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A Scoping Review for Usage of Telerehabilitation among Older Adults with Mild Cognitive Impairment or Cognitive Frailty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074000. [PMID: 35409683 PMCID: PMC8997970 DOI: 10.3390/ijerph19074000] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022]
Abstract
Older adults are vulnerable towards cognitive frailty that can lead to adverse health outcomes and telerehabilitation appears to be a potential platform to reverse cognitive frailty among older adults. The aim of this coping review is to identify the usage of telerehabilitation and its common platform of delivery among older adults with mild cognitive impairment (MCI) or cognitive frailty (CF). Articles published from January 2015 until October 2020 were selected. Out of the 1738 articles retrieved, six studies were identified. Two articles were randomized controlled trials, one was a pilot study and three were qualitative studies. The outcome suggests that telerehabilitation may improve the quality of life among participants as well as it can be a useful and supportive digital platform for health care. Some types of technologies commonly used were smartphones or telephones with internet, television-based assistive integrated technology, mobile application and videoconference. Telerehabilitation utilization in managing cognitive frailty among older adults is still limited and more research is required to evaluate its feasibility and acceptability. Although telerehabilitation appears to be implemented among older adults with MCI and CF, some social support is still required to improve the adherence and effectiveness of telerehabilitation. Future research should focus on the evaluation of acceptance and participants’ existing knowledge towards telerehabilitation to achieve its target.
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Kouvonen A, Kemppainen T, Taipale S, Olakivi A, Wrede S, Kemppainen L. Health and self-perceived barriers to internet use among older migrants: a population-based study. BMC Public Health 2022; 22:574. [PMID: 35321678 PMCID: PMC8941300 DOI: 10.1186/s12889-022-12874-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background In older adults, including those with a migrant background, ill health is associated with less internet use. However, it is not known what are the specific self-perceived barriers to internet use among older migrants with different health conditions. The aim of this study was to investigate the associations between different health conditions and self-perceived barriers to internet use among older migrants. Methods We used the Care, Health and Ageing of Russian-speaking Minority in Finland (CHARM) study, which is a nationally representative survey of community-dwelling Russian-speaking adults aged ≥50 years living in Finland (N=1082, 57% men, mean age 63.2 years, standard deviation 8.4 years, response rate 36%). Postal survey data were collected in 2019. Health indicators were self-rated health (SRH), depressive symptoms, cognitive functioning, and doctor-diagnosed conditions. Linear regression analyses were used to investigate the associations between health indicators and a summary scale consisting of the following barriers of internet use: (1) internet use is too complicated and hard to learn; (2) having concerns about safety issues; (3) internet use is too expensive; (4) physical limitations hinder the internet use; (5) memory problems hinder the internet use. In addition, the two most commonly reported barriers (the first two) were examined separately using logistic regression analyses. The analyses were adjusted for age, sex, education, marital status, local language proficiency, and income support, and the health conditions, and were performed with weights accounting for the survey design and non-response. Results After adjustments, spine/back problems (b=0.13; p=0.049), depressive symptoms (b=0.40; p=0.007), and problems in learning new things (b=0.60; p<0.0005) were associated with higher level of overall barriers to internet use. In addition, a number of health conditions were associated with individual barriers, albeit some health conditions appeared protective. Conclusions In general, older migrants with declining health experience more barriers to internet use than their counterparts with better health. To provide better access to healthcare for older adults, including older migrants, rapidly changing devices, software and apps need to be modified and adapted for those with specific health-related needs.
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Affiliation(s)
- Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, PO Box 54, 00014, Helsinki, Finland. .,Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| | - Teemu Kemppainen
- Department of Geosciences and Geography, University of Helsinki, PO Box 64, 00014, Helsinki, Finland.,Centre Maurice Halbwachs (CNRS/EHESS/ENS), École Normale Supérieure 48, boulevard Jourdan, 75014, Paris, France
| | - Sakari Taipale
- Department of Social Sciences and Philosophy, University of Jyvaskyla, PO Box 35, 40014, Jyvaskyla, Finland.,Faculty of Social Sciences, University of Ljubljana, Kardeljeva ploščad 5, 1000, Ljubljana, Slovenia
| | - Antero Olakivi
- Faculty of Social Sciences, University of Helsinki, PO Box 54, 00014, Helsinki, Finland
| | - Sirpa Wrede
- Faculty of Social Sciences, University of Helsinki, PO Box 54, 00014, Helsinki, Finland.,Swedish School of Social Science, University of Helsinki, PO Box 16, 00014, Helsinki, Finland
| | - Laura Kemppainen
- Faculty of Social Sciences, University of Helsinki, PO Box 54, 00014, Helsinki, Finland
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Evers EC, Fritz SA, Colditz GA, Burnham JP. Perceptions of telemedicine and costs incurred by a visit to a general infectious diseases clinic: A survey. Open Forum Infect Dis 2022; 9:ofab661. [PMID: 35187192 PMCID: PMC8852313 DOI: 10.1093/ofid/ofab661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background The costs of attending in-person general infectious diseases clinics and preferences for visit type (telemedicine vs in-person) are not well known. We aimed to measure the time-related, monetary, social, and societal costs associated with travel to an in-person clinic visit and to assess patients’ preferences, questions, and concerns regarding telemedicine. Methods Patients (≥18 years, living ≥25 miles from clinic at time of clinic visit) were recruited for this survey study from the general infectious diseases (ID) clinic at Washington University from June 2019 to February 2020. We calculated time and money potentially saved by telemedicine, as well as carbon dioxide emissions, with the assistance of Google Maps (low/high estimates). We also determined patient preferences regarding telemedicine for ID care. Results Seventy-five patients completed the study. The round-trip mean travel distance was 227.2 ± 142.6 miles, mean travel time was 3.6 ± 2.0 hours to 4.5 ± 2.3 hours (low and high estimates from Google Maps), travel costs were $131.34 ± $82.27, and mean carbon dioxide emissions were 91.79 ± 57.60 kg. Fifty-eight patients (77.3%) said they would be willing to have a telemedicine visit in the future, and 30 (40.5%) said they would rather have had their visit the day the survey was completed as a telemedicine visit. Conclusions Telemedicine has the potential to significantly reduce patient costs, both monetary and time-related, and offers substantial environmental benefits, while being an acceptable method of care delivery to most patients at a general ID clinic.
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Affiliation(s)
- Emily C Evers
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jason P Burnham
- Division of Infectious Diseases Washington University School of Medicine, St. Louis, Missouri, USA
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Pham Q, El-Dassouki N, Lohani R, Jebanesan A, Young K. The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic. J Med Internet Res 2022; 24:e29876. [PMID: 34994707 PMCID: PMC8783290 DOI: 10.2196/29876] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/18/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has fundamentally changed how Canadians access health care. Although it is undeniable that the rapid adoption of virtual care has played a critical role in reducing viral transmission, the gap in equitable access to virtual care remains pervasive for Canada’s aging and ethnocultural minority communities. Existing virtual care solutions are designed for the English-speaking, health-literate, and tech-savvy patient population, excluding older ethnic adults who often do not see themselves reflected in these identities. In acknowledging the permanency of virtual care brought on by the pandemic, we have a collective responsibility to co-design new models that serve our older ethnic patients who have been historically marginalized by the status quo. Building on existing foundations of caregiving within ethnocultural minority communities, one viable strategy to realize culturally equitable virtual care may be to engage the highly motivated and skilled family caregivers of older ethnic adults as partners in the technology-mediated management of their chronic disease. The time is now to build a model of shared virtual care that embraces Canada’s diverse cultures, while also providing its older ethnic adults with access to health innovations in partnership with equally invested family caregivers who have their health at heart.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Noor El-Dassouki
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Raima Lohani
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Aravinth Jebanesan
- Global Health Office, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Karen Young
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Heponiemi T, Kaihlanen AM, Kouvonen A, Leemann L, Taipale S, Gluschkoff K. The role of age and digital competence on the use of online health and social care services: A cross-sectional population-based survey. Digit Health 2022; 8:20552076221074485. [PMID: 35111333 PMCID: PMC8801649 DOI: 10.1177/20552076221074485] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/03/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Online health and social care services are getting widespread which increases the risk that less advantaged groups may not be able to access these services resulting in digital exclusion. We examined the combined effects of age and digital competence on the use of online health and social care services. METHODS We used a large representative population-based sample of 4495 respondents from Finland. Paper-based self-assessment questionnaire with an online response option was mailed to participants. The associations were analyzed using survey weighted logistic regression, exploring potential non-linear effects of age and controlling for potential sex differences. RESULTS Higher age, starting from around the age of 60 was associated with a lower likelihood of using online services for receiving test results, renewing prescriptions and scheduling appointments. Good digital competence was able to hinder the age-related decline in online services use, but only up to around the age of 80. CONCLUSIONS Our results suggest that older adults are at risk of digital exclusion, and not even good digital competence alleviates this risk among the oldest. We suggest that health and social care providers should consider older users' needs and abilities more thoroughly and offer easy to use online services. More digital support and training possibilities should be provided for older people. It is equally important that face-to-face and telephone services will be continued to be provided for those older people who are not able to use online services even when supported.
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Affiliation(s)
- T Heponiemi
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - A-M Kaihlanen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - A Kouvonen
- Faculty of Social Sciences, University of Helsinki, Finland.,Centre for Public Health, Queen's University Belfast, UK
| | - L Leemann
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - S Taipale
- Faculty of Humanities and Social Sciences, University of Jyvaskyla, Finland.,Faculty of Social Science, University of Ljubljana, Slovenia
| | - K Gluschkoff
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Singh G, Nimmon L, Sawatzky B, Ben Mortenson W. Barriers and Facilitators to eHealth Technology Use Among Community-Dwelling Individuals With Spinal Cord Injury: A Qualitative Study. Top Spinal Cord Inj Rehabil 2022; 28:196-204. [PMID: 35521060 PMCID: PMC9009201 DOI: 10.46292/sci21-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background As eHealth technologies become a more prevalent means to access care and self-manage health, it is important to identify the unique facilitators and barriers to their use. Few studies have evaluated the use or potential use of eHealth technologies in spinal cord injury (SCI) populations. Objectives The primary objective of this study was to explore and identify barriers and facilitators to engagement with eHealth technologies among individuals with SCI. Methods A qualitative descriptive study was conducted. Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger clinical trial. Analysis of the transcripts was undertaken using a four-phase process of content analysis. Results Our analysis identified three barriers to engagement with eHealth technologies, including (1) overcoming a digital divide to comprehending and utilizing eHealth technologies, (2) navigating internet resources that provide too much information, and (3) interacting with these technologies despite having limited hand function. Our analysis also identified three facilitators to using eHealth technologies, including (1) having previous successful experiences with eHealth technologies, (2) being able to use voice activation features, and (3) being able to interact in an online community network. Conclusion By exploring barriers and facilitators to eHealth technology use, these findings may have a short-term impact on informing researchers and clinicians on important factors affecting engagement of individuals with SCI with telemedicine, mobile, and web applications (apps) and a long-term impact on informing future development of eHealth interventions and tools among chronic disease populations.
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Affiliation(s)
- Gurkaran Singh
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,International Collaboration on Repair Discoveries, Vancouver, Canada
,G.F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Bonita Sawatzky
- International Collaboration on Repair Discoveries, Vancouver, Canada
,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - W. Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,International Collaboration on Repair Discoveries, Vancouver, Canada
,G.F. Strong Rehabilitation Centre, Vancouver, Canada
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Nimmons D, Armstrong M, Pigott J, Walters K, Schrag A, Ogunleye D, Dowridge W, Read J, Davies N. Exploring the experiences of people and family carers from under-represented groups in self-managing Parkinson's disease and their use of digital health to do this. Digit Health 2022; 8:20552076221102261. [PMID: 35651731 PMCID: PMC9149607 DOI: 10.1177/20552076221102261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/05/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Digital health is thought to enable people to better manage chronic
conditions, such as Parkinson's. However, little is known about how people
from under-represented groups with chronic conditions use digital health to
self-manage. Objective The objective of our study was to explore the experiences of people and
family carers from under-represented groups in self-managing Parkinson's,
including their use of digital health to do this. Methods Semi-structured interviews (n = 18, including four dyadic) were conducted
remotely, with 16 people with Parkinson's and six family carers in
2020–2021. Participants were purposively sampled from under-represented
groups: belong to an ethnic minority, or having significant physical or
sensory impairment. Interviews were audio-recorded, transcribed and analysed
using thematic analysis. Results Three main themes of importance were developed: ‘self-management support’,
‘digital health use to support self-management’ and ‘identity, attitudes and
characteristics’. Participants received medical, psychological, social and
practical self-management support. Some participants used digital health
resources, e.g., Parkinson's UK website. Digital literacy was the biggest
barrier to using digital health, regardless of background, often dependant
on previous occupation and confidence. Few ethnic minority participants
thought race or culture alters self-management ability and most believed
there was no need for digital health interventions to be tailored to an
individual's race or culture. Some felt inclusivity was important in terms
of diverse images of people. A range of considerations were identified to
optimise digital health, such as assistive equipment for people with sensory
impairment. Conclusions Barriers to using digital health for self-management were primarily dependent
on personal factors including digital literacy and attitudes but rarely race
or culture. We recommend the optimisation of digital health interventions by
providing assistive technology at low cost, and visual inclusiveness should
be promoted by including images of people from diverse backgrounds.
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Affiliation(s)
- Danielle Nimmons
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | - Megan Armstrong
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | | | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | - Anette Schrag
- Department of Neurology, Institute of Neurology, UCL, UK
| | - Della Ogunleye
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | - Wesley Dowridge
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | - Joy Read
- Department of Neurology, Institute of Neurology, UCL, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
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Robinson TD, Pollard T, Sarver WL. Examining the Use of Web-Based Health Education and Information Among Ambulatory Care Clinic Diabetic Patients. J Ambul Care Manage 2022; 45:55-62. [PMID: 34524176 DOI: 10.1097/jac.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Web-based health education provides access to information and better coordination of care. Demographic and geographical factors may impact use and effectiveness of these services. The purpose of this study was to identify factors associated with use of web-based health education programs among diabetic patients at ambulatory clinics of a safety-net hospital. This was a retrospective chart review. Total sample size was 300. Patients who completed a web-based video were younger, Caucasian, living outside inner city core, users of patient portal, and more likely to complete annual diabetic eye examination. Web-based education may empower patients to manage health conditions and improve health outcomes. Health care organizations must consider barriers to use of these tools.
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Wong SS, Lim HM, Chin AJZ, Chang FWS, Yip KC, Teo CH, Abdullah A, Ng CJ. eHealth literacy of patients attending a primary care clinic in Malaysia and its associated factors: A cross-sectional study. Digit Health 2022; 8:20552076221135392. [PMID: 36420318 PMCID: PMC9677303 DOI: 10.1177/20552076221135392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND People are overloaded with online health information (OHI) of variable quality. eHealth literacy is important for people to acquire and appraise reliable information to make health-related decisions. While eHealth literacy is widely studied in developed countries, few studies have been conducted among patients in low- and middle-income countries (LMICs). OBJECTIVE We aimed to determine the level of eHealth literacy in patients attending a primary care clinic in Malaysia and its associated factors. METHODS A cross-sectional study using a self-administered questionnaire was conducted in an urban primary care clinic. We used a systematic random sampling method to select patients aged 18 years and above who attended the clinic. The eHealth literacy scale (eHEALS) was used to measure eHealth literacy. RESULTS A total of 381 participants were included. The mean eHEALS was 24.4 ± 7.6. The eHEALS statements related to skills in appraising OHI were scored lower than statements related to looking for online resources. Higher education level of attending upper secondary school (AOR 2.53, 95% CI 1.05-6.11), tertiary education (AOR 4.05, 95% CI 1.60-10.25), higher monthly household income of >US$470 (AOR 1.95, 95% CI 1.07-3.56), and those who had sought OHI in the past month (AOR 1.95, 95% CI 1.13-3.36) were associated with a higher eHealth literacy level. CONCLUSIONS This study found a low eHealth literacy level among primary care patients in Malaysia. While the patients were confident in searching for OHI, they lacked skills in appraising them. Our findings inform the interventions for improving eHealth literacy in LMICs, especially educating the public about OHI appraisal.
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Affiliation(s)
- Swee Shiuan Wong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adrian Jian Zhi Chin
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Felicia Wen Si Chang
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Chun Yip
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore
- Duke-NUS Medical School, Singapore
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Sindi AS, Mittal R, Mattoo K, Deep A, Khateeb SU, Algarni YA, Baba SM, Hakami AM. Impact of an Auditory Mediated Patient Health Education (PHE) Program on Treatment Compliance and Satisfaction Among Patients Seeking Prosthodontic Care During COVID Pandemic - A Prospective Interventional Study. Patient Prefer Adherence 2022; 16:1247-1255. [PMID: 35602466 PMCID: PMC9121987 DOI: 10.2147/ppa.s366684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients health education by healthcare workers has been affected by pandemic guidelines. This study aimed to evaluate the influence of an audio-mediated intervention for patient health education (PHE) on treatment compliance and treatment satisfaction among patients seeking prosthodontic treatment during the Covid pandemic. METHODS A total of 666 patients (aged 40-70 years) who fulfilled the study criteria were treated for denture-associated disease. PHE for 5 different categories was performed using an educational audio (MP3) in the experimental group (Group E), and traditional methods (oral/verbal) in the control group (Group C). Patient/clinician satisfaction with the PHE program was evaluated with a pre-validated questionnaire, whereas treatment compliance and satisfaction were evaluated using a denture hygiene index (DHI) and a visual analog scale (VAS). Differences between qualitative variables were determined using the chi-square test, whereas continuous variables were assessed using an unpaired t-test. Differences were considered to be statistically significant at p ≤ 0.05. RESULTS Patient satisfaction with PHE was significantly higher and differed in the Group E for two parameters: education method (80%), educational material (94%). For all parameters of procedural education, patient/clinician satisfaction was significantly higher for Group E [method (93%), material (85%), patient preparation (89%), personalized education (84%), program (93%)]. From three different ratings of disease education, 70% in Group E rated education as "effective" as compared to 41% in the Group C. Effectiveness of post treatment, education measured through DHI, revealed a lower hygiene score in Group E (m = 1.18) as compared to Group C (m = 2.92), with differences being significant. For treatment satisfaction, patients in Group E rated higher for speech (m = 8.21), ease of chewing (m = 7.36), and general satisfaction (m = 7.9). CONCLUSION This study concluded that using audio as a means of imparting PHE positively influences the treatment compliance and satisfaction among outpatients and overcomes the drawback of wearing mask during the pandemic.
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Affiliation(s)
- Abdulelah Sameer Sindi
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Rashmi Mittal
- Department of Prosthodontics, S. R. Aggarwal Dental Clinic, Badaut, Uttar Pradesh, 250611, India
- Department of Prosthodontics, Subharti Dental College and Hospital, Swami Vivekananda Subharti University, Uttar Pradesh, 250005, India
| | - Khurshid Mattoo
- Department of Prosthodontics, Subharti Dental College and Hospital, Swami Vivekananda Subharti University, Uttar Pradesh, 250005, India
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, 45142, Kingdom of Saudi Arabia
- Correspondence: Khurshid Mattoo, Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, 45142, Kingdom of Saudi Arabia, Tel +966595086078, Fax +960173295000, Email
| | - Anchal Deep
- Department of Prosthodontics, Subharti Dental College and Hospital, Swami Vivekananda Subharti University, Uttar Pradesh, 250005, India
- Department of Prosthodontics, IDEAS Dental College, Madhya Pradesh Medical Science University, Madhya Pradesh, 482003, India
| | - Shafait Ullah Khateeb
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Youssef Abdullah Algarni
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Suheel Manzoor Baba
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
- Department of Restorative Dentistry, Subharti Dental College and Hospital, Swami Vivekananda Subharti University, Uttar Pradesh, 250005, India
| | - Areej M Hakami
- Department of Prosthodontics, College of Dentistry, Jazan University, Jazan, 45142, Kingdom of Saudi Arabia
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Ekstedt M, Kirsebom M, Lindqvist G, Kneck Å, Frykholm O, Flink M, Wannheden C. Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010391. [PMID: 35010652 PMCID: PMC8744716 DOI: 10.3390/ijerph19010391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 05/07/2023]
Abstract
The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.
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Affiliation(s)
- Mirjam Ekstedt
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 391 82 Kalmar, Sweden
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
| | - Marie Kirsebom
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Gunilla Lindqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, Box 111 89, 100 61 Stockholm, Sweden;
| | - Oscar Frykholm
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Stockholm, Sweden;
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Carolina Wannheden
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
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Maurer LE, Bansal C, Bansal P. Methods to Engage Patients in the Modern Clinic. Ann Allergy Asthma Immunol 2021; 128:132-138. [PMID: 34813954 DOI: 10.1016/j.anai.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify current patient and provider engagement methods that utilize technology in allergy and immunology clinics, hospitals and at home. DATA SOURCES Apple App Store and Google searches for allergy and immunology technology apps, PubMed search of literature involving keywords of: website, technology, EMR, medical devices, disparity in technology, coding for remote patient monitoring and artificial intelligence. STUDY SELECTIONS Studies that addressed the keywords were included and narrowed down based upon their applicability in the allergy and immunology clinic. RESULTS There has been rapid innovation in the digital healthcare space with expansion of EMR services and the patient portal, creation of allergy and immunology specific medical devices and apps with remote patient monitoring capabilities, and website and artificial intelligence development to interact with patients. CONCLUSION These technological advances provide distinct advantages to the provider and patient, but also have a burden of time for evaluation of the data for the provider and disparate access to certain technologies for patients. The development of these technologies has been fast-tracked since the start of the Covid-19 pandemic. With the explosion in telehealth and medical device development, advancement of medical technology is not showing any signs of slowing down. It is paving a new way to interact with patients in the future.
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Affiliation(s)
- Laura E Maurer
- Fellow in Training, Feinberg School of Medicine of Northwestern University, 355 E. Ohio Street, Unit 4102.
| | - Chandani Bansal
- Student, University of Texas at Austin, 715 West 23rd Street, Apartment 517A, Austin, TX 78705.
| | - Priya Bansal
- Faculty, Department of Medicine Feinberg School of Medicine of Northwestern University, Home: 1187 Cleander Court, Naperville, IL 60540.
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63
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Chen Z, Qi H, Wang L. Study on the Types of Elderly Intelligent Health Management Technology and the Influencing Factors of Its Adoption. Healthcare (Basel) 2021; 9:healthcare9111494. [PMID: 34828539 PMCID: PMC8619684 DOI: 10.3390/healthcare9111494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
[Background]: In recent years, aging has become a global social problem. Intelligent health management technology (IHMT) provides solutions for the elderly to deal with various health risks. However, the elderly are facing many difficulties in using IHMT. Studying the application types of IHMT and the influencing factors of the elderly’s acceptance of it will help to improve the use behavior of the elderly. [Methods]: This paper summarizes the application types of IHMT, identifies the influencing factors of the elderly’s adaption of IHMT, and makes a systematic comment on the influencing factors. [Results]: We divide the different functions of IHMT for the elderly into four types: self-monitoring, medical care, remote monitoring, and health education. The influencing factors are divided into three types: individual, social, and technology. [Conclusions]: This study finds that IHMT’s application covers all aspects of the health services of the elderly. Among these applications, self-monitoring is the most used. We divided the influencing factors of the elderly’s acceptance of IHMT into three categories and nine subcategories, having 25 variables.
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Affiliation(s)
- Zhu Chen
- School of Nursing, Peking University, Beijing 100191, China;
| | - Huiying Qi
- Department of Health Informatics and Management, School of Health Humanities, Peking University, Beijing 100191, China;
- Correspondence: ; Tel.: +86-10-82805574
| | - Luman Wang
- Department of Health Informatics and Management, School of Health Humanities, Peking University, Beijing 100191, China;
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Yan K, Balijepalli C, Druyts E. The Impact of Digital Therapeutics on Current Health Technology Assessment Frameworks. Front Digit Health 2021; 3:667016. [PMID: 34713140 PMCID: PMC8521991 DOI: 10.3389/fdgth.2021.667016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022] Open
Abstract
Historically healthcare has been delivered offline (e.g., physician consultations, mental health counseling services). It is widely understood that healthcare lags behind other industries (e.g., financial, transportation) whom have already incorporated digital technologies in their workflow. However, this is changing with the recent emergence of digital therapeutics (DTx) helping to bring healthcare services online. To promote adoption, healthcare providers need to be educated regarding the digital therapy to allow for proper prescribing. But of equal importance is affordability and many countries rely on reimbursement support from the government and insurance agencies. Here we briefly explore how national reimbursement agencies or non-profits across six countries (Canada, United States of America, United Kingdom, Germany, France, Australia) handle DTx submissions and describe the potential impact of digital therapeutics on current health technology assessment (HTA) frameworks. A targeted review to identify HTA submissions and guidelines from national reimbursement agencies or non-profits was conducted. We reviewed guidelines from the Institute for Clinical and Economic Review (ICER) in the USA, the Canadian Agency for Drugs and Technologies in Health (CADTH) in Canada, the National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK), the Institute for Quality and Efficiency in Health Care (IQWIG) in Germany, Haute Autorité de Santé (HAS) in France, and the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia. Our review identified one set of guidelines developed by NICE in the UK. The guidelines by NICE outlined an evidence standards framework for digital health technologies (DHT). Depending on the organizational impact, financial commitment, and economic risk for the payer, different economic analyses are required. Economic analyses levels are separated into 3 categories, basic, low financial commitment, and high financial commitment. All economic analyses levels require a budget impact analysis. A cost-utility analysis is recommended for DHTs categorized in the high financial commitment category. Whereas, for DHTs that are in the low financial commitment category, a cost-consequence analysis is typically recommended. No HTA guidelines for DTx submissions were identified for the remaining countries (Canada, USA, Germany, France, and Australia)
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Affiliation(s)
- Kevin Yan
- Pharmalytics Group, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Zheng DX, Xiang L, Mulligan KM, Cullison CR, Scott JF. Bridging the digital divide among advanced age skin cancer patients. J Plast Reconstr Aesthet Surg 2021; 74:3196-3211. [PMID: 34538567 PMCID: PMC8418129 DOI: 10.1016/j.bjps.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/25/2021] [Indexed: 11/15/2022]
Affiliation(s)
- David X Zheng
- Case Western Reserve University School of Medicine, Cleveland, OH, United States.
| | - Laura Xiang
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Kathleen M Mulligan
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | | | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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66
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Patient education is an essential component of an Enhanced Recovery Pathway in colon and rectal surgery. SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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67
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Sharma A, Paredes-Vincent A, Kahle EM. Awareness, Utilization, and Preferences for Traditional and Contemporary HIV Prevention Strategies Among Facebook and Instagram-Using MSM in the United States. J Int Assoc Provid AIDS Care 2021; 20:23259582211024770. [PMID: 34132144 PMCID: PMC8212379 DOI: 10.1177/23259582211024770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
HIV prevention research among men who have sex with men (MSM) has traditionally
focused on individual risk reduction strategies. Our study evaluated awareness,
utilization, and preferences for 10 complementary HIV prevention strategies
among 1,286 MSM recruited via Facebook and Instagram from June-August 2018. Ages
ranged from 18-85 years, and the majority were non-Hispanic white (n = 1,019,
79.24%), college-educated (n = 819, 63.69%), gay-identifying (n = 1,074,
83.51%), and partnered (n = 808, 62.83%). Post-exposure prophylaxis was the
least familiar option, and engaging in sexual activities other than anal sex was
the most utilized option. Progressively older and bisexual-identifying MSM were
less likely, but those with higher educational levels and easy access to local
HIV resources were more likely to be aware of and to be utilizing a greater
number of strategies. Additionally, Hispanic MSM were less likely to be aware
of, and those in a “closed” relationship were less likely to be utilizing a
greater number of strategies. In a subset of 775 multiple strategy users,
pre-exposure prophylaxis, regularly testing for HIV, and limiting the number of
sex partners emerged as the most preferred options. Combination intervention
packages for MSM should be tailored to personal circumstances, including sexual
orientation, relationship characteristics and access to local HIV resources.
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Affiliation(s)
- Akshay Sharma
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Ariana Paredes-Vincent
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erin M Kahle
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
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68
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DesRoches CM, Salmi L, Dong Z, Blease C. How do older patients with chronic conditions view reading open visit notes? J Am Geriatr Soc 2021; 69:3497-3506. [PMID: 34405397 DOI: 10.1111/jgs.17406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/11/2021] [Accepted: 07/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND We examine the experiences with and perceptions of the effect of reading clinical outpatient visit notes on patients with multiple chronic conditions at three healthcare organizations with significant experience sharing clinical notes with patients. METHODS A cross-sectional survey was conducted via patient portals at three diverse healthcare organizations in the United States: Beth Israel Deaconess Medical Center (Boston, MA), UW Medical Center (Seattle, WA), and Geisinger Health System (Danville, PA). Participants were aged 65 and older patient portal users who read at least one clinical note over the 12 months before the survey. We examined the effect of note reading on patient engagement and managing medications. RESULTS The majority of respondents had read two or more clinical notes in the 12 months before the survey. Patients with more than two chronic conditions were more likely than those with fewer or none to report that reading their notes helped them remember their care plan, take their medications as prescribed, and understand and feel more in control of their medications. Very few patients reported feeling worried or confused about their health or medications due to reading their notes. CONCLUSIONS Older patients with chronic conditions are particularly vulnerable to misremembering and mismanaging their care and medication plans. Findings from this study suggest that these patients and their care partners could receive important benefits from accessing their notes. Healthcare organizations should work to maximize patient's engagement with their health information both through the patient portal and through other methods to ensure that patients and the healthcare systems reap the full benefit of the increased transparency of medical records.
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Affiliation(s)
- Catherine M DesRoches
- Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Liz Salmi
- Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Zhiyong Dong
- Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Charlotte Blease
- Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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69
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Solar C, Halat AM, MacLean RR, Rajeevan H, Williams DA, Krein SL, Heapy AA, Bair MJ, Kerns RD, Higgins DM. Predictors of engagement in an internet-based cognitive behavioral therapy program for veterans with chronic low back pain. Transl Behav Med 2021; 11:1274-1282. [PMID: 33098304 DOI: 10.1093/tbm/ibaa098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Internet-based interventions for chronic pain have demonstrated efficacy and may address access barriers to care. Participant characteristics have been shown to affect engagement with these programs; however, limited information is available about the relationship between participant characteristics and engagement with internet-based programs for self-management of chronic pain. The current study examined relationships between demographic and clinical characteristics and engagement with the Pain EASE program, a self-directed, internet-based cognitive behavioral therapy intervention for veterans with chronic low back pain (cLBP). Veterans with cLBP were enrolled in a 10 week trial of the Pain EASE program. Engagement measures included the number of logins, access to coping skill modules, and completed study staff-initiated weekly check-in calls. Regression analyses were conducted to identify significant predictors of engagement from hypothesized predictors (e.g., race/ethnicity, age, depressive symptom severity, and pain interference). Participants (N = 58) were 93% male, 60.3% identified as White, and had a mean age of 54.5 years. Participants logged into the program a median of 3.5 times, accessed a median of 2 skill modules, and attended a median of 6 check-in calls. Quantile regression revealed that, at the 50th percentile, non-White-identified participants accessed fewer modules than White-identified participants (p = .019). Increased age was associated with increased module use (p = .001). No clinical characteristics were significantly associated with engagement measures. White-identified race/ethnicity and increased age were associated with greater engagement with the Pain EASE program. Results highlight the importance of defining and increasing engagement in internet-delivered pain care.
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Affiliation(s)
- Chelsey Solar
- Department of Emergency Medicine, VA Boston Healthcare System, Boston, MA USA
| | - Allison M Halat
- Research Service, VA Boston Healthcare System, Boston, MA, USA
| | - R Ross MacLean
- Department of Psychology, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Haseena Rajeevan
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah L Krein
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alicia A Heapy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew J Bair
- Center for Health Information and Communication (CHIC), VA Health Services Research and Development, Indianapolis, IN, USA.,Department of Medicine, Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, USA
| | - Robert D Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, USA
| | - Diana M Higgins
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Ponvel P, Shahar S, Singh DKA, Ludin AFM, Rajikan R, Rajab NF, Ai-Vyrn C, Din NC, Ibrahim N, Subramaniam P, Haron H, Ismail A, Sharif R, Ramasamy K, Majeed ABA, Ali NM, Mohamad M, Noah SAM, Ibrahim AM, Safien AM, Khalid NM, Fadzil NHM, Mangialasche F, Kivipelto M. Multidomain Intervention for Reversal of Cognitive Frailty, Towards a Personalized Approach (AGELESS Trial): Study Design. J Alzheimers Dis 2021; 82:673-687. [PMID: 34092633 PMCID: PMC8385532 DOI: 10.3233/jad-201607] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF. Objective: The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention. Methods: A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 330 older adults with CF from urban, semi-urban, and rural areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n = 165). The control group (n = 165) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use. Results: The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able is to reverse CF. Conclusion: This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia.
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Affiliation(s)
- Pavapriya Ponvel
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Arimi Fitri Mat Ludin
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Roslee Rajikan
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Fadilah Rajab
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chin Ai-Vyrn
- Geriatric Division, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Normah Che Din
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Aniza Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Razinah Sharif
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | | | - Mazlyfarina Mohamad
- Centre for Diagnostic, Therapeutic & Investigative Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shahrul Azman Mohd Noah
- Centre for Artificial Intelligence Technology, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Malaysia
| | - Azianah Mohd Ibrahim
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Aisyah Mohd Safien
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Mustafa Khalid
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Hidayah Md Fadzil
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Alzheimer Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Alzheimer Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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71
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Moon Z, Zuchowski M, Moss-Morris R, Hunter MS, Norton S, Hughes LD. Disparities in access to mobile devices and e-health literacy among breast cancer survivors. Support Care Cancer 2021; 30:117-126. [PMID: 34236506 PMCID: PMC8264175 DOI: 10.1007/s00520-021-06407-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
Background The number of e-health interventions developed for breast cancer survivors continues to increase. However, issues with engagement and retention are common. This study aimed to explore e-health literacy rates and access to smartphones and tablets in a large sample of breast cancer survivors. Methods In study 1, women were recruited from outpatient breast clinics across England and Wales. Eligible women were asked to complete a questionnaire pack to assess their access to devices and their e-health literacy. Multiple regression analyses were run to assess the relationship between technology access and e-health literacy with sociodemographic variables such as age, social deprivation, and education. Study 2 presents a smaller sample recruited through social media who answered a questionnaire relating to use of mobile devices and e-health, and apps. Results Two thousand nine women participated in the study. Seventy-one percent had access to a smartphone, 54% had access to a tablet, and 20% did not have access to either device. Multiple logistic regressions showed that women who were younger, had higher levels of education, and who were from less deprived areas were more likely to have access to either device. Poorer e-health literacy was associated with being older, having less education, and not having access to a mobile device. Conclusions Whilst the results show relatively widespread access to mobile devices, there is evidence of a digital divide across some groups. Online interventions should be developed with consideration of individuals who are less e-health-literate and less technologically adept in order to increase the likelihood of engagement. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06407-2.
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Affiliation(s)
- Zoe Moon
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Mira Zuchowski
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Myra S Hunter
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Lyndsay D Hughes
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
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Pattern of Use of Electronic Health Record (EHR) among the Chronically Ill: A Health Information National Trend Survey (HINTS) Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147254. [PMID: 34299705 PMCID: PMC8304473 DOI: 10.3390/ijerph18147254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/20/2022]
Abstract
Effective patient–provider communication is a cornerstone of patient-centered care. Patient portals provide an effective method for secure communication between patients or their proxies and their health care providers. With greater acceptability of patient portals in private practices, patients have a unique opportunity to manage their health care needs. However, studies have shown that less than 50% of patients reported accessing the electronic health record (EHR) in a 12-month period. We used HINTS 5 cycle 1 and cycle 2 to assess disparities among US residents 18 and older with any chronic condition regarding the use of EHR for secure direct messaging with providers, to request refills, to make clinical decisions, or to share medical records with another provider. The results indicate that respondents with multimorbidity are more likely to share their medical records with other providers. However, respondents who are 75 and older are less likely to share their medical records with another provider. Additionally, respondents who are 65 and older are less likely to use the EHR for secure direct messaging with their provider. Additional health care strategies and provider communication should be developed to encourage older patients with chronic conditions to leverage the use of patient portals for effective disease management.
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73
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Kouvonen A, Kemppainen L, Ketonen EL, Kemppainen T, Olakivi A, Wrede S. Digital Information Technology Use, Self-Rated Health, and Depression: Population-Based Analysis of a Survey Study on Older Migrants. J Med Internet Res 2021; 23:e20988. [PMID: 34125069 PMCID: PMC8240805 DOI: 10.2196/20988] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/28/2020] [Accepted: 05/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous studies have found that in general, poor health is associated with a lower likelihood of internet use in older adults, but it is not well known how different indicators of health are associated with different types of digital information technology (DIT) use. Moreover, little is known about the relationship between health and the types of DIT use in older ethnic minority and migrant populations. OBJECTIVE The aim of this study is to examine the associations among depressive symptoms and self-rated health (SRH) with different dimensions of DIT use in older migrants. METHODS We analyzed data from the Care, Health and Ageing of Russian-speaking Minority (CHARM) study, which is based on a nationally representative sample of community-dwelling, Russian-speaking adults aged 50 years or older residing permanently in Finland (men: 616/1082, 56.93%; age: mean 63.2 years, SD 8.4 years; response rate: 1082/3000, 36.07%). Data were collected in 2019 using a postal survey. Health was measured using depressive symptoms (measured using the Center for Epidemiologic Studies Depression Scale) and SRH. Binary logistic regression analyses were used to investigate the associations between the two health indicators and the following six outcomes: daily internet use, smartphone ownership, the use of the internet for messages and calls, social media use, the use of the internet for personal health data, and obtaining health information from the internet. A number of sociodemographic and socioeconomic factors were controlled for in the logistic regression regression analysis. Analyses were performed with weights accounting for the survey design and nonresponse. RESULTS After adjusting for sociodemographic and socioeconomic factors, depressive symptoms (odds ratio [OR] 2.68, 95% CI 1.37-5.24; P=.004) and poor SRH (OR 7.90, 95% CI 1.88-33.11; P=.005) were associated with a higher likelihood of not using the internet daily. Depressive symptoms (OR 1.88, 95% CI 1.06-3.35; P=.03) and poor SRH (OR 5.05, 95% CI 1.58-16.19; P=.006) also increased the likelihood of smartphone nonuse. Depressive symptoms were additionally associated with a lower likelihood of social media use, and poor SRH was associated with a lower likelihood of using the internet for messaging and calling. CONCLUSIONS Poor SRH and depressive symptoms are associated with a lower likelihood of DIT use in older adults. Longitudinal studies are required to determine the directions of these relationships.
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Affiliation(s)
- Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Research Institute of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Laura Kemppainen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | | | - Teemu Kemppainen
- Department of Geosciences and Geography, University of Helsinki, Helsinki, Finland
| | - Antero Olakivi
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Sirpa Wrede
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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74
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Achieving person-centredness through technologies supporting integrated care for older people living at home: an integrative review. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-03-2021-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PurposeThe purpose of this paper is to identify the range, type and outcomes of technological innovations aimed at supporting older people to maintain their independence within the context of integrated care at home. We also discuss key emergent themes relevant to the use of person-centred technology for older people in integrated care and propose recommendations for policy and practice.Design/methodology/approachAn integrative review methodology was used to identify and describe recent scientific publications in four stages: problem identification, literature search, data evaluation and data analysis.FindingsTwelve studies were included in the review. Three studies described remote consultations, particularly telemedicine; five studies described tools to support self-management; three studies described the use of healthcare management tools, and one study described both remote consultation and self-care management. Emergent themes were: acceptability, accessibility and use of digital technologies; co-ordination and integration of services; the implementation of digital technologies; and safety and governance. Several recommendations are proposed relevant to integrated care teams, technology developers and researchers.Originality/valueThis review uniquely considers the extent to which novel digital technologies used in integrated care for older people are person-centred.
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75
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Sacca L, Maroun V, Khoury M. Predictors of high trust and the role of confidence levels in seeking cancer-related information. Inform Health Soc Care 2021; 47:53-61. [PMID: 34014145 DOI: 10.1080/17538157.2021.1925676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
One of the most commonly searched topics on the internet in the United States is cancer. Our study aims to provide a general overview of the predictors of trust for two health information sources, doctors and the internet, when seeking cancer-related information. The data were obtained from the 2018 HINTS 5 Cycle 2 survey, which was administered from January through May to a total of 3,504 respondents. We carried out next a series of ordinal logistic regression models to identify predictors of high trust in doctors and the internet separately for cancer-seeking information. Demographic predictor variables varied as predictors of high trust for cancer knowledge across both sources. Respondents who reported less confidence in their ability to seek cancer information had significantly higher odds of high trust in both doctors (OR = 8.43, CI: 5.58-12.73) and the internet (OR = 2.93, CI: 1.97-4.35) as compared to those who reported being "completely confident" in their ability to obtain cancer information. Understanding the key predictors of trust in doctors and the internet is crucial to the enhancement of health. The role of confidence as a predictor of trust in seeking cancer information has been shown to consistently influence the levels of trust attributed to each topic.
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Affiliation(s)
- Lea Sacca
- Center for Health Promotion Disease Prevention, University of Texas School of Public, Health, TX, Houston, 77030, USA
| | | | - Milad Khoury
- Department of Endocrinology, Penn State University, Hershey, PA, USA
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76
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Abstract
Abstract
Having access and skills to use social technology, i.e. social internet use, social media and social applications, are considered as being vital to online social connection. Whilst evidence exists around facilitators and barriers to general technology use, evidence is limited with regards to the motivators, skills and tangible offline benefits older technology users experience with social technology. Therefore, this study used a qualitative, exploratory method to understand older adults’ experiences of using social technology to connect with others. Semi-structured interviews were conducted with 20 older adults (65+ years) across England, Scotland and Wales. Despite having access to social technology for social connection, and using this technology regularly, multiple barriers impacted motivators and skills for use, namely perceived self-efficacy and fear, the culture of online communication, absence of social capital and physical functioning. Some of these barriers of social technology use are reminiscent of barriers of wider technology use and emphasise the importance of addressing these barriers for digital exclusion, as well as social connection. However, some of these barriers were specific to social technology use and should be considered when providing guidance or interventions to increase older adults’ online social connection. Social connection was a clear tangible outcome to social technology use, and individuals discussed the benefits of using social technology, particularly visual communication tools, for online connection.
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77
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Friedman BB, Suri S, Solé-Padullés C, Düzel S, Drevon CA, Baaré WFC, Bartrés-Faz D, Fjell AM, Johansen-Berg H, Madsen KS, Nyberg L, Penninx BWJH, Sexton C, Walhovd KB, Zsoldos E, Budin-Ljøsne I. Are People Ready for Personalized Brain Health? Perspectives of Research Participants in the Lifebrain Consortium. THE GERONTOLOGIST 2021; 60:1050-1059. [PMID: 31682729 PMCID: PMC7427479 DOI: 10.1093/geront/gnz155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives A healthy brain is central to physical and mental well-being. In this multi-site, qualitative study, we investigated views and attitudes of adult participants in brain research studies on the brain and personalized brain health as well as interest in maintaining a healthy brain. Design and Methods We conducted individual interviews with 44 adult participants in brain research cohorts of the Lifebrain consortium in Spain, Norway, Germany, and the United Kingdom. The interviews were audio recorded, transcribed, and coded using a cross-country codebook. The interview data were analyzed using qualitative content analysis. Results Most participants did not focus on their own brain health and expressed uncertainty regarding how to maintain it. Those actively focusing on brain health often picked one specific strategy like diet or memory training. The participants were interested in taking brain health tests to learn about their individual risk of developing brain diseases, and were willing to take measures to maintain their brain health if personalized follow-up was provided and the measures had proven impact. The participants were interested in more information on brain health. No differences in responses were identified between age groups, sex, or countries. Discussion and Implications Concise, practical, personalized, and evidence-based information about the brain may promote brain health. Based on our findings, we have launched an ongoing global brain health survey to acquire more extensive, quantitative, and representative data on public perception of personalized brain health.
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Affiliation(s)
- Barbara Bodorkos Friedman
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Norway
| | - Sana Suri
- Department of Psychiatry and Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, UK
| | - Cristina Solé-Padullés
- Department of Medicine, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Spain
| | - Sandra Düzel
- Max Planck Institute for Human Development, Berlin, Germany
| | - Christian A Drevon
- Vitas AS, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - William F C Baaré
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre,Denmark
| | - David Bartrés-Faz
- Department of Medicine, Faculty of Medicine and Health Sciences and Neuroscience Institute, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Anders M Fjell
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Norway
| | | | - Kathrine S Madsen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Lars Nyberg
- Centre for Functional Brain Imaging, Umeå Universitet, Sweden
| | | | - Claire Sexton
- Department of Psychiatry and Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, UK.,Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, Oslo, Norway
| | - Kristine B Walhovd
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Norway
| | - Enikő Zsoldos
- Department of Psychiatry and Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, UK
| | - Isabelle Budin-Ljøsne
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Norway.,Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
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"A Touch of Sugar": A Qualitative Study of the Impact of Health Beliefs on Type 1 and Type 2 Diabetes Self-Management Among Black Canadian Adults. Can J Diabetes 2021; 45:607-613.e2. [PMID: 33582043 DOI: 10.1016/j.jcjd.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/07/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Black Canadians have higher rates of diabetes and complications compared with White Canadians. However, research on diabetes self-management in this community is lacking. We conducted a qualitative study to explore diabetes self-management in the Black Canadian community using the lens of the Health Belief Model. METHODS Forty-three individuals who identify as Black Canadians, living with or caring for a person with diabetes, were recruited. Data were collected through focus groups and interviews, and then analyzed using content analysis. RESULTS We found that participants appreciated they are susceptible to diabetes based on family or peer experiences. Perceived severity is variable for which some believe that diabetes is only a "sugar problem," and the majority highlighted a perceived lack of knowledge about diabetes complications. Perceived benefits to treatment included prolonging life and cleansing one's body. Perceived barriers included lack of culturally appropriate dietary advice, lack of shared decision-making driven by a language barrier and cultural mismatch between patient and provider, socioeconomic status and difficulty navigating and accessing the Canadian health-care system. Peers, family members, churches and online platforms served as the main information sources and cues to action, influencing each of the 4 aforementioned categories. A number of solutions were proposed by the participants to address the barriers from patient, health-care delivery and health advocacy perspectives. CONCLUSIONS Black Canadians face unique barriers to diabetes self-management, some of which are rooted within health belief systems. Avenues for intervention include peer education through narratives and a renewed focus on providing culturally appropriate care.
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Hussein WF, Bennett PN, Pace S, Chen S, Legg V, Atwal J, Sun S, Schiller B. The Mobile Health Readiness of People Receiving In-Center Hemodialysis and Home Dialysis. Clin J Am Soc Nephrol 2021; 16:98-106. [PMID: 33355235 PMCID: PMC7792646 DOI: 10.2215/cjn.11690720] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Mobile health is the health care use of mobile devices, such as smartphones. Mobile health readiness is a prerequisite to successful implementation of mobile health programs. The aim of this study was to examine the status and correlates of mobile health readiness among individuals on dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A cross-sectional 30-item questionnaire guided by the Khatun mobile health readiness conceptual model was distributed to individuals on dialysis from 21 in-center hemodialysis facilities and 14 home dialysis centers. The survey assessed the availability of devices and the internet, proficiency, and interest in using mobile health. RESULTS In total, 949 patients (632 hemodialysis and 317 home dialysis) completed the survey. Of those, 81% owned smartphones or other internet-capable devices, and 72% reported using the internet. The majority (70%) reported intermediate or advanced mobile health proficiency. The main reasons for using mobile health were appointments (56%), communication with health care personnel (56%), and laboratory results (55%). The main reported concerns with mobile health were privacy and security (18%). Mobile health proficiency was lower in older patients: compared with the 45- to 60-years group, respondents in age groups <45, 61-70, and >70 years had adjusted odds ratios of 5.04 (95% confidence interval, 2.23 to 11.38), 0.39 (95% confidence interval, 0.24 to 0.62), and 0.22 (95% confidence interval, 0.14 to 0.35), respectively. Proficiency was lower in participants with Hispanic/Latinx ethnicity (adjusted odds ratio, 0.49; 95% confidence interval, 0.31 to 0.75) and with less than college education (adjusted odds ratio for "below high school," 0.09; 95% confidence interval, 0.05 to 0.16 and adjusted odds ratio for "high school only," 0.26; 95% confidence interval, 0.18 to 0.39). Employment was associated with higher proficiency (adjusted odds ratio, 2.26; 95% confidence interval, 1.18 to 4.32). Although home dialysis was associated with higher proficiency in the unadjusted analyses, we did not observe this association after adjustment for other factors. CONCLUSIONS The majority of patients on dialysis surveyed were ready for, and proficient in, mobile health. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER DIALYSIS MHEALTH SURVEY,: NCT04177277.
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Affiliation(s)
- Wael F. Hussein
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Paul N. Bennett
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Sloane Pace
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Shijie Chen
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Veronica Legg
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Jugjeet Atwal
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Sumi Sun
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Brigitte Schiller
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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80
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Schooley B, Singh A, Hikmet N, Brookshire R, Patel N. Integrated Digital Patient Education at the Bedside for Patients with Chronic Conditions: Observational Study. JMIR Mhealth Uhealth 2020; 8:e22947. [PMID: 33350961 PMCID: PMC7785403 DOI: 10.2196/22947] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patient education delivered by a health care provider increases patients' understanding and adherence to medical instructions, which helps to improve patient health. Multiple challenges exist to delivering effective patient education to patients with multiple chronic conditions, including giving the necessary time, range, and types of learning materials, and assessing the level of understanding. To help overcome these challenges, it is important to study new electronic means to assist in patient education, such as the use of mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside. OBJECTIVE The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike. METHODS A mixed-methods approach was employed including survey administration to 178 patients after they received digital patient education in person with a health care provider, and qualitative interviews with 16 nurse educators who used the mobile digital health education technology to deliver instruction to patients. Patient survey data were analyzed using chi-square statistical tests. Qualitative interviews were analyzed for user acceptance and perceived value themes. RESULTS Patients who were counseled using a blended digital health education approach reported improved understanding of educational content (P=.034) and chronic health conditions (P<.001), were more motivated to care for themselves at home (P<.001), were more likely to say that they felt capable of making health care decisions with their doctors (P<.001) and on their own (P=.001), and were more likely to report their intention to follow their doctor's instructions (P<.001) than were patients whose education was not computer-based. Nurse educators felt that the digital education system and content enhanced their education efforts and could be easily integrated into the outpatient clinical workflow. CONCLUSIONS Patient education for individuals with chronic conditions may be more effective than traditional formats when provided in blended digital formats supervised by a health care provider.
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Affiliation(s)
- Benjamin Schooley
- Health Information Technology Program, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Akanksha Singh
- Department of Computer Science and Engineering, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Neşet Hikmet
- Health Information Technology Program, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Robert Brookshire
- Health Information Technology Program, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Nitin Patel
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, SC, United States
- Digital Health, Prisma Health, Columbia, SC, United States
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81
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Poss-Doering R, Kühn L, Kamradt M, Stürmlinger A, Glassen K, Andres E, Kaufmann-Kolle P, Wambach V, Bader L, Szecsenyi J, Wensing M. Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena. Antibiotics (Basel) 2020; 9:E878. [PMID: 33302559 PMCID: PMC7764260 DOI: 10.3390/antibiotics9120878] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/04/2023] Open
Abstract
The cluster randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation assessed determinants of practice and explored factors associated with antibiotic prescribing patterns. This work describes its findings on uptake and impacts of the complex intervention program and indicates potential implementation into routine care. In a nested mixed-methods approach, a three-wave study-specific survey for participating physicians and medical assistants assessed potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews, with a purposive sample of physicians, medical assistants and stakeholders, explored program component acceptance for daily practice and perceived sustainability of intervention component effects. Intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for educational components: feedback reports, background information, e-learning modules and disease-specific quality circles (QCs). Participation in PCNs was seen as the motivational factor for guideline-oriented patient care and adoption of new routines. Future approaches to fostering appropriate antibiotics use by targeting health literacy competencies and clinician's therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.
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Affiliation(s)
- Regina Poss-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Lukas Kühn
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Martina Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Anna Stürmlinger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Katharina Glassen
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Edith Andres
- aQua Institut, Maschmuehlenweg 8-10, 37073 Goettingen, Germany; (E.A.); (P.K.-K.)
| | - Petra Kaufmann-Kolle
- aQua Institut, Maschmuehlenweg 8-10, 37073 Goettingen, Germany; (E.A.); (P.K.-K.)
| | - Veit Wambach
- Agentur deutscher Arztnetze e.V., Friedrichstraße 171, 10117 Berlin, Germany;
| | - Lutz Bader
- Kassenärztliche Vereinigung Bayerns (KVB), 80684 München, Germany;
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
- aQua Institut, Maschmuehlenweg 8-10, 37073 Goettingen, Germany; (E.A.); (P.K.-K.)
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
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82
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Coombs LA, Ellington L, Fagerlin A, Mooney K. Age Is Not a Barrier: Older Adults With Cancer Derive Similar Benefit in a Randomized Controlled Trial of a Remote Symptom Monitoring Intervention Compared With Younger Adults. Cancer Control 2020; 27:1073274820968878. [PMID: 33153313 PMCID: PMC7791468 DOI: 10.1177/1073274820968878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study investigated a remote symptom monitoring intervention to examine if
older participants with cancer received a similar magnitude of benefit compared
with younger adults with cancer. We analyzed a longitudinal symptom monitoring
intervention for 358 participants beginning a new course of chemotherapy
treatment in community and academic oncology practices. The study design was a
randomized control trial; participants were randomized to the intervention or
usual care, the intervention was delivered during daily automated coaching.
Older adults with moderate and severe symptoms derived similar benefit as those
adults younger than 60 years of age, adherence to the study protocol which
involved daily calls was high. There was no significant difference between the 2
age categories; on average, older adult participants made 88% of expected daily
calls and younger adult participants made 90% of expected daily calls. Our
results challenge the perception that older adults are unwilling or unable to
use a technological tool such as interactive voice response and suggest that
patient utilization may be guided by other factors, such as ease of use and
perceived benefit from the intervention.
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Affiliation(s)
- Lorinda A Coombs
- School of Nursing, University of North Carolina at Chapel Hill, NC USA.,Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Lee Ellington
- University of Utah College of Nursing, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Kathi Mooney
- University of Utah College of Nursing, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
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83
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Choi M. Association of eHealth Use, Literacy, Informational Social Support, and Health-Promoting Behaviors: Mediation of Health Self-Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217890. [PMID: 33126469 PMCID: PMC7662976 DOI: 10.3390/ijerph17217890] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/11/2020] [Accepted: 10/20/2020] [Indexed: 01/16/2023]
Abstract
This descriptive, cross-sectional study identified the association of eHealth use, literacy, informational support, and health-promoting behaviors among older adults, as mediated by health self-efficacy. Convenience sampling was conducted at senior welfare centers in Chuncheon, in the Republic of Korea. Data analysis was performed using Pearson’s correlation and via path analyses. The findings showed that eHealth use had an indirect effect on health-promoting behaviors, as mediated by self-efficacy. Informational support was indirectly mediated by self-efficacy and had direct effects upon health-promoting behaviors. eHealth can facilitate self-efficacy and health management, despite not having direct effects upon health-promoting behaviors themselves. Thus, older adults need to be prepared for the increased use of eHealth. In addition, healthcare professionals should support older people in their use of eHealth and encourage informational support through comprehensive interventions so as to facilitate self-efficacy and health behaviors.
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Affiliation(s)
- MoonKi Choi
- College of Nursing, Kangwon National University, Chuncheon 24341, Korea
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84
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Onyeaka HK, Romero P, Healy BC, Celano CM. Age Differences in the Use of Health Information Technology Among Adults in the United States: An Analysis of the Health Information National Trends Survey. J Aging Health 2020; 33:147-154. [PMID: 33031007 DOI: 10.1177/0898264320966266] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Despite significant advancements in the use of health information technologies (HITs) in health care, older adults' adoption of new technologies has consistently lagged behind that of younger adults. Objective: To compare ownership rates and preferences for utilizing technology for health information exchange among older and younger adults. Methods: Utilizing data from the 2017 and 2018 iterations of the Health Information National Trends Survey (n = 6789), we performed multivariable logistic regression while controlling for sociodemographic characteristics. Results: Older adults were less likely than younger adults to own technological devices such as smartphones, less likely to report finding these tools beneficial in monitoring their health, and less likely to use these tools in communicating with their health providers. However, these differences were substantially attenuated after adjustment for technology ownership. Discussion: Future research should aim to identify factors associated with access, usability, and adoption of HIT for managing care among older adults.
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Affiliation(s)
- Henry K Onyeaka
- 2348Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Perla Romero
- 2348Massachusetts General Hospital, Boston, MA, USA
| | - Brian C Healy
- Harvard Medical School, Boston, MA, USA.,Harvard T.H Chan School of Public Health, Boston, MA, USA.,1861Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher M Celano
- 2348Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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85
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Evans HEL, Forbes CC, Vandelanotte C, Galvão DA, Newton RU, Wittert G, Chambers S, Kichenadasse G, Brook N, Girard D, Short CE. Examining the Priorities, Needs and Preferences of Men with Metastatic Prostate Cancer in Designing a Personalised eHealth Exercise Intervention. Int J Behav Med 2020; 28:431-443. [PMID: 32968943 DOI: 10.1007/s12529-020-09932-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few individuals with metastatic prostate cancer have access to prostate cancer-specific exercise support, despite demonstrated benefits. eHealth tools, such as websites, may be viable options for increasing access. To be effective and acceptable, future eHealth websites need to consider end-users' perspectives, capacity and needs. We aim to provide insight into these factors by exploring daily priorities, activities and health literacy of individuals with metastatic prostate cancer and their perspectives towards exercise and exercise-based web-based eHealth interventions. METHODS Semi-structured interviews explored participant's experiences and understanding of their disease, exercise levels, advice received from health care providers, as well as acceptability of and suggested content for an eHealth tool. A thematic analysis was undertaken. RESULTS Interviews were conducted with eighteen Australians (55-83 years; M = 71.5, SD = 8.9) living with metastatic prostate cancer. Needing to perform daily responsibilities was a key priority. Participants had limited understanding of the benefits of prostate cancer-specific exercise, and less than half discussed exercise with their health team. Fourteen men felt they could report metastases location, but only four could provide detailed information, which has clinical implications for exercise prescription. A potential web-based intervention was considered acceptable by seventeen men for reasons such as affordability, accessibility and convenience. User-friendly design and practitioner support were important. CONCLUSIONS Results identified key aspects useful for person-centred design of exercise programs. Participants were positive towards the proposed web-based tool and expressed the need for individualised, user-friendly and reliable information with support from a professional embedded. Lastly, not all participants could accurately report metastasis locations.
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Affiliation(s)
- Holly E L Evans
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, PO Box 11060, Adelaide, South Australia, 5001, Australia.
| | - Cynthia C Forbes
- Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, Appleton Institute, Physical Activity Research Group, Central Queensland University, Bruce Highway, North Rockhampton, Queensland, 4702, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, PO Box 11060, Adelaide, South Australia, 5001, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, New South Wales, 2007, Australia
| | - Ganessan Kichenadasse
- College of Medicine and Public Health, Flinders Centre for Innovation in Cancer, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Nicholas Brook
- Department of Surgery, University of Adelaide, Corner of North Terrace & George Street, Adelaide, South Australia, 5000, Australia
| | - Danielle Girard
- School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Camille E Short
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, PO Box 11060, Adelaide, South Australia, 5001, Australia.,Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences and Melbourne School of Health Sciences, University of Melbourne, Barry Building, Tin Alley, Parkville, Victoria, 3010, Australia
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86
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Sun X, Yan W, Zhou H, Wang Z, Zhang X, Huang S, Li L. Internet use and need for digital health technology among the elderly: a cross-sectional survey in China. BMC Public Health 2020; 20:1386. [PMID: 32917171 PMCID: PMC7488462 DOI: 10.1186/s12889-020-09448-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background China is becoming an aging society at the fastest pace in history, and there are a large number of empty nesters in the country. With economic and social development, internal support systems among families are gradually weakening. Supporting the elderly is thus emerging as a significant issue, and promoting digital health technologies is an effective way to help address it. Encouraging the application of Internet to elderly care and Internet use among the elderly are important means of promoting digital health technologies. This paper examines the current state of the use of the Internet by the elderly and factors influencing it (including physical, psychological, and social) as well as demand among the elderly for smart services. Methods A total of 669 subjects over the age of 60 years were randomly selected from 13 cities in Heilongjiang province and surveyed using questionnaires from May 1 to July 31, 2018. The questionnaires were collected for descriptive statistics, the chi-square test, and the analysis of influential factors. Results Of the people surveyed, 38.6% used the Internet. Their favorite online activity was online dating (74.2%), and the health information they obtained through the Internet was mainly related to diet (63.1%) and exercise (47.1%). The subjects demanded smart bracelets (MD = 2.80) and emergency callers (MD = 2.77). Gender, age, education, monthly income, quality of life, number of friends, and social participation were found to have an impact on Internet use. Conclusions More measures are needed to reduce barriers to the use of the Internet and promote digital health technologies. The society, equipment manufacturers, and family members of the elderly should work together to enable them to reap the benefits of online technologies.
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Affiliation(s)
- Xinran Sun
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wenxin Yan
- School of Health Management, Harbin Medical University, Harbin, China
| | - Hao Zhou
- Department of Quality Control, Center for Disease Control and Prevention, Harbin, China
| | - Zhaoqing Wang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Xueying Zhang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Shuang Huang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Li Li
- School of Health Management, Harbin Medical University, Harbin, China.
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87
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Sahoo S, Millar RJ, Yamashita T, Cummins PA. Problem-solving in technology-rich environments and cancer screening in later life. Eur J Cancer Prev 2020; 29:474-480. [PMID: 32740175 DOI: 10.1097/cej.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Routine cancer screening is widely recognized as an effective preventive strategy to reduce cancer mortality - the second leading cause of death in the US. However, cancer screening requires a complex array of tasks such as seeking up-to-date guidelines, making appointments, planning hospital visits, and communicating with health care professionals. Importantly, modern health care largely relies on technology to disseminate the latest information and administer the system. Yet, little is known about the technology-related skills that are relevant to regular cancer screening. This study examined the association between problem-solving skills in the technology-rich environment and cancer screening in later life. Using 2012/2014 Program for International Assessment of Adult Competencies data, binary logistic regressions with survey weights were used to estimate the association between problem-solving skills in the technology-rich environment and four cancer screening behaviors among the corresponding target populations aged between 45 and 74 years old (n = 1374 for cervical screening; n = 1373 for breast screening; n = 1166 for prostate screening; n = 2563 for colon screening). Results showed that greater problem-solving skills in the technology-rich environment scores (0-500 points) were significantly and positively associated with prostate cancer screening (odds ratio = 1.005, P < 0.05) among men, but not with colon (men and women) or cervical or breast (women) cancer screenings. Improvement in problem-solving skills in the technology-rich environment may promote specific cancer screening behaviors. Our findings inform future policy discussions and interventions that seek to improve cancer screening among a vulnerable section of older populations.
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Affiliation(s)
- Shalini Sahoo
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County
- Gerontology Doctoral Program, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Roberto J Millar
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County
- Gerontology Doctoral Program, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Takashi Yamashita
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County
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88
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Agher D, Sedki K, Tsopra R, Despres S, Jaulent MC. Influence of Connected Health Interventions for Adherence to Cardiovascular Disease Prevention: A Scoping Review. Appl Clin Inform 2020; 11:544-555. [PMID: 32814353 DOI: 10.1055/s-0040-1715649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Recent health care developments include connected health interventions to improve chronic disease management and/or promote actions reducing aggravating risk factors for conditions such as cardiovascular diseases. Adherence is one of the main challenges for ensuring the correct use of connected health interventions over time. OBJECTIVE This scoping review deals with the connected health interventions used in interventional studies, describing the ways in which these interventions and their functions effectively help patients to deal with cardiovascular risk factors over time, in their own environments. The objective is to acquire knowledge and highlight current trends in this field, which is currently both productive and immature. METHODS A structured literature review was constructed from Medline-indexed journals in PubMed. We established inclusion criteria relating to three dimensions (cardiovascular risk factors, connected health interventions, and level of adherence). Our initial search yielded 98 articles; 78 were retained after screening on the basis of title and abstract, 49 articles underwent full-text screening, and 24 were finally retained for the analysis, according to preestablished inclusion criteria. We excluded studies of invasive interventions and studies not dealing with digital health. We extracted a description of the connected health interventions from data for the population or end users. RESULTS We performed a synthetic analysis of outcomes, based on the distribution of bibliometrics, and identified several connected health interventions and main characteristics affecting adherence. Our analysis focused on three types of user action: to read, to do, and to connect. Finally, we extracted current trends in characteristics: connect, adherence, and influence. CONCLUSION Connected health interventions for prevention are unlikely to affect outcomes significantly unless other characteristics and user preferences are considered. Future studies should aim to determine which connected health design combinations are the most effective for supporting long-term changes in behavior and for preventing cardiovascular disease risks.
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Affiliation(s)
- Dahbia Agher
- INSERM, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris, France.,BeWellConnect, Research and Development, Visiomed Group 75016 Paris, France
| | - Karima Sedki
- INSERM, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris, France
| | - Rosy Tsopra
- INSERM, Université Paris Descartes, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006 Paris, France.,Department of Medical Informatics, H⊚pital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Sylvie Despres
- INSERM, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris, France
| | - Marie-Christine Jaulent
- INSERM, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Paris, France
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89
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Kruse C, Fohn J, Wilson N, Nunez Patlan E, Zipp S, Mileski M. Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review. JMIR Med Inform 2020; 8:e20359. [PMID: 32784177 PMCID: PMC7450384 DOI: 10.2196/20359] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/11/2020] [Accepted: 07/06/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Rising telehealth capabilities and improving access to older adults can aid in improving health outcomes and quality of life indicators. Telehealth is not being used ubiquitously at present. OBJECTIVE This review aimed to identify the barriers that prevent ubiquitous use of telehealth and the ways in which telehealth improves health outcomes and quality of life indicators for older adults. METHODS This systematic review was conducted and reported in accordance with the Kruse protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers queried the following four research databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE), Web of Science, and Embase (Science Direct). Reviewers analyzed 57 articles, performed a narrative analysis to identify themes, and identified barriers and reports of health outcomes and quality of life indicators found in the literature. RESULTS Reviewers analyzed 57 studies across the following five interventions of telehealth: eHealth, mobile health (mHealth), telemonitoring, telecare (phone), and telehealth video calls, with a Cohen κ of 0.75. Reviewers identified 14 themes for barriers. The most common of which were technical literacy (25/144 occurrences, 17%), lack of desire (19/144 occurrences, 13%), and cost (11/144 occurrences, 8%). Reviewers identified 13 medical outcomes associated with telehealth interventions. The most common of which were decrease in psychological stress (21/118 occurrences, 18%), increase in autonomy (18/118 occurrences, 15%), and increase in cognitive ability (11/118 occurrences, 9%). Some articles did not report medical outcomes (18/57, 32%) and some did not report barriers (19/57, 33%). CONCLUSIONS The literature suggests that the elimination of barriers could increase the prevalence of telehealth use by older adults. By increasing use of telehealth, proximity to care is no longer an issue for access, and thereby care can reach populations with chronic conditions and mobility restrictions. Future research should be conducted on methods for personalizing telehealth in older adults before implementation. TRIAL REGISTRATION PROSPERO CRD42020182162; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020182162. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/15490.
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Affiliation(s)
- Clemens Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Joanna Fohn
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Nakia Wilson
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | | | - Stephanie Zipp
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, United States
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90
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Bowden JL, Lamberts R, Hunter DJ, Melo LR, Mills K. Community-based online survey on seeking care and information for lower limb pain and injury in Australia: an observational study. BMJ Open 2020; 10:e035030. [PMID: 32690504 PMCID: PMC7371145 DOI: 10.1136/bmjopen-2019-035030] [Citation(s) in RCA: 3] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Musculoskeletal pain is a leading cause of disability globally. In geographically and socioeconomically diverse countries, such as Australia, care seeking when someone experiences musculoskeletal pain is varied and potentially influenced by their individual characteristics, access to practitioners or perceived trustworthiness of information. This study explored how consumers currently access healthcare, how well it is trusted and if sociodemographic factors influenced healthcare utilisation. DESIGN Anonymous online observational survey. SETTING Australia. PARTICIPANTS A convenience sample of 831 community-based individuals (18+ years). OUTCOME MEASURES Descriptive analyses and generalised estimating equations were used to quantify healthcare-seeking behaviours, sources and trust of health information for (A) first-contact practitioners, (B) medical practitioners, and (C) other sources of information. RESULTS Of the 761 respondents, 73% were females, 54% resided in capital cities. 68% of respondents had experienced pain or injury in more than one lower limb joint. Despite this, more than 30% of respondents only sought help when there had not been natural resolution of their pain. Physiotherapists had the highest odds of being seen, asked and trusted for healthcare information. The odds of seeking care from general practitioners were no higher than seeking information from an expert website. Older individuals and women exhibited higher odds of seeking, asking and trusting health information. CONCLUSION Intelligible and trustworthy information must be available for consumers experiencing lower limb pain. Individuals, particularly younger people, are seeking information from multiple, unregulated sources. This suggests that healthcare professionals may need to invest time and resources into improving the trustworthiness and availability of healthcare information to improve healthcare quality.
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Affiliation(s)
- Jocelyn L Bowden
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Rod Lamberts
- Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Luciano Ricardo Melo
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia
- Sax Institute, Haymarket, New South Wales, Australia
| | - Kathryn Mills
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
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91
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Cherid C, Baghdadli A, Wall M, Mayo NE, Berry G, Harvey EJ, Albers A, Bergeron SG, Morin SN. Current level of technology use, health and eHealth literacy in older Canadians with a recent fracture-a survey in orthopedic clinics. Osteoporos Int 2020; 31:1333-1340. [PMID: 32112118 DOI: 10.1007/s00198-020-05359-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/19/2020] [Indexed: 12/20/2022]
Abstract
UNLABELLED Among older adults who have recently sustained a fracture, there is substantial adoption of mobile technology. Furthermore, health and eHealth literacy level reported by participants supports the development of interactive eHealth interventions toward fostering better patient engagement in skeletal health management. INTRODUCTION Electronic health resources are increasingly used in the self-management of medical conditions. We aimed to identify the current level of technology adoption, health, and eHealth literacy among older adults with a recent fracture, to determine if the use of electronic interventions would be feasible and acceptable in this population. METHODS Adults ≥ 50 years with recent fractures were invited to complete a self-administered survey composed of 21 questions, including an 8-item perceived eHealth literacy scale. RESULTS A total of 401 participants completed the survey (women, 64%; ≥ 65 years, 59%; university education, 32%). Most participants reported no difficulty in reading printed health material (67%) and felt confident in filling out medical forms (65%). Younger age and higher levels of education were associated with higher health literacy. Most respondents (81%) owned at least one mobile device (smartphone, 49%; tablet, 45%). eHEALS scores were similar among men (29, IQR 24-32) and women (29, IQR 25-33), and between younger age group categories (50-64 years, 30; IQR 26-33; and 65-74 years, 29; IQR 25-32), but lower in the oldest age group (≥ 75 years, 24; IQR 21-29; p < 0.05). Compared with the youngest group, those ≥ 75 years had higher odds of an eHEALS < 26 (odds ratio, 4.2; 95% confidence interval 2.0-8.9) after adjusting for sex and education level. CONCLUSION There is significant adoption of mobile technology among older adults. Health and eHealth literacy reported by this study population supports the development of interactive eHealth interventions toward fostering better patient engagement in skeletal health management.
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Affiliation(s)
- C Cherid
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Canada
| | - A Baghdadli
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
| | - M Wall
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
| | - N E Mayo
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Canada
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
| | - G Berry
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
- Department of Orthopedics, Faculty of Medicine, McGill University, Montreal, Canada
| | - E J Harvey
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada
- Department of Orthopedics, Faculty of Medicine, McGill University, Montreal, Canada
| | - A Albers
- Department of Orthopedics, Faculty of Medicine, McGill University, Montreal, Canada
- St. Mary's Hospital, Montreal, Canada
| | - S G Bergeron
- Department of Orthopedics, Faculty of Medicine, McGill University, Montreal, Canada
- Jewish General Hospital, Montreal, Canada
| | - S N Morin
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Canada.
- The Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve O, Room 3E-11, Montreal, Québec, H4A 3S5, Canada.
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92
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Li P, Luo Y, Yu X, Wen J, Mason E, Li W, Jalali MS. Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China. J Med Internet Res 2020; 22:e17221. [PMID: 32525483 PMCID: PMC7317627 DOI: 10.2196/17221] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/11/2020] [Accepted: 04/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. OBJECTIVE This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. METHODS We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. RESULTS Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). CONCLUSIONS We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.
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Affiliation(s)
- Peiyi Li
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Yunmei Luo
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Xuexin Yu
- Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Elizabeth Mason
- Massachusetts General Hospital's Institute for Technology Assessment, Harvard Medical School, Boston, MA, United States
| | - Weimin Li
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Mohammad S Jalali
- Massachusetts General Hospital's Institute for Technology Assessment, Harvard Medical School, Boston, MA, United States
- MIT Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, United States
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93
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Merkel S, Hess M. The Use of Internet-Based Health and Care Services by Elderly People in Europe and the Importance of the Country Context: Multilevel Study. JMIR Aging 2020; 3:e15491. [PMID: 32490837 PMCID: PMC7301259 DOI: 10.2196/15491] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/30/2019] [Accepted: 02/07/2020] [Indexed: 01/23/2023] Open
Abstract
Background Digital health care is becoming increasingly important, but it has the risk of further increasing the digital divide, as not all individuals have the opportunity, skills, and knowledge to fully benefit from potential advantages. In particular, elderly people have less experience with the internet, and hence, they are in danger of being excluded. Knowledge on the influences of the adoption of internet-based health and care services by elderly people will help to develop and promote strategies for decreasing the digital divide. Objective This study examined if and how elderly people are using digital services to access health and social care. Moreover, it examined what personal characteristics are associated with using these services and if there are country differences. Methods Data for this study were obtained from the Special Eurobarometer 460 (SB 460), which collected data on Europeans’ handling of and attitudes toward digital technologies, robots, and artificial intelligence, including data on the use of internet-based health and social care services, among 27,901 EU citizens aged 15 years or older. Multilevel logistic regression models were adopted to analyze the association of using the internet for health and social care services with several individual and country-level variables. Results At the individual level, young age, high education, high social class, and living in an urban area were positively associated with a high probability of using internet-based health and social services. At the country level, the proportion of elderly people who participated in any training activity within the last month was positively associated with the proportion of elderly people using these services. Conclusions The probability of using internet-based health and social services and their accompanying advantages strongly depend on the socioeconomic background. Training and educational programs might be helpful to mitigate these differences.
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Affiliation(s)
- Sebastian Merkel
- Faculty of Social Sciences, Ruhr-University Bochum, Bochum, Germany
| | - Moritz Hess
- SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany
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94
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Clarke MA, Fruhling AL, Sitorius M, Windle TA, Bernard TL, Windle JR. Impact of Age on Patients' Communication and Technology Preferences in the Era of Meaningful Use: Mixed Methods Study. J Med Internet Res 2020; 22:e13470. [PMID: 32478658 PMCID: PMC7296425 DOI: 10.2196/13470] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/22/2019] [Accepted: 01/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Identifying effective means of communication between patients and their health care providers has a positive impact on patients' satisfaction, adherence, and health-related outcomes. OBJECTIVE This study aimed to identify the impact of patients' age on their communication and technology preferences when managing their health. We hypothesize that a patient's age affects their communication and technology preferences when interacting with clinicians and managing their health. METHODS A mixed methods study was conducted to identify the preferences of patients with cardiovascular diseases. Results were analyzed based on the patients' age. Grounded theory was used to analyze the qualitative data. Patients were recruited based on age, gender, ethnicity, and zip code. RESULTS A total of 104 patients were recruited: 34 young adults (19-39 years), 33 middle aged (40-64), and 37 senior citizens (>65). Young adults (mean 8.29, SD 1.66) reported higher computer self-efficacy than middle-aged participants (mean 5.56, SD 3.43; P<.05) and senior citizens (mean 47.55, SD 31.23; P<.05). Qualitative analysis identified the following three themes: (1) patient engagement (young adults favored mobile technologies and text messaging, middle-aged patients preferred phone calls, and senior citizens preferred direct interactions with the health care provider); (2) patient safety (young adults preferred electronic after-visit summaries [AVS] and medication reconciliation over the internet; middle-aged patients preferred paper-based or emailed AVS and medication reconciliation in person; senior citizens preferred paper-based summaries and in-person medication reconciliation); (3) technology (young adults preferred smartphones and middle-aged patients and senior citizens preferred tablets or PCs). Middle-aged patients were more concerned about computer security than any other group. A unique finding among senior citizens was the desire for caregivers to have access to their personal health record (PHR). CONCLUSIONS Patients of different ages have different communication and technology preferences and different preferences with respect to how they would like information presented to them and how they wish to interact with their provider. The PHR is one approach to improving patient engagement, but nontechnological options need to be sustained to support all patients.
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Affiliation(s)
- Martina A Clarke
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ann L Fruhling
- School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska Omaha, Omaha, NE, United States
| | - Marilyn Sitorius
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Thomas A Windle
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tamara L Bernard
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - John R Windle
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
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95
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Ramirez-Zohfeld V, Seltzer A, Xiong L, Morse L, Lindquist LA. Use of Electronic Health Records by Older Adults, 85 Years and Older, and Their Caregivers. J Am Geriatr Soc 2020; 68:1078-1082. [PMID: 32159860 DOI: 10.1111/jgs.16393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/13/2020] [Accepted: 02/01/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Healthcare providers may not offer patient portal (PP) access to electronic health records (EHRs) to their patients older than 85 years, due to the false impression that they do not utilize technology. It is imperative that older adults be given equal opportunity to use technology in regard to their healthcare. OBJECTIVE To characterize the content and frequency of use of PP messaging tethered to EHRs by older adults, aged 85 years and older, and their caregivers. DESIGN, SETTING, AND PARTICIPANTS User-initiated communications from electronic PPs (MyChart) tethered to an EHR (Epic) for patients who were 85 years and older, receiving care at outpatient internal medicine and geriatric clinics at an academic health center from July 1, 2016, to December 31, 2016, were reviewed retrospectively and analyzed with mixed methods. RESULTS A total of 1254 user-initiated messages, sent by 62 patients aged 85 years and older (mean age = 87.9 years; n = 576 messages; mean = 9.9 messages per person) and 82 caregivers (n = 678 messages; mean = 7.8 messages per person), were analyzed. Qualitative analysis revealed 12 main themes: clinical issues, medication/vaccine questions, medication refills, laboratory orders/results, therapy/durable medical equipment, care coordination, care transitions, scheduling, appreciation/thank you, administrative/billing, telephone requests, and death notification. Caregivers significantly initiated messages more for care transitions (P < .001). Patients significantly initiated messages more for scheduling (P = .04) and medication refills (P = .04). Patients who had heart failure, coronary artery disease, or Alzheimer's disease were significantly more likely to have caregivers using the PP as their proxy (30.7% vs 21.6%; P = .01). CONCLUSIONS Adults, aged 85 years and older, and their caregivers utilize PPs tethered to EHRs. Healthcare providers should ensure inclusivity and offer access to EHRs to older adult populations, especially those aged 85 years and older. J Am Geriatr Soc 68:1078-1082, 2020.
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Affiliation(s)
- Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne Seltzer
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Linda Xiong
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lucy Morse
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lee A Lindquist
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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96
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Singh G, MacGillivray M, Mills P, Adams J, Sawatzky B, Mortenson WB. Patients' Perspectives on the Usability of a Mobile App for Self-Management following Spinal Cord Injury. J Med Syst 2019; 44:26. [PMID: 31828440 DOI: 10.1007/s10916-019-1487-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
With decreasing inpatient lengths of stay following spinal cord injury (SCI), newly injured patients may be discharged into the community without the self-management skills needed to prevent secondary conditions. A mobile app was developed to facilitate self-management skills following SCI in the inpatient rehabilitation and early community settings. The objective of this study was to explore patients' perspectives on the usability of this self-management app. A mixed-methods study design was implemented. The app was trialed at a local rehabilitation centre with 20 inpatient participants who experienced a SCI. They received mobile app training sessions throughout their inpatient rehabilitation. A thematic analysis was performed on qualitative data from post-discharge exit questionnaires and researchers' field notes. Quantitative data (in the form of participants' tool usage data and self-reported system usability scale scores) were collected at discharge and 3 months post-discharge. Three main themes emerged from the qualitative analysis: (1) being accessible to users (i.e., being easy to adopt and compatible with assistive technologies), (2) being intuitive to navigate (i.e., incorporating a simple app layout and a system of alert notifications), and (3) offering users flexibility (i.e., providing users with control over their data). The mobile app received above average mean system usability scale scores, both at discharge (78.1/100) and 3 months post-discharge (71.6/100). Given that participants found the app acceptable for use in inpatient rehabilitation and following discharge into the community, further testing is warranted to explore its efficacy in preventing secondary complications.
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Affiliation(s)
- Gurkaran Singh
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre-ICORD, 3rd Floor, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.,Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Megan MacGillivray
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre-ICORD, 3rd Floor, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.,Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Patricia Mills
- G.F. Strong Rehabilitation Centre, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Bonita Sawatzky
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre-ICORD, 3rd Floor, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.,Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre-ICORD, 3rd Floor, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada. .,G.F. Strong Rehabilitation Centre, Vancouver, Canada. .,Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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97
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Poli A, Kelfve S, Motel-Klingebiel A. A research tool for measuring non-participation of older people in research on digital health. BMC Public Health 2019; 19:1487. [PMID: 31703655 PMCID: PMC6842243 DOI: 10.1186/s12889-019-7830-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/22/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Healthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research - deriving from the processes of non-recruitment of targeted individuals and self-selection - can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection. METHODS Based on a review of the relevant literature, we designed an instrument - the NPART survey questionnaire - for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study. RESULTS Results indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature. CONCLUSIONS The NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.
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Affiliation(s)
- Arianna Poli
- Division Ageing and Social Change (ASC), Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
| | - Susanne Kelfve
- Division Ageing and Social Change (ASC), Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
- Aging Research Center (ARC), Karolinska Institutet & Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden
| | - Andreas Motel-Klingebiel
- Division Ageing and Social Change (ASC), Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
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98
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Wesley DB, Schubel L, Hsiao CJ, Burn S, Howe J, Kellogg K, Lincoln A, Kim B, Ratwani R. A socio-technical systems approach to the use of health IT for patient reported outcomes: Patient and healthcare provider perspectives. J Biomed Inform 2019; 100S:100048. [PMID: 34384570 DOI: 10.1016/j.yjbinx.2019.100048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patient-Reported Outcomes (PROs) can be used to inform the clinical management of individuals, including patient self-management, care planning, and goal setting. Despite a rapid proliferation of technology to collect and integrate PROs in clinical care, uptake by patients and healthcare providers remains sub optimal. A consideration of systems factors to understand these challenges is needed. OBJECTIVES To apply the socio-technical systems (STS) model as a framework for understanding the usability and functional requirements of patients collecting PRO data using applications (apps), and of healthcare providers using these data at the point of care in ambulatory settings. METHODS With questions guided by the STS model, semi-structured interviews were conducted with eighteen patients and nine healthcare providers to elicit feedback about facilitators and barriers to successful use of PRO apps and PRO data in ambulatory settings. Patient participants were selected to fit into two categories: older, low utilizers of technology with less than a bachelor's degree, and younger higher utilizers of technology with at least a bachelor's degree. Participants were from primary and specialty care practices. Data were analyzed inductively to identify emergent themes. RESULTS Younger patients were only interested in using a PRO app if they had an active health issue to track. The nine older patients preferred passive means of data collection if they were to track a health issue, and preferred direct contact with their healthcare provider and using office visits to share information. All patients desired optimal usability and emphasized bidirectional communication in an app that is transparent about privacy. All nine healthcare providers agreed that PRO data would be most useful and relevant if key patient populations were targeted based on the specific measure. In this case the healthcare providers noted potentially optimal utility of collecting physical function PRO data for patients 65 and older. Access to the data was highlighted by each healthcare provider stating that these data would be most useful if they were seamlessly integrated into the electronic health record. DISCUSSION Several emergent themes were identified under the five selected dimensions of the STS model (clinical content, human computer interface, hardware and software computing infrastructure, people, and workflow and communication). Findings highlighted the continued need for innovative methods to obtain more rapid cycle, continuous feedback to identify system factors impacting use of these technologies. CONCLUSION The STS model provides a comprehensive framework that can be applied to collect patient and healthcare provider feedback to better guide the design and implementation of new health information technology.
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Affiliation(s)
| | - Laura Schubel
- MedStar Health Research Institute, United States; MedStar Health National Center for Human Factors in Healthcare, United States
| | - Chun-Ju Hsiao
- Agency for Healthcare Research and Quality, United States
| | - Sacha Burn
- MedStar Health National Center for Human Factors in Healthcare, United States
| | - Jessica Howe
- MedStar Health National Center for Human Factors in Healthcare, United States
| | - Kathryn Kellogg
- MedStar Health National Center for Human Factors in Healthcare, United States
| | | | - Bryan Kim
- Agency for Healthcare Research and Quality, United States
| | - Raj Ratwani
- MedStar Health National Center for Human Factors in Healthcare, United States
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99
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Assessing electronic personal health information use: An update on progress toward healthy people 2020 objectives. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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100
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Murray E, Daff K, Lavida A, Henley W, Irwin J, Valabhji J. Evaluation of the digital diabetes prevention programme pilot: uncontrolled mixed-methods study protocol. BMJ Open 2019; 9:e025903. [PMID: 31122973 PMCID: PMC6538049 DOI: 10.1136/bmjopen-2018-025903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes is rising steeply. National Health Service England (NHSE) is exploring the potential of a digital diabetes prevention programme (DDPP) and has commissioned a pilot with embedded evaluation. METHODS AND ANALYSIS This study aims to determine whether, and if so, how, should NHSE implement a national DDPP, using a mixed-methods pretest and post-test design, underpinned by two theoretical frameworks: the Coventry, Aberdeen and London - Refined (CALO-RE) taxonomy of behavioural change techniques for the digital interventions and the Consolidated Framework for Implementation Research (CFIR) for implementation processes. In eight pilot areas across England, adults with non-diabetic hyperglycaemia (NDH) (glycated haemoglobin (HbA1c) 42-47 mmol/mol or fasting plasma glucose 5.5-6.9 mmol/L) and adults without NDH who are overweight (body mass index (BMI) >25 kg/m2) or obese (BMI >30 kg/m2) will be referred to one of five digitally delivered diabetes prevention interventions. The primary outcomes are reduction in HbA1c and weight (for people with NDH) and reduction in weight (for people who are overweight or obese) at 12 months. Secondary outcomes include use of the intervention, satisfaction, physical activity, patient activation and resources needed for successful implementation. Quantitative data will be collected at baseline, 6 months and 12 months by the digital intervention providers. Qualitative data will be collected through semistructured interviews with commissioners, providers, healthcare professionals and patients. Quantitative data will be analysed descriptively and using generalised linear models to determine whether changes in outcomes are associated with demographic and intervention factors. Qualitative data will be analysed using framework analysis, with data pertaining to implementation mapped onto the CFIR. ETHICS AND DISSEMINATION The study has received ethical approval from the Public Health England Ethics and Research Governance Group (reference R&D 324). Dissemination will include a report to NHSE to inform future policy and publication in peer-reviewed journals.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Anthi Lavida
- Primary Care and Population Health, University College London, London, UK
| | - William Henley
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | | | - Jonathan Valabhji
- Medical Directorate, NHS England, London, UK
- Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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