The evolution of e-health has the potential to assist in the management of scarce resources and the shortage of skills, enhance efficiencies, improve quality and increase work productivity within the healthcare sector. As a result, an increase is seen in e-health solutions developments with the aim to improve healthcare services, hospital information systems, health decision support, telemedicine and other technical systems that have the potential to reduce cost, improve quality, and enhance the accessibility and delivery of healthcare. However, unfortunately their implementation contiues to fail. Although there are several reasons for this, in this study a lack of project quality management is viewed as a key contributor to the failure of e-health solutions implementation projects in rural hospitals. This results in neglected aspects of quality assurance (QA), which forms an integral part of project quality management. The purpose of this study is to develop a Genertic Quality Assurance Model (GQAM) for the successful acquisition (i.e. development and implementation) of e-health solutions in rural hospitals in the Eastern Cape Province to enable improved quality of care and service delivery. In order to develop and test this model it was necessary to identify the QA methodologies that are currently used in rural hospitals and to evaluate their strengths and weaknesses, as well as their impact on project success. The study is divided into four phases; in each phase different study designs were followed. The study used triangulation of qualitative and some elements of quantitative research approaches, in terms of which a case study approach was adpoted to answer the research questions. This study did indeed develop a GQAM that can be used to ensure e-health solution success in rural hospitals. Furthermore, to aid in the implementation of this model, a set of QA value chain implementation guidelines were developed, as a framework, to inject the nodel into typical (SDLC) phases.

Context: Health information sharing improves the performance of patient self-management when dealing with challenging chronic disease care. Cloud computing has the potential to provide a more imaginative long-term solution compared with traditional systems. However, there is a need for identifying a suitable way to share patient health information via cloud. Objectives: This study aims to identify what health information is suitable and valuable to share from a type 2 diabetes patient when multiple stakeholders are involved for different purposes, and find out a promising and achievable cloud based solution which enables patients to share the health information what and where they want to share. Methods: To get a clear and deep understanding on the subject area, and identify available knowledge and information on relevant researches, a literature review was performed. And then, a prototype on the case of type 2 diabetes is implemented to prove the feasibility of the proposed solution after analyzing the knowledge acquired from literatures. Finally, professionals and patient were interviewed to evaluate and improve the proposed solution. Results: A hybrid cloud solution is identified as a suitable way to enable patient to share health information for promoting the treatment of chronic disease. Conclusions: Based on the research with type 2 diabetes, it was concluded that most records in daily life such as physiologic measurements, non-physiologic measurements and lifestyle are valuable for the treatment of chronic diseases. It was also concluded that hybrid cloud is suitable and achievable for sharing patient-recorded health information among trusted and semi-trusted stakeholders. Moreover, anonymous and patient opt-in consent model are suitable when sharing to semi-trusted stakeholders.

Objective: This study aims to trace the epidemiological profile of Primary Health Care in the town of Santa Maria in the year 2012, from the Primary Health Care Information System (PHCIS). Method: It was employed an ecological study of the variables that compose the PHCIS and take part in the monitoring instrument of the PMAQ available in DATASUS. Results: Data related to the pregnancy stage and to the children were considered insufficient and some appropriate when compared to the established goal. The others, related to infectious diseases, chronic diseases and mental health, were considered inadequate or unavailable. Another significant difficulty is the lack or not updated data, in other words, referring only to a month to some indicators, which obstruct their computation. Conclusion: It has been obtained as a hypothesis a lack of understanding from de evolved ones on the importance of updating these data and what they mean to the health work process. This information is very useful when thinking about planning, executing, evaluating and monitoring health actions. In order to have a new integrated information system in health working properly it is necessary to understand the background to, in that way, succeed in the proposals that it offers. / Objetivo: Este estudo busca traçar o perfil epidemiológico da Atenção Básica do município de Santa Maria no ano de 2012, a partir do Sistema de Informação da Atenção Básica (SIAB). Método: Trata-se de um estudo ecológico das variáveis que compõem o SIAB e fazem parte do instrumento de monitoramento do Programa de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ), disponíveis no DATASUS. A adequação do indicador foi avaliada comparando com a meta estabelecida pelo PMAQ e limítrofe quando distava 10% desta. Uma apresentação gráfica dos resultados em quadro com cores é proposta. Resultados: Apenas os relacionados ao período gestacional e às crianças foram considerados limítrofes ou adequados. Os demais, relacionados a doenças infectocontagiosas, doenças crônicas não transmissíveis e saúde mental, foram inadequados ou não estavam disponíveis. A desatualização dos dados foi uma dificuldade, ou seja, estava disponível apenas um mês para alguns indicadores. Conclusão: A ausência de informações no SIAB não permite conhecer a atenção básica prestada em Santa Maria. Os dados existentes mostram indícios da inadequação desta atenção. A falta de entendimento dos atores envolvidos sobre a importância da atualização destes dados e o que significam para o processo de trabalho em saúde pode ser o determinante do sub-registro. Para a implantação adequada de um novo sistema de informação como o E-SUS, é preciso compreender o uso e deficiências dos preexistentes, como o SIAB, para que este seja efetivo no monitoramento das políticas e serviços de saúde.

Medication prescriptions constitute an important type of clinical intervention. Medication adherence is the degree to which a patient consumes their medication as agreed upon with a prescriber. Despite many years of research, medication non-adherence continues to be a problem of note, partially due to its multi-faceted in nature. Numerous interventions have attempted to improve adherence but none have emerged as definitive. A significant sub-problem is the lack of consensus regarding definitions and measurement of adherence. Several recent reviews indicate that discrepancies in definitions, measurement techniques, and study methodologies make it impossible to draw strong conclusions via meta-analyses of the literature. Technological interventions aimed at improving adherence have been the subject of ongoing research. Due to the increasing prevalence of the Internet of Things, technology can be used to provide a continuous stream of data regarding a patient's behaviour. To date, several researchers have proposed interventions that leverage data from the Internet of Things, however none have established an acceptable means of analyzing and acting upon this wealth of data. This thesis introduces a computational definition for adherence that can be used to support continued development of technological adherence interventions. A central part of the proposed definition is a formal language for specifying prescriptions that uses fuzzy set theory to accommodate imprecise concepts commonly found in natural language medication prescriptions. A prescription specified in this language can be transformed into an evaluation function which can be used to score the adherence of a given medication taking behaviour. Additionally, the evaluator function is applied to the problem of scheduling medication administrations. A compiler for the proposed language was implemented and had its breadth of expression and clinical accuracy evaluated. The results indicate that the proposed computational definition of adherence is acceptable as a proof of concept and merits further works. / Graduate

ABSTRACT This thesis represents a two phase, qualitative study using both Expert Review Panel and Delphi Panel research methods. The two research questions guiding this study were: 1) Phase I: What does culturally safe nursing practice mean, and how do we know when it is being practiced; and 2) Phase II: Can proposed culturally safe nursing practices be coded through use of International Classification for Nursing Practice (ICNP®) and/or Nursing Intervention Classification (NIC)? Originating from the field of nursing in New Zealand, there is interest in adopting cultural safety in Canada to support culturally safe nursing care for Canada’s Indigenous people (Canadian Nurses Association, 2009). A synthesis of the literature was conducted in Phase I of this study revealing six hallmarks of culturally safe nursing care. Those are: 1) Creating trust; 2) Relinquishing power over relationships; 3) Approaching people with respect; 4) Seeking permission; 5) Listening with your heart and ears; and 6) Attending to those who’s beliefs and practices differ. Representing culturally safe care of an Indigenous elder, a case scenario, developed by the principle investigator (PI), was presented to cultural safety experts (n=3) participating on an Expert Review Panel (ERP). The results of ERP showed that all six culturally safe nursing practices were represented in the case scenario. Validating that culturally safe nursing practices could be succinctly defined contributes to new knowledge, and most importantly informs nurses how to practice in a culturally safe nursing way. The purpose of using a Delphi panel method in Phase II was to see if culturally safe nursing practices in the case scenario could be represented in the ICNP® and NIC nursing languages by experts in those particular languages. To explore this two groups of subject matter experts in ICNP® (n=3) and NIC (n = 3) were invited to participate in separate Delphi panels. Overall, the Phase II Delphi panel results reflected the divergent way ICNP® and NIC are structured, in that terms alone do not provide enough contextual meaning to support clinical practice. The results of the ICNP® Delphi Panel showed that one ICNP® nursing intervention could represent culturally safe nursing care: Establishing Trust. Otherwise, the abstract composition of ICNP® terms affected the study results. The NIC Delphi panel results reflect the content and structure of NIC, and as such the experts identified the following four NIC nursing interventions that reflect culturally safe nursing care, they are: 1) Culture Brokerage, 2) Complex Relationship Building, 3) Emotional Support, and 4) Active Listening. Succinctly defining what nurses do is important; therefore, nursing languages need to be unambiguous, contextual so they are accurately and consistently documented. Validating culturally safe nursing practices exist—and further ensuring they are represented in standardized nursing languages and terminology sets and thus coded for use in an electronic health record (EHR)—ensures that culturally safe nursing care data is captured in the EHR. / Graduate

Magister Public Health - MPH / HIV/AIDS is the largest and most serious global epidemic in the recent times. To date, the epidemic has affected approximately 40 million people (range 33 - 46 million) of whom 67%, that is, an estimated 27 million people are in the Sub Saharan Africa. The Sub Saharan Africa is also reported to have the highest regional prevalence of 7.2% compared to an average of 2% in other regions. A medical cure for HIV/AIDS remains elusive but use of antiretroviral therapy (ART) has resulted in improvement of quality and quantity of life as evidenced by the reduction of mortality and morbidity associated with the infection, hence longer and good quality life for HIV/AIDS patients on ART. / South Africa

Magister Public Health - MPH / Background: The Provincial Government Western Cape (PGWC) Department of Health identified a lack of data on inpatient diagnoses and procedures in a form suitable to use for operational, strategic as well as financial health care planning. The only format in which diagnostic and procedure data was available was a paper based one encompassing individual patient notes in folders and discharge summaries. Making the data available in a coded format within an electronic database would facilitate storage, analysis and utilisation of that data for health service planning. Recognising the lack of availability of such coded data, this study was undertaken to evaluate different coding systems for their ability to code data in order to assist in deciding which coding systems best fit the need to facilitate easy and accurate recording of data on diagnoses and procedures from patient records. The identification of the most appropriate coding system for the context in which the PGWC Department of health functions should facilitate the easy recording, storage and retrieval of data that is accurate, reliable and useful for management decision making and would support optimal patient care. Aim: The aim of the study was to evaluate a selection of potentially suitable coding systems in order to determine which would be best able to code public sector district and regional hospital diagnostic and procedure data in the Western Cape Province. Method: A cross sectional analytical study design was used. Discharge diagnosis and procedure data were extracted from 342 patient folders from 3 district and 3 regional public hospitals in the Western Cape. This yielded 221 different diagnostic concepts and 126 different procedure concepts. The diagnostic concepts were further grouped into “all” diagnostic concepts recorded, diagnostic concepts recorded as “symptoms only” and diagnostic concepts recorded as “proper diagnoses”. The diagnostic coding systems evaluated were ICD-10 (International Classification of Diseases), ICPC-2 (International Classification of Primary Care 2nd edition) and ICD-10 Condensed Morbidity List. The procedure coding systems evaluated were CCSA-2001 (Current Procedure Terminology for South Africa) ICD-9-CM (International Classification of Diseases Clinical Modification 9th revision) and ICPC-2. The diagnoses and procedures were then coded in all of the coding systems being evaluated. Each diagnosis and procedure concept was matched with its representing concept in the coding system and scored according to the ability of the coding system to provide an “exact” match which was scored as (3) or a “partial” match scored as (2) or a “poor” match scored as (1) or “no” match scored as (0). Results: ICD-10 was better able to code diagnoses obtained from district and regional hospitals in the Western Cape compared to ICPC-2 and ICD-10 Condensed Morbidity list. For all recorded diagnostic concepts, ICD-10 was able to score 82% of the concepts as either an “exact” or a “partial” match compared to 79% in ICPC-2 and 30% in ICD-10-CL. ICD-10 consistently performed best across different stratification of diagnostic concepts namely concepts recorded as “proper diagnoses”, concepts recorded from regional hospitals only, concepts recorded from district hospitals only, concepts designated as “common diagnoses” and for concepts designated as “very common diagnoses”. In addition ICD-10 had zero diagnostic concepts for which “no match” could be found. CCSA -2001 proved to be the best coding system for coding procedures across all hospitals with an overall percentage of “exact” and “partial” matches of 83% compared to 65% for ICD-9-CM and 39% for ICPC-2 and also proved to be best across all strata. Conclusion: There were striking differences between the evaluated coding systems with regard to their ability to code diagnoses and procedures in the evaluated district and regional hospitals in the Western Cape Province. ICD-10 covers the scope of clinical diagnoses in more accurate and specific detail than ICPC-2 and ICD-10 CL. Though ICPC-2 is simpler and easier to use than ICD-10, it is not as detailed and specific as the latter but it proved ideal for symptoms rather than for specific diagnoses. ICD-10 Condensed Morbidity List was shown to be inadequate for coding diagnoses. However the difference between the two, although statistically significant were not very large and given the ease of use of ICPC-2, it could be recommended for use. As for procedures CCSA-2001 was assessed as being the most appropriate for coding procedures recorded in this setting compared to the other coding systems. ICPC-2 performed poorest for coding procedures across all evaluated settings and thus would be inappropriate to use. ICD-10 in most comparisons performed second best to ICPC-2 in terms of coding ability for diagnoses and could be considered for recommendation as a diagnostic coding tool.

Magister Public Health - MPH / Ensuring that routine health information systems provide good quality information for informed decision making and planning in health systems remain a major priority in several countries and health systems. The lack of use of health information or use of poor quality data in health care and systems results in inadequate assessments and evaluation of health care and result in weak and poorly functioning health systems. The Nigerian health system like in many developing countries has challenges with the building blocks of the health system with a weak Health Information System. Although the quality of data in the Nigerian routine health information system has been deemed poor in some reports and studies, there is little research based evidence of the current state of data quality in the country as well as factors that may influence data quality in routine health information systems. This study explored the data quality of routine health information generated from health facilities in Oyo State, Nigeria, providing the state of data quality of the routine health information. This study was a cross sectional descriptive study taking a retrospective look at paper based and electronic data records in the National Health Management Information System in Nigeria. A mixed methodology approaches with quantitative to assess the quality of data within the health information system and qualitative methods to identify factors influencing the quality of health information at the health facilities in the district. Assessment of the quality of information was done using a structured evaluation tool looking at completeness, accuracy and consistency of routine health statistics generated at these health facilities. A multistage sampling method was used in the quantitative component of the research. For the qualitative component of the research, purposive sampling was done to select respondents from each health facility to describe the factors influencing data quality. The study found incomplete and inaccurate data in facility paper summaries as well as in the electronic databases storing aggregate information from the facility data.

A novel, interactive Android app has been developed that monitors the health of type 2 diabetic patients in real-time, providing patients and their physicians with real-time feedback on all relevant parameters of diabetes. The app includes modules for recording carbohydrate intake and blood glucose; for reminding patients about the need to take medications on schedule; and for tracking physical activity, using movement data via Bluetooth from a pair of wearable insole devices. Two machine learning models were developed to detect seven physical activities: sitting, standing, walking, running, stair ascent, stair descent and use of elliptical trainers. The SVM and decision tree models produced an average accuracy of 85% for these seven activities. The decision tree model is implemented in an app that classifies human activity in real-time.

Ensuring the objectivity of systematic reviews and meta-analyses (SRMA) begins with comprehensive searches into diverse resources mining primary studies. Guidelines for systematic reviews recommend authors to routinely search of trial registries to identify unpublished studies. In this dissertation, I investigated the utilization of ClinicalTrials.gov (CTG), the world’s largest clinical trial registry that contains data from clinical trials of products that are subject to United States Food and Drug Administration (FDA) regulation, as an information resource in SRMAs. First, I examined the use of various information resources including CTG in SRMAs published from 2005-2016, and identified the factors associated with their use. Thereafter, to determine the accuracy of trial safety data reported at CTG, I compared the data at CTG with that in corresponding journal articles and FDA drug reviews. I found that trial safety data at both CTG and articles differed frequently from FDA drug reviews, but the differences were modest in magnitude. Finally, I repeated published meta-analysis (conducted using data from primary study articles) with data at CTG to find that most meta-analysis results were reproduced using CTG data. Taken together, this work suggests that CTG should not only be searched more often to find primary research for systematic reviews, but that data at CTG can also be used to conduct quantitative data synthesis.