BackgroundNon-communicable diseases (NCD) are the leading causes of death globally. In Pakistan, they are among the top ten causes of mortality, especially in the productive age group (30–69 years). Evidence suggests that health perceptions and beliefs strongly influence the health behavior of an individual. We performed focus group interviews to delineate the same so as to design the user interface of a non-invasive stroke risk monitoring device.MethodsIt was a qualitative study, designed to explore how health perceptions and beliefs influence behavior for NCD prevention. Four focus group discussions (FGD) were conducted with 30 stable participants who had diabetes mellitus, ischemic heart disease, blood pressure, and stroke. The data was collected using a semi-structured interview guide designed to explore participants’ perceptions of their illnesses, self-management behaviors and factors affecting them. The interviews were transcribed and content analysis was done using steps of content analysis by Morse and Niehaus [10].ResultsMedication adherence, self-monitoring of blood sugars and blood pressures, and medical help seeking were the commonly performed self-management behaviors by the participants. Personal experience of illness, familial inheritance of disease, education and fear of premature death when life responsibilities were unfulfilled, emerged as strong facilitators of self-management behaviors. A sense of personal invincibility, Fatalism or inevitability, lack of personal threat realization, limited knowledge, inadequate health education, health care and financial constraints appeared as key barriers to the self-management of chronic disease in participants.ConclusionsBehavioural interventional messaging will have to engender a sense of personal vulnerability and yet empower self-efficacy solutions at the individual level to deal with both invincibility and inevitability barriers to adoption of healthy behavior.

BackgroundThe electrocardiogram is the most convenient and widely used method of cardiac monitoring. The information provided by the ECG has the potential to be used as a means by which cardiac arrhythmia can be detected at an early stage in order to prevent life-threatening complications. Its significance is widely accepted in the medical field so much so that tele-monitoring is being utilized across the world for cardiac activity. To perform cardiac monitoring more efficiently, a mobile application, used in conjunction with a sensor unit, is designed to perform real-time monitoring of the cardiac signal. The device consists of 3-lead EKG patches with an integrated Bluetooth module allowing a point-to-point pairing between the hardware and smartphone application. The hardware can either be placed on humanoid robot arm fingers or connected to a wearable patch placed on the chest. A real-time EKG signal is transmitted to the Android application on which a time vs. voltage plot will be displayed. ResultsThe device was tested using the ProSim8 ECG simulator by Fluke Biomedical. The test confirmed the signal quality of the ECG signal with clear P, QRS, and T waves. ConclusionsThis device provides a more cost-effective telemedicine solution for cardiac home care assistance in remote areas which can serve as a viable alternative to conventional monitors as it has the potential to reduce the time for clinical procedures

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BACKGROUND Pakistan has an estimated 7 million stroke survivors. It is estimated that around 80% of these events can be prevented by early detection of clinically silent risk factors and conditions like hypertension (HTN), diabetes (DM), atrial fibrillation (Afib) and abnormal cholesterol metabolism. OBJECTIVE We proposed to develop an intelligent device that enables noninvasive detection of blood pressure, Electrocardiography (EKG) and blood glucose levels accompanied with interactive feedback based software that runs on android based cell phones, that interprets these values. We tested the feasibility of use in Pakistani families. Our rationale is to use this technology to enable early risk detection and prevent strokes. METHODS A pragmatic prototype testing along with qualitative interviews was conducted. Four families living in Karachi, Pakistan were identified through convenience sampling. The study participants included apparent healthy as well as those who have known NCD risks factors like Hypertension, Diabetes Mellitus, atrial fibrillation and others. Each family member received a detailed teaching session on how to use the device. Each participant was instructed to record the minimal periodic measurements required for the study. RESULTS The study was conducted from August to September 2015. A total of 4 families were approached and total of 12 participants with 5 males and 7 females were recruited. The mean age of the participants was 51±14.97 years. The participants were instructed to perform at least 3-4 observations daily by their device for period of four weeks. In total 90 observations were made over a period of 4 weeks. During the study period the device detected, hypertension in 9 readings, hypotension in 18, abnormal hyperglycemia was detected 7 times, low glucose values in 13, tachycardia 5 times, bradycardia 2 times and atrial fibrillation was identified in one user. In order to verify abnormal readings identified by the device repeated observations and validated tests were performed. All medically important observations identified by device also received physician consultation. Qualitative in-depth interviews were performed for user feedback which further informed refinement of device for use in diverse settings and users in future testing. CONCLUSIONS The proof of concept demonstrated the real time feasibility of the use of the device in an LMIC setting. It repeatedly identified modifiable risk factors within the study participants over four weeks. Wi-Fi networks with their bandwidths currently operating within Pakistan were able to support the remote detection of abnormalities and transmit the data for recording and interpretation. CLINICALTRIAL Not Applicable. This is not a trial.