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Igelström H, Hauffman A, Alfonsson S, Sjöström J, Cajander Å, Johansson B. User Experiences of an Internet-Based Stepped-Care Intervention for Individuals With Cancer and Concurrent Symptoms of Anxiety or Depression (the U-CARE AdultCan Trial): Qualitative Study. J Med Internet Res 2020; 22:e16604. [PMID: 32427108 PMCID: PMC7268002 DOI: 10.2196/16604] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/04/2020] [Accepted: 03/21/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The internet-based stepped-care intervention iCAN-DO, used in the multicenter randomized controlled trial AdultCan, was developed for adult patients undergoing treatment for cancer and concurrently experiencing anxiety or depressive symptoms. iCAN-DO aimed to decrease symptoms of anxiety or depression. Step 1 comprises access to a library with psychoeducational material and a peer-support section, as well as the possibility to pose questions to a nurse. Step 2 of the intervention offers treatment consisting of internet-based cognitive behavioral therapy (iCBT) to participants still experiencing anxiety or depression at 1, 4, or 7 months after inclusion. OBJECTIVE The study aimed to explore user experiences of delivery, design, and structure of iCAN-DO from the perspective of people with cancer. METHODS We studied user experiences by interviewing 15 informants individually: 10 women with breast cancer (67%), 4 men with prostate cancer (27%), and 1 man with colorectal cancer (7%) with a mean age 58.9 years (SD 8.9). The interviews focused on informants' perceptions of ease of use and of system design and structure. Informants had been included in iCAN-DO for at least 7 months. They were purposefully selected based on activity in Step 1, participation in iCBT (ie, Step 2), gender, and diagnosis. RESULTS Of the 15 informants, 6 had been offered iCBT (40%). All informants used the internet on a daily basis, but 2 (13%) described themselves as very inexperienced computer users. The analysis revealed three subthemes, concerning how user experiences were affected by disease-specific factors and side effects (User experience in the context of cancer), technical problems (Technical struggles require patience and troubleshooting), and the structure and design of iCAN-DO (Appealing and usable, but rather simple). CONCLUSIONS The results indicate that user experiences were affected by informants' life situations, the technical aspects and the design of iCAN-DO, and informants' preferences. The results have generated some developments feasible to launch during the ongoing study, but if iCAN-DO is to be used beyond research interest, a greater level of tailoring of information, features, and design may be needed to improve user experiences. The use of recurrent questionnaires during the treatment period may highlight an individual's health, but also function as a motivator showing improvements over time.
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Affiliation(s)
- Helena Igelström
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Immmunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anna Hauffman
- Department of Immmunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Sven Alfonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Sjöström
- Department of Informatics and Media, Uppsala University, Uppsala, Sweden
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Birgitta Johansson
- Department of Immmunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Kapoor A, Nambisan P. Personal decision support for survivor engagement: formulation and feasibility evaluation of a conceptual framework for implementing online cancer survivorship care plans. BMC Med Inform Decis Mak 2020; 20:59. [PMID: 32293436 PMCID: PMC7092430 DOI: 10.1186/s12911-020-1073-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/16/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Although cancer survivorship care plans have been in use for several years, they have been shown to not be effective in meeting the long-term needs of cancer survivors, in addition being generic and passive in nature. Interactive survivorship care plans in the form of a personal decision support aid could provide an opportunity to not only engage survivors in their health care, but also capture meaningful treatment-related outcomes to use as a rich data source as the basis for making informed decisions. The objective of this research is to formulate an evidence-based model framework for implementing breast cancer survivorship guidelines via an online breast cancer survivorship care plan (SCP). METHODS The study was completed in three steps. In the first step, or the requirements gathering phase, we conducted personal interviews of breast cancer survivors to determine their use of the survivorship care plan (SCP) and related needs to determine core SCP functions and formulate an implementation framework for an online SCP. In the second step, we used the framework as a guide to design and develop the online SCP tool. Finally, in the third step, we conducted preliminary testing to determine the feasibility of the developed tool among online users. RESULTS Fifteen breast cancer survivors were consulted, who reported several issues from their use of the traditional paper-based SCP. Four themes were identified that represent the SCP's core desired functions. Eight features were matched to implement these core functions. Using a personal decision approach, an online SCP tool called ACESO that incorporates these features and functions was developed. Preliminary feasibility testing yielded overall positive responses from breast cancer survivors (n = 51). CONCLUSION Our study demonstrated that survivors face challenges from their use of a traditional paper-based SCP. The online SCP we developed is technically feasible and has the potential to effectively engage breast cancer survivors in self-management and shared decision-making with their clinicians and caregivers. Further testing is required to assess its usability and long-term impact.
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Affiliation(s)
- Akshat Kapoor
- Health Services and Information Management, East Carolina University, 600 Moye Blvd. (Mail Stop 668), Greenville, NC, 27834, USA.
| | - Priya Nambisan
- Department of Health Informatics and Administration, Social Media and Health Research & Training Lab, College of Health Sciences, University of Wisconsin - Milwaukee, Northwest Quadrant Building B, Rm #6410, 2025 East Newport Avenue, Milwaukee, WI, 53201-0413, USA
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IMPlementation of An online Relatives' Toolkit for psychosis or bipolar (IMPART study): iterative multiple case study to identify key factors impacting on staff uptake and use. BMC Health Serv Res 2020; 20:219. [PMID: 32183787 PMCID: PMC7077000 DOI: 10.1186/s12913-020-5002-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar. METHODS A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team. RESULTS In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT's long-term availability. CONCLUSIONS Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions. TRIAL REGISTRATION Study registration: ISCTRN 16267685.
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Sittig S, Wang J, Iyengar S, Myneni S, Franklin A. Incorporating Behavioral Trigger Messages Into a Mobile Health App for Chronic Disease Management: Randomized Clinical Feasibility Trial in Diabetes. JMIR Mhealth Uhealth 2020; 8:e15927. [PMID: 32175908 PMCID: PMC7105932 DOI: 10.2196/15927] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/13/2019] [Accepted: 02/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background Although there is a rise in the use of mobile health (mHealth) tools to support chronic disease management, evidence derived from theory-driven design is lacking. Objective The objective of this study was to determine the impact of an mHealth app that incorporated theory-driven trigger messages. These messages took different forms following the Fogg behavior model (FBM) and targeted self-efficacy, knowledge, and self-care. We assess the feasibility of our app in modifying these behaviors in a pilot study involving individuals with diabetes. Methods The pilot randomized unblinded study comprised two cohorts recruited as employees from within a health care system. In total, 20 patients with type 2 diabetes were recruited for the study and a within-subjects design was utilized. Each participant interacted with an app called capABILITY. capABILITY and its affiliated trigger (text) messages integrate components from social cognitive theory (SCT), FBM, and persuasive technology into the interactive health communications framework. In this within-subjects design, participants interacted with the capABILITY app and received (or did not receive) text messages in alternative blocks. The capABILITY app alone was the control condition along with trigger messages including spark and facilitator messages. A repeated-measures analysis of variance (ANOVA) was used to compare adherence with behavioral measures and engagement with the mobile app across conditions. A paired sample t test was utilized on each health outcome to determine changes related to capABILITY intervention, as well as participants’ classified usage of capABILITY. Results Pre- and postintervention results indicated statistical significance on 3 of the 7 health survey measures (general diet: P=.03; exercise: P=.005; and blood glucose: P=.02). When only analyzing the high and midusers (n=14) of capABILITY, we found a statistically significant difference in both self-efficacy (P=.008) and exercise (P=.01). Although the ANOVA did not reveal any statistically significant differences across groups, there is a trend among spark conditions to respond more quickly (ie, shorter log-in lag) following the receipt of the message. Conclusions Our theory-driven mHealth app appears to be a feasible means of improving self-efficacy and health-related behaviors. Although our sample size is too small to draw conclusions about the differential impact of specific forms of trigger messages, our findings suggest that spark triggers may have the ability to cue engagement in mobile tools. This was demonstrated with the increased use of capABILITY at the beginning and conclusion of the study depending on spark timing. Our results suggest that theory-driven personalization of mobile tools is a viable form of intervention. Trial Registration ClinicalTrials.gov NCT04132089; http://clinicaltrials.gov/ct2/show/NCT004122089
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Affiliation(s)
- Scott Sittig
- School of Computing, University of South Alabama, Mobile, AL, United States
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Sriram Iyengar
- College of Medicine Phoenix, The University of Arizona, Phoenix, AZ, United States
| | - Sahiti Myneni
- School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Amy Franklin
- School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston, TX, United States
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Cotchett M, Rathleff MS, Dilnot M, Landorf KB, Morrissey D, Barton C. Lived experience and attitudes of people with plantar heel pain: a qualitative exploration. J Foot Ankle Res 2020; 13:12. [PMID: 32143679 PMCID: PMC7059663 DOI: 10.1186/s13047-020-0377-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Plantar heel pain is a common source of pain and disability. Evidence-based treatment decisions for people with plantar heel pain should be guided by the best available evidence, expert clinical reasoning, and consider the needs of the patient. Education is a key component of care for any patient and needs to be tailored to the patient and their condition. However, no previous work has identified, far less evaluated, the approaches and content required for optimal education for people with plantar heel pain. The aim of this study was to gather the patients’ perspective regarding their lived experience, attitudes and educational needs in order to inform the content and provision of meaningful education delivery approaches. Methods Using a qualitative descriptive design, semi-structured interviews were conducted with participants with a clinical diagnosis of plantar heel pain. A topic guide was utilised that focused on the experience of living with plantar heel pain and attitudes regarding treatment and educational needs. Interviews were audio recorded, transcribed verbatim and analysed using the Framework approach. Each transcription, and the initial findings, were reported back to participants to invite respondent validation. Results Eighteen people with plantar heel pain were interviewed. Descriptive analysis revealed eight themes including perceptions of plantar heel pain, impact on self, dealing with plantar heel pain, source of information, patient needs, patient unmet needs, advice to others and interest in online education. Participants revealed doubt about the cause, treatment and prognosis of plantar heel pain. They also expressed a desire to have their pain eliminated and education individually tailored to their condition and needs. Respondent validation revealed that the transcripts were accurate, and participants were able to recognise their own experiences in the synthesised themes. Conclusion Plantar heel pain has a negative impact on health-related quality of life. Participants wanted their pain eliminated and reported that their expectations and needs were frequently unmet. Health professionals have an important role to be responsive to the needs of the patient to improve their knowledge and influence pain and behaviour. Our study informs the content needed to help educate people with plantar heel pain.
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Affiliation(s)
- Matthew Cotchett
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia.
| | - Michael Skovdal Rathleff
- Center for General Practice, Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark.,SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Matthew Dilnot
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia.,La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia
| | | | - Christian Barton
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
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Appel L, Peisachovich E, Sinclair D, Jokel R, Da Silva C. SafeHome: A Serious Game to Promote Safe Environments for Persons Living with Dementia. Cureus 2020; 12:e6949. [PMID: 32076588 PMCID: PMC7015112 DOI: 10.7759/cureus.6949] [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] [Indexed: 11/23/2022] Open
Abstract
The dementia epidemic continues to affect families across Canada. The number of persons living with dementia (PLWD) is projected to reach 1.1 million over the next 20 years, placing further financial and resource constraints on the Canadian healthcare system. Caregiver education is vital in ensuring the quality of life and safety for PLWD and can increase the time they are able to live at home, which is correlated with positive outcomes for both PLWD and their caregivers, and a reduction in system costs. However, current educational support often requires individuals to travel to local, urban service care centers and educational content is often provided in English, which can exacerbate the difficulties faced by marginalized caregivers (e.g., immigrants and those living in rural settings) who are caring for PLWD. To address this issue, a team of researchers developed a serious game called “SafeHome” that teaches safety strategies by having players identify and rectify potential hazards in the home setting that may negatively impact on PLWD outcomes, such as falls. A usability study was conducted using an adapted, validated questionnaire and semi-structured focus groups to better understand users’ experience and obtain suggestions for the SafeHome serious game improvement. Results indicated that 80% of the participants were satisfied with the activities provided through SafeHome. All participants (n = 13) made recommendations for improving the usability, functionality, and comprehensiveness of the educational content. This feedback will inform future iterations of SafeHome and add valuable contributions to the growing literature on innovative e-learning resources that support PLWD and their caregivers.
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Affiliation(s)
- Lora Appel
- Medical Education and Simulation, York University, Toronto, CAN
| | | | - Don Sinclair
- Medical Education and Simulation, York University, Toronto, CAN
| | - Regina Jokel
- Neurology, Baycrest Health Sciences, Toronto, CAN
| | - Celina Da Silva
- Medical Education and Simulation, York University, Toronto, CAN
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Wen Yin W, Moghavvemi S. Social media communication and healthy eating behaviour: Facebook for Healthy Eating (Preprint). J Med Internet Res 2019. [DOI: 10.2196/17562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McGar AB, Kindler C, Marsac M. Electronic Health Interventions for Preventing and Treating Negative Psychological Sequelae Resulting From Pediatric Medical Conditions: Systematic Review. JMIR Pediatr Parent 2019; 2:e12427. [PMID: 31710299 PMCID: PMC6878107 DOI: 10.2196/12427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 07/15/2019] [Accepted: 09/04/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Pediatric medical conditions have the potential to result in challenging psychological symptoms (eg, anxiety, depression, and posttraumatic stress symptoms [PTSS]) and impaired health-related quality of life in youth. Thus, effective and accessible interventions are needed to prevent and treat psychological sequelae associated with pediatric medical conditions. Electronic health (eHealth) interventions may help to meet this need, with the capacity to reach more children and families than in-person interventions. Many of these interventions are in their infancy, and we do not yet know what key components contribute to successful eHealth interventions. OBJECTIVE The primary objective of this study was to conduct a systematic review to summarize current evidence on the efficacy of eHealth interventions designed to prevent or treat psychological sequelae in youth with medical conditions. METHODS MEDLINE (PubMed) and PsycINFO databases were searched for studies published between January 1, 1998, and March 1, 2019, using predefined search terms. A total of 2 authors independently reviewed titles and abstracts of search results to determine which studies were eligible for full-text review. Reference lists of studies meeting eligibility criteria were reviewed. If the title of a reference suggested that it might be relevant for this review, the full manuscript was reviewed for inclusion. Inclusion criteria required that eligible studies (1) had conducted empirical research on the efficacy of a Web-based intervention for youth with a medical condition, (2) had included a randomized trial as part of the study method, (3) had assessed the outcomes of psychological sequelae (ie, PTSS, anxiety, depression, internalizing symptoms, or quality of life) in youth (aged 0-18 years), their caregivers, or both, (4) had included assessments at 2 or more time points, and (5) were available in English language. RESULTS A total of 1512 studies were reviewed for inclusion based on their title and abstracts; 39 articles qualified for full-text review. Moreover, 22 studies met inclusion criteria for the systematic review. Of the 22 included studies, 13 reported results indicating that eHealth interventions significantly improved at least one component of psychological sequelae in participants. Common characteristics among interventions that showed an effect included content on problem solving, education, communication, and behavior management. Studies most commonly reported on child and caregiver depression, followed by child PTSS and caregiver anxiety. CONCLUSIONS Previous research is mixed but suggests that eHealth interventions may be helpful in alleviating or preventing problematic psychological sequelae in youth with medical conditions and their caregivers. Additional research is needed to advance understanding of the most powerful intervention components and to determine when and how to best disseminate eHealth interventions, with the goal of extending the current reach of psychological interventions.
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Affiliation(s)
- Ashley Brook McGar
- Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States
| | - Christine Kindler
- Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States
| | - Meghan Marsac
- Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States.,College of Medicine, University of Kentucky, Lexington, KY, United States
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O'Malley DM, Davis SN, Devine KA, Sullivan B, Bator A, Clemow L, Ferrante JM, Findley PA, Miller SM, Hudson SV. Development and usability testing of the e-EXCELS tool to guide cancer survivorship follow-up care. Psychooncology 2019; 29:123-131. [PMID: 31626397 DOI: 10.1002/pon.5222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/21/2019] [Accepted: 08/31/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study is to describe a user-centered (e.g., cancer survivors and clinicians) development process of an eHealth tool designed to facilitate self-management of cancer survivorship follow-up care. METHODS Guided by Cognitive-Social Health Information Processing (C-SHIP) model and informed by core self-management skills, we engaged in a user-centered design process. In phase I, we conducted in-depth interviews with survivors of breast (n = 33), prostate (n = 4), and colorectal (n = 6) cancers, and (n = 9) primary care providers to develop content and design of the web tool. Phase II utilized iterative user testing interviews (n = 9) to test the web-based tool prototype. Data from both phases were independently coded using a template/content analytic approach. RESULTS The top 5 functions identified in phase I for the web-based platform included: (a) educational materials to learn and prepare for health encounters (80%); (b) questions for health providers (74%); (c) ability to track contact information of providers (67%); (d) provide general information (64%); and, (e) support information (62%). Users of the prototype reported patient burden, tool fatigue, introduction timing of the tool, relevance, and security/privacy as concerns in phase II. CONCLUSIONS This study demonstrates the value of using a theoretically informed and user-centered design process to develop relevant and patient-centered eHealth resources to support cancer survivorship. A larger study is needed to establish the efficacy of this eHealth tool as an intervention to improve adherence to follow-up care guidelines.
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Affiliation(s)
- Denalee M O'Malley
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Stacy N Davis
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,School of Public Health, Health Behavior, Society, and Policy, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Katie A Devine
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Brittany Sullivan
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Alicja Bator
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lynn Clemow
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jeanne M Ferrante
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Patricia A Findley
- Rutgers School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Suzanne M Miller
- Fox Chase Cancer Center/Temple Health, Philadelphia, Pennsylvania
| | - Shawna V Hudson
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,School of Public Health, Health Behavior, Society, and Policy, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Shang L, Zuo M, Ma D, Yu Q. The Antecedents and Consequences of Health Care Professional-Patient Online Interactions: Systematic Review. J Med Internet Res 2019; 21:e13940. [PMID: 31573908 PMCID: PMC6785718 DOI: 10.2196/13940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/05/2019] [Accepted: 07/31/2019] [Indexed: 01/26/2023] Open
Abstract
Background Online health care services effectively supplement traditional medical treatment. The development of online health care services depends on sustained interactions between health care professionals (HCPs) and patients. Therefore, it is necessary to understand the demands and gains of health care stakeholders in HCP-patient online interactions and determine an agenda for future work. Objective This study aims to present a systematic review of the antecedents and consequences of HCP-patient online interactions. It seeks to reach a better understanding of why HCPs and patients are willing to interact with each other online and what the consequences of HCP-patient online interactions are for health care stakeholders. Based on this, we intend to identify the gaps in existing studies and make recommendations for future research. Methods In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic retrieval was carried out from the Web of Science, PubMed, and Scopus electronic databases. The search results were confined to those papers published in English between January 1, 2000 and June 30, 2018. Selected studies were then evaluated for quality; studies that did not meet quality criteria were excluded from further analysis. Findings of the reviewed studies related to our research questions were extracted and synthesized through inductive thematic analysis. Results A total of 8440 records were found after the initial search, 28 papers of which were selected for analysis. Accessibility to HCPs, self-management, and unmet needs were the main triggers for patients to participate in online interaction. For HCPs, patient education, career needs, and self-promotion were the major reasons why they took the online approach. There were several aspects of the consequences of HCP-patient online interactions on health care stakeholders. Consequences for patients included patient empowerment, health promotion, and acquisition of uncertain answers. Consequences for HCPs included social and economic returns, lack of control over their role, and gaining more appointments. HCP-patient online interactions also improved communication efficiency in offline settings and helped managers of online health care settings get a better understanding of patients’ needs. Health care stakeholders have also encountered ethical and legal issues during online interaction. Conclusions Through a systematic review, we sought out the antecedents and consequences of HCP-patient online interactions to understand the triggers for HCPs and patients to participate and the consequences of participating. Potential future research topics are the influences on the chain of online interaction, specifications and principles of privacy design within online health care settings, and roles that sociodemographic and psychological characteristics play. Longitudinal studies and the adoption of text-mining method are worth encouraging. This paper is expected to contribute to the sustained progress of online health care settings.
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Affiliation(s)
- Lili Shang
- Research Institute of Smart Senior Care, School of Information, Renmin University of China, Beijing, China
| | - Meiyun Zuo
- Research Institute of Smart Senior Care, School of Information, Renmin University of China, Beijing, China
| | - Dan Ma
- Research Institute of Smart Senior Care, School of Information, Renmin University of China, Beijing, China
| | - Qinjun Yu
- School of Basic Medicine, Peking University Health Science Center, Beijing, China
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Carrasco S, Symes L. Patient Use of Electronic Methods to Self-Report Symptoms: An Integrative Literature Review. Oncol Nurs Forum 2019; 45:399-416. [PMID: 29683117 DOI: 10.1188/18.onf.399-416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Clinicians are unaware of most of their patients' symptoms. Symptoms may be poorly documented and their impact underestimated. Undertreatment of symptoms may lead to increased symptom distress and decreased quality of life. Improving the communication of symptoms to nurses is vital in symptom management and quality-of-life improvement. Electronic patient self-report of symptoms may be beneficial. LITERATURE SEARCH An integrative review of the literature was conducted to describe the use of electronic methods for symptom self-report by patients with cancer and to inform best practices. DATA EVALUATION The final sample for this integrative review consisted of 36 studies (32 quantitative and 4 qualitative). SYNTHESIS Data analysis was used to summarize the findings of the 36 studies. Patients with cancer found electronic self-report of symptoms to be feasible and the devices usable. Electronic symptom reporting may improve patient-clinician communication, leading to improved physical and psychosocial outcomes. IMPLICATIONS FOR PRACTICE In the studies that included an interactive communication component, oncology nurses were central in receiving, reviewing, and reporting changes to the provider. Patients expressed themselves more when consulting with nurses than with physicians.
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Benson T, Potts HWW, Bark P, Bowman C. Development and initial testing of a Health Confidence Score (HCS). BMJ Open Qual 2019; 8:e000411. [PMID: 31259277 PMCID: PMC6568167 DOI: 10.1136/bmjoq-2018-000411] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Patients need to feel confident about looking after their own health. This is needed to improve patient outcomes and clinical support. With few suitable tools available to measure self-care health confidence, we developed and validated a short, generic survey instrument for use in evaluation and quality improvement. Methods The Health Confidence Score (HCS) was developed through literature review, patient and expert focus groups and discussions. This paper reports an initial survey (n = 1031, study 1) which identified some issues and a further face-to-face survey (n = 378, study 2) to test the construct and concurrent validity of the final version. Scores were correlated against the My Health Confidence (MHC) rating scale, howRu (health status measure) and relevant demographics. Results The HCS is short (50 words) with good readability (reading age 8). It has four items covering health knowledge, capability to self-manage, access to help and shared decision-making; each has four response options (strongly agree, agree, neutral disagree). Items are reported independently and as a summary score.The mean summary score was 76.7 (SD 20.4) on 0-100 scale. Cronbach's alpha = 0.82. Exploratory factor analysis suggested that the four items relate to a single dimension. Correlation of the HCS summary score with MHC was high (Spearman r = 0.76). It was also associated with health status (Spearman r = 0.49), negatively with number of medications taken (r=-0.29) and age (r=-0.22) and not with ethnicity, having children or education level. Conclusions The HCS is short, easy to use, with good psychometric properties and construct validity. Each item is meaningful independently and the summary score gives an overall picture of health confidence.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Thatcham, UK
- Institute of Health Informatics, UCL, London, UK
| | | | - Pippa Bark
- Institute of Health Informatics, UCL, London, UK
| | - Clive Bowman
- School of Health Sciences, City, University of London, London, UK
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Information needs, communication and usage of social media by cancer patients and their relatives. J Cancer Res Clin Oncol 2019; 145:1865-1875. [PMID: 31123824 DOI: 10.1007/s00432-019-02929-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/02/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate cancer patients' need for information, their communication and usage of social media. METHODS We developed a standardized questionnaire comprising sections on information needs, communication behavior and usage of social media with respect to cancer and combined this with a validated instrument on eHealth literacy for patients. This questionnaire was provided online and with the help of bloggers and leaders of social media groups, distributed in their networks. RESULTS The Internet was the most important information source (n = 308; 77.4%). Yet, most of the participants wanted to get information from their doctor (n = 342; 85.9%). With respect to trust in a source of information, oncologists were named most often (n = 285; 71.6%). On the one hand, many participants got in contact with others, especially peers, via social media (n = 319; 80.3%) with a growing bond to their family members on the other hand (n = 324; 81.6%). The cancer diagnosis was an impulse for starting with active participation in social media for some participants (n = 196; 49.2%). CONCLUSIONS With social media gaining importance as source of information for patients, improving the quality of information in these networks is an important task in health care systems.
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Ramírez-Correa P, Grandón EE, Ramírez-Santana M, Belmar Órdenes L. Explaining the Use of Social Network Sites as Seen by Older Adults: The Enjoyment Component of a Hedonic Information System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101673. [PMID: 31091670 PMCID: PMC6571809 DOI: 10.3390/ijerph16101673] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/28/2019] [Accepted: 04/22/2019] [Indexed: 11/28/2022]
Abstract
Previous studies suggest that older adults are living increasingly alone and without the company of their close relatives, which cause them depression problems and a detriment to their health and general wellbeing. The use of social network sites (SNS) allows them to reduce their isolation, improve their social participation, and increase their autonomy. Although the adoption of various information technologies by older adults has been studied, some assumptions still predominate, for example, that older adults use SNS only for utilitarian purposes. However, considering SNS as hedonic information systems, and in order to extend the theoretical explanation of the intention to use hedonic systems to their actual use, this study aims to determine the influence of perceived enjoyment, perceived usefulness, and perceived ease of use on the use of SNS by elders in Concepción, Chile. Two hundred fifty-three older adults participated in the cross-sectional study. The results indicate that perceived ease of use is the variable that has the greatest total effect in explaining the use of SNS and that by adding the perceived enjoyment construct, the explanatory power of the model increases significantly. Therefore, advancement in user acceptance models, especially in the use of SNS by elders, can be made by focusing on the type of system, hedonic or utilitarian.
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Affiliation(s)
| | - Elizabeth E Grandón
- Department of Information Systems, Universidad del Bío-Bío, Concepción 4030000, Chile.
| | - Muriel Ramírez-Santana
- Department of Public Health, Faculty of Medicine, Universidad Católica del Norte, Coquimbo 1780000, Chile.
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Goehner A, Kricheldorff C, Bitzer EM. Trained volunteers to support chronically ill, multimorbid elderly between hospital and domesticity - a systematic review of one-on-one-intervention types, effects, and underlying training concepts. BMC Geriatr 2019; 19:126. [PMID: 31046693 PMCID: PMC6498473 DOI: 10.1186/s12877-019-1130-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/05/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND New approaches are needed to address the challenges of demographic change, staff shortages, and societal change in the care of the elderly. While volunteering has barely been established as a pillar of the welfare state in several countries, legislators and nonprofit or community-based organizations in some countries favor the increased integration of volunteers, as they can rely on many dedicated people. When caring for the multimorbid elderly, the transition from hospital to domesticity involves certain risks. Currently, no systematic knowledge exists on whether and how elderly benefit from volunteer support after a hospital stay. Objectives of this systematic review were to (1) identify evaluated approaches with trained volunteers supporting chronically ill, multimorbid elderly one-on-one at the interface between hospital and domesticity; (2) investigate the patient-related effectiveness of the approaches; (3) present the characteristics of the supporting volunteers; and (4) present the underlying teaching and training concepts for the volunteers. METHODS A systematic search of the following online databases was conducted in April 2017: the Cochrane Library, Medline (PubMed), CINAHL, and PsycINFO (Ebscohost). We included (cluster/quasi-) randomized controlled trials, controlled clinical trials and single-group pre-post design. An institutional search was conducted on eight national institutions from research and practice in Germany. Screening was conducted by one researcher, risk of bias was assessed. Study authors were contacted for study and training details. RESULTS We identified a total of twelve studies, eight of which evaluated treatment following hospital stay: psychosocial-coordinative support (n = 2), physical-cognitive activation (n = 4), and assistance with medication intake (n = 2). We saw short-term effects with small and medium effect sizes. Most volunteers were women aged between 45 and 61 years. Their training lasted 12-26 h and took place prior to first patient contact. During the intervention, volunteers could rely on permanent supporting structures. CONCLUSIONS Few studies exist that have evaluated one-on-one-volunteer support following hospitalization, and the effects are inconsistent. As such, further, well-designed studies are needed. The suitability and transferability of the interventions in country-specific settings should be examined in feasibility studies. Furthermore, an international discussion on the appropriate theoretical backgrounds of volunteer training is needed.
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Affiliation(s)
- Anne Goehner
- Center for Geriatric Medicine and Gerontology Freiburg, Medical Center, Faculty of Medicine, University of Freiburg, Lehener Str. 88, 79106 Freiburg, Germany
- University of Education Freiburg, Public Health & Health Education, Kunzenweg 21, 79117 Freiburg, Germany
| | - Cornelia Kricheldorff
- Catholic University of Applied Sciences Freiburg, Karlstr. 63, 79104 Freiburg, Germany
| | - Eva Maria Bitzer
- University of Education Freiburg, Public Health & Health Education, Kunzenweg 21, 79117 Freiburg, Germany
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Finnerty M, Austin E, Chen Q, Layman D, Kealey E, Ng-Mak D, Rajagopalan K, Hoagwood K. Implementation and Use of a Client-Facing Web-Based Shared Decision-Making System (MyCHOIS-CommonGround) in Two Specialty Mental Health Clinics. Community Ment Health J 2019; 55:641-650. [PMID: 30317442 PMCID: PMC6447505 DOI: 10.1007/s10597-018-0341-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/01/2018] [Indexed: 11/18/2022]
Abstract
Electronic shared-decision making programs may provide an assistive technology to support physician-patient communication. This mixed methods study examined use of a web-based shared decision-making program (MyCHOIS-CommonGround) by individuals receiving specialty mental health services, and identified qualitative factors influencing adoption during the first 18 months of implementation in two Medicaid mental health clinics. T-tests and χ2 analyses were conducted to assess differences in patient use between sites. Approximately 80% of patients in both clinics created a MyCHOIS-CommonGround user profile, but marked differences emerged between clinics in patients completing shared decision-making reports (79% vs. 28%, χ2(1) = 109.92, p < .01) and average number of reports (7.20 vs. 3.60, t = - 3.64, p < .01). Results suggest high penetration of computer-based programs in specialty mental health services is possible, but clinic implementation factors can influence patient use including leadership commitment, peer staff funding to support the program, and implementation strategy, most notably integration of the program within routine clinical workflow.
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Affiliation(s)
- Molly Finnerty
- New York State Office of Mental Health, 330 5th Ave, New York, NY, 10001, USA.
- New York University Langone Medical Center, One Park Ave, 7th Floor, New York, NY, USA.
| | - Elizabeth Austin
- New York State Office of Mental Health, 330 5th Ave, New York, NY, 10001, USA
- Department of Surgery, University of Washington, 1107 NE 45th Street, Box 354808, Seattle, WA, USA
| | - Qingxian Chen
- New York State Office of Mental Health, 75 New Scotland Ave, CDPC Unit R, Albany, NY, USA
| | - Deborah Layman
- New York State Office of Mental Health, 330 5th Ave, New York, NY, 10001, USA
| | - Edith Kealey
- New York State Office of Mental Health, 330 5th Ave, New York, NY, 10001, USA
- NYC Department of Social Services, 150 Greenwich St., 42nd Floor, New York, NY, USA
| | - Daisy Ng-Mak
- Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA, 01752, USA
| | | | - Kimberly Hoagwood
- New York University Langone Medical Center, One Park Ave, 7th Floor, New York, NY, USA
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Aparicio-Martínez P, Martínez-Jiménez MDP, Perea-Moreno AJ, Vaquero-Álvarez E, Redel-Macías MD, Vaquero-Abellán M. Is possible to train health professionals in prevention of high-risk pathogens like the Ebola by using the mobile phone? TELEMATICS AND INFORMATICS 2019. [DOI: 10.1016/j.tele.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Chao YS, Wu CJ, Wu HC, Chen WC. Drug trends among non-institutionalized Canadians and the impact of data collection changes in the Canadian Health Measures Survey 2007 to 2015. PLoS One 2019; 14:e0214718. [PMID: 30978234 PMCID: PMC6461261 DOI: 10.1371/journal.pone.0214718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/19/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is a global trend of increasing use in prescription and over-the-counter (OTC) drugs. This hasn't been verified in Canada. In addition, there are changes made to the collection method of medication information after the Canadian Health Measures Survey (CHMS) cycle 2. This study aims to review the potential impact of the changes in medication data collection and the trends in medication use if data quality remains similar throughout the CHMS cycles 1 to 4. This is fundamental for the analysis of this biomonitoring database. METHODS The CHMS cycle 1 to 4 medication and household data were used to study the trends of medication use between 2007 and 2015. The use of prescription or OTC drugs was grouped based on the first levels of the Anatomical Therapeutic Chemical (ATC) Classification system. The total numbers of medications were asked in all cycles. However, only a maximum of 15 and 5 drugs could be respectively reported for existing and new prescription or OTC drugs in cycles 1 and 2. There were no restrictions on drug reporting after cycle 2. The trends of medication use were described as ratios, compared to cycle 1. RESULTS The total numbers of the types of medication ever identified decreased from 739 to 603 between cycles 1 and 4. The proportions of using any drugs were from 0.90 to 0.88 between cycles 1 and 4 (ratio = 1.08 in cycle 4, 95% CI = 0.89 to 1.26). The numbers of drugs in use were from 3.9 to 3.8 (ratio = 1.05 in cycle 4, 95% CI = 0.86 to 1.24). The proportions of prescription drug use were from 0.53 to 0.55 (ratio = 1.13 in cycle 4, 95% CI = 0.89 to 1.37), while the numbers of prescription were from 1.51 to 1.68 (ratio = 1.20 in cycle 4, 95% CI = 0.92 to 1.48). The use of diabetes and thyroid medication had trends similar to the respective disease prevalence. The use and the numbers of drugs for blood and blood forming organs significantly increased between cycles 1 and 4 (ratio = 1.56 in cycle 4, 95% CI = 1.03 to 2.10). CONCLUSIONS There is an increasing trend in the use of blood and blood forming agents through cycles 2 to 4 and cardiovascular drugs in cycle 3. For diabetes and thyroid medication, the proportions of medication use increase proportionally with disease prevalence. The changes in the medication information collection method may not have important impact on the reporting of the use of prescription or OTC drugs.
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Affiliation(s)
- Yi-Sheng Chao
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Montréal, Québec, Canada
| | - Chao-Jung Wu
- Département d'informatique, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Hsing-Chien Wu
- Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Davis SN, O'Malley DM, Bator A, Ohman-Strickland P, Clemow L, Ferrante JM, Crabtree BF, Miller SM, Findley P, Hudson SV. Rationale and design of extended cancer education for longer term survivors (EXCELS): a randomized control trial of 'high touch' vs. 'high tech' cancer survivorship self-management tools in primary care. BMC Cancer 2019; 19:340. [PMID: 30971205 PMCID: PMC6458696 DOI: 10.1186/s12885-019-5531-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Breast, colorectal, and prostate cancer survivors are at increased risk for late and long-term effects post-treatment. The post-treatment phase of care is often poorly coordinated and survivors navigate follow-up care with minimal information or guidance from their healthcare team. This manuscript describes the Extended Cancer Education for Longer-term Survivors (EXCELS) in Primary Care protocol. EXCELS is a randomized controlled trial to test the efficacy of patient-level self-management educational strategies on adherence to preventative health service use and cancer survivorship follow-up guidelines. Methods The EXCELS trial compares four conditions: (1) EXCELS-website (e.g., a mobile-optimized technology platform); (2) EXCELS-health coaching; (3) EXCELS-website and health coaching; and (4) a print booklet. Approximately 480 breast, colorectal, and prostate survivors will be recruited through the New Jersey Primary Care Research Network (NJPCRN) and New Jersey State Cancer Registry (NJSCR). Eligible survivors (diagnosed stages 1–3) must have completed active treatment, access to a phone and a computer, smartphone or tablet with internet access, and be able to speak and read English. Patient assessments occur at baseline, 6, 12, and 18 months. The primary outcomes are increased engagement in preventive health services and monitoring for cancer recurrence and treatment-related late effects. Discussion The EXCELS trial is the first to test cancer survivorship educational self-management interventions for cancer survivors in a primary care context. Findings from this trial will inform successful implementation and engagement strategies for longer-term, post-treatment cancer survivors managed in primary care settings. Trial registration Registered August 1, 2017 at ClinicalTrials.gov, trial # NCT03233555.
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Affiliation(s)
- Stacy N Davis
- Rutgers Biomedical and Health Sciences, Rutgers, the State University of New Jersey, 112 Paterson Street, Room 446, New Brunswick, NJ, 08901, USA.,Rutgers School of Public Health, Health Behavior, Society and Policy, Piscataway, NJ, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Denalee M O'Malley
- Rutgers Biomedical and Health Sciences, Rutgers, the State University of New Jersey, 112 Paterson Street, Room 446, New Brunswick, NJ, 08901, USA.,Rutgers Robert Wood Johnson Medical School, Department of Family, Medicine and Community Health, New Brunswick, NJ, USA
| | - Alicja Bator
- Rutgers Biomedical and Health Sciences, Rutgers, the State University of New Jersey, 112 Paterson Street, Room 446, New Brunswick, NJ, 08901, USA.,Rutgers Robert Wood Johnson Medical School, Department of Family, Medicine and Community Health, New Brunswick, NJ, USA
| | - Pamela Ohman-Strickland
- Rutgers Biomedical and Health Sciences, Rutgers, the State University of New Jersey, 112 Paterson Street, Room 446, New Brunswick, NJ, 08901, USA.,Rutgers School of Public Health, Health Behavior, Society and Policy, Piscataway, NJ, USA.,Rutgers Robert Wood Johnson Medical School, Department of Family, Medicine and Community Health, New Brunswick, NJ, USA.,Rutgers School of Public Health, Biostatistics, Piscataway, NJ, USA
| | - Lynn Clemow
- Rutgers Biomedical and Health Sciences, Rutgers, the State University of New Jersey, 112 Paterson Street, Room 446, New Brunswick, NJ, 08901, USA.,Rutgers Robert Wood Johnson Medical School, Department of Family, Medicine and Community Health, New Brunswick, NJ, USA
| | - Jeanne M Ferrante
- Rutgers Biomedical and Health Sciences, Rutgers, the State University of New Jersey, 112 Paterson Street, Room 446, New Brunswick, NJ, 08901, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Rutgers Robert Wood Johnson Medical School, Department of Family, Medicine and Community Health, New Brunswick, NJ, USA
| | - Benjamin F Crabtree
- Rutgers Biomedical and Health Sciences, Rutgers, the State University of New Jersey, 112 Paterson Street, Room 446, New Brunswick, NJ, 08901, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Rutgers Robert Wood Johnson Medical School, Department of Family, Medicine and Community Health, New Brunswick, NJ, USA
| | | | | | - Shawna V Hudson
- Rutgers Biomedical and Health Sciences, Rutgers, the State University of New Jersey, 112 Paterson Street, Room 446, New Brunswick, NJ, 08901, USA. .,Rutgers School of Public Health, Health Behavior, Society and Policy, Piscataway, NJ, USA. .,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. .,Rutgers Robert Wood Johnson Medical School, Department of Family, Medicine and Community Health, New Brunswick, NJ, USA.
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Musgrave LM, Homer CSE, Kizirian NV, Gordon A. Addressing preconception behaviour change through mobile phone apps: a protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:86. [PMID: 30947750 PMCID: PMC6449990 DOI: 10.1186/s13643-019-0996-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Many of the adverse outcomes experienced by mothers and babies are directly related to the health of the woman prior to pregnancy. This preconception period is a unique window of opportunity when women are often more motivated to optimise health and change their lifestyle in preparation for pregnancy. Several risk factors in the preconception period can contribute to adverse perinatal outcomes. These risk factors can be divided into three broad areas: biomedical, social and environmental. Mobile phone applications as a behaviour change intervention have the potential to address these risks through supporting the provision of information, healthier lifestyles and informed decision-making. The aim of this systematic review is to assess the effectiveness of mobile phone applications in promoting behaviour change and improving long-term outcomes for mother and babies, in women of reproductive age. METHODS This review will include trials that assess any mobile phone application (app) that assist women of reproductive age to optimise health behaviours. Randomised controlled trials, quasi-randomised controlled trials and cluster-randomised trials will be included. The search strategy will use both MeSH and keyword combinations to search databases including the WHO Global Health Library, CINHAL, The Cochrane Library, Embase and MEDLINE for relevant studies. Retrieved citations will be screened independently by two authors to assess eligibility. Studies will be selected only if the intervention was commenced prior to pregnancy. Comparisons will be made including mobile phone applications versus text messaging-based communications or paper-based, face-to-face or telephone conversations and standard care or no specific intervention. The Cochrane Handbook for Systematic Reviews of Interventions will be utilised to assess the quality of included randomised studies. Primary and secondary outcomes will be compared and analysed. Results of the review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. DISCUSSION This systematic review is the first to assess the effects of preconception mobile phone app behaviour change and educational interventions in improving future pregnancy and maternal and child outcomes, in women of reproductive age. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2017: CRD42017065903 .
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Affiliation(s)
- Loretta M. Musgrave
- Sydney Medical School, Charles Perkins Centre, The University of Sydney, The Hub, Level 2, John Hopkins Drive, Camperdown, NSW 2006 Australia
- Sydney Local Health District, Sydney, NSW Australia
| | - Caroline S. E. Homer
- Burnet Institute, Melbourne, VIC Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, NSW Australia
| | - Nathalie V. Kizirian
- Sydney Medical School, Charles Perkins Centre, The University of Sydney, The Hub, Level 2, John Hopkins Drive, Camperdown, NSW 2006 Australia
| | - Adrienne Gordon
- Sydney Medical School, Charles Perkins Centre, The University of Sydney, The Hub, Level 2, John Hopkins Drive, Camperdown, NSW 2006 Australia
- Sydney Local Health District, Sydney, NSW Australia
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Ramos SR, Warren R, Shedlin M, Melkus G, Kershaw T, Vorderstrasse A. A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions. Behav Med 2019; 45:166-176. [PMID: 31343963 PMCID: PMC6793989 DOI: 10.1080/08964289.2019.1570074] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 10/26/2022]
Abstract
The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.
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Affiliation(s)
| | - Rueben Warren
- b Tuskegee University National Center for Bioethics in Research and Health Care
| | | | - Gail Melkus
- a New York University Rory Meyers College of Nursing
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Wray TB, Kahler CW, Simpanen EM, Operario D. User-centered, interaction design research approaches to inform the development of health risk behavior intervention technologies. Internet Interv 2019; 15:1-9. [PMID: 30425932 PMCID: PMC6222087 DOI: 10.1016/j.invent.2018.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Computers have tremendous potential for helping people change behaviors that put their health at risk. This potential has led to the development of a variety of health behavior intervention technologies (BITs) in recent years. While many of these BITs have been informed by scientific theories on behavior change, poor design can fail to engage intended users. User-centered, interaction design (IxD) research can help BIT developers create tools that are intuitive and enjoyable and that align with intended users' goals. In this manuscript, we describe an IxD research process we used to inform the development of a tablet-optimized web application designed to help heavy drinking gay and bisexual men reduce their risk for HIV when they seek HIV testing. METHODS We conducted focus groups with subject matter experts (SMEs, N = 10) and intended users (N = 25). In the SME group, HIV test counselors were recruited to provide an understanding of the priorities and challenges of post-test counseling. In focus groups with intended users, participants created detailed, personalized models of two "typical" users of the proposed app ("personas") that could be used to guide design decisions. RESULTS SMEs emphasized the importance of putting patients at ease, and suggested that interventions should prioritize identifying personal risks and provide options for change. Personas created by intended users provided important details about users' attitudinal and emotional contexts, and their possible motivations and goals for using the app. These suggested that users might be most motivated to use the app in order to understand their personal risks, compare their behavior with others like them, help them decide whether they want to change to reduce their risk, and see all their options for doing so. Personas also provided insights about the aesthetic experience that might be most appealing to users. CONCLUSIONS Interaction design research can provide BIT development teams with personal models of likely users to help guide decisions about the allocation of design resources and the overall form and spirit of the software. These insights can help teams build BITs that are more engaging and interesting to intended users.
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Affiliation(s)
- Tyler B. Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI 02906, United States of America
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Voigt-Radloff S, Schöpf AC, Boeker M, Frank L, Farin E, Kaier K, Körner M, Wollmann K, Lang B, Meerpohl JJ, Möhler R, Niebling W, Serong J, Lange R, van der Keylen P, Maun A. Well informed physician-patient communication in consultations on back pain - study protocol of the cluster randomized GAP trial. BMC FAMILY PRACTICE 2019; 20:33. [PMID: 30803433 PMCID: PMC6388488 DOI: 10.1186/s12875-019-0925-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Back pain is one of the most frequent causes of health-related work absence. In Germany, more than 70% of adults suffer from at least one back pain episode per annum. It has strong impact on health care costs and patients' quality of life. Patients increasingly seek health information on the internet. However, judging its trustworthiness is difficult. In addition, physicians who are being confronted with this type of information often experience it to complicate the physician-patient interaction. The GAP trial aims to develop, implement and evaluate an evidence-based, easy-to-understand and trustworthy internet information portal on lower back pain to be used by general practitioners and patients during and after the consultation. Effectiveness of GAP portal use compared to routine consultation on improving communication and informedness of both physicians and patients will be assessed. In addition, effects on health care costs and patients' days of sick leave will be evaluated. METHODS We will conduct a prospective multi-centre, cluster-randomized parallel group trial including 1500 patients and 150 recruiting general practitioners. The intervention group will have access to the GAP portal. The portal will contain brief guides for patients and physicians on how to improve the consultation as well as information on epidemiology, aetiology, symptoms, benefits and harms of treatment options for acute, sub-acute and chronic lower back pain. The GAP portal will be designed to be user-friendly and present information on back pain tailored for either patients or physicians in form of brief fact sheets, educative videos, info-graphics, animations and glossaries. Physicians and patients will assess their informedness and the physician-patient communication in consultations at baseline and at two time points after the consultations under investigation. Days of sick leave and health care costs related to back pain will be compared between control and intervention group using routine data of company health insurance funds. DISCUSSION The GAP-trial intends to improve the communication between physicians and their patients and the informedness of both groups. If proven beneficial, the evidence-based and user-friendly portal will be made accessible for all patients and health professionals in back pain care. Inclusion of further indications might be implemented and evaluated in the long term. TRIAL REGISTRATION German Clinical Trials Register DRKS00014279 (registered 27th of April 2018).
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Affiliation(s)
- Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Andrea C. Schöpf
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Medical Data Science, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Luca Frank
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Division Methods in Clinical Epidemiology, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs-University, Freiburg, Germany
| | - Katharina Wollmann
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
- Cochrane Germany Foundation, Freiburg, Germany
| | - Britta Lang
- Clinical Trials Unit of the Medical Center, University of Freiburg, Freiburg, Germany
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Ralph Möhler
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wilhelm Niebling
- Division of General Practice, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Serong
- Institute for Journalism, Technical University of Dortmund, Dortmund, Germany
| | - Renate Lange
- Bavarian State Association of Company Health Insurance Funds, Bavarian, Germany
| | - Piet van der Keylen
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
| | - Andy Maun
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Division of General Practice, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Reiners F, Sturm J, Bouw LJW, Wouters EJM. Sociodemographic Factors Influencing the Use of eHealth in People with Chronic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E645. [PMID: 30795623 PMCID: PMC6406337 DOI: 10.3390/ijerph16040645] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
Abstract
Alongside the growing number of older persons, the prevalence of chronic diseases is increasing, leading to higher pressure on health care services. eHealth is considered a solution for better and more efficient health care. However, not every patient is able to use eHealth, for several reasons. This study aims to provide an overview of: (1) sociodemographic factors that influence the use of eHealth; and (2) suggest directions for interventions that will improve the use of eHealth in patients with chronic disease. A structured literature review of PubMed, ScienceDirect, Association for Computing Machinery Digital Library (ACMDL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted using four sets of keywords: "chronic disease", "eHealth", "factors", and "suggested interventions". Qualitative, quantitative, and mixed-method studies were included. Four researchers each assessed quality and extracted data. Twenty-two out of 1639 articles were included. Higher age and lower income, lower education, living alone, and living in rural areas were found to be associated with lower eHealth use. Ethnicity revealed mixed outcomes. Suggested solutions were personalized support, social support, use of different types of Internet devices to deliver eHealth, and involvement of patients in the development of eHealth interventions. It is concluded that eHealth is least used by persons who need it most. Tailored delivery of eHealth is recommended.
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Affiliation(s)
- Fabienne Reiners
- School of Allied Health Professions, Fontys University of Applied Science, P.O. Box 347, 5600 AH Eindhoven, The Netherlands.
| | - Janienke Sturm
- School of HRM and Psychology, Fontys University of Applied Science, P.O. Box 347, 5600 AH Eindhoven, The Netherlands.
| | - Lisette J W Bouw
- School of Allied Health Professions, Fontys University of Applied Science, P.O. Box 347, 5600 AH Eindhoven, The Netherlands.
| | - Eveline J M Wouters
- School of Allied Health Professions, Fontys University of Applied Science, P.O. Box 347, 5600 AH Eindhoven, The Netherlands.
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands.
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Garrido D, Watanabe A, Ciamponi AL, Couto TM, Alves LAC, Haddad AE. Patterns of Internet and smartphone use by parents of children with chronic kidney disease. PLoS One 2019; 14:e0212163. [PMID: 30753212 PMCID: PMC6372181 DOI: 10.1371/journal.pone.0212163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Smartphones have become a part of universal technology by combining mobile and handheld functions, enabling expanded access to health information sources available on the Internet. The purpose of this study was to describe the pattern of smartphones and Internet use to search for health information by parents of children with chronic kidney disease (CKD). METHODS In a cross-sectional study, a questionnaire was applied to 111 parents of patients in a Brazilian pediatric nephrology center. Descriptive assessments were performed on Internet use patterns, and associative analyses were made of the influence of the smartphone use pattern on the search for health information. RESULTS Of the 111 participants, 91% (101/111) accessed the Internet, 88% (89/101) searched for health information, and 90% (80/89) searched for CKD information. Smartphones were the most commonly used devices to access the Internet. There was no significant difference between age groups, schooling levels, places of residence and smartphone use to search information about CKD. Physicians continue to be primary sources of information (87%, 88/101), but now they share space with the Internet, which surpassed traditional sources such as books and other health professionals. There seems to be some discomfort on the part of the parents in admitting their research habit to the physician, considering that 65% (52/80) said they did not discuss the fact that they had looked for information on the Internet with their doctor. Obtaining more information about the disease and gaining knowledge regarding its complications were the main reasons that led to performing a search on the Internet, whose results were considered useful by 93% (74/80). CONCLUSION Parents of children with CKD have been using the Internet largely through smartphones to research about CKD, irrespective of age, schooling and place of residence. Given its wide use, the Internet can be an important vehicle for health education and contribute to providing the support needed by parents and patients to cope with the disease.
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Affiliation(s)
- Deise Garrido
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
- Telehealth Center, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Andreia Watanabe
- Pediatric Nephrology, Department of Pediatrics, Children's Institute, Clinical Hospital, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Lídia Ciamponi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Taciana Mara Couto
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Levy Anderson César Alves
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Estela Haddad
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
- Telehealth Center, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Warrington L, Absolom K, Conner M, Kellar I, Clayton B, Ayres M, Velikova G. Electronic Systems for Patients to Report and Manage Side Effects of Cancer Treatment: Systematic Review. J Med Internet Res 2019; 21:e10875. [PMID: 30679145 PMCID: PMC6365878 DOI: 10.2196/10875] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There has been a dramatic increase in the development of electronic systems to support cancer patients to report and manage side effects of treatment from home. Systems vary in the features they offer to patients, which may affect how patients engage with them and how they improve patient-centered outcomes. OBJECTIVE This review aimed to (1) describe the features and functions of existing electronic symptom reporting systems (eg, symptom monitoring, tailored self-management advice), and (2) explore which features may be associated with patient engagement and patient-centered outcomes. METHODS The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed guidelines from the Centre for Reviews and Dissemination (University of York, United Kingdom). Primary searches were undertaken of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and the Health Technology Assessment databases. Secondary searches were undertaken by screening reference lists and citations. Two researchers applied broad inclusion criteria to identify and select relevant records. Data were extracted and summarized using Microsoft Excel. In order to meet the aims, the study selection, data extraction, and data synthesis comprised two stages: (1) identifying and characterizing available systems and (2) summarizing data on patient engagement and patient-centered outcomes. RESULTS We identified 77 publications relating to 41 distinct systems. In Stage 1, all publications were included (N=77). The features identified that supported clinicians and care were facility for health professionals to remotely access and monitor patient-reported data (24/41, 58%) and function to send alerts to health professionals for severe symptoms (17/41, 41%). Features that supported patients were facility for patients to monitor/review their symptom reports over time (eg, graphs) (19/41, 46%), general patient information about cancer treatment and side effects (17/41, 41%), tailored automated patient advice on symptom management (12/41, 29%), feature for patients to communicate with the health care team (6/41, 15%), and a forum for patients to communicate with one another (4/41, 10%). In Stage 2, only publications that included some data on patient engagement or patient-centered outcomes were included (N=29). A lack of consistency between studies in how engagement was defined, measured, or reported, and a wide range of methods chosen to evaluate systems meant that it was not possible to compare across studies or make conclusions on relationships with system features. CONCLUSIONS Electronic systems have the potential to help patients manage side effects of cancer treatment, with some evidence to suggest a positive effect on patient-centered outcomes. However, comparison across studies is difficult due to the wide range of assessment tools used. There is a need to develop guidelines for assessing and reporting engagement with systems, and a set of core outcomes for evaluation. We hope that this review will contribute to the field by introducing a taxonomy for characterizing system features. TRIAL REGISTRATION PROSPERO CRD42016035915; www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016035915.
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Affiliation(s)
- Lorraine Warrington
- Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Kate Absolom
- Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Beverly Clayton
- Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Michael Ayres
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Galina Velikova
- Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
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Yu XH, Zhong L, Huang J. How online ADHD-related information affects Chinese parents' decisions? World J Pediatr 2019; 15:57-65. [PMID: 30478599 PMCID: PMC6394639 DOI: 10.1007/s12519-018-0207-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a major public health problem in China. Parents of children with confirmed, or suspected ADHD often face a difficult process in making decisions concerning diagnosis and treatment. The internet is a major source of information for parents. The purpose of this study is to survey Chinese parental motivation and experience in using the internet to retrieve ADHD-related information, and how well online information is associated with making decisions. METHODS Parents were recruited to fill out an online questionnaire in the health portal. A total of 404 valid questionnaires were collected. RESULTS A total of 47.8% of parents agree that the internet helps them to understand the potential treatment options, but 77.7% of all parents still have conflict during decision-making. CONCLUSIONS Parents search for ADHD-related information online, but their acquisition skills need to be improved. Internet information affects their health decisions. Parents still have highly conflicting decision-making. Improving the ability of parents to obtain information on the Internet may reduce the conflict in decision-making.
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Affiliation(s)
- Xiao-He Yu
- Department of Pediatrics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China.
| | - Le Zhong
- Department of Pediatrics, Distinct Healthcare, Shenzhen, 518000, China
| | - Jia Huang
- Department of Pediatrics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China
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Vázquez FL, Otero P, García-Casal JA, Blanco V, Torres ÁJ, Arrojo M. Efficacy of video game-based interventions for active aging. A systematic literature review and meta-analysis. PLoS One 2018; 13:e0208192. [PMID: 30533015 PMCID: PMC6289420 DOI: 10.1371/journal.pone.0208192] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/13/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Due to the appeal and recent technological advances of video games, the games have gained interest as an intervention tool for active aging. The aim of this systematic literature review and meta-analysis was to determine the efficacy of video games for active aging and to examine the influence of potential moderator variables. METHODS A systematic search was done using the following databases: Medline, PsycINFO, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. In addition, previous reviews and meta-analyses were used to identify randomized controlled trials (RCT) of video game-based interventions for active aging published through February 28, 2018. An evaluation of the methodological quality of the articles and a meta-analysis and moderator analysis was conducted. RESULTS A total of 22 articles depicting 21 RCT with 1125 participants were included. The results indicated that video game-based interventions produced positive effects on objectively measured physical health, negative affect and social health, with small effect sizes (d = 0.41, d = 0.26 and d = 0.40, respectively). The magnitude of this effect was moderated by the presence of subclinical conditions of participants, the type of game (exergames), the presence of physical activity, the type of prevention (indicated), non-blinded assignation, and older age of participants. The methodological quality of the studies was acceptable, the weakest area being external validity. CONCLUSION These finding indicate that video game-based interventions may assist adults in leading active aging processes and preventing secondary aging. Although more research is needed, video game-based interventions are a promising and accessible tool for active aging promotion.
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Affiliation(s)
- Fernando L. Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Patricia Otero
- Department of Psychology, University of A Coruña, A Coruña, Spain
| | - J. Antonio García-Casal
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanessa Blanco
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángela J. Torres
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain
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Nguyen BJ, Kim Y, Park K, Chen AJ, Chen S, Van Fossan D, Chao DL. Improvement in Patient-Reported Quality of Life Outcomes in Severely Visually Impaired Individuals Using the Aira Assistive Technology System. Transl Vis Sci Technol 2018; 7:30. [PMID: 30386682 PMCID: PMC6205681 DOI: 10.1167/tvst.7.5.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/18/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose We evaluate patient-reported quality of life outcomes in severely visually impaired (SVI) individuals using the Aira system, an on demand assistive wearable technology. Methods Aira is an on-demand assistive wearable technology designed for the severely visually impaired (visual acuity of better eye <20/200). The user wears glasses with a video camera mounted that, when activated, livestreams to a human agent who assists the user in the specified task. Aira subscribers were recruited consecutively and administered the 28-item Impact of Vision Impairment-Very Low Vision (IVI-VLV) Questionnaire, a previously validated survey for vision-related quality of life specifically for low vision individuals. The questionnaire was administered by phone before starting Aira and at 3-month follow-up. Total score as well as validated subset scores of activities of daily living, mobility and safety (ADLMS) and emotional wellbeing (EWB) were assessed. Results A total of 69 participants (mean age, 52.1; 35 female, 34 male) were recruited with a mean of 108 (SD = 19.7) days to follow-up. Mean total minutes used over the interval were 334.1 (SD = 318.5). Initial total score (mean 51.7 ± 18.6) significantly improved at follow-up (mean 62.2 ± 15.0; P < 0.0001) with mean change +10.4 ± 12.5. ADLMS subset score (mean 30.4 ± 10.8) significantly improved at follow-up (mean 36.6 ± 8.8; P < 0.0001) with mean change +6.5 ± 8.7. EWB subset score (mean 21.6 ± 8.8) significantly improved at follow-up (mean 25.6 ± 7.9 respectively; P < 0.0001) with mean change +4.0 ± 5.2. There was no correlation between minutes used and improvement in total (r = −0.205, P = 0.098), ADLMS (r = −0.237, P = 0.055), and EWB (r = −0.242, P = 0.051) scores. Conclusions In this exploratory study, regardless of minutes used, the use of Aira significantly improves IVI-VLV total score and ADLMS and EWB subscores for SVI individuals. This improvement is not correlated with total minutes used. Translational Relevance The Aira assistive technology system may provide improvement in quality of life for low vision patients and is worthy of further study to assess the use of this technology to assist SVI patients.
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Affiliation(s)
- Brian J Nguyen
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Yeji Kim
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Kathryn Park
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Allison J Chen
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Scarlett Chen
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Donald Van Fossan
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Daniel L Chao
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
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Petersson C, Björkander J, Fust R. Discovering aspects of health-experiences of a web-based health diary among adults with primary immunodeficiency. Nurs Open 2018; 5:642-648. [PMID: 30338110 PMCID: PMC6178285 DOI: 10.1002/nop2.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/30/2018] [Indexed: 11/28/2022] Open
Abstract
AIM Advances in technology generate new opportunities to develop e-health tools to help individuals in self-management by assessing symptoms of illness and its relation to treatments. Self-management is central when living with primary immunodeficiency diseases. The aim was to explore the experiences of people living with primary immunodeficiency, who used a pilot version of the web-based health diary. DESIGN Explorative design. METHODS In total, 16 participants (median age 59) attended one of three focus groups. Inductive content analysis was used. RESULTS The participants could be encouraged to discover aspects of their health by contributing to documentation which could support the health concept. A greater understanding about their own health and communicating with healthcare professionals during encounters was expressed. The web-based health diary is a helpful tool to discover aspects of health that affects the individuals' life situation and assists the self-management of a long-term condition such as immunodeficiency.
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Affiliation(s)
- Christina Petersson
- Department of Nursing at School of Health and Welfare, Jönköping University and Member of IMPROVE Research Group at the Academy for Improvement of Health and WelfareJönköping UniversitySweden
| | - Janne Björkander
- Academy for Health and CareFuturumJönköpingSweden
- Department of Clinical ImmunologyUniversity Hospital of LinköpingLinköpingSweden
| | - Ramona Fust
- Department of Infectious DiseasesUniversity Hospital of Linköping LinköpingSweden
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Higgins KS, Tutelman PR, Chambers CT, Witteman HO, Barwick M, Corkum P, Grant D, Stinson JN, Lalloo C, Robins S, Orji R, Jordan I. Availability of researcher-led eHealth tools for pain assessment and management: barriers, facilitators, costs, and design. Pain Rep 2018; 3:e686. [PMID: 30324177 PMCID: PMC6172815 DOI: 10.1097/pr9.0000000000000686] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Numerous eHealth tools for pain assessment and management have been developed and evaluated with promising results regarding psychometric properties, efficacy, and effectiveness. Although considerable resources are spent on developing and evaluating these tools with the aim of increasing access to care, current evidence suggests they are not made available to end users, reducing their impact and creating potential research waste. METHODS This study consisted of 2 components: (1) a systematic review of eHealth tools for pediatric pain assessment and/or management published in the past 10 years, and (2) an online survey, completed by the authors of identified tools, of tool availability, perceived barriers or facilitators to availability, grant funding used, and a validated measure of user-centeredness of the design process (UCD-11). RESULTS Ninety articles (0.86% of citations screened) describing 53 tools met inclusion criteria. Twenty-six survey responses were completed (49.06%), 13 of which (50.00%) described available tools. Commonly endorsed facilitators of tool availability included researchers' beliefs in tool benefits to the target population and research community; barriers included lack of infrastructure and time. The average cost of each unavailable tool was $314,425.31 USD ($3,144,253.06 USD total, n = 10). Authors of available tools were more likely to have followed user-centered design principles and reported higher total funding. CONCLUSION Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste. User-centered design and implementation science methods could improve the availability of eHealth tools and should be further explored in future studies.
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Affiliation(s)
- Kristen S. Higgins
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Holly O. Witteman
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec City, Canada
- CHU de Québec, Québec City, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Colchester East Hands ADHD Clinic, Colchester East Hants Health Authority, Truro, Canada
| | - Doris Grant
- Industry Liaison and Innovation, Dalhousie University, Halifax, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Chronic Pain Program, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Sue Robins
- Patient Advocate and Partner, Bird Communications, Vancouver, Canada
| | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
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Murray E, Ross J, Pal K, Li J, Dack C, Stevenson F, Sweeting M, Parrott S, Barnard M, Yardley L, Michie S, May C, Patterson D, Alkhaldi G, Fisher B, Farmer A, O’Donnell O. A web-based self-management programme for people with type 2 diabetes: the HeLP-Diabetes research programme including RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background
In the UK, 6% of the UK population have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Diabetes mellitus accounts for 10% of NHS expenditure (£14B annually). Good self-management may improve health outcomes. NHS policy is to refer all people with T2DM to structured education, on diagnosis, to improve their self-management skills, with annual reinforcement thereafter. However, uptake remains low (5.6% in 2014–15). Almost all structured education is group based, which may not suit people who work, who have family or other caring commitments or who simply do not like group-based formats. Moreover, patient needs vary with time and a single education session at diagnosis is unlikely to meet these evolving needs. A web-based programme may increase uptake.
Objectives
Our aim was to develop, evaluate and implement a web-based self-management programme for people with T2DM at any stage of their illness journey, with the goal of improving access to, and uptake of, self-management support, thereby improving health outcomes in a cost-effective manner. Specific objectives were to (1) develop an evidence-based theoretically informed programme that was acceptable to patients and health-care professionals (HCPs) and that could be readily implemented within routine NHS care, (2) determine the clinical effectiveness and cost-effectiveness of the programme compared with usual care and (3) determine how best to integrate the programme into routine care.
Design
There were five linked work packages (WPs). WP A determined patient requirements and WP B determined HCP requirements for the self-management programme. WP C developed and user-tested the Healthy Living for People with type 2 Diabetes (HeLP-Diabetes) programme. WP D was an individually randomised controlled trial in primary care with a health economic analysis. WP E used a mixed-methods and case-study design to study the potential for implementing the HeLP-Diabetes programme within routine NHS practice.
Setting
English primary care.
Participants
People with T2DM (WPs A, D and E) or HCPs caring for people with T2DM (WPs B, C and E).
Intervention
The HeLP-Diabetes programme; an evidence-based theoretically informed web-based self-management programme for people with T2DM at all stages of their illness journey, developed using participatory design principles.
Main outcome measures
WPs A and B provided data on user ‘wants and needs’, including factors that would improve the uptake and accessibility of the HeLP-Diabetes programme. The outcome for WP C was the HeLP-Diabetes programme itself. The trial (WP D) had two outcomes measures: glycated haemoglobin (HbA1c) level and diabetes mellitus-related distress, as measured with the Problem Areas in Diabetes (PAID) scale. The implementation outcomes (WP E) were the adoption and uptake at clinical commissioning group, general practice and patient levels and the identification of key barriers and facilitators.
Results
Data from WPs A and B supported our holistic approach and addressed all areas of self-management (medical, emotional and role management). HCPs voiced concerns about linkage with the electronic medical records (EMRs) and supporting patients to use the programme. The HeLP-Diabetes programme was developed and user-tested in WP C. The trial (WP D) recruited to target (n = 374), achieved follow-up rates of over 80% and the intention-to-treat analysis showed that there was an additional improvement in HbA1c levels at 12 months in the intervention group [mean difference –0.24%, 95% confidence interval (CI) –0.44% to –0.049%]. There was no difference in overall PAID score levels (mean difference –1.5 points, 95% CI –3.9 to 0.9 points). The within-trial health economic analysis found that incremental costs were lower in the intervention group than in the control group (mean difference –£111, 95% CI –£384 to £136) and the quality-adjusted life-years (QALYs) were higher (mean difference 0.02 QALYs, 95% CI 0.000 to 0.044 QALYs), meaning that the HeLP-Diabetes programme group dominated the control group. In WP E, we found that the HeLP-Diabetes programme could be successfully implemented in primary care. General practices that supported people in registering for the HeLP-Diabetes programme had better uptake and registered patients from a wider demographic than those relying on patient self-registration. Some HCPs were reluctant to do this, as they did not see it as part of their professional role.
Limitations
We were unable to link the HeLP-Diabetes programme with the EMRs or to determine the effects of the HeLP-Diabetes programme on users in the implementation study.
Conclusions
The HeLP-Diabetes programme is an effective self-management support programme that is implementable in primary care.
Future work
The HeLP-Diabetes research team will explore the following in future work: research to determine how to improve patient uptake of self-management support; develop and evaluate a structured digital educational pathway for newly diagnosed people; develop and evaluate a digital T2DM prevention programme; and the national implementation of the HeLP-Diabetes programme.
Trial registration
Research Ethics Committee reference number 10/H0722/86 for WPs A–C; Research Ethics Committee reference number 12/LO/1571 and UK Clinical Research Network/National Institute for Health Research (NIHR) Portfolio 13563 for WP D; and Research Ethics Committee 13/EM/0033 for WP E. In addition, for WP D, the study was registered with the International Standard Randomised Controlled Trial Register as reference number ISRCTN02123133.
Funding details
This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 6, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jamie Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kingshuk Pal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Charlotte Dack
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Maria Barnard
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Susan Michie
- Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - David Patterson
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Ghadah Alkhaldi
- Research Department of Primary Care and Population Health, University College London, London, UK
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Brian Fisher
- Patient Access to Electronic Records Systems Ltd (PAERS), Evergreen Life, Manchester, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Orla O’Donnell
- Research Department of Primary Care and Population Health, University College London, London, UK
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Griffiths AJ, White CM, Thain PK, Bearne LM. The effect of interactive digital interventions on physical activity in people with inflammatory arthritis: a systematic review. Rheumatol Int 2018; 38:1623-1634. [PMID: 29556750 PMCID: PMC6105152 DOI: 10.1007/s00296-018-4010-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/12/2018] [Indexed: 12/05/2022]
Abstract
The aim of this systematic review was to evaluate the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of interactive digital interventions (IDIs) for physical activity (PA) and health related quality of life (HRQoL) in people with Inflammatory Arthritis [rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) axial Spondyloarthritis (AS) and psoriatic arthritis (PsA)]. Seven electronic databases identified published and unpublished studies. Two reviewers conducted independent data extraction and quality assessment using the Cochrane risk of bias tool (RoB). The primary outcome was change in objective PA after the intervention; secondary outcomes included self-reported PA and HRQoL after the intervention and objective or self-reported PA at least 1 year later. Five manuscripts, reporting four RCTs (three high and one low RoB) representing 492 (459 RA, 33 JIA) participants were included. No trials studying PsA or AS met the inclusion criteria. Interventions ranged from 6 to 52 weeks and included 3-18 Behaviour Change Techniques. Due to heterogeneity of outcomes, a narrative synthesis was conducted. No trials reported any significant between group differences in objective PA at end of intervention. Only one low RoB trial found a significant between group difference in self-reported vigorous [MD Δ 0.9 days (95% CI 0.3, 1.5); p = 0.004], but not moderate, PA in people with RA but not JIA. There were no between group differences in any other secondary outcomes. There is very limited evidence for the effectiveness of IDIs on PA and HRQoL in RA and JIA and no evidence for their effectiveness in PsA or AS.
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Affiliation(s)
- Alison J. Griffiths
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King’s College London, Addison House, Guys Campus, London, SE1 1UL UK
| | - Claire M. White
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King’s College London, Addison House, Guys Campus, London, SE1 1UL UK
| | - Peter K. Thain
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King’s College London, Addison House, Guys Campus, London, SE1 1UL UK
| | - Lindsay M. Bearne
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King’s College London, Addison House, Guys Campus, London, SE1 1UL UK
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84
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Sturm AC, Schmidlen T, Scheinfeldt L, Hovick S, McElroy JP, Toland AE, Roberts JS, Sweet K. Early Outcome Data Assessing Utility of a Post-Test Genomic Counseling Framework for the Scalable Delivery of Precision Health. J Pers Med 2018; 8:jpm8030025. [PMID: 30046027 PMCID: PMC6164140 DOI: 10.3390/jpm8030025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 12/02/2022] Open
Abstract
Information on patients’ preferences is essential to guide the development of more efficient genomic counseling service delivery models. We examined patient preferences in the context of use of a post-test genomic counseling framework on patients (n = 44) with chronic disease receiving online test reports for eight different diseases and one drug-response result. We also explored patients’ disease risk awareness, recall of test report information, and confidence in knowing what to do with their test results. Prior to the post-test genomic counseling session, all participants viewed at least one test report; 81.6% of available test reports were reviewed in total. Participants requested more phone (36) than in-person counseling sessions (8), and phone sessions were shorter (mean 29.1 min; range 12–75 min) than in-person sessions (mean 52.8 min; range 23–85 min). A total of 182 test reports were discussed over the course of 44 counseling sessions (mean 4.13, range 1–9). Thirty-six (81.8%) participants requested assessment for additional medical/family history concerns. In exploring patient experiences of disease risk awareness and recall, no significant differences were identified in comparison to those of participants (n = 199) that had received in-person post-test genomic counseling in a parent study randomized controlled trial (RCT). In summary, a novel post-test genomic counseling framework allowed for a tailored approach to counseling based on the participants’ predetermined choices.
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Affiliation(s)
- Amy C Sturm
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH 43221, USA.
- Genomic Medicine Institute, Geisinger, Danville, PA 17821, USA.
| | - Tara Schmidlen
- Genomic Medicine Institute, Geisinger, Danville, PA 17821, USA.
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA.
| | - Laura Scheinfeldt
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA.
| | - Shelly Hovick
- School of Communication, Ohio State University, Columbus, OH 43214, USA.
| | - Joseph P McElroy
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH 43221, USA.
| | - Amanda E Toland
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH 43221, USA.
| | - J Scott Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - Kevin Sweet
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH 43221, USA.
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85
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Feldman DI, Theodore Robison W, Pacor JM, Caddell LC, Feldman EB, Deitz RL, Feldman T, Martin SS, Nasir K, Blaha MJ. Harnessing mHealth technologies to increase physical activity and prevent cardiovascular disease. Clin Cardiol 2018; 41:985-991. [PMID: 29671879 DOI: 10.1002/clc.22968] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/04/2018] [Accepted: 04/16/2018] [Indexed: 11/11/2022] Open
Abstract
Research into prevention of cardiovascular disease has increasingly focused on mobile health (mHealth) technologies and their efficacy in helping individuals adhere to heart-healthy recommendations, including daily physical activity levels. By including the use of mHealth technologies in the discussion of physical activity recommendations, clinicians empower patients to play an active daily role in modifying their cardiovascular risk-factor profile. In this review, we critically evaluate the mHealth and physical activity literature to determine how these tools may lower cardiovascular risk while providing real-time tracking, feedback, and motivation on physical activity levels. We analyze the various domains-including user knowledge, social support, behavioral change theory, and self-motivation-that potentially influence the effectiveness of smartphone applications to impact individual physical activity levels. In doing so, we hope to provide a thorough overview of the mHealth landscape, in addition to highlighting many of the administrative, reimbursement, and patient-privacy challenges of using these technologies in patient care. Finally, we propose a behavioral change model and checklist for clinicians to assist patients in utilizing mHealth technology to best achieve meaningful changes in daily physical activity levels.
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Affiliation(s)
- David I Feldman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - W Theodore Robison
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin M Pacor
- Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Luke C Caddell
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Erica B Feldman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Rachel L Deitz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Theodore Feldman
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.,Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
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86
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Suh SR, Lee MK. Effects of Nurse-Led Telephone-Based Supportive Interventions for Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2018. [PMID: 28632251 DOI: 10.1188/17.onf.e168-e184] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION To evaluate the effects of nurse-led telephone-based supportive interventions (NTSIs) for patients with cancer.
. LITERATURE SEARCH Electronic databases, including EMBASE®, MEDLINE, Google Scholar,
Cochrane Library CENTRAL, ProQuest Medical Library, and CINAHL®, were searched through February 2016.
. DATA EVALUATION 239 studies were identified; 16 were suitable for meta-analysis. Cochrane's risk of bias tool and the Comprehensive Meta-Analysis software were used.
. SYNTHESIS The authors performed a meta-analysis of 16 trials that met eligibility criteria. Thirteen randomized, controlled trials (RCTs) and three non-RCTs examined a total of 2,912 patients with cancer. Patients who received NTSIs were compared with those who received attentional control or usual care (no intervention).
. CONCLUSIONS Telephone interventions delivered by a nurse in an oncology care setting reduced cancer symptoms with a moderate effect size (ES) (-0.33) and emotional distress with a small ES (-0.12), and improved self-care with a large ES (0.64) and health-related quality of life (HRQOL) with a small ES (0.3). Subgroup analyses indicated that the significant effects of NTSIs on cancer symptoms, emotional distress, and HRQOL were larger for studies that combined an application of a theoretical framework, had a control group given usual care, and used an RTC design.
. IMPLICATIONS FOR RESEARCH The findings suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of NTSI for adoption of specific care models.
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87
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Dehghani A, Dehghan Nayeri N, Ebadi A. Features of Coping with Disease in Iranian Multiple Sclerosis Patients: a Qualitative Study. J Caring Sci 2018; 7:35-40. [PMID: 29637055 PMCID: PMC5889796 DOI: 10.15171/jcs.2018.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 11/28/2017] [Indexed: 02/03/2023] Open
Abstract
Introduction: Coping with disease is of the main
components improving the quality of life in multiple sclerosis patients.
Identifying the characteristics of this concept is based on the experiences of
patients. Using qualitative research is essential to improve the quality of
life. This study was conducted to explore the features of coping with the
disease in patients with multiple sclerosis.
Method: In this conventional
content analysis study, eleven multiple sclerosis patients from Iran MS Society
in Tehran (Iran) participated. Purposive sampling was used to select
participants. Data were gathered using semi structured interviews. To analyze
data, a conventional content analysis approach was used to identify meaning
units and to make codes and categories.
Results: Results showed that features
of coping with disease in multiple sclerosis patients consists of (a) accepting
the current situation, (b) maintenance and development of human interactions,
(c) self-regulation and (d) self-efficacy. Each of these categories is composed
of sub-categories and codes that showed the perception and experience of
patients about the coping with disease.
Conclusion: Accordingly, a unique set of features regarding
features of coping with the disease were identified among the patients with
multiple sclerosis. Therefore, working to ensure the emergence of, and
subsequent reinforcement of these features in MS patients can be an important
step in improving the adjustment and quality of their lives.
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Affiliation(s)
- Ali Dehghani
- Department of Nursing, Faculty of Nursing and Paramedical, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Nahid Dehghan Nayeri
- Department of Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Department of Nursing, Behavioral Sciences Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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88
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Santarossa S, Kane D, Senn CY, Woodruff SJ. Exploring the Role of In-Person Components for Online Health Behavior Change Interventions: Can a Digital Person-to-Person Component Suffice? J Med Internet Res 2018; 20:e144. [PMID: 29643048 PMCID: PMC5917076 DOI: 10.2196/jmir.8480] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/23/2018] [Accepted: 02/25/2018] [Indexed: 12/27/2022] Open
Abstract
The growth of the digital environment provides tremendous opportunities to revolutionize health behavior change efforts. This paper explores the use of Web-based, mobile, and social media health behavior change interventions and determines whether there is a need for a face-to-face or an in-person component. It is further argued that that although in-person components can be beneficial for online interventions, a digital person-to-person component can foster similar results while dealing with challenges faced by traditional intervention approaches. Using a digital person-to-person component is rooted in social and behavioral theories such as the theory of reasoned action, and the social cognitive theory, and further justified by the human support constructs of the model of supportive accountability. Overall, face-to-face and online behavior change interventions have their respective advantages and disadvantages and functions, yet both serve important roles. It appears that it is in fact human support that is the most important component in the effectiveness and adherence of both face-to-face and online behavior change interventions, and thoughtfully introducing a digital person-to-person component, to replace face-to-face interactions, can provide the needed human support while diminishing the barriers of in-person meetings. The digital person-to-person component must create accountability, generate opportunities for tailored feedback, and create social support to successfully create health behavior change. As the popularity of the online world grows, and the interest in using the digital environment for health behavior change interventions continues to be embraced, further research into not only the use of online interventions, but the use of a digital person-to-person component, must be explored.
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Affiliation(s)
- Sara Santarossa
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Deborah Kane
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Charlene Y Senn
- Department of Psychology, University of Windsor, Windsor, ON, Canada.,Department of Women's and Gender Studies, University of Windsor, Windsor, ON, Canada
| | - Sarah J Woodruff
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
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89
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Improvement of medication adherence in adolescents and young adults with SLE using web-based education with and without a social media intervention, a pilot study. Pediatr Rheumatol Online J 2018; 16:18. [PMID: 29540181 PMCID: PMC5852975 DOI: 10.1186/s12969-018-0232-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Self-management skills, including medication management, are vital to the health of adolescents and young adults with systemic lupus erythematosus (SLE). The purpose of this study was to assess the feasibility and preliminary effects of an online educational program in a cohort of adolescent and young adults with SLE with and without a social media (SM) experience. METHODS Adolescents and young adults with SLE participated weekly for 8 sessions on a web-based educational program about SLE created specifically for this project. Subjects were randomized to respond to questions at the end of each weekly module in a journal or on a SM forum with other SLE subjects. Patients were surveyed prior to initiating the study, (T0) and 6 weeks after completion of the sessions (T1). Medication adherence for hydroxychloroquine, utilizing the medication possession ratio (MPR), was compared for the 3 months preceding T0 and for the 3 months following T1. RESULTS Twenty-seven of the 37 subjects (73%) enrolled completed the study, including the two required sets of surveys. Reasons for being lost to follow up included being too busy, forgetting, and/or not seeing email reminders. Medication adherence improved in all subjects (p < 0.001). The percentage of the SM intervention group that was adherent (MPR ≥ 80%) significantly improved from 50% to 92% (p = 0.03), while the control group did not. Secondary outcome measures that improved, only in the SM group, included self-efficacy, sense of agency (SOA), sense of community (SOC), and empowerment. There was a strong correlation between empowerment with SOA and SOC and in turn a strong correlation with SOA and SOC with MPR, providing a possible explanation for why social media participation helped to improve medication adherence. Subjective reporting of medication adherence was not reliably correlated to MPR. CONCLUSIONS This pilot study has demonstrated feasibility for the use of an online educational SLE website, recruitment, and measurement of chosen outcome measures. This study provides evidence for a larger multi-site trial which has the potential to address an important service gap by delivering self-management education and peer interactions in a format that is accessible, and engaging to young people with SLE. TRIAL REGISTRATION Trial registration: NCT03218033 . Retrospectively registered 14 July 2017.
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90
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Çetin Ç, Cebeci F. Effects of Web-Based Educational Intervention on Self-Management in Kidney Recipients. EXP CLIN TRANSPLANT 2018. [PMID: 29528006 DOI: 10.6002/ect.tond-tdtd2017.p9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Information technology and the Internet are rapidly becoming effective tools for teaching. Selfmanagement skills are important for adaptation and long-term survival in kidney recipients. Web-based training may help patients develop self-management skills through information access. This literature review aimed to determine the effects of Web-based educational intervention on self-management in kidney recipients. The Internet supports effective health education intervention strategies by providing a learning environment that is always available. Medicine management, routine follow-up, awareness of the signs and symptoms of rejection, infection prevention, self-monitoring, physical activity, and nutrition are important during the posttransplant period. Another important component of achievement in related matters is the competence of individuals with their own self-management. Webbased training is beneficial for appointment follow-up, nutritional adaptation, and treatment of anxiety and depression. Web-based training allows kidney recipients to access information at any time and place; this information promotes proper self-management.
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Affiliation(s)
- Çiğdem Çetin
- From the Surgical Nursing Department, Akdeniz University Faculty of Nursing, Antalya, Turkey
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91
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Kotecha D, Chua WWL, Fabritz L, Hendriks J, Casadei B, Schotten U, Vardas P, Heidbuchel H, Dean V, Kirchhof P. European Society of Cardiology smartphone and tablet applications for patients with atrial fibrillation and their health care providers. Europace 2018; 20:225-233. [PMID: 29040548 PMCID: PMC5834097 DOI: 10.1093/europace/eux299] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/02/2017] [Indexed: 01/02/2023] Open
Abstract
We are in the midst of a digital revolution in health care, although the application of new and useful technology in routine clinical practice is variable. The Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly (CATCH ME) Consortium, in collaboration with the European Society of Cardiology (ESC), has funded the creation of two applications (apps) in atrial fibrillation (AF) for use in smartphones and tablets. The patient app aims to enhance patient education, improve communication between patients and health care professionals, and encourage active patient involvement in the management of their condition. The health care professional app is designed as an interactive management tool incorporating the new ESC Practice Guidelines on AF and supported by the European Heart Rhythm Association (EHRA), with the aim of improving best practice approaches for the care of patients with AF. Both stand-alone apps are now freely available for Android and iOS devices though the Google Play, Amazon, and Apple stores. In this article, we outline the rationale for the design and implementation of these apps. Our objective is to demonstrate the value of integrating novel digital technology into clinical practice, with the potential for patient engagement, optimization of pharmacological and interventional therapy in AF, and ultimately to improve patient outcomes.
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Affiliation(s)
- Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, The Medical School, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK
- Cardiology Department, University Hospitals Birmingham NHS Trust and Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Corresponding author. Tel: +44 121 371 8122; fax: +44 121 371 4175. E-mail address:
| | - Winnie W L Chua
- University of Birmingham Institute of Cardiovascular Sciences, The Medical School, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK
| | - Larissa Fabritz
- University of Birmingham Institute of Cardiovascular Sciences, The Medical School, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK
- Cardiology Department, University Hospitals Birmingham NHS Trust and Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Department of Cardiovascular Medicine, University Hospital Muenster, Germany
| | - Jeroen Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide, Australia
- Department of Medical and Health Sciences, University of Linköping, Sweden
| | - Barbara Casadei
- Division of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+ and Maastricht Centre for Systems Biology, Maastricht, The Netherlands
| | - Panos Vardas
- Cardiology Department, University Hospital of Heraklion, Crete, Greece
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Veronica Dean
- European Society of Cardiology, Sophia-Antipolis, France
| | - Paulus Kirchhof
- University of Birmingham Institute of Cardiovascular Sciences, The Medical School, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK
- Cardiology Department, University Hospitals Birmingham NHS Trust and Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Department of Cardiovascular Medicine, University Hospital Muenster, Germany
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Lobban F, Appleton V, Appelbe D, Barraclough J, Bowland J, Fisher NR, Foster S, Johnson S, Lewis E, Mateus C, Mezes B, Murray E, O'Hanlon P, Pinfold V, Rycroft-Malone J, Siddle R, Smith J, Sutton CJ, Walker A, Jones SH. IMPlementation of A Relatives' Toolkit (IMPART study): an iterative case study to identify key factors impacting on the implementation of a web-based supported self-management intervention for relatives of people with psychosis or bipolar experiences in a National Health Service: a study protocol. Implement Sci 2017; 12:152. [PMID: 29282135 PMCID: PMC5745602 DOI: 10.1186/s13012-017-0687-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Web-based interventions to support people to manage long-term health conditions are available and effective but rarely used in clinical services. The aim of this study is to identify critical factors impacting on the implementation of an online supported self-management intervention for relatives of people with recent onset psychosis or bipolar disorder into routine clinical care and to use this information to inform an implementation plan to facilitate widespread use and inform wider implementation of digital health interventions. METHODS A multiple case study design within six early intervention in psychosis (EIP) services in England, will be used to test and refine theory-driven hypotheses about factors impacting on implementation of the Relatives' Education And Coping Toolkit (REACT). Qualitative data including behavioural observation, document analysis, and in-depth interviews collected in the first two EIP services (wave 1) and analysed using framework analysis, combined with quantitative data describing levels of use by staff and relatives and impact on relatives' distress and wellbeing, will be used to identify factors impacting on implementation. Consultation via stakeholder workshops with staff and relatives and co-facilitated by relatives in the research team will inform development of an implementation plan to address these factors, which will be evaluated and refined in the four subsequent EIP services in waves 2 and 3. Transferability of the implementation plan to non-participating services will be explored. DISCUSSION Observation of implementation in a real world clinical setting, across carefully sampled services, in real time provides a unique opportunity to understand factors impacting on implementation likely to be generalizable to other web-based interventions, as well as informing further development of implementation theories. However, there are inherent challenges in investigating implementation without influencing the process under observation. We outline our strategies to ensure our design is transparent, flexible, and responsive to the timescales and activities happening within each service whilst also meeting the aims of the project. TRIAL REGISTRATION ISCTRN 16267685 (09/03/2016).
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Affiliation(s)
- Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK.
| | - Victoria Appleton
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
| | - Duncan Appelbe
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Block F, Waterhouse Bld 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Johanna Barraclough
- Doctorate in Clinical Psychology Programme, Furness College, Lancaster University, Lancaster, LA1 4YG, UK
| | - Julie Bowland
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
| | - Naomi R Fisher
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
| | - Sheena Foster
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, 6th Floor, Maple House, London, W1T 7BN, UK
| | - Elizabeth Lewis
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
| | - Céu Mateus
- Division of Health Research, Lancaster University Furness College, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
| | - Barbara Mezes
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, Upper floor 3, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Puffin O'Hanlon
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Vanessa Pinfold
- The McPin Foundation, 32-36 Loman Street, London, SE1 0EH, UK
| | - Jo Rycroft-Malone
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, College Road, Bangor, LL572DG, UK
| | - Ron Siddle
- Cumbria Partnership NHS Foundation Trust, Penrith, UK
| | - Jo Smith
- Institute of Health and Society, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK
| | - Chris J Sutton
- Lancashire Clinical Trials Unit, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Andrew Walker
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK
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93
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Young A, Tordoff J, Smith A. ‘What do patients want?’ Tailoring medicines information to meet patients' needs. Res Social Adm Pharm 2017; 13:1186-1190. [DOI: 10.1016/j.sapharm.2016.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022]
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Sharpe EE, Karasouli E, Meyer C. Examining Factors of Engagement With Digital Interventions for Weight Management: Rapid Review. JMIR Res Protoc 2017; 6:e205. [PMID: 29061557 PMCID: PMC5673884 DOI: 10.2196/resprot.6059] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 02/02/2017] [Accepted: 09/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital interventions for weight management provide a unique opportunity to target daily lifestyle choices and eating behaviors over a sustained period of time. However, recent evidence has demonstrated a lack of user engagement with digital health interventions, impacting on the levels of intervention effectiveness. Thus, it is critical to identify the factors that may facilitate user engagement with digital health interventions to encourage behavior change and weight management. OBJECTIVE The aim of this study was to identify and synthesize the available evidence to gain insights about users' perspectives on factors that affect engagement with digital interventions for weight management. METHODS A rapid review methodology was adopted. The search strategy was executed in the following databases: Web of Science, PsycINFO, and PubMed. Studies were eligible for inclusion if they investigated users' engagement with a digital weight management intervention and were published from 2000 onwards. A narrative synthesis of data was performed on all included studies. RESULTS A total of 11 studies were included in the review. The studies were qualitative, mixed-methods, or randomized controlled trials. Some of the studies explored features influencing engagement when using a Web-based digital intervention, others specifically explored engagement when accessing a mobile phone app, and some looked at engagement after text message (short message service, SMS) reminders. Factors influencing engagement with digital weight management interventions were found to be both user-related (eg, perceived health benefits) and digital intervention-related (eg, ease of use and the provision of personalized information). CONCLUSIONS The findings highlight the importance of incorporating user perspectives during the digital intervention development process to encourage engagement. The review contributes to our understanding of what facilitates user engagement and points toward a coproduction approach for developing digital interventions for weight management. Particularly, it highlights the importance of thinking about user-related and digital tool-related factors from the very early stages of the intervention development process.
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Affiliation(s)
| | - Eleni Karasouli
- Division of Clinical Trials, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Caroline Meyer
- Warwick Manufacturing Group, University of Warwick, Coventry, United Kingdom
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95
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Staszewska A, Zaki P, Lee J. Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review. JMIR Med Inform 2017; 5:e36. [PMID: 28986341 PMCID: PMC5650682 DOI: 10.2196/medinform.6405] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 07/31/2017] [Accepted: 08/09/2017] [Indexed: 12/26/2022] Open
Abstract
Background Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decision making, and increase modification of previous decisions. Objective The purpose of this systematic review is to assess the impact of computerized decision aids on patient-centered outcomes related to SDM for seriously ill patients. Methods PubMed and Scopus databases were searched to identify randomized controlled trials (RCTs) that assessed the impact of computerized decision aids on patient-centered outcomes and SDM in serious illness. Six RCTs were identified and data were extracted on study population, design, and results. Risk of bias was assessed by a modified Cochrane Risk of Bias Tool for Quality Assessment of Randomized Controlled Trials. Results Six RCTs tested decision tools in varying serious illnesses. Three studies compared different computerized decision aids against each other and a control. All but one study demonstrated improvement in at least one patient-centered outcome. Computerized decision tools may reduce unnecessary treatment in patients with low disease severity in comparison with informational pamphlets. Additionally, electronic health record (EHR) portals may provide the opportunity to manage care from the home for individuals affected by illness. The quality of decision aids is of great importance. Furthermore, satisfaction with the use of tools is associated with increased patient satisfaction and reduced decisional conflict. Finally, patients may benefit from computerized decision tools without the need for increased physician involvement. Conclusions Most computerized decision aids improved at least one patient-centered outcome. All RCTs identified were at a High Risk of Bias or Unclear Risk of Bias. Effort should be made to improve the quality of RCTs testing SDM aids in serious illness.
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Affiliation(s)
- Anna Staszewska
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Pearl Zaki
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Joon Lee
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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96
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Moradian S, Voelker N, Brown C, Liu G, Howell D. Effectiveness of Internet-based interventions in managing chemotherapy-related symptoms in patients with cancer: a systematic literature review. Support Care Cancer 2017; 26:361-374. [PMID: 28948360 DOI: 10.1007/s00520-017-3900-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/12/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE The aims of this review were to (1) examine the effectiveness of Internet-based interventions on cancer chemotherapy-related physical symptoms (severity and/or distress) and health-related quality of life (HRQOL) outcomes and (2) identify the design elements and processes for implementing these interventions in oncology practices. METHODS A systematic review was performed. The Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and PsycINFO were searched for studies dating from January 2000 through to October 2016. Based on pre-determined selection criteria, data was extracted from eligible studies. Methodological quality of studies was assessed using an adapted version of the Cochrane Collaboration Back Review Group checklist. RESULTS The literature search yielded 1766 studies of which only six RCTs fulfilled the eligibility criteria. Although the content, duration, and frequency of interventions varied considerably across studies, commonly used elements included tailored information, education, self-management support, and communication with clinicians. Five studies measured symptom distress and four of them reported statistically significant differences between study groups. Of the three studies that measured HRQOL, two reported improvement (or no deterioration over time) for the intervention group. However, several methodological issues including high attrition rates, poor adherence to interventions, and use of non-validated measures affect confidence in the strength of evidence. CONCLUSION Despite the evidence in support of using the Internet as a worthwhile tool for effective patient engagement and self-management of chemotherapy-related symptoms outside clinic visits, methodological limitations in the evidence base require further well-planned and quality research.
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Affiliation(s)
- S Moradian
- Psychosocial Oncology, Ontario Cancer Institute, University of Toronto, Toronto, Canada
| | - N Voelker
- University of Waterloo, Waterloo, Canada
| | - C Brown
- University Health Network, Toronto, Canada
| | - G Liu
- Ontario Cancer Institute, Princess Margaret Cancer Care, University of Toronto, Toronto, Canada
| | - D Howell
- Psychosocial Oncology, Ontario Cancer Institute, University of Toronto, Toronto, Canada. .,Princess Margaret Cancer Care, 610 University Avenue, Toronto, M5G 2M9, Canada.
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Heitkemper EM, Mamykina L, Travers J, Smaldone A. Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis. J Am Med Inform Assoc 2017; 24:1024-1035. [PMID: 28379397 PMCID: PMC6080842 DOI: 10.1093/jamia/ocx025] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/08/2016] [Accepted: 03/01/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. MATERIALS AND METHODS Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models. RESULTS Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies ( n = 10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet ( n = 2), cellular/automated telephone ( n = 4), Internet-based ( n = 4), and telemedicine/telehealth ( n = 3). Pooled A1c decreases were found at 6 months (-0.36 (95% CI, -0.53 and -0.19]; I 2 = 35.1%, Q = 5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I 2 = 42.4%, Q = 10.4). DISCUSSION Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME. CONCLUSION These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group.
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Affiliation(s)
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University Medical Center
| | - Jasmine Travers
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Arlene Smaldone
- School of Nursing, Columbia University Medical Center, New York, NY, USA
- Department of Dental Behavioral Sciences, College of Dental Medicine, Columbia University Medical Center
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98
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Alkhaldi G, Modrow K, Hamilton F, Pal K, Ross J, Murray E. Promoting Engagement With a Digital Health Intervention (HeLP-Diabetes) Using Email and Text Message Prompts: Mixed-Methods Study. Interact J Med Res 2017; 6:e14. [PMID: 28829328 PMCID: PMC5566257 DOI: 10.2196/ijmr.6952] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 03/01/2017] [Accepted: 04/21/2017] [Indexed: 11/27/2022] Open
Abstract
Background Engagement with digital health interventions (DHIs) may be regarded as a prerequisite for the intervention to achieve positive health or behavior change outcomes. One method employed to promote engagement is the use of prompts such as emails and text messages. However, little is known about the characteristics of prompts that promote engagement. This study explored the association between the content and delivery mode of prompts and the users’ engagement with HeLP-Diabetes (Healthy Living for People with type 2 Diabetes), a DHI that aimed to promote self-management in adults with type 2 diabetes. Objective The objective of this study was to identify the characteristics of prompts, specifically the content and delivery mode, which were associated with increased engagement. Methods This was a mixed-methods study. Email and text message prompts were sent to the registered users of HeLP-Diabetes. Use of the intervention was recorded and examined to identify which email and text message prompts were associated with subsequent visits to the DHI. Characteristics of prompts that were identified as particularly effective or ineffective were explored through think-aloud interviews with the participants. Results Of a total of 39 email prompts, 49% (19/39) prompts showed a significant association with subsequent visits to the DHI. However, none of the text message prompts were associated with subsequent visits to the DHI. Furthermore, think-aloud interviews were carried out with 6 experienced participants with type 2 diabetes. The findings suggest that these participants preferred email prompts that were clear, relatively short, and empowering; used nondirective advice; included health professional references; were visually appealing; and contained news and updates. Conclusions The findings of this study contribute to the existing evidence supporting the role of email prompts in promoting and maintaining engagement with DHIs. This study described the content of prompts that may be engaging. However, the results should be interpreted with caution, as prompts may be context-specific interventions and the results may not be generalizable across other DHIs or other types of interventions targeting self-management of type 2 diabetes.
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Affiliation(s)
- Ghadah Alkhaldi
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Kerstin Modrow
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Fiona Hamilton
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Kingshuk Pal
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Jamie Ross
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
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Escoffery C. Gender Similarities and Differences for e-Health Behaviors Among U.S. Adults. Telemed J E Health 2017; 24:335-343. [PMID: 28813630 DOI: 10.1089/tmj.2017.0136] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Technology access and use are increasing worldwide. Adults can potentially use technology to assist with health promotion and medical care. INTRODUCTION The purpose of this study was to compare the prevalence of participation in online health-related activities between different genders of U.S. adults aged 18-90 years. METHODS Primary data collected through a survey panel were used to examine associations between gender and technology ownership, Internet health-seeking behaviors and online behaviors related to health, having an app, and preferences for health information. Data were collected through an online survey panel of U.S. adults (n = 400) in March 2017. Results and Materials: Almost 75% had ever looked for health information and 56.8% had searched for information in the past month. About one-third of both genders (34.1%) reported tracking any health indicator regularly, and 24% had a health app. Compared with males, females were more likely to have ever sought health information online and to have a mobile app for health. No significant differences were observed between gender and individual or total e-health literacy scores. The top three preferences for health sources were Web sites (81.3%), in person (72.0%), and then print materials (72.0%). CONCLUSIONS This study illustrates that U.S. adults are using the Internet for health activities; however, females are more likely to engage in different e-health behaviors than males. Additional research could determine the causal factors behind these group differences in the use of online healthcare and health implications in public health practice for each group.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia
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100
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Mouelhi Y, Alessandrini M, Pauly V, Dussol B, Gentile S. Internet and social network users' profiles in Renal Transplant Recipients in France. BMC Nephrol 2017; 18:259. [PMID: 28768480 PMCID: PMC5541418 DOI: 10.1186/s12882-017-0670-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/19/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The use of the Internet for searching and sharing health information and for health care interactions may have a great potential for Renal Transplant Recipients (RTR). This study aims to determine the characteristics associated with Internet and social network use in a representative sample of RTR at the time of their inclusion in the study. METHODS Data of this cross-sectional design is retrieved from a longitudinal study conducted in five French kidney transplant centers in 2011, and included Renal Transplant Recipients aged 18 years with a functioning graft for at least 1 year. Measures include demographic characteristics (age, gender, level of education, employment status, living arrangement, having children, invalidity and monthly incomes in the household), psycho-social characteristics measured by the perceived social support questionnaire, and medical characteristics (previous dialysis treatment, duration since transplantation, graft rejection episodes, chronic graft dysfunction, health status and comorbidities: neoplasia for the current transplant, hypertension, diabetes mellitus, smoking status, BMI > 30 kg/m2 and Charlson Comorbidity Index (CCI)). Polytomous linear regression analysis was performed to describe the Internet and social network users' profiles, using lack of Internet access as the comparison category. RESULTS Among the 1416 RTR participating in the study, 20.1% had no Internet access in the household, 29.4% connected to social networks and 50.5% were not connected to social networks. Patients who connected the most to the Internet and social networks were younger, male, without children, employed, with high monthly incomes in the household, without hypertension and having felt a need for an informative or an esteem support. CONCLUSION In our study, the majority of RTR were actively using Internet and social networks. Renal transplant units should develop flexible and Web-based sources related to transplant information, which will allow a rapid adaptation to changes in prevalent practice, improve the health of the patients and reflect their preferences.
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Affiliation(s)
- Yosra Mouelhi
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France.
| | - Marine Alessandrini
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France
| | - Vanessa Pauly
- Service Santé Publique et Information Médicale, CHU Marseille, Marseille, France
| | - Bertrand Dussol
- Centre de Néphrologie et de Transplantation Rénale, CHU Marseille, Marseille, France
| | - Stéphanie Gentile
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France
- Service Santé Publique et Information Médicale, CHU Marseille, Marseille, France
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