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PubMed2026

Tele-Oncology in the Post-Pandemic Era: Clinical Integration, Access Disparities and Medico-Legal Accountability.

PURPOSE OF THE REVIEW: Tele-health has evolved from a marginal tool confined to rural populations and selected follow-up programs into a structurally integrated component of modern cancer care. Prior to COVID-19, its adoption was constrained by regulatory fragmentation, non-uniform reimbursement, and licensure barriers. This narrative review evaluates the evolutionary integration of tele-health in oncology post-COVID-19, examines digital disparities across patient populations, and addresses the medico-legal implications of this integration, with the objective of providing a comprehensive and clinically actionable framework for the governance of virtual oncology care. RECENT FINDINGS: The pandemic acted as a global catalyst, driving telehealth to over 50% of oncology outpatient encounters in some settings, before stabilising post-pandemic at approximately 10-20% of consultations within hybrid care models. Evidence supports meaningful clinical benefits - improved access to specialist services, reduced travel burden, and sustained continuity of care - with outcomes comparable to in-person care in postoperative follow-up, symptom monitoring, and survivorship. However, persistent disparities in device availability, connectivity, and digital literacy disproportionately affect older, rural, and socioeconomically disadvantaged patients, raising the risk that geographic inequalities are replaced by technological ones. From a medico-legal standpoint, the remote modality does not modify the applicable standard of care, yet restricted physical examination and reliance on patient-reported data introduce risks of diagnostic delay and incomplete clinical assessment, with direct implications for professional liability, data protection under HIPAA and GDPR, cross-border licensure, and multi-party accountability across physicians, institutions, and technology providers. Tele-oncology has become a permanent structural feature of modern cancer care, offering demonstrable benefits in access, continuity, and patient satisfaction. Yet its integration has been uneven, its governance remains fragmented, and its medico-legal landscape is still evolving. Realising the full potential of virtual oncology care - equitably and safely - requires coherent regulatory frameworks, sustained investment in digital infrastructure, and explicit attention to the populations at greatest risk of being left behind.

Humans↗
PubMed1990

Does growth monitoring work as it ought to in countries of low literacy?

The paper examines various aspects of the growth monitoring (GM) component of the Integrated Child Development Services (ICDS) programme of India. Data of 3704 rural children, 0-6 years of age revealed that growth of almost half of the children had never been monitored, and monitored inadequately in another 25 per cent of cases. While very few mothers (1 per cent) could interpret growth charts (GC) correctly, 87 per cent of the ICDS functionaries could do this. There was a significant and positive relationship between maternal knowledge and functionary knowledge of the growth chart (GC), and coverage of children for GM. Impact of mothers' GC knowledge on nutritional status of children was determined largely by their literacy status; however, only 17 per cent were literate. Analysis of covariance of the effect of GM on weight-for-age and morbidity controlling for socio-economic status and other programme services showed that GM did not have an impact on the nutritional or health status of children. It is therefore concluded that very high levels of illiteracy amongst mothers may be a major determinant to the success of GM programmes in India.

Child↗
PubMed2006

Vaccination status of tribal mothers and their under five children.

A study was done to find out the vaccination status of the tribal mothers and their under 5 children in some selected villages of Durgapur upazila under Netrakona district. It was a cross sectional study in which 92 tribal mothers and 91 under 5 children were included. The study was carried out in 4 different tribal villages under Netrakona district from February to June 2001. According to National EPI schedule, it was revealed that 58.2% of the children were fully vaccinated, 26.4% incompletely and 15.4% not vaccinated. The individual vaccine coverage was 84.6% for BCG, 68.1% for OPV and DPT, 58.2% for Measles. Considering the literacy, most of the respondents (78.3%) were illiterate and 21.7% had some basic education. None of the mother completed 5 doses of TT coverage. The individual TT coverage was found 78.3% for TT(1), 67.4% for TT(2), 17.4% for TT(3) and 1.1% for TT(4). This study observed that the vaccination status in the tribal children was satisfactory in relation to National coverage, but the vaccination status of the tribal mothers was not satisfactory in our national context.

Adolescent↗
PubMed2002

Minimum health indicator set for South Eastern Europe.

AIM: The Stability Pact includes a program for the development and reconstruction of training and research in public health for the countries of South Eastern Europe (PH-SEE). One of the identified priorities of national public health development is the definition of a Minimum Indicator Set for all countries of SEE. METHODS: A Task Force of the PH-SEE Network (www.snz.hr/ph-see) has proposed a Minimum Indicator Set on the basis of the list of the 224 indicators of the World Health Organization (WHO) Health for All (HFA) 21 strategy. The indicators selected follow the selection criteria as defined by expert groups of WHO and the European Commission. A meta-database describing the indicators should be established soon. RESULTS: A list of 32 indicators was agreed at a workshop in Ohrid, Macedonia, in September 2001. All indicators are included in the WHO HFA 21 indicator set. Some indicators are related specifically to the SEE post-war situation, such as indicators on suicide and homicide, literacy rate, average number of calories per person a day, and average number of persons per room. CONCLUSION: After principal agreement of the expert group on the list of indicators, further practical steps are necessary, especially testing the indicators and building a logistic network for realizing the Minimum Indicator Set. This includes a pilot phase, a revision of the Minimum Indicator Set after testing, responsibilities and timelines for data collection and data analysis, and transfer of the project into a continuous surveillance and monitoring system.

Adolescent↗
PubMed2002

Use of a computerized risk-appraisal instrument for cancer prevention education of medical students.

BACKGROUND: Interactive computer-based tools are increasingly used for patient and medical student instruction. METHOD: To assess medical students' responses to a computer-based risk-appraisal instrument aimed at teaching concepts of risk and cancer prevention, and to evaluate perceived barriers to using such tools in clinical practice and knowledge about risk factors for colon cancer. DESIGN: An electronic survey of 133 second-year medical students elicited their responses to the instrument after using it for a case-based learning exercise. RESULTS: The students identified several potential barriers to use, including inadequate time during the office visit (75% of students) and problems with literacy (48%). They were generally knowledgeable about risk factors for colon cancer. 84% found the instrument "very helpful" or "somewhat helpful" in understanding a case patient's health and setting priorities for behavioral changes. CONCLUSIONS: Medical students may benefit from exposure to interactive, computer-based tools such as health-appraisal instruments when learning skills in risk counseling and cancer prevention. Second-year students were already concerned about having adequate time during office visits to use such instruments.

Clinical Competence↗
PubMed2006

Parental literacy and infant health: an evidence-based healthy start intervention.

Syracuse Healthy Start, a federally funded infant mortality prevention project in Onondaga County, New York, has undertaken a range of interventions to address parental low literacy as a risk factor for infant mortality. A growing number of studies advocate for health-related information that is easy to read, of a low literacy level, and culturally appropriate. Creation of an evidence-based public health intervention involves analyzing local data, reviewing published studies, assessing available materials, initiating programmatic interventions, and evaluating the outcomes. Preparing health educational materials that are clear, culturally sensitive, and at appropriate reading levels follows Paulo Freire's lead in empowering the disadvantaged to positively affect their health and the health of their infants toward the reduction of infant mortality.

Educational Status↗
PubMed2006

Evaluating the strengths and weaknesses of tuberculosis educational activities for prisoners in Honduras.

SETTING: Prisons throughout Honduras. OBJECTIVE: To assess the strengths, weaknesses, and opportunities to improve non-standardized tuberculosis (TB) educational campaign materials utilized in prisons. DESIGN: A qualitative assessment was conducted. Prison staff completed a survey describing development and implementation of educational activities at each prison (n=25). Completed surveys with photographs or copies of educational materials were collected and cataloged. The content, literacy demand, illustrations, learning stimulation, and cultural appropriateness of cataloged items were assessed using an adapted version of the Suitability Assessment of Materials Instrument. Results from this assessment were examined in conjunction with information collected through focus groups conducted with prisoners and interviews with prison staff. RESULTS: Campaign strengths included the development and dissemination of print materials appropriate for individuals with low literacy levels. By actively engaging prisoners in the campaigns, materials often incorporated the language, values, and experiences encountered within prison culture. Content of print materials and presentations focused on correcting misperceptions and facilitating acceptance of TB control activities. Campaign weaknesses included the creation of illustrations that could perpetuate the stigma associated with TB and use of some materials in which the purpose was not apparent. CONCLUSIONS: The campaigns were generally suitable, and the evaluation allowed for their improvement.

Adult↗
PubMed2007

Willingness to pay for cataract surgery in rural Southern China.

PURPOSE: To study willingness to pay for cataract surgery, and its associations, in Southern China. DESIGN: Cross-sectional willingness-to-pay interview incorporating elements of the open-ended and bidding formats. PARTICIPANTS: Three-hundred thirty-nine persons presenting for cataract screening in Yangjiang, China, with presenting visual acuity (VA) < or = 6/60 in either eye due to cataract. METHODS: Subjects underwent measurement of their VA and a willingness-to-pay interview. Age, gender, literacy, education, and annual income also were recorded. MAIN OUTCOME MEASURES: Maximum amount that the subjects would be willing to pay for cataract surgery. RESULTS: Among 325 (95.9%) subjects completing the interview, 169 (52.0%) were 70 years or older, 213 (65.5%) were women, and 217 (66.8%) had an annual income of <5000 renminbi (5000 = US 625 dollars). Eighty percent (n = 257) of participants were willing to pay something for surgery (mean, 442+/-444 renminbi [US 55 dollars+/-55]). In regression models, older subjects were willing to pay less (8 renminbi [US 1 dollar] per year of age; P = 0.01). Blind subjects were significantly more likely (odds ratio, 5.7; 95% confidence interval, 1.7-19.3) to pay anything for surgery, but would pay on average 255 renminbi (US 32 dollars) less (P = 0.004). Persons at the highest annual income level (>10,000 renminbi [US 1250 dollars]) would pay 50 dollars more for surgery than those at the lowest level (<5000 renminbi) (P = 0.0003). The current cost of surgery in this program is 500 renminbi (US 63 dollars). CONCLUSIONS: Sustainable programs will need to attract younger, more well-to-do persons with better vision, while still providing access to the neediest patients.

Aged↗
PubMed2004

How Hawaii/Pacific Basin Area Health Education Center (AHEC) is using technology to make the Pacific smaller.

INTRODUCTION: In order to improve health literacy in rural areas, the Hawaii/Pacific Basin AHEC and Ke 'Anuenue AHEC are working to connect rural communities via video teleconferencing. METHODS: Video teleconferencing connectivity has been established to 15 rural and underserved locations across Hawaii and to the Republic of the Marshall Islands. RESULTS: An average of 15 individuals participate in weekly facilitated health education sessions. DISCUSSION: Participants have reported lifestyle change as a result of sessions and attendance is significantly increasing. In some areas, mid level health care professionals attend in order to obtain information for their patients.

Area Health Education Centers↗
PubMedDate not supplied

The use of personal digital assistants at the point of care in an undergraduate nursing program.

This study examined the relationships between the use of personal digital assistants and self-efficacy and the preparation for medication administration among second-year Bachelor of Science in Nursing students in a medical-surgical clinical environment. By using a controlled experimental method, the study attempted to support claims about the educational benefits of personal digital assistants which have generally been reported in more descriptive and anecdotal formats. The sample consisted of 36 students, of which two groups had personal digital assistants and two groups served as a control. The control groups were provided with paper resources equivalent to the software provided by the personal digital assistants. Findings showed a significant increase in self-efficacy in the groups with personal digital assistants.

Attitude of Health Personnel↗
PubMed2003

Health policy and the coloring of an American male crisis: a perspective on community-based health services.

Health services at the community level are organized and financed in such a way that men need access but encounter barriers to care such as poor service design, lack of insurance, and the absence of health literacy. Community health delivery systems may not be appropriate, effective, fit, or able to meet the needs they are charged to fill. Community-based health services, including health departments, are underfunded, understaffed, and unable to carry out their mission in a way that protects the health of the community. The current design for funding and delivering health care services excludes poor men, particularly men of color. Improving the health of men requires modifications in the way health care is financed, delivered, and managed.

Adult↗
PubMed1978

Social justice and the demographic transition: lessons from India's Kerala State.

Kerala is a small, densely crowded state in South India. It is a poor state, even by Indian standards. Its per capita income of US$80 lies well below the all-India average of US$120, and it suffers from the lowest per capita caloric intake in India. Nevertheless, Kerala has managed to achieve the demographic transition from high (premodern) to low (modern) birth and death rates-something no other Indian state has been able to attain. Indeed, the magnitude of Kerala's fertility decline-the birth rate fell from 39 in 1961 to 26.5 in 1974-has never before been observed in a nation with comparable levels of income and undernutrition. Other indices of Kerala's soical development are equally surprising: levels of literacy, life expectancy, female education, and age at marriage are the highest in India, while mortality rates, including infant and child mortality, are the lowest among Indian states. But Kerala's anomalous and unexpected demographic trends and levels are not the result of the direct interventions designed to influence health and fertility levels elsewhere in India-conventional strategies of population control and health services delivery that thus far are notable for their failure to generate such positive results. Instead, Kerala's demographic levels evidently reflect a broad social response to structural reforms in its political economy.

Birth Rate↗
PubMed2000

Cognitive, mood, and functional evaluations using touchscreen technology.

We describe the design and development of the Cognitive Evaluation Protocol (CEP), a computer software program for evaluating cognitive and functional capacities and mood. The program is self-administered by subjects using touchscreen monitors for input. Stimuli in CEP subtests are randomized to reduce the effects of learning on repeated assessments. Findings demonstrate that a) minimum instruction is required for touchscreen use, even for computer-naive subjects; c) both normative subjects and psychiatric patients respond positively to self-administered evaluations; and c) CEP can be used for within-subject repeated evaluations with minimal distortion of results due to practice effects. The CEP Report Generator provides immediate printed performance results and creates a database for long-term digital storage and information use.

Affect↗
PubMedDate not supplied

Developing health education materials for inner-city low literacy parents.

The question of identifying and treating childhood illness confronts all new parents. Misconceptions often lead parents to manage illnesses in their young children inappropriately through overly aggressive treatment or insufficient attention. This responsibility is especially challenging for low-income new parents who lack the literacy levels needed to understand and use much of the existing health education literature and who are without access to health facilities and providers. In response to a perceived need for health information directed at low-income, low-literacy parents, students from the University of California at Los Angeles School of Public Health created an easy-to-use reference booklet called "A Parent's Guide: When Your Child Is Sick." The booklet's aim is to assist parents in treating common childhood illness and identifying more serious diseases requiring medical attention. A comprehensive and manageable amount of information is provided in the booklet. Behaviors and issues covered include (a) recognition of symptoms, (b) actions that could be taken in the home, (c) medicines that could be administered, and (d) recommendations on how persistent problems might be handled.

Child↗
PubMed1995

The role of doctors in influencing infant feeding practices in South India.

Infant feeding practices are influenced by many factors including culture, household income, literacy, advice from health care workers and advertising. In South India doctors play a very significant role in influencing a mother's decision about when or whether to supplement breastfeeding with formula feeds. Doctors exert their influence on mothers both directly and indirectly, and they are increasingly targeted by commercial infant food companies. Doctors need continuing education about nutrition education, lactation management, and a greater awareness about the influence of inappropriate promotional practices by companies.

Breast Feeding↗
PubMed2006

HIV, HBV, HCV, and syphilis co-infections among patients attending the STD clinics of district hospitals in Northern India.

OBJECTIVE: The objective of the study was to assess the risk of co-infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis among patients attending sexually transmitted disease (STD) clinics, antenatal clinics (ANC) and Ob-Gyn outpatients department (OPD) clinics which were part of the sentinel surveillance program. METHODS: A serological screening was carried out during the period August-November 2002 to assess the risk of infection with HIV-1/2, and co-infection with HBV, HCV, and syphilis among the outpatients attending STD clinics, Ob-Gyn OPD clinics, and ANC of three district hospitals (Agra, Etawah, and Farrukhabad) of Uttar Pradesh state in Northern India. Unlinked and coded serum samples received from 863 patients (635 females and 228 males) were screened by laboratory tests commonly used for laboratory diagnosis of HIV, HBV, HCV, and syphilis. RESULTS: Among the 863 samples serological reactivity was detected for HIV-1/2 in 21 (2.4%), HBV in 25 (2.9%), HCV in nine (1.0%), and syphilis in 47 (5.4%). The incidence of HBV was higher among males than females, i.e. 10/228 (4.4%) versus 15/635 (2.4%). Co-infection was observed for HIV-HBV in two (0.2%), HBV-HCV in one (0.1%), and HIV-syphilis in one (0.1%). None were found to have co-infection with HIV-HCV, HBV-syphilis, and HCV-syphilis. Age, sex, literacy level, occupation, locality, migration, and presence of different sexually transmitted infections did not significantly influence the rate of HIV positives. CONCLUSION: A substantial percentage of the outpatients seen in the clinics of the district hospital in Uttar Pradesh harbor HIV and viral hepatitis infections, which otherwise would remain undiagnosed without serological screening.

Adolescent↗
PubMed1996

Use of a photoessay to teach low-income African American women about mammography.

BACKGROUND: Although incidence rates of breast cancer are lower among African American women than white women, mortality rates among African American women are higher, especially for women of lower socioeconomic levels. Reasons for this situation include the lesser use of breast cancer screening examinations by low-income, primarily African American women, late stage of diagnosis, and delays in treatment. METHODS: As part of community outreach and public health clinic inreach programs for the Forsyth County Cancer Screening Project, approximately 908 African American women who reside in low-income housing communities were targeted for educational efforts related to breast cancer screening. Early in the project, it was discovered that many of the women were unfamiliar with mammography and had very little awareness of how the entire examination was conducted. This low level of knowledge was particularly important because it was a barrier for obtaining regular mammography. A photoessay depicting the process of getting a mammogram was developed and used in community outreach efforts in three formats: in educational classes, as a display in the housing communities, and in physicians' offices. The acceptability of this photoessay to communicate knowledge of and reduce fears about mammography was assessed through evaluation surveys in interviews with a sample of 47 women from the target population. RESULTS: Overall, these women liked the photoessay and felt that it provided knowledge about mammography and reduced fears associated with anticipating mammography. CONCLUSIONS: Strategies such as this may be ideal to communicate important information about cancer prevention and control in low-literacy populations.

Adult↗
PubMed1996

Students' perceptions of a multimedia computer-aided instruction resource in histology.

OBJECTIVE: To develop an interactive multimedia-based computer-aided instruction (CAI) programme, to determine its educational worth and efficacy in a multicultural academic environment and to evaluate its usage by students with differing levels of computer literacy. DESIGN: A prospective descriptive study evaluating pre- and post-module testing, student usage tracking and a questionnaire survey. SETTING: University of Natal Medical School. PARTICIPANTS: Thirty-four volunteers from the class of 125 second-year M.B. Ch.B. students who participated in the CAI study; 13 of these were not computer-literate. INTERVENTION: The study group used the CAI module for 2 weeks as part of the course. MAIN OUTCOME MEASURES: Post-test scoring and evaluation of questionnaire responses. RESULTS: Results of pre- and post-tests show that CAI users' scores were slightly lower on pre-testing (22.1% v. 23.2%), while their post-test scores were higher (65.6% v. 60.7%). Lack of computer literacy did not restrict or hinder students in their use of the programme. Responses to a questionnaire completed by all CAI users indicate consensus that the programme helped the students to learn (94%), that it provided important basic knowledge (88%) and that it was a helpful learning experience (88%). All but 1 student wished to have more programmes like this available in histology. CONCLUSIONS: The CAI programme reduced the time spent by students in the histology microscopy laboratory and did not negatively affect their marks in post-course evaluation. The concept of multimedia-based CAI in medical education was positively received by the students who participated.

Computer-Assisted Instruction↗