Background: Sickle cell disease is an inherited blood disorder that affects over 100,000 Americans. Sickle cell disease–related complications lead to significant morbidity and early death. Evidence supporting the feasibility, acceptability, and efficacy of self-management electronic health (eHealth) interventions in chronic diseases is growing; however, the evidence is unclear in sickle cell disease. Objective: We systematically evaluated the most recent evidence in the literature to (1) review the different types of technological tools used for self-management of sickle cell disease, (2) discover and describe what self-management activities these tools were used for, and (3) assess the efficacy of these technologies in self-management. Methods: We reviewed literature published between 1995 and 2016 with no language limits. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and other sources. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included texting, mobile phone–based apps, or other eHealth interventions designed to improve self-management in pediatric and adult patients with sickle cell disease. Results: Of 1680 citations, 16 articles met all predefined criteria with a total of 747 study participants. Interventions were text messaging (4/16, 25%), native mobile apps (3/16, 19%), Web-based apps (5/16, 31%), mobile directly observed therapy (2/16, 13%), internet-delivered cognitive behavioral therapy (2/16, 13%), electronic pill bottle (1/16, 6%), or interactive gamification (2/16, 13%). Interventions targeted monitoring or improvement of medication adherence (5/16, 31%); self-management, pain reporting, and symptom reporting (7/16, 44%); stress, coping, sleep, and daily activities reporting (4/16, 25%); cognitive training for memory (1/16, 6%); sickle cell disease and reproductive health knowledge (5/16, 31%); cognitive behavioral therapy (2/16, 13%); and guided relaxation interventions (1/16, 6%). Most studies (11/16, 69%) included older children or adolescents (mean or median age 10-17 years; 11/16, 69%) and 5 included young adults (≥18 years old) (5/16, 31%). Sample size ranged from 11 to 236, with a median of 21 per study: 50 participants in 4 studies (25%). Most reported improvement in self-management–related outcomes (15/16, 94%), as well as high satisfaction and acceptability of different study interventions (10/16, 63%). Conclusions: Our systematic review identified eHealth interventions measuring a variety of outcomes, which showed improvement in multiple components of self-management of sickle cell disease. Despite the promising feasibility and acceptability of eHealth interventions in improving self-management of sickle cell disease, the evidence overall is modest. Future eHealth intervention studies are needed to evaluate their efficacy, effectiveness, and cost effectiveness in promoting self-management in patients with sickle cell disease using rigorous methods and theoretical frameworks with clearly defined clinical outcomes.

Patient-Centered eHealth Interventions for Children, Adolescents, and Adults With Sickle Cell Disease: Systematic Review

Objective Digital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs. Design Systematic review. Setting/participants All settings/all participants. Intervention We classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth). Primary and secondary outcome measures Feasibility, acceptability, impact. Methods We searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis. Results We reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99). All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials. Conclusion Digital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space.

https://bmjopen.bmj.com/content/bmjopen/7/11/e017604.full.pdf

Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017)

Examining stress perceptions and coping strategies among Saudi nursing students: A systematic review.

INTRODUCTION: obesity is a global epidemic There are rising rates of obesity and its associated disorders, especially in developing countries, including among Health Service Providers (HSPs) Obesity is associated with early retirement, increased morbidity and mortality Thus, obesity has the potential of reducing long-term retention of HSPs in inadequately staffed health systems of developing countries This study aimed to determine the magnitude of and factors associated with obesity among HSPs of a tertiary health care facility in Lagos, Nigeria METHODS: a cross sectional study was carried out with a questionnaire, which included the International Physical Activity Questionnaire short form (IPAQ-SF) Obesity was defined as BMI ≥30kg/m2 Statistical significance was set at p 40 years (OR 351,p=0003), female gender (OR 284, p=0007) and earning a monthly salary of ? 200,000 naira relative to 201,000-400,000 naira (OR 258, p=0006) were significantly associated with obesity CONCLUSION: obesity was prevalent among these Nigerian HSPs This calls for concern, especially with the implication of loosing health workers to obesity related disorders and early retirement

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Obesity among health service providers in Nigeria: danger to long term health worker retention?

Background : Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective : This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods : During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected ( n =36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results : The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion : The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care. Keywords : nursing unit managers; quality of care; hospitals; time and motion; South Africa (Published: 11 May 2015) Citation : Glob Health Action 2015,  8 : 26243 -  http://dx.doi.org/10.3402/gha.v8.26243 SUPPLEMENTARY MATERIAL : This paper is part of the Special Issue:  Transforming Nursing in South Africa . More papers from this issue can be found at  http://www.globalhealthaction.net

The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

Nurses account for a significant proportion of the health care workforce in most countries. In the African continent, it is estimated that nurses constitute about 80% of the health care professionals, however they are marginally represented in health research investigations and policy/decision-making roles. A descriptive research design was used to obtain data from 120 registered nurses in Calabar municipality, Nigeria. The study aimed at assessing the extent of nurses’ involvement in research and policy development. The findings revealed that only 30(25.0%) of the respondents indicated that they had been involved in research activity. Majority 74(61.7%) utilized research findings and perceived research as a tool to enhance development of nursing. 93(77.5%) respondents were not aware of any financial support for research and only 4(3.3%) had ever received research grant to support research activities. The results also revealed minimal 8(6.7%) involvement of nurses in health care policy development. A significant relationship (P < 0.05) existed between nursing educational qualification and involvement in research activities after school. These findings therefore suggest the building of supportive research environments and strengthening nurses’ research capacity for effective participation of nurses in health care policy decisions in low and middle income countries (LMICs) and global health priorities.

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Assessing Nurses' Capacity for Health Research and Policy Engagement in Nigeria

Aim
To evaluate the effectiveness of mobile phones in enhancing self-care, adjustment and engagement in non-disclosed youth living with HIV.

Background
Youth aged 15–24 years represent 42% of new HIV infections globally. Youth who are aware of their HIV status generally do not disclose it or utilize HIV-related facilities because of fear of stigma. They rely on the Internet for health maintenance information and access formal care only when immune-compromised and in crisis.

Introduction
This study shows how non-disclosed youth living with HIV can be reached and engaged for self-management and adjustment through mobile phone.

Study design
One-group pre-test/post-test experimental design was used.

Methods
Mobile phones were used to give information, motivation and counselling to 19 purposively recruited non-disclosed youth with HIV in Calabar, South-South Nigeria. Psychological adjustment scale, modified self-care capacity scale and patient activation measure were used to collect data. Data were analysed using PASW 18.0.

Results
Scores on self-care capacity, psychological adjustment and engagement increased significantly at post-test. HIV-related visits to health facilities did not improve significantly even at 6 months. Participants still preferred to consult healthcare providers for counselling through mobile phone.

Discussion
Mobile phone-based interventions are low cost, convenient, ensure privacy and are suitable for youth. Such remote health counselling enhances self-management and positive living.

Conclusion and implications for health policy
Mobile phones enhance self-care, psychological adjustment and engagement in non-disclosed youth living with HIV, and can be used to increase care coverage. Findings underline the importance of policies to increase access by locating, counselling and engaging HIV-infected youth in care.

Enhancing self-care, adjustment and engagement through mobile phones in youth with HIV.

Breastfeeding is an important resource which includes exclusive breastfeeding (EBF). It provides food, health and care simultaneously. Therefore a descriptive survey was carried out to assess knowledge, attitudes, beliefs and practices as related to EBF. The study population consisted of all mothers of child bearing ages (15-49 years) who had children from (0-2 years). Simple random sampling was used in selecting ten villages out of twenty-three and single-stage cluster sampling was used to select three hundred (300) respondents for the study. A questionnaire was used for data collection. Data were analysed using descriptive statistics and chi-square tests. The results revealed that the majority of the respondents 240 (80.0%) were aware of EBF; 162 (54.0%) were knowledgeable about EBF while 180 (60.0%) practised EBF. It was concluded that women in the Ikot Omin community, in Nigeria practised EBF and the recommendations focused on the fact that health workers should continue to encourage mothers to breastfeed exclusively.

Mothers' knowledge, attitudes, beliefs and practices concerning exclusive breastfeeding in Calabar, Nigeria

Incivility among nursing faculty: A multi-country study.

Background : People living with HIV/AIDS (PLWHA) now enjoy appreciable longevity and there is need to enhance their quality of life. Unfortunately, limited studies in Nigeria have used the World Health Organization Quality Of Life BREF (WHOQOL-BREF) to determine the quality of life of PLWHA. Aim : This study was to assess the quality of life of PLWHA participating in five support groups in Southern Cross River Senatorial District. Methods : The study was a descriptive survey. It was delimited to PLWHA who belonged to support groups and were available to complete the questionnaire. A total of 123 PLWHA were recruited into the study. WHOQOL BREF was used for data collection. Results : The mean (SD) age of the PLWHA was 36.4 +/- 10.9. Most 83(67.5%) were females while 40 (32.5%) were males (Figure 1). With regards to education, most of the respondents 60(48.8%) attended secondary school, followed by 48(39%) who attended tertiary institutions while only 15(12.2%) had primary education (Figure 2).The highest mean (SD) quality of life score emanated from physical health, 14.04+2.66.The mean (SD) scores in the three domains were similar among the PLWHA: psychological health, 13.55+ 2.45; social relation, 13.60+3.01; environment, 13.25+2.58. Conclusion : The study suggests that the lower mean score for environment may be an indication of poverty and poor living conditions while higher mean score for physical health may suggest accessibility to anti retroviral drugs. Therefore it was suggested that loan should made accessible to PLWHA in Cross River State. This should empower them to establish means of livelihood.

 Key words : Quality of life, people living with HIV/AIDS, physical health, psychological health, WHOQOL-BREF, Nigeria

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P. E. Samson-Akpan

Papers

Assessing Nurses' Capacity for Health Research and Policy Engagement in Nigeria

Enhancing self-care, adjustment and engagement through mobile phones in youth with HIV.

Mothers' knowledge, attitudes, beliefs and practices concerning exclusive breastfeeding in Calabar, Nigeria

Incivility among nursing faculty: A multi-country study.

Quality of life of people living with HIV/AIDS in Cross River, Nigeria