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Research Grants

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  • Patient with gout – their journey from symptoms to management: implications for health care in Singapore

    Principal Investigator
    Helen Smith

    Funding body
    NMRC HSRG

    Amount awarded
    $159,692

    Duration
    1.5 years

    Summary
    Gout is a common form of arthritis. It is more prevalent amongst older populations and its incidence is rising. In the Asia Pacific High Income region, it has resulted in a 56% increase in disability adjusted life years (DALYs) over the past two decades and with increasing ageing populations, it is estimated that the number of people living with disability from gout will continue to rise.

    Gout is very amenable to treatment and early intervention can reduce the burden of the disease dramatically for the individual, society and healthcare systems. Yet there is international, widespread evidence that gout is inadequately treated and that adherence to urate-lowering treatments and dietary modifications is low. Various reasons have been put forward for this, including a lack of expertise in primary care where majority of patients are diagnosed and managed. In addition, studies have shown low health literacy in older adults is a predictor of poor health outcomes, and is a modifiable factor associated with self-management skills and health behaviours related to health status.

    This study explores the meaning people give to their health experiences like taking into account diversity around age, gender, quality of life, ethnicity and culture25. It will adopt a qualitative research design to enable us to explore the primary research questions and circumstances of patients’ first gout attacks, their responses at the time, types of support and care they used, and use, in managing it, and the implications for health care policy and service organisation. In addition, if the influence of someone else including a caregiver, or a loved one, is highlighted in the face-to-face interview, we will ask seek permission for a further interview with the ‘significant other’ so as to maximise data collection on the topic.

  • Health Literacy: The Household as an Unexplored Dimension

    Principal Investigator
    Helen Smith

    Funding body
    Primary Health Care Research in Multi-morbidity and Mental Health in a Multi-Ethnic Population (PRIME) Centre Grant

    Amount awarded
    $50,000

    Duration
    18 months

    Summary
    Low health literacy (HL) is associated with poorer health outcomes, increased morbidity and higher mortality rates. HL is defined by the World Health Organization as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.

    The concept of HL is extensive and much more than being able to read information and attend appointments, and incorporates functional, communicative/interactive, and critical domains. It also considers environmental, political and social factors that structure inequalities. Consequently, whilst most studies of HL focus on the individual, there are growing calls to broaden its conceptualisation beyond the individual (micro) to the meso (family) and macro (community and society) levels. In Singapore, the family remains the primary unit of support and therefore it is appropriate to look at HL within a household context rather than as an isolated individual. A second innovative aspect to this work is the involvement of lay community members to recruit households, assist with data collection and inform interpretation of the findings.

    The aims of our study are threefold:
    1. Test the feasibility of using the Health Literacy Test for Singapore (HLTS) to identify ranges of health literacy within households in Singapore
    2. Explore the feasibility of training lay people to work as collaborators within the three main ethnic communities in Singapore (Chinese, Malay and Indian)
    3. Develop an intervention to improve household HL in a subsequent large-scale study.

    Feasibility will be assessed by recruitment data and ethnographic field notes from lay collaborators and researchers. Comparisons will be made across different ethnic communities to identify possible cultural dimensions within our findings.

  • Retaining women healthcare professionals in the workforce

    Principal Investigator
    Helen Smith

    Funding body
    NMRC HSRG

    Amount awarded
    $291,400

    Duration
    2 years (Aug 2018 - Aug 2020)

    Summary
    This study will investigate the opportunities and challenges that female health professionals face when balancing their careers with their responsibilities as mothers and caregivers, and how these influence their decision to remain, return to or to exit the workforce. The increasing chronic disease burden of an ageing population requires more health professionals. This need can be achieved most cost effectively by increasing the numbers trained whilst simultaneously introducing initiatives that promote retention in the workforce. We hypothesised that women are less likely to stay in the health profession if they have greater family responsibilities imposed on them. Women are likely to be expected to sacrifice their working hours for the family. They are more likely than men to reduce their working hours after having a child or even leave the workforce to care for their children. Gender inequality in income and promotion, and the lack of female mentors may also act as the factors that caused women to consider working part-time or to leave the jobs.

    The proposed study will use a mixture of methodologies (structured literature review, one to one interviews, focus groups, survey questionnaire). The study involves the collection of data beyond the women themselves; in the focus group discussions each woman will be invited to contribute with the individual she had identified as having had a strong influence on her career decisions. In the final phase the observations generated from non-probability sampling will be tested for frequency and generalisability in a questionnaire survey of a large random sample of female health professionals. This enables the assessment of the relative importance of the different challenges and experiences identified within the female health professional workforce.

    The data will be interpreted with the help of our Study Advisory Panel and reports generated for different target audiences (ministries, employees, professional bodies).

  • Improving recruitment, retention and reengagement of doctors within general practice and family medicine

    Principal Investigator
    Helen Smith

    Funding body
    NMRC HSRG

    Amount awarded
    $221,220

    Duration
    21 months (Aug 2018 - May 2020)

    Summary
    Singapore recognises that caring for an ageing population with multiple chronic conditions will require more doctors with generic clinical skills, and doctors whose style of practice has a whole patient and family focus, characteristics found in General Practitioners and Family Physicians. An increase in workforce can be achieved by increasing the numbers of doctors trained, an example being the recent scheme to increase the number of Family Physicians in training by 30%. We hypothesised that in parallel to recruitment, there is a need to have initiatives that focused on retention of doctors in the primary care workforce, together with schemes to facilitate re-entry of doctors taking a career break. We also hypothesised that the trend of health care needs and/or career opportunities in General Practice/Family Medicine may potentially affect the choice in career path for medical students and, affect currently working physicians to make a decision on whether to leave or to stay in the General Practice/Family Medicine workforce. Plans to boost recruitment, retention and re-entry need to be informed by an understanding of the experiences, perceptions and career aspirations of the workforce. We have planned a series of sequential studies involving medical students, doctors working in General Practice/Family Medicine and those who have left this field of work. The research will use qualitative (in-depth interviews and focus groups) and quantitative methods (online surveys), and the findings generated will help inform interventions to boost recruitment, minimise attrition and optimise the contribution of appropriately qualified doctors to the general practice workforce.
  • ​A mixed method descriptive evaluation of the impact of a Telemedicine Dermatology service

    Principal Investigator
    Helen Smith

    Funding body
    NHG-LKCMedicine Centre for Primary Health Care Research & Innovation​

    Amount awarded
    $50,000

    Duration

    Summary
    Skin problems present frequently in family medicine and attendances for dermatology-related problems are increasing year on year. Since the introduction of telemedicine, the total number of dermatology referrrals to NSC have remained stable on a background of increasing dermatology attendances in primary care.

    To date, the impacts of this innovation ('store and forward teledermatology') on patient wellbeing, workload and costs have not been evaluated rigorously. To ensure the quality and safety of the care provided it is necessary to go beyond the analysis of the number of patients referred, to calculate outcomes such as appropriateness of referrals, diagnostic accuracy and resultant changes in medication.

    This research proposal will evaluate the impact of the introduction of a teledermatology intervention on polyclinic care for patients with skin problems. The study will be a 'before-and-after' design, combined with experienced based design methodology. These data will enable us to highlight modifications that need to be made to the existing intervention, and to design a pragmatic randomised controlled trial, including an economic evaluation, of store and forward dermatology. The seedcorn funding available will not cover the costs of the definitive trial, but it will enable us to provide strong supporting evidence of preliminary research, and the need for formal evaluation of 'store and forward' teledermatology, in an external funding proposal (for example, to MOH or NMRC) which we plan to submit in latter half of 2018.

  • WhatsApp-delivered lifestyle intervention in Singaporeans with prediabetes: a feasibility study

    Principal Investigator
    Lorainne Tudor Car

    Funding body
    ARISE

    Amount awarded
    $50,000

    Duration
    1 year

    Summary
    Singapore has the second-highest proportion of people with diabetes among developed nations. One in three elderly people (aged 60 years and above) have diabetes in Singapore. Prediabetes, a precursor stage to diabetes, affects 22% of those aged 60 and above. Early preclinical changes to the microvasculature are often observable at the prediabetes stage and most people with prediabetes will eventually progress to have diabetes. This transition is preventable with lifestyle modification interventions. Mobile phone-delivered interventions, i.e. mHealth, have been proven to be effective for prevention and management of a range of chronic diseases, and are increasingly used for diabetes. The aim of this study will be to carry out a developmental phase for a randomised trial assessing cost-effectiveness of messaging chatbot app-delivered diabetes prevention intervention compared to usual care in working Singaporeans with prediabetes. The study will also examine the effectiveness of using other mobile messaging platforms (i.e. WhatsApp) for delivery of diabetes prevention, in comparison to Chabot and usual care.
  • Information seeking behaviour of primary care practitioners in Singapore: finding evidence to support high-quality patient care

    Principal Investigator
    Lorainne Tudor Car​


    Funding body
    NHG-LKCMedicine Centre for Primary Health Care Research & Innovation

    Amount awarded
    $50,000

    Duration
    1 year

    Summary
    This is a collaborative study between National Healthcare Group Polyclinics (NHGP) and Lee Kong Chain School of Medicine (LKCMedicine), NTU. Our aim is to explore and report on information seeking behaviour of primary care physicians and nurses in Singapore. There is a range of healthcare-related information and evidence sources currently available to healthcare professionals encompassing clinical practice guidelines, care guides, journal articles, online webpages, blogs and medical literature databases. However, research shows there is a wide variation in the adoption of evidence across healthcare disciplines, which could lead to poorer primary care outcomes such as patient healthcare quality, satisfaction and adverse outcomes. Besides the difference in evidence adoption, primary care physicians and nurses also differ in their information seeking behaviour. These healthcare professionals differ in their training, working practices and responsibilities, all of which are factors that can influence their information seeking behaviour. There is evidence on information seeking behaviour in primary care settings in various countries but reports of information seeking behaviours in Singapore is limited. The widespread inclination towards evidence-based healthcare, coupled with the constant growth in medical knowledge and increasing complexity of patient care, it is therefore essential to identify relevant information needs, and information seeking behaviour for primary care providers in Singapore. We will recruit physicians and nurses involved in provision of primary care within NHGP. We intend to use surveys and interviews for collection of data.
  • Experiences of patients with diabetic foot amputation in the initial postoperative period within 6 months in primary healthcare: Physical healing or emotional healing?

    Principal Investigator
    Julia Zhu​

    FMPC Lead
    Bernadette Bartlam

    Funding body
    LKCMedicine Centre for Primary Health Care Research & Innovation​

    Amount awarded

    $50,000

    Duration
    1 year

    Summary
    Diabetic foot amputation, affects one’s quality of life, and increases morbidity and mortality. It in turn results in higher healthcare expenses and poorer patient outcomes. Statistics tells us that there is an increase in numbers of such cases, but we know little about those patients’ experiences with diabetic foot amputation in Singaporean context. Therefore, this study aims to explore the lived experiences of patients within 6 months of post operation with a foot or partial foot amputation in primary healthcare. The study adopts qualitative design to enable those patients with amputations to share individual experiences of their daily life in the initial post-discharge period which will contribute to the understanding how an individual copes with life changes related to diabetic foot amputations. Research findings will inform the type and level of assistance and support to be offered to patients during the initial postoperative period by healthcare professionals in primary healthcare setting which will ultimately promote both patients’ wound healing and emotional healing. The findings of this study will also contribute to enhancement of existing services which would better meet the holistic needs of the studied population and build care pathways to treat the “whole” patient considering the bio-psycho-social factors, not just leaving the patients with the “hole” that they have to deal with after their amputation.
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