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Ku GM, Kegels G. The performance of the Finnish diabetes risk score, a modified Finnish diabetes risk score and a simplified Finnish diabetes risk score in community-based cross-sectional screening of undiagnosed type 2 diabetes in the Philippines. Our sample size for individuals was calculated based on a mean difference of HBA1c of 0.2% (SD = 1.09) with standard parameters (alpha = 0.05, power = 0.80). Mabolo, Philippine Department of Health, personal communication, June 16, 2014). Those CHAP-P participants whose FINDRISC scores indicate diabetes risk (moderate: score of 12–14, high: score of 15–20, or very high: score of > 20) will be referred to the Rural Health Unit for fasting blood glucose testing. Manage cookies/Do not sell my data we use in the preference centre. Results will also be published in relevant conference and journals to disseminate our findings to other researchers and policy makers planning to implement an out-of-the-box program for diabetes detection, management, and prevention. The remainder of the work force go on to seek out other professional career opportunities outside the country. Campbell MK, Piaggio G, Elbourne DR, Altman DG, Group C. Consort 2010 statement: extension to cluster randomised trials. van Olmen J, Ku GM, van Pelt M, Kalobu JC, Hen H, Darras C, Van Acker K, Villaraza B, Schellevis F, Kegels G. The effectiveness of text messages support for diabetes self-management: protocol of the TEXT4DSM study in the democratic republic of Congo, Cambodia and the Philippines. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Electronic data will be stored in an encrypted program (REDCap) or in password-protected files on a secure institutional network. Each municipality is classified with an income class ranging from first (the highest income class) to sixth (the lowest) based on their average income in a four-year period. Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. Little RR, Rohlfing CL, Wiedmeyer HM, Myers GL, Sacks DB, Goldstein DE. of the Philippine Nurses Association. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. Long-term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance. Cardiovascular health awareness program (CHAP): a community cluster-randomised trial among elderly Canadians. Pages: 179-188. 2015;350:h2147. A member of the research staff team will ask individuals selected to participate in the study to provide consent, and the survey will be conducted with consenting individuals (See Additional files 1, 2, 3 and 4 for all consent forms). Type 2 diabetes is increasing globally, with the highest burden in low- to middle-income countries (LMICs) such as the Philippines. The provinces and cities are broken down into municipalities, and the municipalities are broken into the smallest administrative districts in the Philippines, known as barangays, which are small villages or neighbourhoods. Diabetes Care. Therefore, adopting and testing an effective low-cost intervention that enhances early diagnosis and management of diabetes shows promise for LMICs. Zamboanga Peninsula was chosen as the program site for this initiative because it exemplifies underprivileged regions in many LMICs in terms of geographical isolation, poverty, and scarce health resources where low-cost, community-owned health programs – such as CHAP-P – are urgently needed. We have opted to take 26 (13 pairs of intervention: control) communities with 100 residents per community giving a total sample size of 2600 residents (1300 per arm). Graduates of BS in Nursing may pursue a career path in various hospital settings and community clinics. Thirteen barangays will receive the CHAP-P sessions and will be considered intervention communities, while the other 13 communities will receive care as usual and will be considered control communities. This will be done based on the advice of the local health workers and leaders in the municipalities and cities. Updated Community Health Nursing 1. (DOCX 169 kb), Consent Form – Community Resident Focus Group. Ardena GJRA, Paz-Pacheco E, Jimeno CA, Lantion-Ang FL, Paterno E, Juban N. Knowledge, attitudes and practices of persons with type 2 diabetes in a rural community: phase I of the community-based diabetes self-management education (DSME) program in San Juan, Batangas, Philippines. ... 17162230 Concept of Public Health and Community Health Nursing. NVivo qualitative data analysis software 11 edition [Computer software]. Telefax: 525-1596 Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Diabetes Res Clin Pract. A large community cluster randomized controlled trial in Canada demonstrated that the CHAP intervention resulted in a statistically significant 9% reduction in annual hospital admissions due to stroke, heart failure, and heart attacks in people aged 65 and over at the population [11]. The primary aim of this study is to adapt the CHAP model to a Philippine context as the Community Health Assessment Program in the Philippines (CHAP-P) and evaluate the effect of CHAP-P on glycated hemoglobin (HbA1c) compared to a random sample of community residents in control communities. Community health nursing involve assessment of a community, diagnosis of needs in the community, planning how to increase health awareness in the community, implementing of the plan and evaluating the outcome of the plan. All p-values will be reported to three decimal places with those less than 0.001 reported as p < 0.001. Lindstrom J, Tuomilehto J. Phase 1 was a qualitative community scan that examined the sociocultural, economic, and health service context in the Zamboanga Peninsula, Philippines in order to adapt the CHAP intervention for best fit. Improving cardiovascular health at population level: 39 community cluster randomised trial of cardiovascular health awareness program (CHAP). Nurses can help clients internalize the importance of healthy behaviors by teaching and adapting the care plan to the individual client. 2003;35:1381–95. https://doi.org/10.1186/s12889-019-6974-z, DOI: https://doi.org/10.1186/s12889-019-6974-z. We are using paired randomization, therefore intervention and control community pairs need to have relatively similar sizes. The WatchBP Office Target will be used to measure blood pressure as it was found to show the most reliable results based on our pilot study [27]. Nutr Res. The Filipino Nurses Association was established on October 15, and the organization initiated the publication of Filipino Nurse Journal. Health Care Delivery System. Package of essential noncommunicable (PEN) disease interventions for primary health Care in low-resource Settings. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. Figure 1 shows the financing flows for health as to sources and uses. Public Health Nursing is proud to announce that it is now the official journal of Council of Public Health Nursing Organizations (CPHNO) (formerly known as the Quad Council Coalition of Public Health Nursing Organizations), www.cphno.org Global estimates of diabetes prevalence for 2013 and projections for 2035. 2017;19(9):899–903. Barangays will be paired based on municipality, population size, and similarity in the setting (i.e., religion, being under the same health district providing health services, and distance from the municipal centre). 2015;11:93–107. Public health nursing in the Philippines by , 2007, National League of Philippine Government Nurses edition, in English - [10th ed.] The Philippines has begun implementation of the World Health Organization Package of Essential Noncommunicable Disease Interventions for primary care settings in low resource areas [7], created the National Centre for Disease Prevention and Control in 2000 including a diabetes-specific office, and has listed reduction of mortality and morbidity from lifestyle-related diseases such as diabetes as one of the goals in the “National Objectives for Health 2005-2010” [8]. First, 100 participants will be randomly selected and recruited from each of the 26 barangays involved in the trial for a community survey. Terms and Conditions, In: Lavrakas PJ, editor. Six-month, 26-community (13 intervention, 13 control) parallel cluster randomized controlled trial in Zamboanga Peninsula, an Administrative Region in the southern Philippines. All data will be collected through an electronic REDCap mobile app database [26] via a tablet computer, which was found to be the most accurate and acceptable choice of data collection method for BHWs during the pilot stages [30]. Community survey participants will be interviewed in their homes by trained research staff at baseline and 6 months. ISSN: 0048-3818: OCLC Number: 4841184: Description: volumes illustrations 25 cm: Other Titles: Philippine journal of nursing However, there are currently some gaps in the areas of detection and treatment for diabetes. Community Health Nursing Reflection 1262 Words | 6 Pages. 1663 F.T. Privacy Guenter D, Angeles R, Kaczorowski J, Agarwal G, Cristobal FL, Arciaga R, Smith JF, Kessomboon P, Jarraya F, Agbulos R, et al. Current Issue - Journal of Community and Public Health Nursing displays the articles that are accepted and meant for publication during that month. Community public health nursing is not entirely different in nursing practice with that of clinical nursing confined in the four corners of the hospital. This trial and all materials (consent, database, education materials) has obtained ethics approval from the Ateneo de Zamboanga (ADZU) research ethics board, Philippines (approval #2018-SM-0001), and the Hamilton Integrated Research Ethics Board (HiREB), Canada (project ID #4303). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The data that is collected will only be made available for review by authorized persons including CHAP-P research team in the Philippines and Canada, institutional review boards, and transcriber of the focus groups. Grand Challenges Canada/grand Défis Canada: Integrated innovation. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Facebook; Prev Article Next Article . SPIRIT 2013 statement: defining standard protocol items for clinical trials. Public Health Nursing: the term used before for Community Health NursingAccording to Dr. C.E. For the evaluation purposes, we will be recruiting 100 randomly selected residents aged 40 and over from each of 26 barangays (communities). In 2012, this region had the fourth highest poverty incidence of the 17 regions of the Philippines (33.7%) [17]. Our project is also guided by the Integrated Innovation approach, which posits that one can create a synergistic effect when addressing an issue or challenge by combining social, business, and scientific innovations [15]. If there are no eligible or willing participants within a household, the team will move on to the next household based on the systematic random sampling procedure. CHAP is a community-based, primary care-centred, volunteer-led, free of charge, cardiovascular disease risk assessment and blood pressure monitoring program, which is combined with health education sessions for community-dwelling older adults [10]. Presented at the North American Primary Care Group (NAPCRG) Annual Meeting. Gina Agarwal. Potential communities will be stratified by province, population size, income class, and type (urban versus rural). Instead, public health experts agree that the health of a community can have far-reaching—and sometimes surprising—impacts on individual health and beyond. To maintain confidentiality, data will be de-identified prior to analysis. Questionnaires will be completed on paper and later entered into a REDCap [26] database by trained research staff. The intervention will occur as follows (see Fig. 3). The Philippine Journal of Health Research and Development (PJHRD) (formerly the UP Manila Journal) is a peer-reviewed journal that aims to publish researches with a broad scope covering all aspects of environmental and human health. To improve penetration within the communities, we have decided to ensure the CHAP-P sessions rotate between puroks (a subdivision of a barangay) rather than having them in the same location week-by-week. Prev Med. Several studies have demonstrated the cost-effectiveness of early diagnosis and management of diabetes through the use of opportunistic screening and risk assessment screening tools [4, 5]. Only 15-25% of jobs in the Philippines are provided for the nursing population. 2003;26:725–31. Criteria for community selection include: adequate political stability, connection with local champions, travel feasibility, and refrigerated space for materials. Initially, a stepped-wedge cluster RCT was planned rather than a parallel cluster RCT, yet instead of solving issues of logistical constraints [38], it introduced some - the stepped-wedge design would have been more expensive and more time-consuming. 2010;90:160–6. The trial is also registered with ClinicalTrials.gov (identifier NCT03481335, first posted March 29, 2018; last updated August 17, 2018). The Cardiovascular Health Awareness Program (CHAP), an evidence-based Canadian intervention, may be an appropriate model for LMICs due to its low cost, ease of implementation, and focus on health promotion and disease prevention. Agarwal G, Angeles R, Pirrie M, Marzanek F, McLeod B, Parascandalo J, Dolovich L. Effectiveness of a community paramedic-led health assessment and education initiative in a seniors’ residence building: the community health assessment program through emergency medical services (CHAP-EMS). Philippine Health Care System - Free download as Powerpoint Presentation (.ppt), PDF File (.pdf), Text File (.txt) or view presentation slides online. Social innovations can bring scientific solutions to a local setting, while business innovations can deliver them at an affordable price point. This may affect the ability of the research team to visit communities for monthly fidelity checks, yet the intervention will be able to continue as BHWs can continue facilitating CHAP-P sessions in their local communities. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. First, residents will be invited to attend the CHAP-P sessions, which are facilitated by Barangay Health Workers (BHWs), who are trained local volunteers. A cost-effectiveness analysis will be conducted comparing the program cost of implementing CHAP-P and healthcare resource utilization costs to percentage reduction in HbA1c. BHWs will receive program-specific in-person training at the start of CHAP-P, with refresher sessions during their work with the program. The community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic condition assessment, blood pressure monitoring, and health education. This project is funded through the Canadian Institutes of Health Research (CIHR; project #139438) and the International Development Research Centre (IDRC; project #107826–001) via the Global Alliance of Chronic Diseases (GACD; project DM04). “A diffused light has little power or impact. PubMed  We will use multiple imputation to handle missing data. “Community health impacts everything—educational achievement, safety and crime, people’s ability to work and be financially healthy, life expectancy, happiness and more,” Bognanno says. Many doctors abandon the public sector to look for these higher paid jobs, resulting in the Philippine public health system to begin to collapse. The Philippines is a culturally and historically diverse archipelago consisting of a cluster of over 7,000 islands in the Southeast Pacific Rim. Community health nursing is essential to the health and welfare of the entire population. During the CHAP-P sessions, the BHWs will collect participants’ consent, measure blood pressure, collect other physical measurements (height, weight, waist circumference), and collect participant information to determine clients’ risk of diabetes using the FINDRISC [23]. Montreal; 2017. BMJ. As part of participating in the CHAP-P sessions, individuals give consent to participate in the study and for the information collected during the sessions to be linked with municipal/city health office records. Amendment of certain sections of the Act 2008 was conducted in … Google ScholarÂ. 2011;342:d442. ClinicalTrials.gov (NCT03481335), registered March 29, 2018. QSR international Pty ltd. 2015. Generalized Estimating Equations. This community survey will be completed at baseline and at 6 months and will use an open-cohort design. Hu Z, Qin LL, Xu HL. See Fig. 1 for an overview of the overall project design. For the qualitative data, once transcripts are produced from the interviews and focus groups, identifiers of participants will be removed. Any amendments regarding protocol changes will be submitted to both ethical review boards. HYL and DO are contributing to the development of the methods for economic analysis. Brooks R. EuroQol: the current state of play. These outcomes, whether they pertain to cluster or individual participant level, and their measures and sources are listed in Table 1. Diabetes Res Clin Pract. Those who have blood pressure greater than 140/80 mmHg will be referred to the midwife, with those with blood pressure over 180/100 mmHg being immediately referred to the Rural Health Unit or District Hospital, and those with blood pressure under 180/100 mmHg being referred to the Rural Health Unit with less immediacy, for further evaluation and management. For example, though screening kits and medications are available at no cost, the case detection for new cases of diabetes is poor, the diabetes registry is poorly maintained, and the medications often get left unused in the stockrooms of local health centres (Dr M.A. Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The PRECIS-2 tool: designing trials that are fit for purpose. Communities are separated by sea and mountains, with several ethnic and linguistic groups spread throughout the region and connected by inconsistent transportation and communication systems. The authors would like to thank the entire project team for their contributions to this research program, including staff and stakeholders in the Philippines and Canada, and the members of our international Project Advisory Group (including 5 primary investigators, 6 Canadian co-investigators or advisors, 5 Filipino co-investigators, a GACD representative, Canadian and Filipino research staff, and 4 other advisors from Tunisia, Thailand, and Peru). Evaluation also includes community process evaluation and cost-effectiveness analysis. 2008;336:1180–5. A major strength of this study is the multi-phase, multi-year nature of the overall research program. By using this website, you agree to our HEALTH FINANCING The health financing system in the country is complex as it involves different layers of financial sources, regulatory bodies and health service providers. Chronic Illness. Gillies CL, Lambert PC, Abrams KR, Sutton AJ, Cooper NJ, Hsu RT, Davies MJ, Khunti K. Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis. The journal is a forum for community health professionals to share their experience … Article. Those with other specific risk factors such as low physical activity, high salt intake, or smoking will be given further health education and referred to appropriate local programs. The authors declare that they have no competing interests. Related Posts. Erin E. Montgomery DNP, RN & Yvonne Harris Smith DNP, RN-BC, CNE, NCSN. Developing effective interventions could improve detection, prevention, and treatment of diabetes. This study will help fill that gap. 2016;17:8. Brussels: International diabetes federation; 2014. All analyses will be performed using SAS 9.4 (Cary, NC) or Stata 11 (College Station, TX). Based on our pilot, the intraclass correlation coefficient (ICC) was 0.006. Agarwal G. Primary care diabetes: issues facing family doctors. Phase 1, the qualitative community scan, and Phase 2, piloting the elements, were vital to integrate the components and building a diabetes intervention that would make sense in the context of the Zamboanga Peninsula, Philippines. Second, the mobile HbA1c test kit can be difficult to work with, as it only lasts for approximately 5 minutes in the heat and humidity of the Philippines. Accessed 8 Feb 2019. Journal of Community & Public Health Nursing publishes empirical research reports, program evaluations, and case reports focused on populations at risk across the lifespan. Agarwal, G., Angeles, R.N., Dolovich, L. et al. Ateneo de Zamboanga University, Philippines, Community Health Assessment Program in the Philippines, EuroQol-5 dimension-5 level (quality of life measure), Hamilton Integrated Research Ethics Board, Canada, International Development Research Centre, International Physical Activity Questionnaire (measure). Criteria for community selection include: security, connection with a local champion, feasibility for travel, and facility with refrigerated space for the HbA1c kits. Clin Chem. 1996;37:53–72. H Index. Reporting will follow the CONSORT 2010 statement: extension for cluster randomized trials [19]; reporting of this protocol follows the SPIRIT 2013 checklist [20], see Additional file 5. Boca Raton: CRC Press; 2002. Participants will then be asked to go to a community location for the HbA1c test and to be provided with a small token of appreciation. Both cost-effectiveness and cost-utility analyses will include overall program cost measures and participant health resource utilization and cost thereof. See Table 2 for the statistical analysis plan. RSA, RMA, JB, EG, SH, FDA, and NJ contributed to the contextualization of the research design and methods to the local setting. For the community survey and CHAP-P session data, after the full data set is collected (including the HbA1c test results), data will be anonymized. Milbank Q. Not only do community health nurses deliver patient care, they also help reduce the occurrence of injuries, illnesses and deaths by informing people about health … The Philippine Health Agenda 2016 to 2022. (DOCX 164 kb). When the Philippine nurses come to America they leave behind nursing shortages in their home country. The Cardiovascular Health Awareness Program (CHAP) intervention model may be particularly suited to LMICs due to its low cost, implementability, and focus on population-based health promotion and disease prevention. They will be recruited through convenience sampling with research team members inviting those who have been involved with the CHAP-P intervention. Pimentel GD, Portero-Mclellan KC, Oliveira EP, Spada APM, Oshiiwa M, Zemdegs JCS, Barbalho SM. The funding bodies had no role in study design, collection, analysis, interpretation of data, or in writing the manuscript. Within selected households, individuals 40 years of age or older will be eligible to participate in the survey. BMJ. The survey participants are not necessarily the same individuals who will attend the CHAP-P sessions in intervention communities, though entire communities will be invited to the CHAP-P sessions. The primary outcome is the mean difference in HbA1c at 6 months in a random sample of individuals from the random sample of individuals from the intervention barangays compared to the control barangays. The Integrated Innovation approach will be combined with the knowledge-to-action process, which depicts the relationship between knowledge creation and action steps to promote the application of knowledge (in our case the generation of CHAP-P) and evaluation of the success of the actions taken [16]. CDC Diabetes Cost-Effectiveness Study Group. Stall the Fall: Training Non-Clinical Caregivers to Prevent Falls in Community-Dwelling Older Adults. Article  Cookies policy. BMC Public Health One-year results of a synthetic intervention model for the primary prevention of T2D among elderly individuals with prediabetes in rural China. They may apply as a staff nurse, community health nurse, hospice nurse, geriatric nurse, clinical nurse, school nurse, private nurse, nurse educator, or a nurse practitioner. Hardin JW, Hilbe JM. https://www.doh.gov.ph/node/837. Cost per QALY will be calculated as the cost-utility measure; QALYs will be computed based on local EQ-5D-5 L values. For LMICs, one of the challenges of managing the impact of diabetes is developing effective and low-cost interventions to prevent or delay the onset of type 2 diabetes that can be successfully implemented, scaled up, and sustained [3]. PubMed  It considers original articles written for, but not limited to, Filipino nurses at all levels of health care organizations and in various settings. 2009;42:377–81. 2010. Community health nurses, especially those in public health settings, are now considered first responders—a role that traditionally belonged to law enforcement and emergency response professionals. BMC Public Health. The overall project is a three-phase mixed methods evaluation. 2014;103:137–49. http://www.who.int/cardiovascular_diseases/publications/pen2010/en/, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12889-019-6974-z. HbA1c testing will be conducted at baseline and 6 months, following the community survey at each time point. During World War II, the Philippines repeatedly exchanged hands between … 2015;350:h391. Communities will be selected and randomized by the local program manager. A community cluster design was chosen as CHAP-P is intended as a community-level intervention. Philippine Health Care Laws. Results may inform policy and practice in the Philippines and have the potential to be applied to other LMICs. J Clin Hypertens (Greenwich). With different reasons such as low budget, low number of man power, or general neglect for the poor, the Philippines has always been unable to keep up with the high standards of healthcare abroad. Information stored on computers will be protected by a password. This study has the potential to improve diabetes detection, management, and prevention in the Philippines and similar LMICs. Percentage decrease in participant HbA1c will be the measure of effectiveness used in the cost-effectiveness analysis. Springer Nature. A community process evaluation will also be undertaken during the project in order to monitor the implementation of the CHAP-P intervention to assess for any problems or process issues during or after the implementation of the project. 2010;30:186–90. Finally, Phase 3 is the RCT described in this paper. THE PHILIPPINE HEALTH SYSTEM AT A GLANCE 1.1. PubMed Google Scholar. Transcripts will be cleaned and data will be summarized using thematic analysis (open coding axial coding, selective coding). Study data will be anonymized. For CHAP-P session participants, the FINDRISC, blood pressure, and other physical measurement data collected as part of the CHAP-P sessions will be included in the evaluation. BMJ. Google ScholarÂ. This will be done through paired randomization with staggered starts. It considers original articles written for, but not limited to, Filipino nurses at all levels of health care organizations and in various settings. Of all registered health practitioners, nurses are among the largest group, even though there are very few nursing positions or jobs available to them. McMaster University; 2011. Diabetes self-management programs and other community-based interventions are being implemented across the Philippines, yet large-scale experimental studies are still a gap in the literature [9, 35,36,37]. Part of theOccupational and Environmental Health Nursing Commons, and thePublic Health and Community Nursing Commons This Project is brought to you for free and open access by the Theses, ... Health for All,” as part of the Philippine Health Agenda for 2017 to 2022 (WHO, 2017). Health Policy. Thousand Oaks: Sage Publications, Inc.; 2011. Choosing the optimal method of blood pressure measurement for limited-resource rural communities in the “community health assessment program-Philippines”. Journal of Nursing, an international peer reviewed Journal, is the multi-phase, multi-year nature the., http: //creativecommons.org/publicdomain/zero/1.0/, https: //doi.org/10.1186/s12889-019-6974-z, DOI: https //doi.org/10.1186/s12889-019-6974-z! Store and manage qualitative data, once transcripts are produced from the interviews focus... Association published biannually community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic assessment... 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