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The CareConekta App
The CareConekta app was built through collaboration between the study team and Jembi Health Systems in Cape Town [
PMC10238954
Methods
PMC10238954
Study Design and Dates
We conducted a prospective, unblinded randomized controlled trial at the Gugulethu Midwife Obstetric Unit (MOU), a public sector clinic providing integrated HIV and peripartum care for pregnant women near Cape Town, South Africa. Full details of the study design can be found in our published protocol [
PMC10238954
App Design Specifications
EVENT
To characterize participant mobility during the study period, the CareConekta app was designed to collect 2 GPS location heartbeats per day. In addition, the app was built with a geographic list of health facilities in South Africa so that users could see a map of nearby facilities as they traveled. App connectivity an...
PMC10238954
Recruitment and Eligibility
Pregnant women were recruited during routine antenatal care at the MOU. Women were eligible if they were in the third trimester of pregnancy (≥28 weeks); aged ≥18 years; able to speak and understand isiXhosa (the predominant local language) or English; diagnosed with HIV at any time before enrollment; able to demonstra...
PMC10238954
Smartphone Technical Requirements
For the purpose of this study, a smartphone was defined as a mobile phone device with a touchscreen interface and internet and GPS capabilities. CareConekta was designed for phones using the Android operating system, version 5.0 or later. In our preliminary work, nearly 90% of the smartphones of the women approached fo...
PMC10238954
App Installation and Operation
The app was installed at the study site by connecting the smartphone to the study’s Wi-Fi source. Because the app was available on the Google Play Store, all participants first needed a Google email address to download the app. For the app to function properly after installation, the GPS needed to remain enabled (with ...
PMC10238954
Study Measures
Participant-reported data were collected at enrollment and follow-up—approximately 6 months post partum—directly into REDCap (Research Electronic Data Capture; Vanderbilt University) using tablet computers. REDCap is a secure, encrypted, and web-based software platform designed to support data capture for research stud...
PMC10238954
Analysis
We report counts and proportions for categorical variables and medians and IQRs for continuous variables. Data analysis was performed using SAS (version 9.4; SAS Institute). Open-ended responses were reviewed to identify key topics or themes and illustrative quotes.
PMC10238954
Ethics Approval
This study was approved by the institutional review boards of Vanderbilt University (reference 181640) and the University of California, San Francisco (237757), and the Human Services Research Committee of the University of Cape Town (659/2018). All participants signed a written informed consent form before enrollment,...
PMC10238954
Results
PMC10238954
Installation Experience
App installation at enrollment was a highly variable experience. The most common reasons for slow experiences at installation were the need to delete items on the phone to make room for another app, the need to create a Google or Gmail account to use the Google Play Store, the need to update the Google Play Store app v...
PMC10238954
Investigator Withdrawals
6/200
In total, 7 participants were withdrawn from the study soon after enrollment owing to technical issues. Most (6/200, 3%) were withdrawn at the end of the enrollment visit because of an app installation failure that could not be resolved. In addition, 1 (0.5%) other participant was withdrawn for changing their phone to ...
PMC10238954
Phone Sharing
Approximately one in seven (25/173, 14.4%) participants reported sharing their phone during the study. These participants most often shared their phone with one of their family members (12/25, 48%), their boyfriend or husband (11/25, 44%), or one of their friends who was not their boyfriend or husband (3/25, 12%). Of t...
PMC10238954
Version Updates
From December 2019 to December 2020, the CareConekta app moved from version 1 to version 7. At one point, a version change (version 5 to 6) meant that the heartbeat data submitted by older versions were no longer received. From July to August 2020, participants were phoned, notified of the new app version, and assisted...
PMC10238954
Gaps in GPS Heartbeat Signals
A key feasibility measure was the successful transmission of at least 1 data location heartbeat per participant per day. Heartbeat data were observed daily by the study staff via the dashboard and periodically exported as a CSV file for analysis. During the study, we experienced periods when the dashboard was offline a...
PMC10238954
Raffle
HOLIDAYS
In November 2020, to encourage participants to keep the CareConekta app installed on their phone and the GPS function enabled throughout the study period, we implemented an incentive: a weekly raffle of one 200 MB data bundle (worth approximately US $4). Participants were eligible to enter the raffle if their phone sen...
PMC10238954
Additional Technical Challenges
On multiple occasions, the staff-facing dashboard was either not accessible or not fully functional, which meant that the team was unable to view or download heartbeat data. During the early study period, these problems often resulted in app revisions and version updates. In some instances, when the dashboard was down,...
PMC10238954
Data Expenditure
Overall, for all their cell phone needs, participants reported spending a median of R51 (IQR 30-100; US $2.75, IQR US $1.60-5.40) for data per month, with a similar response for monthly spend on airtime: median R50 (IQR 29-100; US $2.71, IQR US$1.57-5.40). Cellular data in South Africa cost approximately R10 (US $0.50)...
PMC10238954
Participants’ Understanding of the CareConekta App
SAID
At follow-up, participants were asked, “If you were to explain to a friend what the CareConekta app does, how would you explain it?” Nearly all participants (167/170, 98.2%) mentioned the clinic finder feature:I’d say it’s an app used to search for clinics when I travel to the Eastern Cape so I don’t suffer when I run ...
PMC10238954
Participants’ Acceptability of the CareConekta App
Similar to the participants’ responses regarding their understanding of the app, most of the responses regarding what participants liked about using the app were related to the clinic finder feature:I found it useful because I don’t have to look for clinics should I travel outside Cape Town. The app connects me to the ...
PMC10238954
Initial Efficacy of the Intervention
SECONDARY
Although the initial efficacy of the intervention was a secondary aim of the study, we were unable to assess this because the app did not function as designed. Without receiving regular GPS heartbeats, the study team did not know when a participant was traveling; therefore, the intervention could not be initiated. Duri...
PMC10238954
Discussion
PMC10238954
Principal Findings
EVENT
This is one of the first GPS-based mHealth studies—if not the first GPS-based mHealth study—targeted at improving HIV care in South Africa, and we found that several key challenges impeded its implementation. This study was designed to test the feasibility and acceptability of the CareConekta app and the initial effica...
PMC10238954
Conclusions
AIDS
AIDS
In conclusion, we did not demonstrate the feasibility of using a GPS-based tracking app to characterize mobility and improve engagement in HIV care. Our most common problems that contributed to failure were a lack of mobile phone data, app uninstallations, phone changes, and missing heartbeat data. We are far less moti...
PMC10238954
Abbreviations
antiretroviral therapymobile healthMidwife Obstetric UnitResearch Electronic Data Capture
PMC10238954
Background
Preventing addiction through training takes precedence over treatment and plays a crucial role in enhancing the well-being of adolescents. Utilizing inclusive and participatory methods can significantly enhance the effectiveness of education. Numerous studies have demonstrated that gamification, as an interactive and c...
PMC10641928
Aim
This study aimed to assess the impact of gamification-based training to prevent substance and internet addiction on the knowledge and attitudes of male adolescents. Additionally, the study examined this educational program’s effects on male adolescents’ academic achievement.
PMC10641928
Methods
This study employed a quasi-experimental design with a control group. One hundred fourteen male adolescents were randomly assigned to the intervention or control groups. They completed a pre-intervention questionnaire assessing addiction-related knowledge, attitudes, and academic achievement. Subsequently, the interven...
PMC10641928
Results
Before the intervention, there were no significant differences in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement between the intervention and control groups (P > 0.05). However, after the intervention, the intervention group demonstrated significant...
PMC10641928
Conclusion
The current study highlights the positive impact of gamification-based training on enhancing male adolescents’ knowledge, attitudes, and academic achievement.
PMC10641928
Supplementary Information
The online version contains supplementary material available at 10.1186/s12909-023-04858-1.
PMC10641928
Keywords
PMC10641928
Background
anxiety, behavioral dependence, aggression, learning behaviors, impaired social connections, substance addiction, substance abuse
ADVERSE EFFECTS, ABUSE, DISORDERS, WEST
During adolescence, judgment and decision-making skills are developing, and the ability to accurately assess risks and make decisions is underdeveloped [Adolescence is a pivotal developmental stage marked by profound physical, cognitive, emotional, social, and behavioral transformations. The biological and neural chang...
PMC10641928
Materials and methods
PMC10641928
The study environment and population
substance abuse
This study employed a quasi-experimental design with pre-test and post-test measurements, including a control group. The research population consisted of male adolescents aged 13–15 who attended health centers affiliated with Shiraz University of Medical Sciences in 2021.The authors used MedCalc software version 18 to ...
PMC10641928
Method of study
Initially, participants were contacted by phone. The purpose of the study, the methodology, and the commitment to information confidentiality were explained to motivate honest responses from the adolescents. In light of COVID-19 conditions, informed consent forms were collected online from the students and their parent...
PMC10641928
Data collection and statistical analysis
substance addiction, CVI, substance abuse, anxiety
MINOR
The research instrument included a five-part questionnaire covering demographic information, addiction knowledge, attitudes toward substances and the Internet, and academic achievement.The Addiction Knowledge Questionnaire was designed by the researchers and consisted of 18 true/false questions, with 10 related to subs...
PMC10641928
Results
substance abuse
The study involved 114 adolescents aged 13 to 15, with an equal distribution of 50% in the intervention group and 50% in the control group. The subjects had a mean age of 14.0 years with a standard deviation of 6.85.Most adolescents in both groups were the first child in their families (50 individuals, 43.8%). Most (46...
PMC10641928
Discussion
substance abuse
EVANS, STD
Table The results of this study highlight the positive impact of gamification on improving students’ knowledge, attitude, and academic achievement. Gamification enhances the teaching process, making it more efficient and effective. This method can find applications in medical sciences and health education, promoting he...
PMC10641928
Conclusion
adolescence
This study demonstrated that gamification-based addiction prevention training is an engaging and effective method for enhancing knowledge, improving attitudes, and boosting adolescent academic achievement. Prevention training during adolescence is not only cost-effective but also superior to treatment.As a recommendati...
PMC10641928
Acknowledgements
This article was derived from an MSc dissertation in community health nursing by Esmaeel Taghipour and received financial support from the Vice-Chancellor of Shiraz University of Medical Sciences (Grant No: 22445). The authors extend their gratitude to all participating adolescents and their parents.
PMC10641928
Authors’ contributions
F V, E.T: Conceptualization, Methodology, Software, Data curation, Writing- Original draft preparation, Visualization, Investigation, Supervision, Validation, Writing- Reviewing and Editing. N.Z: Conceptualization, Methodology, Investigation, Supervision.
PMC10641928
Funding
This study received financial support from the Vice-Chancellor of Research, Shiraz University of Medical Sciences (Grant No: 22445). The funder had no involvement in the study’s design, data collection, analysis, interpretation, or manuscript preparation.
PMC10641928
Data Availability
Upon request from the first author, data is available. For inquiries related to data access, please contact essitaghipour1997@gmail.com.
PMC10641928
Declarations
PMC10641928
Ethics approval and consent to participate
All interventions in this study were conducted under the approval of the Ethics Committee of Shiraz University of Medical Sciences (Approval Number: IR.SUMS.REC1399.1299). The study adhered to the fundamental principles outlined in the Helsinki Declaration (2013), and the investigator obtained the commitment of all par...
PMC10641928
Consent for publication
Not applicable.
PMC10641928
Competing interests
The authors declare no conflicts of interest regarding this research, authorship, or publication.
PMC10641928
List of abbreviations
Not applicable.
PMC10641928
References
PMC10641928
1. Introduction
movement sensations, post-stroke, Stroke, neuromuscular disability, lower-limb impairments, sudden loss of focal neurological function, stroke, urban mobility, visual motor imagery, hemorrhage, neurological diseases, neuromuscular disabilities, kinesthetic motor imagery, MP, infarction
NEUROLOGICAL DISEASE, STROKE, STROKE, EVENT, DISORDERS, HEMORRHAGE, INFARCTION, CORTEX, BRAIN INFARCTION
Stroke is a debilitating clinical condition resulting from a brain infarction or hemorrhage that poses significant challenges for motor function restoration. Previous studies have shown the potential of applying transcranial direct current stimulation (tDCS) to improve neuroplasticity in patients with neurological dise...
PMC10708803
2. Materials and Methods
PMC10708803
2.1. Patient
right hemiparesis of a subacute, post-stroke, stroke, hemorrhagic post-stroke, aphasia
STROKE, SKIN LESIONS, OSTEOPOROSIS
The patient in our research was a 73-year-old male, suffering from right hemiparesis of a subacute (2 months) hemorrhagic post-stroke, who was followed by a multidisciplinary rehabilitation team composed of clinical staff and engineers for 3 weeks.The inclusion criteria to be included in this research were as follows: ...
PMC10708803
2.2. Study Design
This study adopted an ATD (quasi-experimental), as suggested by Slijper in 2014 [This research was approved by the Research and Ethical Committees of the UFES/Brazil (registry number CAAE: 46099421.9.0000.5542) and conducted in accordance with the Declaration of Helsinki.
PMC10708803
2.3. Protocol
In our protocol, before the use of the BCI, tDCS was applied for 20 min, with an intensity of 2 mA, following the dual-tDCS model, with the anode positioned over M1 of the affected hemisphere and the cathode positioned over the cerebellum of the contralateral hemisphere (
PMC10708803
2.4. Brain-Computer Interface
MP
The system developed here is a novel MI-BCI [The EEG signal acquisition is achieved using the OpenViBE platform, with an EEG cap used to acquire brain signals through Ag/AgCl electrodes at 8 locations (FC1, FC2, C3, C4, Cz, CP1, CP2, and Pz) positioned according to the International 10–20 system. The A1 Ground (GND) an...
PMC10708803
2.5. Functional and Somatosensory Outcomes
neuropathic diseases
SENSORY DISORDERS, PBC, BEND
In our protocol, the subject was subjected weekly, and at the end of the training period, to functional and somatosensory assessments by the same evaluator. For function evaluation, we used the following metrics: Fugl-Meyer [We also used the Semmes Weinstein Monofilaments to evaluate the subject’s sensitivity to crude ...
PMC10708803
2.6. Data Analysis
MP
To investigate the cortical effects using our BCI, we analyzed the significant event-related desynchronization (ERD) patterns in the time-frequency representation of the EEG signals. Additionally, we performed Pearson correlation analyses between cycling velocities in the Mu, low beta, and high beta rhythms.The signifi...
PMC10708803
3. Results
PMC10708803
3.1. Functional and Somatosensory Parameters
A summary of the data obtained through functional evaluation is presented in The Semmes Weinstein Monofilaments test was used to evaluate the somatosensory parameter, whose results are described in
PMC10708803
3.2. Quantitative EEG
The ERD patterns were analyzed in Matlab after each protocol session (We also tested the Pearson correlation between the velocities of cycling rhythms in Mu, low beta, and high beta (
PMC10708803
4. Discussion
post-stroke, motor impairments, neuromuscular rehabilitation post-stroke, a loss of motor function, stroke, somatosensory deficits, urinary incontinence, pain, leg motor deficits, attention and motor imagery, MP, Sensory impairments
STROKE, MOTION SICKNESS, URINARY INCONTINENCE, CORTEX
We investigated the sequential use of tDCS and MI-BCI, as well as the use of a VR and an MP device, for neurological recovery in people with a loss of motor function due to stroke. The aim of this research was to measure and compare the effects of tDCS in a post-stroke patient. Overall, we report two important results:...
PMC10708803
Author Contributions
J.P.S.L.: conducted the research, analysis, writing, review and editing; L.A.S.: performed the research, analysis, data curation, writing and editing; D.D.-R.: conceptualization, supervision, review and editing; V.F.C.: performed the research; E.M.N.-P.: conceptualization; T.F.B.-F.: conceptualization, supervision, rev...
PMC10708803
Institutional Review Board Statement
This research was approved by the Research and Ethical Committees of the UFES/Brazil, under the code number CAAE 46099421.9.0000.5542, and conducted in accordance with the Declaration of Helsinki.
PMC10708803
Informed Consent Statement
The patient gave his informed consent with a handwritten signature for inclusion before he participated in the study.
PMC10708803
Data Availability Statement
The data that support the findings of this study are available upon reasonable request from the authors.
PMC10708803
Conflicts of Interest
The authors declare no conflict of interest.
PMC10708803
References
MP, discrimination loss
Assembly modeling with the tDCS equipment used in our study, with the anode positioned over M1 and the cathode positioned over the cerebellum of the other hemisphere.Methods: (1) The subject is subjected to brain stimulation through transcranial direct current stimulation (tDCS). (2a) The brain-computer interface (BCI)...
PMC10708803
Background
diabetes
DIABETES
In high-resource settings, structured diabetes self-management education is associated with improved outcomes but the evidence from low-resource settings is limited and inconclusive.
PMC9957611
Aim
diabetes
TYPE 2 DIABETES, DIABETES
To compare, structured diabetes self-management education to usual care, in adults with type 2 diabetes, in low-resource settings.Research design and methods.
PMC9957611
Design
diabetes
TYPE 2 DIABETES, DIABETES
Single-blind randomised parallel comparator controlled multi-centre trial.Adults (> 18 years) with type 2 diabetes from two hospitals in urban Ghana were randomised 1:1 to usual care only, or usual care plus a structured diabetes self-management education program. Randomisation codes were computer-generated, and allotm...
PMC9957611
Results
death, diabetes
RECRUITMENT, DIABETES
Recruitment: 22We randomised 206 participants (69% female, median age 58 years [IQR: 49–64], baseline HbA1c median 64 mmol/mol [IQR: 45–88 mmol/mol],7.9%[IQR: 6.4–10.2]). Primary outcome data was available for 79 and 80 participants in the intervention and control groups, respectively. Reasons for loss to follow-up wer...
PMC9957611
Conclusion
diabetes
DIABETES
In low-resource settings, diabetes self-management education might not be associated with glycaemic control. Clinician’s expectations from diabetes self-management education must therefore be guarded.
PMC9957611
Supplementary Information
The online version contains supplementary material available at 10.1186/s12913-023-09188-y.
PMC9957611
Keywords
PMC9957611
What is already known on this topic?
diabetes
DIABETES
In high-resource settings, structured diabetes self-management education is associated with improved outcomes.
PMC9957611
What this study adds?
There was no between group difference in mean HbA1c at 3 months following a 6-hour structured DSME intervention.HbA1c decreased by 9 mmol/mol [95%CI:-13 to-5, HbA1c decreased by-3 mmol/mol [95%CI:-6 to 1,
PMC9957611
What are the implications of the study?
diabetes
DIABETES
In low-resource settings, the effect size of structured diabetes self-management education on glycaemic control may be limited and thus, clinician’s expectations from diabetes education must be guarded.
PMC9957611
Background
diabetes, Diabetes
DIABETES, DIABETES
Diabetes is a long-standing epidemic with over half a billion adults affected globally. [Self-care is essential for PLD. This underpins the need for self-management education. In high-income countries, structured diabetes self-management education (DSME) programmes such as, the Diabetes Education and Self-Management fo...
PMC9957611
Methods
PMC9957611
Study design and approval
TYPE 2 DIABETES
A multicentre, parallel-group, single-blind randomised controlled trial was conducted at two hospitals (WGMH and KBTH) in Accra, Ghana. Adults living with type 2 diabetes were randomised 1:1 to structured DSME plus usual care, or usual care only.
PMC9957611
Ethical approval
Ethical approval was provided by the Ghana Health Service Ethics Review Committee (protocol ID no: GHS-ERC 009/11/20), and the Institutional Review Board of KBTH (protocol ID no: KBTH-IRB 000,175/2021).
PMC9957611
Study participants and study setting
T2DM, chronic kidney disease
SICKLE CELL DISEASE
Eligibility criteria included aged 18 years or above, ability to participate in activities in a group setting, known to have T2DM, and not known to have chronic kidney disease or sickle cell disease.The study was conducted between January-May 2021, at two public primary facilities in Accra, Ghana. Potential participant...
PMC9957611
Randomisation and masking
Participants were randomly assigned either to usual care, or usual care plus intervention. Usual care at KBTH polyclinic consisted of informal brief education given by doctors whilst consulting. At WGMH, usual care consisted of unstructured group education, lasting approximately 30 min, delivered on clinic days; by nur...
PMC9957611
Procedures
PMC9957611
Intervention
coronavirus infectious disease-2019, Diabetes
DIABETES
The intervention tested was a structured DSME program which had been adapted from DESMOND: EXTENDing availability of self-management structured education programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND). EXTEND has been piloted in Malawi and Mozambique [We further culturally adapted...
PMC9957611
Follow-up intervals and assessments
The first 206 patients were consecutively randomised 1:1 either to structured DSME plus usual care or usual care only (Fig. Trial profileDespite prior acceptance of the invitation to participate in endline data collection, some participants failed to show up by the trial end date. Specifically, 71 participants in the i...
PMC9957611
Outcomes
diabetes-related distress, diabetes-related emotional distress
ADVERSE EVENTS
The primary outcome was change in HbA1c after 3-month follow-up. HbA1c was assessed centrally in an accredited laboratory, adhering to international criteria, set out according to International Organisation for Standardisation standards (ISO Standard 15,189:2012). HbA1c measurement was conducted using the turbidimetric...
PMC9957611
Statistical analysis
PMC9957611
Sample size calculation
RECRUITMENT
Mean reductions in HbA1c, between baseline and follow-up, were assumed to be 0 mmol/mol (0·0%) in the usual care group, and 4·8 mmol/mol (0·5%) in the intervention group [At the time of recruitment, the COVID-19 epidemic was unfolding with vaccines not yet available. Considering the uncertainties surrounding the epidem...
PMC9957611
Baseline Characteristics
The baseline characteristics show high WHO Qol scores, despite low incomes, low literacy, and high unemployment levels (Table
PMC9957611
Secondary outcomes
SECONDARY
Similarly, there was insufficient evidence that the intervention had an effect on any of the secondary outcomes except for an improvement in physical health. The difference in physical health between the intervention and control was 3 (
PMC9957611
Adverse events
ASYMPTOMATIC HYPOGLYCAEMIA
No significant harms were observed. One participant however, had to be treated for symptomatic hypoglycaemia during delivery of the intervention. The participant’s medications included human insulin.
PMC9957611
Discussion
irregular diabetes, diabetes
DISEASE, BLIND, COMPLICATIONS, DIABETES
Our aim was to study the association between structured DSME, and glycaemic control. Our results show that, in people living with diabetes (PLD) in resource-constrained settings, structured DSME may not be associated with change in HbA1c at 3-months. A clinically relevant reduction in HbA1c was observed in the interven...
PMC9957611
Conclusion
Glycaemic control was not associated with DSME in this study, although the reduction in HbA1c was larger in the intervention group compared to usual care. Ideally, DSME equips individuals with skills for decision making and taking action. We thus recommend larger cluster randomised studies, with longer duration of foll...
PMC9957611
Acknowledgements
Diabetes
DIABETES
We acknowledge the support of MDS-Lancet laboratories Ghana, Leicester Diabetes Centre, National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester General Hospital, Leicester, U.K and National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK fo...
PMC9957611
Authors' contributions
MH, MJD
RL led in conceptualization of the study, drafting protocol, and data collection. RL wrote the first draft of the report with input from MAC, KKG, GOA, MMB, DD, and MH. MAC, KKG, RG, GOA, FA, MC, MH, MJD, IA, AY reviewed the protocol and submitted it for ethical clearance. DD participated in delivery of the interventio...
PMC9957611
Funding
RL is supported by the UMC Utrecht Global Health Support PhD programme. This study was supported in part by Novo Nordisk. They had no role in the study design, collection, analysis, interpretation of data, writing of the report or decision to submit the article for publication.
PMC9957611
Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
PMC9957611