Search

SummaryBackgroundSocial media has risen beyond a communicational advance to represent a way of being. While problematic social media use and addiction have been increasingly associated with mental disorder risks among younger people, whether these risks are modified by specific online activities and communication types remains largely unexamined. This study aimed to test four characteristic communication types – consumption, broadcasting, offline connections, and parasocial interaction – on how they moderate the link between social media addiction (SMA) and anxiety.MethodsA diary-based study was conducted to capture the daily experience of SMA, communication types, and mental well-being in two weeks. The participants were current undergraduate students at New York University. In total, 1009 daily records were completed by 79 participants. Prospective analyses were conducted to evaluate fluctuations in daily anxiety. Generalized estimation equations (GEE) were used to account for repeated measures.FindingsOverall SMA scores and three addiction components were associated with higher anxiety levels. Interaction analysis revealed that levels of parasocial interaction and consumption moderated the association between SMA and anxiety outcomes. For young adults with higher levels of consumption or parasocial interaction, 1-standard-deviation increase in social conflict was associated with an 11%-13% increase of a standard deviation in anxiety levels in the coming day. And these links did not exist for young adults with low and moderate amounts of consumption scores.InterpretationHigh levels of passive consumption and unilateral interactions are strongly intertwined with early-stage anxiety symptoms such as social conflict. More research is needed to explore the potential of health guidelines and interventions to reduce perceived anxiety by promoting regulations on unchecked social media browsing and facilitating two-sided online interactions.

BackgroundMany implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform targeted re-implementation strategies.MethodsThis study took place in two public health centers with tuberculosis (TB) units in Uganda that previously implemented diabetes mellitus (DM) screening in 2017. In 2019, we conducted interviews with clinic staff to determine current DM practices. We mapped themes identified in the interviews to a Social Ecological Model with three levels: outer setting, inner setting, and individuals.ResultsWe conducted nine interviews with clinic staff. Respondents explained that DM screening ceased due to disruptions in the supply chain for glucose test strips. This outer setting interruption had cascading effects on the inner setting and individuals. The lack of screening supplies limited the staff’s opportunities to perform DM screening within the inner setting level, which was associated with diminished self-efficacy within the individual level. However, culture, compatibility and individual beliefs about DM screening sustained throughout the interruption.ConclusionsWe identified factors that diminished and sustained within and between ecological levels during a program interruption. Using this approach, other programs facing interruptions can identify factors and cascading effects of the interruption to target them for re-implementation.

BackgroundCommunities of Practice (CoPs) are a low-cost strategy for health workers to share and create knowledge through social interactions to improve the delivery of high-quality care. However, there remain critical gaps in understanding the behavioral mechanisms through which CoPs can facilitate community health worker’s (CHWs) performance. Therefore, we carried out a qualitative study of a CoP to identify the behavior change techniques (BCTs) and intervention functions that improved CHWs’ performance.MethodsWe organized CHWs from two tuberculosis (TB) clinics in Kampala, Uganda into a CoP from February to August 2018. We conducted interviews with CoP members to understand their perceptions of how the CoP influenced delivery of TB contact investigation. Using an abductive approach, we first applied inductive codes characterizing CHWs’ perceptions of how the CoP activities affected their delivery of contact investigation. We then systematically mapped these codes into their functional categories using the BCT Taxonomy and Behavior Change Wheel framework. We triangulated all interview findings with detailed field notes.ResultsAll eight members of the CoP agreed to participate in the interviews. CHWs identified five CoP activities as improving the quality of their work: (1) individual review of feedback reports, (2) collaborative improvement meetings, (3) real-time communications among members, (4) didactic education sessions, and (5) clinic-wide staff meetings. These activities represented nine different BCTs and five distinct intervention functions. Taken together, CoP meetings enabled members to foster social support, problem solving, and knowledge sharing. The CoP enabled CHWs to identify barriers they face in the field and develop solutions. The CoP was motivating, strengthened their social and professional identities within and outside of the group, and improved their self-efficacy.ConclusionsWe identified several behavioral mechanisms through which CoPs may improve CHW performance. Future studies should evaluate the importance of these mechanisms in mediating the effects of CoPs on program effectiveness.

A discrete choice experiment (DCE) is a method to quantify preferences for goods and services in a population. Participants are asked to choose between sets of 2 hypothetical scenarios that differ in terms of particular characteristics. Their selections reveal the relative importance of each “attribute”, or characteristic, and the extent to which people consider trade-offs between characteristics. DCEs are increasingly used in healthcare and public health settings as they can inform the design of health-related interventions to achieve maximum impact. Specific efforts must be made in the development process to ensure relevance of DCEs to the communities in which they are administered. Herein, we build upon gaps in the prior literature by offering researchers a step-by-step process to guide DCE development for resource-limited settings, including detailed methodological considerations for each step and a specific actionable approach that we hope will simplify the process for other researchers. We present the 6 steps we followed to develop a DCE to evaluate patient preferences for management of hypertension and diabetes in rural Uganda. These steps are: 1) formative work; 2) attribute selection; 3) attribute level selection; 4) DCE design selection; 5) determination of attribute level combinations; and 6) assessment and enhancement of tool comprehensibility. We describe each of these steps in detail to ease the development process for researchers looking to develop locally contextualized, end-user-centric health interventions.

BackgroundThe growing burden of non-communicable diseases (NCDs) threatens low-income countries. Self-care practices are crucial for successful management of NCDs to prevent complications. We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda.MethodsBetween April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted 19 in-depth interviews exploring treatment practices and response to symptoms. We used content analysis to identify emergent themes.ResultsThree themes emerged in patients’ descriptions of their self-care practices. First, patients preferred conventional medicines as their first line of resort, but often used traditional medicines. In particular, patients used traditional medicines to mitigate the negative impacts of inconsistent access to conventional medicines and to supplement those medicines. Second, patients adopted a wide range of vernacular practices to supplement treatments and unavailable diagnostic tests, including tasting their urine to gauge blood-sugar level. Finally, patients sought social support for self-care activities, relying on networks of family members and peers for instrumental and emotional support. Patients saw their children as the most reliable source of support, especially money for medicines, transport and home necessities.InterpretationPatients valued conventional medicines but also engaged in varied self-care practices. They depended upon networks of social support from family and peers to maintain self-care. Interventions to improve self-care may be more effective if they improve access to medicines and engage or enhance patients’ social support networks.

Background Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.