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Agarwal",coverURL:"https://cdn.intechopen.com/books/images_new/1992.jpg",editedByType:"Edited by",editors:[{id:"38519",title:"Prof.",name:"Ramesh K.",surname:"Agarwal",slug:"ramesh-k.-agarwal",fullName:"Ramesh K. Agarwal"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"74405",title:"Cultural Adaptation of a Cardiovascular Health Education Program among Hypertensive Primary Care Patients from Rural Nigeria",doi:"10.5772/intechopen.94542",slug:"cultural-adaptation-of-a-cardiovascular-health-education-program-among-hypertensive-primary-care-pat",body:'Hypertension is a major risk factor of cardiovascular diseases (CVD), and is highly prevalent in sub-Saharan Africa (SSA) [1, 2]. CVD including ischemic heart disease and stroke are the world’s biggest killers, having killed 15.2 million people in 2016 alone [3], and being responsible for 17.9 million (31%) of global deaths annually [4]. To limit CVD, World health organization (WHO) advocated preventive management of hypertension and other CVD risk factors [4]. In Nigeria where the age-standardized prevalence of Hypertension is 19.3%, only 8% of hypertensive patients are aware, 3% controlled and just 5% are covered by treatment [5]. Fortunately though, willingness to adopt recommended lifestyle measures is encouraging among hypertensive patients [6].
In African rural settings deep-routed cultural orientations can manifest in beliefs and perceptions about health that vary with modern medical perceptions. It is beneficial to re-orientate people in such deeply cultural settings to acquire well informed modern health perspectives. This can be achieved by introducing culturally appropriate behavioral health interventions that have undergone cultural adaptation based on the people’s traditional health practices and cultural beliefs.
An ideal behavioral treatment intervention should be adapted culturally by following standard procedures. Studies have shown that guideline-based cultural adaptation process has potential to increase acceptability, attractiveness and effectiveness of treatment support programs among target populations [9, 10, 11]. Furthermore evidence abounds that systematic cultural adaptation of behavioral treatments offer intrinsic self-efficacy benefits for patients [12, 13, 14]. Reports further suggests that cultural adaptation of health interventions can enhance service delivery when implemented as a living process with dynamism for continuous feedback, replicability and improvement [11]. Conversely other interventions that are not culturally adapted can unwittingly discourage uptake of recommended lifestyles by patients at risk of CVD [15]. Systematic review evidence from global perspective have also highlighted usefulness of culturally adapted interventions in control of CVD risk factors [16]. Currently however, there is a dearth of regional studies investigating usefulness and exploitability of cultural adaptation of treatment interventions in SSA settings.
To implement standard cultural adaptation, Barrera et al. identified five guideline-based sequential stages involved from a Consensus on Updates of Models for Effective Cultural Adaptation as follows:
The effectiveness of culturally adapted interventions can be evaluated using standard testing procedures. Studies suggest that goal setting and pursuance among patients can be effective in promoting acculturation and adoption of adapted interventions among populations at risk of CVD. Similar evidence abounds that goal setting is useful in evaluating effectiveness of culturally adapted interventions including acquisition of behavioral self-management skills [18, 19, 20, 21]. Indeed the setting and pursuing of culturally adapted goals to stimulate healthy behavior have enhanced chronic disease self-management skills [18, 20]. Available evidence further suggests that the more frequently goals are set and pursued, the easier and faster patients learn and acquire targeted self-management skills [19].
In this study, following standard guidelines and procedures we culturally adapted an existing hypertension education program to produce a similar variant with enhanced cultural content and sensitivity using the first three out of five sequential steps. We proceeded further to evaluate the adapted program for
A mixed methods study in two phases: in
Cultural adaptation study in relation to QUICK-1 and QUICK-2 studies.
In the current study, our focus is to describe the
Our study was implemented at a primary healthcare center,
In the following section we describe the steps taken in adapting CHEP from CAHE and in evaluating the former, based on designs, measures, procedures and analysis adopted.
In the
Beyond what was already known from CAHE, CHEP specifically sought to know the local, cultural and contextual factors the Nigerian hypertensive patients perceive as inhibitors or enablers of prescribed hypertension care and self-management: what hypertension is and how it presents; what situations make hypertension easy or difficult for patients to manage as advised; how patients’ finances affect their treatment goals; and how patients’ native customs and social environment affect their use of medications, food selection, exercise or weight management. During a follow-up focused group discussion (FGD) after CHEP counseling sessions, participants were further asked: how they view CHEP counseling on pills use, healthy diet, salt reduction/substitution and exercise; what was particularly helpful, or frustrating about CHEP counseling; how much they have been able to meet their hypertension self-management goals; and ways in which the education program can be improved upon in future.
In addition to the qualitative interviews, at a later stage we conducted FGD with participants to get their views about usefulness, acceptability, sustainability and effectiveness or otherwise of CHEP. As was done in CAHE, the CHEP development interviews began with the interviewer familiarizing with respondents to determine preferred language of communication. Thereafter we introduced participants to the research objectives: to elicit patients’ explanatory model of hypertension regarding cause, presentation, course, duration, consequence, treatment, self-management and contextual factors relating to hypertension including social, cultural, religious, and financial factors. Furthermore, while CAHE sought to know the effect migration had on hypertension self-management efforts of its immigrant participants, CHEP explored how peculiar local features of Nigeria’s rural, social and cultural environments can be exploited to optimize hypertension self-care.
We used MAXQDA data management software [29], and Grounded Theory [30] to analyze our data. The analytic process was at first carried out by two researchers independently, thereafter the interview transcripts were exchanged and coding and analytic steps repeated all over by individual researcher. Following this, areas of disagreement were jointly resolved by discussing the data further. In analyzing, we repeatedly examined, compared, verified and reordered the data in line with identified themes and concepts. This produced a matrix of concepts, sub-categories and categories from multi-level coding along thematic lines as follows: a) first we identified clusters of similar concepts in each interview transcript by assigning series of open codes to similar text fragments and emerging themes that reflected same ideas. To produce a code list we inductively coded sections of each transcript that provided information on respondents’ ideas about hypertension and hypertension self-management; b) next we reviewed the code list to eliminate duplicates and streamline similar concepts to produce a smaller set of mutually exclusive concepts; and c) we scrutinized the data further and grouped streamlined concepts and related text fragments under four major themes to address our core research question: what social, cultural or native factors affect compliance with prescribed pills, diet and healthy behavior among hypertensive primary care patients from rural Nigeria?
In the preliminary adaptation stage, we tailored CHEP culturally using information collected in the
Both CHEP and CAHE had notable similarities in forms and contents; each was implemented in three modules over 6 months among hypertensive patients in Europe (
Excluding goals setting and few self-report measures, many other measures were assessed in both CAHE and CHEP including patient demographics and physiological measures. Other measures include perceived stress, social support, and illness perception, beliefs about medicines, self efficacy, medication adherence, lifestyle adherence and satisfaction with care. Unlike CHEP however, a measure of ‘discrimination’ was deemed relevant and included in CAHE whose participants had migrated to Europe and could possibly experience social exclusion.
A CHEP counseling visit usually began with participants familiarizing with others and the trainers. This is followed by: group interactive counseling on hypertension and hypertension self-management; poster teaching on culturally relevant exercises; a visit to the local market to familiarize with healthy foods; an audiovisual viewing session on pills use, healthy diet and lifestyle; a field practical exercise session; and a goal setting and assessment session. CAHE on the other hand was delivered in one-on-one teaching sessions, featured no audiovisual session, and did not involve teaching visits to local market or grocery store but nevertheless deployed a specially prepared take-home hypertension handbook to teach her relatively more literate participants about healthy food choices, food preparation methods, pills use and healthy lifestyle. Both CAHE and CHEP counseling trainings were structured into 3 modules and delivered on 3 occasions few weeks apart, over six months in between a baseline and a final assessment visit. In both programs, every participant had physiological, anthropometric and self-report measurements at baseline and final visits. However, CHEP additionally had these measures taken during each of the 3 intervening educational visits because it was observed during pre-baseline information visits that the patients valued such interim measurements if the results are immediately communicated to motivate their self-management efforts.
The
We measured and recorded participants’ socio-demographic parameters (age, gender, ethnicity, marital status, income level, employment status, educational status, alcohol use and tobacco use) and assessed their hypertension treatment outcomes including blood pressure control, body mass index, medication adherence, behavioral adherence as well as social support, satisfaction with care, illness perception, beliefs about medicines, and medication adherence self efficacy. Furthermore we asked participants specific questions on physical activity and exercise, use of salt, alcohol and smoking and graded their responses on a Likert Scale. Finally we asked participants to set and practice preferred culturally adapted behavioral health goals and graded their performances of set goals as a measure of ‘cultural fitness.
Each of the 149 participants individually had an initial baseline assessment, followed by 3 modules of CHEP training in groups of 12–15 at 6 weeks, 10 weeks and 14 weeks past baseline. They were later disaggregated to have final individual assessments at 6 months past baseline. In essence, each participant had five study visits including a baseline assessment visit, a final assessment visit and three intervening group educational and goals setting assessment visits. Following the baseline visit (1st study visit) each participant was guided to set 3 culturally adapted behavioral goals during the first training session (2nd study visit), and to practice the selected goals at home until he/she revisits for the second training session (3rd study visit). The same goals setting instructions were repeated at the end of second training towards the third and final training session (4th study visit). Participants were additionally guided to practice preferred physical exercises for 20 minutes during the 3rd training session only, and they were encouraged to continue the exercises at home until the final visits at 6 months (5th study visit). In the section on assessment of set goals, participants’ goals related performances were rated on a Likert scale and compared over 6 months before and after the intervention. Full details of the effectiveness of CHEP evaluation study are available in a related study [13].
Data were analyzed based on: 1) qualitative self-report from each of the 149 participants on performance of set goals as instructed; and 2) quantitative ‘before-, and after’ comparison of changes in treatment outcomes of participants following intervention.
In assessing performance of set goals, we recorded the number and types of goals set by each participant during a current visit following practice of such goals at home as instructed during previous visit. Using a Likert scale we inquired and got qualitative responses from each participant on the extent to which they practiced selected goals at home. For the CHEP effectiveness study we employed descriptive statistics and regression analysis to evaluate changes in BP control, Body Mass Index, behavioral adherence and medication adherence and got promising improvements as reported in Odusola, et al. [13].
By design we have reserved the last two stages of the cultural adaptation process, ‘
Approval for Ethical conduct of the main study was obtained from the Ethics Committee of University of Ilorin Teaching Hospital on 30th March 2010. The current study is one of the sub-studies of the main study.
We collected qualitative information from 40 hypertensive patients (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg). Most of them were 50 years or older, two third were Christians, almost all (80%) earn less than 5USD per day while 70% had only primary school education, and most were artisans engaged in farming, fishing, or petty trading (Table 1).
Hereunder we describe our results based on the first three out of five guideline-based cultural adaptation stages.
The results are in two streams: a)
Our data showed that a people’s culture, customs and beliefs have capacity to discourage uptake and practice of healthy behavior (Table 2).
Our data yielded a rich mix of information on factors encouraging healthy behavior among participants (Table 2). Many felt cultural adaptation of certain local practices made it easier, cheaper and more attractive to practice healthy behavior.
Characteristics | N (%) |
---|---|
Age group (years) | |
• 30–50 | 9 (22.5%) |
• 50–70 | 26 (65%) |
• 70–90 | 5 (12.5%) |
Gender | |
• Male | 16 (40%) |
• Female | 24 (60%) |
Educational level | |
• None or primary education | 28 (70%) |
• Secondary education | 9 (22.5%) |
• Tertiary education | 3 (7.5%) |
Ethnicity | |
• Nupe | 6 (15%) |
• Yoruba | 31 (77.5%) |
• Others | 3 (7.5%) |
Socio-demographic characteristics of participants.
Category | Sub-category | Concepts and Examples | |
---|---|---|---|
Factors motivating healthy behavior | Factors inhibiting healthy behavior | ||
Food related practices: Salt use | Food conservation practices | Salt can preserve food stocks against microbial degradation [n = 3]* | |
Food preparation practices | A salt-less diet is repulsive to the African mindset [n = 7] | ||
Salt and salt products (e.g.maggi) are substantially used in meals preparation [n = 14] | |||
Medicinal use of salt | Salted water (salt solution) is a sure panacea for abdominal/stomach discomfort [n = 3] | ||
Food related practices: Salt use | Availability of suitable salt substitute | Following health counseling, I found out that meals prepared with | |
Food related practices: Fruits and vegetables consumption | Endowment of rural environments with health-promoting possibilities and practices: arable land for vegetable and fruit farming and poultry; and streams and rivers for fishing | I now get enough vegetables in my regular diet from vegetable gardening at my backyard [n = 5] | |
Societal socio-cultural perceptions: weight gain | Increase in body size perceived as wealth, affluence, comfort | The bigger one is the wealthier, affluent and more comfortable he/she is perceived [n = 12] | |
Decrease in body size perceived as illness, disease | Deliberate weight loss or slimming down perceived as being caused by serious internal disease [n = 13] | ||
Increase in body size (bigness) perceived as a woman’s beauty or sexual attractiveness | The fatter a woman is, the more beautiful and attractive she is viewed [n = 7] | ||
Weight gain or Obesity perceived inherited or natural in some families | Heaviness or fatness runs in my family; we normally have big sizes [n = 3] | ||
Some local delicacies have fattening tendency | Popular local meals are often heavily starch-based, e.g. Pounded yam, Garri-eba [n = 5] | ||
Red Palm-oil, Groundnut oil readily available in our environment [n = 11] | |||
Popular local goat-breeding practice makes red meat readily available [n = 2] | |||
Socio-cultural perceptions: weight reduction | Cultural perceptions and orientations: being fat is tantamount to ugliness, sluggishness and physical unfitness | People will say: look at him, ‘big for nothing’, he will not be able to enjoy breathing, worse still [n = 3]. | |
Socio-cultural perceptions: lack of exercise | Perception of exercise as related to elderly “fragile” health and wellbeing | Popular view: exercising is dangerous with increasing age, and to health the elderly [n = 7] | |
Perception of exercise as related to perceived necessity | Popular view: walking long distances just to exercise could only mean one is unserious and greedy to avoid spending travel costs [n = 5] | ||
Socio-cultural perceptions: exercise and physical fitness | Cultural practices and environmental possibilities to achieve physical fitness | Brisk trekking to farm, other destinations; dancing and clapping in church; drumming during festivals; food grains grinding and yam pounding; farming and gardening activities; laundry (washing clothes), sweeping floors,; and where feasible canoe paddling on rivers | |
Socio-cultural perceptions: social habits | Smoking and non-smoking tobacco and Snuff uses are wrongly perceived beneficial to health | Cigarette smoking and Snuff sniffing relieve tension and aid work [n = 1] | |
There’s a perception that local alcoholic beverage (Palm wine) and Kola nuts are beneficial to health | Palm wine makes vision clearer [n = 1], chewing kola nuts stimulate task performance and it’s a social standard for elders to chew kola nuts [n = 2] | ||
Socio-cultural perceptions: social habits | Faith-based and gender-based considerations that discourages use of alcohol and tobacco | Faith-based and gender-based abhorrence of smoking, alcohol and tobacco by women; society frowns seriously at sight of a woman smoking cigarette |
Motivational and inhibitory factors of healthy behavior: Thematic matrix of categories, sub-categories and concepts.
Notes: n refers to the number of respondents who expressed the implied view.
Cultural adaptation of the Education Program was accomplished based on the conceptual framework of formative research using information obtained from qualitative interviews with patients. The other anticipated source of information, literature review, did not yield much useful information on the topic from the study region. Osuna et al. similarly relied substantially on information from a Focus Group Discussion with participants to achieve cultural adaptation design of a diabetes Intervention program among Latinas in the United States [11]. The adaptation in our study was achieved through cultural modification of existing behavioral health practices among the local population. This involved modifying the
Furthermore, in Table 4 we highlight the thematic categories of the relationships existing between traditional local perspectives and cultural practices, and their adaptability following educational counseling drawing from newly available culturally relevant information.
Program Content & Procedure | CAHE | CHEP |
---|---|---|
Type of program | Hypertension education program | Hypertension education program |
Focus of program | Hypertension self-management | Hypertension self-management |
Implementation setting | Urban Amsterdam, Netherlands | Rural Kwara, Nigeria |
Study population | Hypertensive Primary care African immigrants (mostly literate) | Hypertensive primary care native Africans (mostly illiterate) |
Language of communication | English | Native Yoruba and Nupe |
Cultural familiarity of education counselors or trainers | Used Dutch nurse Practitioner | Used native African medical and nurse practitioners |
Information gathering method | Qualitative interviews with hypertensive participants | FGD and Qualitative interviews with hypertensive participants |
Cultural exploratory content | Exploratory from a perspective of European urban/city environment | More deeply exploratory from a perspective of rural African socio-cultural environment |
Behavioral health facilities available to support physical fitness and exercise habits | Promoted use of lifestyle referral facilities like gyms, swimming pool, walking out etc. | Promoted use of cultural and environmental possibilities like household chores, farm work, food preparation activities etc. |
Adapted component of dietary counseling | Counseled participants to reduce dietary salt consumption | Supported dietary salt reduction counseling with possibility to replace salt with a suitable local substitute |
Assessment of cultural fitness | Did not assess participants for cultural fitness | Assessed participants for cultural fitness using culturally tailored behavioral health goals |
Effect on hypertension treatment outcome | Significant improvements in diastolic blood pressure and lifestyle adherence | Significant improvements in blood pressure control, medication adherence and lifestyle adherence |
Contents and procedural variances and similarities between culturally adapted CHEP and CAHE.
Notes: CAHE – Culturally appropriate hypertension education; CHEP – Cardiovascular health education program.
Category | Sub-category | Cultural perspectives and linkages | Cultural adaptation and tailoring |
---|---|---|---|
Cultural endowments towards healthy behavior – Diet | Rural African food preservation and preparation practices | Africans are naturally accustomed to high-salt diet | Ability to replace salt with Iru, a suitable local substitute |
Medicinal use of salt | Health-driven ignorant use of salt further diminishes health | Provide enlightenment information about avoidable use of salt | |
Cultural awareness towards healthy behavior – Weight | Local perceptions about body image and size | Societal perception driven preference for big body sizes | Provide useful information to situate body size within health perspectives |
Cultural re-orientation towards healthy behavior – Exercise | Perceived danger of exercise to health | Health-driven concerns about older age-related dangers of exercise | Re-orientate about benefits/risks of age-tailored exercising |
Cultural practices and environmental endowments towards healthy behavior – Physical activity | Perceptions that it is difficult, expensive and time wasting to achieve physical fitness | Realizations that physical fitness is also achievable using usual everyday household chores, cultural and occupational activities, leisure and faith-based activities | Re-orientate patients about the possibility and practicability of cheap, user-friendly, attractive and acceptable cultural and environmental activities as exercise |
Faith-based and societal perspectives and norms | Societal perceptions of certain behaviors as ‘unfaithful’ and ‘anti-social’ e.g. smoking and use of alcohol | Health-driven exploitation of faith-based abhorrence of certain norms to drive healthy behavior | Provide useful information to exploit faith-based and gender-based socio-cultural practices |
Culturally adapted components of existing behavioral practices: Categories, sub-categories, concepts and thematic linkages.
Preliminary evaluation of the culturally adapted educational intervention was implemented in two arms: 1) cultural fitness assessment based on performance of set behavioral health goals; and 2) assessment of effectiveness based on changes in participants’ hypertension treatment outcomes.
To assess cultural fitness, we examined and recorded serial performance of set goals as reported by participants themselves over six 6 months.
Simultaneously, the effectiveness assessment study took place over same period but this not being the focus of the current study, is reported fully elsewhere [13]. Briefly it involved before-, and after assessments of changes in blood pressure (BP) control, medication adherence, behavioral adherence, and body mass index (BMI). Out of an initial 149 included participants, 140 (94%) completed the study. More participants reported high adherence to prescribed medications and behavioral advice at 6 months compared to baseline: respectively, 101 (72%) at 6 months versus 70 (50%) at baseline, (p < 0.001) and 126 (90%) at 6 months versus 106 (76%) at baseline, (p < 0.001). Similarly, participants with controlled BP doubled from 34 (24%) at baseline to 65 (46%) at 6 months, (p = 0.001). The median SBP and DBP decreased from 129.0 to 122.0 mmHg, (p = 0.002) and from 80.0 to 73.5 mmHg, (p < 0.001), respectively. However, BMI did not change (p = 0.444). The improvement in medication adherence was associated with a decrease in medication concerns (p = 0.045) and improvement in medication self-efficacy (p < 0.001).
As indicated in the methods each participant made 5 visits over 6 months: a baseline assessment visit, three intervening group education visits, and a final assessment visit. Hereunder we report the performance of set goals by participants based on self-reports. Using information from our interview data we structured existing local behavioral health practices of the region into 12 distinct culturally tailored goals (Box 1). We guided participants to select, set and practice three preferred goals during the three intervening group visits as well as at home in the weeks that followed their current visit. Their performances were assessed qualitatively during the subsequent visits.
Culturally tailored behavioral health goals set by participants
To reduce amount of salt and salt-containing condiments I currently use in food preparation and/or preservation by half before my next visit
To completely replace salt with
To increase my consumption of healthy foods by eating more fish and at least 3 servings of vegetables and fruits daily before my next visit
To decrease my consumption of unhealthy foods by eating less of red palm oil, groundnut oil, goat meat and other fatty food daily before my next visit
To stop smoking completely if I do, or at least reduce the number of cigarette sticks I smoke daily by half before my next visit
To completely discontinue the use of all socially acceptable non-smoking forms of tobacco (Taba/Snuff), and Kola nuts, or reduce the quantity I use daily by half before my next visit
To completely discontinue consumption of Alcohol and other alcoholic beverages (Spirit, Palm wine, Gin, Ogogoro) perceived as culturally acceptable, or at least reduce the quantities I consume daily by half before my next visit
To exercise more regularly using locally available methods like brisk walking, canoe paddling, cycling or others, to and from my destinations for at least 30 minutes everyday
To exercise more regularly using food preparation processes such as yam/grain pounding in mortars whenever feasible over at least 30 minutes per session before my next visit
To exercise more regularly using usual household chores such as sweeping floors, laundry (washing clothes), pulling/fetching water from wells or others over at least 30 minutes daily before my next visit
To exercise more regularly using usual farming activities such as ground hoeing, shoveling, bush clearing, manual harvesting, gardening etc. over at least 30 minutes daily before my next visit
To exercise more regularly using usual leisurely or faith-related activities such as clapping, dancing, singing, drumming, gaming or others for at least 30 minutes daily before my next visit
We inquired verbally from participants about how well they practiced selected goals during a subsequent visit and graded their responses on a Likert scale as follows:
For how many days in a week did you perform the selected goal?
Response grading: 0-1 day (poor); 2–3 days (fair); 4–5 days (good); 6–7 days (very good)
For how many minutes in a day did you perform the selected goal?
Response grading: 0–10 mins (poor); 11–20 mins (fair); 21–30 mins (good); > 30 mins (very good)
How seriously did you perceive any challenges or difficulties encountered in performing the goals you selected and how well did you resolve the challenges?
Response grading: serious challenges, not resolved (poor); moderate challenges, partly resolved (fair); minor challenges, fully resolved (good); encountered no challenges (very good)
On a scale of 1 to 4 (1 – poor, 2 – fair, 3 – good, 4 – very good), how would you rate yourself on degree of performance (effectiveness), of set goals?
Response: not performed at all (poor); sometimes performed (fair); often performed (good); always performed (very good).
Following this we graded self-rated performances of participants on a Likert scale (Table 5), and found that an overwhelming majority of them performed the selected goals reasonably well. At least 49% and 28% of participants were graded ‘good’ and ‘very good’ respectively on the number of minutes they performed selected goals daily. Furthermore, regarding number of days per week they performed selected goals, about 61% and 11% were graded ‘good’ and ‘very good’ respectively. On their abilities to resolve potential challenges faced, 18% and 56% of participants were graded ‘good’ and ‘very good’ respectively. Finally 30% and 53% of participants were graded ‘good’ and ‘very good’ respectively regarding their perceived effectiveness in performing selected goals.
Performance scale | Participants’ graded performance (Minutes/day) | Participants’ graded performance (Days/week) | Participants’ graded performance (Resolution of challenges) | Participants’ self-rated goals performance (Effectiveness) |
---|---|---|---|---|
N (%) | N (%) | N (%) | N (%) | |
Poor | 23 (16) | 21 (15) | 11 (8) | 0 |
Fair | 10 (7) | 19 (14) | 25 (18) | 24 (17) |
Good | 68 (49) | 85 (61) | 25 (18) | 42 (30) |
Very good | 39 (28) | 15 (11) | 79 (56) | 74 (53) |
Total | 140 (100) | 140 (100) | 140 (100) | 140 (100) |
Assessment of performance of set goals by participants.
The particular types of culturally adapted goals participants preferred to set and pursue yielded interesting information from our data. Viewed against the background of attractiveness and acceptability, such information can be useful in guiding physicians and care givers on behavioral health practices likely to be accepted and complied with by hypertensive patients. This type of information can predict areas in need of counseling reinforcement for patients in efforts to improve hypertension self-management skills. Extracts from our data (Table 6) reveals that the three most preferred and set goals are dietary salt reduction, exercising and compliance with pills use. Similarly, the three least preferred and set goals are stopping tobacco use, limiting alcohol use and stopping kola nuts consumption. Finally, important considerations that guided participants in selecting particular goals include funding performance of the goals, ease/rigor of performance, and access to practicing the goals.
Types of Goals | Educational Sessions | ||
---|---|---|---|
CHEP 1, N (%) | CHEP 2, N (%) | CHEP 3, N (%) | |
Diet (salt restriction) | 124 (89) | 97 (69) | 66 (47) |
Diet (fat restriction) | 23 (16) | 12 (9) | 27 (19) |
Diet (vegetables & fruits consumption) | 16 (11) | 9 (6) | 8 (6) |
Physical fitness & exercise | 121 (86) | 100 (71) | 93 (66) |
Weight reduction | 59 (42) | 47 (34) | 32 (23) |
Quit smoking | 4 (3) | 4 (3) | 2 (1) |
Quit non-smoked tobacco | 5 (4) | 2 (1) | 0 (0) |
Quit Kola nut | 14 (10) | 4 (3) | 7 (5) |
Restrict alcohol | 13 (9) | 10 (7) | 7 (5) |
Comply with pills use | 92 (66) | 78 (56) | 59 (42) |
Comply with clinic appointments | 13 (9) | 19 (14) | 15 (11) |
Frequency and types of behavioral goals set during educational sessions.
We examined the proceedings and results of cultural adaptation of a behavioral treatment program following standard guidelines, among primary care patients with hypertension from rural Nigeria highlighting cultural fitness and effectiveness of the adapted program on their hypertension self-management. Based on theoretical and conceptual framework of formative research described by Resnicow et al. [7], we combined information from exploratory interviews with hypertensive patients with extracts from a review of literature on the topic to adapt a Cardiovascular Health Education Program (CHEP) from an existing Culturally Appropriate Hypertension Education (CAHE) previously deployed among hypertensive African immigrants in the Netherlands [12]. The literature review however did not yield enough relevant information. Our goal was to increase cultural sensitivity and contents of CHEP relative to CAHE and to make the adapted CHEP relevant to specific needs of hypertensive patients from rural Nigeria. Resnicow et al. had proposed combining: a)
Following debates on the most appropriate process for cultural adaptation, researchers arrived at a consensus aggregating various approaches to establish a standard guideline involving five sequential stages: 1) information gathering, stage one; 2) preliminary adaptation design, stage two; 3) preliminary adaptation testing, stage three; 4) adaptation refinement, stage four; and 5) adaptation trial, stage five [10, 17]. In the current study however, by design we opted to adapt CHEP from CAHE using the first three of five guideline-based stages, deferring the last two stages for a future CHEP efficacy trial. A diabetes lifestyle intervention program was similarly adapted for Latinas in the USA using stages one to three only [11].
The local and cultural environments of patients in our study are endowed with materials and possibilities that influenced their hypertension self-management capacities. We found that locally grown Locust Beans ‘
Cultural fitness is determined by the extent to which a people accept and use the language, values, beliefs and materials characteristics of newly introduced culturally tailored interventions targeting their self-management skills. We assessed the adapted intervention for cultural fitness by conducting a goals setting and performance exercise among participants and got promising results on performances by most participants. Similar findings have also been reported from other studies [19, 20, 21]. Moreover during a follow-up FGD participants spoke excitedly and expressed desires to continue to use the education program even after the study. Interestingly we observed that the three most common behavioral goals practiced by participants were
Limitations encountered in this study include:
Participants could have been biased in recalling events and they may have given socially desirable answers on some aspects of our results that are based on self-reports
Without prejudice to results obtained, logistics and funding constraints limited our ability to implement all the five guideline-based cultural adaptation stages
We followed standard guidelines to culturally adapt an existing behavioral health intervention among hypertensive patients from rural Nigeria. Modeled after a similar intervention from Europe we systematically developed and adapted the new intervention using frameworks of formative research. We got quite promising results on evaluating the adapted intervention for cultural fitness and effectiveness. We submit that guide-line based culturally adapted behavioral treatments have potential to improve hypertension treatment outcomes and limit cardiovascular diseases.
The successful control of risk factors among patients at risk of cardiovascular diseases is a major goal of every attending physician. But a major obstacle to this goal is the difficulties faced by patients in adhering to prescribed pills and behavioral advices. Innovations like the current intervention which provides unique information on behavioral practices preferred and disliked by patients can guide physicians on acceptable and adoptable behaviors.
Authors are grateful to the staff of Ogo Oluwa hospital and the health insurance company. We thank Health Insurance Fund, PharmAccess Foundation, and NUFFIC for supporting the study.
The authors declare no conflict of interest.
AO drafted the manuscript, designed and conducted the study. AA revised versions of the draft. Both authors approved the final draft.
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This problematic is particularly relevant with medical imaging data, where linear techniques are frequently unsuitable for capturing variations in anatomical structures. In many cases, there is enough structure in the data (CT, MRI, ultrasound) so a lower dimensional object can describe the degrees of freedom, such as in a manifold structure. Still, complex, multivariate distributions tend to demonstrate highly variable structural topologies that are impossible to capture with a single manifold learning algorithm. This chapter will present recent techniques developed in manifold theory for medical imaging analysis, to allow for statistical organ shape modeling, image segmentation and registration from the concept of navigation of manifolds, classification, as well as disease prediction models based on discriminant manifolds. 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We study several extensions of this framework for pairwise constraint, p-Laplacian learning, hypergraph learning, etc.",book:{id:"7342",slug:"manifolds-ii-theory-and-applications",title:"Manifolds II",fullTitle:"Manifolds II - Theory and Applications"},signatures:"Xueqi Ma and Weifeng Liu",authors:null},{id:"53713",doi:"10.5772/67008",title:"An Intrinsic Characterization of Bonnet Surfaces Based on a Closed Differential Ideal",slug:"an-intrinsic-characterization-of-bonnet-surfaces-based-on-a-closed-differential-ideal",totalDownloads:1459,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"The structure equations for a two‐dimensional manifold are introduced and two results based on the Codazzi equations pertinent to the study of isometric surfaces are obtained from them. Important theorems pertaining to isometric surfaces are stated and a theorem due to Bonnet is obtained. A transformation for the connection forms is developed. It is proved that the angle of deformation must be harmonic, and that the differentials of many of the important variables generate a closed differential ideal. This implies that a coordinate system exists in which many of the variables satisfy particular ordinary differential equations, and these results can be used to characterize Bonnet surfaces.",book:{id:"5488",slug:"manifolds-current-research-areas",title:"Manifolds",fullTitle:"Manifolds - Current Research Areas"},signatures:"Paul Bracken",authors:[{id:"92883",title:"Prof.",name:"Paul",middleName:null,surname:"Bracken",slug:"paul-bracken",fullName:"Paul Bracken"}]},{id:"72257",doi:"10.5772/intechopen.92441",title:"Quasiconformal Reflections across Polygonal Lines",slug:"quasiconformal-reflections-across-polygonal-lines",totalDownloads:419,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"An important open problem in geometric complex analysis is to establish algorithms for explicit determination of the basic curvelinear and analytic functionals intrinsically connected with conformal and quasiconformal maps, such as their Teichmüller and Grunsky norms, Fredholm eigenvalues and the quasireflection coefficient. This has not been solved even for convex polygons. This case has intrinsic interest in view of the connection of polygons with the geometry of the universal Teichmüller space and approximation theory. This survey extends our previous survey of 2005 and presents the new approaches and recent essential progress in this field of geometric complex analysis, having various important applications. Another new topic concerns quasireflections across finite collections of quasiintervals.",book:{id:"8760",slug:"structure-topology-and-symplectic-geometry",title:"Structure Topology and Symplectic Geometry",fullTitle:"Structure Topology and Symplectic Geometry"},signatures:"Samuel L. Krushkal",authors:[{id:"316576",title:"Prof.",name:"Samuel",middleName:null,surname:"Krushkal",slug:"samuel-krushkal",fullName:"Samuel Krushkal"}]}],mostDownloadedChaptersLast30Days:[{id:"73123",title:"Some Applications of Clifford Algebra in Geometry",slug:"some-applications-of-clifford-algebra-in-geometry",totalDownloads:784,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In this chapter, we provide some enlightening examples of the application of Clifford algebra in geometry, which show the concise representation, simple calculation, and profound insight of this algebra. The definition of Clifford algebra implies geometric concepts such as vector, length, angle, area, and volume and unifies the calculus of scalar, spinor, vector, and tensor, so that it is able to naturally describe all variables and calculus in geometry and physics. Clifford algebra unifies and generalizes real number, complex, quaternion, and vector algebra and converts complicated relations and operations into intuitive matrix algebra independent of coordinate systems. By localizing the basis or frame of space-time and introducing differential and connection operators, Clifford algebra also contains Riemann geometry. Clifford algebra provides a unified, standard, elegant, and open language and tools for numerous complicated mathematical and physical theories. Clifford algebra calculus is an arithmetic-like operation that can be well understood by everyone. This feature is very useful for teaching purposes, and popularizing Clifford algebra in high schools and universities will greatly improve the efficiency of students to learn fundamental knowledge of mathematics and physics. So, Clifford algebra can be expected to complete a new big synthesis of scientific knowledge.",book:{id:"8760",slug:"structure-topology-and-symplectic-geometry",title:"Structure Topology and Symplectic Geometry",fullTitle:"Structure Topology and Symplectic Geometry"},signatures:"Ying-Qiu Gu",authors:[{id:"314607",title:"Dr.",name:"Ying-Qiu",middleName:null,surname:"Gu",slug:"ying-qiu-gu",fullName:"Ying-Qiu Gu"}]},{id:"52596",title:"Symplectic Manifolds: Gromov-Witten Invariants on Symplectic and Almost Contact Metric Manifolds",slug:"symplectic-manifolds-gromov-witten-invariants-on-symplectic-and-almost-contact-metric-manifolds",totalDownloads:1496,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In this chapter, we introduce Gromov-Witten invariant, quantum cohomology, Gromov-Witten potential, and Floer cohomology on symplectic manifolds, and in connection with these, we describe Gromov-Witten type invariant, quantum type cohomology, Gromov-Witten type potential and Floer type cohomology on almost contact metric manifolds. 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Manifold regularization is one of the most popular works that exploits the geometry of the probability distribution that generates the data and incorporates them as regularization terms. There are many representative works of manifold regularization including Laplacian regularization (LapR), Hessian regularization (HesR) and p-Laplacian regularization (pLapR). Based on the manifold regularization framework, many extensions and applications have been reported. In the chapter, we review the LapR and HesR, and we introduce an approximation algorithm of graph p-Laplacian. 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According to the behaviour of the tangent bundle of a sub-manifold, with respect to the action of almost Riemannian product structure of the ambient manifolds, we have three typical classes of sub-manifolds such as invariant sub-manifolds, anti-invariant sub-manifolds and semi-invariant sub-manifolds. In addition, slant, semi-slant and pseudo-slant sub-manifolds are introduced by many geometers.",book:{id:"5488",slug:"manifolds-current-research-areas",title:"Manifolds",fullTitle:"Manifolds - Current Research Areas"},signatures:"Mehmet Atçeken, Ümit Yıldırım and Süleyman Dirik",authors:[{id:"191326",title:"Prof.",name:"Mehmet",middleName:null,surname:"Atceken",slug:"mehmet-atceken",fullName:"Mehmet Atceken"},{id:"196148",title:"Dr.",name:"Umit",middleName:null,surname:"Yildirim",slug:"umit-yildirim",fullName:"Umit Yildirim"}]},{id:"52886",title:"Head Pose Estimation via Manifold Learning",slug:"head-pose-estimation-via-manifold-learning",totalDownloads:1793,totalCrossrefCites:4,totalDimensionsCites:3,abstract:"For the last decades, manifold learning has shown its advantage of efficient non-linear dimensionality reduction in data analysis. Based on the assumption that informative and discriminative representation of the data lies on a low-dimensional smooth manifold which implicitly embedded in the original high-dimensional space, manifold learning aims to learn the low-dimensional representation following some geometrical protocols, such as preserving piecewise local structure of the original data. Manifold learning also plays an important role in the applications of computer vision, i.e., face image analysis. According to the observations that many face-related research is benefitted by the head pose estimation, and the continuous variation of head pose can be modelled and interpreted as a low-dimensional smooth manifold, we will focus on the head pose estimation via manifold learning in this chapter. Generally, head pose is hard to directly explore from the high-dimensional space interpreted as face images, which is, however, can be efficiently represented in low-dimensional manifold. Therefore, in this chapter, classical manifold learning algorithms are introduced and the corresponding application on head pose estimation are elaborated. Several extensions of manifold learning algorithms which are developed especially for head pose estimation are also discussed and compared.",book:{id:"5488",slug:"manifolds-current-research-areas",title:"Manifolds",fullTitle:"Manifolds - Current Research Areas"},signatures:"Chao Wang, Yuanhao Guo and Xubo Song",authors:[{id:"190308",title:"Dr.",name:"Chao",middleName:null,surname:"Wang",slug:"chao-wang",fullName:"Chao Wang"},{id:"190461",title:"Prof.",name:"Xubo",middleName:null,surname:"Song",slug:"xubo-song",fullName:"Xubo Song"},{id:"191562",title:"MSc.",name:"Yuanhao",middleName:null,surname:"Guo",slug:"yuanhao-guo",fullName:"Yuanhao Guo"}]}],onlineFirstChaptersFilter:{topicId:"165",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Science",numberOfPublishedBooks:9,numberOfPublishedChapters:100,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],subseriesList:[{id:"22",title:"Applied Intelligence",scope:"This field is the key in the current industrial revolution (Industry 4.0), where the new models and developments are based on the knowledge generation on applied intelligence. The motor of the society is the industry and the research of this topic has to be empowered in order to increase and improve the quality of our lives.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",keywords:"Machine Learning, Intelligence Algorithms, Data Science, Artificial Intelligence, Applications on Applied Intelligence"},{id:"23",title:"Computational Neuroscience",scope:"Computational neuroscience focuses on biologically realistic abstractions and models validated and solved through computational simulations to understand principles for the development, structure, physiology, and ability of the nervous system. This topic is dedicated to biologically plausible descriptions and computational models - at various abstraction levels - of neurons and neural systems. This includes, but is not limited to: single-neuron modeling, sensory processing, motor control, memory, and synaptic plasticity, attention, identification, categorization, discrimination, learning, development, axonal patterning, guidance, neural architecture, behaviors, and dynamics of networks, cognition and the neuroscientific basis of consciousness. Particularly interesting are models of various types of more compound functions and abilities, various and more general fundamental principles (e.g., regarding architecture, organization, learning, development, etc.) found at various spatial and temporal levels.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",keywords:"Single-Neuron Modeling, Sensory Processing, Motor Control, Memory and Synaptic Pasticity, Attention, Identification, Categorization, Discrimination, Learning, Development, Axonal Patterning and Guidance, Neural Architecture, Behaviours and Dynamics of Networks, Cognition and the Neuroscientific Basis of Consciousness"},{id:"24",title:"Computer Vision",scope:"The scope of this topic is to disseminate the recent advances in the rapidly growing field of computer vision from both the theoretical and practical points of view. Novel computational algorithms for image analysis, scene understanding, biometrics, deep learning and their software or hardware implementations for natural and medical images, robotics, VR/AR, applications are some research directions relevant to this topic.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",keywords:"Image Analysis, Scene Understanding, Biometrics, Deep Learning, Software Implementation, Hardware Implementation, Natural Images, Medical Images, Robotics, VR/AR"},{id:"25",title:"Evolutionary Computation",scope:"Evolutionary computing is a paradigm that has grown dramatically in recent years. This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",keywords:"Genetic Algorithms, Genetic Programming, Evolutionary Programming, Evolution Strategies, Hybrid Algorithms, Bioinspired Metaheuristics, Ant Colony Optimization, Evolutionary Learning, Hyperparameter Optimization"},{id:"26",title:"Machine Learning and Data Mining",scope:"The scope of machine learning and data mining is immense and is growing every day. It has become a massive part of our daily lives, making predictions based on experience, making this a fascinating area that solves problems that otherwise would not be possible or easy to solve. This topic aims to encompass algorithms that learn from experience (supervised and unsupervised), improve their performance over time and enable machines to make data-driven decisions. It is not limited to any particular applications, but contributions are encouraged from all disciplines.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",keywords:"Intelligent Systems, Machine Learning, Data Science, Data Mining, Artificial Intelligence"},{id:"27",title:"Multi-Agent Systems",scope:"Multi-agent systems are recognised as a state of the art field in Artificial Intelligence studies, which is popular due to the usefulness in facilitation capabilities to handle real-world problem-solving in a distributed fashion. The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Artificial Intelligence",id:"14"},selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"May 7th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:96,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/85199",hash:"",query:{},params:{id:"85199"},fullPath:"/profiles/85199",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()