Imperial College London

Eva F Riboli-Sasco

Faculty of MedicineDepartment of Surgery & Cancer

Research Assistant
 
 
 
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e.riboli-sasco

 
 
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Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

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19 results found

Riboli-Sasco E, El-Osta A, El Asmar ML, Karki M, Kerr G, Sathaymoorthy G, Majeed Aet al., 2024, Investigating barriers & facilitators for the successful implementation of the BP@home initiative in London: Primary care perspectives., PLoS One, Vol: 19

BACKGROUND: The COVID-19 pandemic led to the implementation of a national policy of shielding to safeguard clinically vulnerable patients. To ensure consistent care for high-risk patients with hypertension, NHS England introduced the BP@home initiative to enable patients to self-monitor their blood pressure by providing them with blood pressure monitors. This study aimed to identify barriers and facilitators to the implementation of the initiative based on the experience and perspectives of programme managers and healthcare professionals (HCPs) involved in its implementation in London. METHODS AND FINDINGS: We conducted five semi-structured focus groups and one individual interview with a total of 20 healthcare professionals involved at different levels and stages in the BP@home initiative across four of the five London Integrated Care Systems (ICSs). All focus groups and interviews were audio-recorded, transcribed and analysed thematically following the Framework Method. Respondents reported being challenged by the lack of adequate IT, human and financial resources to support the substantial additional workload associated with the programme. These issues resulted in and reinforced the differential engagement capacities of PCNs, practices and patients, thus raising equity concerns among respondents. However respondents also identified several facilitators, including the integration of the eligibility criteria into the electronic health record (EHR), especially when combined with the adoption of practice-specific, pragmatic and opportunistic approaches to the onboarding of patients. Respondents also recommended the provision of blood pressure monitors (BPMs) on prescription, additional funding and training based on needs assessment, the incorporation of BP@home into daily practice and simplification of IT tools, and finally the adoption of a person-centred care approach. Contextualised using the second iteration of the Consolidated Framework for Implementation Resear

Journal article

Huang D, Goodship A, Webber I, Alaa A, Riboli-Sasco E, Hayhoe B, El-Osta Aet al., 2023, Experience and severity of menopause symptoms and effects on health-seeking behaviours: a cross sectional online survey of community dwelling adults in the United Kingdom, BMC Women's Health, Vol: 23, Pages: 1-10, ISSN: 1472-6874

Background Almost all women will experience menopause, and the symptoms can have a severely detrimental impact on their quality of life. However, there is limited research exploringhealth-seeking behaviours and alternative service design or consultation formats. Group consultations have been successfully deployed in perinatal and diabetic care, improving accessibility and outcomes. This cross-sectional online survey was conducted to explore women’s personal experiences of menopause, including perspectives on group consultations. Methods An online survey investigated the experiences of individuals at all stages of menopause and their receptiveness towards group consultations for menopause. Respondents were categorised by menopause stage according to the STRAW +10 staging system. Associations between menopause stage, acceptability of group consultations and participant demographics were assessed using logistic regression. Results Respondents experienced an average of 10.7 menopausal symptoms, but only 47% of respondents felt they had the knowledge and tools to manage their symptoms. Advice on menopause was sought from a healthcare professional (HCP) by 61% of respondents, the largest trigger for this being severity of symptoms and the main barrier for this was the perception that menopause wasn’t a valid enough reason to seek help. Of the respondents seeking advice from HCP, 32% were prescribed transdermal HRT, 30% received oral HRT, 19% were offered antidepressants, 18% received local oestrogen and 6% were prescribed testosterone. Over three quarters (77%) of respondents indicated that they would join a group consultation for menopause and would be comfortable sharing their experiences with others (75%). Logistic regression indicated premenopausal respondents were 2.84 times more likely than postmenopausal women to be interested in a group consultation where they can meet or learn from others’ experiences.Conclusions This study highlighted a strong

Journal article

El-Osta A, Riboli Sasco E, Barbanti E, Webber I, Alaa A, Karki M, El Asmar M, Almadi M, Massoud F, Alboksmaty A, Majeed Aet al., 2023, Tools for measuring individual self-care capability: a scoping review, BMC Public Health, Vol: 23, Pages: 1-31, ISSN: 1471-2458

BackgroundOur ability to self-care can play a crucial role in the prevention, management and rehabilitation of diverse conditions, including chronic non-communicable diseases. Various tools have been developed to support the measurement of self-care capabilities of healthy individuals, those experiencing everyday self-limiting conditions, or one or more multiple long-term conditions. We sought to characterise the various non-mono-disease specific self-care measurement tools for adults as such a review was lacking.ObjectiveThe aim of the review was to identify and characterise the various non-mono-disease specific self-care measurement tools for adults. Secondary objectives were to characterise these tools in terms of their content, structure and psychometric properties.DesignScoping review with content assessment.MethodsThe search was conducted in Embase, PubMed, PsycINFO and CINAHL databases using a variety of MeSH terms and keywords covering 1 January 1950 to 30 November 2022. Inclusion criteria included tools assessing health literacy, capability and/or performance of general health self-care practices and targeting adults. We excluded tools targeting self-care in the context of disease management only or indicated to a specific medical setting or theme. We used the Seven Pillars of Self-Care framework to inform the qualitative content assessment of each tool.ResultsWe screened 26,304 reports to identify 38 relevant tools which were described in 42 primary reference studies. Descriptive analysis highlighted a temporal shift in the overall emphasis from rehabilitation-focused to prevention-focused tools. The intended method of administration also transitioned from observe-and-interview style methods to the utilisation of self-reporting tools. Only five tools incorporated questions relevant to the seven pillars of self-care.ConclusionsVarious tools exist to measure individual self-care capability, but few consider assessing capability against all seven pillars of s

Journal article

Sivarajasingam V, Webber I, Riboli-Sasco E, Alaa A, El-Osta Aet al., 2023, Investigating public awareness, prevailing attitudes and perceptions towards domestic violence and abuse in the UK: a qualitative study, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 73, ISSN: 0960-1643

Journal article

El-Osta A, Riboli-Sasco E, 2023, Characterising extant technology related barriers & enablers for streamlined delivery of BP@home in North Central London: Report for NCL LTC Clinical Network, Publisher: Self-Care Academic Research Unit, Imperial College London

Report objectives:This report summarises the key findings of a place-based evaluation to identify barriers and enablers to the streamlined use of digital tools to support successfulimplementation of BP@home in North Central London (NCL). Specifically, we characterised the IT landscape in NCL, investigated the views and experiences of HCPs regarding the use of place-based IT solutions and processes, and synthesised a list of evidence-based recommendations for the consideration of NCL leadership team.Methods:We used a mixed methods research approach and six phases of investigation to address these aims, including desktop research, personal interviews and focusgroups, action research, data analysis, synthesis and reporting.Results:The evaluation showed that there was a lack of standardisation across IT systems, internal processes and templates in PCNs in NCL, leading to challenges inimplementing and using digital tools to support BP@home. These challenges were not unique to NCL. AccurX and the locally created NCL template are the most widely used IT tools to support the program in NCL. Other digital platforms being tested in NCL include Suvera, each with unique strengths and weaknesses. Other digital tools, such as Omron Connect, could be considered to support management of hypertension and other chronic conditions. HCPs faced challenges with patient engagement, data quality, IT system integration and resource allocation, but generally felt that the current approach works. Basic requirements for the use andadoption of IT tools and systems include adequate resources, stakeholder engagement, user-friendly interfaces, and interoperability between different systems. We proposed 16 actionable insights and recommendations that could be implemented to help improve the delivery of BP@home in NCL. These includestandardising IT systems, improving patient engagement, providing adequate training and support, and promoting the benefits of remote monitoring.Conclusion:On balance, we

Report

Riboli-Sasco E, El-Osta A, Alaa A, Webber I, Karki M, El Asmar ML, Purohit K, Painter A, Hayhoe Bet al., 2023, Triage and diagnostic accuracy of Online Symptom Checkers: a systematic review, Journal of Medical Internet Research, Vol: 25, Pages: 1-18, ISSN: 1438-8871

Background:In the context of a deepening global shortage of health workers and, in particular, the COVID-19 pandemic, there is growing international interest in, and use of, online symptom checkers (OSCs). However, the evidence surrounding the triage and diagnostic accuracy of these tools remains inconclusive.Objective:This systematic review aimed to summarize the existing peer-reviewed literature evaluating the triage accuracy (directing users to appropriate services based on their presenting symptoms) and diagnostic accuracy of OSCs aimed at lay users for general health concerns.Methods:Searches were conducted in MEDLINE, Embase, CINAHL, Health Management Information Consortium (HMIC), and Web of Science, as well as the citations of the studies selected for full-text screening. We included peer-reviewed studies published in English between January 1, 2010, and February 16, 2022, with a controlled and quantitative assessment of either or both triage and diagnostic accuracy of OSCs directed at lay users. We excluded tools supporting health care professionals, as well as disease- or specialty-specific OSCs. Screening and data extraction were carried out independently by 2 reviewers for each study. We performed a descriptive narrative synthesis.Results:A total of 21,296 studies were identified, of which 14 (0.07%) were included. The included studies used clinical vignettes, medical records, or direct input by patients. Of the 14 studies, 6 (43%) reported on triage and diagnostic accuracy, 7 (50%) focused on triage accuracy, and 1 (7%) focused on diagnostic accuracy. These outcomes were assessed based on the diagnostic and triage recommendations attached to the vignette in the case of vignette studies or on those provided by nurses or general practitioners, including through face-to-face and telephone consultations. Both diagnostic accuracy and triage accuracy varied greatly among OSCs. Overall diagnostic accuracy was deemed to be low and was almost always lower than t

Journal article

Manisha K, El-Asmar M, Riboli-Sasco E, Loombia P, Harland D, Neville R, El-Osta Aet al., 2023, What is the potential of public libraries to promote public mental health and wellbeing? Findings from a cross-sectional study of community-dwelling adults, Sage Open, ISSN: 2158-2440

Purpose of research:To explore the potential of libraries as community hubs to promote mental and physical health and wellbeing.Design:Cross-sectional online survey and interview-based study with community-dwelling adults and library staff.Methods:We analysed data from 58 respondents using a 14-item electronic survey and conducted interviews with 12 library users and staff to gauge perceptions. Descriptive statistics and thematic analysis were used to identify key trends and emergent themes.Results:Libraries remain popular and are considered a 'safe place' by members of thecommunity, irrespective of whether they are frequent users of services. Library users' lack of awareness of community-facing services could act as a hurdle to improving community health and wellbeing. Targeted engagement with residents is needed to increase awareness of the services libraries offer, including community interventions to help tackle loneliness and inequalities in digital and health literacy. Library staff often did not feel involved in important decision-making. Various barriers and drivers and practical recommendations were identified to leverage libraries as hubs to promotecommunity health and wellbeing.Conclusion:Libraries already offer a variety of resources that either directly or indirectly support the health and wellbeing of community-dwelling adults and young people, but public awareness of these services is limited. By acting as community hubs, libraries are ideally suited to deliver interventions to help tackle the increasing health and digital inequalities following the advent of the COVID-19 pandemic.

Journal article

El-Osta A, Riboli-Sasco E, Banarsee R, 2023, Identifying technology related barriers & enablers to streamlining delivery of BP@home in NCL, Publisher: The Self-Care Academic Research Unit (SCARU)

Report objectives:This report summarises the key findings of a place-based evaluation to identify barriers and enablers to the streamlined use of digital tools to support successfulimplementation of BP@home in North Central London (NCL). Specifically, we characterised the IT landscape in NCL, investigated the views and experiences ofHCPs regarding the use of place-based IT solutions and processes, and synthesised a list of evidence-based recommendations for the consideration of NCL leadership team.Methods:We used a mixed methods research approach and six phases of investigation to address these aims, including desktop research, personal interviews and focusgroups, action research, data analysis, synthesis and reporting.Results:The evaluation showed that there was a lack of standardisation across IT systems, internal processes and templates in PCNs in NCL, leading to challenges inimplementing and using digital tools to support P@home. These challenges were not unique to NCL. AccurX and the locally created NCL template are the most widelyused IT tools to support the program in NCL. Other digital platforms being tested in NCL include Suvera, each with unique strengths and weaknesses. Other digital tools,such as Omron Connect, could be considered to support management of hypertension and other chronic conditions. HCPs faced challenges with patient engagement, data quality, IT system integration and resource allocation, but generally felt that the currentapproach works. Basic requirements for the use and adoption of IT tools and systems include adequate resources, stakeholder engagement, user-friendly interfaces, and interoperability between different ystems. We proposed 16 actionable insights and recommendations that could be implemented to help improve the delivery of BP@home in NCL. These include standardising IT systems, improving patient engagement, providing adequate training and support, and promoting the benefits of remote monitoring.Conclusion:On balance, we rec

Report

El-Osta A, Kerr G, Alaa A, Asmar MLE, Karki M, Webber I, Sasco ER, Blume G, Beecken W-D, Mummery Det al., 2023, Investigating self-reported efficacy of lifestyle medicine approaches to tackle erectile dysfunction: a cross-sectional eSurvey based study, BMC Urology, Vol: 23, Pages: 1-12, ISSN: 1471-2490

Background:Erectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED are amenable to treatment using lifestyle medicine approaches with or without pharmacotherapy.Aim:Investigate self-reported efficacy of lifestyle medicine approaches to tackle ED.Methods:A cross-sectional online survey of 1177 community dwelling adults explored the prevalence and methods used to tackle ED in the community setting. We examined differences between participants with and without ED. Variables associated with ED in univariable analyses were included in a multivariable logistic regression to identify variables independently associated with the condition.Outcomes:Self-reported measure: perceived effectiveness of lifestyle medicine interventions to tackle ED.Results:Most respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, hypercholesterolaemia and obesity. Medication was the most common management strategy overall (65.9%), followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) did not use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferers received a mental health assessment and 29.2% received other tests (e.g., blood test, medical imaging) by GPs. Cardiovascular training was identified as the best rated strategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity (32.6%) were also positively rated.Clinical implicationsStructured education to general practitioners and community dwelling adults about the impact of lifestyle behaviour modification and how this could influence the appearance or trajectory of ED could help improve personal choice when tackling ED.Strengths and limitations:To our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. The principal li

Journal article

Sivarajasingam V, Webber I, Riboli-Sasco E, Alaa A, El-Osta Aet al., 2022, Investigating public awareness, prevailing attitudes and perceptions towards domestic violence and abuse in the United Kingdom: a qualitative study, BMC PUBLIC HEALTH, Vol: 22

Journal article

Painter A, Hayhoe B, Riboli-Sasco E, El-Osta Aet al., 2022, Online symptom checkers: recommendations for a vignette-based clinical evaluation standard, Journal of Medical Internet Research, Vol: 24, ISSN: 1438-8871

The use of patient-facing online symptom checkers (OSCs) has expanded in recent years, but their accuracy, safety, and impact on patient behaviors and health care systems remain unclear. The lack of a standardized process of clinical evaluation has resulted in significant variation in approaches to OSC validation and evaluation. The aim of this paper is to characterize a set of congruent requirements for a standardized vignette-based clinical evaluation process of OSCs. Discrepancies in the findings of comparative studies to date suggest that different steps in OSC evaluation methodology can significantly influence outcomes. A standardized process with a clear specification for vignette-based clinical evaluation is urgently needed to guide developers and facilitate the objective comparison of OSCs. We propose 15 recommendation requirements for an OSC evaluation standard. A third-party evaluation process and protocols for prospective real-world evidence studies should also be prioritized to quality assure OSC assessment.

Journal article

Painter A, Hayhoe B, Riboli-Sasco E, El-Osta Aet al., 2022, Online symptom checkers: Recommendations for a vignette-based clinical evaluation standard (Preprint), Publisher: JMIR Publications Inc.

The use of patient-facing online symptom checkers (OSCs) has expanded in recent years, but their accuracy, safety, and impact on patient behaviours and healthcare systems remains unclear. The lack of a standardised process of clinical evaluation has resulted in significant variation in approaches to OSC validation and objective evaluation of outcomes. The aim of this paper is to characterise a set of congruent requirements for a standardised vignette-based clinical evaluation process of OSCs. Discrepancies in the findings of comparative studies to date suggest that different steps in OSC evaluation methodology can significantly influence outcomes. A standardised process with a clear specification for vignette-based clinical evaluation is urgently needed to guide developers and to facilitate the objective comparison of OSCs. We propose 15 recommendation requirements for an OSC evaluation standard. A third-party evaluation process and protocols for prospective real-world evidence studies should also be prioritised to quality assure OSC assessment.

Working paper

El-Osta A, Riboli-Sasco E, Kerr G, 2022, BP@home Pan-London Evaluation: Report Presented to NHSE I & LCEG (London), Publisher: Self-Care Academic Research Unit (SCARU), Imperial College London

Report objectives:This report summarises the key findings of a Pan-London evaluation to assess levels of implementation and identify key barriers and enablers to the streamlined implementation of the BP@home program across London. Specifically, we mapped the reception and distribution of BP@home monitors, investigated the views and experiences of primary care workers involved in the implementation of the programme, and quantify changes in outcomes using SNOMED codes. This data was synthesised and used to develop a list of evidence-based recommendations for the consideration of NHSE leadership team.Methods:We used a mixed methods research approach and six phases of investigation to address these aims, including desktop research, personal interviews and focus groups, action research, data analysis, synthesis and reporting.Results:The evaluation showed that there are different levels of readiness and implementation across the 5 London ICSs. The roll-out of BP@home programme has been challenging due to a number of key factors across the pathway, including the limited IT infrastructure, insufficient human and financial resources, and the lack of adequate and specific SNOMED codes. These challenges were further increased by the competing demands on limited capacity in Primary Care, especially during the Covid-19 pandemic. However, respondents also identified some facilitators, including the onboarding material provided by NHSE, the inclusion of the UCLP criteria the EHR and the provision of conditional incentives in certain ICSs. A more structured and holistic approach to onboarding patients is needed to ensure high quality compliance and satisfactory results for patients. Another key recommendation devised by respondents was to offer BP monitors on prescription, along with the creation of specific SNOMED codes.Conclusion:At the time of redaction of this report, there are local evaluation plans in each ICS & a national evaluation of @Home programme was recently commis

Report

El-Osta A, Alaa A, Webber I, Riboli-Sasco E, Emmanouil B, Millar HL, Vidal Hall C, Majeed Aet al., 2021, How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the United Kingdom? A cross-sectional online survey, BMJ Open, Vol: 11, Pages: 1-11, ISSN: 2044-6055

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age childrenDesignCross sectional online survey of parents of primary and secondary school-age childrenSettingCommunity settingParticipants 1214 parents of school-age children in the United KingdomMethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA three-item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression modelsMain outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.Results Half of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single-parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study-space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. Two modifiable health seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) were identified as key factors in reducing feelings of social isolation and loneliness during lockdown.

Journal article

Tudor Car L, Riboli-Sasco EF, Marcano Belisario JS, Nikolaou CK, Majeed A, Zary N, Car Jet al., 2018, Mobile learning for delivering health professional education, Cochrane Database of Systematic Reviews, ISSN: 1469-493X

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objective of this review is to evaluate the effectiveness of mLearning educational interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on students' knowledge, skills, professional attitudes and satisfaction.

Journal article

Greenfield R, Busink E, Wong CP, Riboli-Sasco E, Greenfield G, Majeed A, Car J, Wark PAet al., 2016, Truck drivers' perceptions on wearable devices and health promotion: a qualitative study., BMC Public Health, Vol: 16, ISSN: 1471-2458

BACKGROUND: Professional truck drivers, as other shift workers, have been identified as a high-risk group for various health conditions including cardiovascular disease, obesity, diabetes, sleep apnoea and stress. Mobile health technologies can potentially improve the health and wellbeing of people with a sedentary lifestyle such as truck drivers. Yet, only a few studies on health promotion interventions related to mobile health technologies for truck drivers have been conducted. We aimed to explore professional truck drivers' views on health promotion delivered via mobile health technologies such as wearable devices. METHODS: We conducted a phenomenological qualitative study, consisting of four semi-structured focus groups with 34 full-time professional truck drivers in the UK. The focus groups were audio-taped, transcribed verbatim and analysed using thematic content analysis. We discussed drivers' perceptions of their health, lifestyle and work environment, and their past experience and expectations from mobile health technologies. RESULTS: The participants viewed their lifestyle as unhealthy and were aware of possible consequences. They expressed the need and wish to change their lifestyle, yet perceived it as an inherent, unavoidable outcome of their occupation. Current health improvement initiatives were not always aligned with their working conditions. The participants were generally willing to use mobile health technologies such as wearable devices, as a preventive measure to avoid prospect morbidity, particularly cardiovascular diseases. They were ambivalent about privacy and the risk of their employer's monitoring their clinical data. CONCLUSIONS: Wearable devices may offer new possibilities for improving the health and wellbeing of truck drivers. Drivers were aware of their unhealthy lifestyle. They were interested in changing their lifestyle and health. Drivers raised concerns regarding being continuously monitored by their employer. Health improvement i

Journal article

Tudor Car L, Riboli-Sasco EF, Marcano Belisario JS, Nikolaou CK, Majeed FA, Zary N, Car Jet al., 2015, Mobile learning for delivering health professional education (protocol), Cochrane Database of Systematic Reviews, Vol: 2015, ISSN: 1469-493X

This is the protocol for a review and there is no abstract. The objectives are as follows:The objective of this review is to evaluate the effectiveness of mLearning educational interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on students’ knowledge, skills, professional attitudes and satisfaction.

Journal article

George PP, Papachristou N, Belisario JM, Wang W, Wark PA, Cotic Z, Rasmussen K, Sluiter R, Riboli-Sasco E, Car LT, Musulanov EM, Molina JA, Heng BH, Zhang Y, Wheeler EL, Al Shorbaji N, Majeed A, Car Jet al., 2014, Online eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction, JOURNAL OF GLOBAL HEALTH, Vol: 4, ISSN: 2047-2978

Journal article

Rasmussen K, Belisario JM, Wark PA, Molina JA, Loong SL, Cotic Z, Papachristou N, Riboli-Sasco E, Car LT, Musulanov EM, Kunz H, Zhang Y, George PP, Heng BH, Wheeler EL, Al Shorbaji N, Svab I, Atun R, Majeed A, Car Jet al., 2014, Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction, JOURNAL OF GLOBAL HEALTH, Vol: 4, ISSN: 2047-2978

Journal article

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