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Lee J, Yeom I, Chung ML, Kim Y, Yoo S, Kim E. Use of Mobile Apps for Self-care in People With Parkinson Disease: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33944. [PMID: 35060910 PMCID: PMC8817212 DOI: 10.2196/33944] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Self-care is essential for people with Parkinson disease (PD) to minimize their disability and adapt to alterations in physical abilities due to this progressive neurodegenerative disorder. With rapid developments in mobile technology, many health-related mobile apps for PD have been developed and used. However, research on mobile app-based self-care in PD is insufficient. OBJECTIVE This study aimed to explore the features and characteristics of mobile apps for self-care in people with PD. METHODS This study was performed sequentially according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Web of Science, and PsycINFO were searched in consultation with a librarian on June 8, 2021. We used keywords including "Parkinson disease" and "mobile." RESULTS A total of 17 studies were selected based on the inclusion criteria, including 3 randomized controlled trials and 14 observational studies or quasi-experimental studies. The use of mobile apps for self-care in people with PD focused on symptom monitoring, especially motor symptoms. Motor symptoms were objectively measured mainly through the sensors of smartphones or wearable devices and task performance. Nonmotor symptoms were monitored through task performance or self-reported questionnaires in mobile apps. Most existing studies have focused on clinical symptom assessment in people with PD, and there is a lack of studies focusing on symptom management. CONCLUSIONS Mobile apps for people with PD have been developed and used, but strategies for self-management are insufficient. We recommend the development of mobile apps focused on self-care that can enhance symptom management and health promotion practices. Studies should also evaluate the effects of mobile apps on symptom improvement and quality of life in people with PD. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021267374; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021267374.
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Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Centre of Korea: A JBI Affiliated Group, College of Nursing, Yonsei University, Seoul, Republic of Korea.,Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Insun Yeom
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, United States.,College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Yielin Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Subin Yoo
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Eunyoung Kim
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, Republic of Korea
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Kim MJ, Schroeder S, Chan S, Hickerson K, Lee YC. Reviewing the User-Centered Design Process for a Comprehensive Gastroesophageal Reflux Disease (GERD) App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031128. [PMID: 35162160 PMCID: PMC8834221 DOI: 10.3390/ijerph19031128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 12/10/2022]
Abstract
The objective of this study was to design a user-centered mobile health (mHealth) application for individuals with gastroesophageal reflux disease (GERD) and evaluate its design features and effectiveness for use by doctors. Prior to designing, our team undertook a discovery process that involved creating personas, conducting a competitor analysis and heuristic evaluation of existing apps, along with interviews with acid reflux patients. Then, we created a low-fidelity prototype, which was revised on the basis of several rounds of user testing. During the design phase, each round of user testing included a mix of surveys, concurrent think-alouds, and interviews to gather user feedback on the prototypes. Lastly, an evaluation phase consisting of gathering feedback on the user-centered design approach from user experience experts and medical doctors specialized in GERD was conducted. Overall, the final GERD app includes important features for tracking symptoms and triggers, analytics, data export, and community information, while promoting individualization, accessibility, and usability. The documentation of the design process of this app serves as a reference point for future medical app developers as it followed an empirically supported user-centered design strategy and resulted in an app which received positive feedback from users and human factors experts. We also intend to share some of the limitations due to the constrained resources, as well as potential ways to strengthen the design process for mHealth applications.
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Gardner RL, Haskell J, Jenkins B, Capizzo LF, Cooper EL, Morphis B. Innovative Use of a Mobile Web Application to Remotely Monitor Nonhospitalized Patients with COVID-19. Telemed J E Health 2022; 28:1285-1292. [PMID: 35020491 DOI: 10.1089/tmj.2021.0429] [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: 11/13/2022] Open
Abstract
Introduction: Most patients with COVID-19 do not require hospitalization but may need close monitoring, which can strain primary care practices. Our objective was to describe the implementation of a mobile web application to monitor COVID-19 signs and symptoms among nonhospitalized primary care patients and to assess the feasibility and acceptability of the application. Study Design: Retrospective analysis of (1) mobile web application data from March through December 2020 and (2) cross-sectional surveys administered in June 2020. Materials and Methods: We enrolled nonhospitalized patients and staff from nine New England primary care practices across 29 sites. Outcomes included feasibility and acceptability of the application as measured by the proportion of texts that resulted in a response, proportion of patients who agreed using the application was easy, and proportion of practice staff who agreed the application reduced outreach burden and that they would recommend use. Results: Five thousand five hundred thirty-two patients used the mobile web application, with 26,466 total responses. Overall, 78% of the daily texts resulted in a response from patients. Most patients agreed that responding to texts was easy (95%) and that they would be willing to participate in other texting programs (78%). Most staff agreed that the program reduced burden of outreach (94%) and that they would recommend use to other practices (100%). Conclusions: Use of a COVID-19 symptom tracking application was feasible and acceptable to patients and primary care practice staff. Outpatient practices should consider use of mobile web applications to monitor nonhospitalized patients with other acute illnesses.
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Affiliation(s)
- Rebekah L Gardner
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Healthcentric Advisors, Providence, Rhode Island, USA
| | | | | | | | | | - Blake Morphis
- Healthcentric Advisors, Providence, Rhode Island, USA
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Oh SW, Kim KK, Kim SS, Park SK, Park S. Effect of an Integrative Mobile Health Intervention in Patients With Hypertension and Diabetes: Crossover Study. JMIR Mhealth Uhealth 2022; 10:e27192. [PMID: 35014961 PMCID: PMC8790692 DOI: 10.2196/27192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/18/2021] [Accepted: 11/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background Obesity, hypertension, and type 2 diabetes mellitus (T2DM) are worldwide epidemics that inflict burdens on both public health and health care costs. Self-management plays an important role in the proper management of these 3 chronic diseases, and in this context, mobile health (mHealth) can be a cost-effective self-management tool. Objective The aim of this pilot study is to evaluate the effects of an integrative mHealth approach for obesity, hypertension, and T2DM on body fat, blood pressure, and blood glucose levels and demonstrate the clinical outcomes. The participants were patients aged 40 to 70 years who were treated for T2DM (hemoglobin A1c [HbA1c] above 6.0%) without insulin or hypertension and obesity, controlled with pharmacotherapy. Methods This pilot study was performed using a controlled, randomized, 3-month, 2-period crossover design. A total of 37 participants were recruited from 2 university hospitals in South Korea. Integrative mHealth comprised 4 parts: self-measuring home devices for monitoring blood glucose and blood pressure; 2 smartphone apps, where one gathered lifestyle data, giving them feedback with health information, and the other provided drug information and reminders of the medication schedule; unmanned kiosks for official measurement of blood pressure and body composition; and web-based access to participants’ health information. Results Data from the 32 participants were analyzed. Their mean HbA1c level was 7.5% (SD 0.8, ranging from 6.1% to 9.4%). Approximately 38% (12/32) of the participants had hypertension. BMIs of all participants except 1 were >23 kg/m2. The input rates of food intake and exercise to the smartphone app were very low (24.9% and 5.3%, respectively). On the contrary, the input rate of medicine intake was high (84.0%). Moreover, there was no significant difference in the input rate of taking medicine irrespective of whether the mHealth period was before or after the conventional treatment period (80.3% and 87.3%, respectively; P=.06). Among the 3 input functions of food intake, exercise, and medicine intake in smartphone apps, the input of medicine intake was a more helpful, easier to use, and better-designed function than the others. There were no significant differences in changes in body weight (−0.519 kg vs 0 kg), BMI (−0.133 kg/m2 vs −0.167 kg/m2), body composition (body fat −0.255% vs 0.172%), blood pressure (systolic −0.226 mm Hg vs −2.839 mm Hg), and HbA1c (−0.269% vs –0.009%) between the integrative mHealth and conventional treatment groups. However, in proportion to the elevation in the input rate of taking medicine, body fat mass (P=.04) and HbA1c (P=.03) were lower in the integrative mHealth group. Conclusions Although smartphone apps can influence body fat and blood glucose levels, they have failed to show clinical improvement. A higher input rate of taking medicine was related to significantly lower body fat mass and HbA1c levels.
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Affiliation(s)
- Sang Woo Oh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Kyoung-Kon Kim
- Department of Family Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sung Soo Kim
- Department of Family Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Su Kyung Park
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Sangshin Park
- Graduate School of Urban Public Health & Department of Urban Big Data Convergence, University of Seoul, Seoul, Republic of Korea
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Nelson LA, Spieker AJ, Mayberry LS, McNaughton C, Greevy RA. Estimating the impact of engagement with digital health interventions on patient outcomes in randomized trials. J Am Med Inform Assoc 2021; 29:128-136. [PMID: 34963143 PMCID: PMC8714267 DOI: 10.1093/jamia/ocab254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Guidance is needed on studying engagement and treatment effects in digital health interventions, including levels required for benefit. We evaluated multiple analytic approaches for understanding the association between engagement and clinical outcomes. MATERIALS AND METHODS We defined engagement as intervention participants' response rate to interactive text messages, and considered moderation, standard regression, mediation, and a modified instrumental variable (IV) analysis to investigate the relationship between engagement and clinical outcomes. We applied each approach to two randomized controlled trials featuring text message content in the intervention: REACH (Rapid Encouragement/Education and Communications for Health), which targeted diabetes, and VERB (Vanderbilt Emergency Room Bundle), which targeted hypertension. RESULTS In REACH, the treatment effect on hemoglobin A1c was estimated to be -0.73% (95% CI: [-1.29, -0.21]; P = 0.008), and in VERB, the treatment effect on systolic blood pressure was estimated to be -10.1 mmHg (95% CI: [-17.7, -2.8]; P = 0.007). Only the IV analyses suggested an effect of engagement on outcomes; the difference in treatment effects between engagers and non-engagers was -0.29% to -0.51% in the REACH study and -1.08 to -3.25 mmHg in the VERB study. DISCUSSION Standard regression and mediation have less power than a modified IV analysis, but the IV approach requires specification of assumptions. This is the first review of the strengths and limitations of various approaches to evaluating the impact of engagement on outcomes. CONCLUSIONS Understanding the role of engagement in digital health interventions can help reveal when and how these interventions achieve desired outcomes.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Candace McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research Education Clinical Center, Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
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Ryan S, Ní Chasaide N, O' Hanrahan S, Corcoran D, Caulfield B, Argent R. mHealth Apps for Musculoskeletal Rehabilitation: State of the Practice Review (Preprint). JMIR Rehabil Assist Technol 2021; 9:e34355. [PMID: 35916688 PMCID: PMC9379789 DOI: 10.2196/34355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Background The number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways. Objective The objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities. Methods A cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction. Results A total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8%) or videos (n=97, 67.4%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8%), communication portal (n=32, 22.2%), patient-reported outcome capture (n=36, 25%), or direct feedback (n=57, 39.6%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34%) and safety advice or disclaimers (n=38, 26.4%). Conclusions The cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies.
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Affiliation(s)
- Shíofra Ryan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Noirín Ní Chasaide
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Shane O' Hanrahan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Darragh Corcoran
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Rob Argent
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open 2021; 4:e2127008. [PMID: 34652447 PMCID: PMC8520130 DOI: 10.1001/jamanetworkopen.2021.27008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE It is unclear whether mobile technology hypertension self-management programs are associated with blood pressure (BP) control. OBJECTIVE To examine whether engagement with a hypertension self-management program with a BP monitor and connected smartphone application with clinically based digital coaching was associated with BP control during a follow-up period of as long as 3 years. DESIGN, SETTING, AND PARTICIPANTS This cohort study enrolled US adults with elevated BP or hypertension between January 1, 2015, and July 1, 2020. The hypertension self-management program was provided through the participant's (or their spouse's) employer health plan. EXPOSURES Program engagement, defined by average number of application sessions. MAIN OUTCOMES AND MEASURES Systolic and diastolic BP measured by a US Food and Drug Administration-cleared BP monitor, with categories defined as normal (systolic BP, <120 mm Hg), elevated (systolic BP, 120-129 mm Hg), stage 1 hypertension (systolic BP, 130-139 mm Hg), and stage 2 hypertension (systolic BP ≥140 mm Hg). Other measures included age, gender, depression, anxiety, diabetes, high cholesterol, smoking, geographic region, area deprivation index, self-reported weight, and device-measured physical activity (steps per day). RESULTS Among 28 189 participants (median [IQR] age, 51 [43-58] years; 9424 women [40.4%]; 13 902 men [59.6%]), median (IQR) baseline systolic BP was 129.5 mm Hg (120.5-139.6 mm Hg) and diastolic BP was 81.7 mm Hg (75.7-88.4 mm Hg). Median systolic BP at 1 year improved at least 1 category for 495 of 934 participants (53.0%) with baseline elevated BP, 673 of 966 (69.7%) with baseline stage 1 hypertension, and 920 of 1075 (85.7%) with baseline stage 2 hypertension. Participants in the program for 3 years had a mean (SEM) systolic BP reduction of 7.2 (0.4), 12.2 (0.7), and 20.9 (1.7) mm Hg compared with baseline for those starting with elevated, stage 1 hypertension, and stage 2 hypertension, respectively. Greater engagement was associated with lower systolic BP over time (high-engagement group: 131.2 mm Hg; 95% CI, 115.5-155.8 mm Hg; medium-engagement group: 133.4 mm Hg; 95% CI 116.3-159.5 mm Hg; low-engagement group: 135.5 mm Hg; 95% CI, 117.3-164.8 mm Hg; P < .001); these results persisted after adjusting for age, gender, depression, anxiety, diabetes, high cholesterol, smoking, area deprivation index rank, and US region, which was partially mediated by greater physical activity. A very high BP (systolic BP >180 mm Hg) was observed 11 637 times from 3778 participants. Greater engagement was associated with lower risk of very high BP; the estimated probability of a very high BP was greater in the low-engagement group (1.42%; 95% CI, 1.26%-1.59%) compared with the medium-engagement group (0.79%; 95% CI, 0.71%-0.87%; P < .001) and the high-engagement group (0.53%; 95% CI, 0.45%-0.60%; P < .001 for comparison with both groups). CONCLUSIONS AND RELEVANCE The findings of this study suggest that a mobile technology hypertension self-management program can support long-term BP control and very high BP detection. Such programs may improve real-world BP monitoring and control.
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Affiliation(s)
| | | | - Alexis L. Beatty
- Department of Epidemiology & Biostatistics and Division of Cardiology, University of California, San Francisco
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Cunha BCR, Rodrigues KRDH, Zaine I, da Silva EAN, Viel CC, Pimentel MDGC. Experience Sampling and Programmed Intervention Method and System for Planning, Authoring, and Deploying Mobile Health Interventions: Design and Case Reports. J Med Internet Res 2021; 23:e24278. [PMID: 34255652 PMCID: PMC8314159 DOI: 10.2196/24278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/09/2020] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Health professionals initiating mobile health (mHealth) interventions may choose to adapt apps designed for other activities (eg, peer-to-peer communication) or to employ purpose-built apps specialized in the required intervention, or to exploit apps based on methods such as the experience sampling method (ESM). An alternative approach for professionals would be to create their own apps. While ESM-based methods offer important guidance, current systems do not expose their design at a level that promotes replicating, specializing, or extending their contributions. Thus, a twofold solution is required: a method that directs specialists in planning intervention programs themselves, and a model that guides specialists in adopting existing solutions and advises software developers on building new ones. OBJECTIVE The main objectives of this study are to design the Experience Sampling and Programmed Intervention Method (ESPIM), formulated toward supporting specialists in deploying mHealth interventions, and the ESPIM model, which guides health specialists in adopting existing solutions and advises software developers on how to build new ones. Another goal is to conceive and implement a software platform allowing specialists to be users who actually plan, create, and deploy interventions (ESPIM system). METHODS We conducted the design and evaluation of the ESPIM method and model alongside a software system comprising integrated web and mobile apps. A participatory design approach with stakeholders included early software prototype, predesign interviews with 12 health specialists, iterative design sustained by the software as an instance of the method's conceptual model, support to 8 real case studies, and postdesign interviews. RESULTS The ESPIM comprises (1) a list of requirements for mHealth experience sampling and intervention-based methods and systems, (2) a 4-dimension planning framework, (3) a 7-step-based process, and (4) an ontology-based conceptual model. The ESPIM system encompasses web and mobile apps. Eight long-term case studies, involving professionals in psychology, gerontology, computer science, speech therapy, and occupational therapy, show that the method allowed specialists to be actual users who plan, create, and deploy interventions via the associated system. Specialists' target users were parents of children diagnosed with autism spectrum disorder, older persons, graduate and undergraduate students, children (age 8-12), and caregivers of older persons. The specialists reported being able to create and conduct their own studies without modifying their original design. A qualitative evaluation of the ontology-based conceptual model showed its compliance to the functional requirements elicited. CONCLUSIONS The ESPIM method succeeds in supporting specialists in planning, authoring, and deploying mobile-based intervention programs when employed via a software system designed and implemented according to its conceptual model. The ESPIM ontology-based conceptual model exposes the design of systems involving active or passive sampling interventions. Such exposure supports the evaluation, implementation, adaptation, or extension of new or existing systems.
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Affiliation(s)
| | | | - Isabela Zaine
- Institute of Mathematics and Computer Sciences, University of São Paulo, São Carlos, Brazil
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Abstract
In this updated Self-care of Hypertension Inventory Version 3.0 (SC-HI v3.0), items were added to better reflect the Theory of Self-care of Chronic Illness and revised based on recent research. The reorganized and expanded SC-HI now reflects the theoretical concepts of self-care maintenance, monitoring, and management. OBJECTIVE To evaluate the psychometric properties of the SC-HI v3.0, we conducted exploratory factor analyses. Here, we report on its reliability and construct validity. METHODS A sample of 200 adults with chronic hypertension completed a sociodemographic survey and the SC-HI v3.0. Exploratory factor analyses were conducted on item sets using principal factor method for analyzing the correlation matrix. Reliability was calculated using common factor coefficient of determinacy for multidimensional scales, for which values greater than 0.80 are considered adequate. RESULTS The sample was 83.4% non-Hispanic White; 56% were women, with a mean age of 62.2 ± 12.5 years. The self-care maintenance scale (mean, 75.9 ± 13.6) had adequate reliability (ρ = 0.81, 0.80) for a 2-dimensional model of self-care maintenance identified as autonomous and consultative behaviors. The new self-care monitoring scale (mean score, 58.5 ± 21.99) had a single-factor solution with very good reliability (ρ = 0.94). The self-care management scale (mean score, 64.5 ± 19.5) had a single-factor solution, with moderate to strong factor loadings (0.22-0.68) and acceptable reliability (ρ = 0.84). CONCLUSIONS Initial testing suggests that the SC-HI v3.0 is a sound measure of the essential elements of self-care for adults with chronic hypertension. With the new self-care monitoring scale, the SC-HI v3.0 is a valid reflection of the theory on which it is based.
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Enricho Nkhoma D, Jenya Soko C, Joseph Banda K, Greenfield D, Li YCJ, Iqbal U. Impact of DSMES app interventions on medication adherence in type 2 diabetes mellitus: systematic review and meta-analysis. BMJ Health Care Inform 2021; 28:bmjhci-2020-100291. [PMID: 33853862 PMCID: PMC8054079 DOI: 10.1136/bmjhci-2020-100291] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives To conduct systematic review and meta-analysis of interventional studies to investigate the impact of diabetes self-management education and support (DSMES) apps on adherence in patients with type 2 diabetes mellitus (T2D). Methods PubMed, Embase, CENTRAL, Web of Science, Scopus and ProQuest were searched, in addition to references of identified articles and similar reviews. Experimental studies, reported in English, assessing DSMES app intervention’s impact on adherence and clinical outcomes of patients with T2D compared with usual care were included. Study bias was assessed using Cochrane Risk of Bias V.2.0 tool. Analysis plan involved narrative synthesis, moderator and meta-analysis. Results Six randomised controlled trials were included, involving 696 participants (average age 57.6 years, SD 10.59). Mobile apps were mostly used for imputing clinical data, dietary intake or physical activity, and transmitting information to the provider. At 3 months, DSMES apps proved effective in improving medication adherence (standardized mean difference (SMD)=0.393, 95% CI 0.17 to 0.61), glycated haemoglobin (HbA1c) (mean difference (MD)=−0.314, 95% CI −0.477 to –0.151) and Body Mass Index (BMI) (MD=−0.28, 95% CI −0.545 to –0.015). All pooled estimates had low heterogeneity (I2 0%). Four studies had moderate risk of bias while one each was judged to be low and high risks, respectively. Conclusion DSMES apps had significant small to moderate effects on medication adherence, HbA1c and BMI of patients with T2D compared with usual care. Apps were described as reliable, easy to use and convenient, though participants were required to be phone literate. Evidence comes from feasibility trials with generally moderate risk of bias. Larger trials with longer follow-up periods using theory-based interventions are required to improve current evidence.
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Affiliation(s)
- Dumisani Enricho Nkhoma
- Nkhata Bay District Health Office, Nkhata Bay District Hospital, Nkhata Bay, Malawi.,Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Charles Jenya Soko
- Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Kondwani Joseph Banda
- PhD Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - David Greenfield
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Sydney, New South Wales, Australia
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Taipei Municipal Wan Fang Hospital, Taipei, Taiwan.,International Medical Informatics Association (IMIA), Geneva, Switzerland.,Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei, Taiwan .,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,PhD Program of Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Chen T, Or CK, Chen J. Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials. J Am Med Inform Assoc 2021; 28:414-423. [PMID: 33236109 DOI: 10.1093/jamia/ocaa282] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The study sought to examine the effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain by a systematic review and meta-analysis of randomized controlled trials. MATERIALS AND METHODS We searched MEDLINE, EMBASE, CINAHL Plus, and the Cochrane Library from database inception to August 2020. A meta-analysis and subgroup analyses, stratified by technology type and program feature, were conducted. RESULTS Twelve randomized controlled trials were reviewed, all of which implemented the programs for 4 weeks to 6 months. Telephone, Web, mobile app, computer, and virtual reality were used to deliver the programs. The meta-analysis showed that these programs were associated with significant improvements in knee pain (standardized mean difference [SMD] = -0.29; 95% confidence interval [CI], -0.48 to -0.10; P = .003) and quality of life (SMD = 0.25; 95% CI, 0.04 to 0.46; P = .02) but not with significant improvement in physical function (SMD = 0.22; 95% CI, 0 to 0.43; P = .053). Subgroup analyses showed that some technology types and program features were suggestive of potential benefits. CONCLUSIONS Using technology to deliver the exercise programs appears to offer benefits. The technology types and program features that were associated with health values have been identified, based on which suggestions are discussed for the further research and development of such programs.
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Affiliation(s)
- Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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Xie Z, Liu K, Or C, Chen J, Yan M, Wang H. An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension. BMC Public Health 2020; 20:1227. [PMID: 32787809 PMCID: PMC7424981 DOI: 10.1186/s12889-020-09274-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence. METHODS We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression. RESULTS Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes. CONCLUSIONS Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.
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Affiliation(s)
- Zhenzhen Xie
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Kaifeng Liu
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China.
| | - Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Mian Yan
- School of Intelligent Systems Science and Engineering, Jinan University, Zhuhai, China
| | - Hailiang Wang
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Hong Kong, China
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