Dr Nyangi Gityamwi

Digital health technology (DHT) holds the potential to improve health services, and its adoption has proliferated in recent decades owing to technological advancement. Optimal evaluation methodologies appropriate for generating quality evidence on DHT have yet to be established; traditional comparative designs present several limitations. This study aimed to scope the literature to highlight common methodological approaches used and their limitations to inform considerations for designing robust DHT evaluation studies. A scoping review was conducted following the Joanna Briggs Institute (JBI) scoping review guidelines. A systematic search was conducted using the CINAHL (EBSCO), MEDLINE (EBSCOhost), PsycINFO (EBSCO), EMBASE (Elsevier) and Web of Science (Clarivate Analytics) databases using iteratively developed search terms. We selected studies published in English between January 2016 and March 2022 and focussed on primary research evaluating the effectiveness of DHT with technology-user interactive or asynchronous features for adults (≥18 years) with cancer, diabetes or cardiovascular conditions. The final number of articles, after the screening and selection process, comprised 140 records. Data were analysed descriptively (frequency and percentages) and summarised thematically. Results showed most studies (n = 104, 74.3%) employed the standard two-arm parallel RCT design, with usual/standard care as the preferred comparator in nearly half (n = 65, 47.1%) of all included studies. Of the 104 comparative studies reviewed, limitations in recruitment were most frequently reported (n = 70, 37%), followed by limitations in evaluation/measurement techniques (n = 57, 27%), presence of confounding factors (n = 50, 24%) and short duration of studies (n = 24, 11%). The review highlights the need to consider inclusive approaches to recruitment and adoption of the emerging methodological approaches that account for the fast-paced, multi-component and group contamination problem resulting from the unconcealable nature of DHT interventions.

OBJECTIVESDomestic Abuse (DA) is a public health concern impacting multiple sectors. Partnerships and coordinated responses from statutory agencies are vital to ensure DA survivors’ needs are met, but this is impeded by the accessibility of quality DA data. We present an innovative data sharing and visualisation tool (DAVIT) and its perceived potential to improve DA insight and multi-agency collaborations. STUDY DESIGNQualitative exploratory study METHODSDAVIT was developed by Surrey County Council (SCC) through a consultation and prioritisation process with multi-agencies interested in DA. Focus group discussions (FGDs) were conducted on Zoom with representatives of agencies responding to DA in Surrey area to obtain their views regarding the relevance, acceptability and the potential for implementing DAVIT into practice. Qualitative data analysis was guided by the updated Consolidation Framework of Implementation Research (CFIR). RESULTSFifteen individuals representing seven agencies participated in one-hour long FGDs. Participants perceived DAVIT as well-designed, simple to use and adaptable to the local context but it needed improvements in data quality and comprehensiveness. Our findings suggest that DAVIT could enable intelligent planning and allocation of resources, delivery of targeted interventions and commissioning of DA service. Organisations’ networks and connections, favourable data governance structure, policies, and regulations (outer settings); availability of resources, knowledge & information (inner settings); and individuals’ capacity, competence and support from high-level leaders will all influence the implementation of DAVIT into practice. CONCLUSIONS: DAVIT is acceptable and if improved and successfully implemented into practice could improve DA services. Provision of minimal training to data officers in organisations will maximize the utility of DAVIT. A clear data governance structure and data sharing framework will help the implementation of DAVIT.

Malnutrition is common among dialysis patients, but there is insufficient literature on the problem from resource-poor settings of the sub-Saharan region. We conducted a cross-sectional investigation of dietary intake and nutritional status of haemodialysis (HD) patients to inform the current status of this population group in the region. HD patients aged >= 18 years, with dialysis vintage of >= 3 months, at one nephrology unit in Tanzania were assessed for their habitual diet and nutrient intake. Anthropometric measures and biochemistry tests were also performed. The diet was predominantly starchy food based, accompanied by a limited selection of vegetables. Fruits and animal protein were also minimally consumed (1 portion/day each). Fruit consumption was higher in females than males (median (25(th), 75(th)) = 2 (1, 2.3) versus 0.5 (0, 1.7) portions, p = 0.008). More than 70% of participants had suboptimal measures for protein and energy intake, dietary iron, serum albumin, muscle mass, and hand grip strength (HGS). Inadequacies in protein and energy intake and dialysis clearance (URR) increased with the increase in body weight/BMI and other specific components (MAMC and FMI). Consumption of red meats correlated significantly and positively with serum creatinine (r = 0.46, p = 0.01), potassium (r = 0.39, p = 0.03), and HGS (r = 0.43, p = 0.02) and was approaching significance for a correlation with serum iron (r = 0.32, p = 0.07). C-RP correlated negatively with albumin concentration (r = -0.32, p = 0.02), and participants with C-RP within acceptable ranges had significantly higher levels of haemoglobin (p = 0.03, effect size = -0.28). URR correlated negatively with haemoglobin concentration (r = -0.36, p = 0.02). Patients will benefit from improved nutritional services that deliver individually tailored and culturally practical dietary advice to enable them to make informed food choices whilst optimizing disease management.