Association of Novel Clinical and Behavioural Markers with HbA1c Improvement: A Latent Class Analysis of 912 Patients with Type 2 Diabetes Mellitus.

Objective: The escalating prevalence of Type 2 Diabetes Mellitus (T2DM) overwhelms healthcare systems. Lifestyle interventions enhancing patient monitoring and adherence vary in efficacy, emphasizing the need to understand differential response across patient subgroups. This study aimed to segment patients with T2DM into distinct latent classes and identify characteristics associated with optimal 12-month glycated haemoglobin (HbA1c) reduction.

Exploring the Determinants of Age-Friendly Neighbourhoods Among Seniors Residing in a Low-Income Urban Community in Singapore: A Participatory Study.

The growing interest regarding the role of the living environment in healthy ageing highlights the need to investigate place-related urban features contributing to health and socio-emotional wellbeing. This study aimed to use a participatory methodology to explore the determinants of an age-friendly neighbourhood built environment that promotes or limits healthy ageing in place among seniors residing in a low-income urban community in Singapore. The study utilised photovoice and semi-structured interviews with 25 community-dwelling seniors aged 65 and above, residing in government-built public housing.

Advancing social prescribing in Singapore: an update on progress.

In 2019, SingHealth Community Hospitals (SCH) introduced Social Prescribing (SP) program to support patients in transitioning back to the community after hospitalization, which involves personalized care plans developed by Wellbeing Coordinators (WBCs) to connect patients with relevant community resources. With the recent launch of the nation-wide 'Healthier SG' initiative, a population health strategy in Singapore aimed at enabling individuals to prevent and manage chronic diseases, it is important to provide an update on our program's recent developments. This includes creating a living asset map, updating outcome assessment tools, organizing training sessions to enhance the skills SP practitioners, and establishing the Singapore Community of Practice in Social Prescribing (SCOMP).

Psychological Resilience in Post-acute Care: A Cross-Sectional Study of Health Care Workers in Singapore Community Hospitals.

Objectives: Psychological resilience is a crucial component of mental health and well-being for health care workers. It is positively linked to compassion satisfaction and inversely associated with burnout. The current literature on health care worker resilience has mainly focused on primary care and tertiary hospitals, but there is a lack of studies in post-acute and transitional care settings.

How family physicians in Singapore recognise complexity during consultations: a qualitative study.

Background: The prevalence of persons with complex needs in Singapore is rising. Poor understanding of what constitutes complexity impedes the identification of care gaps and development of interventions to improve care for these individuals. We aim to identify the characteristics contributing to complexity in primary care, from the Family Physicians' (FP) perspectives.

Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study.

Background: Older adults worldwide experienced heightened risks of depression, anxiety, loneliness, and poor mental well-being during the COVID-19 pandemic. During this period, digital technology emerged as a means to mitigate social isolation and enhance social connectedness among older adults. However, older adults' behaviors and attitudes toward the adoption and use of digital technology are heterogeneous and shaped by factors such as age, income, and education.

Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study.

Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension.

Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs.

Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care.

Acceptability of Mobile App-Based Motivational Interviewing and Preferences for App Features to Support Self-Management in Patients With Type 2 Diabetes: Qualitative Study.

Background: Patients with type 2 diabetes mellitus (T2DM) experience multiple barriers to improving self-management. Evidence suggests that motivational interviewing (MI), a patient-centered communication method, can address patient barriers and promote healthy behavior. Despite the value of MI, existing MI studies predominantly used face-to-face or phone-based interventions.

Empowering patients with comorbid diabetes and hypertension through a multi-component intervention of mobile app, health coaching and shared decision-making: Protocol for an effectiveness-implementation of randomised controlled trial.

Introduction: Diabetes and hypertension are prevalent and costly to the health system. We have developed a mobile app (EMPOWER app) which enables remote monitoring and education through personalised nudges. We aim to study the effectiveness of a multi-component intervention comprising the EMPOWER mobile app with health coaching and shared decision-making for diabetes and hypertension.

Frameworks for measuring population health: A scoping review.

Introduction: Many regions in the world are using the population health approach and require a means to measure the health of their population of interest. Population health frameworks provide a theoretical grounding for conceptualization of population health and therefore a logical basis for selection of indicators. The aim of this scoping review was to provide an overview and summary of the characteristics of existing population health frameworks that have been used to conceptualize the measurement of population health.

Prevalence and factors associated with sarcopenia among older adults in a post-acute hospital in Singapore.

Background: Sarcopenia is common in older adults worldwide, but its prevalence varies widely owing to differences in diagnostic criteria, population sampled, and care setting. We aimed to determine the prevalence and factors associated with sarcopenia in patients aged 65 and above admitted to a post-acute hospital in Singapore.

Methods: This was a cross-sectional study of 400 patients recruited from a community hospital in Singapore.

Artificial intelligence, ChatGPT, and other large language models for social determinants of health: Current state and future directions.

This perspective highlights the importance of addressing social determinants of health (SDOH) in patient health outcomes and health inequity, a global problem exacerbated by the COVID-19 pandemic. We provide a broad discussion on current developments in digital health and artificial intelligence (AI), including large language models (LLMs), as transformative tools in addressing SDOH factors, offering new capabilities for disease surveillance and patient care. Simultaneously, we bring attention to challenges, such as data standardization, infrastructure limitations, digital literacy, and algorithmic bias, that could hinder equitable access to AI benefits.

Socioeconomic and behavioral determinants of non-compliance with physician referrals following community screening for diabetes, hypertension and hyperlipidemia: a mixed-methods study.

Early detection of undiagnosed diabetes, hypertension or hyperlipidemia through screening could reduce healthcare costs resulting from disease complications. To date, despite ample research on the factors linked to the uptake of community health screening programs, little attention has been directed at delayed or incomplete follow-up after positive outcomes are identified in community screening tests. This study aimed to investigate the socioeconomic and behavioral factors that influence non-compliance with recommendations for primary care physician referrals, following community-based screening for diabetes, hypertension and hyperlipidemia.

A policy ethnography study of a Singapore regional health system on its governance adaptations and associated challenges as a project organisation to implement Healthier Singapore.

Objectives: Project organisations reflect a modern and non-bureaucratic form of organising public-sector activities, which promises innovation, entrepreneurship, and order and control to bring about change. This study seeks to investigate the project organisation Singapore Health Services (SingHealth) Region Health System (RHS)'s approach to implementing the Healthier Singapore (HSG) strategy, including models of governance and perceptions of RHS leads, identify the challenges facing the RHS, and to draw insights into the conditions necessary for using project organisation as a policy tool in policy implementation.

Study Design: We adopted a policy ethnography approach to answering the research question.

Evaluating the association of COVID-19 restrictions on discharge planning and post-discharge outcomes in the community hospital and Singapore regional health system.

Objectives: The COVID-19 is a global health issue with widespread impact around the world, and many countries initiated lockdowns as part of their preventive measures. We aim to quantify the duration of delay in discharge to community from Community Hospitals, as well as quantify adverse patient outcomes post discharge pre and during lockdown period.

Design And Methods: We conducted a before-after study comparing the length of stay in Community Hospitals, unscheduled readmissions or Emergency Department attendance, patients' quality of life using EQ5D-5l, number and severity of falls, in patients admitted and discharged before and during lockdown period.

Role of Caregivers in Remote Management of Patients With Type 2 Diabetes Mellitus: Systematic Review of Literature.

Background: With the growing use of remote monitoring technologies in the management of patients with type 2 diabetes mellitus (T2DM), caregivers are becoming important resources that can be tapped into to improve patient care.

Objective: This review aims to summarize the role of caregivers in the remote monitoring of patients with T2DM.

Methods: We performed a systematic review in MEDLINE, Embase, Scopus, PsycINFO, and Web of Science up to 2022.

Smartphone ownership, digital literacy, and the mediating role of social connectedness and loneliness in improving the wellbeing of community-dwelling older adults of low socio-economic status in Singapore.

Introduction: During the COVID-19 pandemic, safe-distancing measures resulted in many community-dwelling older adults being socially isolated and lonely, with its attending negative impact on wellbeing and quality of life. While digital technology may have mitigated this, older adults of low socioeconomic status (SES) are more likely to be digitally excluded and hence susceptible to the adverse effects of social isolation and loneliness. This study aims to understand the factors that affect digital literacy, smartphone ownership, and willingness to participate in a digital literacy program (DLP), and to test the hypothesized relations between digital literacy, social connectedness, loneliness, wellbeing, and quality of life amongst community dwelling older adults of low SES.

Pandemic-related health literacy: a systematic review of literature in COVID-19, SARS and MERS pandemics.

Introduction: Health literacy plays an essential role in one's ability to acquire and understand critical medical information in the coronavirus disease 2019 (COVID-19) infodemic and in other pandemics. We aimed to summarise the assessment, levels and determinants of pandemic-related health literacy and its associated clinical outcomes.

Methods: A systematic review was performed in Medline, Embase, PsycINFO, CINAHL and four major preprint servers.

Implementation of social prescribing: lessons learnt from contextualising an intervention in a community hospital in Singapore.

The need to develop holistic public health approaches that go beyond treating the biological causes of ill health, to addressing the social determinants of health, have been highlighted in the global health agenda. Social prescribing, where care professionals link individuals to community resources that tackle social needs have gained increasing traction worldwide. In Singapore, SingHealth Community Hospitals introduced social prescribing in July 2019 to manage the complex health and social needs of the aging populace.

Lessons learned from the hospital to home community care program in Singapore and the supporting AI multiple readmissions prediction model.

In a prior practice and policy article published in Healthcare Science, we introduced the deployed application of an artificial intelligence (AI) model to predict longer-term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home (H2H) program that has been operating since 2017. In this follow on practice and policy article, we further elaborate on Singapore's H2H program and care model, and its supporting AI model for multiple readmission prediction, in the following ways: (1) by providing updates on the AI and supporting information systems, (2) by reporting on customer engagement and related service delivery outcomes including staff-related time savings and patient benefits in terms of bed days saved, (3) by sharing lessons learned with respect to (i) analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants, (ii) balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables, and (iii) the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems, (4) by highlighting how this H2H effort supported broader Covid-19 response efforts across Singapore's public healthcare system, and finally (5) by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards. For the convenience of the reader, some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.

Association of Social Support with Rehabilitation Outcome among Older Adults with Hip Fracture Surgery: A Prospective Cohort Study at Post-Acute Care Facility in Asia.

Objectives: There is growing interest in the role of social support during the recovery after hip fractures. The research to date has been mainly focused on structural support, with few studies concerned with functional support. This study examined the effects of both functional and structural aspects of social support on rehabilitation outcomes among older adults with hip fracture surgery.

Factors Influencing the Uptake of Seasonal Influenza Vaccination among Community-Dwelling Older Adults during COVID-19: A Mixed Methods Study.

: Despite making the influenza vaccine accessible and affordable, vaccination rates remained low among community-dwelling older adults. Therefore, this study aimed to explore the factors influencing vaccine uptake and the impact of COVID-19 on vaccine uptake among community-dwelling older adults in Singapore. A mixed methods study involving a survey and semi-structured interviews were conducted between September 2020 and July 2021.