Health Service Managers Research Articles

The relationship between stress, anxiety and eating behavior among Chinese students: a cross-sectional study.

The expansion of higher education and the growing number of college students have led to increased awareness of mental health issues such as stress, anxiety, and eating disorders. In China, the educational system and cultural expectations contribute to the stress experienced by college students. This study aims to clarify the role of anxiety as a mediator in the relationship between stress and eating behaviors among Chinese college students. This study utilized data from the 2021 Psychology and Behavior Investigation of Chinese Residents, which included 1,672 college students under the age of 25. The analysis methods comprised descriptive statistics, t-tests, Pearson correlation analyses, and mediation effect analysis. The findings indicate that Chinese college students experience high levels of stress, with long-term stress slightly exceeding short-term stress. Both types of stress were positively correlated with increased anxiety and the adoption of unhealthy eating behaviors. Anxiety was identified as a significant mediator, accounting for 28.3% of the relationship between long-term stress and eating behavior (95% CI = 0.058-0.183). The mediation effect of short-term stress on eating behavior through anxiety was also significant, explaining 61.4% of the total effect (95% CI = 0.185-0.327). The study underscores the importance of stress management and mental health services for college students. It recommends a comprehensive approach to reducing external pressures, managing anxiety, and promoting healthy eating behaviors among college students. Suggestions include expanding employment opportunities, providing career guidance, enhancing campus and societal support for holistic development, strengthening mental health services, leveraging artificial intelligence technologies, educating on healthy lifestyles, and implementing targeted health promotion programs.

Distribuição espacial e características clínico epidemiológicas dos casos de síndrome respiratória aguda grave por covid-19 no Brasil: estudo das duas primeiras ondas

The new coronavirus (SARS-CoV-2), the COVID-19 etiological agent, has been established as a challenge for health systems and can present as Flu Syndrome (FS) or Severe Acute Respiratory Syndrome (SARS). This work was aimed at describing the clinical epidemiological profile of SARS cases due to COVID-19 and the spatial distribution of the incidence among the Federative Units of Brazil (FU) in the first two waves. This is a descriptive and ecological study, with the FU as settings. The data collected are related to SARS cases due to COVID-19, with a time frame between March 2020 and June 2021. The sociodemographic and clinical-epidemiological variables were selected with their respective absolute and relative values. The spatial distribution of incidence was determined to identify the presence of spatial autocorrelation in the first two waves. A total of 613,324 SARS cases due to COVID-19 were reported, most were related to males, aged>60 years, typified as non-nosocomial and with a healing outcome; signs and symptoms were: cough,fever, dyspnea, and at least presence of one comorbidity. The average incidence in the countrywas 286.85 cases/100,000 inhabitants, while the Moran Index showed statistical significance I=0.329 (p value<0.001), with global spatial autocorrelation of the incidence in the second wave. The distribution was heterogeneous. These results constitute subsidies for management in health systems and services regarding the strategic implementation for the control and clinical management of this disease.

Investigating healthcare pathway management and inequalities using a novel data source: An observational study using linked, routinely collected data from a digital health system

ABSTRACT Acute coronary syndromes (ACS) are a common cause of morbidity in the UK. The mainstay of treatment is percutaneous coronary angiography (PCA) +/− percutaneous coronary intervention (PCI). In the Northwest sector of Greater Manchester and Salford, PCI labs are shared between hospitals and trusts, co-ordinated by a bespoke online administration system which routinely collects clinical and demographic data for patients requiring angiography. We are not aware of data from such systems previously being analysed and used to guide health service management. We isolated and linked this dataset for the year 2018 with other admission data to explore variations in the time spent on this treatment pathway (from admission to angiography). Unadjusted analysis shows pathway time is affected by weekday, date of admission, age and gender. Regression analysis using demographic and clinical variables shows a persisting disparity according to admission site and gender, with ethnic disparities that are challenging to explain. Although an observational study, the dataset is collected prospectively and has excellent granularity. As well as demonstrating feasibility of use in investigating equality of access and treatment, we demonstrate its utility for service development, management, and improvement. These methods are easily replicable across other clinical systems and specialties.

Prediction of heatwave related mortality magnitude, duration and frequency with climate variability and climate change information

Given the link between climatic factors on one hand, such as climate change and low frequency climate oscillation indices, and the occurrence and magnitude of heat waves on the other hand, and given the impact of heat waves on mortality, these climatic factors could provide some predictive skill for mortality. We propose a new model, the Mortality-Duration-Frequency (MDF) relationship, to relate the intensity of an extreme summer mortality event to its duration and frequency. The MDF model takes into account the non-stationarities observed in the mortality data through covariates by integrating information concerning climate change through the time trend and climate variability through climate oscillation indices. The proposed approach was applied to all-cause mortality data from 1983 to 2018 in the metropolitan regions of Quebec and Montreal in eastern Canada. In all cases, models introducing covariates lead to a substantial improvement in the goodness-of-fit in comparison to stationary models without covariates. Climate change signal is more important than climate variability signal in explaining maximum summer mortality. However, climate indices successfully explain a part of the interannual variability in the maximum summer mortality. Overall, the best models are obtained with the time trend and the North Atlantic Oscillation (NAO) used as covariates. No country has yet integrated teleconnection information in their heat-health watch and warning systems or adaptation plans. MDF modeling has the potential to be useful to public health managers for the planning and management of health services. It allows predicting future MDF curves for adaptive management using the values of the covariates.

What happens between first symptoms and first acute exacerbation of COPD - observational study of routine data and patient survey.

Chronic obstructive pulmonary disease affects nearly 400 million worldwide - over a million in the United Kingdom - and is the third leading cause of death. However, there is limited understanding of what prompts a diagnosis, how long this takes from symptom onset and the different approaches to clinical management by primary care professionals. Map out the clinical management and National Health Service contacts from symptom presentation to chronic obstructive pulmonary disease diagnosis and first acute exacerbation of chronic obstructive pulmonary disease in three time periods; construct risk prediction for first acute exacerbation of chronic obstructive pulmonary disease. Retrospective cohort study and cross-sectional survey. Primary care. Patients with incident chronic obstructive pulmonary disease aged > 35 years in England. None. First acute exacerbation of chronic obstructive pulmonary disease. Clinical Practice Research Datalink Aurum; new online survey. Forty thousand five hundred and seventy-seven patients were diagnosed between April 2006 and March 2007 (cohort 1), 48,249 between April 2016 and March 2017 (cohort 2) and 4752 between March and August 2020 (cohort 3). The mean (standard deviation) age was 68.3 years (12.0); 47.3% were female. Around three-quarters were diagnosed in primary care, with a slight fall in cohort 3. Compliance with National Institute for Health and Care Excellence diagnostic guidelines was slightly higher in cohorts 2 and 3 for all patients; 35.8% (10.0% in the year before diagnosis) had all four elements met for all cohorts combined. Multilevel modelling showed considerable between-practice variation in spirometry. The survey on the charity website had 156 responses by chronic obstructive pulmonary disease patients. Many respondents had not heard of the condition, hoped the symptoms would go away and identified various healthcare-related barriers to earlier diagnosis. Clinical Practice Research Datalink analysis showed notable changes in post-diagnosis prescribing from cohort 1 to 2, such as increases in long-acting muscarinic antagonist (21.7-46.3%). Triple therapy rose from 2.9% in cohort 2 to 11.1% in cohort 3. Documented pulmonary rehabilitation rose from just 0.8% in cohort 1 to 13.7% in cohort 2 and 20.9% in cohort 3. For all patients combined, the median time to first acute exacerbation of chronic obstructive pulmonary disease in patients who had one was 1.4 years in cohorts 1 and 2. Acute exacerbation of chronic obstructive pulmonary disease prediction models identified some consistent predictors, such as age, deprivation, severity, comorbidities, post-diagnosis spirometry and annual review. Models without post-diagnosis general practitioner actions had a c-statistic of around 0.70; the highest c-statistic was 0.81, for cohort 2 with post-diagnosis general practitioner actions and 6-month follow-up. All models had good calibration. The three most important predictors in terms of their population attributable risks were being a current smoker and offered smoking cessation advice (32.8%), disease severity (30.6%) and deprivation (15.4%). The highest population attributable risks for variables with adjusted hazard ratios < 1 were chronic obstructive pulmonary disease review (-27.3%) and flu vaccination (-26.6%). Symptom recording and chronic obstructive pulmonary disease diagnosis vary between practice; predicted forced expiratory volume in 1 second had many missing values. There has been some improvement over time in chronic obstructive pulmonary disease diagnosis and management, with large changes in prescribing, though patient and system barriers to further improvement exist. Data available to general practitioners cannot generate risk prediction models with sufficient accuracy. It will be important to expand the COVID-era cohort with longer follow-up and augment general practitioner data for better prediction. This study is registered as Researchregistry.com: researchregistry4762. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/72) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 43. See the NIHR Funding and Awards website for further award information.

The Role of Marketing in the Management of Health Services: the Case of the Madalena Clinic Group

The Role of Marketing in the Management of Health Services: the Case of the Madalena Clinic Group

Consubstantialities of resistance: Labor process, (bio)materialities, and pathogenicity

As social science scholarship has historically documented, social structure and clinical practice are more commonly as contradictory or incoherent as they are often framed. The increasing emphasis on the rise of antimicrobial resistance (AMR) has drawn attention to how social realms of resistance are entrenched and interconnected through varied structural, political, clinical, biological, and ecological relations. In this study, set in São Paulo, Brazil, I sought to unpack relational consubstantialities of AMR within the healthcare labor process and their enfolded (bio)materialities and pathogenicity by drawing on a series of interviews with primary care-based health professionals, health services managers, and policymakers, completed between late 2021 and early 2023. Participants’ accounts reveal how the reproduction of the labor process in primary care foregrounds (bio)material relations in which antimicrobial resistance finds timely and proper coextensive social conditions of reproduction. In their turn, the study results highlight how work intensification relates to economies of scarcity, teamwork coerciveness, AMR virulence and pathogenicity, destabilizing ecological (bio)materialities amid structural and clinical practice interrelations. Building on renewed materialisms of the political economy of health, I propose an approach to complexify understandings of relational interconnectedness of resistance by instilling relational tension lines of objects against their pragmatic reification in health interventions and theory.

Codesigning a Community Health Navigator program to assist patients to transition from hospital to community

Background This study aimed to identify the potential roles for Community Health Navigators (CHNs) in addressing problems faced by patients on discharge from hospital to the community, and attitudes and factors which may influence their adoption. Methods Twenty-six qualitative interviews and an online codesign workshop were conducted with patients, nurses, general practice staff, health service managers, community health workers, general practitioners, medical specialists, and pharmacists in the Sydney Local Health District. Qualitative themes from the interviews and workshop transcripts were analysed inductively and subsequently grouped according to a socio-ecological model. Results CHNs could assist patients to navigate non-clinical problems experienced by patients on discharge through assessing needs, establishing trust, providing social and emotional support that is culturally and linguistically appropriate, engaging family and carers, supporting medication adherence, and helping to arrange and attend follow up health and other appointments. Important factors for the success of the CHNs in the performance and sustainability of their roles were the need to establish effective communication and trust with other healthcare team members, be accepted by patients, have access to information about referral and support services, receive formal recognition of their training and experience, and be supported by appropriate supervision. Conclusions This study was unique in exploring the potential role of CHNs in addressing problems faced by patients on discharge from Australian hospitals and the factors influencing their adoption. It informed training and supervision needs and further research to evaluate CHNs’ effectiveness and the acceptance of their role within the healthcare team.

Research Trends and Hot Spots in Telemedicine for the Elderly: A Scientometric Analysis.

As the elderly population rapidly grows, age-related health issues are increasing. Telemedicine helps older adults adapt by providing efficient and accessible health management and medical services. This study employs bibliometric analysis to examine research focus areas, emerging trends, and collaboration networks in telemedicine for older adults over the past three decades. The Web of Science Core Collection served as the primary data source for the publications on telemedicine and the elderly since the database's inception through June 2024. Using CiteSpace.6.2.R4 software, keyword and collaboration network visualizations were generated, including clusters, co-authors, and co-citations. This study analyzed 586 papers from 252 countries or regions, which were published across 246 journals and written by 2750 authors. The analysis revealed three primary research directions encompassing 42 clusters: (1) health literacy and technology adaptation; (2) telemedicine technology and health management; and (3) social interaction and economic impact. Research hotspots include elderly fitness, mobile health, technology acceptance, telemedicine, elderly care, and health literacy. Despite the potential benefit of telemedicine, challenges persist in areas such as technology acceptance, usability, effectiveness, service quality, and privacy concerns. This review provides a comprehensive overview of current research on telemedicine for the elderly and highlights emerging trends in the field.

Digital Transformation: A Challenge for the Romanian Health System

This study analyzes the current status of the digitalization of the Romanian Health System (RHS). Data were collected from 135 active public and private health professionals using an online questionnaire with 102 items. The results of the analysis show that, if the qualification level and the experience of managers are high, seniority in management positions is an essential factor in the adoption of digital technologies, the digitalization of health services increases the efficiency and quality of medical and management services, and the success of the implementation of digital technologies is conditioned by the harmonization of a variety of factors because there are differences between the public and private sectors in terms of the economic efficiency determined by the adoption of digital technologies. There are also differences in the implementation of digital technologies between the national and worldwide levels, there are specific technologies that positively influence managerial performance, and the innovation process is conditioned by the management level. Because Romanian health service managers are updated with new technologies, they can ensure the implementation of digital technologies, considering that economic efficiency and managerial performance are directly related to the level of adoption and the type of technologies implemented.

328 Assessment of chronically ill or injured feedlot cattle populations at eight United States and nine Canadian feedlots and implications for cattle welfare

Abstract Cattle health management in the feedlot sector continues to evolve and improve cattle welfare by promoting an understanding of illness and injury to minimize their effects. Many papers have focused on treating individual ill or injured cattle in cattle feeding facilities. However, care, treatment, and outcomes for chronically ill or injured cattle (“chronic cattle”) have received little attention in the literature. The purpose of this descriptive study was to present demographics, diagnoses, and outcomes of chronic cattle in 17 feedlots in the U.S. and Canada and discuss potential risk factors and welfare implications. Individual chronic cattle information and treatment records from 17 feedlots (U.S.: 8; Canada: 9) over 7 yr (2014 – 2020) were retrospectively retrieved from a large feedlot consulting and data-management service (Feedlot Health Management Services, a division of TELUS Agriculture Solutions Inc.). Chronic cattle were defined as those that had spent time in a feedlot’s designated chronic pen. Descriptive results are presented as means ± standard deviations. U.S. feedlots averaged 31,280 ± 23,231 cattle/yr, had an average chronicity rate of 2.24 ± 2.42 % (median 1.53%), and contributed 52,709 chronic cattle to the dataset. Canadian feedlots averaged 21,913 ± 10,497 cattle/yr, had an average chronicity rate of 1.41 ± 0.82% (median 1.10%), and contributed 15,940 chronic cattle to the dataset. U.S. chronic cattle were sourced across all seasons primarily from auctions and ranches, had an average arrival weight of 163 ± 59 kg, and an average days on feed (DOF) of 362 ± 172 d. Canadian chronic cattle were primarily auction-sourced in the fall, weighed 272 ± 95 kg at arrival, and averaged 246 ± 141 DOF. Chronic cattle were treated at least once for respiratory issues (U.S.: 46.3%; Canada: 26.9%), bullers (U.S.: 34.5%; Canada: 5.8%), musculoskeletal issues (U.S.: 2.2%; Canada: 1.4%), lameness (U.S.: 1.7%; Canada: 28.1%), metabolic issues (U.S.: 0.5%; Canada: 4.5%), or other diagnoses (U.S.: 2.2%; Canada: 6.3%), with many cattle treated for multiple issues (U.S.: 12.5%; Canada: 27.0%). Outcomes for chronic cattle were shipped (U.S.: 73.1%; Canada: 52.5%), railed (U.S.: 8.1%; Canada: 20.7%), euthanized (U.S.: 0.7%; Canada: 9.9%) died unassisted (U.S.: 18.1%; Canada: 16.2%), or transferred (U.S.: &amp;lt; 0.1%; Canada: 0.8%). These results are some of the first to describe chronic cattle populations and present interesting trends for further analysis. For example, differences in buller and lameness rates could reflect actual differences but may be artifices of the dataset and feedlot definitions. Additionally, high marketed cattle rates (shipped and railed) indicate positive outcomes for most cattle, but variable mortality rates merit further scrutiny.

Co-Designing Digital Health Intervention for Monitoring Medication and Consultation Among Transgender People in Underserved Communities: Collaborative Approach.

In many parts of the world, men who have sex with men and transgender individuals face criminalization and discrimination. As a result, they are less likely to seek medical help, despite experiencing higher rates of HIV/AIDS, mental health issues, and other health problems. Reaching key populations (KPs) with essential testing, care, and treatment services can be challenging, as they often have a higher likelihood of contracting and spreading the virus. They have limited access to antiretroviral (ARV) therapy (ART) services, which means that KPs may continue to serve as reservoirs for new HIV infections if they do not receive effective HIV programming. This ongoing issue complicates efforts to control the epidemic. Therefore, modeling a digital health system to track ARV medication access and use is crucial. This paper advocates for the use of digital interventions to manage the health of KPs in underserved regions, using Nigeria as a case study. This study aims to assess digital health interventions for monitoring medication and consultations among transgender people in underserved communities. It also sought to determine whether a system exists that could support ART adherence in Nigeria. Additionally, the study evaluated design strategies to address privacy and confidentiality concerns, aiming to reduce nonadherence to ARV medications among KPs in Nigeria. A qualitative approach was adopted for this research, involving a thematic analysis of information collected from interviews with clinicians and other health practitioners who work directly with these communities, as well as from an interactive (virtual) workshop. The findings from the thematic analysis indicate a need to increase attendance at ART therapy sessions through the implementation of an intensive care web app. Unlike previous solutions, this study highlights the importance of incorporating a reminder feature that integrates with an in-app telemedicine consultancy platform. This platform would facilitate discussions about client challenges, such as adverse drug effects, counseling sessions with clinical psychologists, and the impact of identity discrimination on mental health. Other data-driven health needs identified in the study are unique drug request nodes, client-led viral load calculators, remote requests, and drug delivery features within the web app. Participants also emphasized the importance of monitoring medication compliance and incorporating user feedback mechanisms, such as ratings and encouragement symbols (eg, stars, checkmarks), to motivate adherence. The study concludes that technology-driven solutions could enhance ART adherence and reduce HIV transmission among transgender people. It also recommends that local governments and international organizations collaborate and invest in health management services that prioritize health needs over identity.

Assessing Consumer Perception of Effective Health Service Delivery: A Study of The Perspectives of Users of Diocesan Health Services in Sunyani

Background: The standard of the healthcare provided predicts a population's health. The purpose of this study is to comprehend how consumers perceive the effective management and provision of health services at the Diocesan Health Services in Sunyani, Ghana. Materials and Methods: The study used a mixed methodology in which both quantitative and qualitative data were utilized. Semi-structured interviews and a questionnaire were used to collect the data. The nested case study design approach was used for this investigation. The study was carried out in a few chosen facilities of Diocesan Health Services Sunyani. The sample included 331 people from the facilities. Respondents’ data were subjected to descriptive and inferential data analysis. Results: The findings revealed focused primary healthcare delivery, good management and leadership, community engagement, and integration of traditional and complementary medicine into the national health systems as quality healthcare. Conclusion: Users view increased accessibility, acceptability, availability, and good service outcomes as quality health service planning and delivery.

Mobile solution and chronic diseases: development and implementation of a mobile application and digital platform for collecting, analyzing data, monitoring and managing health care

BackgroundTechnological advances based on mobile health (mHealth), the field of digital health (eHealth) aimed at managing health services and care and their concomitant transformations, have become increasingly important in the 21st century. In this context, care for individuals diagnosed with Chronic Non-Communicable Diseases (CNCDs) deserves to be highlighted. The aim of this study is to present the creation, development and implementation of the Telehealth Center of the Federal University of Viçosa (NUTELES - UFV), for the monitoring and management of health care for individuals with Arterial Hypertension (AH) and/or Diabetes Mellitus (DM).MethodsThis study, carried out in 2022 and 2023, involved 374 patients diagnosed with AH and/or DM in the health micro-region of Viçosa/MG, Brazil, comprising nine municipalities. The research aims to describe the creation, development and implementation of a software (NutelesApp) for the collection, storage, management and analysis of epidemiological research in public health, focusing specifically, on the monitoring and management of health care for individuals with AH and/or DM monitored by Primary Health Care (PHC). The parameters collected and analyzed were obtained through a questionnaire applied to patients, consisting of 70 questions, subdivided into 12 classes of questions. The epidemiological survey data was collected using mobile devices and analyzed using computer techniques based on statistical analysis. Once the field teams had completed their work, the files were transferred to servers for general analysis processing, using estimates of means, prevalence and respective standard errors, calculated using the Statistical Package for Social Science (SPSS) program, which takes into account the planning variables and includes the basic weights resulting from the sampling process. This study was approved by the Human Research Ethics Committee and registered, prior to recruitment, by the Brazilian Registry of Clinical Trials (ReBEC), ID: RBR-45hqzmf (Last approval date: 11/30/2022).ResultsThe information obtained through data collection with subsequent exploratory analysis of epidemiological data using the NutelesApp software suggests that mobile applications intended for the purpose of monitoring and managing healthcare for people with AH and/or DM should address the variables necessary to support a process of understanding the health conditions and/or disease of the individual as a whole and provide short- and long-term learning. Regarding the results of the survey using the software, the variables of 374 people were analyzed. Majority are female (73.2%) and white (43.5%). Most patients are elderly (average 64 years), with blood pressure levels within the normal range for this population, BMI indicates overweight, AC increased risk for cardiovascular events and CC within the recommendation value. All biochemical parameters analyzed were above normal limits.ConclusionsThe description of the creation and development of the software includes practical examples of its implementation, the results collected and its applicability in real scenarios, presenting determining criteria that can provide assertive and timely interventions for monitoring and managing the health and/or disease parameters of patients with HA and/or DM. In addition, the beneficial consequences of using this application will extend to health units and their respective management, improving the services provided by PHC and enhancing strategies and actions for health promotion and disease prevention.

Analysis of Educational Technology Approaches in Supporting Health Services at College Clinics

Educational technology is a growing area of interest, including healthcare management in higher education. This study aims to evaluate the role of educational technology in improving health service management in college clinics, with a focus on the Universitas Negeri Manado Clinic. The research method used was a qualitative approach with data collection techniques including in-depth interviews, direct observation, and documentation. Data were analyzed using the triangulation method to identify key themes and in-depth interpretation of the influence of educational technology on health services. The results showed that the implementation of educational technology in college clinics can improve the efficiency and effectiveness of health services. Information technologies such as electronic medical record management systems and e-learning platforms have helped to improve the process of planning, implementing and evaluating health services. However, there are challenges in terms of system integration and additional training needs for staff. This study found that while educational technology provides significant benefits, its successful implementation is highly dependent on infrastructure readiness and user skills. Suggestions for improvement include increasing technology training for staff, updating hardware and software, and strengthening evaluation procedures to ensure that technology can be optimally used to improve the quality of health services.

Establishing a Consensus-Based Framework for the Use of Wearable Activity Trackers in Health Care: Delphi Study.

Physical activity (PA) plays a crucial role in health care, providing benefits in the prevention and management of many noncommunicable diseases. Wearable activity trackers (WATs) provide an opportunity to monitor and promote PA in various health care settings. This study aimed to develop a consensus-based framework for the optimal use of WATs in health care. A 4-round Delphi survey was conducted, involving a panel (n=58) of health care professionals, health service managers, and researchers. Round 1 used open-response questions to identify overarching themes. Rounds 2 and 3 used 9-point Likert scales to refine participants' opinions and establish consensus on key factors related to WAT use in health care, including metrics, device characteristics, clinical populations and settings, and software considerations. Round 3 also explored barriers and mitigating strategies to WAT use in clinical settings. Insights from Rounds 1-3 informed a draft checklist designed to guide a systematic approach to WAT adoption in health care. In Round 4, participants evaluated the draft checklist's clarity, utility, and appropriateness. Participation rates for rounds 1 to 4 were 76% (n=44), 74% (n=43), 74% (n=43), and 66% (n=38), respectively. The study found a strong interest in using WATs across diverse clinical populations and settings. Key metrics (step count, minutes of PA, and sedentary time), device characteristics (eg, easy to charge, comfortable, waterproof, simple data access, and easy to navigate and interpret data), and software characteristics (eg, remote and wireless data access, access to multiple patients' data) were identified. Various barriers to WAT adoption were highlighted, including device-related, patient-related, clinician-related, and system-level issues. The findings culminated in a 12-item draft checklist for using WATs in health care, with all 12 items endorsed for their utility, clarity, and appropriateness in Round 4. This study underscores the potential of WATs in enhancing patient care across a broad spectrum of health care settings. While the benefits of WATs are evident, successful integration requires addressing several challenges, from technological developments to patient education and clinician training. Collaboration between WAT manufacturers, researchers, and health care professionals will be pivotal for implementing WATs in the health care sector.

Accountable hospital governance structure rules in Iran: a qualitative document analysis

PurposeHospital governance accountability structures in Iran, similar to other countries, have undergone various reforms with different goals. The current study aimed to identify the rules and regulations of the hospital governance structure in Iran and how they pay attention to accountability.Design/methodology/approachThis qualitative document content analysis study was conducted using hospital governance structure documents in Iran using the Ready materials, Extract data, Analyze data and Distil (READ) document analysis framework. 2,921 documents were extracted from the official government websites of Iran. After screening, seven documents related to the hospital governance structure were selected. A directed content analysis approach was used. The findings were finally future purification matched with the original documents.FindingsThe findings showed that documents had not addressed the inclusive governance structure of the hospital comprehensively. The medical staff organization structure is not considered in the documents, and its duties are assigned to a technical or a clinical director. Most documents addressed financial accountability. The documents did not require the hospital’s governance to have an inclusive accountability structure. However, they paid more attention to the administrative and financial autonomy of hospitals.Practical implicationsAccountability is one of the most essential components in the hospital's governance structure. It can increase the success of hospital efficiency, effectiveness, vision and mission fulfillment. The study result can help health services policymakers and managers formulate better organization structure rules and regulations for hospital governance accountability.Originality/valueThis study is the first qualitative analysis of accountable governance structure documents in Iranian hospitals. We used the READ method as a comprehensive approach for document analysis.

Implementation of a digital exercise programme in health services to prevent falls in older people.

StandingTall uses eHealth to deliver evidence-based balance and functional strength exercises. Clinical trials have demonstrated improved balance, reduced falls and fall-related injuries and high adherence. This study aimed to evaluate the implementation of StandingTall into health services in Australia and the UK. Two hundred and forty-six participants (Australia, n =184; UK, n =62) were recruited and encouraged to use StandingTall for 2h/week for 6-months. A mixed-methods process evaluation assessed uptake and acceptability of StandingTall. Adherence, measured as % of prescribed dose completed, was the primary outcome. The study, conducted October 2019 to September 2021 in Australia and November 2020 to April 2022 in the UK, was affected by COVID-19. Participants' mean age was 73 ± 7years, and 196 (81%) were female. Of 129 implementation partners (e.g. private practice clinicians, community exercise providers, community service agencies) approached, 34% (n =44) agreed to be implementation partners. Of 41 implementation partners who referred participants, 15 (37%) referred ≥5. Participant uptake was 42% (198/469) with mean adherence over 6 months being 41 ± 39% of the prescribed dose (i.e. 39 ± 41 min/week) of exercise. At 6 months, 120 (76%) participants indicated they liked using StandingTall, 89 (56%) reported their balance improved (moderately to a great deal better) and 125 (80%) rated StandingTall as good to excellent. For ongoing sustainability, health service managers highlighted the need for additional resources. StandingTall faced challenges in uptake, adoption and sustainability due to COVID-19 and a lack of ongoing funding. Adherence levels were lower than the effectiveness trial, but were higher than other exercise studies. Acceptance was high, indicating promise for future implementation, provided sufficient resources and support are made available. Australian and New Zealand Clinical Trials Registry ACTRN12619001329156.

Building a digital supportive supervision system for improving health service delivery in Low- and Middle-Income countries through the collaborative requirements development methodology (CRDM): Experience from Tanzania

Background Supportive supervision is pivotal for both health service providers and managers to improve the quality of services and health outcomes. Tanzania's digital supportive supervision system is called Afya Supportive Supervision System (AfyaSS ®). The latter was designed and developed using a human-centered approach called Collaborative Requirements Development Methodology (CRDM). This paper describes the experiences of building the digital supportive supervision system through CRDM in Tanzania, a transition from the paper-based supportive supervision system. Methods In 2018, with the support of PATH, the government of Tanzania adopted a participatory human-centered design by carrying out desk reviews of existing guidelines and tools, field visits, stakeholder workshops, and user advisory groups to gather information for developing a digital supportive supervision system. The gathered information was analyzed with the lens of identifying the common challenges and system requirements. Results AfyaSS was successfully developed using CRDM and deployed in all regions across the country. It has consolidated multiple checklists for distinct health domains, and dashboard functionalities to track progress toward health system indicators, objectives, and action plans. As part of the deployment, several resources were developed to aid in the deployment process, such as a comprehensive user manual, facilitator's guide, training slides, and video tutorials. Health workers and managers can be empowered and motivated to implement comprehensive and coherent supportive supervision by using the lessons learned from this digitalization process to transform the current supervision processes to improve the quality of care by offering instruments that promote evidence-based actions. Conclusion A human-centered approach has been shown to be useful in developing digital tools for use in Tanzania’s health system. Tanzania's lessons can be applied in other low- and middle- income countries (LMICs) with similar contexts when considering implementing digital health interventions. While using the human-centered approach, it is crucial to establish a system development roadmap, conduct appropriate training, provide sustained information and communication technology, and management support for unforeseen issues, and ensure ongoing maintenance.

Health service requirements of mHealth app users: evidence from Hangzhou, China

PurposeChina’s healthcare system is being burdened by the increasing prevalence of chronic diseases. Therefore, this study investigated the health service requirements of mobile health applications (mHealth apps) users in Hangzhou, China. This study aimed to propose suggestions and theoretical references to improve mHealth apps and promote their development, thereby meeting public medical and health needs and creating an efficient medical service system.Design/methodology/approachWe constructed a model of health service demands using a literature review, network survey, and semi-structured interviews. We analyzed the demand attributes using the Kano model and Better-Worse index and obtained the priority ranking of demands.FindingsThe results revealed 25 demand elements in four dimensions: must-be (M), one-dimensional (O), attractive (A), and indifferent (I) requirements. The findings suggest that mHealth app developers can optimize health services by categorizing and managing health services, focusing on middle-aged users, enhancing the professionalism of health service providers, and improving the feedback mechanism.Originality/valueStudies on mHealth apps user demands, particularly on health service needs, remain scarce. This study employed a mixed-methods approach, integrating both qualitative and quantitative research techniques, to establish a priority ranking of user health service needs for mHealth apps. The study offers recommendations and theoretical references to optimize and improve mHealth app services.HighlightsConstruct a better health service requirements model for mHealth app users.Obtain the prioritization of demand elements in the model.Propose some management suggestions to improve mHealth apps.