability and inclusive design. It underscores the overreaching goal of these concepts in improving the user experience and provide equal access to all user interfaces, albeit with different targeted user groups. Furthermore, the study presents a short review on main accessibility laws and developers guidelines for both Human Computer Interaction and Human Robot Interaction. The review reveals a remarkable gap in accessibility laws and guidelines for Human Robot Interaction, hence, there is an urgent need to broader initiatives and efforts from authorities, researchers community, and industry stakeholders to formulate and create accessibility laws and developers guidelines pertaining to Human Robot Interaction products, where no such laws or guidelines were found in this study, except an individual initiative by the author, which includes a proposal dedicated to help developer in creating accessible interfaces for Socially Assistive Robots. This paper also discusses some practical challenges in implementing accessibility guidelines in HCI and HRI interfaces.

Mechanism to effectively manage the interaction of a two-sided platform with buyers and sellers

Aim. To formalize and investigate a mechanism for effectively managing the interaction of a two-sided platform with buyers and sellers.Objectives. Determination of the purpose and tasks of interaction management; allocation of the core of tools for managing the interaction, formation of criteria of the mechanism functioning efficiency.Methods. The authors used logical, structural, comparative analysis, as well as applied meta-analysis of previous studies to form the theoretical basis of the mechanism of management of the interaction of bilateral platform with buyers and sellers. Consistent with the subject area, the study is based on the standard model of bilateral platforms and extends it with the basic methodological approaches of entrepreneurship theory.Results. The article contains the formalization of the mechanism of effective management of interaction of bilateral platform with buyers and sellers. Aim and objectives of interaction management are defined, the core of tools for managing the interaction is identified, and criteria for the effectiveness of the mechanism are proposed and substantiated. The study identifies key factors affecting the effectiveness of bilateral platforms, including the importance of market saturation and the need to provide flexible conditions for different groups of users. The correlation between the improvement of working conditions on the platform and the growth of its financial performance was proved.Conclusions. The formalized mechanism allows to effectively manage the interaction with parties on a two-sided platform, ensuring the growth and sustainable development of the marketplace. Further adaptation of management tools is recommended, taking into account the specifics of markets and user behavior.

Testing the Quality of the Mobile Application Interface Using Various Methods—A Case Study of the T1DCoach Application

The T1DCoach mobile application is designed to educate patients—children with type 1 diabetes (T1D) and their caregivers and diabetes educators. The idea behind the mobile application is that its users perform actions that the patient needs to perform in real life. These include measuring blood glucose levels, operating the insulin pump, meal calculation, bolus administration, etc. These in-application activities are performed on the patient’s digital twin. To increase user engagement, gamification elements have been implemented in the application. An important element of the T1DCoach mobile application is its interface, which should be adapted to very different groups of users: children, their caregivers and educators. In addition to presenting the T1DCoach application, the paper presents the stage examining the quality of the interface using three research groups: children, their caregivers and educators. The research was conducted using the scenario method, using eye-tracking, recording activities and thinking aloud. After the application testing sessions, surveys were carried out using the System Usability Scale method and focus group interviews were conducted. The research results are presented in the article along with the most important recommendations for improving the application interface.

The Management and Guidance of Network Behaviors of Students in Vocational Colleges in the Internet + Era

With the wide spread and rapid development of the Internet, the "Internet +" era has fully arrived. As a key group of Internet users, students in vocational colleges show significant diversity and increasing complexity in their network behaviors. This article focuses on this, aiming to deeply explore the specific current situation, prominent problems and effective management and guidance strategies of network behaviors of students in vocational colleges in the Internet + era. First-hand data is obtained through questionnaires and detailed analysis is conducted by combining typical cases to comprehensively and deeply explore the network behaviors of students in vocational colleges. On this basis, highly targeted and feasible management and guidance suggestions are put forward, committed to creating a healthy network environment for students in vocational colleges, promoting their healthy growth and all-round development, and enabling them to better adapt to the needs of the Internet + era.

AI-Assisted Decision-Making in Long-Term Care: Qualitative Study on Prerequisites for Responsible Innovation.

Although the use of artificial intelligence (AI)-based technologies, such as AI-based decision support systems (AI-DSSs), can help sustain and improve the quality and efficiency of care, their deployment creates ethical and social challenges. In recent years, a growing prevalence of high-level guidelines and frameworks for responsible AI innovation has been observed. However, few studies have specified the responsible embedding of AI-based technologies, such as AI-DSSs, in specific contexts, such as the nursing process in long-term care (LTC) for older adults. Prerequisites for responsible AI-assisted decision-making in nursing practice were explored from the perspectives of nurses and other professional stakeholders in LTC. Semistructured interviews were conducted with 24 care professionals in Dutch LTC, including nurses, care coordinators, data specialists, and care centralists. A total of 2 imaginary scenarios about AI-DSSs were developed beforehand and used to enable participants articulate their expectations regarding the opportunities and risks of AI-assisted decision-making. In addition, 6 high-level principles for responsible AI were used as probing themes to evoke further consideration of the risks associated with using AI-DSSs in LTC. Furthermore, the participants were asked to brainstorm possible strategies and actions in the design, implementation, and use of AI-DSSs to address or mitigate these risks. A thematic analysis was performed to identify the opportunities and risks of AI-assisted decision-making in nursing practice and the associated prerequisites for responsible innovation in this area. The stance of care professionals on the use of AI-DSSs is not a matter of purely positive or negative expectations but rather a nuanced interplay of positive and negative elements that lead to a weighed perception of the prerequisites for responsible AI-assisted decision-making. Both opportunities and risks were identified in relation to the early identification of care needs, guidance in devising care strategies, shared decision-making, and the workload of and work experience of caregivers. To optimally balance the opportunities and risks of AI-assisted decision-making, seven categories of prerequisites for responsible AI-assisted decision-making in nursing practice were identified: (1) regular deliberation on data collection; (2) a balanced proactive nature of AI-DSSs; (3) incremental advancements aligned with trust and experience; (4) customization for all user groups, including clients and caregivers; (5) measures to counteract bias and narrow perspectives; (6) human-centric learning loops; and (7) the routinization of using AI-DSSs. The opportunities of AI-assisted decision-making in nursing practice could turn into drawbacks depending on the specific shaping of the design and deployment of AI-DSSs. Therefore, we recommend considering the responsible use of AI-DSSs as a balancing act. Moreover, considering the interrelatedness of the identified prerequisites, we call for various actors, including developers and users of AI-DSSs, to cohesively address the different factors important to the responsible embedding of AI-DSSs in practice.

The Effects of Nicotine Pouches and E-Cigarettes on Oral Microbes: A Pilot Study

It remains uncertain whether nicotine pouches and electronic cigarettes alter the oral environment and result in a high presence of periodontopathogenic bacteria in saliva, compared to that among cigarette users or non-tobacco users. In this study, saliva samples were collected from respondents using nicotine pouches, electronic cigarettes, and conventional cigarettes, alongside a control group of non-tobacco users. Polymerase chain reaction was used to identify clinical isolates of the following periodontal bacteria: Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Fusobacterium nucleatum, Fusobacterium periodonticum, Porphyromonas endodontalis, and Rothia mucilaginosa. The presence of some periodontal pathogens was detected in the saliva samples from users of nicotine pouches, electronic cigarettes, and conventional cigarettes but not in samples taken from the control group. Therefore, the initial results of this pilot study suggest that the presence of periodontopathogenic bacteria in the saliva of nicotine pouch and electronic cigarette users could alter the oral microbiome, leading to periodontal diseases. However, further quantitative investigation is needed.

From collections to connections in libraries, archives and museums: Do theories meet practice?

Libraries, archives and museums are primarily seen as institutions that preserve and promote collections. However, ongoing social changes are causing them to increasingly focus on their social partners and the relationships that can be established with them. The evolving nature of these institutions’ priorities raises questions about how they are adapting to this shift and its impact on their operations. The objective of this research is to contribute to the conceptualization of the paradigm shift through verification of how selected social and cultural theories of social relations are reflected in the activities of libraries, archives and museums, as well as their connections with various partners. A content analysis of articles from three journals indicates that the relation-centric theories studied, and the concepts presented therein, are taken into account by their authors, albeit to varying degrees. The relationships of libraries, archives and museums primarily concern local communities and special user groups, but also involve other legal or individual entities, as well as the professional community.

Examining the Use of DanMu for Crowdsourcing Control in Virtual Gatherings

The advent of web-based interactive technologies has opened up new possibilities for virtual gatherings in 3D environments. Live-streaming, in particular, has gained increasing attention due to its effectiveness in engaging a large number of users in collective online activities. With an emphasis on audience participation, live-streaming shares common characteristics of the outlook of the metaverse and is driving new waves of interaction in virtual gatherings, such as engaging users through crowdsourcing control. However, this type of social interaction has not been examined in the Asian context, and it lacks systematic investigation of user experience with different crowdsourcing control methods. In this paper, we present a novel crowdsourcing control method based on DanMu, the subtitle system of Bilibili, one of the most successful and prevalent live-streaming platforms in Asia. We organized virtual gatherings by live-streaming a Minecraft virtual campus and examined the use of DanMu for crowdsourcing control. Our first study investigated the influence of three crowdsourcing control methods (First Come First Served, Vote, and Super Command) on collective navigation task efficiency and user experience. These influences were further discussed with user activeness and group sizes in a follow-up study. The results showed that Super Command, a representative mode on top of the democratic voting mechanism, offers better user experiences and social richness in large groups. Participants also rated its usability higher in small groups. Besides, virtual gathering in small groups allows greater pragmatic quality, usability, and a sense of agency than in large groups. Our work provides design guidelines for developers and HCI practitioners to develop crowdsourcing control methods and improve novel virtual gathering experiences in virtual worlds and the future metaverse.

A web-based knowledge database to provide evidence-based information to cancer patients: Utilization within the PIKKO study

PurposeCancer is associated with an urgent need for understandable and reliable information, which is often not satisfied by information available online. Therefore, as part of the PIKKO project, a web-based knowledge database (WDB) was introduced to provide cancer patients with quality-assured, evidence-based information. This paper aims to provide insights into the usage (Who? How? What?) and the effects regarding health literacy of the WDB.MethodsA patient survey and automatically generated logfile data were evaluated. Two user groups, patients and patient navigators (PNs), were compared.ResultsThe 13 PNs were responsible for 1/3 of all accesses over the entire duration of the project. The 413 patients used WDB twice on average and spent an average of 12 min per session online (PNs: 9 min per session, more frequently). The top 3 topics of interest were ‘therapy’, ‘nutrition’ and ‘carcinogenesis’ for the patients, and ‘therapy’, ‘naturopathy’ and ‘legal regulations/support’ for the PNs. Of the patients surveyed, 69% said that WDB was helpful in making informed decisions, 76% found the information they wanted and 90% thought WDB was an appropriate way to provide information.ConclusionOur WDB provided important information about cancer and its treatment on a digital way both, to patients and PNs. In routine cancer care, the WDB can improve health literacy and informed decision-making.Trial registrationThis study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21 Feb 2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703

Comparative analysis of antimicrobial activity leaf extracts against prevalent Bacterial flora Associated with doorknobs at MIET, Meerut (U.P)

Microorganisms can be found everywhere, bacteria and fungi contaminate the human body, our houses, workplaces, and our environment. Fortunately, among many billions of bacteria, only 1500 can be dangerous to our health, causing different diseases such as pneumonia or skin infection. The human hand serves as a medium for the propagation of microorganisms from place to place, and from person to person. Although, it is nearly impossible for the hand to be free of microorganisms, as the presence of pathogenic bacteria may lead to chronic or acute illness. Every day, door handles are often hotspots for bacteria, public handles especially because of the frequent and inevitable use of most door handles, it can often be expected that bacteria are present. Many factors determine the suitability and population of bacteria. The material of the handle itself contributes to the growth of bacteria, with most door handles being constructed with stainless steel which is a more suitable home for bacteria. The material affects the time bacteria can survive on door handles; but more so, the temperature and humidity of the surrounding air, depending on these bacteria can thrive anywhere from a few hours to a few weeks. Human hands usually harbor microorganisms both as part of the body's normal flora as well as transient microbes contacted from the environment. People come into contact with a variety of fomites on a regular basis, and bacterial and fungal infections are on the rise.Investigators looked at the microbial growthconnected to the use of door knobs by students at MIETCOLLEGE OF EDUCATION BAGHPAT BYPASS MEERUT. 50 door knobs were randomly chosen for microbiological analysis. The samples were examined by means of conventional microbiological techniques. Haemolytic Streptococci, Bacillus species, coagulase-negative Staphylococci, Escherichia coli, Proteus species, and Staphylococcus aureus were among the bacteria that were identified from the earphones. Aspergillus spp., Mucor spp., and Rhizopus spp. were the fungi that were isolated. Staph. aureus, 12 (24%), are among the bacteria that were isolated from the door knobs. A substantial difference in the mean occurrence values of the isolates from the two groups was shown by statistical analysis (P 0.05). The study came to the conclusion that microbial growth does increase with frequent and continuous use of door knobs in comparison to nonfrequent use of door by comparing the occurrence values of the isolates from the two groups of door knobs users. The isolates found were screened for their antimicrobial activity and rose leaf propanol extract has the best antimicrobial effect against the isolated microbes. . Key Word; Microbial Contamination, Door, Handles, Knobs, s bacteria, medicinalplants, antimicrobial activity.

Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda

BackgroundEffective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda.MethodsWe installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device).ResultsChlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products.ConclusionThe STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.