WEBVTT

NOTE duration: "00:51:40.970"


NOTE Confidence: 0.8664492

00:00:00.000 --> 00:00:01.439
I'm very pleased to introduce

NOTE Confidence: 0.8664492

00:00:01.439 --> 00:00:03.360
our speaker, Doctor. Li Jing

NOTE Confidence: 0.8664492

00:00:03.360 --> 00:00:05.220
Yang, who is a PhD,

NOTE Confidence: 0.8664492

00:00:05.279 --> 00:00:07.200
Miles per hour, professor of

NOTE Confidence: 0.8664492

00:00:07.200 --> 00:00:08.480
global health and head of

NOTE Confidence: 0.8664492

00:00:08.480 --> 00:00:10.820
the non communicable chronic disease

NOTE Confidence: 0.8664492

00:00:10.880 --> 00:00:11.380
research

NOTE Confidence: 0.9789416

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at the Global Health Research

NOTE Confidence: 0.9789416

00:00:13.360 --> 00:00:13.860
Center

NOTE Confidence: 0.9401553

00:00:14.215 --> 00:00:15.755
and director of the implementation

NOTE Confidence: 0.9696546

00:00:16.055 --> 00:00:18.235
science research on noncommunicable

NOTE Confidence: 0.9933868

00:00:18.855 --> 00:00:19.355
diseases

NOTE Confidence: 0.9959059

00:00:19.655 --> 00:00:20.715
management laboratory

NOTE Confidence: 0.8841894

00:00:21.255 --> 00:00:23.415
called Iron Man Lab at

NOTE Confidence: 0.8841894

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Duke Kunshan University.

NOTE Confidence: 0.9913454

00:00:25.494 --> 00:00:26.454
And maybe you can tell

NOTE Confidence: 0.9913454

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us a little bit about

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00:00:27.335 --> 00:00:29.675
what Duke Kunshan University is

NOTE Confidence: 0.9472534

00:00:30.110 --> 00:00:30.770
as well.

NOTE Confidence: 0.94033253

00:00:31.230 --> 00:00:32.430
Li Jing is currently an

NOTE Confidence: 0.94033253

00:00:32.430 --> 00:00:34.930
adjunct professor at Beijing University

NOTE Confidence: 0.89910865

00:00:35.390 --> 00:00:36.909
Institute for Global Health and

NOTE Confidence: 0.89910865

00:00:36.909 --> 00:00:37.409
Development.

NOTE Confidence: 0.9450532

00:00:38.430 --> 00:00:39.630
The School of Public Health

NOTE Confidence: 0.9450532

00:00:39.630 --> 00:00:40.930
is Wuhan University,

NOTE Confidence: 0.97598505

00:00:41.790 --> 00:00:43.790
Duke Global Health Institute, Duke

NOTE Confidence: 0.97598505

00:00:43.790 --> 00:00:45.495
University in the United States,

NOTE Confidence: 0.9566971

00:00:45.975 --> 00:00:47.434
and the Department of Preventive

NOTE Confidence: 0.9566971

00:00:47.495 --> 00:00:49.495
Medicine at the Feinberg School

NOTE Confidence: 0.9566971

00:00:49.495 --> 00:00:51.835
of Medicine at Northwestern University

NOTE Confidence: 0.96039027

00:00:52.375 --> 00:00:53.114
in Chicago.

NOTE Confidence: 0.9986595

00:00:53.815 --> 00:00:55.195
Quite a lot of affiliations.

NOTE Confidence: 0.94036746

00:00:56.695 --> 00:00:58.135
Previously, she was the director

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00:00:58.135 --> 00:00:59.495
of graduate studies for the

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00:00:59.495 --> 00:01:01.090
master of science in the

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00:01:01.090 --> 00:01:02.690
global health program at Duke

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00:01:02.690 --> 00:01:03.750
Kunshan University,

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00:01:04.369 --> 00:01:05.890
the deputy director of the

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00:01:05.890 --> 00:01:07.650
George Institute for Global Health

NOTE Confidence: 0.9602711

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at Beijing University

NOTE Confidence: 0.9371309

00:01:09.409 --> 00:01:10.630
Health Science Center

NOTE Confidence: 0.903355

00:01:10.930 --> 00:01:12.369
and director of the China

NOTE Confidence: 0.903355

00:01:12.369 --> 00:01:14.549
International Center for chronic disease

NOTE Confidence: 0.99313825

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Prevention, a large network of

NOTE Confidence: 0.99313825

00:01:16.805 --> 00:01:17.705
five international

NOTE Confidence: 0.9998249

00:01:18.165 --> 00:01:19.225
academic institutions

NOTE Confidence: 0.9753521

00:01:19.925 --> 00:01:21.785
and seven Chinese institutions

NOTE Confidence: 0.97176266

00:01:22.565 --> 00:01:24.725
dedicated to combat NCDs in

NOTE Confidence: 0.97176266

00:01:24.725 --> 00:01:25.225
China.

NOTE Confidence: 0.99457806

00:01:25.925 --> 00:01:27.385
She is the former secretary

NOTE Confidence: 0.99457806

00:01:27.525 --> 00:01:28.825
general of the China

NOTE Confidence: 0.9811387

00:01:29.130 --> 00:01:31.290
Consortium of Universities for Global

NOTE Confidence: 0.9811387

00:01:31.290 --> 00:01:33.310
Health and the current standing

NOTE Confidence: 0.9811387

00:01:33.370 --> 00:01:34.729
council member of the Global

NOTE Confidence: 0.9811387

00:01:34.729 --> 00:01:35.550
Health Society

NOTE Confidence: 0.9787514

00:01:35.930 --> 00:01:37.610
and the NCD Prevention and

NOTE Confidence: 0.9787514

00:01:37.610 --> 00:01:39.690
Control Society of the Chinese

NOTE Confidence: 0.9787514

00:01:39.690 --> 00:01:40.190
Preventive

NOTE Confidence: 0.97786

00:01:40.810 --> 00:01:41.790
Medicine Association.

NOTE Confidence: 0.9941308

00:01:42.475 --> 00:01:43.755
She has a bachelor's degree

NOTE Confidence: 0.9941308

00:01:43.755 --> 00:01:44.495
in sociology

NOTE Confidence: 0.99557096

00:01:44.875 --> 00:01:46.334
from Beijing University,

NOTE Confidence: 0.9068249

00:01:46.795 --> 00:01:48.075
a master of public health

NOTE Confidence: 0.9068249

00:01:48.075 --> 00:01:48.815
and epidemiology,

NOTE Confidence: 0.991272

00:01:49.115 --> 00:01:50.575
and a doctorate in demography

NOTE Confidence: 0.99608296

00:01:51.035 --> 00:01:52.815
from the University of California

NOTE Confidence: 0.99608296

00:01:52.955 --> 00:01:53.615
at Berkeley.

NOTE Confidence: 0.9912105

00:01:54.155 --> 00:01:55.775
Her main areas of research

NOTE Confidence: 0.9912105

00:01:55.835 --> 00:01:57.740
are primary care and community

NOTE Confidence: 0.9912105

00:01:57.740 --> 00:01:59.660
based chronic disease prevention and

NOTE Confidence: 0.9912105

00:01:59.660 --> 00:02:00.160
control,

NOTE Confidence: 0.99789435

00:02:00.540 --> 00:02:01.600
including hypertension,

NOTE Confidence: 0.9982923

00:02:02.060 --> 00:02:02.560
stroke,

NOTE Confidence: 0.95707846

00:02:03.100 --> 00:02:04.480
heart disease and diabetes,

NOTE Confidence: 0.98275554

00:02:04.940 --> 00:02:07.200
healthy aging, digital health innovations,

NOTE Confidence: 0.99912775

00:02:07.740 --> 00:02:08.480
and implementation

NOTE Confidence: 0.99868906

00:02:08.940 --> 00:02:09.440
science.

NOTE Confidence: 0.8715439

00:02:09.885 --> 00:02:11.425
She is the principal investigator,

NOTE Confidence: 0.8715439

00:02:11.485 --> 00:02:13.165
a co investigator of over

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00:02:13.165 --> 00:02:15.425
twenty US NIH and UK

NOTE Confidence: 0.96363

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MRC funded and China funded

NOTE Confidence: 0.96363

00:02:17.965 --> 00:02:18.945
research grants

NOTE Confidence: 0.9210178

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totaling over ten million US

NOTE Confidence: 0.9210178

00:02:21.165 --> 00:02:21.665
dollars.

NOTE Confidence: 0.98770255

00:02:22.190 --> 00:02:23.389
She has published over two

NOTE Confidence: 0.98770255

00:02:23.389 --> 00:02:25.650
hundred peer reviewed scientific papers,

NOTE Confidence: 0.9253359

00:02:26.030 --> 00:02:27.710
some in leading medical journals,

NOTE Confidence: 0.9253359

00:02:27.710 --> 00:02:29.250
including JAMA, The Lancet,

NOTE Confidence: 0.8889394

00:02:29.630 --> 00:02:30.830
the New England Journal of

NOTE Confidence: 0.8889394

00:02:30.830 --> 00:02:32.750
Medicine, the British Medical Journal

NOTE Confidence: 0.8889394

00:02:32.750 --> 00:02:33.570
and circulation.

NOTE Confidence: 0.8759898

00:02:34.270 --> 00:02:36.270
Her Google Scholar age index

NOTE Confidence: 0.8759898

00:02:36.270 --> 00:02:37.570
is fifty nine and

NOTE Confidence: 0.95545334

00:02:38.565 --> 00:02:39.925
I ten index one hundred

NOTE Confidence: 0.95545334

00:02:39.925 --> 00:02:41.605
and twenty three with total

NOTE Confidence: 0.95545334

00:02:41.605 --> 00:02:43.785
citations over seventy five thousand

NOTE Confidence: 0.93223494

00:02:44.245 --> 00:02:45.925
as of June twenty twenty

NOTE Confidence: 0.93223494

00:02:45.925 --> 00:02:48.345
four. She advises national international

NOTE Confidence: 0.9598241

00:02:48.965 --> 00:02:51.285
organizations, including the China National

NOTE Confidence: 0.9598241

00:02:51.285 --> 00:02:52.105
Health Commission

NOTE Confidence: 0.99064064

00:02:52.500 --> 00:02:53.880
and World Health Organization.

NOTE Confidence: 0.9680137

00:02:54.260 --> 00:02:55.780
So we clearly have an

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00:02:55.780 --> 00:02:57.000
extremely accomplished,

NOTE Confidence: 0.8902464

00:02:57.940 --> 00:03:00.120
public health researcher in NCDs

NOTE Confidence: 0.8486945

00:03:00.419 --> 00:03:01.560
and in implementation

NOTE Confidence: 0.955496

00:03:01.860 --> 00:03:03.480
science here with us today,

NOTE Confidence: 0.9975636

00:03:03.780 --> 00:03:05.080
probably the leader

NOTE Confidence: 0.9600574

00:03:05.540 --> 00:03:07.155
of this work in

NOTE Confidence: 0.9368182

00:03:07.635 --> 00:03:08.834
China. And so I'm very

NOTE Confidence: 0.9368182

00:03:08.834 --> 00:03:10.355
happy to have here and

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00:03:10.355 --> 00:03:11.794
to turn this over to

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00:03:11.794 --> 00:03:12.294
doctor.

NOTE Confidence: 0.7681187

00:03:14.675 --> 00:03:15.975
Yeah. We we need to

NOTE Confidence: 0.7681187

00:03:16.115 --> 00:03:17.075
make sure we have you

NOTE Confidence: 0.7681187

00:03:17.075 --> 00:03:18.535
set up properly now.

NOTE Confidence: 0.8861909

00:03:19.075 --> 00:03:20.055
We probably wanna

NOTE Confidence: 0.93163204

00:03:20.355 --> 00:03:21.815
maybe minimize this.

NOTE Confidence: 0.88151443

00:03:23.070 --> 00:03:24.350
Don't show this again. Oh,

NOTE Confidence: 0.88151443

00:03:24.350 --> 00:03:26.130
maybe yeah. Let's try that.

NOTE Confidence: 0.9264742

00:03:27.870 --> 00:03:29.070
Oh, maybe I know. Now

NOTE Confidence: 0.9264742

00:03:29.070 --> 00:03:30.350
we can minimize it over

NOTE Confidence: 0.9264742

00:03:30.350 --> 00:03:30.850
here,

NOTE Confidence: 0.9357033

00:03:31.310 --> 00:03:32.430
but the thing would go

NOTE Confidence: 0.9357033

00:03:32.430 --> 00:03:32.930
away.

NOTE Confidence: 0.86353755

00:03:36.305 --> 00:03:37.585
Because there's no mouse here.

NOTE Confidence: 0.86353755

00:03:37.585 --> 00:03:38.705
It's very I have don't

NOTE Confidence: 0.86353755

00:03:38.705 --> 00:03:40.225
like these keypads. Yeah. An

NOTE Confidence: 0.86353755

00:03:40.225 --> 00:03:41.445
attached pad. Mhmm.

NOTE Confidence: 0.47869956

00:03:41.985 --> 00:03:42.485
Say,

NOTE Confidence: 0.7247699

00:03:43.345 --> 00:03:44.945
yeah. I mean Or click

NOTE Confidence: 0.7247699

00:03:44.945 --> 00:03:47.045
on somewhere else. Oh, okay.

NOTE Confidence: 0.82454836

00:03:47.905 --> 00:03:48.405
Sorry.

NOTE Confidence: 0.886876

00:03:50.680 --> 00:03:51.640
Denise, you know what to

NOTE Confidence: 0.886876

00:03:51.640 --> 00:03:52.940
do? I'm good.

NOTE Confidence: 0.6284019

00:03:53.240 --> 00:03:54.640
That's the voice mail. It's

NOTE Confidence: 0.6284019

00:03:54.640 --> 00:03:55.580
not. It's okay.

NOTE Confidence: 0.8823279

00:03:58.440 --> 00:04:00.280
No. Pull pull that screen

NOTE Confidence: 0.8823279

00:04:00.280 --> 00:04:02.040
down, and that way, the

NOTE Confidence: 0.8823279

00:04:02.040 --> 00:04:03.420
thing will, like, go away.

NOTE Confidence: 0.9099662

00:04:04.685 --> 00:04:06.525
It. Maybe because I did

NOTE Confidence: 0.9099662

00:04:06.525 --> 00:04:07.885
the laser pointer thing. Yeah.

NOTE Confidence: 0.9099662

00:04:07.885 --> 00:04:08.685
But I just have to

NOTE Confidence: 0.9099662

00:04:08.685 --> 00:04:10.145
get to the bar here.

NOTE Confidence: 0.78285265

00:04:11.005 --> 00:04:12.205
Yeah. And then we're gonna

NOTE Confidence: 0.78285265

00:04:12.205 --> 00:04:13.485
go here. Now to the

NOTE Confidence: 0.78285265

00:04:13.485 --> 00:04:14.845
next one. The left. Next

NOTE Confidence: 0.78285265

00:04:14.845 --> 00:04:16.525
one. Now in Austin. Yeah.

NOTE Confidence: 0.78285265

00:04:16.525 --> 00:04:18.545
Click that. There you go.

NOTE Confidence: 0.78285265

00:04:18.685 --> 00:04:19.725
I think now you're in

NOTE Confidence: 0.78285265

00:04:19.725 --> 00:04:21.380
a good Okay. Well, thank

NOTE Confidence: 0.78285265

00:04:21.380 --> 00:04:22.420
you so much.

NOTE Confidence: 0.88424903

00:04:22.820 --> 00:04:24.339
Thank you, Donna for the

NOTE Confidence: 0.88424903

00:04:24.339 --> 00:04:24.839
invitation.

NOTE Confidence: 0.86625385

00:04:25.220 --> 00:04:26.500
Thank you, Ally and Denise,

NOTE Confidence: 0.86625385

00:04:26.500 --> 00:04:27.160
for helping.

NOTE Confidence: 0.9986901

00:04:28.020 --> 00:04:28.839
I I'm

NOTE Confidence: 0.9137304

00:04:29.140 --> 00:04:30.820
surprised that Donna read through

NOTE Confidence: 0.9137304

00:04:30.820 --> 00:04:32.955
the file. Yeah. Yeah. It's

NOTE Confidence: 0.9137304

00:04:32.955 --> 00:04:34.918
so No. It's so boring.

NOTE Confidence: 0.9144009

00:04:35.573 --> 00:04:37.210
I hope my talk will

NOTE Confidence: 0.9144009

00:04:37.210 --> 00:04:38.846
not be so boring. Mhmm.

NOTE Confidence: 0.9144009

00:04:39.173 --> 00:04:41.137
And, also, of course, I

NOTE Confidence: 0.9144009

00:04:41.137 --> 00:04:43.101
know Yale, and, I have,

NOTE Confidence: 0.9144009

00:04:43.428 --> 00:04:45.065
collaborated and know people in,

NOTE Confidence: 0.9144009

00:04:45.392 --> 00:04:47.400
including, you know, Donna, Professor

NOTE Confidence: 0.9144009

00:04:47.400 --> 00:04:48.920
Li and others. And one

NOTE Confidence: 0.9144009

00:04:48.920 --> 00:04:50.440
of my former students, and

NOTE Confidence: 0.9144009

00:04:50.440 --> 00:04:52.440
he's also here. So, so

NOTE Confidence: 0.9144009

00:04:52.440 --> 00:04:53.720
glad to see you all.

NOTE Confidence: 0.9144009

00:04:53.720 --> 00:04:54.680
But this is my very

NOTE Confidence: 0.9144009

00:04:54.680 --> 00:04:55.420
first time,

NOTE Confidence: 0.95952606

00:04:55.960 --> 00:04:57.320
in the university in the

NOTE Confidence: 0.95952606

00:04:57.320 --> 00:04:59.385
city. So, great to be

NOTE Confidence: 0.95952606

00:04:59.385 --> 00:05:00.585
here. And today, I will

NOTE Confidence: 0.95952606

00:05:00.585 --> 00:05:02.265
be very focused in talking

NOTE Confidence: 0.95952606

00:05:02.265 --> 00:05:02.765
about,

NOTE Confidence: 0.97687685

00:05:03.545 --> 00:05:05.464
this study, which is a,

NOTE Confidence: 0.9443339

00:05:06.425 --> 00:05:08.505
trial that, for people familiar

NOTE Confidence: 0.9443339

00:05:08.505 --> 00:05:10.425
with implementation science is the

NOTE Confidence: 0.9443339

00:05:10.425 --> 00:05:12.525
effectiveness implementation trial.

NOTE Confidence: 0.9967098

00:05:12.839 --> 00:05:13.339
So

NOTE Confidence: 0.7236591

00:05:13.960 --> 00:05:14.460
the,

NOTE Confidence: 0.89476615

00:05:16.520 --> 00:05:17.960
I think I should try

NOTE Confidence: 0.89476615

00:05:17.960 --> 00:05:19.180
to move this,

NOTE Confidence: 0.75496775

00:05:20.040 --> 00:05:20.540
below.

NOTE Confidence: 0.89422476

00:05:22.120 --> 00:05:23.160
That's kind of hard to

NOTE Confidence: 0.89422476

00:05:23.160 --> 00:05:24.279
do, but it's doesn't it?

NOTE Confidence: 0.89422476

00:05:24.279 --> 00:05:25.160
So yeah. You can put

NOTE Confidence: 0.89422476

00:05:25.160 --> 00:05:25.820
it down.

NOTE Confidence: 0.96233624

00:05:26.360 --> 00:05:28.205
Okay. Now it's working. Sort

NOTE Confidence: 0.96233624

00:05:28.205 --> 00:05:28.705
of.

NOTE Confidence: 0.6952622

00:05:29.565 --> 00:05:30.625
And my mortality

NOTE Confidence: 0.29529032

00:05:31.085 --> 00:05:31.904
view is.

NOTE Confidence: 0.7097479

00:05:33.565 --> 00:05:34.065
Okay.

NOTE Confidence: 0.9488647

00:05:34.925 --> 00:05:36.705
So today, I will introduce

NOTE Confidence: 0.9488647

00:05:36.765 --> 00:05:38.525
this study according to this

NOTE Confidence: 0.9488647

00:05:38.525 --> 00:05:39.025
paradigm,

NOTE Confidence: 0.87154233

00:05:39.485 --> 00:05:41.265
that is, called the titles.

NOTE Confidence: 0.9068968

00:05:42.100 --> 00:05:43.560
You can see what petals

NOTE Confidence: 0.9068968

00:05:43.620 --> 00:05:44.120
is.

NOTE Confidence: 0.9777647

00:05:44.500 --> 00:05:45.380
And then I will talk

NOTE Confidence: 0.9777647

00:05:45.380 --> 00:05:46.200
about revaluation,

NOTE Confidence: 0.98979473

00:05:46.820 --> 00:05:48.260
which is the s part

NOTE Confidence: 0.98979473

00:05:48.260 --> 00:05:49.700
of the petals. So let's

NOTE Confidence: 0.98979473

00:05:49.700 --> 00:05:51.400
take a look at petals.

NOTE Confidence: 0.82011527

00:05:54.740 --> 00:05:55.800
This works better.

NOTE Confidence: 0.90610576

00:05:57.154 --> 00:05:58.835
Okay. So this is for

NOTE Confidence: 0.90610576

00:05:59.075 --> 00:06:00.675
this is proposed by professor,

NOTE Confidence: 0.90610576

00:06:00.995 --> 00:06:01.975
Roman Xu,

NOTE Confidence: 0.83350474

00:06:02.355 --> 00:06:03.795
a leader in implementation science

NOTE Confidence: 0.83350474

00:06:03.795 --> 00:06:05.175
that Donna knows well,

NOTE Confidence: 0.95716

00:06:05.795 --> 00:06:07.714
that this is to this

NOTE Confidence: 0.95716

00:06:07.714 --> 00:06:09.015
is a model for implementation

NOTE Confidence: 0.95716

00:06:09.154 --> 00:06:10.355
research. You can see it

NOTE Confidence: 0.95716

00:06:10.355 --> 00:06:12.150
starts with the problem p.

NOTE Confidence: 0.95716

00:06:12.150 --> 00:06:13.510
So the real world problem

NOTE Confidence: 0.95716

00:06:13.510 --> 00:06:14.730
that we want to address.

NOTE Confidence: 0.95716

00:06:14.790 --> 00:06:15.990
And the EBP is the

NOTE Confidence: 0.95716

00:06:15.990 --> 00:06:18.230
evidence based practice that we

NOTE Confidence: 0.95716

00:06:18.230 --> 00:06:19.690
adopt in the study.

NOTE Confidence: 0.97066694

00:06:19.990 --> 00:06:20.810
And determinants

NOTE Confidence: 0.93907285

00:06:21.110 --> 00:06:21.610
actually,

NOTE Confidence: 0.9989257

00:06:22.230 --> 00:06:23.529
refers to facilitators

NOTE Confidence: 0.98254514

00:06:24.150 --> 00:06:25.370
and, barriers

NOTE Confidence: 0.9645865

00:06:25.750 --> 00:06:26.570
for implementation.

NOTE Confidence: 0.99227154

00:06:27.605 --> 00:06:29.605
And action is the term

NOTE Confidence: 0.99227154

00:06:29.605 --> 00:06:31.145
used, to show,

NOTE Confidence: 0.9979746

00:06:31.605 --> 00:06:32.585
to mean implementation

NOTE Confidence: 0.9621378

00:06:33.045 --> 00:06:34.725
strategies. That's the typical term

NOTE Confidence: 0.9621378

00:06:34.725 --> 00:06:37.145
in implementation research. And l

NOTE Confidence: 0.9621378

00:06:37.205 --> 00:06:39.145
is for long term sustainment

NOTE Confidence: 0.9618764

00:06:39.445 --> 00:06:40.425
of the implementation.

NOTE Confidence: 0.9724183

00:06:41.045 --> 00:06:43.065
And scale is for,

NOTE Confidence: 0.94987184

00:06:44.750 --> 00:06:46.589
evaluation and scaling up. So

NOTE Confidence: 0.94987184

00:06:46.589 --> 00:06:48.050
this is the PEDLS model.

NOTE Confidence: 0.92136467

00:06:48.510 --> 00:06:50.610
And, you can see PEDLS,

NOTE Confidence: 0.92136467

00:06:50.910 --> 00:06:52.589
the acronym is gray because

NOTE Confidence: 0.92136467

00:06:52.589 --> 00:06:53.710
it shows like it's like

NOTE Confidence: 0.92136467

00:06:53.710 --> 00:06:54.850
the bicycle pedaling.

NOTE Confidence: 0.939636

00:06:55.150 --> 00:06:56.850
And, there is this iterative

NOTE Confidence: 0.939636

00:06:56.990 --> 00:06:58.510
process and the circle is

NOTE Confidence: 0.939636

00:06:58.510 --> 00:07:00.245
showing that. And two other

NOTE Confidence: 0.939636

00:07:00.245 --> 00:07:01.764
things to point out is,

NOTE Confidence: 0.939636

00:07:01.764 --> 00:07:03.705
one, is the application of

NOTE Confidence: 0.939636

00:07:03.925 --> 00:07:05.944
various models and frameworks throughout,

NOTE Confidence: 0.9219818

00:07:06.645 --> 00:07:08.164
and then also the co

NOTE Confidence: 0.9219818

00:07:08.164 --> 00:07:08.664
production

NOTE Confidence: 0.98912185

00:07:08.964 --> 00:07:10.185
process with stakeholders,

NOTE Confidence: 0.99955595

00:07:11.125 --> 00:07:11.784
are important.

NOTE Confidence: 0.9744578

00:07:12.740 --> 00:07:14.660
So for our study, what

NOTE Confidence: 0.9744578

00:07:14.660 --> 00:07:16.660
is the problem that, we

NOTE Confidence: 0.9744578

00:07:16.660 --> 00:07:18.600
are interested in addressing?

NOTE Confidence: 0.9601797

00:07:19.140 --> 00:07:20.420
In a nutshell, it's,

NOTE Confidence: 0.9670418

00:07:21.140 --> 00:07:22.980
stroke prevention and control and

NOTE Confidence: 0.9670418

00:07:22.980 --> 00:07:25.155
particularly in rural China. So

NOTE Confidence: 0.9670418

00:07:25.155 --> 00:07:26.675
I would point your attention

NOTE Confidence: 0.9670418

00:07:26.675 --> 00:07:28.375
to these two figures.

NOTE Confidence: 0.96723574

00:07:29.074 --> 00:07:30.115
You can see this is

NOTE Confidence: 0.96723574

00:07:30.115 --> 00:07:32.775
over time from the, early,

NOTE Confidence: 0.90449566

00:07:34.275 --> 00:07:35.474
century for this one from

NOTE Confidence: 0.90449566

00:07:35.474 --> 00:07:37.155
nineteen ninety three to twenty

NOTE Confidence: 0.90449566

00:07:37.155 --> 00:07:37.655
seventeen.

NOTE Confidence: 0.97349507

00:07:38.410 --> 00:07:40.170
And, the blue one is

NOTE Confidence: 0.97349507

00:07:40.170 --> 00:07:41.870
urban. The red one

NOTE Confidence: 0.99194694

00:07:42.250 --> 00:07:43.930
is rural. So in terms

NOTE Confidence: 0.99194694

00:07:43.930 --> 00:07:45.770
of the prevalence of stroke,

NOTE Confidence: 0.99194694

00:07:45.770 --> 00:07:46.590
you can see,

NOTE Confidence: 0.9932793

00:07:47.490 --> 00:07:48.670
the big rise,

NOTE Confidence: 0.9532521

00:07:49.370 --> 00:07:51.285
in rural China in the

NOTE Confidence: 0.9532521

00:07:51.285 --> 00:07:53.045
prevalence of stroke to the

NOTE Confidence: 0.9532521

00:07:53.045 --> 00:07:54.105
point of surpassing,

NOTE Confidence: 0.90679604

00:07:55.285 --> 00:07:57.705
beyond twenty thirteen. It's passing

NOTE Confidence: 0.90679604

00:07:57.765 --> 00:07:59.285
on urban areas in terms

NOTE Confidence: 0.90679604

00:07:59.285 --> 00:08:00.185
of its burden.

NOTE Confidence: 0.99723405

00:08:00.565 --> 00:08:01.065
However,

NOTE Confidence: 0.98270017

00:08:01.365 --> 00:08:02.665
in terms of the mortality,

NOTE Confidence: 0.9144856

00:08:03.205 --> 00:08:04.985
it's being pretty much consistently

NOTE Confidence: 0.9983524

00:08:05.365 --> 00:08:05.865
higher

NOTE Confidence: 0.966045

00:08:06.180 --> 00:08:07.940
than urban areas. The blue

NOTE Confidence: 0.966045

00:08:07.940 --> 00:08:09.460
being rural and red being

NOTE Confidence: 0.966045

00:08:09.460 --> 00:08:11.460
urban. Green is overall in

NOTE Confidence: 0.966045

00:08:11.460 --> 00:08:12.900
the middle. So we have

NOTE Confidence: 0.966045

00:08:12.900 --> 00:08:14.740
very large burden and it's

NOTE Confidence: 0.966045

00:08:14.740 --> 00:08:15.240
the

NOTE Confidence: 0.95854884

00:08:15.620 --> 00:08:17.540
number one cause of death

NOTE Confidence: 0.95854884

00:08:17.540 --> 00:08:19.160
and disability in rural China.

NOTE Confidence: 0.9866833

00:08:19.585 --> 00:08:21.104
And to to address this

NOTE Confidence: 0.9866833

00:08:21.104 --> 00:08:22.465
burden, there are so many

NOTE Confidence: 0.9866833

00:08:22.465 --> 00:08:24.485
evidence based practices already.

NOTE Confidence: 0.94081324

00:08:25.264 --> 00:08:27.525
Lots of guidelines, clinical guidelines,

NOTE Confidence: 0.9607213

00:08:27.905 --> 00:08:29.345
even for, a for a

NOTE Confidence: 0.9607213

00:08:29.345 --> 00:08:31.125
stroke per se. And,

NOTE Confidence: 0.94643396

00:08:31.824 --> 00:08:33.184
right at the time when

NOTE Confidence: 0.94643396

00:08:33.184 --> 00:08:33.925
we started,

NOTE Confidence: 0.97357905

00:08:34.690 --> 00:08:35.970
work on this study, there

NOTE Confidence: 0.97357905

00:08:35.970 --> 00:08:36.709
is this,

NOTE Confidence: 0.9869162

00:08:39.410 --> 00:08:39.910
guideline

NOTE Confidence: 0.91336405

00:08:40.690 --> 00:08:41.190
produced,

NOTE Confidence: 0.9996456

00:08:41.570 --> 00:08:43.269
in China in Chinese

NOTE Confidence: 0.9825556

00:08:43.809 --> 00:08:45.829
for the primary care level

NOTE Confidence: 0.9825556

00:08:46.050 --> 00:08:47.589
stroke prevention and control.

NOTE Confidence: 0.9890485

00:08:47.934 --> 00:08:49.155
So it's a booklet,

NOTE Confidence: 0.95406896

00:08:49.775 --> 00:08:50.895
and it's being,

NOTE Confidence: 0.9371857

00:08:51.535 --> 00:08:53.535
edited by our collaborators in

NOTE Confidence: 0.9371857

00:08:53.535 --> 00:08:55.055
the tertiary hospital called Tian

NOTE Confidence: 0.9371857

00:08:55.055 --> 00:08:56.915
Tan Hospital, the leading neurology

NOTE Confidence: 0.9371857

00:08:57.055 --> 00:08:58.115
hospital in China.

NOTE Confidence: 0.9541596

00:08:58.495 --> 00:09:00.335
However, even for this, that

NOTE Confidence: 0.9541596

00:09:00.335 --> 00:09:02.670
is earmarked for primary care,

NOTE Confidence: 0.95689976

00:09:03.070 --> 00:09:04.529
it turned out to be,

NOTE Confidence: 0.94270825

00:09:05.309 --> 00:09:07.070
as my question there, it

NOTE Confidence: 0.94270825

00:09:07.149 --> 00:09:09.329
it's not so easily

NOTE Confidence: 0.9979121

00:09:10.029 --> 00:09:10.529
applicable

NOTE Confidence: 0.9962312

00:09:11.070 --> 00:09:12.990
to the reality of primary

NOTE Confidence: 0.9962312

00:09:12.990 --> 00:09:15.089
care in rural China. So

NOTE Confidence: 0.95327246

00:09:15.695 --> 00:09:16.575
we set out to do

NOTE Confidence: 0.95327246

00:09:16.575 --> 00:09:17.855
the study. This is the

NOTE Confidence: 0.95327246

00:09:17.855 --> 00:09:18.355
site.

NOTE Confidence: 0.99078435

00:09:18.895 --> 00:09:19.635
Our study,

NOTE Confidence: 0.99827045

00:09:20.175 --> 00:09:20.995
is conducted

NOTE Confidence: 0.8892375

00:09:21.375 --> 00:09:23.135
was well, is because it's

NOTE Confidence: 0.8892375

00:09:23.135 --> 00:09:25.154
still ongoing, conducted in,

NOTE Confidence: 0.95833224

00:09:25.695 --> 00:09:27.475
one county in this province.

NOTE Confidence: 0.95833224

00:09:27.535 --> 00:09:28.654
And the province is called

NOTE Confidence: 0.95833224

00:09:28.654 --> 00:09:29.774
Hebei. It happened to be

NOTE Confidence: 0.95833224

00:09:29.774 --> 00:09:31.020
my, well, I chose it

NOTE Confidence: 0.95833224

00:09:31.020 --> 00:09:32.000
to be my hometown.

NOTE Confidence: 0.9930415

00:09:32.460 --> 00:09:34.080
And this is actually the,

NOTE Confidence: 0.9979508

00:09:35.100 --> 00:09:35.600
wisest

NOTE Confidence: 0.95204663

00:09:35.900 --> 00:09:37.179
choice I made, if I

NOTE Confidence: 0.95204663

00:09:37.179 --> 00:09:38.400
can speak on that.

NOTE Confidence: 0.9463501

00:09:39.020 --> 00:09:39.420
Because,

NOTE Confidence: 0.89779353

00:09:40.940 --> 00:09:41.420
this,

NOTE Confidence: 0.9991246

00:09:41.820 --> 00:09:42.320
was

NOTE Confidence: 0.9924507

00:09:42.865 --> 00:09:44.065
done in the last few

NOTE Confidence: 0.9924507

00:09:44.065 --> 00:09:45.925
years of my mom's life.

NOTE Confidence: 0.9924507

00:09:45.985 --> 00:09:47.505
So because I chose it

NOTE Confidence: 0.9924507

00:09:47.505 --> 00:09:48.465
here, I was able to

NOTE Confidence: 0.9924507

00:09:48.465 --> 00:09:50.385
see her, more often than

NOTE Confidence: 0.9924507

00:09:50.385 --> 00:09:51.605
I had otherwise.

NOTE Confidence: 0.95323914

00:09:52.385 --> 00:09:53.825
And, but not that's not

NOTE Confidence: 0.95323914

00:09:53.825 --> 00:09:54.945
the only reason. The other

NOTE Confidence: 0.95323914

00:09:54.945 --> 00:09:56.165
reasons would be collaborations,

NOTE Confidence: 0.91388136

00:09:56.625 --> 00:09:58.120
but also the high burden.

NOTE Confidence: 0.91388136

00:09:58.120 --> 00:10:00.040
You can see, Hebei is

NOTE Confidence: 0.91388136

00:10:00.040 --> 00:10:00.860
in the darkest,

NOTE Confidence: 0.9133667

00:10:01.240 --> 00:10:02.920
color in terms of incidence

NOTE Confidence: 0.9133667

00:10:02.920 --> 00:10:03.660
for stroke.

NOTE Confidence: 0.8944406

00:10:05.000 --> 00:10:06.440
And Sorry, Nikki. Can you

NOTE Confidence: 0.8944406

00:10:06.440 --> 00:10:08.059
go back one second? Sure.

NOTE Confidence: 0.8944406

00:10:08.120 --> 00:10:09.500
So is the whole population

NOTE Confidence: 0.8944406

00:10:09.640 --> 00:10:10.845
of the Hebei province

NOTE Confidence: 0.9630004

00:10:11.245 --> 00:10:12.684
three hundred and sixty thousand

NOTE Confidence: 0.9630004

00:10:12.684 --> 00:10:15.004
people? No. It's the total

NOTE Confidence: 0.9630004

00:10:15.004 --> 00:10:16.365
population for the county we

NOTE Confidence: 0.9630004

00:10:16.365 --> 00:10:18.045
chose. Oh, okay. Yeah. Because

NOTE Confidence: 0.9630004

00:10:18.045 --> 00:10:19.084
I thought that was very

NOTE Confidence: 0.9630004

00:10:19.084 --> 00:10:20.605
low for China. Right. It's

NOTE Confidence: 0.9630004

00:10:20.605 --> 00:10:22.605
for this particular county. And

NOTE Confidence: 0.9630004

00:10:22.605 --> 00:10:23.884
the particular county had two

NOTE Confidence: 0.9630004

00:10:23.884 --> 00:10:25.404
hundred eighteen villages. We worked

NOTE Confidence: 0.9630004

00:10:25.404 --> 00:10:27.390
in fifty villages. Okay. Yeah.

NOTE Confidence: 0.9532271

00:10:27.770 --> 00:10:29.529
So, this is a busy

NOTE Confidence: 0.9532271

00:10:29.529 --> 00:10:30.970
timeline, but I would like

NOTE Confidence: 0.9532271

00:10:30.970 --> 00:10:32.170
just to point out there

NOTE Confidence: 0.9532271

00:10:32.170 --> 00:10:33.850
is this long phase where

NOTE Confidence: 0.9532271

00:10:33.850 --> 00:10:34.910
we call formative

NOTE Confidence: 0.87141746

00:10:35.690 --> 00:10:37.209
research where we did, you

NOTE Confidence: 0.87141746

00:10:37.209 --> 00:10:38.330
know, the barriers and the

NOTE Confidence: 0.87141746

00:10:38.330 --> 00:10:40.270
facilitators and the comp contextualization,

NOTE Confidence: 0.9234689

00:10:41.285 --> 00:10:41.785
tailoring.

NOTE Confidence: 0.9778972

00:10:42.485 --> 00:10:44.085
And then after the pilot

NOTE Confidence: 0.9778972

00:10:44.085 --> 00:10:45.865
study, we had this intervention

NOTE Confidence: 0.9778972

00:10:46.085 --> 00:10:47.445
that is only one year

NOTE Confidence: 0.9778972

00:10:47.445 --> 00:10:48.885
long. So this is important

NOTE Confidence: 0.9778972

00:10:48.885 --> 00:10:50.165
to keep in mind. The

NOTE Confidence: 0.9778972

00:10:50.165 --> 00:10:52.005
intervention, the active phase was

NOTE Confidence: 0.9778972

00:10:52.005 --> 00:10:53.765
only one year long. And

NOTE Confidence: 0.9778972

00:10:53.765 --> 00:10:55.065
then after that,

NOTE Confidence: 0.99662846

00:10:55.990 --> 00:10:57.050
after it's over,

NOTE Confidence: 0.9861401

00:10:58.070 --> 00:10:59.690
we had a hiatus,

NOTE Confidence: 0.9859919

00:11:00.309 --> 00:11:01.290
during the COVID,

NOTE Confidence: 0.98786575

00:11:01.750 --> 00:11:03.270
but then we were able

NOTE Confidence: 0.98786575

00:11:03.270 --> 00:11:04.570
to have follow-up studies,

NOTE Confidence: 0.9431718

00:11:05.750 --> 00:11:07.830
which, in October of twenty

NOTE Confidence: 0.9431718

00:11:07.830 --> 00:11:08.330
twenty,

NOTE Confidence: 0.6573963

00:11:08.765 --> 00:11:09.265
two,

NOTE Confidence: 0.92223483

00:11:09.645 --> 00:11:10.925
was one of the two

NOTE Confidence: 0.92223483

00:11:10.925 --> 00:11:11.965
who went to the field

NOTE Confidence: 0.92223483

00:11:11.965 --> 00:11:13.565
to to to support the

NOTE Confidence: 0.92223483

00:11:13.565 --> 00:11:14.545
follow-up study.

NOTE Confidence: 0.95853525

00:11:15.645 --> 00:11:17.565
So, in the for the

NOTE Confidence: 0.95853525

00:11:17.565 --> 00:11:19.404
barriers and facilitators, we did

NOTE Confidence: 0.95853525

00:11:19.404 --> 00:11:21.245
three field visits, forty nine

NOTE Confidence: 0.95853525

00:11:21.245 --> 00:11:22.785
interviews, and four workshops,

NOTE Confidence: 0.92019975

00:11:23.210 --> 00:11:24.910
and one steering committee meeting,

NOTE Confidence: 0.9798133

00:11:25.370 --> 00:11:27.210
in order to, do it.

NOTE Confidence: 0.9798133

00:11:27.210 --> 00:11:29.210
So just quickly for forward

NOTE Confidence: 0.9798133

00:11:29.210 --> 00:11:31.370
to, the conclusion part of

NOTE Confidence: 0.9798133

00:11:31.370 --> 00:11:32.190
the determinants

NOTE Confidence: 0.95699316

00:11:32.730 --> 00:11:34.010
in terms of the barriers.

NOTE Confidence: 0.95699316

00:11:34.010 --> 00:11:35.530
They actually come from multiple

NOTE Confidence: 0.95699316

00:11:35.530 --> 00:11:36.030
levels.

NOTE Confidence: 0.8815852

00:11:37.045 --> 00:11:38.565
At the patient level, there

NOTE Confidence: 0.8815852

00:11:38.565 --> 00:11:39.704
is the low awareness,

NOTE Confidence: 0.98827136

00:11:40.404 --> 00:11:42.584
and poor adherence to medication,

NOTE Confidence: 0.9801599

00:11:43.605 --> 00:11:44.005
and,

NOTE Confidence: 0.8684103

00:11:44.485 --> 00:11:45.785
poor physical functioning,

NOTE Confidence: 0.7482102

00:11:46.725 --> 00:11:48.505
generally low health literacy,

NOTE Confidence: 0.97307754

00:11:49.429 --> 00:11:51.029
And even for the literacy

NOTE Confidence: 0.97307754

00:11:51.029 --> 00:11:52.570
level among women,

NOTE Confidence: 0.9823927

00:11:53.029 --> 00:11:54.390
because most of these patients

NOTE Confidence: 0.9823927

00:11:54.390 --> 00:11:55.910
were older, it is,

NOTE Confidence: 0.94408023

00:11:56.790 --> 00:11:57.510
less than,

NOTE Confidence: 0.9193949

00:11:59.029 --> 00:12:00.470
a third of them could

NOTE Confidence: 0.9193949

00:12:00.470 --> 00:12:00.970
read.

NOTE Confidence: 0.96642965

00:12:01.635 --> 00:12:02.375
Yeah. So,

NOTE Confidence: 0.96205366

00:12:02.755 --> 00:12:04.275
at the village doctor level,

NOTE Confidence: 0.96205366

00:12:04.275 --> 00:12:05.395
there is also the low

NOTE Confidence: 0.96205366

00:12:05.395 --> 00:12:07.315
awareness on clinical guidelines for

NOTE Confidence: 0.96205366

00:12:07.315 --> 00:12:08.835
stroke because they focus a

NOTE Confidence: 0.96205366

00:12:08.835 --> 00:12:09.955
lot of their effort on

NOTE Confidence: 0.96205366

00:12:09.955 --> 00:12:11.575
maternal and trial health and

NOTE Confidence: 0.96205366

00:12:11.635 --> 00:12:12.135
other,

NOTE Confidence: 0.9406999

00:12:12.915 --> 00:12:14.195
conditions such as,

NOTE Confidence: 0.9657582

00:12:14.675 --> 00:12:17.255
hypertension and diabetes according to,

NOTE Confidence: 0.8798539

00:12:17.770 --> 00:12:20.190
the National Public Health package.

NOTE Confidence: 0.95015043

00:12:21.130 --> 00:12:23.130
And they also have low

NOTE Confidence: 0.95015043

00:12:23.130 --> 00:12:26.010
incentive for preventive care. I'll

NOTE Confidence: 0.95015043

00:12:26.010 --> 00:12:27.130
get my cell phone for

NOTE Confidence: 0.95015043

00:12:27.130 --> 00:12:27.870
time control.

NOTE Confidence: 0.8240473

00:12:30.384 --> 00:12:31.925
Where the lack of preventive

NOTE Confidence: 0.8240473

00:12:32.144 --> 00:12:33.904
care, and here we focus

NOTE Confidence: 0.8240473

00:12:33.904 --> 00:12:35.204
on secondary prevention

NOTE Confidence: 0.97099125

00:12:35.824 --> 00:12:36.565
for stroke,

NOTE Confidence: 0.99447626

00:12:37.264 --> 00:12:39.264
instead of, the acute phase,

NOTE Confidence: 0.99447626

00:12:39.264 --> 00:12:40.545
which is not suitable for

NOTE Confidence: 0.99447626

00:12:40.545 --> 00:12:41.605
the primary care.

NOTE Confidence: 0.9432262

00:12:41.985 --> 00:12:43.204
At the county level,

NOTE Confidence: 0.97524005

00:12:43.829 --> 00:12:45.690
they are acute state oriented

NOTE Confidence: 0.97524005

00:12:45.910 --> 00:12:47.610
and provide fragmented fragmented

NOTE Confidence: 0.9899437

00:12:47.990 --> 00:12:49.910
care without patient follow-up, and

NOTE Confidence: 0.9899437

00:12:49.910 --> 00:12:50.730
they're overburdened.

NOTE Confidence: 0.9997527

00:12:51.670 --> 00:12:53.449
I remember visiting the hospital

NOTE Confidence: 0.9935496

00:12:53.910 --> 00:12:55.029
during the winter, you know,

NOTE Confidence: 0.9935496

00:12:55.029 --> 00:12:56.170
around this time.

NOTE Confidence: 0.96511304

00:12:56.695 --> 00:12:58.454
Outside of the neurology ward,

NOTE Confidence: 0.96511304

00:12:58.454 --> 00:12:59.415
there will be lots of

NOTE Confidence: 0.96511304

00:12:59.415 --> 00:13:02.214
deaths and, patients and family

NOTE Confidence: 0.96511304

00:13:02.214 --> 00:13:03.654
members even living in the

NOTE Confidence: 0.96511304

00:13:03.654 --> 00:13:04.154
corridor,

NOTE Confidence: 0.99142975

00:13:04.855 --> 00:13:06.774
because, they they have a

NOTE Confidence: 0.99142975

00:13:06.774 --> 00:13:07.675
surge of,

NOTE Confidence: 0.9668824

00:13:08.295 --> 00:13:10.075
patients, during the wintertime.

NOTE Confidence: 0.9977991

00:13:11.030 --> 00:13:11.690
And then,

NOTE Confidence: 0.8559533

00:13:12.150 --> 00:13:13.750
our specialists, they are very

NOTE Confidence: 0.8559533

00:13:13.750 --> 00:13:14.250
experienced,

NOTE Confidence: 0.9775726

00:13:14.550 --> 00:13:16.230
world class, but they are,

NOTE Confidence: 0.9775726

00:13:16.470 --> 00:13:17.830
they don't know the rural

NOTE Confidence: 0.9775726

00:13:17.830 --> 00:13:19.929
situation. So in the county,

NOTE Confidence: 0.9775726

00:13:20.070 --> 00:13:21.370
this is the three tier,

NOTE Confidence: 0.95618147

00:13:23.184 --> 00:13:25.905
health care delivery system, county

NOTE Confidence: 0.95618147

00:13:25.905 --> 00:13:27.985
hospital being only one, and

NOTE Confidence: 0.95618147

00:13:27.985 --> 00:13:28.645
the leading,

NOTE Confidence: 0.90385866

00:13:29.425 --> 00:13:29.925
facility.

NOTE Confidence: 0.98458797

00:13:30.705 --> 00:13:32.565
And then there are fifteen

NOTE Confidence: 0.98458797

00:13:32.705 --> 00:13:35.025
township health care centers throughout

NOTE Confidence: 0.98458797

00:13:35.025 --> 00:13:36.625
the county. And then each

NOTE Confidence: 0.98458797

00:13:36.625 --> 00:13:37.925
county each township

NOTE Confidence: 0.97680545

00:13:38.410 --> 00:13:40.010
health care centers manages a

NOTE Confidence: 0.97680545

00:13:40.010 --> 00:13:41.390
number of village clinics,

NOTE Confidence: 0.99538296

00:13:41.929 --> 00:13:43.290
that is staffed by village

NOTE Confidence: 0.99538296

00:13:43.290 --> 00:13:43.790
doctors,

NOTE Confidence: 0.94795775

00:13:44.410 --> 00:13:47.150
and, nurses, sometimes pharmacists too.

NOTE Confidence: 0.94795775

00:13:47.290 --> 00:13:48.429
And the village doctors

NOTE Confidence: 0.98248655

00:13:49.130 --> 00:13:51.175
can prescribe medicine. This is

NOTE Confidence: 0.98248655

00:13:51.175 --> 00:13:53.095
different from, for example, Nepal

NOTE Confidence: 0.98248655

00:13:53.095 --> 00:13:53.755
or India,

NOTE Confidence: 0.9753107

00:13:54.135 --> 00:13:54.615
but,

NOTE Confidence: 0.9955014

00:13:55.335 --> 00:13:56.875
they are not board certified

NOTE Confidence: 0.9955014

00:13:57.095 --> 00:13:59.275
physicians as you understand them.

NOTE Confidence: 0.98817587

00:13:59.815 --> 00:14:01.995
They usually receive vocational

NOTE Confidence: 0.98744935

00:14:02.615 --> 00:14:04.475
professional training of two years

NOTE Confidence: 0.98744935

00:14:04.720 --> 00:14:06.320
beyond high school or after

NOTE Confidence: 0.98744935

00:14:06.320 --> 00:14:07.059
middle school.

NOTE Confidence: 0.97093016

00:14:07.679 --> 00:14:10.080
Then, they get certificate from

NOTE Confidence: 0.97093016

00:14:10.080 --> 00:14:11.360
the government to be a

NOTE Confidence: 0.97093016

00:14:11.360 --> 00:14:12.800
village doctor. Some of them

NOTE Confidence: 0.97093016

00:14:12.800 --> 00:14:14.000
full time, many of them

NOTE Confidence: 0.97093016

00:14:14.000 --> 00:14:16.100
also part time doing farming

NOTE Confidence: 0.97093016

00:14:16.160 --> 00:14:17.220
or other things,

NOTE Confidence: 0.88829505

00:14:17.679 --> 00:14:18.785
on the side. Can I

NOTE Confidence: 0.88829505

00:14:18.785 --> 00:14:20.024
ask you one question? What?

NOTE Confidence: 0.88829505

00:14:20.024 --> 00:14:21.305
Can you do that? Sure.

NOTE Confidence: 0.88829505

00:14:21.464 --> 00:14:22.345
The line about,

NOTE Confidence: 0.9524899

00:14:22.904 --> 00:14:24.504
poor adherence to treatment. Mhmm.

NOTE Confidence: 0.9524899

00:14:24.504 --> 00:14:25.625
Just because I don't know

NOTE Confidence: 0.9524899

00:14:25.625 --> 00:14:26.745
I don't know the context.

NOTE Confidence: 0.9524899

00:14:26.745 --> 00:14:28.824
Is the adherence because of

NOTE Confidence: 0.9524899

00:14:28.824 --> 00:14:31.225
access barriers or education or

NOTE Confidence: 0.9524899

00:14:31.225 --> 00:14:32.560
other things? Things? Yeah. That

NOTE Confidence: 0.9524899

00:14:32.560 --> 00:14:34.160
is a great question. There

NOTE Confidence: 0.9524899

00:14:34.160 --> 00:14:35.860
are many reasons. If I

NOTE Confidence: 0.9524899

00:14:36.000 --> 00:14:37.700
focus on the most important

NOTE Confidence: 0.9524899

00:14:37.839 --> 00:14:38.339
adherence,

NOTE Confidence: 0.9937679

00:14:38.880 --> 00:14:40.420
problem, there are

NOTE Confidence: 0.91196126

00:14:40.880 --> 00:14:42.260
not one there are two.

NOTE Confidence: 0.91196126

00:14:42.320 --> 00:14:43.460
One is cost.

NOTE Confidence: 0.9643767

00:14:44.000 --> 00:14:45.279
Some of these medicine are

NOTE Confidence: 0.9643767

00:14:45.279 --> 00:14:47.894
not free, and, I constantly

NOTE Confidence: 0.9643767

00:14:47.894 --> 00:14:49.334
hear patients saying, oh, can

NOTE Confidence: 0.9643767

00:14:49.334 --> 00:14:50.855
we get this for free

NOTE Confidence: 0.9643767

00:14:50.855 --> 00:14:52.214
or at lower cost? And

NOTE Confidence: 0.9643767

00:14:52.214 --> 00:14:53.334
the other thing would be

NOTE Confidence: 0.9643767

00:14:53.415 --> 00:14:54.695
well, the costing we can't

NOTE Confidence: 0.9643767

00:14:54.695 --> 00:14:55.894
really address in our study.

NOTE Confidence: 0.9643767

00:14:55.894 --> 00:14:56.935
We didn't address that in

NOTE Confidence: 0.9643767

00:14:56.935 --> 00:14:58.214
our study. The other thing

NOTE Confidence: 0.9643767

00:14:58.214 --> 00:15:01.290
is the, health literacy. Like,

NOTE Confidence: 0.9643767

00:15:01.529 --> 00:15:03.529
they, would stop their medicine

NOTE Confidence: 0.9643767

00:15:03.529 --> 00:15:04.910
when there is no symptom

NOTE Confidence: 0.89402515

00:15:05.290 --> 00:15:06.430
or they may forget.

NOTE Confidence: 0.9674236

00:15:06.810 --> 00:15:08.570
So there's that kind of

NOTE Confidence: 0.9674236

00:15:08.570 --> 00:15:09.070
reasons.

NOTE Confidence: 0.41005865

00:15:09.610 --> 00:15:09.930
Sorry,

NOTE Confidence: 0.8495096

00:15:11.610 --> 00:15:12.829
On the cost question,

NOTE Confidence: 0.9642024

00:15:14.394 --> 00:15:15.834
can you be how clear

NOTE Confidence: 0.9642024

00:15:15.834 --> 00:15:17.515
can you be about what

NOTE Confidence: 0.9642024

00:15:17.515 --> 00:15:19.355
what exactly is free? Like,

NOTE Confidence: 0.9642024

00:15:19.355 --> 00:15:20.894
a first line WHO

NOTE Confidence: 0.98779464

00:15:21.675 --> 00:15:22.894
recommended antihypertensives

NOTE Confidence: 0.77593637

00:15:24.154 --> 00:15:24.654
free.

NOTE Confidence: 0.9543417

00:15:25.595 --> 00:15:26.875
Are they in stock at

NOTE Confidence: 0.9543417

00:15:26.875 --> 00:15:28.235
all of these, I guess,

NOTE Confidence: 0.9543417

00:15:28.235 --> 00:15:29.915
would be village clinics? At

NOTE Confidence: 0.9543417

00:15:29.915 --> 00:15:30.690
the time time we were

NOTE Confidence: 0.9543417

00:15:30.690 --> 00:15:32.610
working there, the active trial

NOTE Confidence: 0.9543417

00:15:32.610 --> 00:15:33.890
from twenty seventeen to twenty

NOTE Confidence: 0.9543417

00:15:33.890 --> 00:15:34.390
eighteen,

NOTE Confidence: 0.9921733

00:15:34.770 --> 00:15:36.770
these frontline medicines, what we

NOTE Confidence: 0.9921733

00:15:36.770 --> 00:15:38.470
call in the essential formulary

NOTE Confidence: 0.9921733

00:15:38.690 --> 00:15:39.830
Yeah. They are

NOTE Confidence: 0.87772346

00:15:40.370 --> 00:15:41.730
usually they were usually in

NOTE Confidence: 0.87772346

00:15:41.730 --> 00:15:42.230
stock.

NOTE Confidence: 0.99897254

00:15:42.654 --> 00:15:44.175
So availability is not an

NOTE Confidence: 0.99897254

00:15:44.175 --> 00:15:45.315
issue. However,

NOTE Confidence: 0.98980224

00:15:45.695 --> 00:15:47.455
in terms of free, at

NOTE Confidence: 0.98980224

00:15:47.455 --> 00:15:49.475
that time, nothing was completely

NOTE Confidence: 0.98980224

00:15:49.615 --> 00:15:51.455
for free. They needed to

NOTE Confidence: 0.98980224

00:15:51.455 --> 00:15:52.435
have co pay.

NOTE Confidence: 0.974851

00:15:53.214 --> 00:15:55.135
If they register as a

NOTE Confidence: 0.974851

00:15:55.135 --> 00:15:56.595
chronic disease patient

NOTE Confidence: 0.9855979

00:15:57.009 --> 00:15:58.610
through that special policy, they

NOTE Confidence: 0.9855979

00:15:58.610 --> 00:16:00.290
get a larger discount, but

NOTE Confidence: 0.9855979

00:16:00.290 --> 00:16:01.770
it's still not free Mhmm.

NOTE Confidence: 0.9855979

00:16:02.050 --> 00:16:02.870
At that time.

NOTE Confidence: 0.96608806

00:16:04.610 --> 00:16:06.050
Later, it became a little

NOTE Confidence: 0.96608806

00:16:06.050 --> 00:16:06.550
better.

NOTE Confidence: 0.99597675

00:16:07.089 --> 00:16:08.850
And just to calibrate that,

NOTE Confidence: 0.99597675

00:16:08.850 --> 00:16:10.529
what percent of, like, the

NOTE Confidence: 0.99597675

00:16:10.529 --> 00:16:11.509
monthly income

NOTE Confidence: 0.9955144

00:16:11.945 --> 00:16:13.225
would it cost to pay

NOTE Confidence: 0.9955144

00:16:13.225 --> 00:16:14.205
for that medicine?

NOTE Confidence: 0.95297563

00:16:14.585 --> 00:16:16.425
Loss? Well, the medicines we

NOTE Confidence: 0.95297563

00:16:16.425 --> 00:16:17.945
promote actually are very cheap.

NOTE Confidence: 0.95297563

00:16:17.945 --> 00:16:18.445
Mhmm.

NOTE Confidence: 0.9917828

00:16:18.825 --> 00:16:19.325
Like,

NOTE Confidence: 0.9523119

00:16:19.865 --> 00:16:20.985
they could be just a

NOTE Confidence: 0.9523119

00:16:20.985 --> 00:16:22.745
few yuan per month or

NOTE Confidence: 0.9523119

00:16:22.745 --> 00:16:23.245
even

NOTE Confidence: 0.96370023

00:16:23.750 --> 00:16:24.870
like, aspirin is, like, a

NOTE Confidence: 0.96370023

00:16:24.870 --> 00:16:26.110
few yuan per year Mhmm.

NOTE Confidence: 0.96370023

00:16:26.310 --> 00:16:27.350
Which is less than a

NOTE Confidence: 0.96370023

00:16:27.350 --> 00:16:29.290
dollar per year. Mhmm. But

NOTE Confidence: 0.96370023

00:16:29.350 --> 00:16:30.649
the better branding

NOTE Confidence: 0.9437309

00:16:31.350 --> 00:16:33.029
aspirin, like, from there, that

NOTE Confidence: 0.9437309

00:16:33.029 --> 00:16:34.389
costs more. But that's not

NOTE Confidence: 0.9437309

00:16:34.389 --> 00:16:35.670
what we're that's not what

NOTE Confidence: 0.9437309

00:16:35.670 --> 00:16:37.050
we're promoting. Exactly.

NOTE Confidence: 0.9845891

00:16:37.775 --> 00:16:39.135
And, I don't think I

NOTE Confidence: 0.9845891

00:16:39.135 --> 00:16:40.575
would remember to mention this,

NOTE Confidence: 0.9845891

00:16:40.575 --> 00:16:41.615
but some of you may

NOTE Confidence: 0.9845891

00:16:41.615 --> 00:16:42.115
know,

NOTE Confidence: 0.98443615

00:16:42.575 --> 00:16:44.115
that it's led by professor,

NOTE Confidence: 0.876408

00:16:45.135 --> 00:16:46.975
Jiang He from Tulane who's

NOTE Confidence: 0.876408

00:16:46.975 --> 00:16:49.155
at Texas now, and professor

NOTE Confidence: 0.876408

00:16:49.295 --> 00:16:49.795
from

NOTE Confidence: 0.9311716

00:16:50.175 --> 00:16:51.990
China. They published two papers

NOTE Confidence: 0.9311716

00:16:51.990 --> 00:16:53.269
in Lancet, and I wrote

NOTE Confidence: 0.9311716

00:16:53.269 --> 00:16:55.589
an editorial for them. They

NOTE Confidence: 0.9311716

00:16:55.589 --> 00:16:57.670
had this large trial of

NOTE Confidence: 0.9311716

00:16:57.670 --> 00:16:58.389
three hundred,

NOTE Confidence: 0.99086547

00:16:58.949 --> 00:17:00.630
or so clusters of thirty

NOTE Confidence: 0.99086547

00:17:00.630 --> 00:17:02.410
three thousand patients,

NOTE Confidence: 0.9896557

00:17:02.790 --> 00:17:05.015
with first result of eighteen

NOTE Confidence: 0.9896557

00:17:05.015 --> 00:17:06.455
months follow-up of a blood

NOTE Confidence: 0.9896557

00:17:06.455 --> 00:17:07.275
pressure reduction.

NOTE Confidence: 0.86282724

00:17:07.655 --> 00:17:09.255
It's humongous. It's like fourteen

NOTE Confidence: 0.86282724

00:17:09.255 --> 00:17:09.755
millimetric

NOTE Confidence: 0.9588677

00:17:10.055 --> 00:17:11.195
blood pressure reduction

NOTE Confidence: 0.9189366

00:17:11.494 --> 00:17:13.494
because they provided medicine for

NOTE Confidence: 0.9189366

00:17:13.494 --> 00:17:14.855
free not because of that.

NOTE Confidence: 0.9189366

00:17:14.855 --> 00:17:15.895
But the large reason was

NOTE Confidence: 0.9189366

00:17:15.895 --> 00:17:17.575
that they provided medicine for

NOTE Confidence: 0.9189366

00:17:17.575 --> 00:17:19.490
free to over ninety percent

NOTE Confidence: 0.9189366

00:17:19.490 --> 00:17:20.690
of those in the international

NOTE Confidence: 0.9189366

00:17:20.690 --> 00:17:21.190
are.

NOTE Confidence: 0.94556975

00:17:21.649 --> 00:17:23.169
That that they did that.

NOTE Confidence: 0.94556975

00:17:23.169 --> 00:17:24.210
And then in the thirty

NOTE Confidence: 0.94556975

00:17:24.210 --> 00:17:25.570
six month follow-up, they had

NOTE Confidence: 0.94556975

00:17:25.570 --> 00:17:27.750
a reduction of somewhere between

NOTE Confidence: 0.94556975

00:17:28.049 --> 00:17:29.570
fifteen to twenty five percent

NOTE Confidence: 0.94556975

00:17:29.570 --> 00:17:30.309
in cardiovascular.

NOTE Confidence: 0.962893

00:17:31.465 --> 00:17:32.984
So that's their their study.

NOTE Confidence: 0.962893

00:17:32.984 --> 00:17:34.365
And, our study

NOTE Confidence: 0.93132305

00:17:34.904 --> 00:17:35.644
was different,

NOTE Confidence: 0.9929351

00:17:36.744 --> 00:17:37.244
in

NOTE Confidence: 0.9194618

00:17:37.784 --> 00:17:38.825
terms of the provision of

NOTE Confidence: 0.9194618

00:17:38.825 --> 00:17:39.325
medicine.

NOTE Confidence: 0.9907933

00:17:40.024 --> 00:17:41.625
And we observed a much

NOTE Confidence: 0.9907933

00:17:41.625 --> 00:17:42.125
smaller

NOTE Confidence: 0.97332895

00:17:42.664 --> 00:17:44.350
effect size. Because you're using

NOTE Confidence: 0.97332895

00:17:44.350 --> 00:17:45.789
the health system rather than

NOTE Confidence: 0.97332895

00:17:45.789 --> 00:17:47.230
providing Yes. We use we

NOTE Confidence: 0.97332895

00:17:47.230 --> 00:17:49.309
use the existing, system as

NOTE Confidence: 0.97332895

00:17:49.309 --> 00:17:50.750
much as as we could.

NOTE Confidence: 0.97332895

00:17:50.750 --> 00:17:51.789
Yeah. I'm sorry. I also

NOTE Confidence: 0.97332895

00:17:51.789 --> 00:17:52.669
have a question of the

NOTE Confidence: 0.97332895

00:17:52.669 --> 00:17:54.909
village doctors. Mhmm. So do

NOTE Confidence: 0.97332895

00:17:54.909 --> 00:17:55.869
they have would you say

NOTE Confidence: 0.97332895

00:17:55.869 --> 00:17:56.669
that they all have a

NOTE Confidence: 0.97332895

00:17:56.669 --> 00:17:57.650
high school education?

NOTE Confidence: 0.9427223

00:17:58.655 --> 00:18:00.255
Some of them would mean,

NOTE Confidence: 0.9427223

00:18:00.575 --> 00:18:02.255
community college. Uh-huh. So they're

NOTE Confidence: 0.9427223

00:18:02.335 --> 00:18:03.375
They may not have high

NOTE Confidence: 0.9427223

00:18:03.375 --> 00:18:04.655
school. They may go to

NOTE Confidence: 0.9427223

00:18:04.655 --> 00:18:06.914
the vocational school for health

NOTE Confidence: 0.9427223

00:18:07.054 --> 00:18:08.655
after middle school. But they're

NOTE Confidence: 0.9427223

00:18:08.655 --> 00:18:10.494
all literate. Sure. Oh, yes.

NOTE Confidence: 0.9427223

00:18:10.494 --> 00:18:11.315
They're all literate.

NOTE Confidence: 0.92403305

00:18:11.690 --> 00:18:13.290
And other than, a small

NOTE Confidence: 0.92403305

00:18:13.290 --> 00:18:15.609
percentage of, let's say, ten

NOTE Confidence: 0.92403305

00:18:15.609 --> 00:18:17.369
percent ten to fifteen percent

NOTE Confidence: 0.92403305

00:18:17.369 --> 00:18:18.650
at that time, all of

NOTE Confidence: 0.92403305

00:18:18.650 --> 00:18:20.090
the village doctors are used

NOTE Confidence: 0.92403305

00:18:20.250 --> 00:18:21.230
used a smartphone

NOTE Confidence: 0.89361274

00:18:21.690 --> 00:18:23.150
even in twenty seventeen.

NOTE Confidence: 0.9633229

00:18:23.785 --> 00:18:24.905
At this time, I think

NOTE Confidence: 0.9633229

00:18:24.905 --> 00:18:26.345
it's nearly a hundred percent

NOTE Confidence: 0.9633229

00:18:26.345 --> 00:18:27.885
as the older village doctors,

NOTE Confidence: 0.969926

00:18:28.265 --> 00:18:28.765
retired.

NOTE Confidence: 0.99957496

00:18:29.145 --> 00:18:31.165
However, even as of now,

NOTE Confidence: 0.9959331

00:18:31.945 --> 00:18:33.325
nearly no patients

NOTE Confidence: 0.9926152

00:18:33.865 --> 00:18:34.925
use smartphone.

NOTE Confidence: 0.9171319

00:18:37.340 --> 00:18:39.020
They at least have, had

NOTE Confidence: 0.9171319

00:18:39.020 --> 00:18:39.680
a shared

NOTE Confidence: 0.9431824

00:18:40.140 --> 00:18:41.500
cell phone, that is a

NOTE Confidence: 0.9431824

00:18:41.500 --> 00:18:42.619
feature phone, like a basic

NOTE Confidence: 0.9431824

00:18:42.619 --> 00:18:44.540
phone. They can receive calls

NOTE Confidence: 0.9431824

00:18:44.540 --> 00:18:45.520
and text messages.

NOTE Confidence: 0.947293

00:18:46.780 --> 00:18:48.220
So But that's very different

NOTE Confidence: 0.947293

00:18:48.220 --> 00:18:50.144
than, say, community health workers

NOTE Confidence: 0.947293

00:18:50.144 --> 00:18:51.585
in Nepal or ASHA's in

NOTE Confidence: 0.947293

00:18:51.585 --> 00:18:53.684
India who could be even

NOTE Confidence: 0.947293

00:18:53.825 --> 00:18:55.664
barely literate or even not

NOTE Confidence: 0.947293

00:18:55.664 --> 00:18:57.505
literate. Right. That's different. And

NOTE Confidence: 0.947293

00:18:57.505 --> 00:18:58.465
so this is a full

NOTE Confidence: 0.947293

00:18:58.465 --> 00:19:00.005
time job. They're not volunteers.

NOTE Confidence: 0.94346607

00:19:00.625 --> 00:19:02.065
They're not volunteers. Some of

NOTE Confidence: 0.94346607

00:19:02.065 --> 00:19:03.630
them are part time, but

NOTE Confidence: 0.94346607

00:19:03.630 --> 00:19:05.070
they're paid. They they receive

NOTE Confidence: 0.94346607

00:19:05.070 --> 00:19:06.450
some payment from the government.

NOTE Confidence: 0.94346607

00:19:06.750 --> 00:19:08.670
And they are doctors, and

NOTE Confidence: 0.94346607

00:19:08.670 --> 00:19:09.630
they could even they're not

NOTE Confidence: 0.94346607

00:19:09.630 --> 00:19:10.910
just literate literate, but they

NOTE Confidence: 0.94346607

00:19:10.910 --> 00:19:12.050
could prescribe medicine

NOTE Confidence: 0.9494537

00:19:12.430 --> 00:19:13.869
in the formula, in the

NOTE Confidence: 0.9494537

00:19:13.869 --> 00:19:14.770
essential formula.

NOTE Confidence: 0.92029333

00:19:15.655 --> 00:19:16.775
Is it a full time

NOTE Confidence: 0.92029333

00:19:16.775 --> 00:19:17.734
job, or do they have

NOTE Confidence: 0.92029333

00:19:17.734 --> 00:19:18.934
another job and they just

NOTE Confidence: 0.92029333

00:19:18.934 --> 00:19:20.535
do the same size? A

NOTE Confidence: 0.92029333

00:19:20.535 --> 00:19:21.975
a percentage of them. During

NOTE Confidence: 0.92029333

00:19:21.975 --> 00:19:22.934
the time when we did

NOTE Confidence: 0.92029333

00:19:22.934 --> 00:19:24.135
our trial, I think it's

NOTE Confidence: 0.92029333

00:19:24.135 --> 00:19:24.875
higher now,

NOTE Confidence: 0.9969459

00:19:25.494 --> 00:19:26.934
because China is changing so

NOTE Confidence: 0.9969459

00:19:26.934 --> 00:19:27.434
fast.

NOTE Confidence: 0.98439807

00:19:28.055 --> 00:19:29.575
At that time, about,

NOTE Confidence: 0.9394325

00:19:30.700 --> 00:19:31.740
I would say, a little

NOTE Confidence: 0.9394325

00:19:31.740 --> 00:19:33.420
less than half had this

NOTE Confidence: 0.9394325

00:19:33.420 --> 00:19:34.780
as a full time job.

NOTE Confidence: 0.9394325

00:19:34.780 --> 00:19:36.540
Mhmm. But the other over

NOTE Confidence: 0.9394325

00:19:36.540 --> 00:19:38.320
half of the village doctors

NOTE Confidence: 0.97335327

00:19:38.859 --> 00:19:40.400
worked as a village doctor,

NOTE Confidence: 0.9779727

00:19:40.700 --> 00:19:41.980
but at the same time,

NOTE Confidence: 0.9779727

00:19:41.980 --> 00:19:43.500
also did their own business

NOTE Confidence: 0.9779727

00:19:43.500 --> 00:19:44.240
or farming.

NOTE Confidence: 0.97464406

00:19:45.984 --> 00:19:46.965
So it's a mix.

NOTE Confidence: 0.9466073

00:19:47.265 --> 00:19:49.184
But nowadays, more, of them

NOTE Confidence: 0.9466073

00:19:49.184 --> 00:19:50.965
are full time village doctors.

NOTE Confidence: 0.9453535

00:19:51.345 --> 00:19:52.625
Okay. Thank you. So these

NOTE Confidence: 0.9453535

00:19:52.625 --> 00:19:53.905
are important background for you

NOTE Confidence: 0.9453535

00:19:53.905 --> 00:19:55.125
to understand in our study.

NOTE Confidence: 0.96102035

00:19:56.065 --> 00:19:57.744
This is the core functions

NOTE Confidence: 0.96102035

00:19:57.744 --> 00:19:59.710
and core function and forms

NOTE Confidence: 0.96102035

00:19:59.710 --> 00:20:00.750
model that some of you

NOTE Confidence: 0.96102035

00:20:00.750 --> 00:20:02.030
may be familiar. So we

NOTE Confidence: 0.96102035

00:20:02.030 --> 00:20:03.630
start with identification of the

NOTE Confidence: 0.96102035

00:20:03.630 --> 00:20:05.650
problem that needs and identify

NOTE Confidence: 0.96102035

00:20:05.789 --> 00:20:06.530
the standardized

NOTE Confidence: 0.9147029

00:20:06.910 --> 00:20:07.730
core functions,

NOTE Confidence: 0.9942319

00:20:08.270 --> 00:20:10.049
but tailor the core functions

NOTE Confidence: 0.9942319

00:20:10.270 --> 00:20:10.770
to,

NOTE Confidence: 0.96732754

00:20:11.505 --> 00:20:13.025
have the different forms for

NOTE Confidence: 0.96732754

00:20:13.025 --> 00:20:14.165
the different contexts.

NOTE Confidence: 0.9906262

00:20:14.785 --> 00:20:15.285
So,

NOTE Confidence: 0.9784663

00:20:15.585 --> 00:20:16.405
we didn't,

NOTE Confidence: 0.99221915

00:20:17.265 --> 00:20:19.425
actually use this until later

NOTE Confidence: 0.99221915

00:20:19.425 --> 00:20:19.925
on,

NOTE Confidence: 0.9991104

00:20:20.705 --> 00:20:22.565
when we wanted to transfer

NOTE Confidence: 0.9719531

00:20:23.149 --> 00:20:24.669
learnings from this study to

NOTE Confidence: 0.9719531

00:20:24.669 --> 00:20:27.010
other settings. And we realized

NOTE Confidence: 0.9719531

00:20:27.070 --> 00:20:28.190
that this could be used

NOTE Confidence: 0.9719531

00:20:28.190 --> 00:20:29.010
in a retrospective

NOTE Confidence: 0.9270918

00:20:29.390 --> 00:20:31.470
way even to facilitate the

NOTE Confidence: 0.9270918

00:20:31.470 --> 00:20:31.970
transformation,

NOTE Confidence: 0.91929686

00:20:32.510 --> 00:20:33.250
the transferability.

NOTE Confidence: 0.98463506

00:20:33.950 --> 00:20:35.390
For example, we could keep

NOTE Confidence: 0.98463506

00:20:35.390 --> 00:20:36.830
the core functions if we

NOTE Confidence: 0.98463506

00:20:36.830 --> 00:20:38.369
identify the core functions

NOTE Confidence: 0.9177806

00:20:38.765 --> 00:20:40.225
to be transferable.

NOTE Confidence: 0.9809374

00:20:40.685 --> 00:20:42.285
But the forms definitely needs

NOTE Confidence: 0.9809374

00:20:42.285 --> 00:20:43.645
to be adapted and tailored

NOTE Confidence: 0.9809374

00:20:43.645 --> 00:20:44.925
to a different context, which

NOTE Confidence: 0.9809374

00:20:44.925 --> 00:20:45.805
is what we're trying to

NOTE Confidence: 0.9809374

00:20:45.805 --> 00:20:46.305
do,

NOTE Confidence: 0.8612799

00:20:46.845 --> 00:20:48.525
in Nepal with Nepal, actually

NOTE Confidence: 0.8612799

00:20:48.525 --> 00:20:49.265
with Archana,

NOTE Confidence: 0.9869666

00:20:49.805 --> 00:20:50.205
and,

NOTE Confidence: 0.9376771

00:20:50.925 --> 00:20:53.005
other Viraj and others, in

NOTE Confidence: 0.9376771

00:20:53.005 --> 00:20:53.505
Nepal.

NOTE Confidence: 0.9461594

00:20:53.869 --> 00:20:55.470
So, this is a very

NOTE Confidence: 0.9461594

00:20:55.470 --> 00:20:56.450
busy slide.

NOTE Confidence: 0.98211414

00:20:57.470 --> 00:20:59.550
Sorry. Very busy slide, but

NOTE Confidence: 0.98211414

00:20:59.550 --> 00:21:00.430
I don't mean for you

NOTE Confidence: 0.98211414

00:21:00.430 --> 00:21:01.550
to read them, but this

NOTE Confidence: 0.98211414

00:21:01.550 --> 00:21:02.830
is our way of trying

NOTE Confidence: 0.98211414

00:21:02.830 --> 00:21:04.109
to map what we have

NOTE Confidence: 0.98211414

00:21:04.109 --> 00:21:04.609
done,

NOTE Confidence: 0.9478399

00:21:05.150 --> 00:21:05.650
throughout,

NOTE Confidence: 0.99910045

00:21:06.109 --> 00:21:06.609
this

NOTE Confidence: 0.9940282

00:21:07.855 --> 00:21:08.355
matrix.

NOTE Confidence: 0.9857464

00:21:09.534 --> 00:21:11.394
The model that we actively

NOTE Confidence: 0.9857464

00:21:11.615 --> 00:21:13.375
adopted when we were designing

NOTE Confidence: 0.9857464

00:21:13.375 --> 00:21:14.034
the intervention,

NOTE Confidence: 0.9750689

00:21:14.815 --> 00:21:15.134
was,

NOTE Confidence: 0.973118

00:21:15.615 --> 00:21:16.894
at that time, was the

NOTE Confidence: 0.973118

00:21:16.894 --> 00:21:18.115
chronic care model.

NOTE Confidence: 0.9877616

00:21:18.815 --> 00:21:19.695
I don't have time to

NOTE Confidence: 0.9877616

00:21:19.695 --> 00:21:20.734
go into a lot of

NOTE Confidence: 0.9877616

00:21:20.734 --> 00:21:22.115
details, but it covers,

NOTE Confidence: 0.8944348

00:21:22.780 --> 00:21:23.600
six domains,

NOTE Confidence: 0.9692975

00:21:24.220 --> 00:21:25.340
most of them within the

NOTE Confidence: 0.9692975

00:21:25.340 --> 00:21:26.240
health care system.

NOTE Confidence: 0.9781876

00:21:27.020 --> 00:21:28.540
Some in, this one is

NOTE Confidence: 0.9781876

00:21:28.540 --> 00:21:29.359
in the community.

NOTE Confidence: 0.99900544

00:21:29.980 --> 00:21:31.980
And the emphasis of this

NOTE Confidence: 0.99900544

00:21:31.980 --> 00:21:33.600
model is on productive

NOTE Confidence: 0.9996252

00:21:34.060 --> 00:21:34.560
interactions

NOTE Confidence: 0.995747

00:21:35.340 --> 00:21:35.840
between

NOTE Confidence: 0.84487593

00:21:36.300 --> 00:21:36.700
the,

NOTE Confidence: 0.99844295

00:21:37.645 --> 00:21:39.585
provider team and the patient,

NOTE Confidence: 0.99041927

00:21:40.205 --> 00:21:42.225
which is also our emphasis,

NOTE Confidence: 0.99929446

00:21:42.605 --> 00:21:43.825
for the intervention.

NOTE Confidence: 0.97505873

00:21:44.525 --> 00:21:45.885
So now this is a

NOTE Confidence: 0.97505873

00:21:45.885 --> 00:21:47.565
revealing of the acronym called

NOTE Confidence: 0.97505873

00:21:47.565 --> 00:21:48.924
cinema. I've been calling it,

NOTE Confidence: 0.98612213

00:21:49.484 --> 00:21:50.945
since the outline slide.

NOTE Confidence: 0.7807407

00:21:51.484 --> 00:21:51.804
It's,

NOTE Confidence: 0.97692186

00:21:52.460 --> 00:21:53.840
the acronym means,

NOTE Confidence: 0.9459984

00:21:54.619 --> 00:21:55.600
system integrated,

NOTE Confidence: 0.99812806

00:21:56.940 --> 00:21:58.080
technology enabled

NOTE Confidence: 0.95522934

00:21:58.619 --> 00:21:59.680
model of care.

NOTE Confidence: 0.9397718

00:22:00.619 --> 00:22:01.020
And,

NOTE Confidence: 0.8614258

00:22:01.580 --> 00:22:01.980
it's,

NOTE Confidence: 0.9943519

00:22:02.380 --> 00:22:03.680
covering three levels.

NOTE Confidence: 0.9887011

00:22:04.220 --> 00:22:04.720
So

NOTE Confidence: 0.99461573

00:22:05.020 --> 00:22:07.119
the, our way of addressing

NOTE Confidence: 0.98385245

00:22:07.445 --> 00:22:09.205
patient level barriers is through

NOTE Confidence: 0.98385245

00:22:09.205 --> 00:22:11.365
the monthly follow-up visit by

NOTE Confidence: 0.98385245

00:22:11.365 --> 00:22:12.905
the village doctors, the interaction

NOTE Confidence: 0.98385245

00:22:12.965 --> 00:22:13.465
between

NOTE Confidence: 0.9498575

00:22:13.765 --> 00:22:15.145
the the face to face

NOTE Confidence: 0.9498575

00:22:15.285 --> 00:22:17.045
interactions between village doctors and

NOTE Confidence: 0.9498575

00:22:17.045 --> 00:22:17.705
the patients.

NOTE Confidence: 0.99544144

00:22:18.405 --> 00:22:20.244
And then, we provide self

NOTE Confidence: 0.99544144

00:22:20.244 --> 00:22:21.465
management support

NOTE Confidence: 0.95112044

00:22:21.859 --> 00:22:23.380
through the voice messages, and

NOTE Confidence: 0.95112044

00:22:23.380 --> 00:22:24.260
there is a lot of,

NOTE Confidence: 0.95112044

00:22:24.580 --> 00:22:27.060
formative research going into why

NOTE Confidence: 0.95112044

00:22:27.060 --> 00:22:28.580
is voice message not the

NOTE Confidence: 0.95112044

00:22:28.580 --> 00:22:29.940
text message and how we

NOTE Confidence: 0.95112044

00:22:29.940 --> 00:22:31.880
design the voice message, etcetera.

NOTE Confidence: 0.99757445

00:22:33.220 --> 00:22:34.580
And then at the village

NOTE Confidence: 0.99757445

00:22:34.580 --> 00:22:36.994
doctor level, we have training

NOTE Confidence: 0.9379151

00:22:37.295 --> 00:22:39.135
and technology empowerment, which is

NOTE Confidence: 0.9379151

00:22:39.135 --> 00:22:40.734
through a smartphone based app

NOTE Confidence: 0.9379151

00:22:40.734 --> 00:22:42.575
called the cinema app, and

NOTE Confidence: 0.9379151

00:22:42.575 --> 00:22:43.715
also incentives.

NOTE Confidence: 0.67708725

00:22:44.015 --> 00:22:45.075
Incentives both

NOTE Confidence: 0.93368083

00:22:45.375 --> 00:22:47.315
financial incentives, but also,

NOTE Confidence: 0.79098964

00:22:48.494 --> 00:22:48.994
nonfinancial

NOTE Confidence: 0.87830395

00:22:49.295 --> 00:22:50.915
incentives such as recognition,

NOTE Confidence: 0.9925642

00:22:51.295 --> 00:22:51.795
award,

NOTE Confidence: 0.8250139

00:22:52.869 --> 00:22:53.369
etcetera.

NOTE Confidence: 0.994249

00:22:53.990 --> 00:22:54.710
And then,

NOTE Confidence: 0.9473767

00:22:55.109 --> 00:22:56.330
working with the specialists,

NOTE Confidence: 0.99844426

00:22:57.109 --> 00:22:57.609
to

NOTE Confidence: 0.9835159

00:22:58.150 --> 00:23:00.010
task shift and tax share

NOTE Confidence: 0.9835159

00:23:00.230 --> 00:23:01.929
with the primary care providers.

NOTE Confidence: 0.9251767

00:23:03.350 --> 00:23:04.190
Hey, Jane. Can I ask

NOTE Confidence: 0.9251767

00:23:04.190 --> 00:23:06.309
a question about performance based

NOTE Confidence: 0.9251767

00:23:06.309 --> 00:23:06.809
incentives?

NOTE Confidence: 0.9868628

00:23:07.190 --> 00:23:07.690
Yeah.

NOTE Confidence: 0.9858403

00:23:08.205 --> 00:23:10.145
From my somewhat limited experience

NOTE Confidence: 0.9771026

00:23:10.845 --> 00:23:12.044
in low and middle income

NOTE Confidence: 0.9771026

00:23:12.044 --> 00:23:13.664
countries, there's a lot of,

NOTE Confidence: 0.99973816

00:23:14.205 --> 00:23:14.705
resistance

NOTE Confidence: 0.99878216

00:23:15.085 --> 00:23:17.345
to performance based incentives

NOTE Confidence: 0.8714811

00:23:18.125 --> 00:23:18.625
because,

NOTE Confidence: 0.99839586

00:23:19.325 --> 00:23:19.825
governments

NOTE Confidence: 0.99151844

00:23:20.365 --> 00:23:22.180
don't wanna kind of create

NOTE Confidence: 0.99151844

00:23:22.180 --> 00:23:23.800
a dependency where people

NOTE Confidence: 0.9583747

00:23:24.180 --> 00:23:25.540
don't do their jobs unless

NOTE Confidence: 0.9583747

00:23:25.540 --> 00:23:26.600
they get an incentive.

NOTE Confidence: 0.99873155

00:23:27.380 --> 00:23:28.760
And I've also experienced

NOTE Confidence: 0.9455797

00:23:29.140 --> 00:23:30.100
in a study where I

NOTE Confidence: 0.9455797

00:23:30.100 --> 00:23:31.540
worked on it. The same

NOTE Confidence: 0.9455797

00:23:31.540 --> 00:23:32.980
people are, like, the ones

NOTE Confidence: 0.9455797

00:23:32.980 --> 00:23:33.780
who do a really good

NOTE Confidence: 0.9455797

00:23:33.780 --> 00:23:35.140
job every single month. I

NOTE Confidence: 0.9455797

00:23:35.140 --> 00:23:36.680
don't always get the incentives.

NOTE Confidence: 0.9649318

00:23:38.095 --> 00:23:39.455
So I'm just wondering, like,

NOTE Confidence: 0.9649318

00:23:39.455 --> 00:23:40.575
since you said you were

NOTE Confidence: 0.9649318

00:23:40.575 --> 00:23:42.035
co designing with stakeholders

NOTE Confidence: 0.9771153

00:23:42.414 --> 00:23:44.095
Yes. Were they really happy

NOTE Confidence: 0.9771153

00:23:44.095 --> 00:23:45.215
about that, and did they

NOTE Confidence: 0.9771153

00:23:45.215 --> 00:23:46.434
feel it was sustainable?

NOTE Confidence: 0.9439594

00:23:46.815 --> 00:23:48.414
Or I'm so glad you

NOTE Confidence: 0.9439594

00:23:48.655 --> 00:23:49.775
thoughts. I'm so glad you

NOTE Confidence: 0.9439594

00:23:49.775 --> 00:23:50.895
asked this question because I

NOTE Confidence: 0.9439594

00:23:50.895 --> 00:23:51.395
won't

NOTE Confidence: 0.97976154

00:23:51.830 --> 00:23:52.869
spend too much time on

NOTE Confidence: 0.97976154

00:23:52.869 --> 00:23:53.910
this, but this is such

NOTE Confidence: 0.97976154

00:23:53.910 --> 00:23:54.869
a great question that I

NOTE Confidence: 0.97976154

00:23:54.869 --> 00:23:56.250
do want to respond to.

NOTE Confidence: 0.97976154

00:23:56.470 --> 00:23:58.650
Indeed, the concerns are true

NOTE Confidence: 0.97976154

00:23:58.869 --> 00:24:01.030
that, it may provide the

NOTE Confidence: 0.97976154

00:24:01.030 --> 00:24:02.710
wrong incentive for people to

NOTE Confidence: 0.97976154

00:24:02.710 --> 00:24:03.609
just do it

NOTE Confidence: 0.95219463

00:24:03.934 --> 00:24:04.895
if, you know, they don't

NOTE Confidence: 0.95219463

00:24:04.895 --> 00:24:05.615
do it well if they

NOTE Confidence: 0.95219463

00:24:05.615 --> 00:24:06.674
are not getting paid.

NOTE Confidence: 0.9847372

00:24:06.975 --> 00:24:07.455
And,

NOTE Confidence: 0.9197198

00:24:08.575 --> 00:24:10.415
it's usually just the better

NOTE Confidence: 0.9197198

00:24:10.415 --> 00:24:11.475
reform performers.

NOTE Confidence: 0.9862824

00:24:12.015 --> 00:24:13.855
These are valid concerns. I

NOTE Confidence: 0.9862824

00:24:13.855 --> 00:24:15.054
would even say I see

NOTE Confidence: 0.9862824

00:24:15.054 --> 00:24:16.434
that happening in China.

NOTE Confidence: 0.98352504

00:24:16.734 --> 00:24:18.515
Like, China has this performance

NOTE Confidence: 0.98352504

00:24:18.655 --> 00:24:19.155
based

NOTE Confidence: 0.9664627

00:24:19.770 --> 00:24:21.930
system within our national health

NOTE Confidence: 0.9664627

00:24:21.930 --> 00:24:22.590
care system,

NOTE Confidence: 0.99937135

00:24:23.369 --> 00:24:24.830
whether it's for the hospitals

NOTE Confidence: 0.9670293

00:24:25.290 --> 00:24:26.830
or for the public health

NOTE Confidence: 0.9670293

00:24:26.890 --> 00:24:28.910
package, national public health package.

NOTE Confidence: 0.9865571

00:24:29.290 --> 00:24:31.310
And they have very detailed

NOTE Confidence: 0.9865571

00:24:31.450 --> 00:24:32.510
performance measures.

NOTE Confidence: 0.9248927

00:24:33.165 --> 00:24:35.165
That's usually controlled by the,

NOTE Confidence: 0.9248927

00:24:35.485 --> 00:24:36.385
county CDC

NOTE Confidence: 0.94873625

00:24:36.845 --> 00:24:38.285
for the whole county, and

NOTE Confidence: 0.94873625

00:24:38.285 --> 00:24:39.425
then they evaluate

NOTE Confidence: 0.9355009

00:24:40.445 --> 00:24:41.325
the the people and then

NOTE Confidence: 0.9355009

00:24:41.325 --> 00:24:42.605
give them well, having said

NOTE Confidence: 0.9355009

00:24:42.605 --> 00:24:43.645
that, there is the per

NOTE Confidence: 0.9355009

00:24:43.645 --> 00:24:45.325
capita fee for the puppy

NOTE Confidence: 0.9355009

00:24:45.325 --> 00:24:46.225
house plus

NOTE Confidence: 0.9596521

00:24:46.880 --> 00:24:48.480
some fee that is forewarns

NOTE Confidence: 0.9596521

00:24:48.480 --> 00:24:49.680
based. So there is this

NOTE Confidence: 0.9596521

00:24:49.680 --> 00:24:51.780
culture of forewarns based payment

NOTE Confidence: 0.9596521

00:24:51.920 --> 00:24:53.780
in China. So the resistance

NOTE Confidence: 0.95140284

00:24:54.080 --> 00:24:54.980
from the government,

NOTE Confidence: 0.9436143

00:24:55.840 --> 00:24:57.380
officials was low,

NOTE Confidence: 0.98287964

00:24:57.680 --> 00:24:58.880
but I do see a

NOTE Confidence: 0.98287964

00:24:58.880 --> 00:24:59.835
problem with that,

NOTE Confidence: 0.96969575

00:25:00.635 --> 00:25:02.575
that the culture is such.

NOTE Confidence: 0.9489559

00:25:03.355 --> 00:25:05.274
For example, we're designing another

NOTE Confidence: 0.9489559

00:25:05.274 --> 00:25:07.215
study. We're trying to create

NOTE Confidence: 0.9489559

00:25:07.274 --> 00:25:08.794
a culture of, for example,

NOTE Confidence: 0.9489559

00:25:08.794 --> 00:25:09.615
peer leaders

NOTE Confidence: 0.84254766

00:25:09.994 --> 00:25:11.695
or community health volunteers.

NOTE Confidence: 0.9904618

00:25:12.315 --> 00:25:13.674
But the resistance I always

NOTE Confidence: 0.9904618

00:25:13.674 --> 00:25:15.380
get is, will the volunteers

NOTE Confidence: 0.9904618

00:25:15.520 --> 00:25:17.280
be paid? If not, they

NOTE Confidence: 0.9904618

00:25:17.280 --> 00:25:18.340
may not be incentivized.

NOTE Confidence: 0.9834629

00:25:18.960 --> 00:25:20.000
So so there are I

NOTE Confidence: 0.9834629

00:25:20.000 --> 00:25:21.280
mean, I'm not saying China

NOTE Confidence: 0.9834629

00:25:21.280 --> 00:25:22.640
doesn't have a volunteer culture,

NOTE Confidence: 0.9834629

00:25:22.640 --> 00:25:23.680
but I think that's less

NOTE Confidence: 0.9834629

00:25:23.680 --> 00:25:25.280
than some other cultures. And

NOTE Confidence: 0.9834629

00:25:25.280 --> 00:25:27.359
then this room space, payment

NOTE Confidence: 0.9834629

00:25:27.359 --> 00:25:28.260
scheme is,

NOTE Confidence: 0.97985697

00:25:29.075 --> 00:25:30.275
is a double edged sword.

NOTE Confidence: 0.97985697

00:25:30.275 --> 00:25:30.775
Yes.

NOTE Confidence: 0.95409846

00:25:31.555 --> 00:25:33.315
Given our culture, this seems

NOTE Confidence: 0.95409846

00:25:33.315 --> 00:25:34.755
to be working well, and

NOTE Confidence: 0.95409846

00:25:34.755 --> 00:25:35.255
we

NOTE Confidence: 0.9644949

00:25:35.635 --> 00:25:37.715
really designed the indicators for

NOTE Confidence: 0.9644949

00:25:37.715 --> 00:25:39.315
performance to be very simple

NOTE Confidence: 0.9644949

00:25:39.315 --> 00:25:40.435
and is embedded in the

NOTE Confidence: 0.9644949

00:25:40.435 --> 00:25:41.655
app so they could see,

NOTE Confidence: 0.9840976

00:25:42.435 --> 00:25:43.734
etcetera. Yeah.

NOTE Confidence: 0.9555512

00:25:44.880 --> 00:25:46.160
So this is the pilot

NOTE Confidence: 0.9555512

00:25:46.160 --> 00:25:47.200
study we did in the

NOTE Confidence: 0.9555512

00:25:47.200 --> 00:25:48.020
four villages,

NOTE Confidence: 0.9525602

00:25:48.720 --> 00:25:49.119
to,

NOTE Confidence: 0.96925694

00:25:49.920 --> 00:25:51.119
after the design of the

NOTE Confidence: 0.96925694

00:25:51.119 --> 00:25:53.520
intervention to, fur further refine

NOTE Confidence: 0.96925694

00:25:53.520 --> 00:25:54.740
it and tailor it.

NOTE Confidence: 0.9739928

00:25:55.760 --> 00:25:56.260
Some,

NOTE Confidence: 0.9395361

00:25:57.075 --> 00:25:58.515
this is in Chinese. You

NOTE Confidence: 0.9395361

00:25:58.515 --> 00:25:59.554
can't really see it, but

NOTE Confidence: 0.9395361

00:25:59.554 --> 00:26:00.054
basically,

NOTE Confidence: 0.9982826

00:26:00.595 --> 00:26:01.575
it's the monthly

NOTE Confidence: 0.9993542

00:26:01.875 --> 00:26:02.375
follow-up

NOTE Confidence: 0.7460459

00:26:02.835 --> 00:26:03.335
sheet.

NOTE Confidence: 0.9700509

00:26:04.115 --> 00:26:05.715
And, we focus on the

NOTE Confidence: 0.9700509

00:26:05.715 --> 00:26:06.215
medicine,

NOTE Confidence: 0.96686363

00:26:06.755 --> 00:26:08.530
and the physical activity. There

NOTE Confidence: 0.96686363

00:26:08.530 --> 00:26:10.050
is the goal setting and

NOTE Confidence: 0.96686363

00:26:10.050 --> 00:26:11.190
then also reminders,

NOTE Confidence: 0.9840604

00:26:11.890 --> 00:26:13.570
each month. And so each

NOTE Confidence: 0.9840604

00:26:13.570 --> 00:26:14.930
patient gets one sheet per

NOTE Confidence: 0.9840604

00:26:14.930 --> 00:26:16.369
month. So throughout the year,

NOTE Confidence: 0.9840604

00:26:16.369 --> 00:26:17.510
they get twelve sheets,

NOTE Confidence: 0.99401563

00:26:17.970 --> 00:26:19.510
as reminders for them.

NOTE Confidence: 0.9868693

00:26:20.210 --> 00:26:21.330
And this is the APP.

NOTE Confidence: 0.9868693

00:26:21.330 --> 00:26:22.530
The APP is designed to

NOTE Confidence: 0.9868693

00:26:22.530 --> 00:26:23.590
be user friendly.

NOTE Confidence: 0.9634602

00:26:25.325 --> 00:26:27.244
So it's very easy to

NOTE Confidence: 0.9634602

00:26:27.244 --> 00:26:27.744
use,

NOTE Confidence: 0.97705585

00:26:28.285 --> 00:26:30.365
and, we learned. I think

NOTE Confidence: 0.97705585

00:26:30.365 --> 00:26:31.885
it's okay to do that

NOTE Confidence: 0.97705585

00:26:31.885 --> 00:26:33.825
from the WeChat interface.

NOTE Confidence: 0.99014086

00:26:34.525 --> 00:26:36.365
WeChat is this popular social

NOTE Confidence: 0.99014086

00:26:36.365 --> 00:26:36.865
media,

NOTE Confidence: 0.91546804

00:26:37.520 --> 00:26:38.740
sort of like WhatsApp,

NOTE Confidence: 0.9597423

00:26:39.440 --> 00:26:40.100
in China.

NOTE Confidence: 0.99846953

00:26:40.799 --> 00:26:42.159
And then it has multiple

NOTE Confidence: 0.99846953

00:26:42.159 --> 00:26:42.659
functions

NOTE Confidence: 0.95814526

00:26:42.960 --> 00:26:44.159
at the back end, but

NOTE Confidence: 0.95814526

00:26:44.159 --> 00:26:45.440
made it very easy for

NOTE Confidence: 0.95814526

00:26:45.440 --> 00:26:47.220
the users to navigate.

NOTE Confidence: 0.98995954

00:26:49.039 --> 00:26:50.260
So this is some screenshots,

NOTE Confidence: 0.92673224

00:26:51.520 --> 00:26:52.740
of that, APP.

NOTE Confidence: 0.87576103

00:26:53.895 --> 00:26:54.635
We also,

NOTE Confidence: 0.97607

00:26:55.095 --> 00:26:55.595
had

NOTE Confidence: 0.97234964

00:26:58.135 --> 00:26:59.355
ways to design

NOTE Confidence: 0.9251882

00:26:59.815 --> 00:27:00.555
the messages,

NOTE Confidence: 0.87473196

00:27:00.935 --> 00:27:02.535
based on the health belief

NOTE Confidence: 0.87473196

00:27:02.535 --> 00:27:03.755
system, model,

NOTE Confidence: 0.9695514

00:27:04.615 --> 00:27:05.575
as well as,

NOTE Confidence: 0.99945

00:27:06.135 --> 00:27:07.355
focusing on

NOTE Confidence: 0.9963994

00:27:07.735 --> 00:27:08.475
the two

NOTE Confidence: 0.9561724

00:27:10.049 --> 00:27:11.270
evidence based practices,

NOTE Confidence: 0.95585936

00:27:11.650 --> 00:27:13.670
medication adherence and physical activity.

NOTE Confidence: 0.95585936

00:27:13.730 --> 00:27:14.609
There are so many things

NOTE Confidence: 0.95585936

00:27:14.609 --> 00:27:15.830
we could work on,

NOTE Confidence: 0.9394108

00:27:16.290 --> 00:27:17.809
but, we need it really

NOTE Confidence: 0.9394108

00:27:17.809 --> 00:27:18.470
to prioritize

NOTE Confidence: 0.81943387

00:27:18.770 --> 00:27:20.210
to what may generate the

NOTE Confidence: 0.81943387

00:27:20.210 --> 00:27:22.450
larger impact. So these two

NOTE Confidence: 0.81943387

00:27:22.450 --> 00:27:24.285
are what we focus on.

NOTE Confidence: 0.81943387

00:27:24.365 --> 00:27:25.244
I just wanna close your

NOTE Confidence: 0.81943387

00:27:25.244 --> 00:27:26.945
comment. Why didn't you include

NOTE Confidence: 0.81943387

00:27:27.005 --> 00:27:28.545
reducing salt intake?

NOTE Confidence: 0.9988637

00:27:29.325 --> 00:27:30.765
Yes. That's a good question.

NOTE Confidence: 0.9622691

00:27:31.085 --> 00:27:32.605
For this study, we didn't

NOTE Confidence: 0.9622691

00:27:32.605 --> 00:27:33.885
do that. I I I've

NOTE Confidence: 0.9622691

00:27:33.885 --> 00:27:35.405
actually I had many other

NOTE Confidence: 0.9622691

00:27:35.405 --> 00:27:37.005
studies focusing on that. I

NOTE Confidence: 0.9622691

00:27:37.005 --> 00:27:38.260
know. But for for this

NOTE Confidence: 0.9622691

00:27:38.260 --> 00:27:40.020
study, the conscious choice was

NOTE Confidence: 0.9622691

00:27:40.020 --> 00:27:41.300
not to work on education

NOTE Confidence: 0.9622691

00:27:41.540 --> 00:27:43.560
I mean, diet related factors

NOTE Confidence: 0.87200737

00:27:44.180 --> 00:27:44.680
because,

NOTE Confidence: 0.9584112

00:27:46.020 --> 00:27:47.720
it's it's really comp complicated.

NOTE Confidence: 0.9584112

00:27:47.940 --> 00:27:49.400
Not because diet is complicated

NOTE Confidence: 0.9584112

00:27:49.460 --> 00:27:51.065
by itself, but if I

NOTE Confidence: 0.9584112

00:27:51.065 --> 00:27:52.765
add more components to it,

NOTE Confidence: 0.9584112

00:27:52.984 --> 00:27:54.685
it may be too complicated.

NOTE Confidence: 0.9584112

00:27:54.905 --> 00:27:56.765
In indeed, the original proposal

NOTE Confidence: 0.9584112

00:27:56.785 --> 00:27:57.805
included rehabilitation

NOTE Confidence: 0.93046635

00:27:58.505 --> 00:27:59.645
Mhmm. As well,

NOTE Confidence: 0.95791084

00:28:00.345 --> 00:28:01.785
but we decided to cut

NOTE Confidence: 0.95791084

00:28:01.785 --> 00:28:03.225
that part and just focus

NOTE Confidence: 0.95791084

00:28:03.225 --> 00:28:05.085
on the medical and the

NOTE Confidence: 0.95791084

00:28:05.145 --> 00:28:07.559
healthy life lifestyle part. Yeah.

NOTE Confidence: 0.97901523

00:28:08.179 --> 00:28:09.799
So we didn't, choose

NOTE Confidence: 0.9997095

00:28:10.259 --> 00:28:11.559
to have a comprehensive

NOTE Confidence: 0.9987223

00:28:11.859 --> 00:28:12.359
strategy.

NOTE Confidence: 0.9813918

00:28:13.059 --> 00:28:14.580
Having said that, when we

NOTE Confidence: 0.9813918

00:28:14.580 --> 00:28:15.700
build on this and now

NOTE Confidence: 0.9813918

00:28:15.700 --> 00:28:17.859
work in another urban setting,

NOTE Confidence: 0.9813918

00:28:17.859 --> 00:28:19.779
we do have the salt

NOTE Confidence: 0.9813918

00:28:19.779 --> 00:28:20.279
reduction

NOTE Confidence: 0.99923277

00:28:20.659 --> 00:28:21.399
in there.

NOTE Confidence: 0.9957201

00:28:23.595 --> 00:28:24.895
For the long term sustainability,

NOTE Confidence: 0.9835683

00:28:25.675 --> 00:28:27.675
this framework, we didn't, have

NOTE Confidence: 0.9835683

00:28:27.675 --> 00:28:29.355
it at the beginning, but

NOTE Confidence: 0.9835683

00:28:29.355 --> 00:28:31.375
we designed our whole intervention

NOTE Confidence: 0.9835683

00:28:31.435 --> 00:28:33.435
with sustainability and scalability in

NOTE Confidence: 0.9835683

00:28:33.435 --> 00:28:34.875
mind because we don't want

NOTE Confidence: 0.9835683

00:28:34.875 --> 00:28:36.015
it to just be,

NOTE Confidence: 0.9384998

00:28:36.910 --> 00:28:38.290
you know, a one time,

NOTE Confidence: 0.99333906

00:28:38.830 --> 00:28:39.890
kind of effort.

NOTE Confidence: 0.98602086

00:28:40.750 --> 00:28:42.030
But in but having said

NOTE Confidence: 0.98602086

00:28:42.030 --> 00:28:44.450
that, this was investigator initiated,

NOTE Confidence: 0.9603665

00:28:45.550 --> 00:28:46.050
study.

NOTE Confidence: 0.980116

00:28:46.430 --> 00:28:46.930
So,

NOTE Confidence: 0.8666916

00:28:47.630 --> 00:28:48.110
and,

NOTE Confidence: 0.9789865

00:28:49.115 --> 00:28:50.555
as of now, it's not

NOTE Confidence: 0.9789865

00:28:50.555 --> 00:28:51.055
being,

NOTE Confidence: 0.9859005

00:28:51.595 --> 00:28:53.455
scaled up in China.

NOTE Confidence: 0.9552423

00:28:54.075 --> 00:28:55.595
But I'm hoping with our

NOTE Confidence: 0.9552423

00:28:55.595 --> 00:28:56.895
most recent result

NOTE Confidence: 0.921676

00:28:57.275 --> 00:28:58.555
with, one just,

NOTE Confidence: 0.9775289

00:28:58.955 --> 00:29:00.155
published to come out on

NOTE Confidence: 0.9775289

00:29:00.155 --> 00:29:02.075
December thirtieth and another one,

NOTE Confidence: 0.9775289

00:29:02.075 --> 00:29:02.575
hopefully,

NOTE Confidence: 0.8836661

00:29:03.195 --> 00:29:03.695
soon,

NOTE Confidence: 0.9485199

00:29:04.130 --> 00:29:06.230
maybe I will initiate this

NOTE Confidence: 0.9485199

00:29:06.450 --> 00:29:07.890
thing about scaling up in

NOTE Confidence: 0.9485199

00:29:07.890 --> 00:29:09.730
China as well. So we

NOTE Confidence: 0.9485199

00:29:09.730 --> 00:29:10.630
did the,

NOTE Confidence: 0.79624474

00:29:11.330 --> 00:29:11.830
access,

NOTE Confidence: 0.9819295

00:29:12.290 --> 00:29:13.670
assessment on sustainability

NOTE Confidence: 0.9756868

00:29:14.370 --> 00:29:15.190
of the study

NOTE Confidence: 0.98881006

00:29:15.650 --> 00:29:16.630
in this summer

NOTE Confidence: 0.9646081

00:29:16.930 --> 00:29:18.230
according to this framework.

NOTE Confidence: 0.9591727

00:29:19.515 --> 00:29:21.775
So this is the pedal,

NOTE Confidence: 0.9896388

00:29:22.395 --> 00:29:23.455
of the study.

NOTE Confidence: 0.9008951

00:29:24.155 --> 00:29:25.595
The problem we address was

NOTE Confidence: 0.9008951

00:29:25.595 --> 00:29:26.655
the, EBP

NOTE Confidence: 0.9799611

00:29:27.035 --> 00:29:29.055
we adopt, which is mainly

NOTE Confidence: 0.99786943

00:29:29.435 --> 00:29:30.655
the monthly follow-up

NOTE Confidence: 0.9486592

00:29:31.115 --> 00:29:33.515
and medication adherence and physical

NOTE Confidence: 0.9486592

00:29:33.515 --> 00:29:34.015
activity,

NOTE Confidence: 0.93687546

00:29:34.940 --> 00:29:37.080
and and our implementation strategies

NOTE Confidence: 0.93687546

00:29:37.140 --> 00:29:39.480
that addresses the local barriers.

NOTE Confidence: 0.9846965

00:29:40.740 --> 00:29:41.240
And

NOTE Confidence: 0.9851536

00:29:41.620 --> 00:29:43.220
now let's, talk about the

NOTE Confidence: 0.9851536

00:29:43.220 --> 00:29:44.760
evaluation of this intervention.

NOTE Confidence: 0.99867165

00:29:45.140 --> 00:29:46.100
So in terms of the

NOTE Confidence: 0.99867165

00:29:46.100 --> 00:29:47.320
evaluation, the

NOTE Confidence: 0.9386767

00:29:47.674 --> 00:29:49.674
research question as it if

NOTE Confidence: 0.9386767

00:29:49.674 --> 00:29:50.875
we put it into one

NOTE Confidence: 0.9386767

00:29:50.875 --> 00:29:52.335
sentence is this,

NOTE Confidence: 0.9143999

00:29:52.715 --> 00:29:54.015
which is can the,

NOTE Confidence: 0.89573896

00:29:54.715 --> 00:29:56.315
primary health care providers, we

NOTE Confidence: 0.89573896

00:29:56.315 --> 00:29:57.595
call them village doctors in

NOTE Confidence: 0.89573896

00:29:57.595 --> 00:29:58.794
China, they're even if when

NOTE Confidence: 0.89573896

00:29:58.794 --> 00:29:59.835
they are supported by the

NOTE Confidence: 0.89573896

00:29:59.835 --> 00:30:00.335
system

NOTE Confidence: 0.9951777

00:30:00.679 --> 00:30:02.520
and equipped with digital health

NOTE Confidence: 0.9951777

00:30:02.520 --> 00:30:04.140
technology, can they provide

NOTE Confidence: 0.99600613

00:30:04.679 --> 00:30:05.419
the essential,

NOTE Confidence: 0.9993446

00:30:06.200 --> 00:30:07.419
higher quality care

NOTE Confidence: 0.98447585

00:30:07.720 --> 00:30:10.059
and reduce systolic blood pressure?

NOTE Confidence: 0.98447585

00:30:10.280 --> 00:30:11.720
So we have this equal

NOTE Confidence: 0.98447585

00:30:11.720 --> 00:30:12.220
emphasis

NOTE Confidence: 0.9515279

00:30:12.520 --> 00:30:13.740
on two outcomes,

NOTE Confidence: 0.9582483

00:30:14.835 --> 00:30:16.115
which makes it a hybrid

NOTE Confidence: 0.9582483

00:30:16.115 --> 00:30:16.615
two,

NOTE Confidence: 0.8744303

00:30:18.115 --> 00:30:18.615
trial.

NOTE Confidence: 0.9864276

00:30:18.915 --> 00:30:19.875
And many of you are

NOTE Confidence: 0.9864276

00:30:19.875 --> 00:30:21.635
familiar with this. So hybrid

NOTE Confidence: 0.9864276

00:30:21.635 --> 00:30:23.415
one, the primary on effectiveness,

NOTE Confidence: 0.9864276

00:30:23.715 --> 00:30:25.895
hybrid three, primary on implementation,

NOTE Confidence: 0.9864276

00:30:26.115 --> 00:30:27.475
and hybrid two Mhmm. Has

NOTE Confidence: 0.9864276

00:30:27.475 --> 00:30:28.535
this equal emphasis.

NOTE Confidence: 0.95528454

00:30:29.059 --> 00:30:30.740
And in their paper published,

NOTE Confidence: 0.95528454

00:30:30.980 --> 00:30:32.760
by professor Curran et al,

NOTE Confidence: 0.95528454

00:30:32.820 --> 00:30:34.420
and they talk about, what

NOTE Confidence: 0.95528454

00:30:34.420 --> 00:30:35.860
makes it a hybrid two

NOTE Confidence: 0.95528454

00:30:35.860 --> 00:30:37.080
trial. So,

NOTE Confidence: 0.9842623

00:30:38.020 --> 00:30:39.460
skipping over this part, but

NOTE Confidence: 0.9842623

00:30:39.460 --> 00:30:40.420
I think this is more

NOTE Confidence: 0.9842623

00:30:40.420 --> 00:30:40.920
legible.

NOTE Confidence: 0.9690747

00:30:41.615 --> 00:30:43.635
It talks about the conditions

NOTE Confidence: 0.8187772

00:30:44.015 --> 00:30:45.855
of when to adopt a

NOTE Confidence: 0.8187772

00:30:45.855 --> 00:30:47.235
hybrid type two trial.

NOTE Confidence: 0.94887817

00:30:47.535 --> 00:30:48.895
And, for example, it needs

NOTE Confidence: 0.94887817

00:30:48.895 --> 00:30:50.515
to be having strong,

NOTE Confidence: 0.85914

00:30:51.295 --> 00:30:52.195
face validity

NOTE Confidence: 0.9316422

00:30:52.575 --> 00:30:54.015
and a strong base of

NOTE Confidence: 0.9316422

00:30:54.015 --> 00:30:56.190
indirect evidence, a minimal risk,

NOTE Confidence: 0.9316422

00:30:56.350 --> 00:30:57.409
and there is momentum,

NOTE Confidence: 0.9641526

00:30:58.190 --> 00:30:59.070
and it should be,

NOTE Confidence: 0.9934779

00:31:00.269 --> 00:31:00.769
supportable,

NOTE Confidence: 0.95251644

00:31:01.389 --> 00:31:02.769
in terms of the strategies.

NOTE Confidence: 0.95251644

00:31:02.990 --> 00:31:04.909
And, there is reason to

NOTE Confidence: 0.95251644

00:31:04.909 --> 00:31:06.049
gather more data.

NOTE Confidence: 0.9370268

00:31:06.590 --> 00:31:07.490
And the ideal,

NOTE Confidence: 0.969019

00:31:08.029 --> 00:31:09.789
condition is that, there is

NOTE Confidence: 0.969019

00:31:09.789 --> 00:31:10.289
reasonably

NOTE Confidence: 0.9954105

00:31:10.590 --> 00:31:11.090
close

NOTE Confidence: 0.9724045

00:31:11.815 --> 00:31:12.315
evidence,

NOTE Confidence: 0.9983318

00:31:13.095 --> 00:31:14.615
and the overall intervention is

NOTE Confidence: 0.9983318

00:31:14.615 --> 00:31:15.755
not overly complex.

NOTE Confidence: 0.9834622

00:31:16.215 --> 00:31:19.015
So, our cinema trial actually

NOTE Confidence: 0.9834622

00:31:19.015 --> 00:31:21.015
fulfills this requirement. For example,

NOTE Confidence: 0.9834622

00:31:21.015 --> 00:31:22.555
there is strong face validity

NOTE Confidence: 0.9879523

00:31:23.095 --> 00:31:24.235
for both the EBP

NOTE Confidence: 0.9066794

00:31:24.750 --> 00:31:26.290
and the implementation strategy,

NOTE Confidence: 0.99364626

00:31:26.750 --> 00:31:28.510
and the strong indirect evidence

NOTE Confidence: 0.99364626

00:31:28.510 --> 00:31:29.630
actually came from our own

NOTE Confidence: 0.99364626

00:31:29.630 --> 00:31:30.130
study

NOTE Confidence: 0.9517826

00:31:30.510 --> 00:31:32.510
in, rural China and as

NOTE Confidence: 0.9517826

00:31:32.510 --> 00:31:33.650
well as from,

NOTE Confidence: 0.9968374

00:31:34.190 --> 00:31:34.690
Tibet

NOTE Confidence: 0.9865572

00:31:35.150 --> 00:31:35.890
in China.

NOTE Confidence: 0.9926816

00:31:36.430 --> 00:31:37.550
And then there is,

NOTE Confidence: 0.99032146

00:31:38.270 --> 00:31:40.015
low risk in the intervention.

NOTE Confidence: 0.99032146

00:31:40.015 --> 00:31:41.855
We didn't have anything of

NOTE Confidence: 0.99032146

00:31:41.855 --> 00:31:43.295
new drugs or new measures,

NOTE Confidence: 0.99032146

00:31:43.295 --> 00:31:43.795
etcetera.

NOTE Confidence: 0.78344005

00:31:44.735 --> 00:31:46.655
Nothing beyond the implementer, village

NOTE Confidence: 0.78344005

00:31:46.655 --> 00:31:47.135
doctors,

NOTE Confidence: 0.9257755

00:31:47.455 --> 00:31:47.955
capability.

NOTE Confidence: 0.9989899

00:31:48.495 --> 00:31:50.275
And the momentum for implementation

NOTE Confidence: 0.9800949

00:31:50.655 --> 00:31:51.155
was,

NOTE Confidence: 0.9985397

00:31:51.935 --> 00:31:53.955
high at that time when

NOTE Confidence: 0.9985397

00:31:54.095 --> 00:31:55.710
the medical care reform in

NOTE Confidence: 0.9985397

00:31:55.710 --> 00:31:56.210
China

NOTE Confidence: 0.9803491

00:31:56.590 --> 00:31:57.950
was really having this push

NOTE Confidence: 0.9803491

00:31:57.950 --> 00:31:59.790
of strengthening primary care, having

NOTE Confidence: 0.9803491

00:31:59.790 --> 00:32:00.290
hierarchical,

NOTE Confidence: 0.9097788

00:32:01.790 --> 00:32:03.490
health care, and task shifting.

NOTE Confidence: 0.9904571

00:32:04.590 --> 00:32:05.090
And,

NOTE Confidence: 0.9908428

00:32:05.630 --> 00:32:07.470
the institutional support was very

NOTE Confidence: 0.9908428

00:32:07.470 --> 00:32:08.770
strong from provincial,

NOTE Confidence: 0.98953754

00:32:09.485 --> 00:32:11.245
even national level, but more

NOTE Confidence: 0.98953754

00:32:11.245 --> 00:32:12.385
at the local level.

NOTE Confidence: 0.9936929

00:32:13.005 --> 00:32:14.385
And there is equipoise

NOTE Confidence: 0.9618622

00:32:14.685 --> 00:32:16.525
that we don't know the

NOTE Confidence: 0.9618622

00:32:16.525 --> 00:32:18.445
whole intervention package as we

NOTE Confidence: 0.9618622

00:32:18.445 --> 00:32:20.525
design them was effective or

NOTE Confidence: 0.9618622

00:32:20.525 --> 00:32:21.025
not.

NOTE Confidence: 0.9904452

00:32:21.580 --> 00:32:21.980
So,

NOTE Confidence: 0.97238964

00:32:22.620 --> 00:32:23.980
you are familiar with this

NOTE Confidence: 0.97238964

00:32:23.980 --> 00:32:25.500
logic model, like, what do

NOTE Confidence: 0.97238964

00:32:25.500 --> 00:32:27.020
we put in? What do

NOTE Confidence: 0.97238964

00:32:27.020 --> 00:32:28.880
we do? What's the immediate

NOTE Confidence: 0.97238964

00:32:28.940 --> 00:32:30.860
output on the media term

NOTE Confidence: 0.97238964

00:32:30.860 --> 00:32:31.980
outcome and the long term

NOTE Confidence: 0.97238964

00:32:31.980 --> 00:32:33.580
impact? So in terms of

NOTE Confidence: 0.97238964

00:32:33.580 --> 00:32:34.320
our study,

NOTE Confidence: 0.87900555

00:32:35.285 --> 00:32:36.405
this is the logic model

NOTE Confidence: 0.87900555

00:32:36.405 --> 00:32:37.865
for our study is color.

NOTE Confidence: 0.9685761

00:32:38.245 --> 00:32:40.085
The color scheme shows different

NOTE Confidence: 0.9685761

00:32:40.085 --> 00:32:41.125
levels. Like, this is the

NOTE Confidence: 0.9685761

00:32:41.125 --> 00:32:42.505
health care system level,

NOTE Confidence: 0.9926354

00:32:43.285 --> 00:32:44.565
and this is the village

NOTE Confidence: 0.9926354

00:32:44.565 --> 00:32:45.465
doctor level,

NOTE Confidence: 0.96913666

00:32:45.924 --> 00:32:47.765
and this is the patient

NOTE Confidence: 0.96913666

00:32:47.765 --> 00:32:48.265
level,

NOTE Confidence: 0.95928055

00:32:49.830 --> 00:32:51.590
in in a summary. So

NOTE Confidence: 0.95928055

00:32:51.590 --> 00:32:53.270
as we design, in terms

NOTE Confidence: 0.95928055

00:32:53.270 --> 00:32:54.090
of the trial,

NOTE Confidence: 0.9486473

00:32:54.549 --> 00:32:56.570
it's a cluster randomized trial.

NOTE Confidence: 0.934494

00:32:56.870 --> 00:32:58.090
So after we,

NOTE Confidence: 0.9417917

00:33:00.630 --> 00:33:02.730
do the baseline connect collection,

NOTE Confidence: 0.9417917

00:33:02.789 --> 00:33:04.010
then we review

NOTE Confidence: 0.99925333

00:33:04.375 --> 00:33:05.914
the allocation of,

NOTE Confidence: 0.9543261

00:33:06.615 --> 00:33:08.375
the clusters into each groups.

NOTE Confidence: 0.9543261

00:33:08.375 --> 00:33:09.975
This is very important because

NOTE Confidence: 0.9543261

00:33:09.975 --> 00:33:11.654
the for a open label

NOTE Confidence: 0.9543261

00:33:11.654 --> 00:33:12.154
trial,

NOTE Confidence: 0.9307882

00:33:13.174 --> 00:33:15.735
inevitably for complex health intervention

NOTE Confidence: 0.9307882

00:33:15.735 --> 00:33:16.980
like ours, It needs to

NOTE Confidence: 0.9307882

00:33:16.980 --> 00:33:18.100
be open label. There is

NOTE Confidence: 0.9307882

00:33:18.100 --> 00:33:18.900
no way that we can

NOTE Confidence: 0.9307882

00:33:18.900 --> 00:33:19.960
do double blind,

NOTE Confidence: 0.9742742

00:33:20.500 --> 00:33:22.100
but at least it can

NOTE Confidence: 0.9742742

00:33:22.100 --> 00:33:22.840
be concealed

NOTE Confidence: 0.9461792

00:33:23.460 --> 00:33:24.440
for the baseline,

NOTE Confidence: 0.97013235

00:33:26.980 --> 00:33:27.480
measurement.

NOTE Confidence: 0.9643566

00:33:27.860 --> 00:33:29.300
And then, it's in a

NOTE Confidence: 0.9643566

00:33:29.300 --> 00:33:30.740
one to one ratio. So

NOTE Confidence: 0.9643566

00:33:30.740 --> 00:33:31.545
twenty five

NOTE Confidence: 0.9835647

00:33:31.865 --> 00:33:33.705
villages in the intervention, twenty

NOTE Confidence: 0.9835647

00:33:33.705 --> 00:33:35.245
five in control. On average,

NOTE Confidence: 0.99926776

00:33:35.545 --> 00:33:37.805
twenty five patients per cluster

NOTE Confidence: 0.94435817

00:33:38.185 --> 00:33:39.865
of, they're all stroke patients,

NOTE Confidence: 0.94435817

00:33:39.865 --> 00:33:41.165
and we have a quarterly

NOTE Confidence: 0.9907211

00:33:41.465 --> 00:33:44.045
process evaluation, mostly qualitative research.

NOTE Confidence: 0.95493776

00:33:44.400 --> 00:33:45.360
And then in terms of

NOTE Confidence: 0.95493776

00:33:45.360 --> 00:33:47.040
the underlying data collection, it

NOTE Confidence: 0.95493776

00:33:47.040 --> 00:33:47.520
was also,

NOTE Confidence: 0.9617166

00:33:50.000 --> 00:33:51.460
designed to be blinded.

NOTE Confidence: 0.9621408

00:33:52.160 --> 00:33:54.560
Like, the assessors came from

NOTE Confidence: 0.9621408

00:33:54.560 --> 00:33:56.320
a third party, which is

NOTE Confidence: 0.9621408

00:33:56.320 --> 00:33:57.760
the CDC staff from a

NOTE Confidence: 0.9621408

00:33:57.760 --> 00:33:58.260
nearing,

NOTE Confidence: 0.9885646

00:33:58.925 --> 00:34:00.925
neighboring county, not from the

NOTE Confidence: 0.9885646

00:34:00.925 --> 00:34:02.385
intervention county itself.

NOTE Confidence: 0.98998374

00:34:03.005 --> 00:34:04.125
And then they did both

NOTE Confidence: 0.98998374

00:34:04.125 --> 00:34:06.205
the baseline and the end

NOTE Confidence: 0.98998374

00:34:06.205 --> 00:34:06.705
line,

NOTE Confidence: 0.9878952

00:34:07.325 --> 00:34:08.864
according to the same protocol.

NOTE Confidence: 0.9571577

00:34:09.244 --> 00:34:11.244
And from, my observation that

NOTE Confidence: 0.9571577

00:34:11.244 --> 00:34:12.330
they didn't care who who's

NOTE Confidence: 0.9571577

00:34:12.330 --> 00:34:13.370
in the information, who's in

NOTE Confidence: 0.9571577

00:34:13.370 --> 00:34:14.330
the control. We asked them

NOTE Confidence: 0.9571577

00:34:14.330 --> 00:34:15.530
not to ask, and they

NOTE Confidence: 0.9571577

00:34:15.530 --> 00:34:17.130
they just want to do

NOTE Confidence: 0.9571577

00:34:17.130 --> 00:34:18.570
their job, which is the

NOTE Confidence: 0.9571577

00:34:18.570 --> 00:34:19.550
outcome assessment,

NOTE Confidence: 0.8953655

00:34:20.090 --> 00:34:22.170
data, collection and do their

NOTE Confidence: 0.8953655

00:34:22.170 --> 00:34:23.130
job well. Can you come

NOTE Confidence: 0.8953655

00:34:23.130 --> 00:34:24.675
back a second? Mhmm. So

NOTE Confidence: 0.8953655

00:34:24.835 --> 00:34:26.114
my first question is, so

NOTE Confidence: 0.8953655

00:34:26.114 --> 00:34:28.055
this is an individually randomized

NOTE Confidence: 0.8953655

00:34:28.195 --> 00:34:29.315
study or something? It's a

NOTE Confidence: 0.8953655

00:34:29.315 --> 00:34:31.315
cluster randomized trial. Okay. So

NOTE Confidence: 0.8953655

00:34:31.475 --> 00:34:33.395
So twenty five villages into

NOTE Confidence: 0.8953655

00:34:33.395 --> 00:34:33.895
each,

NOTE Confidence: 0.81532407

00:34:34.755 --> 00:34:35.955
three. Okay. Because the way

NOTE Confidence: 0.81532407

00:34:35.955 --> 00:34:36.995
it says it varies, it

NOTE Confidence: 0.81532407

00:34:36.995 --> 00:34:38.695
said six twenty five receiving

NOTE Confidence: 0.8965322

00:34:39.155 --> 00:34:40.215
usual care

NOTE Confidence: 0.8553921

00:34:40.650 --> 00:34:41.150
and,

NOTE Confidence: 0.9317508

00:34:42.170 --> 00:34:43.609
and six twenty five receiving

NOTE Confidence: 0.9317508

00:34:43.609 --> 00:34:44.809
the cinema model. So you

NOTE Confidence: 0.9317508

00:34:44.969 --> 00:34:46.430
So she should have said

NOTE Confidence: 0.9317508

00:34:46.489 --> 00:34:47.930
twenty five versus twenty five.

NOTE Confidence: 0.9317508

00:34:47.930 --> 00:34:48.809
Okay. Yeah. And,

NOTE Confidence: 0.9401255

00:34:49.450 --> 00:34:50.969
because you wouldn't have exactly

NOTE Confidence: 0.9401255

00:34:50.969 --> 00:34:52.250
six twenty five in both

NOTE Confidence: 0.9401255

00:34:52.250 --> 00:34:53.210
groups. You should be in

NOTE Confidence: 0.9401255

00:34:53.210 --> 00:34:54.589
a real study because

NOTE Confidence: 0.94748926

00:34:54.969 --> 00:34:56.170
every village would have a

NOTE Confidence: 0.94748926

00:34:56.170 --> 00:34:57.795
different number of stroke I

NOTE Confidence: 0.94748926

00:34:57.795 --> 00:34:59.315
I don't have exactly six

NOTE Confidence: 0.94748926

00:34:59.315 --> 00:35:00.755
twenty five. Sorry. That's very

NOTE Confidence: 0.94748926

00:35:00.755 --> 00:35:02.275
good catch, Donna. This is

NOTE Confidence: 0.94748926

00:35:02.275 --> 00:35:03.474
wrong. I should have changed

NOTE Confidence: 0.94748926

00:35:03.474 --> 00:35:03.974
it,

NOTE Confidence: 0.9357575

00:35:04.515 --> 00:35:05.015
because,

NOTE Confidence: 0.8966075

00:35:06.755 --> 00:35:08.035
this is the design. I

NOTE Confidence: 0.8966075

00:35:08.035 --> 00:35:09.715
mean, the design also is

NOTE Confidence: 0.8966075

00:35:09.715 --> 00:35:10.835
twenty five versus twenty five.

NOTE Confidence: 0.8966075

00:35:10.835 --> 00:35:12.114
Yeah. Twenty five versus twenty

NOTE Confidence: 0.8966075

00:35:12.114 --> 00:35:13.050
five. I mean, I caught

NOTE Confidence: 0.8966075

00:35:13.050 --> 00:35:14.010
it because this is a

NOTE Confidence: 0.8966075

00:35:14.010 --> 00:35:15.690
main area research in our

NOTE Confidence: 0.8966075

00:35:15.850 --> 00:35:17.930
Yeah. Group looking at Yeah.

NOTE Confidence: 0.8966075

00:35:17.930 --> 00:35:18.890
And I designs and then

NOTE Confidence: 0.8966075

00:35:19.050 --> 00:35:20.010
I should have caught it

NOTE Confidence: 0.8966075

00:35:20.010 --> 00:35:21.530
myself. So that's well, I

NOTE Confidence: 0.8966075

00:35:21.530 --> 00:35:22.890
had another flowchart, but this

NOTE Confidence: 0.8966075

00:35:22.890 --> 00:35:24.570
is a well, yeah. So

NOTE Confidence: 0.8966075

00:35:25.045 --> 00:35:25.545
and

NOTE Confidence: 0.77869844

00:35:25.844 --> 00:35:26.965
I don't think I put

NOTE Confidence: 0.77869844

00:35:26.965 --> 00:35:28.485
in the final flowchart in

NOTE Confidence: 0.77869844

00:35:28.485 --> 00:35:30.085
here. Something that's written like

NOTE Confidence: 0.77869844

00:35:30.085 --> 00:35:30.885
in the back of my

NOTE Confidence: 0.77869844

00:35:30.885 --> 00:35:32.645
chart. Oh, yeah. Sure. Yeah.

NOTE Confidence: 0.7797728

00:35:33.364 --> 00:35:34.165
Can you say a little

NOTE Confidence: 0.7797728

00:35:34.165 --> 00:35:35.045
bit more about what the

NOTE Confidence: 0.7797728

00:35:35.045 --> 00:35:36.965
Morisky Grain Louvain scale and

NOTE Confidence: 0.7797728

00:35:36.965 --> 00:35:38.265
the time jump in Vowetesta?

NOTE Confidence: 0.9427805

00:35:39.630 --> 00:35:41.790
Yeah. So that is the,

NOTE Confidence: 0.99874115

00:35:42.190 --> 00:35:43.170
four item

NOTE Confidence: 0.9746533

00:35:43.549 --> 00:35:44.049
medication

NOTE Confidence: 0.90960866

00:35:44.349 --> 00:35:46.270
adherence scale. And, I'm glad

NOTE Confidence: 0.90960866

00:35:46.510 --> 00:35:47.969
also, I'm glad you asked

NOTE Confidence: 0.90960866

00:35:48.030 --> 00:35:49.549
asked because the more famous

NOTE Confidence: 0.90960866

00:35:49.549 --> 00:35:51.150
one is the eight item,

NOTE Confidence: 0.90960866

00:35:51.150 --> 00:35:51.650
MMAS,

NOTE Confidence: 0.9952007

00:35:52.589 --> 00:35:53.790
which is which needs to

NOTE Confidence: 0.9952007

00:35:53.790 --> 00:35:55.395
be paid. And at Duke

NOTE Confidence: 0.9952007

00:35:55.395 --> 00:35:56.855
University, we were warned

NOTE Confidence: 0.9874704

00:35:57.155 --> 00:35:58.435
that don't use it unless

NOTE Confidence: 0.9874704

00:35:58.435 --> 00:35:59.875
you pay them. Otherwise, even

NOTE Confidence: 0.9874704

00:35:59.875 --> 00:36:01.075
after you publish, you may

NOTE Confidence: 0.9874704

00:36:01.075 --> 00:36:01.975
get into lawsuit.

NOTE Confidence: 0.9956591

00:36:02.435 --> 00:36:02.935
However,

NOTE Confidence: 0.9568847

00:36:03.315 --> 00:36:04.835
this four item one called

NOTE Confidence: 0.9568847

00:36:04.835 --> 00:36:05.335
MGLS

NOTE Confidence: 0.9672953

00:36:06.035 --> 00:36:07.520
is free. So we won't

NOTE Confidence: 0.9672953

00:36:07.520 --> 00:36:08.640
get into trouble. So that's

NOTE Confidence: 0.9672953

00:36:08.640 --> 00:36:09.920
what we did. In terms

NOTE Confidence: 0.9672953

00:36:09.920 --> 00:36:11.040
of the physical function in

NOTE Confidence: 0.9672953

00:36:11.040 --> 00:36:12.420
the time up and go,

NOTE Confidence: 0.9672953

00:36:12.640 --> 00:36:13.540
it's a measure

NOTE Confidence: 0.96552867

00:36:14.000 --> 00:36:16.160
where, we ask them to

NOTE Confidence: 0.96552867

00:36:16.160 --> 00:36:17.760
sit on the chair, and

NOTE Confidence: 0.96552867

00:36:17.760 --> 00:36:19.280
we place a mark three

NOTE Confidence: 0.96552867

00:36:19.280 --> 00:36:21.200
meters away. So we say

NOTE Confidence: 0.96552867

00:36:21.200 --> 00:36:22.480
begin until they stand up

NOTE Confidence: 0.96552867

00:36:22.480 --> 00:36:23.594
and walk three

NOTE Confidence: 0.9303627

00:36:23.895 --> 00:36:24.935
meters. We turn back and

NOTE Confidence: 0.9303627

00:36:24.935 --> 00:36:26.375
sit down. So we time

NOTE Confidence: 0.9303627

00:36:26.375 --> 00:36:28.215
that. So if that is,

NOTE Confidence: 0.9932018

00:36:28.614 --> 00:36:30.695
above fourteen seconds, that means

NOTE Confidence: 0.9932018

00:36:30.695 --> 00:36:32.075
their functioning is not

NOTE Confidence: 0.9824167

00:36:32.455 --> 00:36:34.055
too good in terms of

NOTE Confidence: 0.9824167

00:36:34.055 --> 00:36:34.555
lower.

NOTE Confidence: 0.956717

00:36:35.380 --> 00:36:36.180
Alright. And then in terms

NOTE Confidence: 0.956717

00:36:36.180 --> 00:36:37.700
of adherence then, the scale

NOTE Confidence: 0.956717

00:36:37.700 --> 00:36:39.540
is a self report at

NOTE Confidence: 0.956717

00:36:39.540 --> 00:36:40.760
the level of the patient

NOTE Confidence: 0.956717

00:36:40.980 --> 00:36:42.020
where they just say yes

NOTE Confidence: 0.956717

00:36:42.020 --> 00:36:42.980
or no. They took it

NOTE Confidence: 0.956717

00:36:42.980 --> 00:36:44.180
or they didn't. Yes. And

NOTE Confidence: 0.956717

00:36:44.180 --> 00:36:45.640
there was no other validation.

NOTE Confidence: 0.9331432

00:36:46.020 --> 00:36:47.060
No no pill count and

NOTE Confidence: 0.9331432

00:36:47.219 --> 00:36:48.765
or anything like that. So

NOTE Confidence: 0.9331432

00:36:48.765 --> 00:36:50.364
this is, one of the

NOTE Confidence: 0.9331432

00:36:50.364 --> 00:36:52.305
secondary outcomes we have. Yeah.

NOTE Confidence: 0.9331432

00:36:52.444 --> 00:36:53.964
And then in the follow-up

NOTE Confidence: 0.9331432

00:36:53.964 --> 00:36:55.244
study, we try to have

NOTE Confidence: 0.9331432

00:36:55.244 --> 00:36:57.005
other measures, but still not

NOTE Confidence: 0.9331432

00:36:57.005 --> 00:36:57.505
objective

NOTE Confidence: 0.9310293

00:36:57.805 --> 00:37:00.125
type, but another scale to,

NOTE Confidence: 0.9415113

00:37:00.684 --> 00:37:02.305
to assess medication adherence,

NOTE Confidence: 0.99967635

00:37:02.844 --> 00:37:03.505
which was

NOTE Confidence: 0.9987344

00:37:03.810 --> 00:37:04.310
done

NOTE Confidence: 0.97599834

00:37:04.770 --> 00:37:06.930
in this year. Yeah. In

NOTE Confidence: 0.97599834

00:37:06.930 --> 00:37:07.989
this past summer.

NOTE Confidence: 0.9528433

00:37:09.330 --> 00:37:10.770
So in terms of this

NOTE Confidence: 0.9528433

00:37:10.770 --> 00:37:12.530
implementation outcomes framework, you know,

NOTE Confidence: 0.9528433

00:37:12.530 --> 00:37:14.610
there's implementation outcome, service outcome,

NOTE Confidence: 0.9528433

00:37:14.610 --> 00:37:15.890
and patient outcome. So we

NOTE Confidence: 0.9528433

00:37:15.890 --> 00:37:18.435
try to assess, many of

NOTE Confidence: 0.9528433

00:37:18.734 --> 00:37:20.734
this. So, just quick summaries

NOTE Confidence: 0.9528433

00:37:20.734 --> 00:37:21.234
of,

NOTE Confidence: 0.98722315

00:37:21.695 --> 00:37:23.055
in terms of this trial,

NOTE Confidence: 0.98722315

00:37:23.055 --> 00:37:24.195
the primary outcome,

NOTE Confidence: 0.7546999

00:37:24.734 --> 00:37:25.474
for implementation

NOTE Confidence: 0.99713707

00:37:25.775 --> 00:37:26.675
versus effectiveness

NOTE Confidence: 0.86731386

00:37:27.375 --> 00:37:28.994
and then secondary exploratory.

NOTE Confidence: 0.9874066

00:37:29.710 --> 00:37:30.190
So,

NOTE Confidence: 0.98405045

00:37:30.590 --> 00:37:31.870
at the time of the

NOTE Confidence: 0.98405045

00:37:31.870 --> 00:37:34.050
trial, these outcomes were exploratory,

NOTE Confidence: 0.9845448

00:37:34.590 --> 00:37:36.510
such as recurrence of stroke,

NOTE Confidence: 0.9845448

00:37:36.510 --> 00:37:37.730
mortality, hospitalization.

NOTE Confidence: 0.98916006

00:37:39.150 --> 00:37:40.350
But in the long term

NOTE Confidence: 0.98916006

00:37:40.350 --> 00:37:41.710
follow-up, because we were able

NOTE Confidence: 0.98916006

00:37:41.710 --> 00:37:43.570
to accrue enough events,

NOTE Confidence: 0.9903844

00:37:44.025 --> 00:37:46.025
then, they became primary outcomes

NOTE Confidence: 0.9903844

00:37:46.025 --> 00:37:47.244
for the long term follow-up,

NOTE Confidence: 0.98726106

00:37:50.265 --> 00:37:50.765
like,

NOTE Confidence: 0.9968779

00:37:51.145 --> 00:37:52.204
explained here.

NOTE Confidence: 0.95204794

00:37:53.305 --> 00:37:53.805
So,

NOTE Confidence: 0.97656834

00:37:54.825 --> 00:37:56.184
this is more detail that

NOTE Confidence: 0.97656834

00:37:56.184 --> 00:37:57.464
I'm not gonna spend too

NOTE Confidence: 0.97656834

00:37:57.464 --> 00:37:58.505
much time on. You can

NOTE Confidence: 0.97656834

00:37:58.505 --> 00:37:59.484
see our final,

NOTE Confidence: 0.956612

00:38:00.309 --> 00:38:02.710
patient count. Fifty villages and,

NOTE Confidence: 0.956612

00:38:03.030 --> 00:38:04.809
twelve hundred ninety nine patients.

NOTE Confidence: 0.956612

00:38:04.869 --> 00:38:06.390
So it's not exactly six

NOTE Confidence: 0.956612

00:38:06.390 --> 00:38:07.829
seventy five versus six seventy

NOTE Confidence: 0.956612

00:38:07.829 --> 00:38:08.329
five.

NOTE Confidence: 0.7186297

00:38:10.309 --> 00:38:10.809
Okay.

NOTE Confidence: 0.98303

00:38:11.844 --> 00:38:13.125
One nine one two nine

NOTE Confidence: 0.98303

00:38:13.125 --> 00:38:13.625
nine

NOTE Confidence: 0.9968902

00:38:14.245 --> 00:38:16.185
is the final patient count.

NOTE Confidence: 0.9968902

00:38:16.245 --> 00:38:18.265
So this is a overview

NOTE Confidence: 0.99904025

00:38:18.805 --> 00:38:19.625
of the

NOTE Confidence: 0.7176134

00:38:21.685 --> 00:38:22.185
evaluation,

NOTE Confidence: 0.9410302

00:38:23.125 --> 00:38:25.205
framework, which is mostly the

NOTE Confidence: 0.9410302

00:38:25.205 --> 00:38:27.065
RAIN, but also embedded

NOTE Confidence: 0.96428937

00:38:27.530 --> 00:38:29.390
within the MRC UKMRC

NOTE Confidence: 0.98623854

00:38:29.770 --> 00:38:32.270
process evaluation framework for complex

NOTE Confidence: 0.98623854

00:38:32.410 --> 00:38:32.910
interventions.

NOTE Confidence: 0.9727961

00:38:35.770 --> 00:38:37.130
You can't really read it,

NOTE Confidence: 0.9672699

00:38:37.530 --> 00:38:39.225
and I have another slide,

NOTE Confidence: 0.99805915

00:38:39.705 --> 00:38:41.065
showing it. This is from

NOTE Confidence: 0.99805915

00:38:41.065 --> 00:38:42.605
our process evaluation

NOTE Confidence: 0.92742324

00:38:42.905 --> 00:38:44.445
implementation outcome paper,

NOTE Confidence: 0.9599562

00:38:45.065 --> 00:38:46.185
in terms of quotes and

NOTE Confidence: 0.9599562

00:38:46.185 --> 00:38:47.705
the summary, and this is

NOTE Confidence: 0.9599562

00:38:47.705 --> 00:38:49.305
the RE AIM framework. So

NOTE Confidence: 0.9599562

00:38:49.305 --> 00:38:50.745
in summary, in terms of

NOTE Confidence: 0.9599562

00:38:50.745 --> 00:38:51.245
fidelity,

NOTE Confidence: 0.7499618

00:38:52.665 --> 00:38:54.364
is reasonable, not,

NOTE Confidence: 0.9768735

00:38:55.320 --> 00:38:57.260
perfect, but reasonable. For example,

NOTE Confidence: 0.9893449

00:38:57.560 --> 00:38:58.860
in terms of the training,

NOTE Confidence: 0.9956886

00:38:59.400 --> 00:39:01.400
eighty four percent attended both

NOTE Confidence: 0.9956886

00:39:01.400 --> 00:39:01.900
sessions,

NOTE Confidence: 0.986443

00:39:02.760 --> 00:39:04.840
and, some only attended the

NOTE Confidence: 0.986443

00:39:04.840 --> 00:39:05.580
first one.

NOTE Confidence: 0.9873249

00:39:06.280 --> 00:39:07.960
And on average, they were

NOTE Confidence: 0.9873249

00:39:07.960 --> 00:39:09.800
able to perform the monthly

NOTE Confidence: 0.9873249

00:39:09.800 --> 00:39:10.300
follow-up.

NOTE Confidence: 0.9473869

00:39:11.055 --> 00:39:12.655
And in terms of the

NOTE Confidence: 0.9473869

00:39:12.655 --> 00:39:14.195
messages sent out,

NOTE Confidence: 0.97273135

00:39:14.815 --> 00:39:15.855
I mean, sorry. This is

NOTE Confidence: 0.97273135

00:39:15.855 --> 00:39:17.295
the WeChat message for the

NOTE Confidence: 0.97273135

00:39:17.295 --> 00:39:19.155
village doctors as one way

NOTE Confidence: 0.97273135

00:39:19.454 --> 00:39:19.855
of,

NOTE Confidence: 0.9642822

00:39:20.255 --> 00:39:20.755
support.

NOTE Confidence: 0.9930689

00:39:21.855 --> 00:39:23.135
And for the patients, you

NOTE Confidence: 0.9930689

00:39:23.135 --> 00:39:23.875
can see

NOTE Confidence: 0.950829

00:39:24.719 --> 00:39:26.660
there's eleven percent received

NOTE Confidence: 0.99824476

00:39:27.040 --> 00:39:27.780
less than

NOTE Confidence: 0.9813129

00:39:28.160 --> 00:39:29.219
monthly visit,

NOTE Confidence: 0.96458447

00:39:29.840 --> 00:39:30.660
which means,

NOTE Confidence: 0.959647

00:39:31.200 --> 00:39:31.600
about,

NOTE Confidence: 0.94363594

00:39:32.000 --> 00:39:33.520
eighty nine percent received the

NOTE Confidence: 0.94363594

00:39:33.520 --> 00:39:34.420
monthly visits.

NOTE Confidence: 0.8875162

00:39:34.880 --> 00:39:35.619
And also,

NOTE Confidence: 0.99563485

00:39:36.719 --> 00:39:38.080
in terms of the voice

NOTE Confidence: 0.99563485

00:39:38.080 --> 00:39:40.114
messages though, it was lower.

NOTE Confidence: 0.99563485

00:39:40.114 --> 00:39:40.855
For example,

NOTE Confidence: 0.94954324

00:39:41.875 --> 00:39:42.675
we had,

NOTE Confidence: 0.91628915

00:39:43.474 --> 00:39:44.994
about a little over a

NOTE Confidence: 0.91628915

00:39:44.994 --> 00:39:45.494
quarter

NOTE Confidence: 0.95706123

00:39:46.035 --> 00:39:46.515
who,

NOTE Confidence: 0.9609149

00:39:47.075 --> 00:39:48.435
didn't answer half of the

NOTE Confidence: 0.9609149

00:39:48.435 --> 00:39:50.594
voice messages. Because, basically, the

NOTE Confidence: 0.9609149

00:39:50.594 --> 00:39:52.340
way it worked was that

NOTE Confidence: 0.9609149

00:39:52.400 --> 00:39:54.820
the APP through technical support

NOTE Confidence: 0.9609149

00:39:54.880 --> 00:39:56.080
at the back end can

NOTE Confidence: 0.9609149

00:39:56.080 --> 00:39:57.780
automatically send out the messages

NOTE Confidence: 0.990781

00:39:58.239 --> 00:39:59.060
to the patients.

NOTE Confidence: 0.98800087

00:39:59.920 --> 00:40:01.040
And the time is in

NOTE Confidence: 0.98800087

00:40:01.040 --> 00:40:02.400
the morning when they were

NOTE Confidence: 0.98800087

00:40:02.400 --> 00:40:04.160
usually at home before they

NOTE Confidence: 0.98800087

00:40:04.160 --> 00:40:05.295
go out to work,

NOTE Confidence: 0.9970294

00:40:05.775 --> 00:40:07.395
in the farm. So

NOTE Confidence: 0.97513

00:40:08.094 --> 00:40:09.295
they if they pick up

NOTE Confidence: 0.97513

00:40:09.295 --> 00:40:10.895
this call, then they get

NOTE Confidence: 0.97513

00:40:10.895 --> 00:40:12.835
to hear the message recorded

NOTE Confidence: 0.97513

00:40:12.895 --> 00:40:13.934
for them, and it's a

NOTE Confidence: 0.97513

00:40:13.934 --> 00:40:15.954
one way. There's no interaction.

NOTE Confidence: 0.97614753

00:40:16.734 --> 00:40:18.094
It's not designed to be,

NOTE Confidence: 0.97614753

00:40:18.335 --> 00:40:19.075
so sophisticated.

NOTE Confidence: 0.8499457

00:40:20.415 --> 00:40:20.915
And,

NOTE Confidence: 0.97371244

00:40:22.300 --> 00:40:24.460
the message is usually less

NOTE Confidence: 0.97371244

00:40:24.460 --> 00:40:26.380
than one minute long, so

NOTE Confidence: 0.97371244

00:40:26.380 --> 00:40:28.300
thirty seconds or less, and

NOTE Confidence: 0.97371244

00:40:28.300 --> 00:40:30.000
it's repeated one time

NOTE Confidence: 0.8932029

00:40:30.380 --> 00:40:32.219
in and recorded in, a

NOTE Confidence: 0.8932029

00:40:32.219 --> 00:40:33.040
local dialect,

NOTE Confidence: 0.99802744

00:40:34.140 --> 00:40:35.680
by the wife of our

NOTE Confidence: 0.99802744

00:40:35.875 --> 00:40:37.655
program officer in the country.

NOTE Confidence: 0.9491509

00:40:38.195 --> 00:40:39.555
So if they picked it

NOTE Confidence: 0.9491509

00:40:39.555 --> 00:40:40.295
up, that

NOTE Confidence: 0.98402506

00:40:40.675 --> 00:40:42.275
means they got it. If

NOTE Confidence: 0.98402506

00:40:42.275 --> 00:40:44.035
not, the system will call

NOTE Confidence: 0.98402506

00:40:44.035 --> 00:40:45.795
two more times before eight

NOTE Confidence: 0.98402506

00:40:45.795 --> 00:40:46.295
AM.

NOTE Confidence: 0.9921422

00:40:46.835 --> 00:40:48.355
And then after that, they

NOTE Confidence: 0.9921422

00:40:48.594 --> 00:40:49.715
it will be done for

NOTE Confidence: 0.9921422

00:40:49.715 --> 00:40:51.260
the day. So about a

NOTE Confidence: 0.9921422

00:40:51.260 --> 00:40:53.180
quarter of them didn't receive

NOTE Confidence: 0.9921422

00:40:53.180 --> 00:40:55.020
half. So the fidelity here,

NOTE Confidence: 0.9021778

00:40:55.739 --> 00:40:56.239
is,

NOTE Confidence: 0.9996743

00:40:56.940 --> 00:40:58.719
less than the other measures.

NOTE Confidence: 0.9974534

00:40:59.099 --> 00:41:00.140
So in terms of the

NOTE Confidence: 0.9974534

00:41:00.140 --> 00:41:01.840
summary, we could see,

NOTE Confidence: 0.9993243

00:41:02.619 --> 00:41:02.859
that

NOTE Confidence: 0.90590435

00:41:03.660 --> 00:41:04.640
could you go back?

NOTE Confidence: 0.94264716

00:41:05.285 --> 00:41:06.645
So what I'm wondering is

NOTE Confidence: 0.94264716

00:41:06.645 --> 00:41:07.864
in terms of these fidelity

NOTE Confidence: 0.94264716

00:41:08.085 --> 00:41:08.585
indicators,

NOTE Confidence: 0.93066216

00:41:09.285 --> 00:41:10.725
do you have them, like,

NOTE Confidence: 0.93066216

00:41:10.725 --> 00:41:11.685
do you have them on

NOTE Confidence: 0.93066216

00:41:11.685 --> 00:41:13.605
all privileged doctors and all

NOTE Confidence: 0.93066216

00:41:13.605 --> 00:41:15.225
patients, and how often?

NOTE Confidence: 0.9058791

00:41:16.725 --> 00:41:18.085
That's a good good question,

NOTE Confidence: 0.9058791

00:41:18.085 --> 00:41:19.380
actually. It's a question want

NOTE Confidence: 0.9058791

00:41:19.380 --> 00:41:19.859
to,

NOTE Confidence: 0.9409101

00:41:20.180 --> 00:41:22.579
consult you later on. This

NOTE Confidence: 0.9409101

00:41:22.579 --> 00:41:24.520
is for the intervention religious

NOTE Confidence: 0.9409101

00:41:24.660 --> 00:41:26.339
only, and we have it

NOTE Confidence: 0.9409101

00:41:26.339 --> 00:41:28.020
on all village doctors, all

NOTE Confidence: 0.9409101

00:41:28.020 --> 00:41:29.960
patients in the intervention arm.

NOTE Confidence: 0.9238441

00:41:30.739 --> 00:41:31.380
We don't If you have

NOTE Confidence: 0.9238441

00:41:31.380 --> 00:41:32.420
an alarm, they wouldn't be

NOTE Confidence: 0.9238441

00:41:32.420 --> 00:41:34.279
getting any voice mails Right.

NOTE Confidence: 0.99954176

00:41:34.935 --> 00:41:36.055
Or any of these things.

NOTE Confidence: 0.99954176

00:41:36.055 --> 00:41:37.435
Right? Right. However,

NOTE Confidence: 0.9754715

00:41:37.895 --> 00:41:39.094
there is one thing that

NOTE Confidence: 0.9754715

00:41:39.094 --> 00:41:40.055
we could measure, which is

NOTE Confidence: 0.9754715

00:41:40.055 --> 00:41:41.495
the monthly visit. We ask

NOTE Confidence: 0.9754715

00:41:41.495 --> 00:41:42.155
them. Okay.

NOTE Confidence: 0.9967984

00:41:42.855 --> 00:41:44.295
But, in terms of the

NOTE Confidence: 0.9967984

00:41:44.295 --> 00:41:45.035
other things,

NOTE Confidence: 0.9707197

00:41:45.655 --> 00:41:47.835
the WeChat group, or the

NOTE Confidence: 0.91311723

00:41:48.200 --> 00:41:49.640
voice messages or the APP.

NOTE Confidence: 0.91311723

00:41:49.640 --> 00:41:50.760
They don't talk about that.

NOTE Confidence: 0.91311723

00:41:50.760 --> 00:41:51.800
They don't have it. Yeah.

NOTE Confidence: 0.91311723

00:41:51.800 --> 00:41:53.100
It's gonna be very interesting.

NOTE Confidence: 0.91311723

00:41:53.320 --> 00:41:55.000
Yeah. So, I think for

NOTE Confidence: 0.91311723

00:41:55.000 --> 00:41:55.900
the general

NOTE Confidence: 0.9846577

00:41:56.200 --> 00:41:57.480
outcome, it needs to be

NOTE Confidence: 0.9846577

00:41:57.480 --> 00:41:59.400
across all the clusters and,

NOTE Confidence: 0.9846577

00:41:59.720 --> 00:42:00.940
patients, I think.

NOTE Confidence: 0.9831398

00:42:02.735 --> 00:42:04.035
So this is a summary.

NOTE Confidence: 0.9187292

00:42:04.415 --> 00:42:04.915
They,

NOTE Confidence: 0.9732894

00:42:05.535 --> 00:42:06.594
found that,

NOTE Confidence: 0.9951362

00:42:07.135 --> 00:42:07.635
their

NOTE Confidence: 0.9969275

00:42:08.815 --> 00:42:09.955
knowledge and capability,

NOTE Confidence: 0.9047196

00:42:10.735 --> 00:42:11.555
these enablers

NOTE Confidence: 0.70776564

00:42:11.935 --> 00:42:12.435
being

NOTE Confidence: 0.934094

00:42:12.735 --> 00:42:13.235
improved,

NOTE Confidence: 0.99090815

00:42:13.935 --> 00:42:14.435
and

NOTE Confidence: 0.9910318

00:42:15.730 --> 00:42:17.030
and there is credibility

NOTE Confidence: 0.98029804

00:42:17.330 --> 00:42:18.850
credibility for the top down

NOTE Confidence: 0.98029804

00:42:18.850 --> 00:42:20.050
approach because we work with

NOTE Confidence: 0.98029804

00:42:20.050 --> 00:42:21.989
the government in implementing this.

NOTE Confidence: 0.94333124

00:42:22.610 --> 00:42:23.110
And,

NOTE Confidence: 0.9870289

00:42:23.969 --> 00:42:25.590
in terms of the patient,

NOTE Confidence: 0.7803003

00:42:25.890 --> 00:42:27.730
they perceive benefits of receiving

NOTE Confidence: 0.7803003

00:42:27.730 --> 00:42:29.030
the most voice messages.

NOTE Confidence: 0.74503016

00:42:29.765 --> 00:42:30.665
They appreciated,

NOTE Confidence: 0.9824394

00:42:31.685 --> 00:42:32.425
the content

NOTE Confidence: 0.93313354

00:42:32.725 --> 00:42:33.925
designed to be simple and

NOTE Confidence: 0.93313354

00:42:33.925 --> 00:42:35.525
tailored and give them practical

NOTE Confidence: 0.93313354

00:42:35.525 --> 00:42:37.145
tips, etcetera, and reminders.

NOTE Confidence: 0.68102515

00:42:39.525 --> 00:42:40.025
And,

NOTE Confidence: 0.97740054

00:42:41.045 --> 00:42:42.344
this is the actual flowchart.

NOTE Confidence: 0.97740054

00:42:42.405 --> 00:42:43.125
I did have it. I

NOTE Confidence: 0.97740054

00:42:43.125 --> 00:42:43.625
forgot,

NOTE Confidence: 0.99382466

00:42:44.170 --> 00:42:45.850
because the actual flowchart was

NOTE Confidence: 0.99382466

00:42:45.850 --> 00:42:47.050
meant to show the long

NOTE Confidence: 0.99382466

00:42:47.050 --> 00:42:48.270
term follow-up mostly.

NOTE Confidence: 0.91565144

00:42:49.610 --> 00:42:51.050
So we have one twelve

NOTE Confidence: 0.91565144

00:42:51.130 --> 00:42:52.270
one two nine nine,

NOTE Confidence: 0.9927719

00:42:52.810 --> 00:42:53.790
and this is,

NOTE Confidence: 0.8704265

00:42:54.410 --> 00:42:56.330
three thirty seven, to be

NOTE Confidence: 0.8704265

00:42:56.330 --> 00:42:57.870
exact in the in twenty

NOTE Confidence: 0.8704265

00:42:58.170 --> 00:42:59.150
five. And,

NOTE Confidence: 0.96160185

00:42:59.945 --> 00:43:01.305
the one year follow-up is

NOTE Confidence: 0.96160185

00:43:01.305 --> 00:43:02.685
that, and the two year,

NOTE Confidence: 0.99730605

00:43:03.864 --> 00:43:05.145
and then the long term

NOTE Confidence: 0.99730605

00:43:05.145 --> 00:43:05.645
follow-up,

NOTE Confidence: 0.97390413

00:43:06.425 --> 00:43:08.905
is reported here. Even if

NOTE Confidence: 0.97390413

00:43:08.905 --> 00:43:10.185
they were not, some of

NOTE Confidence: 0.97390413

00:43:10.185 --> 00:43:11.305
them not in the one

NOTE Confidence: 0.97390413

00:43:11.305 --> 00:43:12.665
year follow-up, they could still

NOTE Confidence: 0.97390413

00:43:12.665 --> 00:43:13.860
be followed up later on.

NOTE Confidence: 0.97390413

00:43:14.100 --> 00:43:15.700
And our follow-up rate was

NOTE Confidence: 0.97390413

00:43:15.700 --> 00:43:17.700
very high. It's above ninety

NOTE Confidence: 0.97390413

00:43:17.700 --> 00:43:19.300
five percent of all people

NOTE Confidence: 0.97390413

00:43:19.300 --> 00:43:20.280
who survived.

NOTE Confidence: 0.9975285

00:43:21.860 --> 00:43:23.060
So this is the main

NOTE Confidence: 0.9975285

00:43:23.060 --> 00:43:23.560
result,

NOTE Confidence: 0.9995171

00:43:24.420 --> 00:43:26.840
for the systolic blood pressure.

NOTE Confidence: 0.917181

00:43:27.860 --> 00:43:29.594
It's two busy slides, but

NOTE Confidence: 0.917181

00:43:29.594 --> 00:43:30.415
you can see,

NOTE Confidence: 0.9895226

00:43:31.035 --> 00:43:31.535
here,

NOTE Confidence: 0.9892613

00:43:32.235 --> 00:43:33.455
is the change,

NOTE Confidence: 0.9982877

00:43:34.235 --> 00:43:36.315
by group. The top one

NOTE Confidence: 0.9982877

00:43:36.315 --> 00:43:36.815
is

NOTE Confidence: 0.9468702

00:43:37.675 --> 00:43:38.075
the,

NOTE Confidence: 0.9835072

00:43:38.795 --> 00:43:40.235
control group. The bottom one

NOTE Confidence: 0.9835072

00:43:40.235 --> 00:43:41.594
is the intervention group. You

NOTE Confidence: 0.9835072

00:43:41.594 --> 00:43:42.875
can see the yellow part

NOTE Confidence: 0.9835072

00:43:42.875 --> 00:43:44.100
is the one year of

NOTE Confidence: 0.9835072

00:43:44.260 --> 00:43:45.480
active trial part.

NOTE Confidence: 0.9761778

00:43:45.860 --> 00:43:47.460
There is a large reduction

NOTE Confidence: 0.9761778

00:43:47.460 --> 00:43:48.360
in both groups,

NOTE Confidence: 0.9473945

00:43:48.820 --> 00:43:50.739
including the control group. And

NOTE Confidence: 0.9473945

00:43:50.739 --> 00:43:52.920
then that difference was small.

NOTE Confidence: 0.97185296

00:43:53.380 --> 00:43:55.540
It's being hidden here, only

NOTE Confidence: 0.97185296

00:43:55.540 --> 00:43:56.040
about,

NOTE Confidence: 0.96404856

00:43:56.420 --> 00:43:57.880
two point eight,

NOTE Confidence: 0.9537594

00:43:58.555 --> 00:43:59.614
millimeter mercury,

NOTE Confidence: 0.9830333

00:44:00.075 --> 00:44:02.235
but it's significant for, that

NOTE Confidence: 0.9830333

00:44:02.235 --> 00:44:03.215
lab trial.

NOTE Confidence: 0.99569917

00:44:03.515 --> 00:44:04.255
And then,

NOTE Confidence: 0.95534694

00:44:04.875 --> 00:44:06.075
the long in terms of

NOTE Confidence: 0.95534694

00:44:06.075 --> 00:44:07.594
long term follow-up, you could

NOTE Confidence: 0.95534694

00:44:07.594 --> 00:44:09.375
see both group increased,

NOTE Confidence: 0.9845002

00:44:10.155 --> 00:44:11.055
but the difference,

NOTE Confidence: 0.97195786

00:44:11.435 --> 00:44:12.840
was more or less capped.

NOTE Confidence: 0.97195786

00:44:13.080 --> 00:44:14.120
So you could see the

NOTE Confidence: 0.97195786

00:44:14.120 --> 00:44:15.020
net difference,

NOTE Confidence: 0.9735812

00:44:15.719 --> 00:44:16.920
the result of the test

NOTE Confidence: 0.9735812

00:44:16.920 --> 00:44:18.440
here is is meant to

NOTE Confidence: 0.9735812

00:44:18.440 --> 00:44:20.120
see to show the difference

NOTE Confidence: 0.9735812

00:44:20.120 --> 00:44:20.780
in difference,

NOTE Confidence: 0.9918599

00:44:21.560 --> 00:44:22.700
also here.

NOTE Confidence: 0.9753727

00:44:23.239 --> 00:44:25.340
So it's similar in magnitude,

NOTE Confidence: 0.9753727

00:44:25.480 --> 00:44:26.520
about two point nine or

NOTE Confidence: 0.9753727

00:44:26.520 --> 00:44:28.060
two point eight millimeter mercury.

NOTE Confidence: 0.9731464

00:44:28.364 --> 00:44:29.325
So in terms of the

NOTE Confidence: 0.9731464

00:44:29.325 --> 00:44:30.765
sypholic blood pressure, it was

NOTE Confidence: 0.9731464

00:44:30.765 --> 00:44:31.825
not that high.

NOTE Confidence: 0.99982417

00:44:32.125 --> 00:44:32.625
However,

NOTE Confidence: 0.95249915

00:44:33.485 --> 00:44:34.705
we found that,

NOTE Confidence: 0.99978924

00:44:35.565 --> 00:44:37.344
they are generally consistent

NOTE Confidence: 0.98184824

00:44:38.205 --> 00:44:39.265
across the groups,

NOTE Confidence: 0.99812

00:44:39.725 --> 00:44:42.145
with stronger impacts among women,

NOTE Confidence: 0.9985617

00:44:43.170 --> 00:44:44.630
among lower educated

NOTE Confidence: 0.99392146

00:44:45.010 --> 00:44:46.770
people, among people with lower

NOTE Confidence: 0.99392146

00:44:46.770 --> 00:44:48.450
income. So in other words,

NOTE Confidence: 0.99392146

00:44:48.450 --> 00:44:49.190
our intervention

NOTE Confidence: 0.99897677

00:44:49.650 --> 00:44:50.630
worked better

NOTE Confidence: 0.9440923

00:44:51.089 --> 00:44:52.710
for the more vulnerable group

NOTE Confidence: 0.9440923

00:44:52.930 --> 00:44:53.430
even

NOTE Confidence: 0.9386458

00:44:53.730 --> 00:44:55.890
overall in the resorts limited

NOTE Confidence: 0.9386458

00:44:55.890 --> 00:44:57.270
setting of rural China.

NOTE Confidence: 0.92181367

00:44:58.575 --> 00:45:00.175
And this is but I

NOTE Confidence: 0.92181367

00:45:00.175 --> 00:45:01.055
just wanna look at those

NOTE Confidence: 0.92181367

00:45:01.055 --> 00:45:02.435
p values for interaction

NOTE Confidence: 0.9375071

00:45:03.135 --> 00:45:04.094
because none of them are

NOTE Confidence: 0.9375071

00:45:04.094 --> 00:45:05.075
actually significant.

NOTE Confidence: 0.9981639

00:45:05.455 --> 00:45:06.815
Yeah. So I'm not saying

NOTE Confidence: 0.9981639

00:45:06.815 --> 00:45:08.915
there is interaction. I'm saying

NOTE Confidence: 0.9979876

00:45:09.295 --> 00:45:09.795
that

NOTE Confidence: 0.88903904

00:45:10.440 --> 00:45:10.940
within

NOTE Confidence: 0.9939951

00:45:11.400 --> 00:45:12.219
the subgroups,

NOTE Confidence: 0.9781228

00:45:12.680 --> 00:45:14.680
the intervention effect was stronger

NOTE Confidence: 0.9781228

00:45:14.680 --> 00:45:15.420
in magnitude.

NOTE Confidence: 0.97796726

00:45:15.800 --> 00:45:17.000
I think it's accurate to

NOTE Confidence: 0.97796726

00:45:17.000 --> 00:45:17.800
say it in this way

NOTE Confidence: 0.97796726

00:45:17.800 --> 00:45:19.000
because we really worked hard

NOTE Confidence: 0.97796726

00:45:19.000 --> 00:45:20.300
on how to say it

NOTE Confidence: 0.97796726

00:45:20.359 --> 00:45:21.560
in the paper in this

NOTE Confidence: 0.97796726

00:45:21.560 --> 00:45:23.099
paper that's coming out soon.

NOTE Confidence: 0.9691926

00:45:23.719 --> 00:45:25.957
There is a stronger effect

NOTE Confidence: 0.9691926

00:45:26.209 --> 00:45:29.265
size for the subgroup of

NOTE Confidence: 0.9691926

00:45:29.265 --> 00:45:30.565
more vulnerable subgroups

NOTE Confidence: 0.9941052

00:45:31.425 --> 00:45:32.325
in within

NOTE Confidence: 0.99107707

00:45:33.025 --> 00:45:33.525
that.

NOTE Confidence: 0.94441557

00:45:35.425 --> 00:45:37.265
Yeah. But the injection wasn't

NOTE Confidence: 0.94441557

00:45:37.265 --> 00:45:37.765
significant.

NOTE Confidence: 0.9329777

00:45:42.510 --> 00:45:43.809
And this is the graph

NOTE Confidence: 0.9329777

00:45:44.030 --> 00:45:45.710
for the mortality. And, again,

NOTE Confidence: 0.9329777

00:45:45.710 --> 00:45:46.510
you can see this is

NOTE Confidence: 0.9329777

00:45:46.510 --> 00:45:47.489
the first year,

NOTE Confidence: 0.9973872

00:45:48.109 --> 00:45:49.309
and there is a small

NOTE Confidence: 0.9973872

00:45:49.309 --> 00:45:49.809
separation,

NOTE Confidence: 0.95570034

00:45:50.829 --> 00:45:51.730
but not,

NOTE Confidence: 0.9347219

00:45:52.644 --> 00:45:54.164
and even then, it was

NOTE Confidence: 0.9347219

00:45:54.164 --> 00:45:54.664
significant,

NOTE Confidence: 0.99037474

00:45:54.964 --> 00:45:56.244
but we only had thirty

NOTE Confidence: 0.99037474

00:45:56.244 --> 00:45:56.744
deaths

NOTE Confidence: 0.9661652

00:45:57.125 --> 00:45:59.305
back then for exploratory outcome.

NOTE Confidence: 0.9661652

00:45:59.525 --> 00:46:00.484
But you could see the

NOTE Confidence: 0.9661652

00:46:00.484 --> 00:46:02.404
separation over time was very

NOTE Confidence: 0.9661652

00:46:02.404 --> 00:46:03.285
clear and,

NOTE Confidence: 0.66278976

00:46:03.924 --> 00:46:04.325
if,

NOTE Confidence: 0.9709407

00:46:06.000 --> 00:46:07.540
significant. In a nutshell,

NOTE Confidence: 0.9630708

00:46:08.000 --> 00:46:08.640
it's about,

NOTE Confidence: 0.99018717

00:46:09.120 --> 00:46:10.719
twenty between twenty to thirty

NOTE Confidence: 0.99018717

00:46:10.719 --> 00:46:12.020
percent relative reduction

NOTE Confidence: 0.928881

00:46:12.640 --> 00:46:13.040
in,

NOTE Confidence: 0.9172926

00:46:13.440 --> 00:46:13.940
cardiovascular,

NOTE Confidence: 0.9458854

00:46:14.960 --> 00:46:16.660
mortality or all cause mortality

NOTE Confidence: 0.9458854

00:46:16.800 --> 00:46:17.940
or stroke mortality.

NOTE Confidence: 0.9755778

00:46:19.215 --> 00:46:21.375
So cost effectiveness, I'm skipping

NOTE Confidence: 0.9755778

00:46:21.375 --> 00:46:22.655
over the details of the

NOTE Confidence: 0.9755778

00:46:22.655 --> 00:46:23.155
parameters,

NOTE Confidence: 0.97551554

00:46:24.095 --> 00:46:26.095
and, just to show the

NOTE Confidence: 0.97551554

00:46:26.095 --> 00:46:27.775
summary that is highly cost

NOTE Confidence: 0.97551554

00:46:27.775 --> 00:46:28.275
effective

NOTE Confidence: 0.9643924

00:46:28.735 --> 00:46:29.635
with a,

NOTE Confidence: 0.9769383

00:46:30.335 --> 00:46:32.119
incremental cost effectiveness

NOTE Confidence: 0.8625039

00:46:32.420 --> 00:46:34.500
ratio of, little over eight

NOTE Confidence: 0.8625039

00:46:34.500 --> 00:46:36.039
hundred per quality.

NOTE Confidence: 0.98600703

00:46:36.420 --> 00:46:37.559
And the threshold,

NOTE Confidence: 0.9581692

00:46:38.500 --> 00:46:39.779
for one, or one and

NOTE Confidence: 0.9581692

00:46:39.779 --> 00:46:41.700
a half GDP per capita

NOTE Confidence: 0.9581692

00:46:41.700 --> 00:46:43.319
was over twenty three thousand.

NOTE Confidence: 0.9625597

00:46:43.700 --> 00:46:45.239
So it's highly cost effective.

NOTE Confidence: 0.9980336

00:46:45.940 --> 00:46:46.440
And

NOTE Confidence: 0.9646325

00:46:47.255 --> 00:46:48.775
the figures are blocked, but

NOTE Confidence: 0.9646325

00:46:48.855 --> 00:46:49.355
okay.

NOTE Confidence: 0.9918258

00:46:49.655 --> 00:46:50.155
So,

NOTE Confidence: 0.9718962

00:46:50.614 --> 00:46:51.735
coming to the end, I

NOTE Confidence: 0.9718962

00:46:51.735 --> 00:46:53.435
like to summarize and say,

NOTE Confidence: 0.99116653

00:46:54.135 --> 00:46:55.495
this summary is not in

NOTE Confidence: 0.99116653

00:46:55.495 --> 00:46:56.855
terms of the result, but

NOTE Confidence: 0.99116653

00:46:56.855 --> 00:46:57.755
in terms of,

NOTE Confidence: 0.98968863

00:46:58.535 --> 00:47:00.075
the intervention itself.

NOTE Confidence: 0.99943185

00:47:00.410 --> 00:47:01.310
So the core functions

NOTE Confidence: 0.85043865

00:47:01.690 --> 00:47:03.070
we identify being

NOTE Confidence: 0.9229

00:47:03.370 --> 00:47:05.150
task shifting and task sharing,

NOTE Confidence: 0.9578079

00:47:05.850 --> 00:47:07.710
provider and patient interactions,

NOTE Confidence: 0.93712306

00:47:08.330 --> 00:47:09.390
and the empowerment

NOTE Confidence: 0.9822504

00:47:09.770 --> 00:47:10.590
through different,

NOTE Confidence: 0.9334617

00:47:11.370 --> 00:47:12.750
ways such as training,

NOTE Confidence: 0.9978896

00:47:13.050 --> 00:47:14.110
such as incentives

NOTE Confidence: 0.8096086

00:47:14.410 --> 00:47:15.150
and technology.

NOTE Confidence: 0.9260743

00:47:16.395 --> 00:47:17.695
In terms of the evidence

NOTE Confidence: 0.9260743

00:47:17.755 --> 00:47:18.575
based practices,

NOTE Confidence: 0.9656836

00:47:19.915 --> 00:47:21.375
we focus on these three,

NOTE Confidence: 0.84905034

00:47:22.635 --> 00:47:23.135
follow-up

NOTE Confidence: 0.95233375

00:47:23.675 --> 00:47:25.835
and medication adherence and physical

NOTE Confidence: 0.95233375

00:47:25.835 --> 00:47:27.435
activity. And these are the

NOTE Confidence: 0.95233375

00:47:27.435 --> 00:47:29.855
main implementation strategies of training,

NOTE Confidence: 0.94720143

00:47:30.210 --> 00:47:31.989
incentives, and mobile house technology.

NOTE Confidence: 0.9411438

00:47:32.930 --> 00:47:34.690
So, here is one slide

NOTE Confidence: 0.9411438

00:47:34.690 --> 00:47:35.969
that's in a different scheme

NOTE Confidence: 0.9411438

00:47:35.969 --> 00:47:37.010
because I want to catch

NOTE Confidence: 0.9411438

00:47:37.010 --> 00:47:37.670
your attention.

NOTE Confidence: 0.9620615

00:47:38.210 --> 00:47:39.969
My my, take home message

NOTE Confidence: 0.9620615

00:47:39.969 --> 00:47:40.630
of summary,

NOTE Confidence: 0.99140453

00:47:41.410 --> 00:47:42.545
not based just on this

NOTE Confidence: 0.99140453

00:47:42.545 --> 00:47:43.505
study, but I think it

NOTE Confidence: 0.99140453

00:47:43.505 --> 00:47:44.625
applies to all of the

NOTE Confidence: 0.99140453

00:47:44.625 --> 00:47:46.864
implementation studies we did that,

NOTE Confidence: 0.99140453

00:47:47.105 --> 00:47:48.725
were complex in nature.

NOTE Confidence: 0.99713993

00:47:49.185 --> 00:47:50.565
So the three

NOTE Confidence: 0.96682703

00:47:51.265 --> 00:47:51.765
s,

NOTE Confidence: 0.9759428

00:47:52.545 --> 00:47:54.385
related to the content process

NOTE Confidence: 0.9759428

00:47:54.385 --> 00:47:55.045
and approach

NOTE Confidence: 0.93245554

00:47:55.345 --> 00:47:56.385
in terms of the other

NOTE Confidence: 0.93245554

00:47:56.385 --> 00:47:57.960
two s's I've touched on,

NOTE Confidence: 0.98751765

00:47:58.440 --> 00:47:59.560
saying that even when we're

NOTE Confidence: 0.98751765

00:47:59.560 --> 00:48:01.239
designing it, we hope this

NOTE Confidence: 0.98751765

00:48:01.239 --> 00:48:02.680
is sustainable over time and

NOTE Confidence: 0.98751765

00:48:02.680 --> 00:48:04.140
scalable over space,

NOTE Confidence: 0.94126606

00:48:05.080 --> 00:48:06.380
the designing principles,

NOTE Confidence: 0.9983335

00:48:07.719 --> 00:48:08.940
and the content

NOTE Confidence: 0.98672825

00:48:09.960 --> 00:48:10.940
is undoubtedly

NOTE Confidence: 0.9976707

00:48:11.400 --> 00:48:11.900
complex.

NOTE Confidence: 0.8849734

00:48:12.654 --> 00:48:14.194
It covers multiple levels,

NOTE Confidence: 0.92539394

00:48:14.894 --> 00:48:16.734
patients and village doctors and

NOTE Confidence: 0.92539394

00:48:16.734 --> 00:48:18.015
the system support, and it

NOTE Confidence: 0.92539394

00:48:18.015 --> 00:48:19.375
has technology and all the

NOTE Confidence: 0.92539394

00:48:19.375 --> 00:48:20.275
different strategies.

NOTE Confidence: 0.98341054

00:48:20.654 --> 00:48:21.855
But we should try to

NOTE Confidence: 0.98341054

00:48:21.855 --> 00:48:23.535
keep it simple. And I

NOTE Confidence: 0.98341054

00:48:23.535 --> 00:48:25.055
think some people know what

NOTE Confidence: 0.98341054

00:48:25.055 --> 00:48:25.714
this acronym

NOTE Confidence: 0.87266606

00:48:26.015 --> 00:48:26.515
stand.

NOTE Confidence: 0.5738744

00:48:26.894 --> 00:48:27.394
K?

NOTE Confidence: 0.94155717

00:48:28.560 --> 00:48:29.920
Keep it simple stupid. You

NOTE Confidence: 0.94155717

00:48:29.920 --> 00:48:31.440
know, it's starting from you

NOTE Confidence: 0.94155717

00:48:31.440 --> 00:48:32.640
know, I I I this

NOTE Confidence: 0.94155717

00:48:32.640 --> 00:48:33.840
is a reminder to myself

NOTE Confidence: 0.94155717

00:48:33.840 --> 00:48:34.800
because I tend to make

NOTE Confidence: 0.94155717

00:48:34.800 --> 00:48:36.480
it more complex. I want

NOTE Confidence: 0.94155717

00:48:36.480 --> 00:48:37.680
to pack more into it

NOTE Confidence: 0.94155717

00:48:37.680 --> 00:48:38.800
because I feel, oh, this

NOTE Confidence: 0.94155717

00:48:38.800 --> 00:48:40.239
is needed. The whole clinical

NOTE Confidence: 0.94155717

00:48:40.239 --> 00:48:40.739
guideline

NOTE Confidence: 0.85940945

00:48:41.040 --> 00:48:42.160
is covered so much, but

NOTE Confidence: 0.85940945

00:48:42.160 --> 00:48:44.195
I remind myself constantly.

NOTE Confidence: 0.9966178

00:48:44.655 --> 00:48:46.095
If I don't, I'm being

NOTE Confidence: 0.9966178

00:48:46.095 --> 00:48:46.595
stupid.

NOTE Confidence: 0.9062498

00:48:46.975 --> 00:48:48.415
And the process, we need

NOTE Confidence: 0.9062498

00:48:48.415 --> 00:48:49.875
to have a slim and

NOTE Confidence: 0.9062498

00:48:49.935 --> 00:48:51.715
being streamlined and the approach,

NOTE Confidence: 0.98891956

00:48:52.335 --> 00:48:54.275
with the digital technology, etcetera,

NOTE Confidence: 0.98316455

00:48:54.575 --> 00:48:55.475
to be smart.

NOTE Confidence: 0.90900546

00:48:57.135 --> 00:48:57.635
So

NOTE Confidence: 0.99883175

00:48:59.550 --> 00:49:01.470
the last slide I have,

NOTE Confidence: 0.99897295

00:49:01.870 --> 00:49:02.770
other than the

NOTE Confidence: 0.9440365

00:49:03.070 --> 00:49:04.290
acknowledgments, etcetera,

NOTE Confidence: 0.9845215

00:49:04.590 --> 00:49:04.989
is,

NOTE Confidence: 0.928639

00:49:05.390 --> 00:49:06.610
about sustainability.

NOTE Confidence: 0.98989385

00:49:06.910 --> 00:49:07.950
I said that we're trying

NOTE Confidence: 0.98989385

00:49:07.950 --> 00:49:09.790
to learn how to transfer

NOTE Confidence: 0.98989385

00:49:09.790 --> 00:49:11.070
and adapt to a different

NOTE Confidence: 0.98989385

00:49:11.070 --> 00:49:12.370
setting such as Nepal.

NOTE Confidence: 0.98911923

00:49:12.965 --> 00:49:14.245
In fact, I'm working on

NOTE Confidence: 0.98911923

00:49:14.245 --> 00:49:14.745
the,

NOTE Confidence: 0.67214936

00:49:15.285 --> 00:49:15.785
multimodility

NOTE Confidence: 0.9127452

00:49:16.325 --> 00:49:17.625
NIH grant proposal

NOTE Confidence: 0.98251945

00:49:17.925 --> 00:49:20.265
to focus on, the adaptation

NOTE Confidence: 0.98251945

00:49:20.405 --> 00:49:21.765
to Nepal. So there's a

NOTE Confidence: 0.98251945

00:49:21.765 --> 00:49:23.125
lot more to learn. In

NOTE Confidence: 0.98251945

00:49:23.125 --> 00:49:24.265
terms of sustainability,

NOTE Confidence: 0.9917541

00:49:24.645 --> 00:49:25.545
I think there's,

NOTE Confidence: 0.99912757

00:49:25.844 --> 00:49:26.344
also

NOTE Confidence: 0.98305833

00:49:27.000 --> 00:49:28.520
a lot of studies that

NOTE Confidence: 0.98305833

00:49:28.520 --> 00:49:29.820
we could do in implementation

NOTE Confidence: 0.98305833

00:49:30.040 --> 00:49:30.540
research.

NOTE Confidence: 0.9989624

00:49:30.920 --> 00:49:31.719
I think we need to

NOTE Confidence: 0.9989624

00:49:31.719 --> 00:49:32.219
differentiate

NOTE Confidence: 0.8799592

00:49:32.680 --> 00:49:34.460
as a very simple scheme,

NOTE Confidence: 0.99384475

00:49:34.920 --> 00:49:35.420
differentiate

NOTE Confidence: 0.76742595

00:49:35.719 --> 00:49:37.900
sustainability versus sustained effects.

NOTE Confidence: 0.97245336

00:49:38.200 --> 00:49:39.660
For example, we observed

NOTE Confidence: 0.9216571

00:49:40.114 --> 00:49:41.555
long term outcomes such as

NOTE Confidence: 0.9216571

00:49:41.555 --> 00:49:43.795
mortality reduction, etcetera, but that

NOTE Confidence: 0.9216571

00:49:43.795 --> 00:49:46.035
sustained effect. It's not about

NOTE Confidence: 0.9216571

00:49:46.035 --> 00:49:46.775
the sustainability

NOTE Confidence: 0.9200034

00:49:47.474 --> 00:49:48.295
of the intervention.

NOTE Confidence: 0.93508995

00:49:48.755 --> 00:49:50.035
And the intervention being a

NOTE Confidence: 0.93508995

00:49:50.035 --> 00:49:51.255
bundle or a package,

NOTE Confidence: 0.99815834

00:49:51.635 --> 00:49:52.375
it includes

NOTE Confidence: 0.9992649

00:49:52.869 --> 00:49:53.770
both the implementation

NOTE Confidence: 0.96526545

00:49:54.150 --> 00:49:56.070
strategies and the evidence based

NOTE Confidence: 0.96526545

00:49:56.070 --> 00:49:57.130
practices altogether

NOTE Confidence: 0.98711985

00:49:57.510 --> 00:49:58.810
as the intervention bundle.

NOTE Confidence: 0.98873043

00:49:59.589 --> 00:50:01.510
I think the most important

NOTE Confidence: 0.98873043

00:50:01.510 --> 00:50:02.950
goal for sustainability is for

NOTE Confidence: 0.98873043

00:50:02.950 --> 00:50:03.690
the EBP

NOTE Confidence: 0.94485813

00:50:04.150 --> 00:50:04.905
to go up,

NOTE Confidence: 0.99757165

00:50:05.705 --> 00:50:07.465
so that, the patients can

NOTE Confidence: 0.99757165

00:50:07.465 --> 00:50:08.505
reap the benefits in the

NOTE Confidence: 0.99757165

00:50:08.505 --> 00:50:09.565
long term outcomes.

NOTE Confidence: 0.96358895

00:50:09.864 --> 00:50:11.885
As for the implementation strategies,

NOTE Confidence: 0.96358895

00:50:12.025 --> 00:50:13.145
whether we need that to

NOTE Confidence: 0.96358895

00:50:13.145 --> 00:50:14.344
be so similar or not

NOTE Confidence: 0.96358895

00:50:14.344 --> 00:50:15.465
depends on whether we need

NOTE Confidence: 0.96358895

00:50:15.465 --> 00:50:17.565
it or not. Maybe, hopefully,

NOTE Confidence: 0.9978777

00:50:17.945 --> 00:50:19.325
we don't need that to

NOTE Confidence: 0.9845885

00:50:19.650 --> 00:50:20.529
go on for a long

NOTE Confidence: 0.9845885

00:50:20.529 --> 00:50:22.369
time if the evidence based

NOTE Confidence: 0.9845885

00:50:22.369 --> 00:50:24.170
practices can go on. So

NOTE Confidence: 0.9845885

00:50:24.289 --> 00:50:24.950
which is,

NOTE Confidence: 0.99970704

00:50:25.730 --> 00:50:27.270
the case for our study

NOTE Confidence: 0.9744998

00:50:27.730 --> 00:50:29.809
that, we have, we didn't

NOTE Confidence: 0.9744998

00:50:29.809 --> 00:50:31.270
continue any of the implementation

NOTE Confidence: 0.9744998

00:50:31.569 --> 00:50:32.950
strategies such as training

NOTE Confidence: 0.9434297

00:50:33.569 --> 00:50:35.145
or incentives or technology.

NOTE Confidence: 0.9902146

00:50:35.765 --> 00:50:36.265
But,

NOTE Confidence: 0.99162716

00:50:36.725 --> 00:50:38.405
we have evidence to show

NOTE Confidence: 0.99162716

00:50:38.405 --> 00:50:40.485
that the EBP, which is

NOTE Confidence: 0.99162716

00:50:40.485 --> 00:50:41.305
the interaction,

NOTE Confidence: 0.9332512

00:50:41.925 --> 00:50:43.925
the medication assurance, and physical

NOTE Confidence: 0.9332512

00:50:43.925 --> 00:50:44.425
activity,

NOTE Confidence: 0.9761609

00:50:45.925 --> 00:50:47.385
some of them were kept.

NOTE Confidence: 0.85848767

00:50:48.260 --> 00:50:49.219
So so this is,

NOTE Confidence: 0.9781332

00:50:49.859 --> 00:50:50.359
still,

NOTE Confidence: 0.9284061

00:50:50.820 --> 00:50:52.420
work in progress, and I

NOTE Confidence: 0.9284061

00:50:52.420 --> 00:50:54.339
welcome really feedback if you

NOTE Confidence: 0.9284061

00:50:54.339 --> 00:50:55.859
are interested in sustainability and

NOTE Confidence: 0.9284061

00:50:55.859 --> 00:50:56.359
scalability.

NOTE Confidence: 0.9374555

00:50:57.140 --> 00:50:58.180
And, also, I want to

NOTE Confidence: 0.9374555

00:50:58.180 --> 00:51:00.099
say we didn't explicitly identify

NOTE Confidence: 0.9374555

00:51:00.099 --> 00:51:00.839
our study.

NOTE Confidence: 0.95796746

00:51:01.224 --> 00:51:02.905
And, as a hybrid two

NOTE Confidence: 0.95796746

00:51:02.905 --> 00:51:03.405
trial

NOTE Confidence: 0.99200183

00:51:03.785 --> 00:51:04.605
in the beginning

NOTE Confidence: 0.90256757

00:51:05.464 --> 00:51:06.905
until later on because it

NOTE Confidence: 0.90256757

00:51:07.065 --> 00:51:08.185
this was funded as a

NOTE Confidence: 0.90256757

00:51:08.185 --> 00:51:10.125
health system trial and etcetera.

NOTE Confidence: 0.89488304

00:51:10.905 --> 00:51:12.425
So there even in the

NOTE Confidence: 0.89488304

00:51:12.425 --> 00:51:14.430
professor Kuran's paper, they say,

NOTE Confidence: 0.89488304

00:51:14.510 --> 00:51:15.569
maybe in the grantsmanship,

NOTE Confidence: 0.9550429

00:51:15.869 --> 00:51:17.230
whether it's if it's better

NOTE Confidence: 0.9550429

00:51:17.230 --> 00:51:18.030
for you to say it,

NOTE Confidence: 0.9550429

00:51:18.030 --> 00:51:19.550
then you say it. Otherwise,

NOTE Confidence: 0.9550429

00:51:19.550 --> 00:51:20.589
maybe you focus on the

NOTE Confidence: 0.9550429

00:51:20.589 --> 00:51:22.109
house outcome, which is okay,

NOTE Confidence: 0.9550429

00:51:22.109 --> 00:51:23.170
but you can do

NOTE Confidence: 0.92649436

00:51:23.469 --> 00:51:24.430
do it as a high

NOTE Confidence: 0.92649436

00:51:24.589 --> 00:51:25.969
hybrid type type two.

NOTE Confidence: 0.9987022

00:51:26.750 --> 00:51:27.869
So this is only a

NOTE Confidence: 0.9987022

00:51:27.869 --> 00:51:28.369
partial

NOTE Confidence: 0.5743019

00:51:29.454 --> 00:51:30.675
acknowledgement list,

NOTE Confidence: 0.98684776

00:51:31.135 --> 00:51:32.594
and my email is here.

NOTE Confidence: 0.95548415

00:51:33.135 --> 00:51:35.135
So this is, my talk.

NOTE Confidence: 0.95548415

00:51:35.135 --> 00:51:36.655
I'm sorry I took pretty

NOTE Confidence: 0.95548415

00:51:36.655 --> 00:51:38.415
long. So only limited time

NOTE Confidence: 0.95548415

00:51:38.415 --> 00:51:40.094
for questions, but I'm available

NOTE Confidence: 0.95548415

00:51:40.094 --> 00:51:40.970
here this afternoon.