Background: Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. Objective: This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. Methods: To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ≥65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. Results: We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors’ accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. Conclusions: Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website—Support for Older Adults to Stay Independent at Home (SUSTAIN)—will be implemented and made available to better assist older adults and caregivers in staying independent at home.

Community health workers (CHWs) are key players in providing primary healthcare in low- and middle-income countries. However, their absence from the formal health system in many of these countries often presents a challenge to their remuneration. The objective of this scoping review is to document programs implemented at both small and large scales in low- and middle-income countries, the remuneration strategies they have established, and the effects of these strategies on the work of CHWs. In total, we included 50 articles in this review. We have identified four types of compensation: fixed compensation, performance-based compensation, compensation based on income-generating activities (IGAs), and combined compensation. We identified the strengths and weaknesses of each type of compensation. A common strength for most models was improvement in motivation and performance. A common weakness for most models was irregular payments. The results of this review highlight the need to consider the economic, social, and cultural settings of the countries or environments at hand, and to include CHWs in discussions regarding the selection of a compensation model.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Nurses provide maternity care and thus play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision making (SDM) training program for health professionals focusing on Down syndrome screening decisions. Objective: We assessed the impact of a SDM training program on nurses’ intention to use a decision aid with pregnant women deciding about prenatal screening for Down syndrome. Methods: In this 2-arm parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited online by a private survey firm. They were allocated by convenience either to the intervention group (web-based SDM course that included prenatal screening) or to the control group (web-based course focusing on prenatal screening alone, with no SDM content). The primary outcome was intention to use a decision aid. Secondary outcomes were psychosocial variables of intention (e.g. social influence), as well as knowledge, satisfaction, acceptability, perceived usefulness and reaction to the pedagogical approach. All outcomes were self-assessed through online questionnaires including space for written comments. No blinding was performed. We used Student's t test and Fisher's exact test to compare continuous and categorical variables between groups. Results: Of 57 participants assessed for eligibility, 40 were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the courses. Mean age of participants was 41 years (SD 9). Most were women (97.5%), Caucasian (95%), clinical nurses (70%), and had completed a baccalaureate degree (65%). Post-intervention, the mean score of intention was 6.3 (95% CI: 5.9; 6.7) for the intervention group and 6.0 (5.42; 6.64) for the control group (scale 1 to 7). The difference in intention and other psychosocial variable scores between groups was not statistically significant. Knowledge scores about SDM were significantly higher in the intervention group (79% [70; 89] versus 64% [57; 71], p=0.009). The intervention was significantly more acceptable in the intervention group (4.6 [4.4; 4.8] versus 4.3 [4.1; 4.5]; p=0.02) and reaction to the pedagogical approach was also significantly more positive in the intervention group (4.7 [4.5; 48]) versus 4.4 [4.2; 4.5], p=0.02). There was no significant difference in overall satisfaction (4.5 [4.01; 4.9] versus 4.2 [4.05; 4.4], or in perceived usefulness (4.6 [4.4; 4.8] versus 4.4 [4.2; 4.6]). Seventeen participants (9 in the intervention group and 8 in the control group) provided feedback on the intervention. Conclusions: This study focuses on web-based nursing education and its potential for supporting pregnant women's decision-making needs. It showed that nurses’ intention to use a decision aid to enhance shared decision making in prenatal care is high, with training or without, but that their knowledge about shared decision making can be improved with web-based training. Clinical Trial: ClinicalTrials.gov NCT04162288; https://clinicaltrials.gov/ct2/show/NCT04162288?term=NCT04162288&draw=2&rank=1

Background: Our team has developed a decision aid to help pregnant women and their partners make informed decisions about Down syndrome prenatal screening. However, the decision aid is not yet widely available in Quebec’s prenatal care pathways. Objective: We sought to identify knowledge translation strategies and develop an implementation plan to promote the use of the decision aid in prenatal care services in Quebec, Canada. Methods: Guided by the Knowledge-to-Action Framework and the Theoretical Domains Framework, we performed a synthesis of our research (11 publications) on prenatal screening in Quebec and on the decision aid. Two authors independently reviewed the 11 articles, extracted information, and mapped it onto the Knowledge-to-Action framework. Using participatory action research methods, we then recruited pregnant women, health professionals, managers of three prenatal care services, and researchers to (a) identify the different clinical pathways followed by pregnant women and (b) select knowledge translation strategies for a clinical implementation plan. Then, based on all the information gathered, the authors established a consensus on strategies to include in the plan. Results: Our knowledge synthesis showed that pregnant women and their partners are not sufficiently involved in the decision-making process about prenatal screening and that there are numerous barriers and facilitators of the use of the decision aid in clinical practice (e.g., low intention to use it among health providers). Using a participatory action approach, we met with five pregnant women, three managers, and six health professionals. They informed us about three of Quebec’s prenatal care pathways and helped us identify 20 knowledge translation strategies (e.g., nurse discusses decision aid with women before they meet the doctor) to include in a clinical implementation plan. The research team reached a consensus about the clinical plan and also about broader organizational strategies, such as training healthcare providers in the use of the decision aid, monitoring its impact (e.g., measure decisional conflict) and sustaining its use (e.g., engage key stakeholders in the implementation process). Conclusion: Next steps are to pilot our implementation plan while further identifying global strategies that target institutional, policy, and systemic supports for implementation.

Background: Pregnant women often find it difficult to choose from among the wide variety of available prenatal screening options. To help pregnant women and their partners make informed decisions based on their values, needs, and preferences, a decision aid and a web-based shared decision making (SDM) training program for health professionals have been developed. In Canada, nurses provide maternity care and thus can train as decision coaches for prenatal screening. However, there is a knowledge gap about the effectiveness of SDM interventions in maternity care in nursing practice.Objective: This study aims to assess the impact of an SDM training program on nurses’ intentions to use a decision aid for prenatal screening and on their knowledge and to assess their overall impressions of the training.Methods: This is a 2-arm parallel randomized trial. French-speaking nurses working with pregnant women in the province of Quebec were recruited online by a private survey firm. They were randomly allocated (1:1 ratio) to either an experimental group, which completed a web-based SDM training program that included prenatal screening, or a control group, which completed a web-based training program focusing on prenatal screening alone. The experimental intervention consisted of a 3-hour web-based training hosted on the Université Laval platform with 4 modules: (1) SDM; (2) Down syndrome prenatal screening; (3) decision aids; and (4) communication between health care professionals and the patient. For the control group, the topic of SDM in Module 1 was replaced with “Context and history of prenatal screening,” and the topic of decision aids in Module 3 was replaced with “Consent in prenatal screening.” Participants completed a self-administered sociodemographic questionnaire with close-ended questions. We also assessed the participants' (1) intention to use a decision aid in prenatal screening clinical practice, (2) knowledge, (3) satisfaction with the training, (4) acceptability, and (5) perceived usefulness of the training. The randomization was done using a predetermined sequence and included 40 nurses. Participants and researchers were blinded. Intention to use a decision aid will be assessed by a t test. Bivariate and multivariate analysis will be performed to assess knowledge and overall impressions of the training.Results: This study was funded in 2017 and approved by Genome Canada. Data were collected from September 2019 to late January 2020. This paper was initially submitted before data analysis began. Results are expected to be published in winter 2020.Conclusions: Study results will inform us on the impact of an SDM training program on nurses’ intention to use and knowledge of decision aids for prenatal screening and their overall impressions of the training. Participant feedback will also inform an upgrade of the program, if needed.Trial Registration: ClinicalTrials.gov NCT04162288; https://clinicaltrials.gov/ct2/show/NCT04162288International Registered Report Identifier (IRRID): DERR1-10.2196/17878

Background: There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population’s context. Objective: This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. Methods: This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. Results: Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. Conclusions: Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. Trial Registration: The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq International Registered Report Identifier (IRRID): DERR1-10.2196/37853