Magister Public Health - MPH / Background: Adherence of patients on antiretroviral therapy to lifelong treatment is a major challenge within the public health system in Namibia. Missed appointments have been shown to contribute to poor clinical outcomes and treatment failure, which may necessitate switching to more expensive antiretroviral regimens. In resource limited settings monitoring of appointments for antiretroviral medication pick up is a documented and feasible method for assessing minimum levels of adherence to antiretroviral medication. Aim: This study was aimed at evaluating the effects of telephonic short message service reminders influence on adherence to scheduled antiretroviral medication pick up appointments. It was also aimed at evaluating how socio-demographic parameters might moderate the effectiveness of short message service reminders. Study design: A randomized double blind controlled study design was employed. Methodology: Stable patients attending the ART clinic were recruited and randomly assigned to either an intervention or control group, until the sample size of 398 was reached in the two arms of the study. The study populations were adult patients’ ≥ 18 years who have been enrolled on treatment for ≥ 3months. The intervention group received an unasked for single short message service reminder, sent 48 hours before their scheduled appointments and continued with standard care, while the control group received standard care without any reminder. The study participants were blinded to their study group. Also, research assistants involved in collecting baseline and outcome data were blinded to study participants study group. Baseline data was collected through a structured questionnaire. Study participants were followed up for four consecutive scheduled ARV pick up appointments. The following outcome data were collected at each follow up visit; number of days late after scheduled appointment, adherence measured by pill count and 3 days self-report recall of adherence. Main results: The pre-intervention survey revealed that only 60% of the study participants were willing to be reminded of their medication pick up appointment. Overall, the SMS reminder improved adherence to medication pick up appointments by 1.6 times as compared to no reminder and also reduced the risk of missing medication pick appointments by 22% as compared to no SMS reminder. Study participants that received a reminder were also two times more likely to achieve optimal adherence to their medication, compared to those who received no reminder. The SMS reminder improved adherence to antiretroviral medication by 11% in this study, while the mean difference in the number of days late to collect antiretroviral medication was significantly reduced by about 4 days by the intervention. Participants that are employed were more likely to adhere to antiretroviral medications as compared to the unemployed. Ironically participants that were on ART for less than one year and those that had treatment supporters reminding them of their medication appointments were significantly less likely to honour their medication pick up appointments. Conclusion: Being employed was significantly associated with attaining optimal adherence to antiretroviral medication. There were no other significant associations between the patients socio- economic and demographic characteristics and adherence to scheduled medication pick up appointments, or to adherence to medication. Recommendations: The Ministry of Health and Social Services should consider rolling out SMS reminders to ART sites with similar settings as Swakopmund State Hospital ART Clinic. Patients that are willing to receive the reminder should be targeted in the scaling up of the roll out. Late and missed medication pick up appointments could be used as an easy proxy measurement for assessing adherence to ART.

Thesis advisor: James A. Russell / Theories in moral psychology propose a link between emotions and moral judgments. This dissertation presents a series of studies examining whether different discrete emotions are each linked to a different discrete moral content. Some of the studies tested a proposal called CAD: an acronym for the theory that contempt is linked to violations in the community domain (C), anger is linked to violations in the autonomy domain (A), and disgust is linked to violations in the divinity domain (D). Other studies further focused on the emotion disgust: Whether acts or issues that remind humans of their animal nature elicit disgust and whether the English concept of disgust refers to a single emotional experience pan-culturally. In most of the studies we recruited participants both from America and from India (N = 3893). The findings challenged any clean mappings between different discrete emotions and different contents of moral violations. Instead, moral violations were associated with a range of negative emotions rather than with a specific one. There was no support for the hypothesis that acts or issues that remind us of our animal nature elicit disgust, and the English concept disgust, as referring to unclean substances and moral violations, is equivalent to similar concepts in two Indian languages. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Psychology.

The purpose of the study was to examine the effects of an external focus of attention on the learning of dart throwing at three different focus reminder frequencies (every two, every four and every ten trials). Twenty-four male and female subjects were randomly assigned to one of three groups. Subjects threw darts at a circular target 60 times over two days while getting a reminder of their intended external focus at the three different reminder frequencies. Five-day delayed retention and transfer tests were conducted to assess learning, each consisting of five trials. The target was comprised of five concentric circles, with the center zone worth five points and the outer-most zone worth one point. Target scores were used for statistical analysis. Findings show that the groups given a reminder after every fourth and tenth trial perform better during acquisition (F=13.61; p<0.001). Furthermore, the group that received a reminder after every tenth trial performed the best during the retention test. Although, the high variability within groups may have prevented more significant differences between reminder frequency groups in the retention and transfer test results, it is evident that less-frequent reminders result in better performance and learning of dart throwing.

Objective: High Risk Reminder (HRR) system is the lately mobile application technology developed by Taipei Medical University of Medical Informatics Research Institute. The objective of HRR is to provide high risk patient test results such as lab, radiology, pathology to physician immediately by mobile short message and internet e-mail. The mobile short message is to provide abstract information to physician such as patient name, inpatient bed ward number, the abcdrmal test result. The physician can receive the latest patient’s abcdrmal test information at any place, time. Therefore, the physician can take intervention treatment as soon as possible for patient treatment. Moreover, the physician wants to know more detail the high risk patient’s information can open the e-mail to review the patient’s profile in order to provide treatment plan. The purpose of using the mobile and internet technology is to improve patient safety. The WF Teaching Hospital has using the HRR system to serve its patient and physician for 6 months. There are more than 600 mobile short messages and e-mail communication for physicians. To reach the patient safety goals is the critical mission of WF Hospital. Therefore, the evaluation of HRR patient safety contribution needs to analyze.。This study is introducing HRR system functions and evaluating HRR’s contribution.。This research is based on the empirical study. We investigate the HRR’s impaction to assist high risk patient severe test result information communication for physician to assist patient’s treatment for physician and hospital. Meanwhile, the two mobile short message and e-mail communication media which one is more effective for physician is analyzed also. Design: This study measures dimensions of information quality, system quality, use, user satisfaction, individual impact and organizational impact based on the D&M IS Success Model. Multivariate techniques were used to evaluate the relationships of the Model. Measurements: The dimensionality of each scale and degree of association of each item with the attribute of interest were determined by principal components factor analysis with orthogonal varimax rotation. The reliability of each resultant scale was computed using Cronbach’s alpha coefficient. Construct validity was examined through factor analysis and by correlation analyses. Multiple regression techniques were used to evaluate the relationship between the set of six dimensions and comparison of PHS and e-mail. Results: Physicians have using the HRR systems are the surveyors composed of this survey samples. There are 56 questionnaires had been distributed the physicians. Seven questionnaires are invalid due to rarely using the HRR system. The valid questionnaires are 85%。Of the respondents, 93% were male; 73% were undergraduate; 90% were primary physicians.。 From the research finding , the two communication medias of short message, and e-mail are positive relationships for effective and efficiency communication for physicians to assist high risk patient severe test result information delivery. The research two constructs of PHS and e-mails’ indicators are positive for improving better communication; The information quality for user’s effectiveness, satisfaction relationship impacts for users and organization. Comparison effective communication between PHS and e-mail media, the research finding is PHS is more powerful than e-mail to deliver information for physician. From regression analysis, each □ value of PHS is higher than e-mail. The individual using PHS and e-mail is positive to effect the hospital to diffuse of HRR system. Conclusion: The survey of user’s satisfaction of using the HRR system is reached over 70%. However, 60 % of physicians indicates the HRRS provides efficiency and effectiveness each high risk patient’s information causing the information overload. This is the drawback of the implementation HRR system. How to decrease the information overload pressure needs to solve in the near future to improve HRR system. Furthermore, utilization mobile technology to provide two channel communication for physician to access the patient‘s database treatment, test, medication information to integrate all required information to develop the well treatment plan to improve patient safety and reduce patient risk.

Wearable computing has been in existence as part of our attire for many years, a few examples being the watches, cell phones and MP3 players. Recently, many researchers have been devising ways to incorporate wearable devices seamlessly into our lives with the goal of making them an indispensable part of our daily routines. In this thesis, a new wearable computing device called WARM (Wearable Assistant for Remote Monitoring) for use by the elderly and the handicapped is proposed and its software architecture is defined and described. The physically challenged or the elderly, living on their own, but who require assistance with daily tasks, could retain some of their independence with the use of device like WARM. The software architecture of this proposed device is being designed so that the level and types of assistance necessary will be customized based on the user's needs and their family members can remotely monitor them and be alerted to any issues. In order to maintain extensibility and scalability, a table driven approach is used. The information for reminders is entered through the web-based front end portion of the application which is then written out to relational database tables using stored procedures. The synchronization program, which runs on the user's PC, also uses a series of stored procedure calls to determine while a reminder is to be sent, when contacts should be alerted and finally moves the cleared reminders to the log table for future reporting. The architecture of the proposed WARM device, its salient features, the software interface, the simulation set up and the results are presented.

In this research we present a model for medication adherence from information systems and technologies (IS/IT) perspective. Information technology applications for healthcare have the potential to improve cost-effectiveness, quality and accessibility of healthcare. To date, measurement of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice. IS/IT perspective helps in leveraging the technology advancements to develop a health IT system for effectively measuring medication adherence and administering interventions. Majority of medication adherence studies have focused on average medication adherence. Average medication adherence is the ratio of the number of doses consumed and the number of doses prescribed. It does not matter in which order or pattern patients consume the dose. Patients with enormously diverse dosing behavior can achieve the same average levels of medication adher­ence. The same outcomes with different levels of ad­herence raise the possibility that patterns of adherence affect the effectiveness of medication adherence. We propose that medication adherence research should utilize effective medication adherence (EMA), derived by including both the pattern and average medication adherence for a patient. Using design science research (DSR) approach we have developed a model as an artifact for smart interventions. We have leveraged behavior change techniques (BCTs) based on the behavior change theories to design smart intervention. Because of the need for real time requirements for the system, we are also focusing on hierarchical control system theory and reference model architecture (RMA). The benefit of using this design is to enable an intervention to be administered dynamically on a need basis. A key distinction from existing systems is that the developed model leverages probabilistic measure instead of static schedule. We have evaluated and validated the model using formal proofs and by domain experts. The research adds to the IS knowledge base by providing the theory based smart interventions leveraging BCTs and RMA for improving the medication adherence. It introduces EMA as a measurement of medication adherence to healthcare systems. Smart interventions based on EMA will further lead to reducing the healthcare cost by improving prescription outcomes.

Context: Sensor base data is being used for many purposes in designing various memory aid systems for cognitive impaired people. Different memory aids or reminder systems are based on various technologies such as NFC, accelerometer, GPS and gyroscope. Smart phones are equipped with such sensors and can be used for assistance of persons. In this study we use smart phone sensors in order to design a context aware reminder system to assist cognitive impaired people. Objectives: Different reminder systems, needs for such systems, technologies and models used to build a reminder system are identified in this research work. Ultimate goal of the study is to assist cognitive people in their daily life activities, using available embedded technologies of smart phones. Following objectives were set to achieve the goal of the thesis work: • What are reminder systems and why do we need such systems? • What are the different kinds of technologies reported in literature for reminder systems? • What are the issues encountered by cognitive impaired/elderly people while performing their daily life activities? • How to design and implement context aware reminder system using Smartphone embedded sensors? Methods: Mix method approach is used to carry out this study. Literature review is conducted based on the notion of systematic review. Data is collected through survey and interviews, conducted in south Sweden municipality, to analyze and indentify daily life issues and problems of cognitive people. Experiments are performed in real environment to test and verify our application. We evaluate the performance of activity recognition algorithm, implemented in the application, using Weka. Results: Various reminder systems, their needs and underlined technologies are identified and reported. Activities of daily living and issues addressed by these reminder systems are also identified. Survey and interviews help us to identify issues and problems faced by cognitive impaired/elderly while performing their daily life activities. For example, we find out that cognitive people not only forget their daily life activities but also during performing these activities. Conclusions: Many proposed models in literature are related to each other and use similar sensor based data from various technologies. Based on literature review, survey and interviews we have concluded that context based reminder system is essential for cognitive disabled people. It leads us to design a context based reminder system for android based smart phones. The preliminary tests help us to verify our model but there is absolute need for further empirical verification and validation.

Health care providers face large costs in terms of operating rooms not being utilized due to patients (1) not canceling enough in advance to allow a different patient to be scheduled or (2) not being in a good enough condition to be operated on due to failure to follow preoperative instructions properly. This degree project aims to see if SMS text reminders can be used to lower the number of surgeries canceled in this manner. Patients of the surgical-, urological- and orthodontic clinics at a hospital in Stockholm were placed into one of three groups; (1) a group that did not receive a text message reminder, (2) a group that received a "short" reminder, (3) and a group that received a "long" reminder. A survey was also conducted to determine what the patients thought of the reminders and whether they believed it influenced them or not. The study suggests that reminders do not work as a method to decrease the short notice cancellation rate as it may not be a poor memory that causes the patient to cancel. Instead, anxiety might have a greater impact than expected. Further studies should be conducted in order to confirm this hypothesis. / Sjukvårdsgivare möts av stora kostnader då operationssalar inte används på grund av att patienter (1) inte avbokar i tid för att tillåta att en annan patient tar deras platser eller (2) inte är i tillräckligt bra tillstånd för att bli opererad på grund av ett misslyckande att följa de preoperativa instruktionerna ordentligt. Detta examensarbete har som mål att undersöka om SMS-påminnelser kan användas för att minska antalet operationer som avbokas på detta vis. Patienter från de kirurgiska-, urologiska och ortopediska klinikerna på ett sjukhus i Stockholm placerades i en av tre grupper; (1) en grupp som inte mottog SMS-påminnelser, (2) en grupp som mottog en ”kort påminnelse”, (3) och en grupp som mottog en ”lång” påminnelse. En enkätstudie utfördes för att kunna avgöra om patienter ansåg att påminnelserna påverkade dem eller inte. Studien antyder att påminnelser inte fungerar som ett sätt att minska antalet avbokningar med kort varsel eftersom det avbokningar eventuellt inte beror på minnet. Istället är det möjligt att ångest har en större påverkan än förväntat. Fler studier borde utföras för att kunna bekräfta denna hypotes.

With the rapid development of technology for context awareness, pervasive computing is releasing people from their traditional desktops. Since mobile devices feature portability and are (nearly) always connected, people tend to carry them wherever they go. Hence, devices such as cellular phones and Pocket PCs are the most suitable platforms for developing context aware applications which users will utilize in their daily life. For these context aware systems, using this context information not only improves the user experience of ubiquitous computing, but also lets the system know who you are or what you have. More importantly, the device can know where you are and predict what you might like to do, thus simplifying many of the user’s interactions with devices and other people around them. This thesis project involves the design, implementation and evaluation of a context aware application, based upon a Pocket PC, that can remind the user of tasks when the user approaches the relevant location for this task. The application interacts with a context aware infrastructure by using the SIP for Instant Messaging and Presence Leveraging Extensions (SIMPLE) protocol, receives context information for the user described using XML. A number of new tags, based upon a new XML schema, have been introduced for this task. This context aware mechanism enables the user to receive any form of information updated by the context server. In this thesis, updates to this information are driven by changes in the user’s location. Additionally, by using the existing calendar application on the Pocket PC, the user can experience location based reminders without learning how to use a new user interface. / Med den snabba utvecklingen av kontextmedvetna teknologier befriar den genomträngande datoriseringen människor från deras traditionella datorer. Eftersom mobila apparater medför bärbarhet och är (nästan) alltid uppkopplade, tenderar människor att bära dem överallt. Följaktligen blir apparater som mobiltelefoner och Pocket-PC de mest passande plattformarna för utvecklandet avkontextmedvetna applikationer för daglig användning. För dessa kontextmedvetna system kommer inte bara användandet av kontexinformation förbättra användarens upplevelse av överallt förekommande datorisering, utan låter även systemet veta vem du är eller vad du har. ännu viktigare är att apparaten kan veta var du befinner dig samt förutsäga vad du skulle kunna vilja göra, och därigenom förenkla mycket av användarens interaktion med andra apparater och människor i omgivningen. Detta examensarbetsprojekt involverar designen, implementationen och evalueringen av en kontextmedvetet applikation, baserad på en Pocket-PC, som kan påminna användaren om uppgifter när användaren närmar sig det relevanta området för dessa uppgifter. Applikationen interagerar med en kontextmedveten infrastruktur genom användandet av protokollet “SIP for Instant Messaging and Presence Leveraging Extensions (SIMPLE)”, mottas kontextinformation för användaren beskriven i XML-format. Ett antal nya taggar, baserade på en ny XML-schema, har introducerats för denna uppgift. Denna kontextmedvetna mekanism gör det möjligt för användaren att ta emot alla typer av uppdaterad information från kontextservern. I denna avhandling uppdateras denna information genom att användaren förflyttar sig. Dessutom kan användaren, genom att använda den befintliga kalenderapplikationen i Pocket-PC:n, få lägesbaserade påminnelser skickade till sig utan att behöva lära sig använda ännu ett interface.

Hypothetical bias continues to be a challenge for practitioners of the contingent valuation method (CVM). This study compared the effect of three hypothetical bias mitigation techniques in a CVM survey focused on estimating maximum willingness to pay for a beach conditions monitoring service among U.S. Gulf Coast beachgoers. Beach conditions information is known to affect beach patronage but no valuation study has yet estimated its value. The two techniques tested are: budget and substitutes cheap talk treatments and certainty follow-up. We presented a theoretically consistent model of budget-constrained utility maximization which accounts for the respondents’ subjective probability of a good beach trip with and without the beach conditions information. Interval regression was used to estimate respondents WTP for beach conditions monitoring service. Both mitigation treatments were unable to mitigate HB. The mean WTP was $3.39 and the net benefit for the program was between $188,531,063 and $391,474,452.