Mari Armstrong-Hough

Mari Armstrong-Hough
Associate Professor of Social & Behavioral Sciences and Epidemiology
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Professional overview
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Dr. Mari Armstrong-Hough is Associate Professor in the Department of Social & Behavioral Sciences and in the Department of Epidemiology. She is a medical sociologist and epidemiologist of respiratory disease.
Dr. Armstrong-Hough’s global health research examines the epidemiologic interfaces among tuberculosis (TB), HIV, and non-communicable diseases. Combining training in epidemiology and sociology, her work develops and evaluates interventions to increase early case-finding, status awareness, and linkage to care in high-burden settings like Uganda and South Africa. She has published on predictors of evaluation for TB among high-risk groups, novel approaches to active case-finding for TB and HIV, the ways that providers and patients imagine and communicate risk for respiratory infection, and the availability of essential medicines in settings with double burdens of infectious and non-communicable disease. Her first book, Biomedicalization and the Practice of Culture: Globalization and Type 2 Diabetes in the United States and Japan (University of North Carolina Press, 2018), examined how the practice and experience of global evidence-based medicine is shaped by local cultural repertoires. Her recent work has appeared in the Journal of AIDS, International Journal of Tuberculosis and Lung Disease, and the The Lancet Respiratory Medicine. She also co-directs the NIH-funded Mixed-Methods Fellowship of the Pulmonary Complications of AIDS Research Training Program at Makerere University in Kampala, Uganda. She is PI of a prospective cohort study of patients initiating treatment for pulmonary TB in Uganda and a co-investigator on NIH-funded studies of contact tracing for TB.
Dr. Armstrong-Hough’s US-based research examines racial and ethnic disparities in survival of respiratory failure and seeks to develop interventions to ensure that all patients with respiratory failure receive evidence-based care. Approximately 750,000 Americans die each year from respiratory failure, and its 2.5 million survivors experience poor physical function and quality of life persisting five years after discharge. Minority patients are significantly less likely to survive respiratory failure, with up to twice the odds of death as non-Hispanic White patients. Dr. Armstrong-Hough co-PIs the Promoting Equity via Changes In Practice for Respiratory Failure (PRECIPICE) studies, which use large-scale, multicenter data from US ICUs to identify care processes associated with inequities in survival and long-term outcomes. Early work related to these studies has been accepted to Annals of the American Thoracic Society.
Before coming to NYU, Dr. Armstrong-Hough was an Associate Research Scientist in Epidemiology in the Department of Epidemiology of Microbial Diseases at Yale School of Public Health. She previously taught at Davidson College, Meiji University in Tokyo, and Duke University. She has conducted fieldwork in the United States, Japan, Uganda, Ethiopia, and Nepal and is a recipient of the Robert E. Leet and Clara Guthrie Patterson Trust Mentored Research Award in Clinical, Health Services and Policy Research.
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Education
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BA, Sociology, History, and Political Science, University of Wisconsin–MadisonMA, East Asian Studies, Duke UniversityPhD, Sociology, Duke UniversityPostdoctoral MPH, Applied Biostatistics and Epidemiology, Yale
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Publications
Publications
'Something so hard': a mixed-methods study of home sputum collection for tuberculosis contact investigation in Uganda
Armstrong-Hough, M., Armstrong-Hough, M., Ggita, J., Turimumahoro, P., Meyer, A. J., Ochom, E., Dowdy, D., Cattamanchi, A., Katamba, A., & Davis, J. L. (n.d.).Publication year
2018Journal title
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung DiseaseVolume
22Issue
10Page(s)
1152-1159AbstractHome sputum collection could facilitate prompt evaluation and diagnosis of tuberculosis (TB) among contacts of patients with active TB. We analyzed barriers to home-based collection as part of an enhanced intervention for household TB contact investigation in Kampala, Uganda.(Re)designing interventions: Research with a commitment to equity
Armstrong-Hough, M. (n.d.).Publication year
2023AbstractSymposium talkA user-centred implementation strategy for tuberculosis contact investigation in Uganda : protocol for a stepped-wedge, cluster-randomised trial
Katamba, A., Gupta, A. J., Turimumahoro, P., Ochom, E., Ggita, J. M., Nakasendwa, S., Nanziri, L., Musinguzi, J., Hennein, R., Sekadde, M., Hanrahan, C., Byaruhanga, R., Yoeli, E., Turyahabwe, S., Cattamanchi, A., Dowdy, D. W., Haberer, J. E., Armstrong-Hough, M., Kiwanuka, N., & Davis, J. L. (n.d.).Publication year
2023Journal title
BMC public healthVolume
23Issue
1AbstractBackground: Tuberculosis(TB) is among the leading causes of infectious death worldwide. Contact investigation is an evidence-based, World Health Organisation-endorsed intervention for timely TB diagnosis, treatment, and prevention but has not been widely and effectively implemented. Methods: We are conducting a stepped-wedge, cluster-randomised, hybrid Type III implementation-effectiveness trial comparing a user-centred to a standard strategy for implementing TB contact investigation in 12 healthcare facilities in Uganda. The user-centred strategy consists of several client-focused components including (1) a TB-education booklet, (2) a contact-identification algorithm, (3) an instructional sputum-collection video, and (4) a community-health-rider service to transport clients, CHWs, and sputum samples, along with several healthcare-worker-focused components, including (1) collaborative improvement meetings, (2) regular audit-and-feedback reports, and (3) a digital group-chat application designed to develop a community of practice. Sites will cross-over from the standard to the user-centred strategy in six, eight-week transition steps following a randomly determined site-pairing scheme and timeline. The primary implementation outcome is the proportion of symptomatic close contacts completing TB evaluation within 60 days of TB treatment initiation by the index person with TB. The primary clinical effectiveness outcomes are the proportion of contacts diagnosed with and initiating active TB disease treatment and the proportion initiating TB preventative therapy within 60 days. We will assess outcomes from routine source documents using intention-to-treat analyses. We will also conduct nested mixed-methods studies of implementation fidelity and context and perform cost-effectiveness and impact modelling. The Makerere School of Public Health IRB(#554), the Uganda National Council for Science and Technology(#HS1720ES), and the Yale Institutional Review Board(#2000023199) approved the study and waived informed consent for the main trial implementation-effectiveness outcomes. We will submit results for publication in peer-reviewed journals and disseminate findings to local policymakers and representatives of affected communities. Discussion: This pragmatic, quasi-experimental implementation trial will inform efforts to find and prevent undiagnosed persons with TB in high-burden settings using contact investigation. It will also help assess the suitability of human-centred design and communities of practice for tailoring implementation strategies and sustaining evidence-based interventions in low-and-middle-income countries. Trial registration: The trial was registered(ClinicalTrials.gov Identifier NCT05640648) on 16 November 2022, after the trial launch on 7 March 2022.A user-centred implementation strategy for tuberculosis contact investigation in Uganda: Protocol for a stepped-wedge, cluster-randomised trial
Armstrong-Hough, M., Katamba, A., Gupta, A. J., Turimumahoro, P., Ochom, E., Ggita, J. M., Nakasendwa, S., Nanziri, L., Musinguzi, J., Hennein, R., Sekadde, M., Hanrahan, C., Byaruhanga, R., Yoeli, E., Turyahabwe, S., Cattamanchi, A., Dowdy, D. W., Haberer, J. E., Armstrong-Hough, M., … Davis, J. L. (n.d.).Publication year
2023Journal title
Research squareAbstractTuberculosis (TB) is among the leading causes of infectious death worldwide. Contact investigation is an evidence-based, World Health Organisation-endorsed intervention for timely TB diagnosis, treatment, and prevention but has not been widely and effectively implemented. We are conducting a stepped-wedge, cluster-randomised, hybrid Type III implementation-effectiveness trial comparing a user-centred to a standard strategy for implementing TB contact investigation in 12 healthcare facilities in Uganda. The user-centred strategy consists of several client-focused components including 1) a TB-education booklet, 2) a contact-identification algorithm, 3) an instructional sputum-collection video, and 4) a community-health-rider service to transport clients, CHWs, and sputum samples, along with several healthcare-worker-focused components, including 1) collaborative improvement meetings, 2) regular audit-and-feedback reports, and 3) a digital group-chat application designed to develop a community of practice. Sites will cross from the standard to the user-centred strategy in six, eight-week transition steps following a randomly determined site-pairing scheme and timeline. The primary implementation outcome is the proportion of symptomatic close contacts completing TB evaluation within 60 days of TB treatment initiation by the index person with TB. The primary clinical effectiveness outcomes are the proportion of contacts diagnosed with and initiating active TB disease treatment and the proportion initiating TB preventative therapy within 60 days. We will assess outcomes from routine source documents using intention-to-treat analyses. We will also conduct nested mixed-methods studies of implementation fidelity and context and perform cost-effectiveness and impact modelling. The Makerere School of Public Health IRB (#554), the Uganda National Council for Science and Technology (#HS1720ES), and the Yale Institutional Review Board (#2000023199) approved the study with a waiver of informed consent for the main trial implementation-effectiveness outcomes. We will submit trial results for publication in a peer-reviewed journal and disseminate findings to local shareholders, including policymakers and representatives of affected communities. This pragmatic, quasi-experimental implementation trial will inform efforts to find and prevent undiagnosed persons with TB in high-burden setting using contact investigation. It will help assess the suitability of human-centred design and communities of practice for tailoring implementation strategies and sustain evidence-based interventions in low-and-middle-income countries. ClinicalTrials.gov Identifier: NCT05640648.Adaptation and validation of perceived HIV and TB stigma scales among persons with TB
Armstrong-Hough, M., Ponticiello, M. N., Nanziri, L. M., Hennein, R., Ochom, E., Gupta, A. J., Turimumahoro, P., White, M. A., Armstrong-Hough, M., Katamba, A., Davis, J. L., & Davis, J. L. (n.d.).Publication year
2025Journal title
International Journal of Tuberculosis and Lung DiseaseVolume
29Issue
3Page(s)
127-134AbstractB A C K G R O U N D: Stigma is a barrier to care for people affected by TB and HIV in Uganda, where these conditions remain endemic. While scales have been adapted and validated to measure stigma among TB-affected households in Uganda, there is a need for scales that measure the experiences of persons with TB (PWTB). M E T H O D S: We adapted the Van Rie 12-item individual perspectives TB scale and 10-item individual perspectives HIV scale for use in Uganda through cross-cultural discussions with a multidisciplinary research team and four cognitive interviews with community health workers and PWTB. We then conducted a cross-sectional study administering each scale to 125 PWTB. We performed exploratory factor analysis, evaluated internal validity, and assessed convergent validity with perceived social support. R E S U L T S: Exploratory factor analysis yielded a one-factor solution for both scales, with marginal model fit (standardised root mean square residual ¼ 0.09 for TB, ¼ 0.07 for HIV). There was evidence of convergent validity through a positive correlation of the TB (r ¼ 0.22, p ¼ 0.01) and HIV stigma (r ¼ 0.22, p ¼ 0.01) scales with perceived social support. Both scales had good internal validity (Cronbach’s a ¼ 0.86 for TB, ¼ 0.87 for HIV). C O N C L U S I O N: Adapted scales to measure perceived HIV and TB stigma among PWTB in Uganda demonstrated promising psychometric properties by removing one and two items, respectively.Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam : a case study
Shelley, D., Alvarez, G. G., Nguyen, T., Nguyen, N., Goldsamt, L. A., Cleland, C. M., Tozan, Y., Shuter, J., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1AbstractBackground: Smoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial. Methods: Data collection and analyses were guided by two implementation science frameworks and the socio-ecological model. Qualitative interviews were conducted with 13 health care providers and 24 patients in three OPCs. Workflow analyses were conducted in each OPC. Qualitative data were analyzed using rapid qualitative analysis procedures. Based on findings, components of the intervention and implementation strategies were adapted, followed by a 3-month pilot study in one OPC with 16 patients randomized to one of two intervention arms. Results: The primary adaptations included modifying the TDT intervention counseling content to address barriers to quitting among PLWH and Vietnamese sociocultural norms that support smoking cessation. Implementation strategies (i.e., training and system changes) were adapted to respond to provider- and clinic-level determinants of implementation effectiveness (e.g., knowledge gaps, OPC resource constraints, staffing structure, compatibility). Conclusions: Adaptations were facilitated through a mixed method, stakeholder (patient and health care provider, district health leader)-engaged evaluation of context-specific influences on intervention and implementation effectiveness. This data-driven approach to refining and adapting components aimed to optimize intervention effectiveness and implementation in the context of HIV care. Balancing pragmatism with rigor through the use of rapid analysis procedures and multiple methods increased the feasibility of the adaptation process. Trial registration: ClinicalTrials.gov NCT05162911 . Registered on December 16, 2021.Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study
Armstrong-Hough, M., Shelley, D., Alvarez, G. G. G., Nguyen, T., Nguyen, N., Goldsamt, L., Cleland, C., Tozan, Y., Shuter, J., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1Page(s)
112AbstractSmoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial.ADHD in Japan: A sociological perspective
Armstrong-Hough, M. (n.d.). (M. R. Bergey, A. M. Filipe, P. Conrad, & I. Singh, Eds.).Publication year
2018Page(s)
261-269AbstractJapanese research on ADHD is prolific, and clinical management of this condition in Japan takes place in one of the most accessible and efficient health care delivery systems in the world. It is therefore particularly instructive to examine differences in the identification, management, and social context of ADHD in Japan; these differences can tell us much about the role of 'local' cultural, political, and institutional forces in professional and popular perceptions of a global illness. As this subchapter shows, differences in the sociocultural and institutional context of ADHD in Japan lead not only to different experiences of illness among individuals, but also to different choices about its management and treatment for parents and clinicians. Although rates of medication usage for ADHD are on the rise in Japan, they remain low by international standards. The classic formulation of Ritalin, emblematic of the rise of ADHD in the United States, is eschewed completely, and there is evidence that clinicians and regulators alike have a preference for nonstimulant drug therapy. Medicalized understandings of the origins of ADHD symptoms do not seem to have removed the stigma associated with the diagnosis. These differences in the medicalization of ADHD in Japan are particularly notable in the context of the country’s notoriously competitive, exam-based educational system and high levels of anxiety surrounding child and adolescent behavioral issues. This short subchapter responds to three related sociological questions about the rise of ADHD in Japan. First, and most broadly, how has the medicalization of ADHD progressed in Japan? Second, what is the nature of the stigma associated with ADHD in Japan, what are its origins, and how is it changing? And finally, how has the course of its medicalization and its changing association with deviance influenced the identification and treatment of ADHD in Japan? (PsycINFO Database Record (c) 2018 APA, all rights reserved)An adapted scale to measure perceived TB and HIV stigma during household contact investigation
Armstrong-Hough, M., Armstrong-Hough, M., Shelby, T., Ggita, J., Nangendo, J., Gupta, A. J., Davis, J. L., & Katamba, A. (n.d.).Publication year
2024Journal title
International Journal of Tuberculosis and Lung DiseaseVolume
28Issue
9Page(s)
433-438AbstractBACKGROUND: Measuring stigma for TB and HIV in households undergoing contact investigation for TB is critical for understanding its impacts on health behaviours and identifying opportunities for intervention. However, standardised measurements for TB-HIV stigma in household contact investigations are limited. METHODS: We adapted and validated a household stigma scale in Uganda. This involved field testing measures from another setting with 163 household contacts of newly diagnosed TB patients, conducting cognitive interviews with seven household contacts, adapting scale items using cognitive interview data, and retesting the adapted scales in a random sample of 60 contacts. We assessed inter-item covariance and performed factor analysis to select the final scale items. RESULTS: In whole-scale factor analysis, no cross-loading of items with scores ≥0.32 was found after the elimination of items based on covariance and symmetry. All TB items were loaded onto a single factor with scores ≥0.5, and all but one HIV item was loaded onto a second factor with scores ≥0.5. The final subscale internal consistency (Cronbach’s alpha) was 0.92 for TB and 0.89 for HIV. CONCLUSIONS: The adapted TB-HIV stigma scale demonstrated acceptable psychometric properties and is substantially shorter and easier to administer than previous scales, making it suitable for programmatic research and evaluation.An emerging syndemic of smoking and cardiopulmonary diseases in people living with HIV in Africa
Peprah, E., Armstrong-Hough, M., Cook, S. H., Mukasa, B., Taylor, J. Y., Xu, H., Chang, L., Gyamfi, J., Ryan, N., Ojo, T., Snyder, A., Iwelunmor, J., Ezechi, O., Iyegbe, C., O’reilly, P., & Kengne, A. P. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
6Page(s)
1-12AbstractBackground: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa
Armstrong-Hough, M., Peprah, E., Armstrong-Hough, M., Cook, S. H., Mukasa, B., Taylor, J. Y., Xu, H., Chang, L., Gyamfi, J., Ryan, N., Ojo, T., Snyder, A., Iwelunmor, J., Ezechi, O., Iyegbe, C., O’Reilly, P., & Pascal Kengne, A. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
6AbstractAfrican countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2-4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke.Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation : Protocol for a cluster-randomised trial
Armstrong-Hough, M., Ggita, J., Gupta, A. J., Shelby, T., Nangendo, J., Ayen, D. O., Davis, J. L., & Katamba, A. (n.d.).Publication year
2022Journal title
BMJ openVolume
12Issue
5AbstractIntroduction HIV status awareness is important for household contacts of patients with tuberculosis (TB). Home HIV testing during TB contact investigation increases HIV status awareness. Social interactions during home visits may influence perceived stigma and uptake of HIV testing. We designed an intervention to normalise and facilitate uptake of home HIV testing with five components: guided selection of first tester; prosocial invitation scripts; opt-out framing; optional sharing of decisions to test; and masking of decisions not to test. Methods and analysis We will evaluate the intervention effect in a household-randomised controlled trial. The primary aim is to assess whether contacts offered HIV testing using the norming strategy will accept HIV testing more often than those offered testing using standard strategies. Approximately 198 households will be enrolled through three public health facilities in Kampala, Uganda. Households will be randomised to receive the norming or standard strategy and visited by a community health worker (CHW) assigned to that strategy. Eligible contacts ≥15 years will be offered optional, free, home HIV testing. The primary outcome, proportion of contacts accepting HIV testing, will be assessed by CHWs and analysed using an intention-to-treat approach. Secondary outcomes will be changes in perceived HIV stigma, changes in perceived TB stigma, effects of perceived HIV stigma on HIV test uptake, effects of perceived TB stigma on HIV test uptake and proportions of first-invited contacts who accept HIV testing. Results will inform new, scalable strategies for delivering HIV testing. Ethics and dissemination This study was approved by the Yale Human Investigation Committee (2000024852), Makerere University School of Public Health Institutional Review Board (661) and Uganda National Council on Science and Technology (HS2567). All participants, including patients and their household contacts, will provide verbal informed consent. Results will be submitted to a peer-reviewed journal and disseminated to national stakeholders, including policy-makers and representatives of affected communities. Trial registration number ClinicalTrials.gov Identifier: NCT05124665.Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation: protocol for a cluster-randomised trial
Armstrong-Hough, M., Armstrong-Hough, M., Ggita, J., Gupta, A. J., Shelby, T., Nangendo, J., Ayen, D. O., Davis, J. L., & Katamba, A. (n.d.).Publication year
2022Journal title
BMJ openVolume
12Issue
5Page(s)
e061508AbstractHIV status awareness is important for household contacts of patients with tuberculosis (TB). Home HIV testing during TB contact investigation increases HIV status awareness. Social interactions during home visits may influence perceived stigma and uptake of HIV testing. We designed an intervention to normalise and facilitate uptake of home HIV testing with five components: guided selection of first tester; prosocial invitation scripts; opt-out framing; optional sharing of decisions to test; and masking of decisions not to test.Associations among past trauma, post-displacement stressors, and mental health outcomes in Rohingya refugees in Bangladesh : A secondary cross-sectional analysis
Ritsema, H., & Armstrong-Hough, M. (n.d.).Publication year
2023Journal title
Frontiers in Public HealthVolume
10AbstractObjective: The Rohingya endured intense trauma in Myanmar and continue to experience trauma related to displacement in Bangladesh. We aimed to evaluate the association of post-displacement stressors with mental health outcomes, adjusting for previously experienced trauma, in the Rohingya refugee population in Cox's Bazar, Bangladesh. Methods: We analyzed data from the Cox's Bazar Panel Survey, a cross sectional survey consisting of 5,020 household interviews and 9,386 individual interviews completed in 2019. Using logistic regression, we tested the association between post-displacement stressors such as current exposure to crime and conflict and two mental health outcomes: depression and post-traumatic stress disorder (PTSD). In adjusted analyses, we controlled for past trauma, employment status, receiving an income, food security, and access to healthcare and stratified by gender. Results: The prevalence of depressive symptoms was 30.0% (n = 1,357) and PTSD 4.9% (n = 218). Most (87.1%, n = 3,938) reported experiencing at least one traumatic event. Multiple post-displacement stressors, such as current exposure to crime and conflict (for men: OR = 2.23, 95% CI = 1.52–3.28, p < 0.001; for women: OR = 1.92, 95% CI = 1.44–2.56, p < 0.001), were associated with higher odds of depressive symptoms in multivariable models. Trauma (OR = 4.98, 95% CI = 2.20–11.31, p < 0.001) was associated with increased odds of PTSD. Living in a household that received income was associated with decreased odds of PTSD (OR = 0.74, 95% CI = 0.55–1.00, p = 0.05). Conclusion: Prevalence of depressive symptoms was high among Rohingya refugees living in Cox's Bazar. Adjusting for past trauma and other risk factors, exposure to post-displacement stressors was associated with increased odds of depressive symptoms. There is a need to address social determinants of health that continue to shape mental health post-displacement and increase mental healthcare access for displaced Rohingya.Associations among past trauma, post-displacement stressors, and mental health outcomes in Rohingya refugees in Bangladesh: A secondary cross-sectional analysis
Armstrong-Hough, M., Ritsema, H., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Frontiers in public healthVolume
10Page(s)
1048649AbstractThe Rohingya endured intense trauma in Myanmar and continue to experience trauma related to displacement in Bangladesh. We aimed to evaluate the association of post-displacement stressors with mental health outcomes, adjusting for previously experienced trauma, in the Rohingya refugee population in Cox's Bazar, Bangladesh.Associations Among Patient Race, Sedation Practices, and Mortality in a Large Multi-Center Registry of COVID-19 Patients
Armstrong-Hough, M., Valley, T. S., Iwashyna, T. J., Cook, S., Hough, C. L., & Armstrong-Hough, M. (n.d.).Publication year
2021Journal title
American Journal of Respiratory and Critical Care MedicineVolume
203Issue
9Abstract~Availability, functionality and access of blood pressure machines at the points of care in public primary care facilities in Tororo district, Uganda
Armstrong-Hough, M., Besigye, I. K., Okuuny, V., Armstrong-Hough, M., Katahoire, A. R., Sewankambo, N. K., Mash, R., & Katamba, A. (n.d.).Publication year
2021Journal title
South African family practice : official journal of the South African Academy of Family Practice/Primary CareVolume
63Issue
1Page(s)
e1-e6AbstractEarly diagnosis of hypertension prevents a significant number of complications and premature deaths. In resource-variable settings, diagnosis may be limited by inadequate access to blood pressure (BP) machines. We sought to understand the availability, functionality and access of BP machines at the points of care within primary care facilities in Tororo district, Uganda.Biomedicalization and the practice of culture : globalization and type 2 diabetes in the United States and Japan
Armstrong-Hough, M. (n.d.).Publication year
2018Abstract~Brief Report: "Give Me Some Time": Facilitators of and Barriers to Uptake of Home-Based HIV Testing During Household Contact Investigation for Tuberculosis in Kampala, Uganda
Armstrong-Hough, M., Armstrong-Hough, M., Ggita, J., Ayakaka, I., Dowdy, D., Cattamanchi, A., Haberer, J. E., Katamba, A., & Davis, J. L. (n.d.).Publication year
2018Journal title
Journal of acquired immune deficiency syndromes (1999)Volume
77Issue
4Page(s)
400-404AbstractIntegrating home-based HIV counseling and testing (HCT) with tuberculosis (TB) evaluation could improve the uptake of HIV testing among household contacts of patients with active TB. We sought to identify the facilitators of and barriers to HCT during household contact investigation for TB in Kampala, Uganda.Clinical Practices Following Train-The-Trainer Trauma Course Completion in Uganda : A Parallel-Convergent Mixed-Methods Study
Tang, Z., Kayondo, D., Ullrich, S. J., Namugga, M., Muwanguzi, P., Klazura, G., Ozgediz, D., & Armstrong-Hough, M. (n.d.).Publication year
2023Journal title
World Journal of SurgeryAbstractBACKGROUND: Despite the growth of trauma training courses worldwide, evidence for their impact on clinical practice in low- and middle-income countries (LMICs) is sparse. We investigated trauma practices by trained providers in Uganda using clinical observation, surveys, and interviews.METHODS: Ugandan providers participated in the Kampala Advanced Trauma Course (KATC) from 2018 to 2019. Between July and September of 2019, we directly evaluated guideline-concordant behaviors in KATC-exposed facilities using a structured real-time observation tool. We conducted 27 semi-structured interviews with course-trained providers to elucidate experiences of trauma care and factors that impact adoption of guideline-concordant behaviors. We assessed perceptions of trauma resource availability through a validated survey.RESULTS: Of 23 resuscitations, 83% were managed without course-trained providers. Frontline providers inconsistently performed universally applicable assessments: pulse checks (61%), pulse oximetry (39%), lung auscultation (52%), blood pressure (65%), pupil examination (52%). We did not observe skill transference between trained and untrained providers. In interviews, respondents found KATC personally transformative but not sufficient for facility-wide improvement due to issues with retention, lack of trained peers, and resource shortages. Resource perception surveys similarly demonstrated profound resource shortages and variation across facilities.CONCLUSIONS: Trained providers view short-term trauma training interventions positively, but these courses may lack long-term impact due to barriers to adopting best practices. Trauma courses should include more frontline providers, target skill transference and retention, and increase the proportion of trained providers at each facility to promote communities of practice. Essential supplies and infrastructure in facilities must be consistent for providers to practice what they have learned.Clinical Practices Following Train-The-Trainer Trauma Course Completion in Uganda: A Parallel-Convergent Mixed-Methods Study
Armstrong-Hough, M., Tang, Z., Kayondo, D., Ullrich, S. J., Namugga, M., Muwanguzi, P., Klazura, G., Ozgediz, D., & Armstrong-Hough, M. (n.d.).Publication year
2023Journal title
World journal of surgeryVolume
47Issue
6Page(s)
1399-1408AbstractDespite the growth of trauma training courses worldwide, evidence for their impact on clinical practice in low- and middle-income countries (LMICs) is sparse. We investigated trauma practices by trained providers in Uganda using clinical observation, surveys, and interviews.Communication attributes modify the anxiety risk associated with problematic social media use : Evidence from a prospective diary method study
Allen Weng, C., Bulgin, J., Diaz, S., Zhang, J., Tan, R., Li, L., & Armstrong-Hough, M. (n.d.).Publication year
2025Journal title
Addictive BehaviorsVolume
166AbstractPurpose: Social media use in younger people has shown mixed associations with mental health. We hypothesized that communication types during social media use might alter the relationship between problematic social media use (PSMU) and anxiety over time. We aimed to identify how four dimensions of communication influence the link between PSMU and anxiety. Methods: We recruited a cohort of undergraduate students aged 18–26 to participate in daily surveys over two weeks using a diary method to assess daily social media use, PSMU, anxiety symptoms, and the four dimensions of communication: Consumption, Broadness, Online Exclusivity, and Parasociality. Lagged logistic regression models with generalized estimating equations evaluated the influence of daily PSMU and communication type on subsequent anxiety levels. Results: Out of 79 participants, 1009 daily records were analyzed. PSMU positively correlated with anxiety (Kendall rank correlation τ = 0.30). Interaction analysis indicated that levels of parasociality and consumption moderated the association between PSMU components and anxiety outcomes. In young adults with high levels of consumption or parasociality, a 1-standard-deviation rise in PSMU's social conflict component led to an 11 %-13 % increase in next-day anxiety scores. This association was absent for those with low to moderate levels of parasociality and consumption. Discussion: Elevated levels of passive consumption and one-sided interactions amplify the anxiety risk associated with PSMU. Further longitudinal evidence can elucidate the connections between communication types, social media exposure, and anxiety, guiding the development of a model for healthy social media use.Conformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Uganda
Armstrong-Hough, M., Meyer, A., Katamba, A., & Davis, J. L. (n.d.).Publication year
2018Journal title
PeerJ PrePrintsAbstractBackground Individuals' observation of how group members ahead of them behave canCore components of a Community of Practice to improve community health worker performance : a qualitative study
Hennein, R., Ggita, J. M., Turimumahoro, P., Ochom, E., Gupta, A. J., Katamba, A., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1AbstractBackground: Communities of Practice (CoPs) offer an accessible strategy for healthcare workers to improve the quality of care through knowledge sharing. However, not enough is known about which components of CoPs are core to facilitating behavior change. Therefore, we carried out a qualitative study to address these important gaps in the literature on CoPs and inform planning for an interventional study of CoPs. Methods: We organized community health workers (CHWs) from two tuberculosis (TB) clinics in Kampala, Uganda, into a CoP from February to June 2018. We conducted interviews with CoP members to understand their perceptions of how the CoP influenced delivery of TB contact investigation. Using an abductive approach, we first applied inductive codes characterizing CHWs’ perceptions of how the CoP activities affected their delivery of contact investigation. We then systematically mapped these codes into their functional categories using the Behavior Change Technique (BCT) Taxonomy and the Behavior Change Wheel framework. We triangulated all interview findings with detailed field notes. Results: All eight members of the CoP agreed to participate in the interviews. CHWs identified five CoP activities as core to improving the quality of their work: (1) individual review of feedback reports, (2) collaborative improvement meetings, (3) real-time communications among members, (4) didactic education sessions, and (5) clinic-wide staff meetings. These activities incorporated nine different BCTs and five distinct intervention functions. CHWs reported that these activities provided a venue for them to share challenges, exchange knowledge, engage in group problem solving, and benefit from social support. CHWs also explained that they felt a shared sense of ownership of the CoP, which motivated them to propose and carry out innovations. CHWs described that the CoP strengthened their social and professional identities within and outside the group, and improved their self-efficacy. Conclusions: We identified the core components and several mechanisms through which CoPs may improve CHW performance. Future studies should evaluate the importance of these mechanisms in mediating the effects of CoPs on program effectiveness.Core components of a Community of Practice to improve community health worker performance: a qualitative study
Armstrong-Hough, M., Hennein, R., Ggita, J. M., Turimumahoro, P., Ochom, E., Gupta, A. J., Katamba, A., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1Page(s)
27AbstractCommunities of Practice (CoPs) offer an accessible strategy for healthcare workers to improve the quality of care through knowledge sharing. However, not enough is known about which components of CoPs are core to facilitating behavior change. Therefore, we carried out a qualitative study to address these important gaps in the literature on CoPs and inform planning for an interventional study of CoPs.