Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development

Background 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. Objective Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. Methods Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. Results Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). Conclusions This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.

Samuel Beckett's digital library

A digital reconstruction of Samuel Beckett's personal library, based on the volumes preserved at his apartment in Paris, in archives (Beckett International Foundation) and private collections (James and Elizabeth Knowlson Collection, Anne Atik, Noga Arikha, Terrence Killeen,...).

Social development as knowledge building: research as a sphere of policy influence

The value of using social development knowledge as a tool for building development policy was promoted by the British Department for International Development in the late 1990s. This article takes the case of a capacity building initiative that sought to build social development knowledge as a resource for policy formulation in 'southern' countries. Situating knowledge as a development resource presents difficulties for intervention processes that have historically developed to provide access to economic and social assets. This article highlights some of the issues involved in trying to build social development capacity and questions the suitability of this style of intervention. Inappropriate and short-term support for knowledge capacity building carries the danger that the traditional separation between the academic and practice spheres will be reinforced, making the process of democratising knowledge more difficult.

Bridging the gaps between agricultural policy, land-use and biodiversity

The fate of biodiversity is intimately linked to agricultural development. Policy reform is an important driver of changes in agricultural land-use, but there is considerable spatial variation in response to policy and its potential impact on biodiversity. We review the links between policy, land-use and biodiversity and advocate a more integrated approach. Ecologists need to recognize that wildlife-friendly farming is not the only land-use strategy that can be used to conserve biodiversity and to research alternative options such as land sparing. There is also a need for social scientists and ecologists to bring their approaches together, so that land-use change and its consequences can be investigated in a more holistic way.

Does watershed development implemented through public private partnership empower women? A case review from Rajasthan, Western India

This paper critically examines the impact of the ‘Guidelines for Hariyali’ – a rural watershed development policy launched in Rajasthan, Western India which has been implemented through a Public Private Partnership (PPP) – for local communities. In 2003, the Government of India launched the ‘Guidelines’ (a comprehensive Integrated Wastelands Development Programme and Drought Prone Areas Programme and Desert Development Programme), the purpose of which is to restore ecological balance by harnessing, conserving and developing natural resources in drought-prone and arid rural areas for the benefit of villages. In the particular case-study area, the policy has been implemented through institutional linkages between a corporation and the government with the aim of sharing responsibilities for finances, planning, implementation and monitoring, the end goal being to enhance the livelihoods of rural households. The analysis focuses specifically on how the ‘Guidelines’ have affected the livelihoods of Rajasthani women, drawing upon findings from focus groups with men and women in the project catchment area, as well as interviews with key actors at public and private sector institutions. Findings reveal that there are significant gaps between policy objectives and the realities on the ground, particularly in the context of women's accessibilities and entitlements. The paper also broadens understanding of how PPPs, if implemented properly, could empower women in the area of watershed management across rural South Asia.

Adaptive social protection: mapping the evidence and policy context in the agriculture sector in south Asia

An aim of government and the international community is to respond to global processes and crises through a range of policy and practical approaches that help limit damage from shocks and stresses. Three approaches to vulnerability reduction that have become particularly prominent in recent years are social protection (SP), disaster risk reduction (DRR) and climate change adaptation (CCA). Although these approaches have much in common, they have developed separately over the last two decades. However, given the increasingly complex and interlinked array of risks that poor and vulnerable people face, it is likely that they will not be sufficient in the long run if they continue to be applied in isolation from one another. In recognition of this challenge, the concept of Adaptive Social Protection (ASP) has been developed. ASP refers to a series of measures which aims to build resilience of the poorest and most vulnerable people to climate change by combining elements of SP, DRR and CCA in programmes and projects. The aim of this paper is to provide an initial assessment of the ways in which these elements are being brought together in development policy and practice. It does this by conducting a meta-analysis of 124 agricultural programmes implemented in five countries in south Asia. These are Afghanistan, Bangladesh, India, Nepal and Pakistan. The findings show that full integration of SP, DRR and CCA is relatively limited in south Asia, although there has been significant progress in combining SP and DRR in the last ten years. Projects that combine elements of SP, DRR and CCA tend to emphasise broad poverty and vulnerability reduction goals relative to those that do not. Such approaches can provide valuable lessons and insights for the promotion of climate resilient livelihoods amongst policymakers and practitioners.

The rise of urban tourism in Havana since 1989

This article looks at the development of urban tourism in Havana, Cuba, in the period since the collapse of state socialism in the USSR and Eastern Europe. It provides an interesting case study of the adoption of an outward-oriented state development policy in the context of a socialist state. The dramatic rise of urban-based tourism in Havana since 1989 is described, followed by a review of the socio-economic impacts of such tourism. These include: income generation; job creation; the rise of the informal economy, including crime and prostitution; increased migration to the primary city, along with spatial concentration on the coastal strip, and associated environmental impacts. In conclusion, the article considers the fat that the promotion of tourism has returned Havana to some of the conditions that existed in the city Socialist Revolution in 1959.

Never the twain shall meet: A memetic analysis of poverty perceptions

Poverty, as defined within development discourse, does not fully capture the reality in which the poor live, which is formed also by values and beliefs specific to a given culture and setting. This article uses a memetic approach to investigating the reality of poverty among pastoralists and urban dwellers in Kenya. By distinguishing the semantic space and the cultural context in which the definitions are framed, it enables the researcher to make sufficient generalisations while also recognising the differences between cultures. The results demonstrate how pastoralists and urban dwellers conceptualise poverty differently particularly in regard to causes. Further, the article suggests that development actors often utilise a Western construct which does not entirely reflect the values and beliefs of the poor.

Exploring the feasibility of farmers' rights

In many developing countries, there is concern that a conventional system of plant breeders' rights provides no rewards to farmers for their role in the conservation and enhancement of agro-biodiversity. To redress this imbalance, developing countries are incorporating farmers' rights provisions in their plant variety protection legislation. This article examines the feasibility of farmers' rights provisions based on intellectual property rights. It argues that the farmers' rights provisions crafted by some developing countries will involve enormous operational difficulties, while IPR-based farmers' rights are unlikely to provide significant economic returns to farmers or farming communities. At the same time, farmers' rights provisions, as currently conceived, are likely significantly to dilute the incentives for innovation provided to institutional plant breeders.

The rapid rise of supermarkets?

A series of articles, many of them published in this journal, have charted the rapid spread of supermarkets in developing and middle-income countries and forecast its continuation. In this article, the level of supermarket penetration (share of the retail food market) is modelled quantitatively on a cross-section of 42 countries for which data could be obtained, representing all stages of development. GDP per capita, income distribution, urbanisation, female labour force participation and openness to inward foreign investment are all significant explanators. Projections to 2015 suggest significant but not explosive further penetration; increased openness and GDP growth are the most significant factors.