Home Visits Research Articles

Student perspectives on designing and implementing an interprofessional education module in chronic disease management at primary care level in Vietnam

PurposeThis study explored students' perspectives on designing and implementing the new clinical interprofessional education (IPE) module for chronic disease management at the primary care level in the Vietnamese context.Design/methodology/approachStudents from seven different university-level healthcare programmes participated in a cross-sectional survey Course Experience Questionnaire-based study. Additionally, two open-ended questions were presented to gather qualitative data, mapping student perspectives. Statistical analyses and thematic analyses were performed.FindingsThe results show that students agree with quality statements about IPE design features, such as good teaching, clear goals and standards, appropriate workload, appropriate assessment and a blended learning approach. Answers to the open-ended comments pointed out the strengths of the IPE module in providing opportunities for interprofessional learning, improving interprofessional collaboration competencies, real-life interprofessional collaboration practice and continuous feedback from tutors. Students also reported weaknesses in the IPE module, including a lack of feedback on the care plan and logistics of the IPE module.Originality/valueStudents positively recognise key design features of the IPE module, combining classroom activities with standardised patient simulations, clinical practice and home visits. Chronic disease management at the primary care level is a suitable context for training students to work interprofessionally. The strengths and weaknesses identified by students could help in the redesign and future implementation of the IPE module in the Vietnamese context. They could inspire practices in Southeast Asian medical education and beyond.

Autonomy and Respect in Pregnancy Care for LGBTQIA+ Families: Evaluation of a Home Visiting Program.

The purpose of this program evaluation was to gather information on proportions of LGBTQIA+ individuals and families, their needs, and care experiences in a county health department's home visiting programs for perinatal clients and to make recommendations for improving culturally competent care for LGBTQIA+ individuals and families. In this engaged scholarship partnership, home visiting nurses administered a questionnaire to perinatal clients including demographic information on sexual orientation and gender identity. Differences between LBGTQIA+ identifying individuals' perception of the perinatal care received and those of heterosexual, cisgender individuals were assessed. On the basis of these data, 10% of the 52 respondents identified as LGBTQIA+ and 4% identified with a gender other than "woman." Clients who identified as straight had similar mean scores to those who listed an LGBTQIA+ sexual orientation. Clients who chose a gender identity other than "woman" had scores that fell within the 50th to 75th percentile of the overall mean. Qualitative interviews with 2 respondents provided additional in-depth information on their experiences. Overall, clients served by these perinatal programs reported similar diversity in terms of gender identity and sexual orientation as compared with national averages. This project provided evidence of the diversity among the clientele served by this agency and the importance of expanding the focus on inclusionary language and practices.

Abstract C057: Pilot study of vaginal microbiome profiles among Black and White endometrial cancer survivors

Abstract Background: Lower vaginal microbiome diversity, and specifically a Lactobacillus crispatis-dominant vagitype, is associated with more favorable health outcomes. Racial variation in the vaginal microbiome has been reported in some studies, including gynecologic cancers. Racial disparities in endometrial cancer 5-year survival are stark—62% for Black women vs. 83% for White women. Cancer treatments can acutely impact the microbiome of surrounding tissues with potential impacts on quality of life in survivorship, including sexual function. The objectives of this pilot research were to assess the feasibility of self-sampling and variation in vaginal microbiome communities by race, cancer treatment, and sexual function among endometrial cancer survivors. Methods: Endometrial cancer survivors (N=50, mean=11 months from diagnosis) enrolled in the Carolina Endometrial Cancer Study were mailed Genotek vaginal microbiome self-collection kits and the validated Sexual Function-Vaginal Changes Questionnaire (SVQ) before a nurse home visit. Microbiota profiles were characterized by bacteria 16S rRNA amplicon sequencing. Vagitypes were classified as Lactobacillus-dominant and other based on relative abundance (>50% vs. ≤50%) and Ward hierarchical clustering. Results: Overall, 48 vaginal samples were obtained. We excluded samples from women who reported antibiotic use within the last month (N=8) or were missing treatment data (N=6), leaving 34 samples. Of these, 47% were from Black survivors and 53% from White. Cancer treatments were categorized as surgery only (47%) vs. any chemotherapy or radiation (53%); and did not vary by race (p >.9). Black women did not have statistically significant different alpha (Shannon p=0.9) or beta (p=0.4) diversity, or a differential proportion of Lactobacillus dominant vagitype (59% vs. 41%, p=0.3) compared to White women. Alpha (Shannon p=0.04) and beta (p=0.004) diversity varied by cancer treatment with higher microbial diversity after chemotherapy or radiation compared to surgery alone. In the surgery only group, 63% of samples were Lactobacillus dominant, compared to 17% among the chemotherapy or radiation group (p=0.006). We examined cancer treatment associations in analyses restricted to the more favorable endometroid histology (N=25), as surgery alone is associated with endometrioid histology and better prognosis. In this subgroup, 57% (8/14) of women treated with surgery only had Lactobacillus-dominant vagitypes compared to 27% (3/11) in the chemotherapy/ radiation group (p=0.1). Lactobacillus-dominant vagitype was not associated with SVQ scales (global satisfaction; changes in intimacy or interest; dryness; pain). Conclusion: Self-collection of vaginal microbiome samples is feasible in cancer survivors. In our study, Lactobacillus-dominant vagitypes were less abundant among women who were treated with more intensive cancer therapies and did not vary by race or sexual function. Radiation and chemotherapy for endometrial cancer may affect vaginal microbiome composition after treatment ends. Citation Format: Mu Jin, Tope Keku, Nikki McCoy, Jordyn Brown, Jamie Hunter, Victoria Bae-Jump, M. Andrea Azcarate-Peril, Stephanie Engle, Andy Olshan, Hazel B Nichols. Pilot study of vaginal microbiome profiles among Black and White endometrial cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C057.

Father Engagement in Home Visiting: Findings From a Continuous Quality Improvement Learning Collaborative.

The present study describes the efforts of a home visiting (HV) continuous quality improvement learning collaborative aimed at increasing father engagement in HV and parenting. Local implementing agencies (n=11) delivering 3 evidence-based HV models participated in the collaborative. Each agency developed and implemented 3 rapid-cycle Plan-Do-Study-Act (PDSA) projects to increase father engagement. Specific, Measurable, Achievable, Realistic, Time-bound (SMART) aims were used to guide development of change strategies and meaningful measurement goals. HV providers collected data from enrolled families (n=714) about fathers' level of parenting and HV involvement. Mean father engagement scores increased 39% from the first to the second assessment and over 60% of the PDSAs met or exceeded their SMART aim goal. Data suggest that fathers are open to participating in HV and are responsive to parenting guidance. In the current paper, we share engagement strategies and lessons learned during the collaborative.

HUBUNGAN KETERATURAN PEMERIKSAAN ANC TERHADAP KEJADIAN ANEMIA DI WILAYAH KERJA PUSKESMAS TURIKALE KECAMATAN TURIKALE KABUPATEN MAROS

Regular pregnancy checks will determine the mother's health status during pregnancy because basically the cause of Fe deficiency anemia in pregnant women is caused by two factors, namely direct and indirect factors. Meanwhile, factors that do not directly influence a person's Hb levels by influencing the availability of Fe in food include the low economy.The aim of this research is to determine the relationship between the regularity of ANC examinations and the incidence of anemia in the Turikale Community Health Center Working Area, Turikale District, Maros Regency. The type and research method used is the Cross Sectional Study method. In this study, the samples taken were 36 third trimester pregnant women who had their pregnancies checked in the Turikale Community Health Center Working Area, Maros Regency, using purposive sampling. The research results showed that 29 people (80.6%) regularly made ANC visits and 7 people (19.4%) did not regularly. Six respondents (16.7%) experienced anemia and 30 respondents (83.3%) did not experience anemia. There is a relationship between the regularity of ANC visits and the incidence of anemia with a value of ρ=0.004<from α=0.05, this means that Ho is rejected and Ha is accepted. It is hoped that it can increase monitoring and screening of pregnant women who experience high levels of anemia through home visits, making class activities more effective for pregnant women and empowering families, especially husbands or parents, to be motivated to invite pregnant women to have their pregnancies checked regularly. The husband or closest family member can be given an understanding of the dangers and efforts to prevent anemia in pregnant women

Preventive Home Visit Practicum by Nursing Students during the COVID-19 Pandemic: Challenges to Continuing Nursing Practice in the Community

Preventive Home Visit Practicum by Nursing Students during the COVID-19 Pandemic: Challenges to Continuing Nursing Practice in the Community

Vitality at home: a phenomenological study of tele-exercise in women aged 80 and older

BackgroundSince the onset of coronavirus 2019, there has been an upsurge of tele-exercise delivery. Previous studies showed old adults find tele-exercise feasible and acceptable. However, there is limited understanding of the oldest-old’s experiences.MethodThis study used the interpretative phenomenological approach. Two semi-structured interviews and home visits were conducted with six oldest-old women, aged between 81 and 91 years, who participated in tele-exercise classes.ResultsFour superordinate themes were identified: ambivalent perception of safety, ease in regular participation, reminded and guided to move the aged body, and technological adaptation.ConclusionOur findings indicate that tele-exercise has the potential to assist the oldest-old living in the community in maintaining an adequate activity levels at home, which they perceive as the safest place. Emerging themes provide insights into their lived experiences, enabling service providers to enhance tele-exercise services for this group in the tele-health era.

Using natural language processing approaches to characterize professional experiences of child welfare workers

High turnover rates among child welfare workers, including caseworkers and supervisors, are associated with negative attitudes and perceptions about work (NAPW). Our study aimed to (a) explore how child welfare workers’ demographic characteristics, professional attributes, and their work narratives are related to NAPW and (b) extract themes from these narratives to understand their professional needs and concerns. In 2022, a statewide online survey was administered to active child welfare caseworkers and supervisors in a large Midwestern state. This survey, combining standardized scales and an open-ended question about work experiences, yielded numeric (N = 551 survey respondents) and text data (N = 2,193 words). We analyzed the numeric data using general linear modeling and the text data using natural language processing (NLP) techniques. Results showed that workers associated with higher NAPW were female, younger, from racial and ethnic minority backgrounds, less tenured, and more likely to be employed in public agencies and to work longer hours. They are predominantly caseworkers rather than supervisors. Worker role and agency affiliation had the largest effect sizes. NLP analysis showed that workers with more NAPW frequently used third-person pronouns and emotionally negative language, suggesting a disconnection from colleagues and job dissatisfaction. Caseworkers often used first-person singular pronouns, indicating feelings of isolation. Two key themes emerged: a) the need for better agency support during home visits and b) concerns over traumatic experiences and ineffective trauma-informed practices. The findings suggest that future interventions should prioritize the well-being of caseworkers in public agencies and consider language patterns in workers’ narratives to understand their vulnerability to NAPW.

Community members' perceptions of community health workers in Melusi, Tshwane, South Africa.

Community health workers (CHWs) play an important role in health promotion through health campaigns and home visits, and provide linkage to care and support patient management. In the informal settlements, CHWs identify health challenges and help residents to access healthcare facilities. This study aimed to explore the perception held by the community members regarding CHWs' contribution to health promotion in Melusi informal settlements within the Tshwane district. The study was conducted in Melusi informal settlement situated in Pretoria west in South Africa. Descriptive exploratory qualitative research methods were used, with open and closed-ended questions during individual interview sessions. Participants were purposefully selected in collaborating with the community leaders and using CHWs' data to identify individuals with direct interaction with CHWs. Participants praised CHWs' communication skills, engagement strategies, and ability to provide valuable health services. Community members expected CHWs to provide healthcare services, educational support, advocacy for health issues and guidance on well-being. Barriers such as community resistance, a lack of privacy and difficulties in reaching households were noticed. However, CHWs were commended for their impact on well-being, offering health services, emergency support, food assistance and improved healthcare accessibility. The study indicates that community members have positive perceptions of CHWs. This highlights the significant role of CHWs in promoting health and well-being within the community.Contribution:This study provides insights into community perceptions of CHWs in informal settlements, emphasising their impact on community well-being. It provides a basis for their effectiveness and support in delivering health services in the informal settlement.

Clinical effects of accreditation in general practice: a pragmatic randomized controlled study.

Accreditation has been implemented in general practice in many countries as a tool for quality improvement. Evidence of the effects of accreditation is, however, lacking. To investigate the clinical effects of accreditation in general practice. A mandatory national accreditation programme in Danish general practice was rolled out from 2016 to 2018. General practices were randomized to year of accreditation at the municipality level. We conducted a pragmatic randomized controlled study with general practices randomized to accreditation in 2016 (intervention group) and 2018 (control group). Data on patients enlisted with these practices were collected at baseline in 2014 (before randomization) and at follow-up in 2017. We use linear and logistic regression models to compare differences in changes in outcomes from baseline to follow-up between the intervention and control groups. The primary outcome was the number of redeemed medications. Secondary outcomes were polypharmacy, nonsteroidal anti-inflammatory drugs (NSAIDs)without proton pump inhibitors, sleeping medicine, preventive home visits, annual controls, spirometry tests, and mortality. We found statistically significant effects of accreditation on the primary outcome, the number of redeemed medications, and the secondary outcome, polypharmacy. No other effects were detected. In this first randomized study exploring the effects of accreditation in a primary care context, accreditation was found to reduce the number of redeemed medications and polypharmacy. We conclude that accreditation can be effective in changing behaviour, but the identified effects are small and limited to certain outcomes. Evaluations on the cost-effectiveness of accreditation are therefore warranted.

The Role of Dosage and Family Profiles in a Child Welfare Home Visiting Program

Abstract Background Among the different modalities of family support, home visiting programs have proved to be one of the most effective secondary prevention models for families involved in child welfare services. Despite the promising outcomes and the extensive available literature, further research is needed to investigate target population characteristics and implementation factors that may explain the heterogeneity in the outcomes of these programs for families receiving child welfare services. Objective This longitudinal study explored the role of dosage and family characteristics related to the effectiveness of the Family Intervention Program (FIP), which is a home-based Spanish child welfare service for supporting families at psychosocial risk. Method To this end, a quasi-experimental design was followed, including a time-series evaluation of the 289 families receiving the FIP. In order to examine the impact of the FIP, the evolution of child well-being (CWB) was evaluated with Child Well-Being Scales every 6 months. Results The results showed that the highest average CWB score was observed after 39 months of intervention, observing no improvements in CWB from that point. Similarly, the results showed that the FIP was more effective for single parent families at higher socioeconomic levels. Conclusions This article provides new knowledge for the understanding of home visiting programs success, concluding that the programs are not equally effective for all family profiles, and that it is necessary to adjust each program to the specific characteristics of the target population.

Feasibility of a Dutch post-discharge parenting intervention (TOP program) for moderate preterm born infants

Background and aimModerate preterm (MP) birth is associated with an increased risk of developmental problems. However, post-discharge support for this group is scarce. The aim of this study was to evaluate the feasibility of a post-discharge parenting program (TOP program) for MP infants. Three feasibility dimensions were evaluated (1) recruitment capability and compliance, (2) intervention acceptability, and (3) limited efficacy testing. MethodsA group of MP infants with a gestational age (GA) between 320/7‐346/7 weeks and their parents received six home visits by a TOP interventionist until 6 months corrected age (CA). A pre-posttest intervention design with quantitative and qualitative measures was used.Recruitment capability and compliance, acceptability, and satisfaction with the intervention were evaluated using a questionnaire, checklists, interviews, and a focus group. Infant socio-emotional development, parental distress, self-efficacy, and reflective functioning were measured with questionnaires. Observation measurements were used for infant motor development and parental sensitivity. ResultsThirty-two families completed the six home visits. The satisfaction rate (scale 0–10) was remarkably high (Mean 9.4, range: 8–10). Parents reported that the program was suitable, enhanced their understanding of their infants' developmental needs, and increased their self-efficacy. The infants showed age-appropriate motor and socio-emotional development post-intervention. Parental self-efficacy, reflective functioning, and sensitivity improved from pre to post intervention, with small to large effect sizes. ConclusionThe study demonstrated high compliance, acceptability, and satisfaction with the TOP program for MP infants with promising infant and parent outcomes. This study contributes to the preparatory work prior to a larger scale evaluation and dissemination.

Test and treat approach for tuberculosis infection amongst household contacts of drug-susceptible pulmonary tuberculosis, Mumbai, India.

Mumbai is one of the most densely populated areas in the world and is a major contributor to the tuberculosis (TB) epidemic in India. A test and treat approach for TB infection (TBI) amongst household contacts (HHC) is part of the national policy for TB preventive treatment (TPT). However, in practice, the use of interferon-gamma release assay (IGRA) tests for infection are limited, and prevalence of TBI in Mumbai is not known. We conducted a cross-sectional study among HHCs exposed to persons with microbiologically-confirmed, drug-susceptible pulmonary TB that were notified for antituberculosis treatment in Mumbai, India during September-December, 2021. Community-based field workers made home visits and offered IGRA (QuantiFERON-TB® Gold In-Tube Plus) tests to HHC aged 5 years and older. After ruling out active TB disease, HHC with IGRA-positive test results were referred for TPT. All HHC were monitored for at least 24 months for progression to active TB disease. Among 502 HHCs tested, 273 (54%) had IGRA-positive results. A total of 254 (93%) were classified as TBI and were eligible for TPT, of which 215 (85%) initiated TPT, and 194 (90%) completed TPT successfully. There was substantial variation in rates of TBI per household. In 32% of households, all HHC (100%) were IGRA positive and in 64% of households >50% of HHC were infected. In all, 22 HHCs (4%; 22/558) were diagnosed with TB disease; of these, five HHC were diagnosed during follow up, of which three were IGRA positive and had no evidence of disease at initial screening but chose not to initiate TPT. A test and treat strategy for HHC resulted in the detection of a substantial proportion of TBI and secondary TB cases. Home-based IGRA testing led to high participation rates, clinical evaluations, TPT initiation, and early diagnoses of additional secondary cases. A community-focused, test and treat approach was feasible in this population and could be considered for broader implementation.

Inside the homes, beyond the classroom: Teacher’s home visitation experiences

The purpose of this study was to describe the lived experiences, challenges, and insights of teachers in an elementary school in the District of Pandan, Division of Antique which were the basis of the proposed intervention program for teachers. On the other hand, the phenomenology research design was used in this study. The study utilized five elementary teachers as research participants. The data was analyzed and interpreted using the thematic analysis of Collaizzi’s method. The research instrument used was in the form of the interview guide. The teachers’ lived experiences with home visitation highlight three key themes: teacher’s commitment and mission, student’s struggles, and school-family connectedness. The home visitation challenges highlight three main themes: geographical problems, seasonal labor-dependent students, and personal safety. Support systems to address these challenges in home visitation programs. The study documents teachers’ insights in home visitation to improve academic performance. It identifies three key themes: innovation in teaching, conferencing, and parental involvement. The proposed intervention program was the Educational Empowerment for All (EEFA) Program.

Testing a Conceptual Model of Early Adversity, Neural Function, and Psychopathology: Protocol for a Retrospective Observational Cohort Study.

Early adversity, broadly defined as a set of negative exposures during childhood, is extremely common and increases risk for psychopathology across the life span. Previous research suggests that separate dimensions of adversity increase risk through developmental plasticity mechanisms shaping unique neurobiological pathways. Specifically, research suggests that deprivation is associated with deficits in higher order cognition, while threat is associated with atypicality in fear learning and emotion dysregulation. However, most of this research has been conducted in adolescent and adult samples, long after exposure to adversity occurs and far from periods of peak developmental plasticity. The Wellness Health and Life Experiences (WHALE) study examines the neurobiological and behavioral mechanisms by which deprivation, threat, and unpredictability increase risk for psychopathology in early childhood (age 4-7 years) directly following periods of peak developmental plasticity. The objective of this study is to describe the study rationale and aims, the research design and procedures, and the analytical plan to test the study hypotheses. This is a retrospective cohort study that examines associations between exposure to deprivation and threat and their hypothesized neurobiological mechanisms, how these neurobiological mechanisms link early adversity and psychopathology, and associations between unpredictability, reward learning, and psychopathology. The sample was a convenience sample of children (aged 4-7 years) and their families, identified through flyers, email blasts to listserves, school-based advertising, and involvement in community events. Data were collected during a home visit, a subsequent laboratory visit, and a final neuroimaging visit. Planned analyses include linear regression, path analyses, and functional magnetic resonance imaging analyses to explore the role of neural function in the association between early adversity and psychopathology. Participants (N=301) have been recruited into the study, and data collection has commenced. The expected results will be available in 2024. The findings of this study will help elucidate the neurobiological mechanisms by which early adversity increases risk for psychopathology in early childhood. This study represents the earliest test of an influential theory of biological embedding of early adversity. DERR1-10.2196/59636.

Routine Language Intervention: Supporting Spanish-Speaking Mothers’ Talk to Toddlers During Everyday Routines

SYNOPSIS Objective. Toddlers learn language as they participate in everyday routines in the home environment. The Routine Language Intervention encourages caregivers to infuse language in everyday routines to support toddlers’ language development. Design. Researchers collaborated with a Spanish-speaking, immigrant community in New York City to develop an intervention that is grounded in the routines that mothers commonly engage in with their toddlers. Altogether, 51 mothers participated in 6 months of group workshops and home visits. To test the efficacy of the intervention, mothers were videorecorded interacting with their toddlers at home before and after participating in the intervention. A comparison group of 12 families drawn from the same community was also videorecorded in their homes. Results. Mothers who participated in the Routine Language Intervention increased their speech to toddlers, nearly doubling word tokens and word types, and used more types and tokens than mothers in the matched comparison group. Increases in maternal speech were seen for words referring to targeted daily routines (e.g., mealtime, grooming, play and literacy) and extended to other words (e.g., unrelated household objects). Conclusions. Routine Language offers a culturally sensitive, easy-to-implement intervention that builds on families’ everyday routines and yields benefits for toddlers’ early language exposure.

The lived experiences of teachers on the implementation of blended learning modality

This phenomenological study aims to examine the teachers’ experiences on the implementation of blended learning modality using an interview guide questionnaire. Seven teachers were selected using purposive sampling and an individual interview was conducted to collect data from the participants. Data from the interview was analyzed thematically using the Colaizzi’s (1978) method. This study illustrated that the main challenges of teachers’ experience is lacked of exposure and readiness in the implementation of blended learning; they had experienced mixed reactions towards blended learning modality. They emphasized the struggles in time management, stress from excessive workloads, slow connectivity, and unmotivated students in blended learning instructions. They cope up with the challenges by having more patience and understanding for students who seemed uninterested in blended learning modality, integration of messenger app for educational purposes, adjustment for additional workloads as they eventually become more flexible, and conducting of home visitation for those students who experience internet connectivity issues. This study may serve as a component towards the implementation of blended learning modality among teachers, particularly in rural areas who experienced the same situation. Since blended learning modality is widely used as backup in education in case of calamity such as extreme heat inside the classroom, the results of this study provides relevant inputs to the proper planning of blended learning modality.

Recruiting people with selected citizenships for the health interview survey GEDA Fokus throughout Germany: evaluation of recruitment efforts and recommendations for future research

BackgroundGermany is the second most common country of immigration after the US. However, people with own or familial history of migration are not represented proportionately to the population within public health monitoring and reporting. To bridge this data gap and enable differentiated analyses on migration and health, we conducted the health interview survey GEDA Fokus among adults with Croatian, Italian, Polish, Syrian, or Turkish citizenship living throughout Germany. The aim of this paper is to evaluate the effects of recruitment efforts regarding participation and sample composition.MethodsData collection for this cross-sectional and multilingual survey took place between 11/2021 and 5/2022 utilizing a sequential mixed-mode design, including self-administered web- and paper-based questionnaires as well as face-to-face and telephone interviews. The gross sample (n = 33436; age range 18–79 years) was randomly drawn from the residents’ registers in 120 primary sampling units based on citizenship. Outcome rates according to the American Association for Public Opinion Research, the sample composition throughout the multistage recruitment process, utilization of survey modes, and questionnaire languages are presented.ResultsOverall, 6038 persons participated, which corresponded to a response rate of 18.4% (range: 13.8% for Turkish citizenship to 23.9% for Syrian citizenship). Home visits accounted for the largest single increase in response. During recruitment, more female, older, as well as participants with lower levels of education and income took part in the survey. People with physical health problems and less favourable health behaviour more often took part in the survey at a later stage, while participants with symptoms of depression or anxiety more often participated early. Utilization of survey modes and questionnaire languages differed by sociodemographic and migration-related characteristics, e.g. participants aged 50 years and above more often used paper- than web-based questionnaires and those with a shorter duration of residence more often used a translated questionnaire.ConclusionMultiple contact attempts, including home visits and different survey languages, as well as offering different modes of survey administration, increased response rates and most likely reduced non-response bias. In order to adequately represent and include the diversifying population in public health monitoring, national public health institutes should tailor survey designs to meet the needs of different population groups considered hard to survey to enable their survey participation.

Effect of a Male-Targeted Digital Decision Support Application Aimed at Increasing Linkage to HIV Care Among Men: Findings from the HITS Cluster Randomized Clinical Trial in Rural South Africa.

Linkage to HIV care remains suboptimal among men. We investigated the effectiveness of a male-targeted HIV-specific decision support app, Empowering People through Informed Choices for HIV (EPIC-HIV), on increasing linkage to HIV care among men in rural South Africa. Home-Based Intervention to Test and Start (HITS) was a multi-component cluster-randomized controlled trial conducted among 45 communities in uMkhanyakude, KwaZulu-Natal. The development of EPIC-HIV was guided by self-determination theory and human-computer interaction design to increase intrinsic motivation to seek HIV testing and care among men. EPIC-HIV was offered in two stages: EPIC-HIV 1 at the time of home-based HIV counseling and testing (HBHCT), and EPIC-HIV 2 at 1 month after a positive HIV diagnosis if not linked to care. Sixteen communities were randomly assigned to the arms to receive EPIC-HIV, and 29 communities to the arms without EPIC-HIV. Among all eligible men, we compared linkage to care (initiation or resumption of antiretroviral therapy after > 3 months of care interruption) at local clinics within 1 year of a home visit, ascertained from individual clinical records. Intention-to-treat analysis was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., financial incentives) and clustering at the community level. We also conducted a satisfaction survey for EPIC-HIV 2. A total of 13,894 men were eligible (i.e., aged ≥ 15 years and resident in the 45 communities). The mean age was 34.6 (±16.8) years, and 65% were married or in an informal union. Overall, 20.7% received HBHCT, resulting in 122 HIV-positive and 6 discordant tests. Among these, 54 men linked to care within 1 year after HBHCT. Additionally, of the 13,765 eligible participants who did not receive HBHCT or received HIV-negative results, 301 men linked to care within 1 year. Overall, only 13 men received EPIC-HIV 2. The proportion of linkage to care did not differ between the arms randomized to EPIC-HIV and those without EPIC-HIV (adjusted risk ratio = 1.05; 95% CI:0.86-1.29). All 13 men who used EPIC-HIV 2 reported the app was acceptable, user-friendly, and useful for getting information on HIV testing and treatment. The reach was low, although the acceptability and usability of the app were very high among those who engaged with it. Enhanced digital support applications could form part of interventions to increase knowledge of HIV treatment among men. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.

“I feel like it's just really become second nature, almost like the screen’s not there”: a qualitative case study of the transition to telehealth for home visitation program to support fragile infants due to the COVID-19 pandemic

A subset of early childhood home visitation programs support fragile infants and prevent hospital readmission as infants transition out of the neonatal intensive care unit (NICU) into their home. However, the COVID-19 pandemic initiated an unexpected change in the delivery of home visitation care to adhere to social distancing guidelines, resulting in a rapid transition into telehealth services. In this study, individual semi-structured interviews were conducted with staff from a NICU-transition home visitation program in Arizona. The Modified Technology Acceptance Model (MTAM) was used to evaluate the experiences of in-person to telehealth home visitations during the COVID-19 pandemic. Rapid Qualitative Analysis Method was utilized to generate a thematic analysis. Three major themes were identified: staff-centric, family-centric, and the experience of collective adjustment to the stressors of the pandemic. Participants faced challenges transitioning to telehealth visits, including not being able to physically demonstrate development skills on the infant. However, the telehealth model allowed staff to serve a larger geographic area, as well as allowing them to build a larger caseload as they had more control over their schedule. Staff also noted that families appreciated telehealth home visits as an added layer of health protection for their fragile infants. Because the transition to telehealth was abruptly necessitated by the COVID-19 pandemic, the study participants did not have the option to not use telehealth; thus, in the future, the MTAM framework could benefit from adaptions that address the rapid adoption of technology due to large disruptors such as COVID-19.