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Item Feasibility and acceptability pilot of video-based direct observed treatment (vDOT) for supporting antitubercular treatment in South India: a cohort study(BMJ Open, 2023) Rashmi Rodrigues; Suman Sarah Varghese; Mohammed Mahrous; Anil Ananthaneni Kumar; Mohammed Naseer Ahmed; George D'SouzaObjectivesThe objective of this study was to assess the feasibility and acceptability of video-based anti-tuberculosis (TB) treatment adherence support in patients with TB (PwTB) in South India.DesignAn exploratory cohort.SettingParticipants were recruited at the TB treatment centre (direct observed treatment short centre) of a tertiary-level teaching facility in Bangalore, Karnataka, South India.ParticipantsThe study enrolled 25 PwTB, with replacement. Adult PwTB who were on drug-sensitive treatment regimens were included, while those who had drug resistant TB were excluded from the study.InterventionParticipants received scheduled adherence reminders and were trained to videorecord themselves swallowing their medication via a mobile application. The application was automated to submit these videos for evaluation. Participants were followed up monthly till treatment completion or withdrawal.Outcome measuresAdherence rate and acceptability of video-based directly observed treatment (vDOT).ResultsThe mean & PLUSMN;SD age of the participants was 33 & PLUSMN;14 years, majority were females (16, 64%), residing in urban areas (24,96%), married (17, 68%) and had access to smart phones (23,92%). A total of 3193 person days of follow-up was completed; of the videos submitted within the first 6 months of enrollment (2501), 94% (2354/2501) were considered 'acceptable' and 16 (64%) participants were optimally adherent (ie, & GE;80%). Participant videos improved in quality and a higher proportion met acceptability criteria over time. Twenty-one (84%) participants stated that they found the application easy to learn; 13 (52%) preferred vDOT over DOT. Mixed model logistic regression showed that those who are married are more likely have daily adherence to anti-TB treatment.ConclusionVideo-based mobile phone interventions are acceptable to PwTB and the ease of using the application increases with time. To provide patient-centred care, vDOT is a promising option that can be offered to patients for treatment support and adherence monitoring.Item Age, gender and socioeconomic patterns of awareness and usage of e-cigarettes across selected WHO region countries: evidence from the Global Adult Tobacco Survey(BMJ Open, 2023) Sampurna Kundu; Subhojit Shaw; Junaid Khan; Aparajita Chattopadhyay; Emerson Augusto Baptista; Balram PaswanObjectivesThe study explores the awareness and e-cigarette use by demographic and socio-economic characteristics of selected 14 Global Adult Tobacco Survey (GATS) countries.DesignCross-sectional.Setting14 countries.ParticipantsSurveyed population >= 15 years selected through multi-stage cluster sampling.Primary and secondary outcome measuresWe selected 14 countries from 6 different WHO regions where GATS was conducted in different years during 2011-2017.ResultsAwareness and usage of e-cigarette were highest in Greece and lowest in India. Females were less aware of e-cigarette across ages. The gender gap in awareness is wide in Greece post 50 years of age, while the gap is distinct in early ages in Kazakhstan and Qatar. The gender difference in use of e-cigarette was negligible in most of the countries except among the younger cohorts of Russia, Philippines Malaysia and Indonesia. Relatively higher prevalence of e-cigarette smoking among females in the older adult age was observed in some of the Asian countries like India. Multivariate analysis indicates that those who were younger, male, residing in urban areas, current tobacco smokers were more likely to use e-cigarette than their counterparts. Though prevalence of e-cigarette use increased with wealth and education, such pattern is not strong and consistent. Promotional advertisement plays important role in higher use of e-cigaratte. The predicted national prevalence of e-ciragette use was highest in Malaysia .ConclusionsE-cigarette use is more among urban adults, current smokers, males and in countries with promotional advertisement of e-cigarette. Area specific interventions are needed to understand the nature of e-cigarette use. Russia, Ukraine, Costa Rica and Mexico need better understanding to explore whether e-cigaratte use is an indulgence to new mode of addiction, as youth being highly likely to adopt this practice.Item How do diverse low-income and middle-income countries implement primary healthcare team integration to support the delivery of comprehensive primary health care? A mixed-methods study protocol from India, Mexico and Uganda(BMJ Open, 2022) Rohina Joshi; Innocent Besigye; Ileana Heredia-Pi; Manushi Sharma; David Peiris; Robert James Mash; Hortensia Reyes-Morales; Felicity Goodyear-Smith; Renu John; Doris Ortega-Altamirano; Emanuel Orozco-NunezThis study aims to understand PHC team integration, composition and organisation in the delivery of CPHC in India, Mexico and Uganda.Item How does a social norms-based intervention affect behaviour change? Interim findings from a cluster randomised controlled trial in Odisha, India(BMJ Open, 2022) Erica Sedlander; Ichhya Pant; Jeffrey Bingenheimer; Hagere Yilma; Lipika Patro; Satyanarayan Mohanty; Rohini Ganjoo; Rajiv RimalThis paper examines the effect of the intervention at midline to understand which components of eduction in Anaemia through Normative Innovations (RANI) intervention affect uptake.Item '[We] learned how to speak with love': a qualitative exploration of accredited social health activist (ASHA) community health worker experiences of the Mobile Academy refresher training in Rajasthan, India(BMJ Open, 2022) Kerry Scott; Osama Ummer; Sara Chamberlain; Manjula Sharma; Dipanwita Gharai; Bibha Mishra; Namrata Choudhury; Amnesty Elizabeth LeFevreIntroduction Mobile Academy is a mobile-based training course for India's accredited social health activist (ASHA) community health workers (CHW). The course, which ASHAs access by dialling a number from their phones, totals 4 hours of audio content. It consists of 11 chapters, each with their own quiz, and provides a cumulative pass or fail score at the end. This qualitative study of Mobile Academy explores how the programme was accessed and experienced by CHWs, and how they perceive it to have influenced their work. Methods We conducted in-depth interviews (n=25) and focus group discussions (n=5) with ASHAs and other health system actors. Open-ended questions explored ASHA perspectives on Mobile Academy, the course's perceived influence on ASHAs and preferences for future training programmes. After applying a priori codes to the transcripts, we identified emergent themes and grouped them according to our CHW mLearning framework. Results ASHAs reported enjoying Mobile Academy, specifically praising its friendly tone and the ability to repeat content. They, and higher level health systems actors, conceived it to primarily be a test not a training. ASHAs reported that they found the quizzes easy but generally did not consider the course overly simplistic. ASHAs considered Mobile Academy's content to be a useful knowledge refresher but said its primary benefit was in modelling a positive communications approach, which inspired them to adopt a kinder, more 'loving' communication style when speaking to beneficiaries. ASHAs and health system actors wanted follow-on mLearning courses that would continue to compliment but not replace face-to-face training. Conclusion This mLearning programme for CHWs in India was well received by ASHAs across a wide range of education levels and experience. Dial-in audio training has the potential to reinforce topical knowledge and showcase positive ways to communicate.Item Compliance of Adolescent Friendly Health Clinics with National and International Standards: Quantitative findings from the i-Saathiya study(BMJ Open, 2024) Deepika Bahl; Shalini Bassi; Heeya Maity; Supriya Krishnan; Stefanie Dringus; Amanda Mason-Jones; Anku Malik; Monika AroraThe paper assess the compliance of Adolescent Friendly Health Clinics (AFHCs) in two of India's largest states, using both national benchmarks (under Rashtriya Kishor Swasthya Karyakram-RKSK) and global standards (by WHO).