Potentials and challenges of using co-design in health services research in low-and middle-income countries

Co-design with people having poor access to health services and fragile health systems in low-and middle-income countries can be momentous in bringing service users and other stakeholders together to improve the delivery and utilisation of health services.There is ample of evidence from high-income countries regarding how co-design can translate available evidence into developing acceptable,feasible,and adaptable health solutions in different settings.However,there is limited literature on co-design in health research in the context of low-and middle-income countries.Therefore,it is crucial to understand how knowledge about collaborative working can be translated into policy and practice in the context of low-and middle-income countries.Thus,this paper discusses the concept of co-design,co-production,and co-creation in health and the potentiality and challenges of using co-design in health services research in low-and middle-income countries.Despite the challenges,the co-design research has considerable potential to encourage the meaningful engagement of service users and other stakeholders in developing,implementing,and evaluating real-world solutions in low-and middle-income countries.It is essential to balance power dynamics in a co-design process through mutual recognition and respect,participant diversity,and reciprocity and flexibility in sharing.The inclusive and collaborative approach to working is complex due to existing rigid hierarchical structures,socio-cultural beliefs,political interference and working practices.However,this could be minimised by developing transparent terms of reference that reflect the value and benefits of equal partnership in particular co-design work.

Review on Efficacy and Health Services Research Studies of Complementary and Alternative Medicine in Inflammatory Bowel Disease

Objective：To assess the evidence of the use and efficacy for complementary and alternative medicine（CAM） in inflammatory bowel disease（IBD）. Methods：A systematic literature search in MEDLINE was performed for randomized controlled trials（RCTs） in Crohn＇s disease and ulcerative colitis.Moreover,a selective literature search for health services research studies on the use of CAM in patients with IBD was performed.Results：Health services research studies showed a high use of CAM in adult and pediatric patients with IBD worldwide.In contrast to the high use among IBD patients,there was a lack of high-quality data for many of the used CAM methods.Although most of the studies showed positive results,the methodological quality of most studies was rather low;therefore,the results had to be interpreted with caution.While there were many studies for probiotics and fish oil,RCTs for the highly used method homeopathy, for most herbal products,and for traditional Chinese medicine methods apart from acupuncture RCTs were completely lacking.Conclusions：The lack of high-quality studies might be the consequence of the problems associated with the funding of clinical trials involving CAM.However,having the high user rates in mind,high-quality studies assessing efficacy and safety of those methods are urgently needed.Furthermore,there is a need for better representation of CAM in undergraduate and postgraduate medical education.

Healthcare delivery interventions to reduce cancer disparities worldwide

Globally,cancer care delivery is marked by inequalities,where some economic,demographic,and sociocultural groups have worse outcomes than others.In this review,we sought to identify patient-facing interventions designed to reduce disparities in cancer care in both high-and low-income countries.We found two broad categories of interventions that have been studied in the current literature:Patient navigation and telehealth.Navigation has the strongest evidence base for reducing disparities,primarily in cancer screening.Improved outcomes with navigation interventions have been seen in both high-and low-income countries.Telehealth interventions remain an active area of exploration,primarily in high income countries,with the best evidence being for the remote delivery of palliative care.Ongoing research is needed to identify the most efficacious,costeffective,and scalable interventions to reduce barriers to the receipt of cancer care globally.

Health system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan

Background:Rheumatic heart disease(RHD)remains a leading cause of morbidity and mortality in Sub-Saharan Africa despite widely available preventive therapies such as prophylactic benzathine penicillin G(BPG).In this study,we sought to characterize facilitators and barriers to optimal RHD treatment with BPG in Sudan.Methods:We conducted a mixed-methods study,collecting survey data from 397 patients who were enrolled in a national RHD registry between July and November 2017.The cross-sectional surveys included information on demographics,healthcare access,and patient perspectives on treatment barriers and facilitators.Factors associated with increased likelihood of RHD treatment adherence to prophylactic BPG were assessed by using adjusted logistic regression.These data were enhanced by focus group discussions with 20 participants,to further explore health system factors impacting RHD care.Results:Our quantitative analysis revealed that only 32%of the study cohort reported optimal prophylaxis adherence.Younger age,reduced primary RHD healthcare facility wait time,perception of adequate health facility staffing,increased treatment costs,and high patient knowledge about RHD were significantly associated with increased odds of treatment adherence.Qualitative data revealed significant barriers to RHD treatment arising from health services factors at the health system level,including lack of access due to inadequate healthcare staffing,lack of faith in local healthcare systems,poor ancillary services,and patient lack of understanding of disease.Facilitators of RHD treatment included strong interpersonal support.Conclusions:Multiple patient and system-level barriers to RHD prophylaxis adherence were identified in Khartoum,Sudan.These included patient self-efficacy and participant perception of healthcare facility quality.Strengthening local health system infrastructure,while enhancing RHD patient education,may help to improve treatment adherence in this vulnerable population.