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A Peer-Led, Social Media-Delivered, Safer Sex Intervention for Chinese College Students: Randomized Controlled Trial.
Journal of Medical Internet Research. 2017 Aug 09; 19(8):e284.BACKGROUND: The peer-led, social media-delivered intervention is an emerging method in sexual health promotion. However, no research has yet investigated its effectiveness as compared with other online channels or in an Asian population. OBJECTIVE: The objective of this study is to compare a peer-led, social media-delivered, safer sex intervention with a sexual health website. Both conditions target Chinese college students in Hong Kong. METHODS: A randomized controlled trial was conducted with a peer-led, safer sex Facebook group as the intervention and an existing online sexual health website as the control. The intervention materials were developed with peer input and followed the information-motivation-behavioral skills model; the intervention was moderated by peer educators. The participants filled out the online questionnaires before and after the 6-week intervention period. Outcome evaluations included safer sex attitudes, behavioral skills, and behaviors, while process evaluation focused on online experience, online-visiting frequency, and online engagement. The effect of online-visiting frequency and online engagement on outcome variables was investigated. RESULTS: Of 196 eligible participants-100 in the control group and 96 in the intervention group-who joined the study, 2 (1.0%) control participants joined the Facebook group and 24 of the remaining 194 participants (12.4%) were lost to follow-up. For the process evaluation, participants in the intervention group reported more satisfying online experiences (P<.001) and a higher level of online-visiting frequency (P<.001). They also had more positive comments when compared with the control group. For outcome evaluation, within-group analysis showed significant improvement in condom use attitude (P=.02) and behavioral skills (P<.001) in the intervention group, but not in the control group. No significant between-group difference was found. After adjusting for demographic data, increased online-visiting frequency was associated with better contraceptive use behavioral intention (P=.05), better behavioral skills (P=.02), and more frequent condom use (P=.04). CONCLUSIONS: A peer-led, social media-delivered, safer sex intervention was found to be feasible and effective in improving attitudes toward condom use and behavioral skills, but was not significantly more effective than a website. Future research may focus on the long-term effectiveness and cost-effectiveness of this popular method, as well as the potential cultural differences of using social media between different countries. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-16009495; http://www.chictr.org.cn/showprojen.aspx?proj=16234 (Archived by WebCite at http://www.webcitation.org/6s0Fc2L9T).
You Are a Part of the Solution: Negotiating Gender-Based Violence and Engendering Change in Urban Informal Settlements in Mumbai, India.
Violence Against Women. 2016 Aug 04; 1-25.This article explores how women front-line workers engage with domestic and gender-based violence in the urban informal settlements of Dharavi in Mumbai, India. We conducted in-depth interviews with 13 voluntary front-line workers, along with ethnographic fieldwork in Dharavi, as a part of a pilot study. Our findings contribute to literature on context-specific approaches to understanding gender-based violence and "models" to prevent domestic violence in urban micro-spaces. Furthermore, we also discuss notions of "change" (badlaav) that the front-line workers experience. Finally, this article presents implications for socially engaged ethnographic research, as well as contextual and grounded insights on ways to reduce gender-based and domestic violence.
Implementation of a Cloud-Based Electronic Medical Record to Reduce Gaps in the HIV Treatment Continuum in Rural Kenya.
PloS One. 2015; 10(8):e0135361.BACKGROUND: Electronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care in developing countries and their implementation can help to strengthen pathways of care and close gaps in the HIV treatment cascade by improving access to and use of data to inform clinical and public health decision-making. METHODS: This study implemented a novel cloud-based electronic medical record system in an HIV outpatient setting in Western Kenya and evaluated its impact on reducing gaps in the HIV treatment continuum including missing data and patient eligibility for ART. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification and clinical decision support. RESULTS: Significant improvements in data quality and provision of clinical care were recorded through implementation of the EMR system, helping to ensure patients who are eligible for HIV treatment receive it early. A total of 2,169 and 764 patient records had missing data pre-implementation and post-implementation of EMR-based data verification and clinical decision support respectively. A total of 1,346 patients were eligible for ART, but not yet started on ART, pre-implementation compared to 270 patients pre-implementation. CONCLUSION: EMR-based data verification and clinical decision support can reduce gaps in HIV care, including missing data and eligibility for ART. A cloud-based model of EMR implementation removes the need for local clinic infrastructure and has the potential to enhance data sharing at different levels of health care to inform clinical and public health decision-making. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality and provision of clinical care are recorded through implementation of this EMR model.
American Journal of Epidemiology. 2015 May 15; 181(10):747-9.Social media-based recruitment for epidemiologic studies has the potential to expand the demographic and geographic reach of investigators and identify potential participants more cost-effectively than traditional approaches. In fact, social media are particularly appealing for their ability to engage traditionally "hard-to-reach" populations, including young adults and low-income populations. Despite their great promise as a tool for epidemiologists, social media-based recruitment approaches do not currently compare favorably with gold-standard probability-based sampling approaches. Sparse data on the demographic characteristics of social media users, patterns of social media use, and appropriate sampling frames limit our ability to implement probability-based sampling strategies. In a well-conducted study, Harris et al. (Am J Epidemiol. 2015;181(10):737-746) examined the cost-effectiveness of social media-based recruitment (advertisements and promotion) in the Contraceptive Use, Pregnancy Intention, and Decisions (CUPID) Study, a cohort study of 3,799 young adult Australian women, and the approximate representativeness of the CUPID cohort. Implications for social media-based recruitment strategies for cohort assembly, data accuracy, implementation, and human subjects concerns are discussed. (c) The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: email@example.com.
American Journal of Epidemiology. 2015 May 15; 181(10):750-1.Add to my documents.
Information as determinant of utilization of family planning services in Rural Akwa Ibom State of South-South Nigeria.
Mediterranean Journal of Social Sciences. 2015 Jul 1; 6(4S1):445-453.Sources and nature of family planning information have been found to influence the use of family planning services. Unfortunately, the exact relationships between these variables and family planning utilization are not certain in Nigeria. This paper therefore searches for better understanding of the interrelationships, using rural Akwa Ibom State as the study area. Data analyses show that utilization of family planning information was greatest among respondents who received information from credible sources and those who were exposed to accurate and reliable information. The implications of the findings are discussed and some useful suggestions made.
Daily short message service surveys to measure sexual behavior and pre-exposure prophylaxis use among Kenyan men and women.
AIDS and Behavior. 2013 Nov; 17(9):2977-85.Pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy which requires high adherence. We tested the use of daily short message service (i.e., SMS/text message) surveys to measure sexual behavior and PrEP adherence in Kenya. Ninety-six HIV-uninfected adult individuals, taking daily oral PrEP in a clinical trial, received daily SMS surveys for 60 days. Most participants (96.9 %) reported taking PrEP on >/=80 % days, but 69.8 % missed at least one dose. Unprotected sex was reported on 4.9 % of days; however, 47.9 % of participants reported unprotected sex at least once. Unprotected sex was not correlated with PrEP use (OR = 0.95). Participants reporting more sex were less likely to report PrEP non-adherence and those reporting no sex were most likely to report missing a PrEP dose (adjusted OR = 1.87). PrEP adherence was high, missed doses were correlated with sexual abstinence, and unprotected sex was not associated with decreased PrEP adherence.
[Baltimore, Maryland], Global Health Knowledge Collaborative [GHKC], .  p.This is a report of the Global Health Knowledge Collaborative's (GHKC's) goals, outputs, and challenges since its inception (under the name Knowledge Management Working Group) in 2010. It provides information about the history of the GHKC, the purposes of the various GHKC products, and a vision for the future.
Washington, D.C., Technical and Operational Performance Support Program [TOPS], 2013 Jul.  p.Supporting Communities of Practice is part of a series of quick guides produced by the Technical and Operational Performance Support (TOPS) Program to improve knowledge sharing and program learning by development practitioners. This guide represents an effort to package the learning gained by the TOPS Knowledge Management team in the process of launching and supporting the Food Security and Nutrition (FSN) Network’s many cross-organizational task forces and online discussion groups. The quick guide focuses on key steps that will help foster a community of practice that is responsive to member needs, opportunities, and expertise, and activities that will foster peer learning, sharing, and positive action around common development interests and practices. The quick guide format, it is hoped, will make a number of easily adopted approaches and techniques accessible to a broad swathe of development practitioners.
Delineating interpersonal communication networks: a study of the diffusion of an intervention among female entertainment workers in Shanghai, China.
AIDS and Behavior. 2012 Oct; 16(7):2004-14.Diffusion of innovation (DOI) is widely cited in the HIV behavior change literature; however there is a dearth of research on the application of DOI in interventions for sex workers. Following a randomized-controlled trial of HIV risk reduction among female entertainment workers (FEWs) in Shanghai, China, we used qualitative approaches to delineate potential interpersonal communication networks and contributing factors that promote diffusion of information in entertainment venues. Results showed that top-down communication networks from the venue owners to the FEWs were efficient for diffusion of information. Mammies/madams, who act as intermediaries between FEWs and clients form an essential part of FEWs' social networks but do not function as information disseminators due to a conflict of interest between safer sex and maximizing profits. Diffusion of information in large venues tended to rely more on aspects of the physical environment to create intimacy and on pressure from managers to stimulate communication. In small venues, communication and conversations occurred more spontaneously among FEWs. Information about safer sex appeared to be more easily disseminated when the message and the approach used to convey information could be tailored to people working at different levels in the venues. Results suggest that safer sex messages should be provided consistently following an intervention to further promote intervention diffusion, and health-related employer liability systems in entertainment venues should be established, in which employers are responsible for the health of their employees. Our study suggests that existing personal networks can be used to disseminate information in entertainment venues and one should be mindful about the context-specific interactions between FEWs and others in their social networks to better achieve diffusion of interventions.
American Journal of Preventive Medicine. 2012 Nov; 43(5):467-74.BACKGROUND: Youth are using social media regularly and represent a group facing substantial risk for sexually transmitted infection (STI). Although there is evidence that the Internet can be used effectively in supporting healthy sexual behavior, this has not yet extended to social networking sites. PURPOSE: To determine whether STI prevention messages delivered via Facebook are efficacious in preventing increases in sexual risk behavior at 2 and 6 months. DESIGN: Cluster RCT, October 2010-May 2011. SETTING/PARTICIPANTS: Individuals (seeds) recruited in multiple settings (online, via newspaper ads and face-to-face) were asked to recruit three friends, who in turn recruited additional friends, extending three waves from the seed. Seeds and waves of friends were considered networks and exposed to either the intervention or control condition. INTERVENTION: Exposure to Just/Us, a Facebook page developed with youth input, or to control content on 18-24 News, a Facebook page with current events for 2 months. MAIN OUTCOME MEASURES: Condom use at last sex and proportion of sex acts protected by condoms. Repeated measures of nested data were used to model main effects of exposure to Just/Us and time by treatment interaction. RESULTS: A total of 1578 participants enrolled, with 14% Latino and 35% African-American; 75% of participants completed at least one study follow-up. Time by treatment effects were observed at 2 months for condom use (intervention 68% vs control 56%, p=0.04) and proportion of sex acts protected by condoms (intervention 63% vs control 57%, p=0.03) where intervention participation reduced the tendency for condom use to decrease over time. No effects were seen at 6 months. CONCLUSIONS: Social networking sites may be venues for efficacious health education interventions. More work is needed to understand what elements of social media are compelling, how network membership influences effects, and whether linking social media to clinical and social services can be beneficial. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.govNCT00725959. Copyright (c) 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Sexual transmission behaviors and serodiscordant partnerships among HIV-positive men who have sex with men in Asia.
Sexually Transmitted Diseases. 2012 Apr; 39(4):312-5.We described sexual transmission behaviors and serodiscordant partnerships among an online sample of HIV-positive men who have sex with men (N = 416) in Asia. High rates of unprotected anal intercourse (74.8%), serodiscordant partnerships (68.5%), and unprotected sex within serodiscordant partnerships ( approximately 60.0%) were reported. Increased number of partners, meeting partners on the Internet, drug use before sex, and not knowing one's viral load were associated with unprotected anal intercourse. Efforts to develop and scale up biomedical and behavioral interventions for HIV-positive men who have sex with men in Asia are needed.
Public Health. 2012 Mar; 126(3):206-9.The focus of this symposium was worldwide prevention of chronic disease through the use of inexpensive Internet pathways, as demonstrated with the Supercourse project, and other initiatives, including promoting mobile phone technology (m-health). This symposium highlighted the need to use the Supercourse to prevent cancer and other chronic diseases. It also highlighted several components of the Supercourse library, including the former Soviet Union network, the Latin American network, and some other initiatives. Copyright A(c) 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Establishing a global knowledge network on HIV stigma and discrimination reduction. Background report.
[Washington, D.C.], International Center for Research on Women [ICRW], .  p. (Background Report)Stigma remains a seriously neglected issue in the global response to HIV despite more than a decade of efforts to understand the causes of HIV stigma, raise awareness about its harmful effects, and develop programs and strategies to reduce it. In November 2008, M.A.C AIDS Fund and the International Center for Research on Women (ICRW) convened a meeting that brought together nearly 60 experts from the program, research, policy, advocacy and donor sectors to identify why HIV stigma has not gained sufficient ground in the global HIV response and what can be done to turn that around. At the meeting, participants prioritized six key actions to galvanize support for scaling-up stigma-reduction efforts globally. Foremost among the action items was the creation of a global knowledge network. This report summarizes findings of the background research conducted on existing health and development networks to identify options for organizing the structure and key functions of the stigma knowledge network.
Public Health. 2011 Jul; 125(7):433-5.Over half (58.4%) of 77 recently diagnosed Chinese HIV infected men having sex with men (MSM) had networked sex partners through Internet in the year prior to their infections. Internet using MSM were younger (29.6y vs 38.7y; t = -4.77, P < 0.01), better educated, more likely to have a regular sex partner, and have undergone regular HIV testing (Chi square = 5.57, P < 0.05). These characteristics could be used for planning public health interventions. Copyright (c) 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Washington, D.C., Futures Group, Health Policy Initiative, 2010 Jun.  p.Throughout Latin America and the Caribbean (LAC), multisectoral Contraceptive Security (CS) Committees are working to address CS issues, including forecasting contraceptive needs and advocating for policy reform to better reach the underserved. A new virtual communication, www.lacdaia.org, has been launched to enable the committees to share experiences, lessons learned, and best practices.
Development of implementation strategies for u-health services based on the healthcare professionals' experiences.
Telemedicine Journal and E - Health. 2011 Mar; 17(2):80-7.OBJECTIVES: The study develops strategies for implementing ubiquitous healthcare (u-health) based on previous experiences of the healthcare professionals. MATERIALS AND METHODS: Qualitative content analysis, one of qualitative research methods, was used on in-depth interviews conducted between July 21 and October 4, 2009, with 11 healthcare professionals including medical doctors and community healthcare specialist nurses who have previously provided u-health services. RESULTS: Four primary subjects were addressed: (1) subjective experiences on the usability, (2) the expectations, (3) the business prospects, and (4) the prerequisites for the success of u-health market. CONCLUSION: Based on the results of this study, desirable u-health services from the perspective of healthcare professionals were proposed.
Science. 2011 Feb 11; 331(6018):714-7.The imperative for improving health in the world's poorest regions lies in research, yet there is no question that low participation, a lack of trained staff, and limited opportunities for data sharing in developing countries impede advances in medical practice and public health knowledge. Extensive studies are essential to develop new treatments and to identify better ways to manage healthcare issues. Recent rapid advances in availability and uptake of digital technologies, especially of mobile networks, have the potential to overcome several barriers to collaborative research in remote places with limited access to resources. Many research groups are already taking advantage of these technologies for data sharing and capture, and these initiatives indicate that increasing acceptance and use of digital technology could promote rapid improvements in global medical science.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, Measurement, Learning and Evaluation Project [MLE], 2011 Mar.  p. (MLE Topic Paper 1-2011)Organizations involved in global efforts to attain good health for all and to achieve the United Nation's Millennium Development Goals (MDGs) by 2015 have identified a number of key barriers to progress. One of these barriers is specifically related to the gap between research findings and decisions that are made in practice (WHO, 2006). The gap means many public health problems remain intractable, despite known solutions. The authors of this topic paper examine ways in which knowledge management (KM) can increase engagement between research, policy-making and public health practice to close such gaps. We base our understanding on the notion that improved knowledge sharing will lead to wider understanding, enhanced cooperation, more effective use of good practices and better health outcomes. KM is important as it can provide cost-effective ways to access knowledge and engagement between different stakeholders -- therefore making knowledge sharing more possible. This topic paper is intended for international health program managers and researchers whose role includes a communication or KM component. KM often has different purposes in different research organizations and different contexts; in this overview, we are looking at KM strategies that facilitate sharing knowledge, building skills and using data for decision making.
[Ottawa, Canada], IDRC, 2011 Mar.  p.The purpose of this evaluation is to inform future IDRC programming in eHealth research in a way that leverages past experience, current trends, as well as IDRC's niche in the field. As IDRC moves to mainstream its work in eHealth into its Governance, Equity and Health (GEH) portfolio, this evaluation will also be used to chart the course of the organization in better integrating ICT research considerations into existing health initiatives and solidifying health-related expertise in existing eHealth initiatives, while engaging in forward-looking strategic planning, proposal review, proposal development, and grant management that continues to build on IDRC's foundational and catalytic work in this area. This report provides an in-depth account of the evaluation findings and recommendations for the next five years of IDRC's eHealth programming. The quantitative and qualitative assessment covered 25 projects representing activities in 25 countries in Africa, Asia, and Latin America and the Caribbean (LAC) of which approximately 50% have been completed and 50% remain on-going ranging in scope from $30,000 - $2,422,652. The total dollar value of the projects included in this evaluation is approximately $17 million CAD. To complement the evaluation a targeted literature review of eHealth, a series of Lessons Learned Workshops with grantees and IDRC staff, and key informant interviews with internal and external stakeholders were conducted. (Excerpt)
Telemedicine Journal and e-Health. 2003 Jun; 9(2):141-147.Two recent parallel developments, the widespread deployment of wireless networks and increased use of handheld devices like the personal digital assistant (PDA), have contributed to the development of mobile access to the Internet. Recent surveys show that approximately 25% or more of physicians use PDAs. Although used mainly for personal information management and static medical applications, PDAs have capabilities to connect to the Internet. We studied the use of handheld devices to access MEDLINE and other knowledge sources in a wireless setting.
Innovation in sexually transmitted disease and HIV prevention: internet and mobile phone delivery vehicles for global diffusion.
Current Opinion In Psychiatry. 2010; 23(2):139-144.Purpose of review Efficacious behavioral interventions and practices have not been universally accepted, adopted, or diffused by policy makers, administrators, providers, advocates, or consumers. Biomedical innovations for sexually transmitted disease (STD) and HIV prevention have been embraced but their effectiveness is hindered by behavioral factors. Behavioral interventions are required to support providers and consumers for adoption and diffusion of biomedical innovations, protocol adherence, and sustained prevention for other STDs. Information and communication technology such as the Internet and mobile phones can deliver behavioral components for STD/HIV prevention and care to more people at less cost. Recent findings Recent innovations in STD/HIV prevention with information and communication technology-mediated behavioral supports include STD/HIV testing and partner interventions, behavioral interventions, self-management, and provider care. Computer-based and Internet-based behavioral STD/HIV interventions have demonstrated efficacy comparable to face-to-face interventions. Mobile phone STD/HIV interventions using text-messaging are being broadly utilized but more work is needed to demonstrate efficacy. Electronic health records and care management systems can improve care, but interventions are needed to support adoption. Summary Information and communication technology is rapidly diffusing globally. Over the next 5-10 years smart-phones will be broadly disseminated, connecting billions of people to the Internet and enabling lower cost, highly engaging, and ubiquitous STD/HIV prevention and treatment support interventions.
Geneva, Switzerland, WHO, 2011.  p.This publication presents data on the 114 WHO Member States that participated in the 2009 global survey on eHealth. Intended as a reference to the state of eHealth development in Member States, the publication highlights selected indicators in the form of country profiles. The objectives of the country profiles are to: describe the current status of the use of ICT for health in Member States; and provide information concerning the progress of eHealth applications in these countries. (Excerpt)
Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth, 2009.
Geneva, Switzerland, WHO, 2010.  p.The telemedicine module of the 2009 survey examined the current level of development of four fields of telemedicine: teleradiology, teledermatogy, telepathology, and telepsychology, as well as four mechanisms that facilitate the promotion and development of telemedicine solutions in the short- and long-term: the use of a national agency, national policy or strategy, scientific development, and evaluation. Telemedicine -- opportunities and developments in Member States discusses the results of the telemedicine module, which was completed by 114 countries (59% of Member States). Findings from the survey show that teleradiology currently has the highest rate of established service provision globally (33%). Approximately 30% of responding countries have a national agency for the promotion and development of telemedicine, and developing countries are as likely as developed countries to have such an agency. In many countries scientific institutions are involved with the development of telemedicine solutions in the absence of national telemedicine agencies or policies; while 50% of countries reported that scientific institutions are currently involved in the development of telemedicine solutions, 20% reported having an evaluation or review on the use of telemedicine in their country published since 2006. (Excerpt)
Cambridge, Massachusetts, Management Sciences for Health [MSH], Leadership, Management, and Sustainability Project [LMS], 2007.  p.This guide is based on the recognition that change is inevitable for survival and that directed, planned change is essential for improvement. A systematic change process underlies all successes in development, including improved reproductive health. We in the development community have the medical/clinical knowledge, technology, and experience to make substantial improvements in maternal and child health, reproductive health and family planning, HIV/AIDS, and other infectious diseases. We also have the knowledge and approaches to successfully implement and scale up changes in health care practices. The missing link is the connection between these two factors: technical knowledge and the known approaches to successful change. Using evidence-based change practices can significantly increase the chances for success and sustainability as we introduce, adapt, apply, and scale up clinical practices. Everyone working to improve health-whether at international donor, research, or technical agencies, at the national, district, clinic/community, and family levels-is fundamentally in the business of fostering, leading, or implementing change. But not everyone involved in this work has a clear pathway that links proven change practices with evidence-based clinical and programmatic practices. This guide offers one such pathway. (excerpt)