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PurposeThe purpose of this paper is to assess the relationship between elderly people's health literacy skills and those people's decision to make use of digital health service platforms. Despite the substantial influence of digitisation on the delivery of healthcare services, understanding how health intervention strategies might help empower elderly people's health literacy skills is critical.Design/methodology/approachThis paper analyses the existing trends in research on the convergence of health literacy, health intervention programmes and digital health service platforms by reviewing 34 studies published between 2000 and 2020.FindingsThe findings of the review indicate three primary themes (health literacy skills, health management competency and attitude/confidence), which provide a summary of the current literature, and in all three the results show that health intervention programmes help to enhance health literacy skills of elderly people. Based on the review results and by organising the fragmented status quo of health intervention research, the authors develop a comprehensive research model and identify future research directions for research in this domain.Practical implicationsThe findings will be useful to health professionals in two ways: (1) the findings provide practical information about the growing need to implement health literacy intervention programmes to satisfy elderly people's appetite for accessing health services due to cognitive and physiological impairments, and (2) the finding help them to understand that with digital health platforms, elderly people have quicker access to health services, improving the quality of care provided to them.Originality/valueThis paper presents a comprehensive research model for analysing the impact of health literacy skills on older people's ability and intention to access digital health information sources, considering various health intervention approaches.

This project described in this protocol aims to explore effects of 'mental imagery' interventions designed to promote face covering intentions and action in the context of the COVID-19 pandemic. The primary study aim is to study the impact of imagery interventions, relative to control, on intention to wear face coverings in public places immediately post intervention and the impact of imagery interventions, relative to control, on wearing face coverings in public places at a 4 week follow-up time point. The second study aim is to explore, through exploratory analyses, whether individual differences in light triad traits, conscientiousness, and narcissism will influence the impact of imagery interventions. Thirdly, the moderating role of social-cognitive variables of intervention effects will be explored. Fourthly, variation in ‘imagery ability’ (how capable individuals are at visualizing future actions) will be examined as a mediator of potential intervention effects.

International audience; These clinical practice guidelines from the French National College of Midwives (CNSF) are intended to define the messages and the preventive interventions to be provided to women and co-parents by the different professionals providing care to women or their children during the perinatal period. These guidelines are divided into 10 sections, corresponding to 4 themes: 1/ the adaptation of maternal behaviors (physical activity, psychoactive agents); 2/ dietary behaviors; 3/ household exposure to toxic substances (household uses, cosmetics); 4/ promotion of child health (breastfeeding, attachment and bonding, screen use, sudden unexplained infant death, and shaken baby syndrome). We suggest a ranking to prioritize the different preventive messages for each period, to take into account professionals’ time constraints.

Recent advances in wearable sensor technology and smartphones enable simple and affordable collection of personal analytics. This paper reflects on the lessons learned in the SWELL project that addressed the design of user-centered ICT applications for self-management of vitality in the domain of knowledge workers. These workers often have a sedentary lifestyle and are susceptible to mental health effects due to a high workload. We present the sense–reason–act framework that is the basis of the SWELL approach and we provide an overview of the individual studies carried out in SWELL. In this paper, we revisit our work on reasoning: interpreting raw heterogeneous sensor data, and acting: providing personalized feedback to support behavioural change. We conclude that simple affordable sensors can be used to classify user behaviour and heath status in a physically non-intrusive way. The interpreted data can be used to inform personalized feedback strategies. Further longitudinal studies can now be initiated to assess the effectiveness of m-Health interventions using the SWELL methods.

The biopsychosocial model is among the most influential frameworks for human-centered health improvement but has faced significant criticism– both conceptual and pragmatic. This paper extends and fundamentally re-structures the biopsychosocial model by combining it with sociotechnical systems theory. The resulting biopsychosociotechnical model addresses key critiques of the biopsychosocial model, providing a more “practical theory” for human-centered health improvement. It depicts the determinants of health as complex adaptive system of systems; includes the the artificial world (technology); and provides a roadmap for systems improvement by: differentiating between “health status” and “health and needs assessment”, [promoting problem framing]; explaining health as an emergent property of the biopsychosociotechnical context [imposing a systems orientation]; focusing on “interventions” vs. “treatments” to modify the biopsychosociotechnical determinants of health, [expanding the solution space]; calling for a participatory design process [supporting systems awareness and goal-orientation]; and including intervention management to support the full lifecycle of health improvement.

To explore the general public’s understanding and judgement of health interventions inside and outside of prisons. To examine the role members of the community have in the successful rehabilitation and reintegration of individuals with convictions.

La violencia de género supone una problemática de grandes dimensiones que afecta a toda la población y se ha reconocido como un problema de salud pública. Las víctimas de violencia de género acuden con más frecuencia a los servicios sanitarios, por eso es importante conocer las intervenciones sanitarias y el papel de enfermería en la violencia de género, que es el objetivo principal de este trabajo. Para ello, se llevó a cabo una revisión bibliográfica de algunas de las principales bases de datos (Pubmed, Scielo, Dialnet, Web of Science…) y del metabuscador Google Académico. De manera que, tras el análisis de los artículos, se determina que el papel de los profesionales sanitarios es remarcable puesto que el sistema sanitario conforma un lugar seguro al que acuden las víctimas de violencia de género. El papel sanitario consiste en la prevención, detección precoz y abordaje, algo que puede realizar el personal de enfermería o bien un equipo multidisciplinar del que la enfermera forma parte. Se concluye diciendo que las víctimas de violencia de género padecen más problemas de salud, por lo que es un problema que incide directamente sobre la sanidad, aunque todavía falta mucha formación de los profesionales para poder atender de manera temprana los casos de violencia de género, que es una de las principales funciones del personal sanitario, junto con la prevención y el abordaje de estos casos. Gender-based violence is a major problem that affects the entire population and has been recognized as a public health problem. Victims of gender-based violence go to health services more frequently, so it is important to know the health interventions and the role of nursing in gender violence, which is the main objective of this work. To this end, a bibliographic review of some of the main databases (Pubmed, Scielo, Dialnet, Web of Science...) and the Google Scholar metasearch engine was carried out. So, after the analysis of the articles, it is determined that the role of health professionals is remarkable since the health system forms a safe place where victims of gender violence go. The health role consists of prevention, early detection and approach, something that can be done by the nursing staff or a multidisciplinary team of which the nurse is part. It is concluded by saying that victims of gender violence suffer more health problems, so it is a problem that directly affects health, although there is still a lack of training of professionals to be able to attend early cases of gender violence, which is one of the main functions of health personnel, along with the prevention and management of these cases. Graduado o Graduada en Enfermería por la Universidad Pública de Navarra Erizaintzan Graduatua Nafarroako Unibertsitate Publikoan

Obesity among children is a rising concern throughout the world. In the U.S., rates of childhood obesity are the highest among children from diverse and economically disadvantaged households. Obesity in adolescence increases the risk of negative physical and psychological health consequences. Mobile-app-based health interventions have been found to be an effective tool to encourage children to adopt a healthier living style. A novel mobile app prototype was developed for early adolescents to communicate with and engage them interactively about healthy eating and active living. To test the app’s usability, students from a U.S. middle school, with a majority of children from low-income families, were recruited to use the app and report their feedback. The usability testing results confirmed that the app was equally well received by participants of different genders, normal weight versus overweight/obesity, and amounts of screen time. Study participants also provided overwhelming positive feedback for the embedded and tailored motivational messages that encourage healthy eating and active living. The conceptualization of the app prototype was guided by the self-determination theory, social cognitive theory, and priming theory, in addition to incorporating evidence-based obesity prevention principles. This prototype, hence, provides a valid platform for building theory-based behavioral interventions.

Music as a potential prevention strategy can play a pivotal role in developing behavioural changes and creating awareness about malaria and malaria prevention. The study was conducted in a moderate-risk malaria district in sub-Saharan Africa. A comparative analysis and pre-and post-intervention evaluation of three teaching intervention methods to teach and educate young children about malaria, e.g., song intervention, drama intervention, and song-and-drama combination, was evaluated. Data were collected by means of pre-and post-intervention interviews with Grade 3 primary school children and teachers, as well as a post-intervention questionnaire with teachers, parents, guardians, and caregivers. The purpose of the study was to investigate knowledge gains on malaria in relation to malaria awareness interventions. The results revealed that the song-only intervention was the most effective learning intervention strategy in this population and that behavioural changes and knowledge growth occurred regarding malaria and malaria prevention in this population. Independent of the teaching styles of each teacher in teaching the song to the children, the findings established that culturally and age-appropriate songs contributed to increasing children’s knowledge growth regarding sustainable malaria prevention.

Background Actively involving patients and communities in health decisions can improve both peoples’ health and the health system. One key strategy is Patient-Public Engagement (PPE). This scoping review aims to identify and describe PPE research in Sub-Saharan Africa; systematically map research to theories of PPE; and identify knowledge gaps to inform future research and PPE development. Methods The review followed guidelines for conducting and reporting scoping reviews. A systematic search of peer-reviewed English language literature published between January 1999 and December 2019 was conducted on Scopus, Medline (Ovid), CINAHL and Embase databases. Independent full text screening by three reviewers followed title and abstract screening. Using a thematic framework synthesis, eligible studies were mapped onto an engagement continuum and health system level matrix to assess the current focus of PPE in Sub-Saharan Africa. Results Initially 1948 articles were identified, but 18 from 10 Sub-Saharan African countries were eligible for the final synthesis. Five PPE strategies implemented were: 1) traditional leadership support, 2) community advisory boards, 3) community education and sensitisation, 4) community health volunteers/workers, and 5) embedding PPE within existing community structures. PPE initiatives were located at either the ‘involvement’ or ‘consultation’ stages of the engagement continuum, rather than higher-level engagement. Most PPE studies were at the ‘service design’ level of the health system or were focused on engagement in health research. No identified studies reported investigating PPE at the ‘individual treatment’ or ‘macro policy/strategic’ level. Conclusion This review has successfully identified and evaluated key PPE strategies and their focus on improving health systems in Sub-Saharan Africa. PPE in Sub-Saharan Africa was characterised by tokenism rather than participation. PPE implementation activities are currently concentrated at the ‘service design’ or health research levels. Investigation of PPE at all the health system levels is required, including prioritising patient/community preferences for health system improvement.

Background Many randomized controlled trials fail to reach their target sample size. When coupled with the omission and underrepresentation of disadvantaged groups in randomized controlled trials, many trials fail to obtain data that accurately represents the true diversity of their target population. Policies and practices have been implemented to increase representation of disadvantaged groups in many randomized controlled trials, with some trials specifically targeting such groups. To our knowledge, no systematic review has quantified the enrollment metrics and effectiveness of inclusion and retention strategies in randomized controlled trials focused on disadvantaged populations specifically. Methods We will conduct a systematic search across EMBASE, MEDLINE, Web of Science, and CINAHL as well as grey literature, conference proceedings, research monographs, and Google Scholar from inception onwards. We will include randomized controlled trials where at least 50% of enrolled participants are considered to be disadvantaged, as per the RCT authors’ definition and in line with our inclusion criteria. Two independent researchers per article will conduct preliminary title and abstract screening, subsequent full text review, and data extraction for the selected trials, with a third reviewer available to resolve conflicts. We will assess the quality of all included studies using specific criteria regarding data reporting, external validity, and internal validity. We will combine all selected studies and conduct a narrative synthesis to assess enrollment metrics. If there is sufficient homogeneity and sufficient trials comparing recruitment strategies within disadvantaged populations, we will conduct a random effects meta-analysis to evaluate the effectiveness of strategies designed to maximize the inclusion of disadvantaged populations in randomized controlled trials. Discussion The findings of this systematic review will establish baseline recruitment and enrollment metrics of trials targeting disadvantaged populations to elucidate the scope of the challenge of recruiting such populations. We hope that our findings will promote future research on the distinct barriers that may prevent disadvantaged populations from participating in health intervention research, will encourage more trials exploring effective, tailored recruitment strategies, and will establish a foundation to track future progress in the recruitment of disadvantaged populations. Trial registrations PROSPERO ID: CRD42020152814

Public health researchers and social scientists highlight the promise of network-based strategies to inform and enhance interventions that curb risky adolescent health behaviors. However, we currently lack an understanding of how different variants of network-based interventions shape the distribution of targeted behaviors. The current project considers the effectiveness of five targeting strategies that are designed to have differential impacts on the health of program participants versus non-participants. Using simulations that are empirically-grounded in 28 observed school-based networks from the PROSPER study, we evaluate how these approaches shape long-term alcohol use for intervention participants and non-participants, separately, and consider whether contextual factors moderate their success. Findings suggest that enrolling well-connected adolescents results in the lowest drinking levels for non-participants, while strategies that target groups of friends excel at protecting participants from harmful influences. These trends become increasingly pronounced in contexts characterized by higher levels of peer influence.

This paper describes Ivy, an office chair that represents sitting time of an office worker through growing ivy strands. The longer one sits, the more strands will grow onto the chair. By means of a qualitative interface called Ivy, we illustrate a design approach that is currently underrepresented in sedentary behavior interventions. With this approach, we counter the current trend of digitalization and quantification of health interventions. Instead of graphs and numbers, Ivy uses data physicalization as a qualitative interface that represents sitting. We describe the design, the process, and future research steps of Ivy as a critical perspective on sedentary behavior interventions. We aim to spark discussion amongst designers and researchers in the field of Human-Computer Interaction to use qualitative interfaces as a promising approach to deepen the user's relationship with the targeted behavior and enrich the ability to construct meaning from the feedback. © 2020 Owner/Author.

Cervical cancer is a disease that is emphasised as one of the gravest threats to women’s life. In low and middle-income countries, it is the cancer type that kills most women and girls. The World Health Organisation situates cervical cancer as a public health problem and highlights that countries need to put focus on strategies towards eliminating cervical cancer as a global burden of disease. In alignment with this, the Ugandan MoH emphasise comprehensive screening services to control and prevent the disease throughout the country. However, a report shows that 80 % of women in Uganda only seek professional help when cervical cancer is in an advanced stage. This qualitative study is an exploration of women’s and health workers’ knowledge, attitudes and beliefs towards cervical cancer and screening in Fort Portal, Uganda. Through in-depth interviews and observations this study explores if these factors influence choices and motivations to present for cervical cancer screening. It suggests that health behaviours cannot be separated from national and global policies; hence this study facilitates a holistic perspective. Based on findings this study reveals that local understandings, beliefs and attitudes as well as societal, historical, economic and political dynamics are critical factors in order to succeed when implementing health services. By providing insights into women’s and health workers’ knowledge, beliefs and attitudes towards cervical cancer screening, and shedding light on access- and awareness in Uganda generally and Fort Portal particularly, this study can contribute to more knowledge on how to implement cervical cancer services that are sensitive to local needs and hence may encourage more women to come forward for screening.

The objective of this study was to design a user-centered mobile health (mHealth) application for individuals with gastroesophageal reflux disease (GERD) and evaluate its design features and effectiveness for use by doctors. Prior to designing, our team undertook a discovery process that involved creating personas, conducting a competitor analysis and heuristic evaluation of existing apps, along with interviews with acid reflux patients. Then, we created a low-fidelity prototype, which was revised on the basis of several rounds of user testing. During the design phase, each round of user testing included a mix of surveys, concurrent think-alouds, and interviews to gather user feedback on the prototypes. Lastly, an evaluation phase consisting of gathering feedback on the user-centered design approach from user experience experts and medical doctors specialized in GERD was conducted. Overall, the final GERD app includes important features for tracking symptoms and triggers, analytics, data export, and community information, while promoting individualization, accessibility, and usability. The documentation of the design process of this app serves as a reference point for future medical app developers as it followed an empirically supported user-centered design strategy and resulted in an app which received positive feedback from users and human factors experts. We also intend to share some of the limitations due to the constrained resources, as well as potential ways to strengthen the design process for mHealth applications.

Within the context of a globally aging population and associated age-related changes to social relationships and individual psycho-physiology, a coalition of mostly European Union (EU) organizations concerned with physical activity in older persons was formed in 2013. The coalition examined worldwide decreases in physical activity among older adults, and the resulting negative effects on health and function for those individuals. After holding expert panel meetings, the coalition developed recommendations about how to address macro- and microlevel changes to increase and sustain physical activity among older populations across Europe. The recommendations were then compiled into a consensus document called "the Rome Statement", aimed at older adults, policy makers, researchers, and private and public professionals. This article presents the Rome Statement and its recommendations, and discusses how the statement can be broadly disseminated, considered, and implemented.

Background Equity in health has become an important policy agenda around the world, prompting health economists to advance methods to enable the inclusion of equity in economic evaluations. Among the methods that have been proposed to explicitly include equity are the weighting analysis, equity impact analysis, and equity trade-off analysis. This is a new development and a comprehensive overview of trends and concepts of health equity in economic evaluations is lacking. Thus, our objective is to map the current state of the literature with respect to how health equity is considered in economic evaluations of health interventions reported in the academic and gray literature. Methods We will conduct a scoping review to identify and map evidence on how health equity is considered in economic evaluations of health interventions. We will search relevant electronic, gray literature and key journals. We developed a search strategy using text words and Medical Subject Headings terms related to health equity and economic evaluations of health interventions. Articles retrieved will be uploaded to reference manager software for screening and data extraction. Two reviewers will independently screen the articles based on their titles and abstracts for inclusion, and then will independently screen a full text to ascertain final inclusion. A simple numerical count will be used to quantify the data and a content analysis will be conducted to present the narrative; that is, a thematic summary of the data collected. Discussion The results of this scoping review will provide a comprehensive overview of the current evidence on how health equity is considered in economic evaluations of health interventions and its research gaps. It will also provide key information to decision-makers and policy-makers to understand ways to include health equity into the prioritization of health interventions when aiming for a more equitable distribution of health resources. Systematic review registration This protocol was registered with Open Science Framework (OSF) Registry on August 14, 2019 (https://osf.io/9my2z/registrations).

Background Doubts exist around the value of compiling league tables for cost-effectiveness results for health interventions, primarily due to methods differences. We aimed to determine if a reasonably coherent league table could be compiled using published studies for one high-income country: New Zealand (NZ). Methods Literature searches were conducted to identify NZ-relevant studies published in the peer-reviewed journal literature between 1 January 2010 and 8 October 2017. Only studies with the following metrics were included: cost per quality-adjusted life-year or disability-adjusted life-year or life-year (QALY/DALY/LY). Key study features were abstracted and a summary league table produced which classified the studies in terms of cost-effectiveness. Results A total of 21 cost-effectiveness studies which met the inclusion criteria were identified. There were some large methodological differences between the studies, particularly in the time horizon (1 year to lifetime) but also discount rates (range 0 to 10%). Nevertheless, we were able to group the incremental cost-effectiveness ratios (ICERs) into general categories of being reported as cost-saving (19%), cost-effective (71%), and not cost-effective (10%). The median ICER (adjusted to 2017 NZ$) was ~ $5000 per QALY/DALY/LY (~US$3500). However, for some interventions, there is high uncertainty around the intervention effectiveness and declining adherence over time. Conclusions It seemed possible to produce a reasonably coherent league table for the ICER values from different studies (within broad groupings) in this high-income country. Most interventions were cost-effective and a fifth were cost-saving. Nevertheless, study methodologies did vary widely and researchers need to pay more attention to using standardised methods that allow their results to be included in future league tables. Electronic supplementary material The online version of this article (10.1186/s12963-019-0192-x) contains supplementary material, which is available to authorized users.

Background Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict. Methods We conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to explore reasons behind provision/non-provision of RMNCAH&N interventions, and the rationale informing decisions, priorities, collaborations and implementation. We attempt to validate findings by triangulating data from both sources. Results Key findings showed that humanitarian organisations operating in Syria adopted a complex multi-hub structure, and some resorted to remote management to improve accessibility to certain geographic areas. The emergency response prioritised trauma care and infectious disease control. Yet, with time, humanitarian organisations successfully advocated for prioritising maternal and child health and nutrition interventions given evident needs. The volatile security context had implications on populations’ healthcare seeking behaviors, such as women reportedly preferring home births, or requesting Caesarean-sections to reduce insecurity risks. Additional findings were glaring data gaps and geographic variations in the availability of data on RMNCAH&N indicators. Adaptations of the humanitarian response included task-shifting to overcome shortage in skilled healthcare workers following their exodus, outreach activities to enhance access to RMNCAH&N services, and operating in ‘underground’ facilities to avoid risk of attacks. Conclusion The case of Syria provides a unique perspective on creative ways of managing the humanitarian response and delivering RMNCAH&N interventions, mainly in the multi-hub structure and use of remote management, despite encountered challenges. The scarcity of RMNCAH&N data is a tremendous challenge for both researchers and implementing agencies, as it limits accountability and monitoring, thus hindering the evaluation of delivered interventions.

Developing and evaluating the implementation of complex health interventions into routine health services in low and middle income countries is challenging. This presentation will explore how Theory of Change, a monitoring and evaluation approach, strengthened the design and evaluation of a complex health intervention (PRIME) which aimed to integrate mental health into primary health in districts or sub-districts in Ethiopia, India, Nepal, South Africa and Uganda. Erica will describe how PRIME used Theory of Change to co-develop district level mental healthcare plans with stakeholders to ensure local relevance within each implementation site while providing an overall framework for evaluation across sites. She will reflect on the strengths and weaknesses of this approach in the context of the evaluation of complex health interventions in global health.

International audience; Today, one important challenge in developed countries is health inequalities. Research conducted in public health policy issues supply little evidence for effective interventions aiming to improve population health and to reduce health inequalities. There is a need for a powerful tool to support priority setting and guide policy makers in their choice of health interventions, and that maximizes social welfare. This paper proposes to divert a spatial tool based on Kulldorff's scan method to investigate social inequalities in health. This commentary argues that this spatial approach can be a useful tool to tackle social inequalities in health by guiding policy makers at three levels: (i) supporting priority setting and planning a targeted intervention; (ii) choosing actions or interventions which will be performed for the whole population, but with a scale and intensity proportionate to need; and (iii) assessing health equity of public interventions.

We propose a novel framework to analyse the macroeconomic impact of noncommunicable diseases. We incorporate measures of disease prevalence into a human capital augmented production function, which enables us to determine the economic costs of chronic health conditions in terms of foregone gross domestic product (GDP). Unlike previously adopted frameworks, this approach allows us to account for i) variations in human capital for workers in different age groups, ii) mortality and morbidity effects of non-communicable diseases, and iii) the treatment costs of diseases. We apply our methodology to China, Japan, and South Korea, and estimate the economic burden of chronic conditions in five domains (cardiovascular diseases, cancer, respiratory diseases, diabetes, and mental health conditions). Overall, total losses associated with these non-communicable diseases over the period 2010-2030 are $16 trillion for China (measured in real USD with the base year 2010), $5.7 trillion for Japan, and $1.5 trillion for South Korea. Our results also highlight the limits of cost-effectiveness analysis by identifying some intervention strategies to reduce disease prevalence in China that are cost beneficial and therefore a rational use of resources, though they are not cost-effective as judged by conventional thresholds.

Background: The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program. Objectives: The objectives of the ACHRU research program are (i) to codesign integrated and person-centered interventions with older adults, family/friend caregivers, and providers; (ii) to examine the feasibility of newly designed interventions; (iii) to determine the intervention effectiveness on Triple Aim outcomes: health, patient/caregiver experience, and cost; (iv) to examine intervention context and implementation barriers and facilitators; (v) to use diverse integrated knowledge translation (IKT) strategies to engage knowledge users to support scalability and sustainability of effective interventions; and (vi) to build patient-oriented research capacity. Design: The research program was informed by the Knowledge-to-Action Framework and the Complexity Model. Six individual studies were conceptualized as integrated pieces of work. The results of the three initial descriptive studies will inform and be followed by three pragmatic randomized controlled trials. IKT and capacity building activities will be embedded in all six studies and tailored to the unique focus of each study. Conclusions: This research program will inform the development of effective and scalable person-centered interventions that are sustainable through interagency and intersectoral partnerships with community-based agencies, policy makers, and other health and social service agencies. Implementation of these interventions has the potential to transform health-care services and systems and improve the quality of life for older adults with multimorbidity and their caregivers. Trial registration: NCT02428387 (study 4), NCT02158741 (study 5), and NCT02209285 (study 6).

Statistical classifications provide a basis for collecting and analysing data, for building knowledge and communicating information. A classification of public health interventions is being developed as part of the World Health Organization’s International Classification of Health Interventions (ICHI). This is a pioneering development, as there have been no previous efforts to produce a standard classification of public health interventions. A comprehensive developmental appraisal of the draft classification of public health interventions was undertaken to gain an understanding of its strengths and limitations, and to identify what should be done to improve its utility. The classification was used to code three data sets of public health interventions, to identify problems encountered and to assess inter-coder reliability. Views of potential users were elicited through key-informant interviews. An analytical structure was developed, comprising a set of criteria concerning the desired features of a statistical classification and a model representing the main elements that make up a statistical classification. ICHI was found to have some utility for representing data on public health interventions. Limitations identified included coverage gaps, overlap between categories, lack of clarity concerning how the classification axes are operationalised for public health interventions, and difficulty splitting complex interventions into their constituent components for coding. This study makes a significant and timely contribution to the development of the draft classification, by providing specific proposals for improvements to ICHI, explicating some fundamental conceptual issues that should be addressed, and indicating a path forward for the further development and use of ICHI in the field of public health. The analytical structure developed through the conduct of this research represents a novel methodological contribution to the field of classification development.

International audience; Background - Budget impact analysis (BIA) provides short- and medium-term estimates on changes in budgets and health outcomes resulting from the adoption of new health interventions. Objective - The purpose of this study is to present the newly developed French National Authority for Health (HAS) guidelines on budget impact analysis as follows: process, literature review, recommendations and comparisons with other guidelines. Methods - The development process of the HAS guidelines included a literature review (search dates: January 2000 to June 2016), a retrospective investigation of BIA previously submitted to HAS, a public consultation, international expert reviews and approval from the HAS Board and the Economic and Public Health Evaluation Committee of HAS. Results - Documents identified in the literature review included 12 national guidelines, 5 recommendations for good practices developed by national and international society of health economics and 14 methodological publications including recommendations for conducting BIA. Based on its research findings, HAS developed its first BIA guidelines, which include recommendations on the following topics: BIA definition, perspective, populations, time horizon, compared scenarios, budget impact models, costing, discounting, choice of clinical data, reporting of results and uncertainty exploration. Conclusion - It is expected that the HAS BIA guidelines will enhance the usefulness, quality and transparency of BIA submitted by drug manufacturers to HAS. BIA is becoming an essential part of a comprehensive economic assessment of healthcare interventions in France, which also includes cost-effectiveness analysis and equity of access to healthcare.

In recent years, health behaviour interventions have received a great deal of attention in both research and policy as a means of encouraging people to lead healthier lives. The emphasis of such interventions has varied over time, in terms of level of intervention (e.g. individual vs community) and drawing on different disciplinary perspectives. Recently, a number of critiques have focused on how health behaviour interventions sometimes sideline issues of social context, framing health as a matter of individual choice and, by implication, a personal responsibility. Part of this criticism is that health behaviour interventions often do not draw on alternative social science understandings of the structured and contextual aspects of behaviour and health. Yet to our knowledge, no study has attempted to empirically assess the extent to which, and in what ways, the health behaviour intervention field has paid attention to social context. In this article, we undertake this task using bibliometric techniques in order to map out the health behaviour intervention field. We find that the number of health behaviour interventions has grown rapidly in recent years, especially since around 2006, and that references to social science disciplines and concepts that foreground issues of social context are rare and, relatively speaking, constitute less of the field post 2006. More quantifiable concepts are used most, and those more close to the complexities of social context are mentioned least. The document co-citation analysis suggests that pre 2006, documents referring to social context were relatively diffuse in the network of key citations, but post 2006 this influence had largely diminished. The journal co-citation analysis shows less disciplinary overlap post 2006. At present, health behaviour interventions are continuing to focus on individualised approaches drawn from behavioural psychology and behavioural economics. Our findings lend empirical support to a number of recent papers that suggest more interdisciplinary collaboration is needed to advance the field.

The authors examine differential progress on health Millennium Development Goals (MDGs) between the poor and the better off within countries. Their findings are based on an original analysis of 235 Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) surveys spanning 64 developing countries over the 1990–2011 period. The authors track five health status indicators and seven intervention indicators from all four health MDGs. In approximately three-quarters of countries, the poorest 40 percent have made faster progress than the richest 60 percent on MDG intervention indicators. On average, relative inequality in these indicators has been falling. However, in terms of MDG outcome indicators, in nearly half of the countries, relative inequality has been growing. Moreover, in approximately one-quarter of the countries, the poorest 40 percent have been slipping backwards in absolute terms on both MDG interventions and outcomes. Despite reductions in most countries, relative inequalities in MDG health indicators are still appreciable, with the poor facing higher risks of malnutrition and death in childhood and lower odds of receiving key health interventions.

Some medical scientists argue that only data from randomized controlled trials (RCTs) are trustworthy. They claim data from natural experiments and administrative data sets are always spurious and cannot be used to evaluate health policies and other population-wide phenomena in the real world. While many acknowledge biases caused by poor study designs, in this article we argue that several valid designs using administrative data can produce strong findings, particularly the interrupted time series (ITS) design. Many policy studies neither permit nor require an RCT for cause-and-effect inference. Framing our arguments using Campbell and Stanley’s classic research design monograph, we show that several “quasi-experimental” designs, especially interrupted time series (ITS), can estimate valid effects (or non-effects) of health interventions and policies as diverse as public insurance coverage, speed limits, hospital safety programs, drug abuse regulation and withdrawal of drugs from the market. We further note the recent rapid uptake of ITS and argue for expanded training in quasi-experimental designs in medical and graduate schools and in post-doctoral curricula.

Reproductive, maternal, newborn, and child health (RMNCH) has been a priority for both governments and civil society in low- and middle-income countries (LMICs). This priority was affirmed by world leaders in the Millennium Development Goals (MDGs) that called for countries to reduce child mortality by 67 percent and maternal mortality by 75 percent between 1990 and 2015. Although substantial progress on these targets has been made, few countries achieved the needed reductions. The United Nations (UN) Secretary-General’s Global Strategy for Women’s and Children’s Health, launched in 2010 and expanded in 2015 to include adolescents, is an indication of the continued global commitment to the survival and wellbeing of women and children (Ban 2010). Annual official development assistance for maternal, newborn, and child health has increased from US$2.7 billion in 2003 to US$8.3 billion in 2012, when there was an additional US$4.5 billion for reproductive health (Arregoces and others 2015). A continued focus on RMNCH is needed to address the remaining considerable burden of disease in LMICs from unwanted pregnancies; high maternal, newborn, and child mortality and stillbirths; high rates of under nutrition; frequent communicable and non-communicable diseases; and loss of human capacity. Cost-effective interventions are available and can be implemented at high coverage in LMICs to greatly reduce these problems at an affordable cost. RMNCH encompasses health problems across the life course from adolescent girls and women before and during pregnancy and delivery, to newborns and children. An important conceptual framework is the continuum-of-care approach in two dimensions. One dimension recognizes the links from mother to child and the need for health services across the stages of the life course. The other is the delivery of integrated preventive and therapeutic health interventions through service platforms ranging from the community to the primary health center and the hospital. This volume presents the levels and trends of RMNCH indicators, proven interventions for prevention of mortality, costs of these interventions and potential health service delivery platforms, and system innovations.

Background: Child vaccination is perhaps the first line of defense to ensure a healthy society. Unfortunately, the coverage of child vaccination in Pakistan is poor resulting in unnecessary yet preventable deaths. This study investigated the determinants and reasons for not vaccinating children in Pakistan. Materials and Methods: The study used the Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002 data. Demographic, distance to health facility, poverty status, literacy and education, and location of residence were used as determinants of nonimmunization of children. Descriptive statistics including frequency distribution, proportions for categorical variables and mean for continuous variables, and logistic regression analysis were done using the Stata 11.0. Results: Almost 7.73% children in Pakistan were never immunized. More than 87.4% of these lived in the rural areas. Prevalence of nonimmunization was highest in Balochistan compared to other provinces. Large households appeared to have increased risk of a child not being vaccinated. Moreover, low literacy and education of the head of the household and the spouse was also associated with low vaccination coverage. Distance from the health facility was found to be another factor related to nonimmunization of children. Increase in per capita income significantly decreased the risk of missing vaccinations. Conclusions: Prevention and immunization programs should focus more on high-risk regions such as Balochistan and rural areas. Literacy, education, and economic status were among the other significant factors associated with low vaccination rates, which need a special focus in the public policy to achieve the target of a healthy society.

The purpose of the study was to describe conditions and dynamics in the lives of high-risk, low-income, Southern United States prenatal-interconceptional women (n = 37) in a home visiting program that promoted maternal health literacy progression. In the Life Course Health Development (LCHD) Model, conditions were risk and protective factors that impacted health. Dynamics drove the complex, epigenetic relationships between risk and protective factors. Maternal health literacy promotion helped participants address conditions and dynamics to create positive life changes. This research was a retrospective, mixed methods study of women&rsquo, s service records documenting care from prenatal admission to 24 months post-delivery. The Life Skills Progression Instrument (LSP) was scored to measure maternal health literacy progression. Ethnographic content analysis of visit notes triangulated with quantitative data enabled specificity of critical data elements. Subsequently, a complementary focus group was conducted with the Registered Nurse Case Managers (RNCM). Severe social conditions included devastating poverty, low educational achievement, transient housing, unstable relationships, incarceration, lack of continuous health insurance, and shortage of health care providers. Dynamics included severe psycho-social stressors, domestic violence, lack of employment, low income, low self-esteem and self-expectations, and social/family restraints upon women&rsquo, s intended positive changes. An important protective factor was the consistent, stable, evidence-informed relationship with the RNCM. Findings from the focus group discussion supported content analysis results.

Essay #1 - Parental Social Influence in Childhood Obesity Interventions: a Systematic Review The objective of this study is to understand the pathways through which social influence at the family level moderates childhood obesity interventions. We conducted a systematic review of obesity interventions in which parents' behaviors are targeted to change children's obesity outcomes, due to the potential social and environmental influence of parents on the nutrition and physical activity behaviors of children. Results for existing mechanisms that moderate parents' influence on children's behavior are discussed and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations to leverage family-based social influence mechanisms for increasing the efficacy of the obesity intervention programs. Essay #2 - Dynamics of Obesity Interventions inside Organizations: a Case Study of Food Carry-Outs in Baltimore A large number of obesity prevention interventions, from upstream (policy and environmental) to downstream (individual level), have been put forward to curb the obesity trend; however, not all those interventions have been successful. Overall effectiveness of obesity prevention interventions relies not only on the average efficacy of a generic intervention, but also on the successful Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) of that intervention. In this study, we aim to understand how effectiveness of organizational level obesity prevention interventions depends on dynamics of AIM. We focus on an obesity prevention intervention, implemented in food carry-outs in low-income urban areas of Baltimore city, which aims to improve dietary behavior for adults through better food access to healthier foods and point-of-purchase prompts. Building on data from interviews and the literature we develop a dynamic model of the key processes of AIM. We first develop a contextualized map of causal relationships integral to the dynamics of AIM, and then quantify those mechanisms using a system dynamics simulation model. With simulation analysis, we show how as a result of several reinforcing loops that span stakeholder motivation, communications, and implementation quality and costs, small changes in the process of AIM can make a big difference in impact. We present how the dynamics surrounding communication, motivation, and depreciation of interventions can create tipping dynamics in AIM. Specifically, small changes in allocation of resources to an intervention could have a disproportionate long-term impact if those additional resources can turn stakeholders into allies of the intervention, reducing the depreciation rates and enhancing sustainability. We provide researchers with a set of recommendations to increase the sustainability of the interventions. Essay #3 - Dynamics of Implementation and Maintenance of Organizational Health Interventions: Case Studies of Obesity Interventions In this study, we present case studies to explore the dynamics of implementation and maintenance of obesity interventions. We analyze how specific obesity prevention interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes. Ph. D.

Background: The high prevalence of physical inactivity worldwide calls for innovative and more effective ways to promote physical activity (PA). There are limited objective data on the effectiveness of Web-based personalized feedback on increasing PA in adults. Objective: It is hypothesized that providing personalized advice based on PA measured objectively alongside diet, phenotype, or genotype information would lead to larger and more sustained changes in PA, compared with nonpersonalized advice. Methods: A total of 1607 adults in seven European countries were randomized to either a control group (nonpersonalized advice, Level 0, L0) or to one of three personalized groups receiving personalized advice via the Internet based on current PA plus diet (Level 1, L1), PA plus diet and phenotype (Level 2, L2), or PA plus diet, phenotype, and genotype (Level 3, L3). PA was measured for 6 months using triaxial accelerometers, and self-reported using the Baecke questionnaire. Outcomes were objective and self-reported PA after 3 and 6 months. Results: While 1270 participants (85.81% of 1480 actual starters) completed the 6-month trial, 1233 (83.31%) self-reported PA at both baseline and month 6, but only 730 (49.32%) had sufficient objective PA data at both time points. For the total cohort after 6 months, a greater improvement in self-reported total PA ( P =.02) and PA during leisure (nonsport) ( P =.03) was observed in personalized groups compared with the control group. For individuals advised to increase PA, we also observed greater improvements in those two self-reported indices ( P =.006 and P =.008, respectively) with increased personalization of the advice (L2 and L3 vs L1). However, there were no significant differences in accelerometer results between personalized and control groups, and no significant effect of adding phenotypic or genotypic information to the tailored feedback at month 3 or 6. After 6 months, there were small but significant improvements in the objectively measured physical activity level ( P

The definitive version is available at www3.interscience.wiley.com, BACKGROUND A project to improve integrated control of schistosomiasis in the primary health care system of Northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom-based treatment and making praziquantel (PZQ) available for an affordable price. OBJECTIVE To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project. METHODS We performed structured interviews with staff from 55 health care facilities in five districts. RESULTS Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty-seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one-third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom-based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower. CONCLUSION Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom-based treatment and further reduction of the costs of PZQ.

Background Schools are repeatedly utilised as a key setting for health interventions. However, the translation of effective research findings to the school setting can be problematic. In order to improve effective translation of future interventions, it is imperative key challenges and facilitators of implementing health interventions be understood from a school’s perspective. Methods Nineteen semi-structured interviews were conducted in primary schools (headteachers n = 16, deputy headteacher n = 1, healthy school co-ordinator n = 2). Interviews were transcribed verbatim and analysed using thematic analysis. Results The main challenges for schools in implementing health interventions were; government-led academic priorities, initiative overload, low autonomy for schools, lack of staff support, lack of facilities and resources, litigation risk and parental engagement. Recommendations to increase the application of interventions into the school setting included; better planning and organisation, greater collaboration with schools and external partners and elements addressing sustainability. Child-centred and cross-curricular approaches, inclusive whole school approaches and assurances to be supportive of the school ethos were also favoured for consideration. Conclusions This work explores schools’ perspectives regarding the implementation of health interventions and utilises these thoughts to create guidelines for developing future school-based interventions. Recommendations include the need to account for variability between school environments, staff and pupils. Interventions with an element of adaptability were preferred over the delivery of blanket fixed interventions. Involving schools in the developmental stage would add useful insights to ensure the interventions can be tailored to best suit each individual schools’ needs and improve implementation.

An overemphasis on clinical trials and behavior change models has narrowed the knowledge base that can be used to design interventions. The overarching point is that the process of overanalyzing variables is impeding the process of gaining insight into the everyday experiences that shape how people define health and seek treatment. This claim is especially important to health decision-making and behavior change because subtle interpretations often influence the decisions that people make. This manuscript provides a critique of traditional approaches to developing health interventions, and theoretically justifies what and why changes are warranted. The limited scope of these models is also discussed, and an argument is made to adopt a strategy that includes the perceptions of people as necessary for understanding health and health-related decision-making. Three practical strategies are suggested to be used with the more standard approaches to assessing the effectiveness and relevance of health interventions.Key words: health interventions, clinical trials, behavior change models, photovoice, ethnography, narratives, theory, public health(Published: 21 July 2014)Citation: Int J Qualitative Stud Health Well-being 2014, 9: 24743 -http://dx.doi.org/10.3402/qhw.v9.24743

Website-delivered interventions are increasingly used to deliver physical activity interventions, yet problems with engagement and retention result in reduced effectiveness. Hence, alternative modes of online intervention delivery need to be explored. Therefore, this study aimed to evaluate the acceptability and effectiveness of a computer-tailored physical activity intervention delivered on the Internet in 3 delivery modes: video, text, or both. Australian adults (N = 803), recruited through e-mail, were randomized into the three delivery modes and received personal physical activity advice. Intervention content was identical across groups. Repeated measures analyses of variance were used to compare the three groups regarding acceptability, website usability, and physical activity. Participants in the video group accepted the content of the physical activity advice significantly better (F = 5.59; p < .01), and spent significantly more time on the website (F = 21.19; p < .001) compared with the text and combination groups. Total physical activity improved significantly over time in all groups (F = 3.95; p < .01). Although the combination group increased physical activity the most, few significant differences between groups were observed. Providing video-tailored feedback has advantages over the conventional text-tailored interventions; however, this study revealed few behavioral differences. More studies, examining alternative delivery modes, that can overcome the limitations of the present study, are needed.

Background: Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aimof this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People’s Democratic Republic (PDR) and the Philippines. Methods: We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns’ health status, the health policy and the health systemcontext for newborn care and the equity situation regarding newborn survival. Results: Main findings: (1) In the three countries, decline of neonatalmortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable. Conclusions: Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality of newborn care provided and inequities in newborn care. Child survival programmes focussed on children over four weeks of age have shown to have positive outcomes. Similar efforts as those used in these programmes should be considered in newborn care.

Background: Many simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. A proven strategy to address the problem of access to health interventions is the Community Directed Interventions (CDI) approach, which has been used successfully in rural areas. This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan, Nigeria. Methods: A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State. Qualitative methods comprising 12 focus group discussions (FGDs) with community members and 73 key informant interviews (KIIs) with community leaders, programme managers, community-based organisations (CBOs), non-government organisations (NGOs) and other stakeholders at federal, state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services, as well as to explore the potential resources for a CDI strategy. All interviews were audio recorded. Content analysis was used to analyse the data. Results: Malaria, upper respiratory tract infection, diarrhoea and measles were found to be prevalent in children, while hypertension and diabetes topped the list of diseases among adults. Healthcare was financed mainly by out-of-pocket expenses. Cost and location were identified as hindrances to utilisation of health facilities; informal cooperatives (esusu) were available to support those who could not pay for care. Immunisation, nutrition, reproductive health, tuberculosis (TB) and leprosy, environmental health, malaria and HIV/AIDs control programmes were the ongoing interventions. Delivery strategies included house-to-house, home-based treatment, health education and campaigns. Community participation in the planning, implementation and monitoring of development projects was reported as common practice. The resources available for these activities and which constitute potential resources for the CDI process include community volunteers, CBOs and NGOs. Others are landlords; professional, women and youth associations; social clubs, religious organisations and the available health facilities. Conclusion: This study’s findings support the feasibility of using the CDI process in delivering health interventions in urban poor communities and show that potential resources for the strategy abound in the communities.

Context : Globally, limited data are available on changing trends of blindness from a single region. Aims : To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design : Rural setting; cross-sectional study. Materials and Methods : Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis : Done using 11 th version of Stata. Results : Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9-9.1%) and 11% (95% CI, 8.3-13.7%), while that of VI was 13.6% (95% CI, 12.2-15.1%) and 40.3% (95% CI, 36.1-44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5-21.8%) compared with APEDS (34%; 95% CI, 20.9-49.3%). Conclusion : There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade.

Background The 58th World Health Assembly called for all health systems to move towards universal coverage where everyone has access to key promotive, preventive, curative and rehabilitative health interventions at an affordable cost. Universal coverage involves ensuring that health care benefits are distributed on the basis of need for care and not on ability to pay. The distribution of health care benefits is therefore an important policy question, which health systems should address. The aim of this study is to assess the distribution of health care benefits in the Kenyan health system, compare changes over two time periods and demonstrate the extent to which the distribution meets the principles of universal coverage. Methods Two nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system is conducted including the public sector, private-not-for-profit and private-for-profit sectors. Standard benefit incidence analysis techniques were applied and adopted to allow application to private sector services. Results The three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care. Conclusions The principles of universal coverage require that all should benefit from health care according to need. The Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need. Deliberate efforts should be directed to restructuring the Kenyan health system to address access barriers and ensure that all Kenyans benefit from health care when they need it.

Teenagers' HIV-preventive cognitions were explored within a protection motivation theory framework. Five hundred and seven adolescent men and women from two cohorts (sixteen and eighteen) completed a confidential postal questionnaire. The effect of demographic variables, previous sexual experience and appraisal of threat and coping resources upon HIV-relevant cognitions was investigated using path analysis. Cognitions promoting (adaptive) and inhibiting (maladaptive) preventive behaviour were considered. Anticipated condom use, intention to limit number of sexual partners and willingness to consider an HIV antibody test were included as adaptive HIV-preventive cognitions. Coping appraisal measures were strongly associated with anticipated condom use but threat appraisal measures were not. Gender, previous sexual experience, coping appraisal measures and denial accounted for 33% of the variance in anticipated condom use. Overall the results provided qualified support for Protection Motivation Theory. Implications for health education are highlighted.

The dual nature of dealing with health problems has been recognized since antiquity. Asklepios, the god of medicine in ancient Greece, had two daughters: Panacea – the goddess of healing and cures, and Hygeia – the goddess of welfare and hygiene, symbolizing curative and preventive medicine respectively. It is well understood nowadays that these two approaches blend: the range from primary and secondary prevention over curative to rehabilitative and promotive action is a continuum rather than a series of neatly separated concepts and activities. Nevertheless, there is a fundamental difference in the people the two approaches are dealing with: curative medicine deals with people who are ill, often acutely so, whereas preventive activities are largely directed at people who are not (yet) ill or only slightly so. Therefore, preventive activities can be organized in a periodic fashion, but curative activities are timely only when carried out at the moment people are ill and thus need to be permanently available – ideally. In present day health services, certainly in developing countries, both approaches are combined, most often in the same health structure and by the same health personnel (WHO 2006). Over the last decades an increasing number of health problems have been identified as priorities, based on their estimated contribution to the overall burden of disease and the availability of cost-effective measures, many of which are related to secondary prevention (Hotez et al. 2007, Johns & Tan Torres Edejer 2003). In a typical West-African country, a list of such problems and measures may (and often does) include Guinea worm, tuberculosis, vitamin A supplementation, schistosomiasis, soil transmitted helminthiasis, trachoma, vaccine preventable child illnesses, reproductive health and malaria, with variable importance given to HIV. All these health priorities are implemented at regional and district level through various strategies such as punctuated mass campaigns or regular outreach activities, each of which requires specific training and temporary mobilization of health workers, and thus valuable time and attention. In Douentza, a rural health district in Mali, we determined the relative importance of the time spent by qualified staff in charge of first line health services on activities requiring their absence from the health centre. We distinguished activities related to their general duties, and specific programme activities, including district mass campaigns. Data for the year 2006 were collected from district reports and administrative district and regional documents. The information concerned first line health care structures (a total of 15 health centres, with 14 situated in rural areas and one in the district’s central town) and their nurses in charge. Table 1 shows that in 2006 the nurse in charge of the health centre was absent during 81 working days in the case of the district central town health centre, and during 118 working days in the case of rural centres. This difference in days of absence is related to the time needed for the nurses in rural areas to reach the district’s central town, where training activities generally take place. In the ‘worst case’ scenario, which applies to the majority of health centres situated outside the district’s central town, the total annual nurse’s absence (118 working days) represents more than half (52%) of the annual total number of working days (225 days per year). Of these 118 days, 69 (58%) were directly attributable to specific programme activities, with mass campaigns being the principal component (Table 1). Mass drug distributions to control and eliminate trachoma, schistosomiasis and soil-transmitted helminthiasis as well as vitamin A distribution campaigns were carried out in the district in 2006. The nurses in charge were instructed to participate in Tropical Medicine and International Health doi:10.1111/j.1365-3156.2008.02174.x

Explores the positive impacts and unexpected challenges of Abbott's investment in a public-private partnership to modernize Tanzania's health system.

The millennium development goals call for reducing by half the proportion of people without sustainable access to safe drinking water. This goal was adopted in large part because clean water was seen as critical to fighting diarrheal disease, which kills two million children annually. There is compelling evidence that provision of piped water and sanitation can substantially reduce child mortality. However, in dispersed rural settlements, providing complete piped water and sanitation infrastructure to households is expensive. Many poor countries have therefore focused instead on providing community level water infrastructure, such as wells. Various traditional child health interventions have been shown to be effective in fighting diarrhea. Among environmental interventions, hand washing and point-of-use water treatment both reduce diarrhea, although more needs to be learned about ways to encourage households to take up these behavior changes. In contrast, there is little evidence that providing community-level rural water infrastructure substantially reduces diarrheal disease or that this infrastructure can be effectively maintained. Investments in communal water infrastructure short of piped water may serve other needs, and may reduce diarrhea in particular circumstances, but the case for prioritizing communal infrastructure provision needs to be made rather than assumed.

BackgroundComputer-tailored physical activity (PA) interventions delivered through the Internet represent a promising and appealing method to promote PA at a population level. However, personalized advice is mostly provided based on subjectively measured PA, which is not very accurate and might result in the delivery of advice that is not credible or effective. Therefore, an innovative computer-tailored PA advice was developed, based on objectively pedometer-measured PA. ObjectiveThe study aim was to evaluate the effectiveness of a computer-tailored, pedometer-based PA intervention in working adults. MethodsParticipants (≥18 years) were recruited between May and December 2012 from eight Flemish workplaces. These workplaces were allocated randomly to an intervention or control group. Intervention group participants (n=137) received (1) a booklet with information on how to increase their steps, (2) a non-blinded pedometer, and (3) an Internet link to request computer-tailored step advice. Control group participants (n=137) did not receive any of the intervention components. Self-reported and pedometer-based PA were assessed at baseline (T0), and 1 month (T1) and 3 months (T2) months post baseline. Repeated measures analyses of covariance were used to examine intervention effects for both the total sample and the at-risk sample (ie, adults not reaching 10,000 steps a day at baseline). ResultsThe recruitment process resulted in 274 respondents (response rate of 15.1%) who agreed to participate, of whom 190 (69.3%) belonged to the at-risk sample. Between T0 and T1 (1-month post baseline), significant intervention effects were found for participants’ daily step counts in both the total sample (P=.004) and the at-risk sample (P=.001). In the at-risk sample, the intervention effects showed a daily step count increase of 1056 steps in the intervention group, compared to a decrease of 258 steps in the control group. Comparison of participants’ self-reported PA revealed a significant intervention effect for time spent walking in the at-risk sample (P=.02). Intervention effects were still significant 3 months post baseline for participants’ daily step counts in both the total sample (P=.03) and the at-risk sample (P=.02); however, self-reported PA differences were no longer significant. ConclusionsA computer-tailored, pedometer-based PA intervention was effective in increasing both pedometer-based and self-reported PA levels, mainly in the at-risk participants. However, more effort should be devoted to recruit and retain participants in order to improve the public health impact of the intervention. Trial RegistrationClinicalTrials.gov: NCT02080585; https://clinicaltrials.gov/ct2/show/NCT02080585 (Archived by WebCite at http://www.webcitation.org/6VvQnRQSy).

Lot quality assurance sampling (LQAS) is used to evaluate health services. Subunits of a population (lots) are accepted or rejected according to the number of failures in a random sample ( N ) of a given lot. If failures are greater than decision value ( d ), we reject the lot and recommend corrective actions in the lot (i.e. intervention area); if they are equal to or less than d , we accept it. We used LQAS to monitor coverage during the last 3 days of a meningitis vaccination campaign in Niger. We selected one health area (lot) per day reporting the lowest administrative coverage in the previous 2 days. In the sampling plan we considered: N to be small enough to allow us to evaluate one lot per day, deciding to sample 16 individuals from the selected villages of each health area, using probability proportionate to population size; thresholds and d to vary according to administrative coverage reported; α≤5% (meaning that, if we would have conducted the survey 100 times, we would have accepted the lot up to five times when real coverage was at an unacceptable level) and β ≤ 20% (meaning that we would have rejected the lot up to 20 times, when real coverage was equal or above the satisfactory level). We classified all three lots as with the acceptable coverage. LQAS appeared to be a rapid, simple, and statistically sound method for in-process coverage assessment. We encourage colleagues in the field to consider using LQAS in complement with other monitoring techniques such as house-to-house monitoring. Keywords : lot quality assurance sampling; coverage; health interventions; immunization; meningitis; Niger (Published: 12 November 2013) Citation : Glob Health Action 2013, 6 : 21921 - http://dx.doi.org/10.3402/gha.v6i0.21921

Aims : To complete an initial estimate of the global cost of eliminating avoidable blindness, including the investment required to build ongoing primary and secondary health care systems, as well as to eliminate the ′backlog′ of avoidable blindness. This analysis also seeks to understand and articulate where key data limitations lie. Materials and Methods : Data were collected in line with a global estimation approach, including separate costing frameworks for the primary and secondary care sectors, and the treatment of backlog. Results : The global direct health cost to eliminate avoidable blindness over a 10-year period from 2011 to 2020 is estimated at $632 billion per year (2009 US$). As countries already spend $592 billion per annum on eye health, this represents additional investment of $397.8 billion over 10 years, which is $40 billion per year or $5.80 per person for each year between 2010 and 2020. This is concentrated in high-income nations, which require 68% of the investment but comprise 16% of the world′s inhabitants. For all other regions, the additional investment required is $127 billion. Conclusions : This costing estimate has identified that low- and middle-income countries require less than half the additional investment compared with high-income nations. Low- and middle-income countries comprise the greater investment proportion in secondary care whereas high-income countries require the majority of investment into the primary sector. However, there is a need to improve sector data. Investment in better data will have positive flow-on effects for the eye health sector.