GCRF_NF151 COVID19:Determining trustworthiness and safety of REmote Consulting in primary healthcare (REaCH) for chronic disease populations in Africa
Lead Research Organisation:
King's College London
Department Name: Nursing
Abstract
During the COVID-19 pandemic, face-to-face healthcare appointments puts Africa's health workers and their patients at risk. Patients are afraid to attend clinics, e.g to collect medicines, and this may harm their health. Remote healthcare, by phone or internet, is advised by the World Health Organisation. Because this is difficult in Africa due to limited digital infrastructure, we have developed a training programme for health workers called REaCH. REaCH enables health workers to deliver trusted and safe care using the phone and limited internet availability.
REaCH training aims to increase the number of appointments held by phone for patients with long-term conditions. We want to test whether these remote appointments are as acceptable, safe and trustworthy as face-to-face appointments.
We will undertake trials in Nigeria and Tanzania. In each country we involve 20 health clinics and train 8-10 health workers in two clinics every month for 12 months. We collect monthly information on appointment type and the number of prescriptions and investigations given out. Twenty patients in each clinic per month will complete questionnaires on 1) how trustworthy they found their health worker to be and 2) how confident they are in managing their own health. Patients, clinic health workers and managers will be interviewed.
We will produce a) Strengthened health care across Africa following REaCH training b) health workers and patients protected from coronavirus/COVID-19 c) stronger scientific research teams in Nigeria and Tanzania.
REaCH training aims to increase the number of appointments held by phone for patients with long-term conditions. We want to test whether these remote appointments are as acceptable, safe and trustworthy as face-to-face appointments.
We will undertake trials in Nigeria and Tanzania. In each country we involve 20 health clinics and train 8-10 health workers in two clinics every month for 12 months. We collect monthly information on appointment type and the number of prescriptions and investigations given out. Twenty patients in each clinic per month will complete questionnaires on 1) how trustworthy they found their health worker to be and 2) how confident they are in managing their own health. Patients, clinic health workers and managers will be interviewed.
We will produce a) Strengthened health care across Africa following REaCH training b) health workers and patients protected from coronavirus/COVID-19 c) stronger scientific research teams in Nigeria and Tanzania.
Organisations
- King's College London (Lead Research Organisation)
- Makerere University (Collaboration)
- St. Francis University College of Health and Allied Sciences (Collaboration)
- African Population and Health Research Center (Collaboration)
- University of Warwick (Collaboration)
- Amref International University (Collaboration)
- Ministry of Health and Social Welfare (Collaboration)
- Ministry of Education, Science, Technology and Sports (Collaboration)
- UNIVERSITY OF BIRMINGHAM (Collaboration)
- University of Malawi (Collaboration)
- University of Ibadan (Collaboration)
- Oyo State Government (Project Partner)
- St. Francis Referral Hospital (Project Partner)
- Kibaoni Health Center (Project Partner)
- Akinyele Local Government (Project Partner)
- Ido Local Government (Project Partner)
- Mlimba District (Project Partner)
| Description | Providing training and airtime resulted in Increased remote consulting: In Nigeria remote consultation increased four-fold (RR 4.4 , [1.34, >10*]) with no evidence of change in the rate of face-face consulting (RR 1.06, 95% CI: [0.98, 1.09]). There was not increase in remote consulting in Tanzania where phoning health-workers was already encouraged. Remote consulting is safe and trustworthy: In Nigeria there was no change in prescribing (1.05, [0.60, 1.14]) and investigation rates (1.06, [0.23, 2.12]). Trustworthiness scores (0.05, [-0.45, 0.42]) were unchanged. In Tanzania, these outcomes also remained unchanged. Remote consulting allowed health-workers and patients to interact at the right time for good management of the health condition: Health workers used remote consulting to give patient test results, adjust medication after tests and in response to side-effects, check how patients take their medication, provide advice on self-management, to direct patients to needed urgent or specialist care and to enable patients to contact the right health-worker when they needed advice. Patients like remote consulting as it improved their access to their trusted health-workers: Patients reported receiving help at the time they need it. They reported trusting their health-worker and feeling cared for. Health-workers like remote consulting and successfully work out how to integrate it in their own facility as far as policy and resource flows allow: On the Acceptability, Appropriateness and Feasibility scale, remote consulting was scored highly by facility managers (17/20) in both countries. Facilities implemented remote consulting in various ways: providing a central number answered by one health-worker who redirected the calls if necessary, providing patients with health-worker phone numbers, or health-worker initiating the remote consulting. Health workers found it convenient to consult remotely. A few health workers reported patients contacting them when off-duty which they accepted but were alert to this becoming burdensome. Optimising the value of remote consulting requires attention to issues such as: how patient information is recorded and stored in facilities, where patients can obtain their medication. |
| Exploitation Route | Through a funded face to face and virtual policy field work with ten sub-Saharan African countries which aims to help them increase their populations' access to safe and trustworthy healthcare through the deployment of remote consultation, by mobile phone, underpinned by our REaCH training. |
| Sectors | Communities and Social Services/Policy,Digital/Communication/Information Technologies (including Software),Education,Healthcare,Government, Democracy and Justice |
| Description | See Partners and collaborator section for full details - they have been used to support health policy makers in six countries to review their digital and e-health policies. This review remains ongoing. |
| First Year Of Impact | 2023 |
| Sector | Education,Healthcare |
| Impact Types | Policy & public services |
| Description | Creation of patient disease registers |
| Geographic Reach | Africa |
| Policy Influence Type | Contribution to new or Improved professional practice |
| Impact | Improved awareness of the prevalence of specific diseases enabling better planning and coordination of services |
| Description | REaCH 2020 - uptake by health workers |
| Geographic Reach | Africa |
| Policy Influence Type | Contribution to new or Improved professional practice |
| Impact | Following training in the use of REaCH, health workers are now undertaking an increased number of consultations remotely (these were not done at all in most clinics prior to the intervention) which has reduced the number of patients physically coming to the clinics during the COVID-19 pandemic, improved patient access to health workers and clinics, enabled health workers to have more consultations and more in-depth consultations where required, and reduced health worker stress. |
| URL | https://www.kcl.ac.uk/research/reach-trial |
| Description | REaCH 2022 builds on REaCH 2020 in the following ways: enabling the training to be delivered without a facilitator, an additional module on communication skills, development of materials that can be culturally adapted in line with each country's needs. |
| Geographic Reach | Africa |
| Policy Influence Type | Contribution to new or Improved professional practice |
| Description | REaCH training on elearning platform for health workers in Tanzania |
| Geographic Reach | Africa |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Description | UKRI ODA Accelerating Impact From REaCH Trials Evidence Across Sub-Saharan Africa |
| Amount | £89,999 (GBP) |
| Organisation | King's College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 10/2022 |
| End | 03/2023 |
| Title | Patient Activation Measure 13; Physician Humanistic Behaviour Questionnaire |
| Description | Patient Activation Measure (PAM-13) aims to understand the knowledge, beliefs and skills required by people to enable them to manage their long-term conditions; Physician Humanistic Behaviour Questionnaire(PHBQ) determines the degree to which healthcare providers communicate humanistically with their patients; Both instruments have been translated into Swahili for the first time. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | Improved accessibility of instruments |
| Title | REaCH patient disease dataset |
| Description | Database of health records and data collected as part of the trial of 5433 patients at 56 health facilities across Tanzania and Nigeria |
| Type Of Material | Data handling & control |
| Year Produced | 2021 |
| Provided To Others? | No |
| Impact | Facilities have been able to create a disease registry enabling them to better plan care and support for patients with certain conditions. |
| Description | REaCH 2020 network |
| Organisation | African Population and Health Research Center |
| Country | Kenya |
| Sector | Academic/University |
| PI Contribution | Intellectual input, training and capacity building of staff, mentorship, network development and facilitation, exploitation, further development of REaCH training package, leadership and management of project |
| Collaborator Contribution | University of Warwick, University of Birmingham, University of Ibadan, APHRC, St France University, Makerere University (project partners) - Intellectual input, training and capacity building of staff, mentorship, further development of REaCH training package, development of network of clinical facilities in Nigeria and Tanzania, development of disease registers in the index conditions at clinical facilities Ministry of Health and Social Welfare, Tanzania - agreed CPD accreditation for the REaCH training for health workers, agreed to host REaCH training on the national health worker elearning platform |
| Impact | Nigeria has created a research network of primary care facilities for future research. Development of a clinical trials unit infrastructure and capabilities in Nigeria - in addition to REaCH, the unit is currently running another trial Tanzania remote and rural health facilities are collecting population data for the trial that they didn't previously collect, and have used this for their own purposes to develop patient and disease registers that are enabling them to examine population health needs locally. In Tanzania, the Ministry of Health and Social Care has agreed CPD accreditation for the REaCH training for health workers, and agreed to host REaCH training on the national health worker elearning platform |
| Start Year | 2020 |
| Description | REaCH 2020 network |
| Organisation | Makerere University |
| Country | Uganda |
| Sector | Academic/University |
| PI Contribution | Intellectual input, training and capacity building of staff, mentorship, network development and facilitation, exploitation, further development of REaCH training package, leadership and management of project |
| Collaborator Contribution | University of Warwick, University of Birmingham, University of Ibadan, APHRC, St France University, Makerere University (project partners) - Intellectual input, training and capacity building of staff, mentorship, further development of REaCH training package, development of network of clinical facilities in Nigeria and Tanzania, development of disease registers in the index conditions at clinical facilities Ministry of Health and Social Welfare, Tanzania - agreed CPD accreditation for the REaCH training for health workers, agreed to host REaCH training on the national health worker elearning platform |
| Impact | Nigeria has created a research network of primary care facilities for future research. Development of a clinical trials unit infrastructure and capabilities in Nigeria - in addition to REaCH, the unit is currently running another trial Tanzania remote and rural health facilities are collecting population data for the trial that they didn't previously collect, and have used this for their own purposes to develop patient and disease registers that are enabling them to examine population health needs locally. In Tanzania, the Ministry of Health and Social Care has agreed CPD accreditation for the REaCH training for health workers, and agreed to host REaCH training on the national health worker elearning platform |
| Start Year | 2020 |
| Description | REaCH 2020 network |
| Organisation | Ministry of Health and Social Welfare |
| Country | Tanzania, United Republic of |
| Sector | Public |
| PI Contribution | Intellectual input, training and capacity building of staff, mentorship, network development and facilitation, exploitation, further development of REaCH training package, leadership and management of project |
| Collaborator Contribution | University of Warwick, University of Birmingham, University of Ibadan, APHRC, St France University, Makerere University (project partners) - Intellectual input, training and capacity building of staff, mentorship, further development of REaCH training package, development of network of clinical facilities in Nigeria and Tanzania, development of disease registers in the index conditions at clinical facilities Ministry of Health and Social Welfare, Tanzania - agreed CPD accreditation for the REaCH training for health workers, agreed to host REaCH training on the national health worker elearning platform |
| Impact | Nigeria has created a research network of primary care facilities for future research. Development of a clinical trials unit infrastructure and capabilities in Nigeria - in addition to REaCH, the unit is currently running another trial Tanzania remote and rural health facilities are collecting population data for the trial that they didn't previously collect, and have used this for their own purposes to develop patient and disease registers that are enabling them to examine population health needs locally. In Tanzania, the Ministry of Health and Social Care has agreed CPD accreditation for the REaCH training for health workers, and agreed to host REaCH training on the national health worker elearning platform |
| Start Year | 2020 |
| Description | REaCH 2020 network |
| Organisation | St. Francis University College of Health and Allied Sciences |
| Country | Tanzania, United Republic of |
| Sector | Academic/University |
| PI Contribution | Intellectual input, training and capacity building of staff, mentorship, network development and facilitation, exploitation, further development of REaCH training package, leadership and management of project |
| Collaborator Contribution | University of Warwick, University of Birmingham, University of Ibadan, APHRC, St France University, Makerere University (project partners) - Intellectual input, training and capacity building of staff, mentorship, further development of REaCH training package, development of network of clinical facilities in Nigeria and Tanzania, development of disease registers in the index conditions at clinical facilities Ministry of Health and Social Welfare, Tanzania - agreed CPD accreditation for the REaCH training for health workers, agreed to host REaCH training on the national health worker elearning platform |
| Impact | Nigeria has created a research network of primary care facilities for future research. Development of a clinical trials unit infrastructure and capabilities in Nigeria - in addition to REaCH, the unit is currently running another trial Tanzania remote and rural health facilities are collecting population data for the trial that they didn't previously collect, and have used this for their own purposes to develop patient and disease registers that are enabling them to examine population health needs locally. In Tanzania, the Ministry of Health and Social Care has agreed CPD accreditation for the REaCH training for health workers, and agreed to host REaCH training on the national health worker elearning platform |
| Start Year | 2020 |
| Description | REaCH 2020 network |
| Organisation | University of Birmingham |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Intellectual input, training and capacity building of staff, mentorship, network development and facilitation, exploitation, further development of REaCH training package, leadership and management of project |
| Collaborator Contribution | University of Warwick, University of Birmingham, University of Ibadan, APHRC, St France University, Makerere University (project partners) - Intellectual input, training and capacity building of staff, mentorship, further development of REaCH training package, development of network of clinical facilities in Nigeria and Tanzania, development of disease registers in the index conditions at clinical facilities Ministry of Health and Social Welfare, Tanzania - agreed CPD accreditation for the REaCH training for health workers, agreed to host REaCH training on the national health worker elearning platform |
| Impact | Nigeria has created a research network of primary care facilities for future research. Development of a clinical trials unit infrastructure and capabilities in Nigeria - in addition to REaCH, the unit is currently running another trial Tanzania remote and rural health facilities are collecting population data for the trial that they didn't previously collect, and have used this for their own purposes to develop patient and disease registers that are enabling them to examine population health needs locally. In Tanzania, the Ministry of Health and Social Care has agreed CPD accreditation for the REaCH training for health workers, and agreed to host REaCH training on the national health worker elearning platform |
| Start Year | 2020 |
| Description | REaCH 2020 network |
| Organisation | University of Ibadan |
| Country | Nigeria |
| Sector | Academic/University |
| PI Contribution | Intellectual input, training and capacity building of staff, mentorship, network development and facilitation, exploitation, further development of REaCH training package, leadership and management of project |
| Collaborator Contribution | University of Warwick, University of Birmingham, University of Ibadan, APHRC, St France University, Makerere University (project partners) - Intellectual input, training and capacity building of staff, mentorship, further development of REaCH training package, development of network of clinical facilities in Nigeria and Tanzania, development of disease registers in the index conditions at clinical facilities Ministry of Health and Social Welfare, Tanzania - agreed CPD accreditation for the REaCH training for health workers, agreed to host REaCH training on the national health worker elearning platform |
| Impact | Nigeria has created a research network of primary care facilities for future research. Development of a clinical trials unit infrastructure and capabilities in Nigeria - in addition to REaCH, the unit is currently running another trial Tanzania remote and rural health facilities are collecting population data for the trial that they didn't previously collect, and have used this for their own purposes to develop patient and disease registers that are enabling them to examine population health needs locally. In Tanzania, the Ministry of Health and Social Care has agreed CPD accreditation for the REaCH training for health workers, and agreed to host REaCH training on the national health worker elearning platform |
| Start Year | 2020 |
| Description | REaCH 2020 network |
| Organisation | University of Warwick |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Intellectual input, training and capacity building of staff, mentorship, network development and facilitation, exploitation, further development of REaCH training package, leadership and management of project |
| Collaborator Contribution | University of Warwick, University of Birmingham, University of Ibadan, APHRC, St France University, Makerere University (project partners) - Intellectual input, training and capacity building of staff, mentorship, further development of REaCH training package, development of network of clinical facilities in Nigeria and Tanzania, development of disease registers in the index conditions at clinical facilities Ministry of Health and Social Welfare, Tanzania - agreed CPD accreditation for the REaCH training for health workers, agreed to host REaCH training on the national health worker elearning platform |
| Impact | Nigeria has created a research network of primary care facilities for future research. Development of a clinical trials unit infrastructure and capabilities in Nigeria - in addition to REaCH, the unit is currently running another trial Tanzania remote and rural health facilities are collecting population data for the trial that they didn't previously collect, and have used this for their own purposes to develop patient and disease registers that are enabling them to examine population health needs locally. In Tanzania, the Ministry of Health and Social Care has agreed CPD accreditation for the REaCH training for health workers, and agreed to host REaCH training on the national health worker elearning platform |
| Start Year | 2020 |
| Description | REaCH Africa Policy Impact Malawi |
| Organisation | University of Malawi |
| Country | Malawi |
| Sector | Academic/University |
| PI Contribution | PIs from four universities in the REaCH collaboration undertook a Policy Field Trip to Malawi in Feb 2023. Facilitated by Associate Professor Dr Christabel Yollanda Kambala, University of Malawi, we held two meetings with senior policy makers at the Ministry of Health, Kampala, to support the implementation of our research findings. |
| Collaborator Contribution | Dr Kambala arranged the meetings and followed up on actions and strategies following the meetings. The Malawi Ministry of Health have requested that members of the team attend the Technical Health Delivery Meeting to present our research and findings to support wider buy in for actions across the broad range of necessary stakeholders. |
| Impact | The disciplines are medicine, nursing, social sciences, information and technology, health professional education, health policy |
| Start Year | 2022 |
| Description | REaCH Africa Policy Impact Uganda |
| Organisation | Ministry of Education, Science, Technology and Sports |
| Country | Uganda |
| Sector | Public |
| PI Contribution | PIs from four universities in the REaCH collaboration undertook a Policy Field Trip to Uganda in Feb 2023. Facilitated by the Ministry's commissioner for Health Education and Training Dr Safinah Kisu Musene, we held meetings with senior Ugandan health policy makers to support the implementation of our research findings. |
| Collaborator Contribution | The Commissioner arranged the meetings, attended the meetings and followed up on actions and strategies following the meetings. The Ministry and their allied agencies (e.g professional regulators/exams boards) have committed to hosting our REaCH health worker training on the Ministry's e-learning platform, consider any adaption for a Uganda context and award it continuing professional development points to support uptake of the free training. |
| Impact | The disciplines are medicine, nursing, social sciences, information and technology, health professional education, health policy |
| Start Year | 2022 |
| Description | REaCH African Policy Impact Kenya |
| Organisation | Amref International University |
| Country | Kenya |
| Sector | Academic/University |
| PI Contribution | PI from four universities in the REaCH collaboration undertook a Policy Field Trip to AMREF International University from 14-17th Feb 2023. Facilitated by the university's Vice Chancellor, Prof Joachin Osur, we held five meetings with senior Kenyan health policy makers to support the implementation of our research findings. |
| Collaborator Contribution | AMREF arranged the meetings, attended the meetings and followed up on actions and strategies following the meetings. They have committed to hosting our REaCH health worker training on the AMREF university e-learning platform, adapt it for a Kenyan context and award it continuing professional development points to support uptake of the free training. |
| Impact | The disciplines are medicine, nursing, social sciences, information and technology, health professional education and health policy |
| Start Year | 2022 |
| Description | REaCH e-learning platform with CPD accreditations Tanzania |
| Organisation | Ministry of Health and Social Welfare |
| Country | Tanzania, United Republic of |
| Sector | Public |
| PI Contribution | The REaCH education development team provided the REaCH training free of charge to enable all health workers in the country to undertake free training on how to deliver safe and trustworthy remote consultations to advance their universal health coverage ambitions. |
| Collaborator Contribution | They have provided an e-learning platform to host the REaCH training and worked closely with Tanzania PI and professional regulation bodies to secure CPD points for the training to incentivise health workers to undertake the training. |
| Impact | Not yet live but being finalised |
| Start Year | 2021 |
| Title | REaCH 2020 training for remote healthcare consultation |
| Description | A training package for healthworkers to learn how to undertake remote consultations |
| IP Reference | |
| Protection | Trade Mark |
| Year Protection Granted | |
| Licensed | No |
| Impact | ... |
| Title | REaCH 2020 training materials and programme |
| Description | A 14-hour training course which enables health workers to confidently deliver healthcare to their patients using their own smart phone and integrate this digital delivery with their existing health care system. The digitally delivered blended training uses train-the-trainer approach: nurses/medical officers/doctors are trained via their smart phones using an app and social media; other cadres of health worker including community health workers are trained using their feature phones and available social media. |
| Type | Support Tool - For Medical Intervention |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2022 |
| Development Status | Under active development/distribution |
| Clinical Trial? | Yes |
| Impact | The clinical trial data collection has been completed but the analysis of results is still underway. However, at this stage we have gained agreement from the Tanzanian Ministry of Health to host REaCH on the national eLearning platform for health workers, and agreed CPD accreditation for those completing the training. |
| URL | https://www.kcl.ac.uk/research/reach-trial |
| Description | Engagement of health ministry, health policy makers and clinical facilities in Nigeria and Tanzania |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Members of the research teams in Nigeria and Tanzania engaged with health practitioners, policy makers, and clinical facilities to gain understanding and approval to trial the REaCH programme in their facilities/communities. The research team in Tanzania engaged with the Ministry of Health, gaining approval for REaCH to be hosted on the national eLearning platform for health workers, with formal CPD accreditation awarded to those who complete the training. Individuals from the following organisations in Nigeria have agreed to attend a workshop to where the trial results will be presented: National Association of Nigeria Nurses and Midwives, Nigerian Medical Association, Nigerian Medical Students Association & University of Ibadan Medical Students Association, Association of Public Health Physicians of Nigeria, Society of Family Physicians of Nigeria, National Association of Resident Doctors of Nigeria, University College Hospital, Oyo State Primary Health Care Agency, Oyo State Hospitals Management Board, Oyo State Ministry of Health, and, Oyo State House of Assembly (Legislators). The health workers will provide context and feedback on the results, and policy makers will consider how REaCH can be deployed at scale, along with considerations for the local context in which the training is deployed. |
| Year(s) Of Engagement Activity | 2020,2021,2022 |
| Description | REaCH - DMEC and TSC |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | ... |
| Year(s) Of Engagement Activity | 2020,2021 |
| Description | REaCH training roll out Nigeria |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | 40 health workers attended a training workshop to be introduced to the REaCH training for remote consulting and the trial findings. They commenced the first two modules together and completed the remaining 5 in their own time. They have competed surveys before and 2-weeks following the training. The data is being analysised currently. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://uhfiles.ui.edu.ng/learn/ |