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Engelsma T, Heijmink S, Hendriksen HMA, Visser LNC, Lemstra AW, Jaspers MWM, Peute LWP. Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study. JMIR Hum Factors 2024; 11:e54032. [PMID: 39083790 PMCID: PMC11325128 DOI: 10.2196/54032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/15/2024] [Accepted: 03/06/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. OBJECTIVE This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. METHODS First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. RESULTS The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57%) with SCD, 1 (14%) with MCI, and 2 (29%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user's expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. CONCLUSIONS By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population.
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Affiliation(s)
- Thomas Engelsma
- eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Simone Heijmink
- eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - Heleen M A Hendriksen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Leonie N C Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Monique W M Jaspers
- eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
| | - Linda W P Peute
- eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
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Piette JD, Lee KCS, Bosworth HB, Isaacs D, Cerrada CJ, Kainkaryam R, Liska J, Lee F, Kennedy A, Kerr D. Behavioral Engagement and Activation Model Study (BEAMS): A latent class analysis of adopters and non-adopters of digital health technologies among people with Type 2 diabetes. Transl Behav Med 2024; 14:491-498. [PMID: 38953616 PMCID: PMC11282572 DOI: 10.1093/tbm/ibae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Many people with Type 2 diabetes (T2D) who could benefit from digital health technologies (DHTs) are either not using DHTs or do use them, but not for long enough to reach their behavioral or metabolic goals. We aimed to identify subgroups within DHT adopters and non-adopters and describe their unique profiles to better understand the type of tailored support needed to promote effective and sustained DHT use across a diverse T2D population. We conducted latent class analysis of a sample of adults with T2D who responded to an internet survey between December 2021 and March 2022. We describe the clinical and psychological characteristics of DHT adopters and non-adopters, and their attitudes toward DHTs. A total of 633 individuals were characterized as either DHT "Adopters" (n = 376 reporting any use of DHT) or "Non-Adopters" (n = 257 reporting never using any DHT). Within Adopters, three subgroups were identified: 21% (79/376) were "Self-managing Adopters," who reported high health activation and self-efficacy for diabetes management, 42% (158/376) were "Activated Adopters with dropout risk," and 37% (139/376) were "Non-Activated Adopters with dropout risk." The latter two subgroups reported barriers to using DHTs and lower rates of intended future use. Within Non-Adopters, two subgroups were identified: 31% (79/257) were "Activated Non-Adopters," and 69% (178/257) were "Non-Adopters with barriers," and were similarly distinguished by health activation and barriers to using DHTs. Beyond demographic characteristics, psychological, and clinical factors may help identify different subgroups of Adopters and Non-Adopters.
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Affiliation(s)
- John D Piette
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | | | | | | - David Kerr
- Sutter Center for Health Systems Research, Santa Barbara, California, USA
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Fundoiano-Hershcovitz Y, Ritholz MD, Horwitz DL, Behar E, Manejwala O, Goldstein P. The Impact of Digital Self-Monitoring of Weight on Improving Diabetes Clinical Outcomes: Quasi-Randomized Study. J Med Internet Res 2024; 26:e54940. [PMID: 38564266 PMCID: PMC11022133 DOI: 10.2196/54940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The management of type 2 diabetes (T2D) and obesity, particularly in the context of self-monitoring, remains a critical challenge in health care. As nearly 80% to 90% of patients with T2D have overweight or obesity, there is a compelling need for interventions that can effectively manage both conditions simultaneously. One of the goals in managing chronic conditions is to increase awareness and generate behavioral change to improve outcomes in diabetes and related comorbidities, such as overweight or obesity. There is a lack of real-life evidence to test the impact of self-monitoring of weight on glycemic outcomes and its underlying mechanisms. OBJECTIVE This study aims to assess the efficacy of digital self-monitoring of weight on blood glucose (BG) levels during diabetes management, investigating whether the weight changes may drive glucose fluctuations. METHODS In this retrospective, real-world quasi-randomized study, 50% of the individuals who regularly used the weight monitoring (WM) feature were propensity score matched with 50% of the users who did not use the weight monitoring feature (NWM) based on demographic and clinical characteristics. All the patients were diagnosed with T2D and tracked their BG levels. We analyzed monthly aggregated data 6 months before and after starting their weight monitoring. A piecewise mixed model was used for analyzing the time trajectories of BG and weight as well as exploring the disaggregation effect of between- and within-patient lagged effects of weight on BG. RESULTS The WM group exhibited a significant reduction in BG levels post intervention (P<.001), whereas the nonmonitoring group showed no significant changes (P=.59), and both groups showed no differences in BG pattern before the intervention (P=.59). Furthermore, the WM group achieved a meaningful decrease in BMI (P<.001). Finally, both within-patient (P<.001) and between-patient (P=.008) weight variability was positively associated with BG levels. However, 1-month lagged back BMI was not associated with BG levels (P=.36). CONCLUSIONS This study highlights the substantial benefits of self-monitoring of weight in managing BG levels in patients with diabetes, facilitated by a digital health platform, and advocates for the integration of digital self-monitoring tools in chronic disease management. We also provide initial evidence of testing the underlying mechanisms associated with BG management, underscoring the potential role of patient empowerment.
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Affiliation(s)
| | - Marilyn D Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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Yang SJ, Lim SY, Choi YH, Lee JH, Yoon KH. Effects of an Electronic Medical Records-Linked Diabetes Self-Management System on Treatment Targets in Real Clinical Practice: Retrospective, Observational Cohort Study. Endocrinol Metab (Seoul) 2024; 39:364-374. [PMID: 38509668 PMCID: PMC11066442 DOI: 10.3803/enm.2023.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGRUOUND This study evaluated the effects of a mobile diabetes management program called "iCareD" (College of Medicine, The Catholic University of Korea) which was integrated into the hospital's electronic medical records system to minimize the workload of the healthcare team in the real clinical practice setting. METHODS In this retrospective observational study, we recruited 308 patients. We categorized these patients based on their compliance regarding their use of the iCareD program at home; compliance was determined through self-monitored blood glucose inputs and message subscription rates. We analyzed changes in the ABC (hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol) levels from the baseline to 12 months thereafter, based on the patients' iCareD usage patterns. RESULTS The patients comprised 92 (30%) non-users, 170 (55%) poor-compliance users, and 46 (15%) good-compliance users; the ABC target achievement rate showed prominent changes in good-compliance groups from baseline to 12 months (10.9% vs. 23.9%, P<0.05), whereas no significant changes were observed for poor-compliance users and non-users (13.5% vs. 18.8%, P=0.106; 20.7% vs. 14.1%, P=0.201; respectively). CONCLUSION Implementing the iCareD can improve the ABC levels of patients with diabetes with minimal efforts of the healthcare team in real clinical settings. However, the improvement of patients' compliance concerning the use of the system without the vigorous intervention of the healthcare team needs to be solved in the future.
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Affiliation(s)
- So Jung Yang
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Young Lim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Hee Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Medical Excellence Inc., Seoul, Korea
| | - Jin Hee Lee
- The Catholic Institute of Smart Healthcare Center, The Catholic University of Korea, Seoul, Korea
| | - Kun-Ho Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Yao W, Han Y, Yang L, Chen Y, Yan S, Cheng Y. Electronic Interactive Games for Glycemic Control in Individuals With Diabetes: Systematic Review and Meta-Analysis. JMIR Serious Games 2024; 12:e43574. [PMID: 38345856 PMCID: PMC10897792 DOI: 10.2196/43574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 05/05/2023] [Accepted: 10/24/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Several electronic interventions have been used to improve glycemic control in patients with diabetes. Electronic interactive games specific to physical activity are available, but it is unclear if these are effective at improving glycemic control in patients with diabetes. OBJECTIVE This study aimed to determine the effects of electronic game-based interventions on glycemic control in patients with diabetes. METHODS Relevant studies that were published before April 1, 2023, were searched from 5 databases: PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Eligibility criteria included prospective studies examining the relationship between electronic games with physical activities or diet education and glycemic control as the outcome. The risk of bias was assessed using the Cochrane risk-of-bias tool. All analyses were conducted using RevMan5.4.1. Depending on the heterogeneity across studies, the pooled effects were calculated using fixed-effects or random-effects models. RESULTS Participants from 9 studies were included and assessed. Glycated hemoglobin (HbA1c) and fasting blood glucose improved in the intervention group, although the analysis revealed no significant reduction in HbA1c (-0.09%, 95% CI -0.29% to 0.10%) or fasting blood glucose (-0.94 mg/dL, 95% CI -9.34 to 7.46 mg/dL). However, the physical activity of individuals in the intervention group was significantly higher than that of those in the control group (standardized mean difference=0.84, 95% CI 0.30 to 1.38; P=.002). Other outcomes, such as weight and blood lipids, exhibited no significant improvement (all P>.05). CONCLUSIONS Electronic games had a good impact on participants' physical activity and offered an advantage in glycemic control without reaching statistical significance. Electronic games are convenient for reminders and education. Low-intensity exercise games may not be considered a better adjuvant intervention to improve diabetes self-management care.
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Affiliation(s)
- WenQi Yao
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - YiBing Han
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Li Yang
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
- Department of Nutrition, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ying Chen
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - ShengZhe Yan
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - YanZhen Cheng
- Department of Endocrinology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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Stara V, Maranesi E, Möller J, Palmier C, Ogawa T, Browne R, Luc M, Wieching R, Boudy J, Bevilacqua R. Technology-Enabled Senior Living: A Preliminary Report on Stakeholder Perspectives. Healthcare (Basel) 2024; 12:381. [PMID: 38338266 PMCID: PMC10855261 DOI: 10.3390/healthcare12030381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The integration of stakeholders is crucial in developing smart living technologies to support the autonomy of elderly populations. Despite the clear benefits of these technologies, there remains a significant gap in comprehensive research. METHODS This study presents the viewpoints of 19 stakeholders from Europe and Japan, focusing on the sustainability of smart living solutions for Active and Healthy Ageing (AHA). Data were gathered through qualitative semi-structured interviews and analysed using a Framework Analysis approach. RESULTS Analysis of the interviews revealed six key sustainability categories: addressing the unmet needs of older adults, functionalities of the smart living coach, integration within organizations, identified barriers, financial considerations, and the social role of the smart living coach. CONCLUSIONS This research underscores the importance of evaluating user needs through the involvement of various stakeholders, including the elderly, their caregivers, professionals, technicians, service providers, and government bodies. Collaborative efforts are essential to generate new evidence demonstrating the value of smart living solutions in facilitating Active and Healthy Ageing.
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Affiliation(s)
- Vera Stara
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (V.S.); (R.B.)
| | - Elvira Maranesi
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (V.S.); (R.B.)
| | - Johanna Möller
- Diocesan Caritas Association for the Archdiocese of Cologne, D-50668 Cologne, Germany;
| | - Cecilia Palmier
- Service de Gériatrie 1&2, AP-HP, Hôpital Broca, 75013 Paris, France;
| | - Toshimi Ogawa
- Smart-Aging Research Center, Tohoku University, Sendai 980-8575, Japan; (T.O.); (R.B.)
| | - Ryan Browne
- Smart-Aging Research Center, Tohoku University, Sendai 980-8575, Japan; (T.O.); (R.B.)
| | - Marine Luc
- AGE Platform Europe, 1150 Brussels, Belgium;
| | - Rainer Wieching
- Institute for New Media and Information Systems, University Siegen, D-57072 Siegen, Germany;
| | - Jerome Boudy
- Institut Mines-Telecom, Telecom SudParis, SAMOVAR IP Paris, 91011 Evry, France;
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Liew SC, Pallath V, Rasali Y, Foong CC, Hong WH, Tan MP. Knowledge, attitude, and practice of virtual consultation among outpatients at a teaching hospital in Malaysia. PLoS One 2023; 18:e0289176. [PMID: 38117842 PMCID: PMC10732386 DOI: 10.1371/journal.pone.0289176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/12/2023] [Indexed: 12/22/2023] Open
Abstract
INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic, the use of virtual consultations has accelerated to ensure continued access to healthcare despite lockdowns and physical distancing measures. We aimed to determine the knowledge (awareness) of, attitude (acceptability) to, and practice (exposure) [KAP] of virtual consultations (VC), the demographic factors associated with poor KAP, and the correlation between the three KAP domains. METHODS A cross-sectional study, using a convenience sampling technique, was conducted from 13 September, 2021 to 28 November, 2021. We designed a 45-item VC KAP questionnaire. This was distributed to outpatient users attending cardiovascular, dermatology, geriatrics, haematology, endocrine, respiratory, gastroenterology, rheumatology, or neurology clinics at the University Malaya Medical Centre. It was completed during face-to-face, online, or telephone interviews. The data were analysed using SPSS version 24.0. Binary logistic regression was used to determine the demographic factors associated with KAP. Correlation between KAP domains was determined using Spearman's rho (r). A p-value of <0.05 was considered statistically significant. RESULTS A total of 366 questionnaires were completed. Knowledge (awareness), attitude (acceptability), and practice (exposure) were considered good in 69.7%, 80.9%, and 24.6% of participants, respectively. There were no significant relationships between age, gender, ethnicity, and duration of hospital attendance (years) with knowledge (awareness), attitude (acceptability), and practice (exposure). A moderate positive correlation was seen between knowledge (awareness) and attitude (acceptability) (Attitude total [Atotal]) (r = 0.48, p<0.001), with no significant correlation between knowledge (awareness) and practice (exposure) (r = 0.04, p = 0.45), and attitude (acceptability) (Atotal) and practice (r = 0.01, p = 0.82). CONCLUSION Overall, outpatient clinic users had good knowledge (awareness) of and were receptive towards VC but had poor practice (exposure). More opportunities for VC use in healthcare can increase exposure and subsequent utilisation. Interventions to increase the effectiveness of VC use should be explored in future studies.
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Affiliation(s)
- Siaw Cheok Liew
- Medical Education Research and Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Clinical Competence, Perdana University-Royal College of Surgeons in Ireland, Kuala Lumpur, Malaysia
- College of Health Science, VinUniversity, Hanoi, Vietnam
| | - Vinod Pallath
- Medical Education Research and Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yassir Rasali
- Medical Education Research and Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chan Choong Foong
- Medical Education Research and Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wei Han Hong
- Medical Education Research and Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Ahmad F, Joshi SH. Self-Care Practices and Their Role in the Control of Diabetes: A Narrative Review. Cureus 2023; 15:e41409. [PMID: 37546053 PMCID: PMC10402910 DOI: 10.7759/cureus.41409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Diabetes mellitus (DM) is a long-standing, continuously growing metabolic ailment in which levels of glucose in the blood increase due to a total (DM of type 1) or incomplete (DM of type 2) decrease in the level of the hormone insulin. Diabetes mellitus affects a large number of individuals worldwide, and as more people develop the disease, the burden will double from what it is now. The requirements of people suffering from diabetes are not only confined to the control of blood glucose; there is also a need to prevent disabilities, side effects, and difficulties in rehabilitation. Studies suggest that seven self-care practices for individuals suffering from this disease have shown good outcomes. Those practices include assessment of sugar levels in the blood, consuming healthy foods, remaining physically active, taking medications regularly and on time, maintaining healthy behavior, and decreasing risk factors. All of these practices collectively have shown good results in maintaining blood glucose levels, decreasing side effects, and increasing life expectancy in people with diabetes mellitus. Those who have DM and practice self-care have shown positive results by reducing the complications of DM, decreasing its progression, and leading to a huge reduction in the burden due to DM. Despite these positive changes, people sticking to these self-care practices are very few, specifically when we see broad and chronic changes. There are many positive contributing factors, such as social factors, demographic factors, and various socio-economic factors, but the role of physicians in increasing the practices associated with personal care for people with this disease is crucial and most important for the desired outcome. Keeping in mind the burden and multidimensional nature of the disorder, proper systematic and combined efforts are needed to increase these self-care practices in patients with diabetes to reduce any chronic side effects and complications.
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Affiliation(s)
- Farhan Ahmad
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shiv H Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Mubeen F, Wang CL, Al Maradni A, Shivaswamy V, Sadhu AR. Digital Health and Shared Decision-Making in Diabetes Care - A Survey Initiative in Patients and Clinicians. Endocr Pract 2023:S1530-891X(23)00401-9. [PMID: 37178788 DOI: 10.1016/j.eprac.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess the landscape of digital health resources in the United States, better understand the impact of the digital health on shared decision-making and identify potential barriers and opportunities for progress in the care of persons with diabetes. METHODS The study consisted of two phases: (1) A qualitative phase in which one-on-one interviews were conducted virtually with 34 physicians (Endocrinologists, Endos: n=15; primary care physicians, PCPs: n=19) between February 11-18, 2021, and (2) A quantitative phase in which two online, email-based surveys in the English language were conducted between April 16 and May 17, 2021: one with healthcare professionals (HCP) (n=403: n=200 Endos and n=203 PCPs), and one with persons with diabetes (n=517: patients with type 1 diabetes, n=257; patients with type 2 diabetes, n=260). RESULTS Diabetes digital health tools were found to be helpful in shared decision-making, but leading barriers include cost, coverage, and lack of time by healthcare professionals. Among diabetes digital health tools, continuous glucose monitoring (CGM) systems were used most commonly and viewed as most effective in improving quality of life and facilitating shared decision-making. Strategies for increasing use of diabetes digital health resources included lower cost, integration into electronic health records, and increased simplicity of tools. CONCLUSION This study revealed that both Endos and PCPs feel that diabetes digital health tools have an overall positive impact. Integration with telemedicine and simpler, lower cost tools with increased patient access can further facilitate shared decision-making and improved diabetes care and quality of life.
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Affiliation(s)
- Faiza Mubeen
- Department of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College at Houston Methodist Hospital, Houston, Texas, USA
| | - Cecilia Low Wang
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Ahmad Al Maradni
- Department of Internal Medicine, Division of Diabetes, Endocrinology, and Metabolism, Banner University Medical Center, and Carl T. Hyden VA Medical Center, Phoenix, Arizona, USA
| | - Vijay Shivaswamy
- Department of Internal Medicine, Division of Diabetes, Endocrinology, Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Archana R Sadhu
- Houston Methodist Academic Medicine Associates, Endocrinology, Houston, Texas, USA
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Replacing conventional telecommunication with a freeform HIPAA compliant healthcare texting app: a survey of patient preference. Surg Endosc 2023; 37:2182-2188. [PMID: 36705752 DOI: 10.1007/s00464-023-09869-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/04/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND The ability to effectively communicate with patients continues to be a challenge for physician offices. Mobile healthcare applications have enhanced the accessibility of healthcare providers to their patients. However, the efficacy of unrestricted, personalized, bidirectional, freeform texting has not been previously evaluated. METHODS We investigated patient preference and self-reported outcomes using a smartphone HIPAA compliant mobile healthcare texting app, compared to conventional telecommunication, in self-reported quality of care, and impact on preventing unnecessary emergency department visits. A retrospective cohort survey study of a single-surgeon hernia specialist's practice was utilized. Patients with access to a smartphone who received care between July 2017 and March 2020 were instructed to utilize the healthcare texting app as a replacement to calling/receiving calls from the physician's office. Messages to and from patients were delivered directly to their surgeon and the surgical team via non-automated, personalized, freeform text messages, and templates, available to patients at all hours of the day. A depersonalized online survey was then distributed to assess patient perceived quality of care using the app, compared to their past experiences calling physician offices, and whether they preferred using text or conventional telecommunication. Additional statistics were reported using the application's built-in software, including response times, adoption rates, and message volumes. RESULTS 90 patients successfully completed the entirety of the survey, median age range 50-60 years old. 97% of respondents reported the texting app provided at least non-inferior quality of care compared to conventional telecommunication, with a majority (75%) experiencing a relatively improved quality of care. 9% reported an unnecessary ED visit being avoided after consulting their physician through the application. CONCLUSIONS Unrestricted, freeform, non-automated communication via texting may be preferred by patients over conventional telecommunication. However, further research is warranted to assess the external validity and clinical impact of such results.
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Moreira TR, Negreiros FDDS, Aquino MDJND, Silva LMSD, Moreira TMM, Torres RAM. Digital technology and its effects on knowledge improvement for diabetes management: An integrative review. Int J Nurs Pract 2023; 29:e13029. [PMID: 34894173 DOI: 10.1111/ijn.13029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/03/2021] [Accepted: 11/14/2021] [Indexed: 02/04/2023]
Abstract
AIM To evaluate the effectiveness of educational digital technology in improving patients' and health professionals' knowledge about diabetes management. BACKGROUND The use of digital technologies has been expanding in recent years in several areas of healthcare and education. DESIGN Integrative literature review. DATA SOURCES The following databases were searched: PubMed, Lilacs, BDENF, Web of Science and SciELO (1 January 2016 and 31 December 2020). REVIEW METHODS Titles and abstracts were screened and selected by independent reviewers based on eligibility criteria. A consensus was drawn on which articles should be included. Data were extracted using an instrument created by the authors, and the synthesis of knowledge was made by compiling the results in a table and identifying thematic axes. RESULTS Seventy-one articles were retrieved, and after the final analysis, a total of 11 were included. Most studies have pointed out benefits from the use of digital technologies in diabetes education, with two thematic categories emerging: 'Digital technologies in the education of patients with diabetes' and 'Digital technologies in continuing professional education in diabetes'. CONCLUSION The use of digital technologies is beneficial and effective both for continuing professional education and educating patients about diabetes management.
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Leung T, Burton L, Loewen P, Wilson R, Singh S, Moroz L, Andrade JG. Patients' Experiences With the Fit of Virtual Atrial Fibrillation Care During the Pandemic: Qualitative Descriptive Study. JMIR Cardio 2023; 7:e41548. [PMID: 36716096 PMCID: PMC9926347 DOI: 10.2196/41548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/23/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In-person health care has been the standard model of care delivery for patients with atrial fibrillation (AF). Despite the growing use of remote technology, virtual health care has received limited formal study in populations with AF. Understanding the virtual care experiences of patients in specialized AF clinics is essential to inform future planning of AF clinic care. OBJECTIVE This qualitative descriptive study aimed to understand patients' virtual AF clinic care experiences during the COVID-19 pandemic. METHODS Participants were recruited from a pool of patients who were receiving care from an AF clinic and who were enrolled in a larger survey study. A total of 8 virtual focus groups (n=30) were conducted in 2 waves between March 2021 and May 2021. Facilitators used a semistructured discussion guide to ask participants questions about their experiences of virtual care and the perceived quality of virtual care and technology support. Three team members initially open coded group data to create a preliminary coding framework. As the analysis progressed, with subsequent focus groups, the code clusters were refined. RESULTS The participants were primarily male (21/30, 70%), aged ≥65 years (20/30, 67%), and college graduates (22/30, 73%). Patients found virtual care to be highly beneficial. Central to their experiences of virtual care was its fit or lack of fit with their health needs, which was integrally connected to communication effectiveness and their preferred virtual care future. Practical benefits included flexibility, convenience, and time and cost savings of virtual care. Virtual care fit occurred for small, quick, and mundane issues (eg, medication refills) but was suboptimal for new and more complex issues that patients thought warranted an in-person visit. Fit often reflected the effectiveness of communication between patient and provider and that of in-clinic follow-up. There was near-complete agreement among participants on the acceptability of virtual communication with their providers in addressing their needs, but this depended on adequate reciprocal communication. Without the benefit of in-person physical assessments, patients were uncertain and lacked confidence in communicating the needed, correct, and comprehensive information. Finally, participants described concerns related to ongoing virtual care with recommendations for their preferred future using a hybrid model of care and integrating patient-reported data (ie, blood pressure measurements) in virtual care delivery. CONCLUSIONS Virtual care from a specialty AF clinic provides practical benefits for patients, but they must be weighed against the need for virtual care's fit with patients' needs and problems. The stability and complexity of patients' health needs, their management, and their perceptions of communication effectiveness with providers and clinics must be considered in decisions about appointment modality. Patients' recommendations for future virtual care through use of hybrid models together with systems for data sharing have the potential to optimize fit.
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Affiliation(s)
| | - Lindsay Burton
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, Vancouver, BC, Canada
| | - Ryan Wilson
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Sarah Singh
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Lana Moroz
- Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Jason G Andrade
- Centre for Cardiovascular Innovation, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
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Klonoff AN, (Andy) Lee WA, Xu NY, Nguyen KT, DuBord A, Kerr D. Six Digital Health Technologies That Will Transform Diabetes. J Diabetes Sci Technol 2023; 17:239-249. [PMID: 34558330 PMCID: PMC9846384 DOI: 10.1177/19322968211043498] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The digital health revolution is transforming the landscape of medicine through innovations in sensor data, software, and wireless communication tools. As one of the most prevalent chronic diseases in the United States, diabetes is particularly impactful as a model disease for which to apply innovation. As with any other newly developed technologies, there are three key questions to consider: 1) How can the technology benefit people with diabetes?, 2) What barriers must be overcome to further advance the technology?, and 3) How will the technology be applied in the future?. In this article, we highlight six areas of innovation that have the potential to reduce the burden of diabetes for individuals living with the condition and their families as well as provide measurable benefits for all stakeholders involved in diabetes care. The six technologies which have the potential to transform diabetes care are (i) telehealth, (ii) incorporation of diabetes digital data into the electronic health record, (iii) qualitative hypoglycemia alarms, (iv) artificial intelligence, (v) cybersecurity of diabetes devices, and (vi) diabetes registries. To be successful, a new digital health technology must be accessible and affordable. Furthermore, the people and communities that would most likely benefit from the technology must be willing to use the innovation in their management of diabetes.
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Affiliation(s)
- Alexander N. Klonoff
- University of Southern California, Los
Angeles, CA, USA
- Alexander N. Klonoff, MD, MBA, LAC+USC
Medical Center, 2020 Zonal Avenue, IRD 620, Los Angeles, CA 90089, USA.
| | | | - Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | | | - David Kerr
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
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15
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Real-world demographic patterns of users of a digital primary prevention service for diabetes. Cardiovasc Endocrinol Metab 2022; 12:e0275. [PMID: 36582668 PMCID: PMC9750647 DOI: 10.1097/xce.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
Rapid urbanization has led to an exponential increase in lifestyle-associated metabolic disorders presenting a huge socioeconomic burden. Waya is a digital prevention program that guides overweight and obese individuals to maintain a healthy lifestyle through exercise, diet, and educational videos. Objectives and aims We aimed to study the demographic patterns of the Waya cohort and examine the prevalence of diabetes (the most common lifestyle-associated metabolic disorder) and its risk factors in comparison to the GEDA 2014/2015-European Health Interview Survey population. Methods Waya participants who registered by 1 October 2020 and who answered at least one health survey question were included in this study. Factors such as obesity, hypertension, and diabetes between the two populations were compared using Chi-square test. Results Of the 837 participants, 86.1% were women. The proportion of obese participants was higher in Waya than in the German Health Update (GEDA) cohort (women: 39.4% vs. 18%, P < 0.05; men: 37.1% vs. 18.3%, P < 0.05), whereas the proportion of participants with hypertension (women: 12.1% vs. 30.9% in GEDA, P < 0.05; men: 22.4% vs. 32.8% in GEDA, P < 0.05) was lower. The proportion of women with diabetes was low in our cohort (3.9% vs. 7% in GEDA, P < 0.05); however, the proportion of men with diabetes remained the same between the two groups. We observed significant differences between the GEDA and Waya cohorts due to changes in the prevalence pattern over time or target bias of the digital program. Conclusion These findings showcase the usability of Waya in collecting real-world insights, which will be beneficial in monitoring the prevalence of chronic metabolic disorders and associated risk factors over time.
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Fu L, Pei T, Yang J, Han J. How smart senior care can achieve value co-creation: Evidence from China. Front Public Health 2022; 10:973439. [PMID: 36211655 PMCID: PMC9533210 DOI: 10.3389/fpubh.2022.973439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
With the rapid rise of artificial intelligence, smart senior care has become a new trend for future development. The collection of "Typical Cases of Chinese Elderly Service Industry Development" is selected by the script materials. The main purpose of this article is to investigate how smart senior care can achieve value co-creation by grounded theory. This study explores the phenomenon of value co-creation in the participation of multiple actors in smart senior care services. Findings show that institutional guarantee, technical intake, market empowerment, emotional support, service interaction, and reciprocity norm are identified as the driving factors for value co-creation. In addition, the behavioral processes of value co-creation include multi-actor value consensus, co-creation environment establishment, practical value co-creation, public value sharing, and diffusion of service added value in smart senior care. Finally, this study constructs a practical logic model of achieving value co-creation. It extends and enriches the scope of the value co-creation theory. This study confirms that value co-creation can be effectively achieved in smart senior care by the above-mentioned ways, revealing its driving factors and behavioral processes. The article expands on the application of value co-creation in the field of public healthcare. The results have important theoretical and practical significance for narrowing the public service equalization gap.
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Affiliation(s)
- Liping Fu
- Center for Social Science Survey and Data, College of Management and Economics, Tianjin University, Tianjin, China,College of Politics and Public Administration, Qinghai Minzu University, Xining, China
| | - Tong Pei
- Center for Social Science Survey and Data, College of Management and Economics, Tianjin University, Tianjin, China,School of Public Administration, Hainan University, Haikou, China,*Correspondence: Tong Pei
| | - Jie Yang
- Center for Social Science Survey and Data, College of Management and Economics, Tianjin University, Tianjin, China
| | - Jiarui Han
- Center for Social Science Survey and Data, College of Management and Economics, Tianjin University, Tianjin, China
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Lee EY, Cha SA, Yun JS, Lim SY, Lee JH, Ahn YB, Yoon KH, Hyun MK, Ko SH. Efficacy of Personalized Diabetes Self-care Using an Electronic Medical Record-Integrated Mobile App in Patients With Type 2 Diabetes: 6-Month Randomized Controlled Trial. J Med Internet Res 2022; 24:e37430. [PMID: 35900817 PMCID: PMC9496112 DOI: 10.2196/37430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background A system that combines technology and web-based coaching can help treat chronic conditions such as diabetes. However, the effectiveness of apps in mobile health (mHealth) interventions is inconclusive and unclear due to heterogeneous interventions and varying follow-up durations. In addition, randomized controlled trial data are limited, and long-term follow-up is lacking, especially for apps integrated into electronic medical records. Objective We aimed to assess the effect of an electronic medical record–integrated mobile app for personalized diabetes self-care, focusing on the self-monitoring of blood glucose and lifestyle modifications, on glycemic control in patients with type 2 diabetes mellitus. Methods In a 26-week, 3-arm, randomized, controlled, open-label, parallel group trial, patients with type 2 diabetes mellitus and a hemoglobin A1c (HbA1c) level of ≥7.5% were recruited. The mHealth intervention consisted of self-monitoring of blood glucose with the automatic transfer of glucose, diet, and physical activity counseling data (iCareD system). Participants were randomly assigned to the following three groups: usual care (UC), mobile diabetes self-care (MC), and MC with personalized, bidirectional feedback from physicians (MPC). The primary outcome was the change in HbA1c levels at 26 weeks. In addition, diabetes-related self-efficacy, self-care activities, and satisfaction with the iCareD system were assessed after the intervention. Results A total of 269 participants were enrolled, and 234 patients (86.9%) remained in the study at 26 weeks. At 12 weeks after the intervention, the mean decline in HbA1c levels was significantly different among the 3 groups (UC vs MC vs MPC: −0.49% vs −0.86% vs −1.04%; P=.02). The HbA1c level decreased in all groups; however, it did not differ among groups after 26 weeks. In a subgroup analysis, HbA1c levels showed a statistically significant decrease after the intervention in the MPC group compared with the change in the UC or MC group, especially in patients aged <65 years (P=.02), patients with a diabetes duration of ≥10 years (P=.02), patients with a BMI of ≥25.0 kg/m2 (P=.004), patients with a C-peptide level of ≥0.6 ng/mL (P=.008), and patients who did not undergo treatment with insulin (P=.004) at 12 weeks. A total of 87.2% (137/157) of the participants were satisfied with the iCareD system. Conclusions The mHealth intervention for diabetes self-care showed short-term efficacy in glycemic control, and the effect decreased over time. The participants were comfortable with using the iCareD system and exhibited high adherence. Trial Registration Clinical Research Information Service, Republic of Korea KCT0004128; https://tinyurl.com/bdd6pa9m
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Affiliation(s)
- Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seon-Ah Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Sun-Young Lim
- Catholic Institute of Smart Healthcare Center, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hee Lee
- Catholic Institute of Smart Healthcare Center, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Kyung Hyun
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
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Murillo Salamanca AM, Alvarado-García AM. Uso de tecnologías de información y comunicación para promover la autogestión de ulceras por pie diabético. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: El uso de las tecnologías de la información y comunicación en las intervenciones educativas de enfermería facilita los procesos de autogestión para lograr la adaptación en las condiciones crónicas de salud. Objetivo: Evaluar el efecto de una intervención educativa de enfermería para promover la autogestión en la prevención de ulceras por pie diabético en adultos diabetes mellitus tipo 2 en Colombia mediante la inclusión de las tecnologías de la Información y comunicación. Materiales y métodos: Estudio cuasi experimental con medición pre y post intervención realizado con 82 adultos que asistían a la consulta de enfermedades crónicas de un hospital de segundo nivel de atención en el departamento de Boyacá Colombia Los grupos fueron asignados aleatoriamente a los grupos experimental y comparación. Los datos fueron recolectados a partir de una ficha de caracterización y un cuestionario de autogestión. Resultados: No hubo diferencias significativas entre los dos grupos de experimental y comparación en términos de puntaje de autogestión, previo a la intervención. Sin embargo, el puntaje promedio de autogestión del grupo experimental fue significativamente mayor que el del grupo control 6 semanas después de la intervención (p<0.005) el resultado primario fueron los comportamientos de autogestión dados desde el cuidado de los pies. Se usaron las pruebas no paramétricas de Wilcoxon y Mann Whitney. Discusión: Las intervenciones de enfermería deben soportarse en enfoques teóricos propios de la disciplina, que permita visualizar resultados específicos, en este caso la autogestión la cual requiere de estrategias como el conocimiento, la habilidad y el soporte social que apoyaran la adaptación para las situaciones de enfermedad crónica. Conclusión: La intervención educativa a partir del uso de las tecnologías de la información y comunicación mejoro la autogestión para la prevención de heridas en pie diabético, logrando las personas un cambio en su comportamiento.
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Liu S, Zhao H, Fu J, Kong D, Zhong Z, Hong Y, Tan J, Luo Y. Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study. BMC Public Health 2022; 22:996. [PMID: 35581565 PMCID: PMC9112275 DOI: 10.1186/s12889-022-13378-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid development of digital health has reduced the time and cost of medical treatment, bringing efficient and economical benefits. However, older adults all over the world are deficient in digital health knowledge and skills to varying degrees. This study intends to investigate the current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China, so as to provide theoretical reference for global digital health researches and the construction of gerontological digital health service models. METHODS A cross-sectional survey was conducted from September 2020 to April 2021 in Chongqing, China. 572 community-dwelling older adults (≥ 65 years) were surveyed by stratified sampling. Data on sociodemographic characteristics, Internet usage, attitude towards Internet health information and digital health literacy were collected. Wherein, the digital health literacy assessment adopted the Digital Health Literacy Assessment Scale for community-dwelling older adults, which was developed by the research group, proven to be with good internal consistency (0.941), split-half reliability (0.889), test-retest reliability (0.941), content validity (0.967), criterion validity (0.938) and construct validity. The influencing factors were explored by univariate analysis and multiple linear regression analysis. RESULTS The average score of digital health literacy was 37.10 (SD 18.65). Univariate analysis showed that there were statistically significant differences in the comparison of digital health literacy according to 16 variables, such as different age and education levels. Multiple linear regression analysis showed that education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy, while age and perceived risk were negatively correlated with digital health literacy. CONCLUSION The overall digital health literacy of community-dwelling older adults in Southwest China is relatively low. In the future, health professionals should fully consider the diverse influencing factors of digital health literacy, assess individual differences and provide targeted intervention programs. Meanwhile, global public health authorities should integrate health resources effectively, and seek health service models for older adults in line with the development of the digital age to narrow the digital divide.
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Affiliation(s)
- Siqi Liu
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, P. R. China
| | - Hongyan Zhao
- Xiaolongkan Community Health Care Service Centre, No. 4 Xiaolongkan Street, Shapingba District, Chongqing, 400030, P. R. China
| | - Jingjing Fu
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, P. R. China
| | - Dehui Kong
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, P. R. China
| | - Zhu Zhong
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, P. R. China
| | - Yan Hong
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, P. R. China
| | - Jing Tan
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, P. R. China.
| | - Yu Luo
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, P. R. China.
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Affinito L, Fontanella A, Montano N, Brucato A. How physicians can empower patients with digital tools. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01370-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
While there is broad consensus that the use of digital tools would significantly improve patient empowerment, to date, an improvement in health outcomes has been elusive.
Objective
The objective of this study was to assess how to improve the ability of physicians to empower patients with digital tools.
Methods
We conducted a web-based survey using SurveyMonkey over nearly 6 months. A questionnaire was sent with an email, explaining the aims of the survey and providing a link to complete the web-based questionnaire, to the heads of each of the 37 medical national societies adhering to the EFIM (European Federation of Internal Medicine), inviting them to disseminate the questionnaire among their members.
Results
Two hundred and eighteen responses were received. They suggest that the main success factors in increasing and improving patient empowerment with digital tools and realizing health goals are clinical evidence, followed by patient/physician involvement in the design, tools designed around the real needs of the patient, and reimbursement. Most of the respondents who have already prescribed digital tools for patient empowerment are just enough satisfied with the results achieved by their patients. Interestingly, 18% of the respondents had spent more than 30 min on the visit of patient to doctor. However, the majority devoted only 5–9 min to illustrating the suggested digital tools.
Conclusions
According to the respondents, clinical evidence, motivation, physician and patient’s involvement in design, and reimbursement, as well as organizations’ appropriate business models and support, are the main determinants of the diffusion and effective adoption of digital tools for successful patient empowerment in internal medicine.
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Fundoiano-Hershcovitz Y, Bacher D, Ritholz MD, Horwitz DL, Manejwala O, Goldstein P. Blood Pressure Monitoring as a Digital Health Tool for Improving Diabetes Clinical Outcomes: Retrospective Real-world Study. J Med Internet Res 2022; 24:e32923. [PMID: 35133284 PMCID: PMC8864523 DOI: 10.2196/32923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/03/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Remote data capture for blood glucose (BG) or blood pressure (BP) monitoring and the use of a supportive digital app are becoming the model in diabetes and hypertension chronic care. One of the goals in chronic condition management is to increase awareness and generate behavioral change in order to improve outcomes in diabetes and related comorbidities, such as hypertension. In addition, there is a lack of understanding of the association between BG and BP levels when using digital health tools. Objective By applying a rigorous study framework to digital health data, this study investigated the relationship between BP monitoring and BG and BP levels, as well as a lagged association between BP and BG. We hypothesized that during the first 6 months of BP monitoring, BG and BP levels would decrease. Finally, we suggested a positive association between BP levels and the following month’s BG levels. Methods In this retrospective, real-world case-control study, we extracted the data of 269 people with type 2 diabetes (T2D) who tracked their BG levels using the Dario digital platform for a chronic condition. We analyzed the digital data of the users who, in addition to BG, monitored their BP using the same app (BP-monitoring [BPM] group, n=137) 6 months before and after starting their BP monitoring. Propensity score matching established a control group, no blood pressure monitoring (NBPM, n=132), matched on demographic and baseline clinical measures to the BPM group. A piecewise mixed model was used for analyzing the time trajectories of BG, BP, and their lagged association. Results Analysis revealed a significant difference in BG time trajectories associated with BP monitoring in BPM and NBPM groups (t=–2.12, P=.03). The BPM group demonstrated BG reduction improvement in the monthly average BG levels during the first 6 months (t=–3.57, P<.001), while BG did not change for the NBPM group (t=0.39, P=.70). Both groups showed similarly stable BG time trajectories (B=0.98, t=1.16, P=.25) before starting the use of the BP-monitoring system. In addition, the BPM group showed a significant reduction in systolic (t=–6.42, P<.001) and diastolic (t=–4.80, P<.001) BP during the first 6 months of BP monitoring. Finally, BG levels were positively associated with systolic (B=0.24, t=2.77, P=.001) and diastolic (B=0.30, t=2.41, P=.02) BP. Conclusions The results of this study shed light on the association between BG and BP levels and on the role of BP self-monitoring in diabetes management. Our findings also underscore the need and provide a basis for a comprehensive approach to understanding the mechanism of BP regulation associated with BG.
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Affiliation(s)
| | | | - Marilyn D Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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Alvarez-Perez Y, Perestelo-Perez L, Rivero-Santana A, Wagner AM, Torres-Castaño A, Toledo-Chávarri A, Duarte-Díaz A, Alvarado-Martel D, Piccini B, Van den Broucke S, Vandenbosch J, González-González C, Perello M, Serrano-Aguilar P. Cocreation of Massive Open Online Courses to Improve Digital Health Literacy in Diabetes: Pilot Mixed Methods Study. JMIR Diabetes 2021; 6:e30603. [PMID: 34898453 PMCID: PMC8713090 DOI: 10.2196/30603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/12/2021] [Accepted: 09/19/2021] [Indexed: 12/19/2022] Open
Abstract
Background Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources—that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs). Objective We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs. Methods The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed. Results A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P<.001). Conclusions Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population.
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Affiliation(s)
| | - Lilisbeth Perestelo-Perez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain
| | - Ana M Wagner
- Department of Endocrinology and Nutrition, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Dácil Alvarado-Martel
- Department of Endocrinology and Nutrition, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Barbara Piccini
- Diabetology Unit, Meyer University Children's Hospital, Florence, Italy
| | | | | | - Carina González-González
- Interaction, Technology, and Education Research Group, Department of Computer Science and Engineering, University of La Laguna, La Laguna, Spain
| | - Michelle Perello
- Consulta Europa Projects and Innovation, Las Palmas de Gran Canaria, Spain
| | - Pedro Serrano-Aguilar
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
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23
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Pankhurst T, Atia J, Evison F, Gallier S, Lewis JM, McKee D, Ryan S, Sapey E, Ball S, Coleman JJ. Rapid adaptation of a local healthcare digital system to COVID-19: The experience in Birmingham (UK). HEALTH POLICY AND TECHNOLOGY 2021; 10:100568. [PMID: 34642622 PMCID: PMC8498783 DOI: 10.1016/j.hlpt.2021.100568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic created unprecedented pressure on hospitals globally. Digital tools developed before the crisis provided novel aspects of management, and new digital tools were rapidly developed as the crisis progressed. In our institution, a digitally mature NHS Trust in England which builds software systems, development during the early months of the crisis allowed increased patient safety and care, efficient management of the hospital and publication of data. The aim of this paper is to present this experience as a case study, describing development and lessons learned applicable to wider electronic healthcare record development. METHODS Request, triage, build and test processes for the digital systems were altered in response to the pandemic. Senior Responsible Officers appointed for the emergency triaged all changes and were supported by expert opinion and research active clinicians. Build and test cycles were compressed. New tools were built or existing ones modified in the central Electronic Healthcare Record, PICS (Prescribing, Information and Communication System), Clinical Dashboards and video platforms for remote consultation were developed. FINDINGS 2236 patients were admitted to UHB with suspected COVID-19 between March and May 2020. Dashboards and visualisation tools enabled by efficient real-time data collection for all new patients, contributed to strategic, operational and clinical decision making.Over 70 urgent changes were made to digital systems, including a screening proforma, improved infection control functions, help and order panels, data dashboards, and updated prescribing features. Novel uses were found for existing functions. INTERPRETATION Digital tools contributed to a co-ordinated response to COVID-19 in an area with a high disease burden. Change management processes were modified during the pandemic and successfully delivered rapid software modifications and new tools. Principal benefits came from the ability to adapt systems to rapidly changing clinical situations. Lessons learned from this intense development period are widely applicable to EHR development. LAY SUMMARY Digital tools, which are well designed, can help clinicians and safeguard patients. Health crises such as the COVID pandemic drove rapid development of digital tools. This case study outlines accelerated development within a governance framework that successfully reused existing tools and built new ones. The lessons from this development are generalizable to digital developments in healthcare.
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Affiliation(s)
- Tanya Pankhurst
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
| | - Jolene Atia
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
| | - Felicity Evison
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
| | - Suzy Gallier
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
- PIONEER: HDR-UK Hub in Acute Care, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TH, UK
| | - Joshua M Lewis
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
| | - Deborah McKee
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
| | - Steve Ryan
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
| | - Elizabeth Sapey
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
- PIONEER: HDR-UK Hub in Acute Care, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TH, UK
| | - Simon Ball
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
- PIONEER: HDR-UK Hub in Acute Care, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TH, UK
| | - Jamie J Coleman
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT, UK
- School of Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2SP, UK
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24
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Balasubramanian GV, Beaney P, Chambers R. Digital personal assistants are smart ways for assistive technology to aid the health and wellbeing of patients and carers. BMC Geriatr 2021; 21:643. [PMID: 34781881 PMCID: PMC8591585 DOI: 10.1186/s12877-021-02436-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Digital health solutions such as assistive technologies create significant opportunities to optimise the effectiveness of both health and social care delivery. Assistive technologies include ‘low-tech’ items, such as memory aids and digital calendars or ‘high-tech’ items, like health tracking devices and wearables. Depending on the type of assistive devices, they can be used to improve quality of life, effect lifestyle improvements and increase levels of independence. Acceptance of technology among patients and carers depends on various factors such as perceived skills and competencies in using the device, expectations, trust and reliability. This service evaluation explored the impact of a pilot service redesign focused on improving health and wellbeing by the use of a voice-activated device ‘smart speaker’, Alexa Echo Show 8. Methods A service evaluation/market research was conducted for a pilot service redesign programme. Data were collected via a survey in person or telephone and from two focus groups of patients (n = 44) and informal carers (n = 7). The age of the study participants ranged from 50 to 90 years. Also, the participants belonged to two types of cohort: one specifically focused on diabetes and the other on a range of long-term health conditions such as multiple sclerosis, dementia, depression and others. Results The device had a positive impact on the health and social well-being of the users; many direct and indirect benefits were identified. Both patients and carers had positive attitudes towards using the device. Self-reported benefits included: reminders for medications and appointments improved adherence and disease control; increased independence and productivity; and for those living alone, the device helped combat their loneliness and low mood. Conclusion The findings from the study help to realise the potential of assistive technology for empowering supporting health/social care. Especially, the season of COVID-19 pandemic has highlighted the need for remote management of health, the use of assistive technology could have a pivotal role to play with the sustainability of health/social care provision by promoting shared care between the care provider and service user. Further evaluation can explore the key drivers and barriers for implementing assistive technologies, especially in people who are ageing and with long-term health conditions.
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Affiliation(s)
| | - Paul Beaney
- Keele University Medical School, Keele, Newcastle-under-Lyme, UK
| | - Ruth Chambers
- Digital Workstream, Staffordshire and Stoke-on-Trent Sustainability and Transformation Partnership (STP), Staffordshire, UK
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25
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Morris BB, Rossi B, Fuemmeler B. The role of digital health technology in rural cancer care delivery: A systematic review. J Rural Health 2021; 38:493-511. [PMID: 34480506 DOI: 10.1111/jrh.12619] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural residents face higher cancer incidence rates and mortality rates, disparities that could be mitigated with health technology interventions, yet a digital divide is also apparent. This paper systematically and critically examines existing literature to understand how digital technologies have been used to support rural oncology care. METHODS PubMed, CINAHL Complete, PsycINFO, and Embase were searched using Medical Subject Headings terms and keywords. Studies were eligible if they presented empirical data investigating the use of technology in rural oncology and were published in English in a peer-reviewed journal within the last decade. The Mixed Methods Appraisal Tool was used to assess methodological quality. FINDINGS Digital health has been less extensively utilized in rural oncology compared with the general cancer population and other chronic diseases. We identified 54 studies that used technology in rural cancer care delivery, a comparatively small number, representing a significant gap in the literature. Studies were classified into 4 categories: Telemedicine (n = 32), phone calls (n = 11), Internet (n = 9), and mobile phone (n = 2). Of the 54 articles, 12 were RCTs, 17 were quasi-experimental, 3 were descriptive, 12 were mixed methods, and 10 were qualitative. Most of the studies involved patients only (n = 31) and were not specific to a cancer type (n = 41). CONCLUSIONS Further implementation and expansion of telemedicine and phone-based strategies in rural cancer care delivery are warranted. Rural cancer survivors value digital approaches to their care. However, social and behavioral determinants of health and access to technology must be considered.
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Affiliation(s)
- Bonny B Morris
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brianna Rossi
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bernard Fuemmeler
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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26
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Rodriguez-León C, Villalonga C, Munoz-Torres M, Ruiz JR, Banos O. Mobile and Wearable Technology for the Monitoring of Diabetes-Related Parameters: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e25138. [PMID: 34081010 PMCID: PMC8212630 DOI: 10.2196/25138] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/27/2020] [Accepted: 03/11/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a metabolic disorder that affects hundreds of millions of people worldwide and causes several million deaths every year. Such a dramatic scenario puts some pressure on administrations, care services, and the scientific community to seek novel solutions that may help control and deal effectively with this condition and its consequences. OBJECTIVE This study aims to review the literature on the use of modern mobile and wearable technology for monitoring parameters that condition the development or evolution of diabetes mellitus. METHODS A systematic review of articles published between January 2010 and July 2020 was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Manuscripts were identified through searching the databases Web of Science, Scopus, and PubMed as well as through hand searching. Manuscripts were included if they involved the measurement of diabetes-related parameters such as blood glucose level, performed physical activity, or feet condition via wearable or mobile devices. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. RESULTS The search yielded 1981 articles. A total of 26 publications met the eligibility criteria and were included in the review. Studies predominantly used wearable devices to monitor diabetes-related parameters. The accelerometer was by far the most used sensor, followed by the glucose monitor and heart rate monitor. Most studies applied some type of processing to the collected data, mainly consisting of statistical analysis or machine learning for activity recognition, finding associations among health outcomes, and diagnosing conditions related to diabetes. Few studies have focused on type 2 diabetes, even when this is the most prevalent type and the only preventable one. None of the studies focused on common diabetes complications. Clinical trials were fairly limited or nonexistent in most of the studies, with a common lack of detail about cohorts and case selection, comparability, and outcomes. Explicit endorsement by ethics committees or review boards was missing in most studies. Privacy or security issues were seldom addressed, and even if they were addressed, they were addressed at a rather insufficient level. CONCLUSIONS The use of mobile and wearable devices for the monitoring of diabetes-related parameters shows early promise. Its development can benefit patients with diabetes, health care professionals, and researchers. However, this field is still in its early stages. Future work must pay special attention to privacy and security issues, the use of new emerging sensor technologies, the combination of mobile and clinical data, and the development of validated clinical trials.
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Affiliation(s)
- Ciro Rodriguez-León
- Research Center for Information and Communication Technologies, University of Granada, Granada, Spain
- Department of Computer Science, University of Cienfuegos, Cienfuegos, Cuba
| | - Claudia Villalonga
- Research Center for Information and Communication Technologies, University of Granada, Granada, Spain
| | - Manuel Munoz-Torres
- Departament of Medicine, University of Granada, Granada, Spain
- Endocrinology and Nutrition Unit, Hospital Universitario Clinico San Cecilio, Granada, Spain
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | - Jonatan R Ruiz
- PROmoting FITness and Health through Physical Activity Research Group, Department of Physical Education and Sports, University of Granada, Granada, Spain
| | - Oresti Banos
- Research Center for Information and Communication Technologies, University of Granada, Granada, Spain
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27
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Mumford B, Oldham V, Lee D, Jones J, Das G. The effectiveness of running virtual clinics as part of insulin pump services for patients with type 1 diabetes. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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28
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Gallardo-Rincón H, Cantoral A, Arrieta A, Espinal C, Magnus MH, Palacios C, Tapia-Conyer R. Review: Type 2 diabetes in Latin America and the Caribbean: Regional and country comparison on prevalence, trends, costs and expanded prevention. Prim Care Diabetes 2021; 15:352-359. [PMID: 33077379 DOI: 10.1016/j.pcd.2020.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To present an overview of type 2 diabetes status in Latin America and the Caribbean region. METHODS The data were collected from the International Diabetes Federation Atlas and other available published sources where we identified the prevalence in Latin America and the Caribbean, the trends by regions, and sex. Also, we summarized the type 2 diabetes direct and indirect costs, and the current preventative programs and policies available for each region. RESULTS Latin America and the Caribbean has one of the fastest-growing prevalence of type 2 diabetes, in particular the Caribbean region. Costs are relatively high in Central American countries and the Caribbean Islands. Currently, type 2 diabetes prevention, diagnosis, and management are insufficient in Latin America and the Caribbean and they do not offer a multidisciplinary integrative approach. CONCLUSION Effective and preventive multidisciplinary policies should be implemented in Latin America and the Caribbean to decrease the high burden of type 2 diabetes.
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Affiliation(s)
| | | | - Alejandro Arrieta
- Robert Stempel College of Public Health and Social Work, Florida International University, United States
| | - Carlos Espinal
- Robert Stempel College of Public Health and Social Work, Florida International University, United States
| | - Marcia H Magnus
- Robert Stempel College of Public Health and Social Work, Florida International University, United States
| | - Cristina Palacios
- Robert Stempel College of Public Health and Social Work, Florida International University, United States
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29
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Eberle C, Stichling S, Löhnert M. Diabetology 4.0: Scoping Review of Novel Insights and Possibilities Offered by Digitalization. J Med Internet Res 2021; 23:e23475. [PMID: 33759789 PMCID: PMC8074865 DOI: 10.2196/23475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/13/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background The increasing prevalence of diabetes mellitus and associated morbidity worldwide justifies the need to create new approaches and strategies for diabetes therapy. Therefore, the ongoing digitalization offers novel opportunities in this field. Objective The aim of this study is to provide an updated overview of available technologies, possibilities, and novel insights into diabetes therapy 4.0. Methods A scoping review was carried out, and a literature search was performed using electronic databases (MEDLINE [PubMed], Cochrane Library, Embase, CINAHL, and Web of Science). The results were categorized according to the type of technology presented. Results Different types of technology (eg, glucose monitoring systems, insulin pens, insulin pumps, closed-loop systems, mobile health apps, telemedicine, and electronic medical records) may help to improve diabetes treatment. These improvements primarily affect glycemic control. However, they may also help in increasing the autonomy and quality of life of people who are diagnosed with diabetes mellitus. Conclusions Diabetes technologies have developed rapidly over the last few years and offer novel insights into diabetes therapy and a chance to improve and individualize diabetes treatment. Challenges that need to be addressed in the following years relate to data security, interoperability, and the development of standards.
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Affiliation(s)
- Claudia Eberle
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
| | - Stefanie Stichling
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
| | - Maxine Löhnert
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
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30
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Sieck CJ, Sheon A, Ancker JS, Castek J, Callahan B, Siefer A. Digital inclusion as a social determinant of health. NPJ Digit Med 2021; 4:52. [PMID: 33731887 PMCID: PMC7969595 DOI: 10.1038/s41746-021-00413-8] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Cynthia J Sieck
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. .,The Ohio State University Center for the Advancement of Team Science, Analytics, and Systems Thinking, Columbus, OH, USA.
| | - Amy Sheon
- Case Western Reserve University School of Medicine, Clinical and Translational Science Collaborative, Cleveland, OH, USA
| | - Jessica S Ancker
- Weill Cornell Medical College, Department of Healthcare Policy & Research, Division of Health Informatics, New York City, NY, USA
| | - Jill Castek
- College of Education, Department of Teaching, Learning, and Sociocultural Studies, University of Arizona, Tucson, AZ, USA
| | - Bill Callahan
- National Digital Inclusion Alliance, Columbus, OH, USA
| | - Angela Siefer
- National Digital Inclusion Alliance, Columbus, OH, USA
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31
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Schreiber MJ, Chatoth DK, Salenger P. Challenges and Opportunities in Expanding Home Hemodialysis for 2025. Adv Chronic Kidney Dis 2021; 28:129-135. [PMID: 34717858 DOI: 10.1053/j.ackd.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Advancing American Kidney Health Initiative has set an aggressive target for home dialysis growth in the United States, and expanding both peritoneal dialysis and home hemodialysis (HHD) will be required. While there has been a growth in HHD across the United States in the last decade, its value in controlling specific risk factors has been underappreciated and as such its appropriate utilization has lagged. Repositioning how nephrologists incorporate HHD as a critical renal replacement therapy will require overcoming a number of barriers. Advancing education of both nephrology trainees and nephrologists in practice, along with increasing patient and family education on the benefits and requirements for HHD, is essential. Implementation of a transitional care unit design coupled with an intensive patient curriculum will increase patient awareness and comfort for HHD; patients on peritoneal dialysis reaching a modality transition point will benefit from Experience the Difference programs acclimating them to HHD. In addition, the potential link between HHD program size and patient outcomes will necessitate an increase in the size of the average HHD program to more consistently deliver quality dialysis results. Addressing the implications of the nursing shortage and need for designing in scope staffing models are necessary to safeguard HHD growth. Seemingly, certain government payment policy changes and physician documentation requirements deserve further examination. Future HHD innovations must result in decreasing the burden of care for HHD patients, optimize the level of device and biometric data flow, facilitate a more functional centralized patient management care approach, and leverage computerized clinical decision support for modality assignment.
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32
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Lee MK, Lee DY, Ahn HY, Park CY. A Novel User Utility Score for Diabetes Management Using Tailored Mobile Coaching: Secondary Analysis of a Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e17573. [PMID: 33625363 PMCID: PMC7946585 DOI: 10.2196/17573] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/06/2020] [Accepted: 02/01/2021] [Indexed: 01/16/2023] Open
Abstract
Background Mobile health applications have been developed to support diabetes self-management, but their effectiveness could depend on patient engagement. Therefore, patient engagement must be examined through multifactorial tailored behavioral interventions from an individual perspective. Objective This study aims to evaluate the usefulness of a novel user utility score (UUS) as a tool to measure patient engagement by using a mobile health application for diabetes management. Methods We conducted a subanalysis of results from a 12-month randomized controlled trial of a tailored mobile coaching (TMC) system among insurance policyholders with type 2 diabetes. UUS was calculated as the sum of the scores for 4 major core components (range 0-8): frequency of self-monitoring blood glucose testing, dietary and exercise records, and message reading rate. We explored the association between UUS for the first 3 months and glycemic control over 12 months. In addition, we investigated the relationship of UUS with blood pressure, lipid profile, and self-report scales assessing diabetes self-management. Results We divided 72 participants into 2 groups based on UUS for the first 3 months: UUS:0-4 (n=38) and UUS:5-8 (n=34). There was a significant between-group difference in glycated hemoglobin test (HbA1c) levels for the 12-months study period (P=.011). The HbA1c decrement at 12 months in the UUS:5-8 group was greater than that of the UUS:0-4 group [–0.92 (SD 1.24%) vs –0.33 (SD 0.80%); P=.049]. After adjusting for confounding factors, UUS was significantly associated with changes in HbA1c at 3, 6, and 12 months; the regression coefficients were –0.113 (SD 0.040; P=.006), –0.143 (SD 0.045; P=.002), and –0.136 (SD 0.052; P=.011), respectively. Change differences in other health outcomes between the 2 groups were not observed throughout a 12-month follow-up. Conclusions UUS as a measure of patient engagement was associated with changes in HbA1c over the study period of the TMC system and could be used to predict improved glycemic control in diabetes self-management through mobile health interventions. Trial Registration ClinicalTrial.gov NCT03033407; https://clinicaltrials.gov/ct2/show/NCT03033407
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Affiliation(s)
- Min-Kyung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Da Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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33
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Fundoiano-Hershcovitz Y, Hirsch A, Dar S, Feniger E, Goldstein P. Role of Digital Engagement in Diabetes Care Beyond Measurement: Retrospective Cohort Study. JMIR Diabetes 2021; 6:e24030. [PMID: 33599618 PMCID: PMC7932839 DOI: 10.2196/24030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/16/2020] [Accepted: 01/20/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The use of remote data capture for monitoring blood glucose and supporting digital apps is becoming the norm in diabetes care. One common goal of such apps is to increase user awareness and engagement with their day-to-day health-related behaviors (digital engagement) in order to improve diabetes outcomes. However, we lack a deep understanding of the complicated association between digital engagement and diabetes outcomes. OBJECTIVE This study investigated the association between digital engagement (operationalized as tagging of behaviors alongside glucose measurements) and the monthly average blood glucose level in persons with type 2 diabetes during the first year of managing their diabetes with a digital chronic disease management platform. We hypothesize that during the first 6 months, blood glucose levels will drop faster and further in patients with increased digital engagement and that difference in outcomes will persist for the remainder of the year. Finally, we hypothesize that disaggregated between- and within-person variabilities in digital engagement will predict individual-level changes in blood glucose levels. METHODS This retrospective real-world analysis followed 998 people with type 2 diabetes who regularly tracked their blood glucose levels with the Dario digital therapeutics platform for chronic diseases. Subjects included "nontaggers" (users who rarely or never used app features to notice and track mealtime, food, exercise, mood, and location, n=585) and "taggers" (users who used these features, n=413) representing increased digital engagement. Within- and between-person variabilities in tagging behavior were disaggregated to reveal the association between tagging behavior and blood glucose levels. The associations between an individual's tagging behavior in a given month and the monthly average blood glucose level in the following month were analyzed for quasicausal effects. A generalized mixed piecewise statistical framework was applied throughout. RESULTS Analysis revealed significant improvement in the monthly average blood glucose level during the first 6 months (t=-10.01, P<.001), which was maintained during the following 6 months (t=-1.54, P=.12). Moreover, taggers demonstrated a significantly steeper improvement in the initial period relative to nontaggers (t=2.15, P=.03). Additional findings included a within-user quasicausal nonlinear link between tagging behavior and glucose control improvement with a 1-month lag. More specifically, increased tagging behavior in any given month resulted in a 43% improvement in glucose levels in the next month up to a person-specific average in tagging intensity (t=-11.02, P<.001). Above that within-person mean level of digital engagement, glucose levels remained stable but did not show additional improvement with increased tagging (t=0.82, P=.41). When assessed alongside within-person effects, between-person changes in tagging behavior were not associated with changes in monthly average glucose levels (t=1.30, P=.20). CONCLUSIONS This study sheds light on the source of the association between user engagement with a diabetes tracking app and the clinical condition, highlighting the importance of within-person changes versus between-person differences. Our findings underscore the need for and provide a basis for a personalized approach to digital health.
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Tejera-Perez C, Moreno-Pérez Ó, Rios J, Reyes-García R. People living with type 1 diabetes point of view in COVID-19 times (COVIDT1 study): Disease impact, health system pitfalls and lessons for the future. Diabetes Res Clin Pract 2021; 171:108547. [PMID: 33278422 PMCID: PMC7711176 DOI: 10.1016/j.diabres.2020.108547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
AIMS To analyse the effects of confinement among people with type 1 diabetes (T1D) and their caregivers over the course of the COVID-19 crisis and to evaluate contemporary changes in medical assistance and patient preferences. METHODS An observational cross-sectional study designed as a self-reported web-based survey was conducted over the course of the COVID-19 pandemic. RESULTS A total of 769 subjects participated in the survey (603 people with T1D and 166 caregivers). Changes in glycaemic control were reported in 66% of cases, weight gain in 40.4% of cases and decreased exercise levels in 65.4% of cases. Of the cohort, 53% maintained contact with the healthcare team, and 23% received specific information related to COVID-19. Emotional support was requested by 17% of respondents. Regarding telemedicine, 97.9% agreed with its use with the following preferences regarding the future: telephone call (84.5%), video-call (60.6%) and platform devices (39.7%). CONCLUSIONS Over the course of the COVID-19 pandemic, at least two-thirds of people with T1D underwent changes in the management of their condition. Almost all participants agreed with the concept of telemedicine, favouring telephone and video calls as their preferred means of communication.
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Affiliation(s)
- Cristina Tejera-Perez
- Unidad de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, Spain.
| | - Óscar Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine department, Miguel Hernández University, Elche, Spain.
| | - Jose Rios
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona.
| | - Rebeca Reyes-García
- Unidad de Endocrinología y Nutrición. Hospital Universitario Torrecárdenas, Almería, Spain. CIBERFES, Instituto de Salud Carlos III.
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Christofides EA, Desai N. Optimal Early Diagnosis and Monitoring of Diabetic Kidney Disease in Type 2 Diabetes Mellitus: Addressing the Barriers to Albuminuria Testing. J Prim Care Community Health 2021; 12:21501327211003683. [PMID: 33749371 PMCID: PMC7983418 DOI: 10.1177/21501327211003683] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is associated with increased risk of end-stage renal disease (ESRD) and cardiovascular disease (CVD). Urine albumin-to-creatinine ratio (UACR) is a sensitive and early indicator of kidney damage, which should be used routinely to accurately assess CKD stage and monitor kidney health. However, this test currently is performed in only a minority of patients with T2D. Here, we review the importance of albuminuria testing and current barriers that hinder patient access to UACR testing and describe solutions to such testing in a community clinical setting.
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Affiliation(s)
| | - Niraj Desai
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Abstract
There has been a rapid advancement in the pace of development of new diabetes technologies and therapies for the management of type 1 diabetes over the past decade. The Diabetes Control and Complications Trial conclusively established that tight glycemic control with intensive insulin therapy decreases the rates of diabetes complications in proportion to glycemic control, and diabetes technologies have accordingly been developed to help patients reach these goals. In this review, the authors discuss new diabetes therapeutics and technologies, including new insulin analogues, insulin pumps, continuous glucose monitoring systems, and automated insulin delivery systems."
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Affiliation(s)
- Jordan S Sherwood
- Diabetes Research Center, Massachusetts General Hospital, 50 Staniford Street, Suite 301, Boston, MA 02114, USA
| | - Steven J Russell
- Diabetes Research Center, Massachusetts General Hospital, 50 Staniford Street, Suite 301, Boston, MA 02114, USA
| | - Melissa S Putman
- Diabetes Research Center, Massachusetts General Hospital, 50 Staniford Street, Suite 301, Boston, MA 02114, USA.
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Khehra A, Cohenca N, Cehreli ZC, Levin L. The International Association of Dental Traumatology ToothSOS mobile app: A 2-year report. Dent Traumatol 2020; 37:145-150. [PMID: 32940392 DOI: 10.1111/edt.12609] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND/AIM The shift in health care and technology calls for innovation through mobile applications as free educational resources for the masses. The International Association of Dental Traumatology (IADT) created ToothSOS, an app (software application for mobile devices) to provide dental trauma information for patients and professionals. The app contains information on the emergency management and prevention of dental injuries, as well as treatment guidelines for dental practitioners. The aim of this study was to assess public utilization of the ToothSOS app in the first 2 years since its launch. METHODS The ToothSOS app was launched by the IADT in the first week of April 2018. Data regarding the number of downloads and usage of the app in the first 2 years (from April 2018 to May 2020) were collected and analyzed. RESULTS The total number of ToothSOS downloads over the 2 years was 47 725. The number of downloads peaked in the first month when the app was initially released. Thereafter, the number of downloads decreased to an average of 1423 ± 363 downloads every month. Europe was the territory with the greatest number of downloads followed by the United States and Canada, Asia, Latin America and the Caribbean, and Africa, the Middle East, and India. CONCLUSIONS Within as short a period as 2 years, the ToothSOS app continues to gain public interest. Further attempts and public campaigns should be made in order to increase the visibility of the app. Dental professionals should encourage patients and communities to use the app in order to increase awareness for the prevention and proper emergency management of traumatic dental injuries.
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Affiliation(s)
- Anahat Khehra
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nestor Cohenca
- University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | | | - Liran Levin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Sommer J, Dyczmons J, Grobosch S, Gontscharuk V, Vomhof M, Roden M, Icks A. Preferences of people with type 2 diabetes for telemedical lifestyle programmes in Germany: protocol of a discrete choice experiment. BMJ Open 2020; 10:e036995. [PMID: 32907900 PMCID: PMC7482475 DOI: 10.1136/bmjopen-2020-036995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/25/2020] [Accepted: 08/15/2020] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Telemedical lifestyle programmes for people with type 2 diabetes mellitus (T2DM) provide an opportunity to develop a healthier lifestyle and consequently to improve health outcomes. When implementing new programmes into standard care, considering patients' preferences may increase the success of the participants. This study aims to examine the preferences of people with T2DM with respect to telemedical lifestyle programmes, to analyse whether these preferences predict programme success and to explore the changes that may occur during a telemedical lifestyle intervention. METHODS AND ANALYSIS We outline the protocol of the development and assessment of a discrete choice experiment (DCE) to examine patient preferences in a telemedical lifestyle programme with regard to the functions of the online portal, communication, responsibilities, group activities and time requirements. To develop the design of the DCE, we conducted pilot work involving healthcare experts and in particular people with T2DM using cognitive pretesting. The final DCE is being implemented within a randomised controlled trial for investigating whether participation in a telemedical lifestyle intervention programme sustainably improves the HbA1c values in 850 members of a large German statutory health insurance with T2DM. Preferences are being assessed before and after participants complete the programme. The DCE data will be analysed using regression and latent class analyses. ETHICS AND DISSEMINATION The DCE study has been approved by the ethics committee of the medical faculty of the Heinrich Heine University Duesseldorf, registration number 2018-242-ProspDEuA, registered on 6 December 2018. The TeLIPro trial is registered at the US National Library of Medicine, registration number NCT03675919, registered on 15 September 2018. We aim to disseminate our results in peer-reviewed journals, at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Jana Sommer
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Jan Dyczmons
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Sandra Grobosch
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Veronika Gontscharuk
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Division of Endocrinology and Diabetology, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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Quinn LM, Davies MJ, Hadjiconstantinou M. Virtual Consultations and the Role of Technology During the COVID-19 Pandemic for People With Type 2 Diabetes: The UK Perspective. J Med Internet Res 2020; 22:e21609. [PMID: 32716898 PMCID: PMC7486671 DOI: 10.2196/21609] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 01/02/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has presented unique challenges for people with diabetes, in addition to their high-risk stratification for infection. Supporting people with diabetes to self-care has been critical to reduce their risk of severe infection. This global pandemic has presented an opportunity to digitalize diabetes care and rapidly implement virtual diabetes clinics, with the aim of optimizing diabetes management and well-being, while keeping patients safe. We performed a rapid review of the literature to evaluate the feasibility and effectiveness of virtual clinics in diabetes care before and during the COVID-19 pandemic and have combined these findings with our own reflections in practice. We identified examples demonstrating safety and feasibility of virtual diabetes clinics, which aligns with our own clinical experience during the pandemic. The advantages of virtual clinics include reduced treatment burden, improved therapeutic alliances, societal and psychological benefits, and in our experience, innovative solutions to overcome the challenges presented by the transition from in-person to virtual care. We have provided three infographics to illustrate lessons learned and key recommendations, including steps to establish a virtual diabetes clinic, a checklist guide for health care professionals conducting virtual clinics, and a patient guide for making the most out of the virtual clinic. It is important to continue adapting to this pandemic and to make technology a sustainable option for the future of diabetes care.
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Affiliation(s)
- Lauren M Quinn
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Melanie J Davies
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom.,Leicester Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Michelle Hadjiconstantinou
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom.,Leicester Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
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Eeg-Olofsson K, Johansson UB, Linder E, Leksell J. Patients' and Health Care Professionals' Perceptions of the Potential of Using the Digital Diabetes Questionnaire to Prepare for Diabetes Care Meetings: Qualitative Focus Group Interview Study. J Med Internet Res 2020; 22:e17504. [PMID: 32812884 PMCID: PMC7468633 DOI: 10.2196/17504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/15/2020] [Accepted: 05/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background In effective diabetes management, it is important that providers and health care systems prioritize the delivery of patient-centered care and that they are respectful of and responsive to individual patient preferences and barriers. Objective The objective of the study was to conduct focus group interviews to capture patients’ and health care professionals’ perceptions and attitudes regarding digital technology and to explore how the digital Diabetes Questionnaire can be used to support patient participation in diabetes care, as a basis for an implementation study. Methods A qualitative study was conducted with six focus group discussions with diabetes specialist nurses and medical doctors (n=29) and four focus group discussions with individuals with diabetes (n=23). A semistructured focus group interview guide was developed, including probing questions. The data were transcribed verbatim, and qualitative content analysis was performed using an inductive approach. Results Two main categories were revealed by the qualitative analysis: perceptions of digital technology and the digital questionnaire in diabetes management and care and perceptions of participation in diabetes care. An overarching theme that emerged from the focus group interviews was patients’ and professionals’ involvement in diabetes care using digital tools. Conclusions The analysis identified important factors to consider when introducing the digital Diabetes Questionnaire in clinical use. Both professionals and patients need support and training in the practical implementation of the digital questionnaire, as well as the opportunity to provide feedback on the questionnaire answers.
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Affiliation(s)
- Katarina Eeg-Olofsson
- Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Unn-Britt Johansson
- Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden
| | - Ebba Linder
- Center of Registers Västra Götaland, Nationella Diabetesregistret, Gothenburg, Sweden
| | - Janeth Leksell
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
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Domańska B, Vansant S, Mountian I. A Companion App to Support Rheumatology Patients Treated with Certolizumab Pegol: Results From a Usability Study. JMIR Form Res 2020; 4:e17373. [PMID: 32716310 PMCID: PMC7418011 DOI: 10.2196/17373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background Certolizumab pegol (CZP) is an anti-tumor necrosis factor drug approved for the treatment of multiple moderate to severe chronic inflammatory diseases. In the European Union, CZP is approved for administration by subcutaneous self-injection using a prefilled syringe, prefilled pen, or reusable electromechanical auto-injector (electronic device). CimplyMe is a companion app for use alongside CZP self-injection devices, designed to support CZP-treated patients self-managing their treatment and disease. Objective This study aimed to validate the usability of the companion app by demonstrating that tasks required for use can be performed successfully by intended end users. Methods We recruited 15 patients with moderate to severe rheumatoid arthritis, currently prescribed biologic treatment, and using apps on a smart phone. Patients were assessed on their ability to use the companion app in a setting designed to simulate a location where patients regularly administer biologic treatment. To assess the usability of the key features of the app, 8 critical and 3 noncritical tasks were designed. Patients’ success on each task was recorded through observations or knowledge-based questions. Successes with difficulty and use errors were also recorded. If a patient made a use error at the first attempt, a second attempt was allowed. Second-attempt use errors were recorded as a task failure. Results A total of 207 first attempts at the 14 components of the 8 critical tasks were evaluated (3 patients failed to complete one component); 178 (86.0%) critical tasks were successfully completed at the first attempt. The remaining first attempts comprised 16 (7.7%) successes with difficulty and 13 (6.3%) use errors, which had to be repeated. One critical task was not re-attempted by one patient due to time constraints; however, there were no use errors in the 12 completed second attempts. A total of 107 first attempts at the 3 noncritical tasks were made, all of which (107/107, 100.0%) were completed without use errors. Conclusions In simulated testing, patients were able to successfully use the companion app without formal training. This study suggests the companion app is easy to use and could help patients prescribed CZP better manage their treatment and disease.
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Ceriello A, deValk HW, Guerci B, Haak T, Owens D, Canobbio M, Fritzen K, Stautner C, Schnell O. The burden of type 2 diabetes in Europe: Current and future aspects of insulin treatment from patient and healthcare spending perspectives. Diabetes Res Clin Pract 2020; 161:108053. [PMID: 32035117 DOI: 10.1016/j.diabres.2020.108053] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 02/08/2023]
Abstract
Due to the progressive nature of type 2 diabetes (T2DM), initiation of insulin therapy is very likely in the disease continuum. This article aims at highlighting the current situation with regard to insulin therapy in people with T2DM in Europe and at presenting the associated unmet need. Challenges for both people with T2DM and healthcare professionals include clinical inertia also derived from fear of hypoglycaemia, weight gain and injections as well as increased need for a comprehensive diabetes management. We compare national and international guidelines and recommendations for the initiation and intensification of insulin therapy with the real-world situation in six European countries, demonstrating that glycaemic targets are only met in a minority of people with T2DM on insulin therapy. Furthermore, this work evaluates currently recorded numbers of people with T2DM treated with insulin in Europe, the proportion not achieving the stated glycaemic targets and thus in need to enhance insulin therapy e.g. by a change in means of insulin delivery including, but not limited to, insulin pens, wearable mealtime insulin delivery patches, patch pumps, and conventional insulin pumps with continuous subcutaneous insulin infusion.
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Affiliation(s)
| | - Harold W deValk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bruno Guerci
- Endocrinology, Diabetology & Nutrition Clinical Unit, Brabois Hospital & Center of Clinical Investigation ILCV, Centre Hospitalier Universitaire of Nancy, University of Lorraine Vandoeuvre-lès-Nancy, France
| | - Thomas Haak
- Diabetes Klinik Bad Mergentheim, Bad Mergentheim, Germany
| | - David Owens
- Diabetes Research Unit Cymru, Swansea University, Swansea, Wales, UK
| | | | | | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany; Forschergruppe Diabetes e.V., Muenchen-Neuherberg, Germany.
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Khanh TQ, Hao PN, Roitman E, Raz I, Marganitt B, Cahn A. Digital Diabetes Care System Observations from a Pilot Evaluation Study in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030937. [PMID: 32028707 PMCID: PMC7037177 DOI: 10.3390/ijerph17030937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 11/29/2022]
Abstract
Digital technologies are gaining an important role in the management of patients with diabetes. We assessed clinical outcomes and user satisfaction of incorporating a digital diabetes care system in diabetes clinics of a developing country. The system integrated a wireless blood glucose monitor that communicates data to any smartphone utilizing a patented acoustic data transfer method, a mobile-app, and cloud-based software that stores, analyzes, and presents data. Five hospital endocrinology clinics in Vietnam sequentially recruited all patients willing to join the study, providing they had a smartphone and access to internet connectivity. Face-to-face visits were conducted at baseline and at 12 weeks, with monthly digital visits scheduled in the interim and additional digital visits performed as needed. HbA1c levels were measured at baseline and at 12 weeks (±20 days). The study included 300 patients of whom 279 completed the evaluation. Average glucose levels declined from 170.4 ± 64.6 mg/dL in the first 2 weeks to 150.8 ± 53.2 mg/dL in the last 2 weeks (n = 221; p < 0.001). HbA1c levels at baseline and 12 weeks declined from 8.3% ± 1.9% to 7.6% ± 1.3% (n = 126; p < 0.001). The digital solution was broadly accepted by both patients and healthcare professionals and improved glycemic outcomes. The durability, scalability, and cost-effectiveness of this approach merits further study.
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Affiliation(s)
- Tran Quang Khanh
- Head of Endocrinology Department, University of Medicine and Pharmacy, Ho Chi Minh City 72000, Vietnam;
| | - Pham Nhu Hao
- Department of Endocrinology, University of Medicine and Pharmacy, Ho Chi Minh City 72000, Vietnam;
| | - Eytan Roitman
- Head Diabetes Technologies Clinic, Diabetes consultant to the Clalit Health Services, Tel Aviv 6209804, Israel;
| | - Itamar Raz
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel;
| | | | - Avivit Cahn
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel;
- Correspondence: ; Tel.: 97-226-776-498; Fax: 97-226-437-940
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Bally ELS, Cesuroglu T. Toward Integration of mHealth in Primary Care in the Netherlands: A Qualitative Analysis of Stakeholder Perspectives. Front Public Health 2020; 7:407. [PMID: 32010660 PMCID: PMC6974538 DOI: 10.3389/fpubh.2019.00407] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background: There is a growing need to structurally change the way chronic illness care is organized as health systems struggle to meet the demand for chronic care. mHealth technologies can alter traditional approaches to health care provision by stimulating self-management of chronically ill patients. The aim of this study was to understand the complex environment related to the introduction of mHealth solutions into primary care for chronic disease management while considering health system functioning and stakeholder views. Methods: A transdisciplinary approach was used informed by the Interactive Learning and Action (ILA) methodology. Exploratory interviews (n = 5) were held with representatives of stakeholder groups to identify and position key stakeholders. Subsequently, professionals and chronically ill patients were consulted separately to elaborate on the barriers and facilitators in integration, using semi-structured interviews (n = 17) and a focus group (n = 6). Follow-up interviews (n = 5) were conducted to discuss initial findings of the stakeholder analysis. Results: Most stakeholders, in particular primary care practitioners and patients, seem to have a supporting or mixed attitude toward integration of mHealth. On the other hand, several powerful stakeholders, including primary care information system developers and medical specialists are likely to show resistance or a lack of initiative toward mHealth integration. Main barriers to mHealth integration were a lack of interoperability with existing information systems; difficulties in financing mHealth implementation; and limited readiness in general practices to change. Potential enablers of integration included co-design of mHealth solutions and incentives for pioneers. Conclusion: Stakeholders acknowledge the benefits of integrating mHealth in primary care. However, important barriers perceived by end-users prevent them to fully adopt and use mHealth. This study shows that the complexity of introducing mHealth into primary care calls for strategies encouraging collaboration between multiple stakeholders to enhance successful implementation.
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Affiliation(s)
- Esmee L S Bally
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Tomris Cesuroglu
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Barnett A, Ding H, Hay KE, Yang IA, Bowman RV, Fong KM, Marshall HM. The effectiveness of smartphone applications to aid smoking cessation: A meta-analysis. CLINICAL EHEALTH 2020. [DOI: 10.1016/j.ceh.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Huang Z, Tan E, Lum E, Sloot P, Boehm BO, Car J. A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e14914. [PMID: 31516127 PMCID: PMC6746066 DOI: 10.2196/14914] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/30/2019] [Accepted: 08/17/2019] [Indexed: 01/19/2023] Open
Abstract
Background The efficacy of smartphone apps for improving medication adherence in type 2 diabetes is not well studied in Asian populations. Objective This study aimed to determine the feasibility, acceptability, and clinical outcomes of using a smartphone app to improve medication adherence in a multiethnic Asian population with type 2 diabetes. Methods We block randomized 51 nonadherent and digitally literate patients with type 2 diabetes between the ages of 21 and 75 years into two treatment arms (control: usual care; intervention: usual care+Medisafe app) and followed them up for 12 weeks. Recruitment occurred at a public tertiary diabetes specialist outpatient center in Singapore. The intervention group received email reminders to complete online surveys monthly, while the control group only received an email reminder(s) at the end of the study. Barriers to medication adherence and self-appraisal of diabetes were assessed using the Adherence Starts with Knowledge-12 (ASK-12) and Appraisal of Diabetes Scale (ADS) questionnaires at baseline and poststudy in both groups. Perception toward medication adherence and app usage, attitude, and satisfaction were assessed in the intervention group during and after the follow-up period. Sociodemographic data were collected at baseline. Clinical data (ie, hemoglobin A1c, body mass index, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels) were extracted from patients’ electronic medical records. Results A total of 51 (intervention group: 25 [49%]; control group: 26 [51%]) participants were randomized, of which 41 (intervention group: 22 [88.0%]; control group: 19 [73.1%]) completed the poststudy survey. The baseline-adjusted poststudy ASK-12 score was significantly lower in the intervention group than in the control group (mean difference: 4.7, P=.01). No changes were observed in the clinical outcomes. The average 12-week medication adherence rate of participants tracked by the app was between 38.3% and 100% in the intervention group. The majority (>80%) of the participants agreed that the app was easy to use and made them more adherent to their medication. Conclusions Our feasibility study showed that among medication-nonadherent patients with type 2 diabetes, a smartphone app intervention was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence, but did not improve clinical outcomes in a developed Asian setting.
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Affiliation(s)
- Zhilian Huang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
| | - Eberta Tan
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Elaine Lum
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia
| | - Peter Sloot
- Complexity Institute, Nanyang Technological University, Singapore, Singapore.,Institute for Advanced Science, University of Amsterdam, Amsterdam, Netherlands.,ITMO University, Saint Petersburg, Russian Federation
| | - Bernhard Otto Boehm
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Reidy C, Klonoff DC, Barnard-Kelly KD. Supporting Good Intentions With Good Evidence: How to Increase the Benefits of Diabetes Social Media. J Diabetes Sci Technol 2019; 13:974-978. [PMID: 31096768 PMCID: PMC6955458 DOI: 10.1177/1932296819850187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Social media provides a platform for easily accessible, relevant health information and emotional and practical support at the touch of a button for millions of people with diabetes. Therein however lies a challenge. The accuracy and reliability of such information is often unknown and unverified, not all interactions are deemed supportive; practically or emotionally, and not all members of society have equitable access. Cyber bullying, requests for personal information and uninvited sharing are among the risks associated with social media, yet the use of online social media is increasing exponentially. Such reliance on web-based health information has given rise to concerns about patients' ability to accurately assess the credibility of online sources as well as the potential detrimental effect on personal well-being and patient-provider relations. In addition, there are rising digital disparities for particular subpopulations. Further, these concerns apply to where and how health care professionals should engage or refer patients to in terms of platforms of online support. There is little doubt regarding the popularity of social media, both within and outside of the health arena but there are also concerns. This article outlines five key areas associated with social media use in people living with diabetes and presents potential considerations moving forward. We focus on (1) social media as a platform for information and support; (2) social media interactions that are not supportive; (3) lessons from the DOC; (4) concerns about accuracy, reliability, and accessibility of information; and (5) differing priorities of health care professionals and patients.
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Affiliation(s)
- Claire Reidy
- Wessex CLAHRC, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- BHR Limited, Portsmouth, UK
| | | | - Katharine D. Barnard-Kelly
- BHR Limited, Portsmouth, UK
- Bournemouth University, Bournemouth, UK
- Katharine D. Barnard-Kelly, PhD, BHR Limited, c/- 42 Kilmiston Dr, Portchester, Fareham PO16 8EG, UK.
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Trahtemberg U, Hallas T, Segman Y, Sheiman E, Shasha M, Nissim K, Segman Y(J. New Paradigm of Personalized Glycemic Control Using Glucose Temporal Density Histograms. J Diabetes Sci Technol 2019; 13:708-717. [PMID: 30616388 PMCID: PMC6610592 DOI: 10.1177/1932296818821423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current methods used to assess glycemic control use averaged measures and provide little information on the glycemic pathology of the patients. In this article we propose visual tools and their related mathematical formulas that allow for improved characterization of the glycemic behavior and achieve better glycemic control. METHODS We present a reanalysis of published data, based on SMBG measurements from clinical trials of both men and women older than 18 years who were either healthy volunteers, prediabetes, or type 1 or type 2 diabetes. New graphic visualizations of glycemia as well as mathematical formulas that describe the glycemic behavior are presented and described, as well as suggested methods for their use to improve glycemic control. RESULTS Patients with different problems in their glycemic control had different histogram shapes. In addition, patients who had the same HbA1c level at the time of the trial revealed significantly different glucose histograms with different shapes, variability and glycemic burden. The derived graphic visualizations provided information about the temporal evolution of the glycemic control. CONCLUSIONS A paradigm change of the existing model of diabetes control is proposed, shifting from standardized treatment algorithms based on HbA1c follow-up to a new controlling approach that is based on the personal glucose density histogram. The histogram is an informative, detailed tool for the current patient glycemic behavior, and a future histogram can be targeted for a successful treatment. In addition, the glucose burden and the glucose severity index are proposed as informative markers for successful treatment. This is applicable to any glycemic data, by means of invasive and noninvasive glucometers.
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Affiliation(s)
| | - Tova Hallas
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Yehonatan Segman
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Ella Sheiman
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Michal Shasha
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Kobi Nissim
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
| | - Yosef (Joseph) Segman
- Cnoga Medical Ltd, Caesarea North
industrial Park, Caesarea, Israel
- Yosef (Joseph) Segman, PhD, Cnoga Medical
Ltd, Caesarea North Industrial Park, 5th Tarshish St, POB 3188, Caesarea,
3088900, Israel.
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El-Huni A, Colonio Salazar FB, Sharma PK, Fleming PS. Understanding factors influencing compliance with removable functional appliances: A qualitative study. Am J Orthod Dentofacial Orthop 2019; 155:173-181. [DOI: 10.1016/j.ajodo.2018.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 10/27/2022]
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