Chioma Amadi

Impact of water, sanitation, and hygiene interventions on improving health outcomes among school children.

Purpose. This review was done to explore the impact of water treatment, hygiene, and sanitary interventions on improving child health outcomes such as absenteeism, infections, knowledge, attitudes, and practices and adoption of point-of-use water treatment. Methods. A literature search was conducted using the databases PubMed and Google scholar for studies published between 2009 and 2012 and focusing on the effects of access to safe water, hand washing facilities, and hygiene education among school-age children. Studies included were those that documented the provision of water and sanitation in schools for children less than 18 years of age, interventions which assessed WASH practices, and English-language, full-text peer reviewed papers. Results. Fifteen studies were included in the final analysis. 73% (n = 11) of the studies were conducted in developing countries and were rural based (53%, n = 8). The childs age, gender, grade level, socioeconomic index, access to hygiene and sanitary facilities, and prior knowledge of hygiene practices were significantly associated with the outcomes. Nutrition practices which are key factors associated with the outcomes were rarely assessed. Conclusion. Further research is required to assess the long-term impact of such interventions in different settings.

An Interactive, Bilingual Touch Screen Program to Promote Breastfeeding Among Hispanic Rural Women: Usability Study

Background Computer technology can be effectively used to educate patients and improve knowledge and attitudes, leading to healthier behavior. Among rural women, breastfeeding outcomes seem to be worst compared to women living in urban areas. The implementation of a bilingual computer mediated health education program to disseminate information and improve outcomes among users with low literacy levels has proven to be successful. Objective The objective of this pilot study was to examine the usability of an interactive, bilingual touch screen computer-based educational program to promote breastfeeding practices among Hispanic women living in rural settings. Methods A convenience sample of 10 Hispanic rural women at the Regional West Medical Center (RWMC), Scottsbluff was enrolled during May 2013. Information about this cross-sectional study was made available through the flyers at the RWMC. A brief introduction of the prototype was given and study subjects were then asked to complete a predefined set of tasks by interacting with the prototype. Users were assigned 6 tasks and information was gathered about the time taken to complete the tasks, number of attempts, and if assistance was needed. Notes and test sessions were audiotaped. Usability assessment was performed using the System Usability Scale (SUS). Results The mean age of the study participants was 28 years (SD 3.6), the majority of them had 12 or more years of education (90%, 9/10), and 60% (6/10) had breastfed less than 6 months. There were 90% (9/10) of the study participants that had no prior history of taking prenatal classes and 80% (8/10) that did not intend to take any prenatal classes in the future. The average SUS scores were 90 and SD was 10.5. There were three participants that had average SUS scores of 100, followed by scores of 97.5 (1/10), 95 (1/10), 87.5 (1/10), 85 (2/10), 82.5 (1/10), and one participant had a score of 67.5 (1/10). No assistance was needed to complete any of the tasks. Conclusions The study participants were able to navigate through the multimedia program with ease and obtain relevant breastfeeding related health information. The interactive, touch screen computer-based breastfeeding program had high acceptance among 10 Hispanic women living in rural settings.

Evaluation of a computer-based bilingual breastfeeding educational program on breastfeeding knowledge, self-efficacy and intent to breastfeed among rural Hispanic women.

OBJECTIVE To evaluate the impact of an interactive, computer based, bi-lingual breastfeeding educational program on breastfeeding knowledge, self-efficacy and intent to breastfeed among rural Hispanic women living in Scottsbluff, Nebraska. METHODS A two-group, repeated measures quasi-experimental study was conducted to evaluate the impact of a breastfeeding intervention. Forty six rural Hispanic women between ages 18 and 38 years were enrolled at the Regional West Medical Center in Scottsbluff, Nebraska. Study participants were randomized into intervention and control groups, with the intervention group (n=23) receiving bi-lingual (English and Spanish) breastfeeding education on a touch screen computer program, while the control group received printed educational material. Study participants were enrolled during their last six weeks of pregnancy, with follow up assessments conducted post-partum at days 3 and 7, weeks 2 and 6, and months 3 and 6. The study protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB protocol #430-12-EP) and City University of New York Institutional Review Board (IRB protocol # 642980-1). RESULTS A significant improvement in the breastfeeding knowledge and intent to breastfeed scores was seen over a 6 month period among all the study participants (p<0.05). There was a gradual increase in the breastfeeding self-efficacy scores till week 6 followed by a decrease in self-efficacy scores at month 3 (p=0.46), and month 6 (P=0.54). Breastfeeding knowledge scores differed significantly between the study participants in the control and intervention groups at week 6 (p=0.03). There were no significant differences in the breastfeeding knowledge between the control and intervention groups at other time points. The control group showed gradual decline in their self-efficacy scores at month 3 and month 6 compared to the intervention group that showed a gradual increase in their self-efficacy scores at different time points during their follow up period. However, there were no significant differences in the self-efficacy scores between the intervention and control groups at different points. The control group showed significantly higher negative breastfeeding sentiment scores compared to the intervention group at days 3 (p=0.02) and 7 (p=0.03) indicating a lower intent to breastfeed. CONCLUSION Hispanic women living in rural settings showed improvement in breastfeeding knowledge, self-efficacy and intent to breastfeed using the computer based bi-lingual educational program. Results show week 6 and month 3 to be the critical time points of intervention so that women continue to breastfeed.

The Nutrition and Dietetics Workforce Needs Skills and Expertise in the New York Metropolitan Area

Background: There is an increased demand in the Nutrition and Dietetics field which has fostered credentialing to ensure competent graduates. The objective of this study is to conduct an exploratory analysis to identify nutrition/dietetics workforce needs, skills and expertise in the New York metropolitan area as exemplified in position announcements over a 4 year period. Methods: We recorded position announcements for jobs in nutrition and dietetics from the New York State Registered Dietitian Yahoo group, and the Hunter College Nutrition and Food Sciences student and alumni listserv (NFS-L) over a 4 year period. Keywords were identified using job categories defined by the Academy of Nutrition and Dietetics (AND) compensation and benefits survey. This served as a starting point to enumerate the types of positions that have been posted for the New York metropolitan area in recent years. Results: Four hundred and twelve (412) unique job postings were recorded. Various educational levels, credentials, and skills desired by these employers were identified, assessed, and compared with similar data from the “supply side” reports from AND. Conclusions: The credentials and skills most desired by employers are similar to some of the learning objectives set forth for DPD and DI programs by ACEND, but not entirely congruent. The need for both client/customer focus and computer literacy may be implicit in the standards, but a more overt inclusion of these skills would likely be of benefit to ensure these are inculcated into every program and student.

Perception of receiving SMS based health messages among hypertensive individuals in urban slums

BACKGROUND Hypertension rates are increasing in India, and prior research has not explored the perception of using mobile based SMS among urban hypertensive individuals living in slum settings in India. OBJECTIVE To explore the perception of receiving SMS based health messages among hypertensive individuals in urban slums. METHODS A cross sectional study was conducted during the period of December 2013 in an urban slum setting of South Delhi, New Delhi, India. Eligible study participants included: 45 individuals aged 30 years and above, with confirmed diagnosis of high blood pressure, owned a mobile phone/landline and were willing to participate. RESULTS Results of our study showed participants (n= 45) had an average age of 48 years (SD = 12), mostly female (64%, n= 29), and currently married (80%, n= 36). Their most common perceived hypertension risk factors included: worry/anxiety/stress (84%, n= 38), and high fat diet (68%, n= 30). Mobile calls were the most preferred mode of receiving lifestyle counseling among study participants (71%, n= 32). Majority preferred to receive counseling in Hindi language (67%, n= 30), and more than half were willing to pay for these services (60%, n= 27). CONCLUSION Our findings suggest the need for innovations that utilize basic phone platforms, mobile calling feature, and language tailored interventions.

assessment of cePh-accredited institutions Offering Public health Programs in the United states: a short report

Aims Examine the distribution of the Council of Education in Public Health (CEPH)-accredited institutions offering public health educational programs in the United States, and characterize their various attributes. Methods A search was conducted during the period of June 2014, using the Association of Schools and Programs of Public Health database (ASPPH), and individual university websites to obtain a complete list of CEPH-accredited institutions offering programs in public health at the Certificate, Masters, and Doctoral levels in the United States. Detailed information were abstracted from the various programs offerings, including school/program information, school type, geographic location, admission cycle, education delivery format, public health concentration, number of credits, presence of a global component, joint programs, and tuition. These data were analyzed in August 2014. Results A total of 85 CEPH-accredited institutions designated as either “Schools of Public Health” or individual “Programs of Public Health” were present in the ASPPH database at the time of this data collection (2014). These institutions offer programs in public health at the Certificate (61%, n = 52), Masters (100%, n = 85), and Doctoral (44%, n = 37) levels in the United States. More than half of the programs offered were provided by schools of public health (58%, n = 49), which were mostly public universities (75%, n = 64), concentrated in the Northeast (22%, n = 19) and mainly admitted students during the fall semester. Ninety-three concentrations of public health currently exist, of which 25 concentrations are predominant. Conclusion To the best of our knowledge, this is the first study that examines the distribution of existing CEPH-accredited public health educational programs offered by United States institutions. We suggest future areas of research to assess existing public health workforce demands, and map them to the curriculums and competencies provided by institutions offering public health educational programs in the United States. This could provide valuable insight on the extent to which public health curriculums are meeting workforce demands.

Urban Rural Comparisons of Polycystic Ovary Syndrome Burden among Adolescent Girls in a Hospital Setting in India

Background. Polycystic ovarian syndrome (PCOS) is a multifaceted disorder characterized by varying clinical presentations. Objective. The aim of this study was to determine urban and rural differences in the burden of polycystic ovarian syndrome among Indian adolescent females aged 12 to 19 years. Methods. A pilot cross-sectional study was conducted for a period of one month (August-September 2013) at Balaji Hospital, Vellore, Tamil Nadu, India. The final sample included 126 study participants located in various urban (50%, n = 63) and rural (50%, n = 63) settings. Information was gathered on sociodemographic and anthropometric characteristics, clinical history, occurrence of acne and hirsutism, serum testosterone levels, obstetric history, family history of chronic diseases, menstrual history, physical activity, and dietary intake. Results. Eighteen percent of the participants were confirmed of having PCOS by recent guidelines of Rotterdam Consensus for adolescent diagnosis of PCOS (presence of all three elements). Majority of the individuals with PCOS had an average age of 16 (SD = 2) (P = .02) years with an average age of menarche 12 years (SD = 1). Conclusion. The proportion of participants diagnosed with PCOS was higher among urban participants in comparison to rural participants.

A Human-Centered Platform for HIV Infection Reduction in New York: Development and Usage Analysis of the Ending the Epidemic (ETE) Dashboard

Background Dashboards have been increasingly used in clinic-based interventions, such as clinical performance improvement and monitoring risk of hospital readmissions, and are now gaining traction in population-based interventions, especially in disease assessment. Objective We describe the design, development, and usage analysis of a geovisualization dashboard, the Ending the Epidemic (ETE) Dashboard. The ETE dashboard is a tool developed to track New York’s progress towards achieving the goal of its ETE Initiative, to reduce new HIV infections from 3000 per year to 750 per year by the end of 2020. Methods The ETE dashboard was adapted from an existing human-centered geovisualization platform, SanaViz, an Internet-enabled, interactive app incorporating principles of human-centered design and cognitive fit theory to enhance visual exploration of population health data. Usage evaluation of the ETE geovisualization dashboard was conducted using Google Analytics over a 4-week period from March 19 to April 18, 2016. The aim was to monitor user activity and analyze traffic on the ETE dashboard using evidence-based metrics that can provide adequate feedback to enhance its utilization. Usage was characterized based on three metrics: (1) number of unique visits to each page, (2) average time on each page in seconds, and (3) page bounce rate (ie, percentage of visits where user left the site immediately after viewing just a single page). Further analysis was also conducted by cross-tabulating specific usage metrics. Results Of 860 sessions, 324 sessions were initiated by unique users (37.7%). The most common acquisition channels included direct source (353/860, 41.0%); followed by referral traffic (340/860, 39.5%) and organic search (134/860, 15.5%). Usage statistics indicate that for the 860 sessions initiated by both new and returning users, the average viewing time was 8 minutes, 51 seconds, and the bounce rate was 46%. These statistics reflect positive results given that prior literature estimates an average session duration of 10-20 seconds and a bounce rate of 40-60% for most websites. Key findings from our study showed that the highest bounce rates were seen for the “About” page of the ETE website (65%), which describes the ETE initiative. The lowest bounce rates were seen for the ETE blog page (17%), consistent with prior research on website usage metrics that indicate that blog pages are often the most frequently viewed pages on Web portals. Conclusions Our findings reveal the potential of Google Analytics as a tool to enhance user traffic and performance of the ETE geovisualization platform by using feedback from regular monitoring of key parameters including page bounce rates and average time on page. It also identifies the need for a follow-up usability assessment of the system.

Evaluating the usability of an interactive, bi-lingual, touchscreen-enabled breastfeeding educational programme: application of Nielson's heuristics

The study purpose was to conduct heuristic evaluation of an interactive, bilingual touchscreen-enabled breastfeeding educational programme for Hispanic women living in rural settings in Nebraska. Three raters conducted the evaluation during May 2013 using principles of Nielson’s heuristics. A total of 271 screens were evaluated and included: interface (n = 5), programme sections (n = 223) and educational content (n = 43). A total of 97 heuristic violations were identified and were mostly related to interface (8 violations/5 screens) and programme components (89 violations/266 screens). The most common heuristic violations reported were recognition rather than recall (62%, n = 60), consistency and standards (14%, n = 14) and match between the system and real world (9%, n = 9). Majority of the heuristic violations had minor usability issues (73%, n = 71). The only grade 4 heuristic violation reported was due to the visibility of system status in the assessment modules. The results demonstrated that the system was more consistent with Nielsen’s usability heuristics. With Nielsen’s usability heuristics, it is possible to identify problems in a timely manner, and help facilitate the identification and prioritisation of problems needing urgent attention at an earlier stage before the final deployment of the system.

Perceptions of online lifestyle counseling among individuals living in rural India

The burden of lifestyle related chronic diseases have increased in recent times. The objective of this pilot study was to explore perceptions about using online lifestyle counseling services among individuals living in rural settings in India. A pilot convenient sample of 100 individuals living in rural settings of Chennai with age 18 years and above was enrolled for the study. Information was gathered about socio-demographic characteristics, health behavior, current disease status; familiarity with technology and perceptions about online lifestyle counseling. The average age of the individuals was 34 years (SD=15). More than half of the individuals had access to computers at home and workplace. Individuals indentified various barriers for unable to obtain lifestyle counseling. Nearly 47% of the individuals were interested in obtaining online lifestyle counseling. There is an urgent need for evaluating the role of an online lifestyle counseling intervention among individuals living in rural settings.