Hu Z, Qin LL, Xu HL. We will use multiple imputation to handle missing data. For the evaluation purposes, we will be recruiting 100 randomly selected residents aged 40 and over from each of 26 barangays (communities). Though we combined many elements to fit the program to the setting, there are still some limitations that warrant consideration. Springer Nature. JAMA. Zamboanga Peninsula was chosen as the program site for this initiative because it exemplifies underprivileged regions in many LMICs in terms of geographical isolation, poverty, and scarce health resources where low-cost, community-owned health programs – such as CHAP-P – are urgently needed. The Philippines is a culturally and historically diverse archipelago consisting of a cluster of over 7,000 islands in the Southeast Pacific Rim. Diabetes Res Clin Pract. Focus group discussions will be held at 6 months for study participants, BHWs, and other LLO staff using a standardized focus group guide consisting of open-ended questions primarily focused on identifying the barriers and facilitators to implementing CHAP-P. Further sources of data include monthly community reports from the communities, monthly observational checklists by research assistants, and record review of the CHAP-P session databases and Rural Health Unit databases. BMC Public Health 19, 682 (2019). The Philippine Health Agenda 2016 to 2022. The remainder of the work force go on to seek out other professional career opportunities outside the country. 2015;11:93–107. It considers original articles written for, but not limited to, Filipino nurses at all levels of health care organizations and in various settings. 1990;16:199–208. A community cluster design was chosen as CHAP-P is intended as a community-level intervention. 2008;46:537–44. Journal of Community Health Nursing. This study is a 26-community parallel open-label cluster randomized controlled trial. of the Philippine Nurses Association. The WatchBP Office Target will be used to measure blood pressure as it was found to show the most reliable results based on our pilot study [27]. 2013;25:92–101. This required a sample size of 520 per arm. Gaziano C. Last-birthday selection. Communities will be selected and randomized by the local program manager. The Philippines has begun implementation of the World Health Organization Package of Essential Noncommunicable Disease Interventions for primary care settings in low resource areas [7], created the National Centre for Disease Prevention and Control in 2000 including a diabetes-specific office, and has listed reduction of mortality and morbidity from lifestyle-related diseases such as diabetes as one of the goals in the “National Objectives for Health 2005-2010” [8]. See Table 2 for the statistical analysis plan. ; Filipino Nurses Association. Allocation will be done by computer generated randomization. It catapulted community health nursing to the center of emergency response plans that would provide mass prophylaxis and contain and manage biochemical threats. It is estimated that 45.8% of individuals with diabetes are undiagnosed, with 83.8% of those undiagnosed being from LMICs [2]. SPIRIT 2013 statement: defining standard protocol items for clinical trials. H Index. Department of Health (DOH): What is barangay health worker? Narayan KM, Chan J, Mohan V. Early identification of type 2 diabetes: policy should be aligned with health systems strengthening. BMC Public Health CAS  Brooks R. EuroQol: the current state of play. 2009;42:377–81. The primary aim of this RCT is to determine the effects of the CHAP-P intervention on HbA1c levels among a random sample of community residents 40 years of age and older, compared to a random sample of community residents in control communities under usual care. The Philippines is estimated to have over 6 million people with diabetes by the year 2035 [1]. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? Community health nurses, especially those in public health settings, are now considered first responders—a role that traditionally belonged to law enforcement and emergency response professionals. Three participant groups will be involved: 1) Random sample of community participants aged 40 or older, 100 per community (1300 control, 1300 intervention participants total); 2) Community members aged 40 years or older who attended at least one CHAP-P session; 3) Community health workers and staff facilitating sessions. The authors would like to thank the entire project team for their contributions to this research program, including staff and stakeholders in the Philippines and Canada, and the members of our international Project Advisory Group (including 5 primary investigators, 6 Canadian co-investigators or advisors, 5 Filipino co-investigators, a GACD representative, Canadian and Filipino research staff, and 4 other advisors from Tunisia, Thailand, and Peru). Health care in the Philippines has been defined by the WHO as "fragmented", meaning there's a large gap between the quality and quantity of health services for the poor and the rich. Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The PRECIS-2 tool: designing trials that are fit for purpose. Questionnaires will be completed on paper and later entered into a REDCap [26] database by trained research staff. California Privacy Statement, As of 2013, an estimated 382 million people are living with type 2 diabetes globally, with the large majority of these individuals living in low- to middle-income countries (LMICs) [1]. Grand Challenges Canada/grand Défis Canada: Integrated innovation. In the home setting, clients have more control over their behaviors in relation to the plan of care; they choose whether or not to follow special diets, exercise regimens, or medication schedules. PubMed  Later, this journal was changed to The Philippine Journal of Nursing. : Republic of the Philippines Department of Health (DOH). However, there are currently some gaps in the areas of detection and treatment for diabetes. Diabetes Care. Article  Reporting will follow the CONSORT 2010 statement: extension for cluster randomized trials [19]; reporting of this protocol follows the SPIRIT 2013 checklist [20], see Additional file 5. HEALTH FINANCING The health financing system in the country is complex as it involves different layers of financial sources, regulatory bodies and health service providers. All authors read and approved the final manuscript. 2017;19(9):899–903. Clin Chem. Package of essential noncommunicable (PEN) disease interventions for primary health Care in low-resource Settings. HbA1c testing will be conducted at baseline and 6 months, following the community survey at each time point. The Community Health Assessment Program for the Philippines (CHAP-P) was based on a formal partnership between universities in the Philippines (Ateneo de Zamboanga University School of Medicine) and Canada (McMaster University Department of Family Medicine) with guidance from a Project Advisory Committee composed of collaborators and researchers from Canada, the Philippines, Peru, Thailand, Tunisia, and the UK. Hardin JW, Hilbe JM. Home Publications Conferences Register … Community survey participants will be interviewed in their homes by trained research staff at baseline and 6 months. Of all registered health practitioners, nurses are among the largest group, even though there are very few nursing positions or jobs available to them. GA, FC, RNA, DG, LD, and JK contributed to the development of the research design and methods. All results will be reported as estimates of effect, corresponding 95% confidence interval and associated p-values. The Philippine government allocated $3.2 billion to the health sector for 2020, which was a … List of issues Volume 37 2020 Volume 36 2019 Volume 35 2018 Volume 34 2017 Volume 33 2016 Volume 32 2015 Volume 31 2014 Volume 30 2013 Volume 29 2012 Volume 28 … These outcomes, whether they pertain to cluster or individual participant level, and their measures and sources are listed in Table 1. This survey was adapted from the measure used in the CP@clinic program in Canada [13] and includes questions from other validated questionnaires as well as physical measurements such as blood pressure, height, weight, and waist circumference. Google ScholarÂ. Study data will be anonymized. We will use Generalized Estimating Equations (GEE) to make comparisons between intervention and control communities, assuming an exchangeable correlation structure [31]. We have opted to take 26 (13 pairs of intervention: control) communities with 100 residents per community giving a total sample size of 2600 residents (1300 per arm). Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada, Gina Agarwal, Ricardo N. Angeles, Lisa Dolovich, Jessica Gaber & Dale Guenter, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada, Department of Family and Emergency Medicine, University of Montreal and CRCHUM, 850 Saint-Denis St, Montreal, Quebec, H2X 0A9, Canada, School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines, Ricardo N. Angeles, Floro Dave Arnuco, Rosemarie S. Arciaga, Jerome Barrera, Elgie Gregorio & Fortunato Cristobal, Institute of Health Policy and Development Studies, University of the Philippines Manila, One Adriatico Place Tower One, Adriatico Street Corner Pedro Gill Street, 1000, Manila, Philippines, Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada, Zamboanga City Health Office, Pettit Barracks, 7000, Zamboanga City, Philippines, Zamboanga Medical Research Foundation, Zamboanga City, Philippines, Graduate School, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines, Department of Health, Zamboanga Peninsula, 7000, Zamboanga City, Philippines, You can also search for this author in Pimentel GD, Portero-Mclellan KC, Oliveira EP, Spada APM, Oshiiwa M, Zemdegs JCS, Barbalho SM. Prev Med. With different reasons such as low budget, low number of man power, or general neglect for the poor, the Philippines has always been unable to keep up with the high standards of healthcare abroad. Campbell MK, Piaggio G, Elbourne DR, Altman DG, Group C. Consort 2010 statement: extension to cluster randomised trials. Cite this article. NVivo qualitative data analysis software 11 edition [Computer software]. Within selected households, individuals 40 years of age or older will be eligible to participate in the survey. The primary outcome is the mean difference in HbA1c at 6 months in a random sample of individuals from the random sample of individuals from the intervention barangays compared to the control barangays. Philippine Scenario In the past 20 years some infectious degenerative diseases are on the rise. “A diffused light has little power or impact. A community process evaluation will also be undertaken during the project in order to monitor the implementation of the CHAP-P intervention to assess for any problems or process issues during or after the implementation of the project. The Integrated Innovation approach will be combined with the knowledge-to-action process, which depicts the relationship between knowledge creation and action steps to promote the application of knowledge (in our case the generation of CHAP-P) and evaluation of the success of the actions taken [16]. Global estimates of diabetes prevalence for 2013 and projections for 2035. The CHAP has been successfully expanded to include a diabetes risk assessment component in the Community Health Awareness of Diabetes (CHAD) program and other community adaptations [12, 13]. Those BHWs and other LLO staff that consent to be part of the evaluation will be invited to participate in focus groups or key informant interviews, depending on their role and availability. (DOCX 165 kb), Consent Form – CHAP-P Session Participant. 2015;38:506–14. Email: philippinenursesassociation@yahoo.com.ph, CALL FOR PAPERS: PJN January-June 2021 Issue: Correspondence to GEE will allow us to model the correlation of outcomes within communities. Figure 1 shows the financing flows for health as to sources and uses. Type 2 diabetes is increasing globally, with the highest burden in low- to middle-income countries (LMICs) such as the Philippines. This multi-stage research project is culminating in a parallel cluster randomized controlled trial (RCT), the protocol of which is the focus of this paper. The data that is collected will only be made available for review by authorized persons including CHAP-P research team in the Philippines and Canada, institutional review boards, and transcriber of the focus groups. Zamboanga Peninsula is an Administrative Region of the Philippines on the island of Mindanao in the southern Philippines consisting of three provinces (Zamboanga del Norte, Zamboanga del Sur, and Zamboanga Sibugay) and two independent cities (Isabela and Zamboanga City). Long-term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance. Global diabetes scorecard: tracking Progress for action. Based on findings during the assessment, BHWs will educate the CHAP-P participants on diabetes, cardiovascular risk factors, and healthy lifestyles, providing educational materials that have been adapted for a local context (including materials such as pamphlets, comic strips, and videos). 1663 F.T. Finally, during the pilot studies there were some security concerns in the region that limited travel of the research team, so something similar may occur during the RCT implementation. International diabetes federation. This community survey will be completed at baseline and at 6 months and will use an open-cohort design. CDC Diabetes Cost-Effectiveness Study Group. The Philippine Journal of Nursing, an international peer reviewed journal, is the official publication of the Philippines Nurses Association published biannually. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. This study will help fill that gap. Kaczorowski J, Chambers LW, Dolovich L, Paterson JM, Karwalajtys T, Gierman T, Farrell B, McDonough B, Thabane L, Tu K, et al. The Philippine Journal of Nursing invites original research and scientific papers, full text or abstract, written by registered nurses on different areas of nursing practice, including but not limited to clinical , community, administration, and education. Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. “Nursing the World to Health through Research”, Evidence-Based Practices in Mentoring Student Nurses in Clinical Placement: A Meta-Analysis, Patients’ Experiences and Level of Satisfaction on the Care Rendered by Student Nurses, The Academic and Licensure Examination Performances of Bachelor of Science in Nursing Graduates in a State College, A Scoping Review on Factors Affecting the NCLEX-RN Performance of Internationally Educated Nurses, Validity and Reliability Testing of Indonesian version of ORTO-15: An Instrument for Orthorexia Nervosa Assessment, Factors Associated with Condom Use to Prevent HIV Infection: an Online Survey of Filipino Men who have Sex with Men, Factors Associated with Length of Stay in the Emergency Department: A Narrative Review, Fertility Desire and Associated Factors among HIV/AIDS Women with Antiretroviral Therapy in Yogyakarta, Indonesia, Accelerating Research Evidence Translation Through Dyadic Engagement: A Developing Model For Evidence-based Practice Implementation, Reflectivity or Reflexivity: Revealing their RealityÂ, Reflexivity on Qualitative Research Methodology as a Mode Of Inquiry. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. They will be recruited through convenience sampling with research team members inviting those who have been involved with the CHAP-P intervention. The cost-effectiveness of screening for type 2 diabetes. Results will also be published in relevant conference and journals to disseminate our findings to other researchers and policy makers planning to implement an out-of-the-box program for diabetes detection, management, and prevention. ClinicalTrials.gov (NCT03481335), registered March 29, 2018. Cookies policy. This study has the potential to improve diabetes detection, management, and prevention in the Philippines and similar LMICs. We are using paired randomization, therefore intervention and control community pairs need to have relatively similar sizes. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. RSA, RMA, JB, EG, SH, FDA, and NJ contributed to the contextualization of the research design and methods to the local setting. Graduates of BS in Nursing may pursue a career path in various hospital settings and community clinics. The community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic condition assessment, blood pressure monitoring, and health education. CHAP-P sessions will continue to be held twice a month in intervention communities, and residents will be encouraged to continue attending for ongoing follow-up and monitoring. Committee NS: the national glycohemoglobin standardization program: a five-year progress report. There are a number of secondary outcomes which will evaluate the mean differences between intervention and control groups at 6 months. Cost per QALY will be calculated as the cost-utility measure; QALYs will be computed based on local EQ-5D-5 L values. The Community Health Assessment Program in the Philippines (CHAP-P) diabetes health promotion program for low- to middle-income countries: study protocol for a cluster randomized controlled trial. The analysis of all outcomes to compare the groups will follow intention-to-treat principle. To improve penetration within the communities, we have decided to ensure the CHAP-P sessions rotate between puroks (a subdivision of a barangay) rather than having them in the same location week-by-week. Gillies CL, Lambert PC, Abrams KR, Sutton AJ, Cooper NJ, Hsu RT, Davies MJ, Khunti K. Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis. Primary Health Care (PHC) Herbal Medicine – Others. Developing effective interventions could improve detection, prevention, and treatment of diabetes. Related Posts. To maintain confidentiality, data will be de-identified prior to analysis. 1998;280:1757–63. Finally, the health economics component of this study will provide policymakers and funders the information they need to decide whether implementation of a program such as CHAP-P is cost-effective for their communities. Mabolo, Philippine Department of Health, personal communication, June 16, 2014). Cardiovascular health awareness program (CHAP): a community cluster-randomised trial among elderly Canadians. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Google ScholarÂ. Global estimates of undiagnosed diabetes in adults. J Biomed Inform. 2003;26:725–31. Finally, Phase 3 is the RCT described in this paper. National Statistical Coordination Board: 2012 Full Year Official Poverty Statistics of the Philippines 2013. This study will provide a robust evaluation of a community diabetes program in the Philippines. Information stored on computers will be protected by a password. ISSN: 0048-3818: OCLC Number: 4841184: Description: volumes illustrations 25 cm: Other Titles: Philippine journal of nursing Ardena GJRA, Paz-Pacheco E, Jimeno CA, Lantion-Ang FL, Paterno E, Juban N. Knowledge, attitudes and practices of persons with type 2 diabetes in a rural community: phase I of the community-based diabetes self-management education (DSME) program in San Juan, Batangas, Philippines. For example, though screening kits and medications are available at no cost, the case detection for new cases of diabetes is poor, the diabetes registry is poorly maintained, and the medications often get left unused in the stockrooms of local health centres (Dr M.A. Ku GMV, Kegels G. Knowledge, attitudes and perceptions of people with type 2 diabetes as related to self-management practices: results of a cross-sectional study conducted in Luzon, Philippines. Boca Raton: CRC Press; 2002. LT is contributing to the methodology for statistical analysis. The authors declare that they have no competing interests. Consent Form – Community Survey Participant. A cost-effectiveness analysis will be conducted comparing the program cost of implementing CHAP-P and healthcare resource utilization costs to percentage reduction in HbA1c. 2004;82:581–629. Healthcare should be accessible to everyone. HbA1c will be tested at a community location at baseline and 6 months, after the participants have completed the community survey in their homes. With prediabetes in rural China decimal places with those less than 0.001 reported as