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Jaffar A, Mohd-Sidik S, Foo CN, Admodisastro N, Abdul Salam SN, Ismail ND. Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study. JMIR Hum Factors 2022; 9:e30989. [PMID: 35113025 PMCID: PMC8855292 DOI: 10.2196/30989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but their effectiveness in pregnant women was limited. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. OBJECTIVE This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. METHODS We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. RESULTS A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design-11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. CONCLUSIONS The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.
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Affiliation(s)
- Aida Jaffar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.,Primary Care Unit, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Wilayah Persekutuan, Malaysia
| | - Sherina Mohd-Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Chai Nien Foo
- Department of Population Medicine, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Novia Admodisastro
- Software Engineering & Information System Department, Faculty of Computer Science & Information Technology, Universiti Putra Malaysia, Selangor, Malaysia
| | - Sobihatun Nur Abdul Salam
- School of Multimedia Technology and Communication, College of Arts and Sciences, Universiti Utara Malaysia, Kedah, Malaysia
| | - Noor Diana Ismail
- Klinik Kesihatan Bt 9 Cheras, Ministry of Health, Selangor, Malaysia
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102
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Akbas S, Said S, Roche TR, Nöthiger CB, Spahn DR, Tscholl DW, Bergauer L. User perceptions of different monitor modalities during high-fidelity simulation: Visual-Patient-avatar, Split Screen and Conventional - a semiquantitative analysis. JMIR Hum Factors 2022; 9:e34677. [PMID: 35119375 PMCID: PMC8976258 DOI: 10.2196/34677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 01/15/2023] Open
Abstract
Background Patient safety during anesthesia is crucially dependent on the monitoring of vital signs. However, the values obtained must also be perceived and correctly classified by the attending care providers. To facilitate these processes, we developed Visual-Patient-avatar, an animated virtual model of the monitored patient, which innovatively presents numerical and waveform data following user-centered design principles. After a high-fidelity simulation study, we analyzed the participants’ perceptions of 3 different monitor modalities, including this newly introduced technique. Objective The aim of this study was to collect and evaluate participants’ opinions and experiences regarding 3 different monitor modalities, which are Visual-Patient-avatar, Split Screen (avatar and Conventional monitor alongside each other), and Conventional monitor after using them during simulated critical anesthetic events. Methods This study was a researcher-initiated, single-center, semiquantitative study. We asked 92 care providers right after finishing 3 simulated emergency scenarios about their positive and negative opinions concerning the different monitor modalities. We processed the field notes obtained and derived the main categories and corresponding subthemes following qualitative research methods. Results We gained a total of 307 statements. Through a context-based analysis, we identified the 3 main categories of “Visual-Patient-avatar,” “Split Screen,” and “Conventional monitor” and divided them into 11 positive and negative subthemes. We achieved substantial interrater reliability in assigning the statements to 1 of the topics. Most of the statements concerned the design and usability features of the avatar or the Split Screen mode. Conclusions This study semiquantitatively reviewed the clinical applicability of the Visual-Patient-avatar technique in a high-fidelity simulation study and revealed the strengths and limitations of the avatar only and Split Screen modality. In addition to valuable suggestions for improving the design, the requirement for training prior to clinical implementation was emphasized. The responses to the Split Screen suggest that this symbiotic modality generates better situation awareness in combination with numerical data and accurate curves. As a subsequent development step, a real-life introduction study is planned, where we will test the avatar in Split Screen mode under actual clinical conditions.
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Affiliation(s)
- Samira Akbas
- University and University Hospital Zurich, Zurich, CH
| | - Sadiq Said
- University Hospital Zurich, Raemistrasse 100, Zurich, CH
| | | | | | | | | | - Lisa Bergauer
- University Hospital Zurich, Raemistrasse 100, Zurich, CH
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103
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Seedahmed MI, Mogilnicka I, Zeng S, Luo G, Whooley MA, McCulloch CE, Koth L, Arjomandi M. Performance of a Computational Phenotyping Algorithm for Sarcoidosis Using Diagnostic Codes in Electronic Medical Records: A Pilot Study from Two Veterans Affairs Medical Centers. JMIR Form Res 2022; 6:e31615. [PMID: 35081036 PMCID: PMC8928044 DOI: 10.2196/31615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Electronic medical records (EMRs) offer the promise of computationally identifying sarcoidosis cases. However, the accuracy of identifying these cases in the EMR is unknown. Objective The aim of this study is to determine the statistical performance of using the International Classification of Diseases (ICD) diagnostic codes to identify patients with sarcoidosis in the EMR. Methods We used the ICD diagnostic codes to identify sarcoidosis cases by searching the EMRs of the San Francisco and Palo Alto Veterans Affairs medical centers and randomly selecting 200 patients. To improve the diagnostic accuracy of the computational algorithm in cases where histopathological data are unavailable, we developed an index of suspicion to identify cases with a high index of suspicion for sarcoidosis (confirmed and probable) based on clinical and radiographic features alone using the American Thoracic Society practice guideline. Through medical record review, we determined the positive predictive value (PPV) of diagnosing sarcoidosis by two computational methods: using ICD codes alone and using ICD codes plus the high index of suspicion. Results Among the 200 patients, 158 (79%) had a high index of suspicion for sarcoidosis. Of these 158 patients, 142 (89.9%) had documentation of nonnecrotizing granuloma, confirming biopsy-proven sarcoidosis. The PPV of using ICD codes alone was 79% (95% CI 78.6%-80.5%) for identifying sarcoidosis cases and 71% (95% CI 64.7%-77.3%) for identifying histopathologically confirmed sarcoidosis in the EMRs. The inclusion of the generated high index of suspicion to identify confirmed sarcoidosis cases increased the PPV significantly to 100% (95% CI 96.5%-100%). Histopathology documentation alone was 90% sensitive compared with high index of suspicion. Conclusions ICD codes are reasonable classifiers for identifying sarcoidosis cases within EMRs with a PPV of 79%. Using a computational algorithm to capture index of suspicion data elements could significantly improve the case-identification accuracy.
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Affiliation(s)
- Mohamed Ismail Seedahmed
- Division of Pulmonary, Critical care, allergy and Immunology, and Sleep., Department of Medicine, University of California San Francisco, 513 Parnassus Ave.HSE 1314, Box 0111, San Francisco, US.,San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, US
| | - Izabella Mogilnicka
- Department of Experimental Physiology and Pathophysiology, Laboratory of the Centre for Preclinical Research, Medical University of Warsaw, Warsaw, PL
| | - Siyang Zeng
- San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, US.,Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, US
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, US
| | - Mary A Whooley
- San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, US.,Department of Medicine, University of California San Francisco, San Francisco, US.,Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, US
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, US
| | - Laura Koth
- Division of Pulmonary, Critical care, allergy and Immunology, and Sleep., Department of Medicine, University of California San Francisco, 513 Parnassus Ave.HSE 1314, Box 0111, San Francisco, US
| | - Mehrdad Arjomandi
- San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, US.,Division of Pulmonary, Critical care, allergy and Immunology, and Sleep., Department of Medicine, University of California San Francisco, 513 Parnassus Ave.HSE 1314, Box 0111, San Francisco, US
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104
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Yu M, Yang MR. Effectiveness and Utility of Virtual Reality Infection Control Simulation (VRICS) for Children with COVID-19: A quasi experimental study (Preprint). JMIR Serious Games 2022; 10:e36707. [PMID: 35575818 PMCID: PMC9150730 DOI: 10.2196/36707] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/26/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background It is essential that nurses quickly learn the proper methods for preventing and controlling nosocomial infection and managing intensive care patients during the COVID-19 pandemic, including the donning and doffing of personal protective equipment (PPE). Virtual reality (VR) simulation offers the advantage of learning in a safe environment with a sense of realism similar to that of an actual clinical setting and has been reported to enhance self-efficacy in infection control, safety performance, and learning satisfaction among students. Objective This study aims to develop a virtual reality infection control simulation (VRICS) program regarding donning and doffing of PPE and respiratory care for pediatric patients admitted to an isolation unit for COVID-19 and to identify the effects of the program on PPE knowledge, infection control performance, and self-efficacy for nursing students. Additionally, the realism of the VRICS program and the students’ level of satisfaction with the program were assessed. Methods This was a quasi-experimental study based on a controlled pretest-posttest design. Third- and fourth-year nursing students were divided into an experimental group (n=25) who participated in a VRICS program and a control group (n=25) with no participation. Data were collected from November 13 to December 10, 2021, and analyzed using descriptive statistics and the t test, paired t test, Mann-Whitney U test, and Wilcoxon matched-pair signed-rank test. The VRICS program consisted of a prebriefing, including direct practice of donning and doffing PPE, VR simulation, and debriefing. The VR simulation comprised 3 sessions: donning and inspection of PPE in the dressing room before entering the negative-pressure isolation unit; assessing for suction care, nasopharyngeal suctioning, and checking of COVID-19 patients in the negative-pressure isolation unit; and doffing PPE in the dressing room. The total execution time for the program was 180 min. Results Compared with the control group, the experimental group showed significantly greater improvements in PPE knowledge (z=–3.28, P<.001), infection control performance (t48=4.89, P<.001), and self-efficacy (t36.2=4.93, P<.001). The experimental group’s mean scores for realistic immersion and learner satisfaction were 4.49 (SD 0.50) points and 4.75 (SD 0.38) points (on a 5-point Likert scale), respectively. Conclusions The VR simulation training program involving pediatric COVID-19 patients combined skills training effectively and enhanced theoretical knowledge, respiratory care skills, and infectious disease preparedness. Thus, it could be applied to training nurses to respond more effectively to public health situations involving infectious diseases, including the COVID-19 pandemic.
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Affiliation(s)
- Mi Yu
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Mi Ran Yang
- Department of Nursing, Kwangju Health University, Kwangju, Republic of Korea
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105
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Morgan C, Tonkin EL, Craddock I, Whone AL. Acceptability of an In-Home Multimodal Sensor Platform in Parkinson’s Disease: A Qualitative Study (Preprint). JMIR Hum Factors 2022; 9:e36370. [PMID: 35797101 PMCID: PMC9305404 DOI: 10.2196/36370] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 12/28/2022] Open
Abstract
Background Parkinson disease (PD) symptoms are complex, gradually progressive, and fluctuate hour by hour. Home-based technological sensors are being investigated to measure symptoms and track disease progression. A smart home sensor platform, with cameras and wearable devices, could be a useful tool to use to get a fuller picture of what someone’s symptoms are like. High-resolution video can capture the ground truth of symptoms and activities. There is a paucity of information about the acceptability of such sensors in PD. Objective The primary objective of our study was to explore the acceptability of living with a multimodal sensor platform in a naturalistic setting in PD. Two subobjectives are to identify any suggested limitations and to explore the sensors’ impact on participant behaviors. Methods A qualitative study was conducted with an inductive approach using semistructured interviews with a cohort of PD and control participants who lived freely for several days in a home-like environment while continuously being sensed. Results This study of 24 participants (12 with PD) found that it is broadly acceptable to use multimodal sensors including wrist-worn wearables, cameras, and other ambient sensors passively in free-living in PD. The sensor that was found to be the least acceptable was the wearable device. Suggested limitations on the platform for home deployment included camera-free time and space. Behavior changes were noted by the study participants, which may have related to being passively sensed. Recording high-resolution video in the home setting for limited periods of time was felt to be acceptable to all participants. Conclusions The results broaden the knowledge of what types of sensors are acceptable for use in research in PD and what potential limitations on these sensors should be considered in future work. The participants’ reported behavior change in this study should inform future similar research design to take this factor into account. Collaborative research study design, involving people living with PD at every stage, is important to ensure that the technology is acceptable and that the data outcomes produced are ecologically valid and accurate. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-041303
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Affiliation(s)
- Catherine Morgan
- Translational Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Emma L Tonkin
- School of Computer Science, Electrical and Electronic Engineering, University of Bristol, Bristol, United Kingdom
| | - Ian Craddock
- School of Computer Science, Electrical and Electronic Engineering, University of Bristol, Bristol, United Kingdom
| | - Alan L Whone
- Translational Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
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106
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Cirillo MN, Halbert JP, Smith JG, Alamiri NS, Ingersoll KS. “#BingeDrinking: Using Social Media to Understand College Binge Drinking (Preprint). JMIR Hum Factors 2022; 9:e36239. [PMID: 35635740 PMCID: PMC9153908 DOI: 10.2196/36239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Madison N Cirillo
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Jennifer P Halbert
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Jessica Gomez Smith
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Nour Sami Alamiri
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Karen S Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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107
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Santarossa S, Rapp A, Sardinas S, Hussein J, Ramirez A, Cassidy-Bushrow AE, Cheng P, Yu E. Understanding the #longCOVID and #longhaulers Conversation on Twitter: Multimethod Study. JMIR INFODEMIOLOGY 2022; 2:e31259. [PMID: 35229074 PMCID: PMC8867393 DOI: 10.2196/31259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/17/2021] [Accepted: 12/07/2021] [Indexed: 12/19/2022]
Abstract
Background The scientific community is just beginning to uncover the potential long-term effects of COVID-19, and one way to start gathering information is by examining the present discourse on the topic. The conversation about long COVID-19 on Twitter provides insight into related public perception and personal experiences. Objective The aim of this study was to investigate the #longCOVID and #longhaulers conversations on Twitter by examining the combined effects of topic discussion and social network analysis for discovery on long COVID-19. Methods A multipronged approach was used to analyze data (N=2500 records from Twitter) about long COVID-19 and from people experiencing long COVID-19. A text analysis was performed by both human coders and Netlytic, a cloud-based text and social networks analyzer. The social network analysis generated Name and Chain networks that showed connections and interactions between Twitter users. Results Among the 2010 tweets about long COVID-19 and 490 tweets by COVID-19 long haulers, 30,923 and 7817 unique words were found, respectively. For both conversation types, “#longcovid” and “covid” were the most frequently mentioned words; however, through visually inspecting the data, words relevant to having long COVID-19 (ie, symptoms, fatigue, pain) were more prominent in tweets by COVID-19 long haulers. When discussing long COVID-19, the most prominent frames were “support” (1090/1931, 56.45%) and “research” (435/1931, 22.53%). In COVID-19 long haulers conversations, “symptoms” (297/483, 61.5%) and “building a community” (152/483, 31.5%) were the most prominent frames. The social network analysis revealed that for both tweets about long COVID-19 and tweets by COVID-19 long haulers, networks are highly decentralized, fragmented, and loosely connected. Conclusions This study provides a glimpse into the ways long COVID-19 is framed by social network users. Understanding these perspectives may help generate future patient-centered research questions.
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Affiliation(s)
- Sara Santarossa
- Department of Public Health Sciences Henry Ford Health System Detroit, MI United States
| | - Ashley Rapp
- Department of Public Health Sciences Henry Ford Health System Detroit, MI United States
| | - Saily Sardinas
- Department of Public Health Sciences Henry Ford Health System Detroit, MI United States
| | - Janine Hussein
- Department of Public Health Sciences Henry Ford Health System Detroit, MI United States
| | - Alex Ramirez
- Department of Public Health Sciences Henry Ford Health System Detroit, MI United States.,School of Medicine Wayne State University Detroit, MI United States
| | | | - Philip Cheng
- Sleep Disorders and Research Center Henry Ford Health System Detroit, MI United States
| | - Eunice Yu
- Henry Ford Medical Group Henry Ford Health System Detroit, MI United States
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108
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Leung C, Pei J, Hudec K, Shams F, Munthali R, Vigo D. The effects of non-clinician guidance on effectiveness and process outcomes of digital mental health interventions: A systematic review and meta-analysis (Preprint). J Med Internet Res 2021; 24:e36004. [PMID: 35511463 PMCID: PMC9244656 DOI: 10.2196/36004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility. Objective This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions. Methods Four databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. Results Thirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=–0.73; 95% CI –1.08 to –0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=–0.17; 95% CI –0.23 to –0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI –0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions. Conclusions Integrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226
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Affiliation(s)
- Calista Leung
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Pei
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristen Hudec
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Farhud Shams
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Munthali
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Vigo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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van Kasteren Y, Strobel J, Bastiampillai T, Linedale E, Bidargaddi N. Implementation of a web-based computerised decision support system for Community Mental Health Services using national electronic health records (Preprint). JMIR Hum Factors 2021; 9:e35403. [PMID: 35788103 PMCID: PMC9297136 DOI: 10.2196/35403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/14/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background A high proportion of patients with severe mental illness relapse due to nonadherence to psychotropic medication. In this paper, we use the normalization process theory (NPT) to describe the implementation of a web-based clinical decision support system (CDSS) for Community Mental Health Services (CMHS) called Actionable Intime Insights or AI2. AI2 has two distinct functions: (1) it provides an overview of medication and treatment history to assist in reviewing patient adherence and (2) gives alerts indicating nonadherence to support early intervention. Objective Our objective is to evaluate the pilot implementation of the AI2 application to better understand the challenges of implementing a web-based CDSS to support medication adherence and early intervention in CMHS. Methods The NPT and participatory action framework were used to both explore and support implementation. Qualitative data were collected over the course of the 14-month implementation, in which researchers were active participants. Data were analyzed and coded using the NPT framework. Qualitative data included discussions, meetings, and work products, including emails and documents. Results This study explores the barriers and enablers of implementing a CDSS to support early intervention within CMHS using Medicare data from Australia’s national electronic record system, My Health Record (MyHR). The implementation was a series of ongoing negotiations, which resulted in a staged implementation with compromises on both sides. Clinicians were initially hesitant about using a CDSS based on MyHR data and expressed concerns about the changes to their work practice required to support early intervention. Substantial workarounds were required to move the implementation forward. This pilot implementation allowed us to better understand the challenges of implementation and the resources and support required to implement and sustain a model of care based on automated alerts to support early intervention. Conclusions The use of decision support based on electronic health records is growing, and while implementation is challenging, the potential benefits of early intervention to prevent relapse and hospitalization and ensure increased efficiency of the health care system are worth pursuing.
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Affiliation(s)
- Yasmin van Kasteren
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
| | - Jörg Strobel
- Barossa Fleurieu Adelaide Hills Local Health Network, South Australia, Australia
| | - Tarun Bastiampillai
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ecushla Linedale
- Health Translation SA, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Niranjan Bidargaddi
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
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Nguyen B, Torres A, Sim W, Kenny D, Campbell DM, Beavers L, Lou W, Kapralos B, Peter E, Dubrowski A, Krishnan S, Bhat V. Digital Interventions to Reduce Distress Among Health Care Providers at the Frontline: Protocol for a Feasibility Trial. JMIR Res Protoc 2021; 11:e32240. [PMID: 34871178 PMCID: PMC8852627 DOI: 10.2196/32240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 12/16/2022] Open
Abstract
Background Stress, anxiety, distress, and depression are high among health care workers during the COVID-19 pandemic, and they have reported acting in ways that are contrary to their moral values and professional commitments that degrade their integrity. This creates moral distress and injury due to constraints they have encountered, such as limited resources. Objective The purpose of this study is to develop and show the feasibility of digital platforms (a virtual reality and a mobile platform) to understand the causes and ultimately reduce the moral distress of health care providers during the COVID-19 pandemic. Methods This will be a prospective, single cohort, pre- and posttest study examining the effect of a brief informative video describing moral distress on perceptual, psychological, and physiological indicators of stress and decision-making during a scenario known to potentially elicit moral distress. To accomplish this, we have developed a virtual reality simulation that will be used before and after the digital intervention for monitoring short-term impacts. The simulation involves an intensive care unit setting during the COVID-19 pandemic, and participants will be placed in morally challenging situations. The participants will be engaged in an educational intervention at the individual, team, and organizational levels. During each test, data will be collected for (1) physiological measures of stress and after each test, data will be collected regarding (2) thoughts, feelings and behaviors during a morally challenging situation, and (3) perceptual estimates of psychological stress. In addition, participants will continue to be monitored for moral distress and other psychological stresses for 8 weeks through our Digital intervention/intelligence Group mobile platform. Finally, a comparison will be conducted using machine learning and biostatistical techniques to analyze the short- and long-term impacts of the virtual reality intervention. Results The study was funded in November 2020 and received research ethics board approval in March 2021. The study is ongoing. Conclusions This project is a proof-of-concept integration to demonstrate viability over 6 months and guide future studies to develop these state-of-the-art technologies to help frontline health care workers work in complex moral contexts. In addition, the project will develop innovations that can be used for future pandemics and in other contexts prone to producing moral distress and injury. This project aims to demonstrate the feasibility of using digital platforms to understand the continuum of moral distress that can lead to moral injury. Demonstration of feasibility will lead to future studies to examine the efficacy of digital platforms to reduce moral distress. Trial Registration ClinicalTrials.gov NCT05001542; https://clinicaltrials.gov/ct2/show/NCT05001542 International Registered Report Identifier (IRRID) DERR1-10.2196/32240
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Affiliation(s)
- Binh Nguyen
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, CA
| | - Andrei Torres
- maxSIMhealth Group, Ontario Tech University, 2000 Simcoe St N, Oshawa, CA
| | - Walter Sim
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, 193 Yonge Street, Suite 6-013, Toronto, CA
| | - Deborah Kenny
- Department of Nursing, University of Colorado, Colorado Springs, US
| | - Douglas M Campbell
- Neonatal Intensive Care Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, CA.,Allan Waters Family Simulation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, CA.,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, CA.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, CA
| | - Lindsay Beavers
- Allan Waters Family Simulation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, CA.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, CA
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, CA
| | - Bill Kapralos
- maxSIMhealth Group, Ontario Tech University, 2000 Simcoe St N, Oshawa, CA
| | - Elizabeth Peter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, CA
| | - Adam Dubrowski
- maxSIMhealth Group, Ontario Tech University, 2000 Simcoe St N, Oshawa, CA
| | - Sridhar Krishnan
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, CA
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, 193 Yonge Street, Suite 6-013, Toronto, CA.,Department of Psychiatry, University of Toronto, Toronto, CA
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Keessen P, van Duijvenbode IC, Latour CH, Kraaijenhagen RA, Janssen VR, Jørstad HT, Scholte Op Reimer WJ, Visser B. Design of a remote coaching program to bridge the gap from hospital discharge to cardiac rehabilitation: an intervention mapping study. (Preprint). JMIR Cardio 2021; 6:e34974. [PMID: 35612879 PMCID: PMC9178457 DOI: 10.2196/34974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/18/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paul Keessen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ingrid Cd van Duijvenbode
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Corine Hm Latour
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Heart Center, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Bart Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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112
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Yaddaden A, Spalla G, Gouin-Vallerand C, Briskie-Semeniuk P, Bier N. A mixed reality cognitive orthosis to support older adults in achieving their daily living activities: A qualitative study (Preprint). JMIR Rehabil Assist Technol 2021; 9:e34983. [PMID: 35857354 PMCID: PMC9350820 DOI: 10.2196/34983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amel Yaddaden
- École de réadaptation, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Guillaume Spalla
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
- Laboratoire Domus, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Charles Gouin-Vallerand
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
- Laboratoire Domus, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patricia Briskie-Semeniuk
- École de réadaptation, Université de Montréal, Montreal, QC, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Nathalie Bier
- École de réadaptation, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
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Mace RA, Greenberg J, Lemaster N, Duarte B, Penn T, Kanaya M, Doorley JD, Burris JL, Jacobs CA, Vranceanu AM. Virtual Mind-Body Program for Obese Knee Osteoarthritis Patients with Comorbid Depression: Development and Feasibility Pilot (Preprint). JMIR Form Res 2021; 6:e34654. [PMID: 35475787 PMCID: PMC9096632 DOI: 10.2196/34654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is the most common joint disorder in the United States and a leading cause of disability. Depression and obesity are highly comorbid with KOA and accelerate knee degeneration and disability through biopsychosocial mechanisms. Mind-body physical activity programs can engage biological, mechanical, and psychological mechanisms to improve outcomes in KOA, but such programs are not currently available. Objective This mixed methods study aims to adapt a mind-body activity program for the unique needs of patients with KOA, depression, and obesity (GetActive-OA) delivered via live video. Methods Participants were adults (aged ≥45 years) from rural Kentucky with obesity (BMI≥30 kg/m2), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (9-item Patient Health Questionnaire ≥10) recruited from 2 orthopedic centers. In phase 1, we developed GetActive-OA and the study protocol using qualitative focus group feedback from the study population (N=9; 2 focus groups, 90 minutes) and multidisciplinary expertise from clinical psychologists and orthopedic researchers. In phase 2, we explored the initial feasibility, credibility, and acceptability of GetActive-OA, live video delivery, and study procedures via an open pilot with exit interviews (N=5; 1 group). This research was guided by National Institutes of Health (NIH) model stage IA. Results Phase 1 qualitative analyses revealed nuanced information about challenges with coping and increasing activity, high interest in a mind-body activity program, program participation facilitators (flexibility with technology) and barriers (amotivation and forgetfulness), and perceived challenges with data collection procedures (blood and urine samples and homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers: acceptability (80%), expectancy (100%), credibility (100%), clinician adherence (90%), homework adherence (80%), questionnaire data collection (100%), program satisfaction (100%), and safety (100%). Adherence to ActiGraph wear (80% baseline, 20% posttest) and collection of blood samples (60%) were low. Participation in GetActive-OA was associated with signals of improvements in general coping (Cohen d=2.41), pain catastrophizing (Cohen d=1.24), depression (Cohen d=0.88), anxiety (Cohen d=0.78), self-efficacy (Cohen d=0.73), pain (Cohen d=0.39), and KOA symptoms (Cohen d=0.36). Qualitative exit interviews confirmed quantitative findings and provided valuable information to optimize the program and protocol. Conclusions Patients with KOA, depression, and obesity from rural Kentucky were interested in a live video mind-body activity program. GetActive-OA shows promise; however, the program and protocol require further NIH stage I refinement before formal efficacy testing (NIH model stage II). International Registered Report Identifier (IRRID) RR2-10.1016/j.conctc.2021.100720
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Affiliation(s)
- Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nicole Lemaster
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, United States
| | - Brooke Duarte
- Integrated Brain Health Clinical and Research Program, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Terence Penn
- Integrated Brain Health Clinical and Research Program, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Millan Kanaya
- Integrated Brain Health Clinical and Research Program, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - James D Doorley
- Integrated Brain Health Clinical and Research Program, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, United States
| | - Cale A Jacobs
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, United States
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Gutierrez G, Rosenblat J, Hawken E, Swainson J, Vazquez G. Intranasal Esketamine versus Intravenous Ketamine: An observational pilot study assessing efficacy and tolerability of two novel 'standard of care' treatments for treatment resistant depression in naturalistic clinical practice. Protocol for an observational pilot study (Preprint). JMIR Res Protoc 2021; 11:e34711. [PMID: 35604752 PMCID: PMC9171596 DOI: 10.2196/34711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Intravenous (IV) ketamine and intranasal (IN) esketamine have been studied as novel alternatives to manage treatment-resistant depression (TRD). The objective of this observational pilot study is to compare the real-world effectiveness and tolerability of IV ketamine and IN esketamine in the management of unipolar TRD. Objective To compare the effectiveness (primary outcome measure) and tolerability (secondary outcome measure) of racemic ketamine and esketamine in the management of TRD in adults and provide an expert qualitative commentary on the application of IV ketamine and IN esketamine in clinical practice (exploratory objective), focusing on the recruitment process, patient retention, effectiveness, and tolerability of the treatments. Methods This is a multicenter prospective observational study of naturalistic clinical practice. We expect to recruit 10 patients per treatment arm—IV ketamine or IN esketamine per center (2 centers, total 40 subjects). Patients experiencing moderate to severe TRD and who are candidates for receiving low-dose IV ketamine treatments or IN esketamine as part of their standard-of-care treatments will be recruited. We will measure the effectiveness of each treatment arm by measuring the severity of depression symptoms using the Montgomery and Åsberg Depression Rating Scale; tolerability, side effects, and the appearance of dissociation symptoms using the simplified 6-item version of the Clinician Administered Dissociative Symptom Scale (CADSS-6); and potential for abuse using a Likeability and Craving Questionnaire. Logistic regression will examine odds ratios, number needed to treat for response and remission, number needed to harm, and likelihood to be helped or harmed of each treatment. Covariate analysis will assess the impact of site and demographic variables on treatment efficacy. Results This observational trial was approved by the Queen’s University Health Science and Affiliated Teaching Hospital’s Research Ethics Board in February 2021. The two research centers involved have started patient recruitment. Our research center (Providence Care Hospital, Kingston, Ontario) has recruited 9 patients so far. We expect to finalize data gathering by August 2022. The manuscript is expected to be published by December 2022. Conclusions We hypothesize that both treatments will have comparable rapid and robust antidepressant effects and similar tolerability profiles in a real-world setting for the management of TRD. International Registered Report Identifier (IRRID) DERR1-10.2196/34711
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Affiliation(s)
- Gilmar Gutierrez
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Joshua Rosenblat
- Canadian Rapid Treatment Center of Excellence, Toronto, ON, Canada
| | - Emily Hawken
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
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115
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Price A, Damaraju A, Kushalnagar P, Brunoe S, Srivastava U, Debidda M, Chu L. Coproduction, Coeducation, and Patient Involvement: Everyone Included Framework for Medical Education Across Age Groups and Cultures. JMIR MEDICAL EDUCATION 2021; 7:e31846. [PMID: 34730539 PMCID: PMC8600436 DOI: 10.2196/31846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 05/12/2023]
Abstract
Medical education, research, and health care practice continue to grow with minimal coproduction guidance. We suggest the Commons Principle approach to medical education as modeled by Ostrom and Williamson, where we share how adapting these models to multiple settings can enhance empathy, increase psychological safety, and provide robust just-in-time learning tools for practice. We here describe patient and public coproduction in diverse areas within health care using the commons philosophy across populations, cultures, and generations with learning examples across age groups and cultures. We further explore descriptive, mixed methods participatory action in medical and research education. We adopt an "Everyone Included" perspective and sought to identify its use in continuing medical education, citizen science, marginalized groups, publishing, and student internships. Overall, we outline coproduction at the point of need, as we report on strategies that improved engagement. This work demonstrates coproduction with the public across multiple settings and cultures, showing that even with minimal resources and experience, this partnership can improve medical education and care.
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Affiliation(s)
- Amy Price
- Stanford Anesthesia Informatics and Media (AIM) Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Poorna Kushalnagar
- Center for Deaf Health Equity, Gallaudet University, Washington, DC, United States
| | | | - Ujwal Srivastava
- Stanford Anesthesia Informatics and Media (AIM) Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Larry Chu
- Stanford Anesthesia Informatics and Media (AIM) Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Anttila MR, Soderlund A, Paajanen T, Kivistö H, Kokko K, Sjögren T. Biopsychosocial Profiles of Patients With Cardiac Disease in Remote Rehabilitation Processes: Mixed Methods Grounded Theory Approach. JMIR Rehabil Assist Technol 2021; 8:e16864. [PMID: 34730548 PMCID: PMC8600434 DOI: 10.2196/16864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/17/2020] [Accepted: 09/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as a part of rehabilitation. This study was based on a previously published study that categorized 4 groups of patients with cardiac disease based on different experiences and attitudes toward technology (e-usage groups): feeling outsider, being uninterested, reflecting benefit, and enthusiastic using. Objective This study identifies differences in the biopsychosocial profiles of patients with cardiac disease in e-usage groups and deepen the understanding of these profiles in cardiac rehabilitation. Methods Focus group interviews and measurements were conducted with 39 patients with coronary heart disease, and the mean age was 54.8 (SD 9.4, range 34-77) years. Quantitative data were gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey honestly significant difference test, a t test, or nonparametric tests—Mann–Whitney and Kruskal–Wallis tests—to compare the 4 e-usage groups—feeling outsider, being uninterested, reflecting benefit, and enthusiastic using—in biopsychosocial variables. Second, we compared the results of the 4 e-groups in terms of recommended and reference values. This analysis contained 13 variables related to biomedical, psychological, and social functioning. Finally, we formed biopsychosocial profiles based on the integration of the findings by constant comparative analysis phases through classic grounded theory. Results The biomedical variables were larger for waistline (mean difference [MD] 14.2; 95% CI 1.0-27.5; P=.03) and lower for physical fitness (MD −0.72; 95% CI −1.4 to −0.06; P=.03) in the being uninterested group than in the enthusiastic using group. The feeling outsider group had lower physical fitness (MD −55.8; 95% CI −110.7 to −0.92; P=.047) than the enthusiastic using group. For psychosocial variables, such as the degree of self-determination in exercise (MD −7.3; 95% CI −13.5 to −1.1; P=.02), the being uninterested group had lower values than the enthusiastic using group. Social variables such as performing guided tasks in the program (P=.03) and communicating via messages (P=.03) were lower in the feeling outsider group than in the enthusiastic using group. The feeling outsider and being uninterested groups had high-risk lifestyle behaviors, and adherence to the web-based program was low. In contrast, members of the being uninterested group were interested in tracking their physical activity. The reflecting benefit and enthusiastic using groups had low-risk lifestyle behavior and good adherence to web-based interventions; however, the enthusiastic using group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently. We renamed the 4 groups as building self-awareness, increasing engagement, maintaining a healthy lifestyle balance, and strengthening self-confidence. Conclusions The results facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation. Professionals can tailor individual web-based lifestyle risk interventions using these biopsychosocial profiles.
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Affiliation(s)
- Marjo-Riitta Anttila
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anne Soderlund
- Department of Physiotherapy, University of Mälardalen, Västerås, Sweden
| | - Teemu Paajanen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heikki Kivistö
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Katja Kokko
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tuulikki Sjögren
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Rahman W, Lee S, Islam MS, Antony VN, Ratnu H, Ali MR, Mamun AA, Wagner E, Jensen-Roberts S, Waddell E, Myers T, Pawlik M, Soto J, Coffey M, Sarkar A, Schneider R, Tarolli C, Lizarraga K, Adams J, Little MA, Dorsey ER, Hoque E. Detecting Parkinson Disease Using a Web-Based Speech Task: Observational Study. J Med Internet Res 2021; 23:e26305. [PMID: 34665148 PMCID: PMC8564663 DOI: 10.2196/26305] [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: 02/19/2021] [Revised: 04/13/2021] [Accepted: 08/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Access to neurological care for Parkinson disease (PD) is a rare privilege for millions of people worldwide, especially in resource-limited countries. In 2013, there were just 1200 neurologists in India for a population of 1.3 billion people; in Africa, the average population per neurologist exceeds 3.3 million people. In contrast, 60,000 people receive a diagnosis of PD every year in the United States alone, and similar patterns of rising PD cases—fueled mostly by environmental pollution and an aging population—can be seen worldwide. The current projection of more than 12 million patients with PD worldwide by 2040 is only part of the picture given that more than 20% of patients with PD remain undiagnosed. Timely diagnosis and frequent assessment are key to ensure timely and appropriate medical intervention, thus improving the quality of life of patients with PD. Objective In this paper, we propose a web-based framework that can help anyone anywhere around the world record a short speech task and analyze the recorded data to screen for PD. Methods We collected data from 726 unique participants (PD: 262/726, 36.1% were women; non-PD: 464/726, 63.9% were women; average age 61 years) from all over the United States and beyond. A small portion of the data (approximately 54/726, 7.4%) was collected in a laboratory setting to compare the performance of the models trained with noisy home environment data against high-quality laboratory-environment data. The participants were instructed to utter a popular pangram containing all the letters in the English alphabet, “the quick brown fox jumps over the lazy dog.” We extracted both standard acoustic features (mel-frequency cepstral coefficients and jitter and shimmer variants) and deep learning–based embedding features from the speech data. Using these features, we trained several machine learning algorithms. We also applied model interpretation techniques such as Shapley additive explanations to ascertain the importance of each feature in determining the model’s output. Results We achieved an area under the curve of 0.753 for determining the presence of self-reported PD by modeling the standard acoustic features through the XGBoost—a gradient-boosted decision tree model. Further analysis revealed that the widely used mel-frequency cepstral coefficient features and a subset of previously validated dysphonia features designed for detecting PD from a verbal phonation task (pronouncing “ahh”) influence the model’s decision the most. Conclusions Our model performed equally well on data collected in a controlled laboratory environment and in the wild across different gender and age groups. Using this tool, we can collect data from almost anyone anywhere with an audio-enabled device and help the participants screen for PD remotely, contributing to equity and access in neurological care.
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Affiliation(s)
- Wasifur Rahman
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Sangwu Lee
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Md Saiful Islam
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Victor Nikhil Antony
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Harshil Ratnu
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Mohammad Rafayet Ali
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Abdullah Al Mamun
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Ellen Wagner
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Stella Jensen-Roberts
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Emma Waddell
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Taylor Myers
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Meghan Pawlik
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Julia Soto
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Madeleine Coffey
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Aayush Sarkar
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Ruth Schneider
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Christopher Tarolli
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Karlo Lizarraga
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Jamie Adams
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Max A Little
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom.,MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - E Ray Dorsey
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Ehsan Hoque
- Department of Computer Science, University of Rochester, Rochester, NY, United States
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Spadaro B, Martin-Key NA, Bahn S. Building the Digital Mental Health Ecosystem: Opportunities and Challenges for Mobile Health Innovators. J Med Internet Res 2021; 23:e27507. [PMID: 34643537 PMCID: PMC8552100 DOI: 10.2196/27507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/20/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Digital mental health technologies such as mobile health (mHealth) tools can offer innovative ways to help develop and facilitate mental health care provision, with the COVID-19 pandemic acting as a pivot point for digital health implementation. This viewpoint offers an overview of the opportunities and challenges mHealth innovators must navigate to create an integrated digital ecosystem for mental health care moving forward. Opportunities exist for innovators to develop tools that can collect a vast range of active and passive patient and transdiagnostic symptom data. Moving away from a symptom-count approach to a transdiagnostic view of psychopathology has the potential to facilitate early and accurate diagnosis, and can further enable personalized treatment strategies. However, the uptake of these technologies critically depends on the perceived relevance and engagement of end users. To this end, behavior theories and codesigning approaches offer opportunities to identify behavioral drivers and address barriers to uptake, while ensuring that products meet users’ needs and preferences. The agenda for innovators should also include building strong evidence-based cases for digital mental health, moving away from a one-size-fits-all well-being approach to embrace the development of comprehensive digital diagnostics and validated digital tools. In particular, innovators have the opportunity to make their clinical evaluations more insightful by assessing effectiveness and feasibility in the intended context of use. Finally, innovators should adhere to standardized evaluation frameworks introduced by regulators and health care providers, as this can facilitate transparency and guide health care professionals toward clinically safe and effective technologies. By laying these foundations, digital services can become integrated into clinical practice, thus facilitating deeper technology-enabled changes.
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Affiliation(s)
- Benedetta Spadaro
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Nayra A Martin-Key
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Sabine Bahn
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom.,Psyomics Ltd, Cambridge, United Kingdom
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Faust G, Booth A, Merinopoulou E, Halhol S, Tosar H, Nawaz A, Szlachetka M, Chiu G. Experiences of Patients with Adjuvant and Metastatic Melanoma using Disease- Specific Social Media Communities in the Advent of Novel Therapies – EXCITE Project (Preprint). JMIR Cancer 2021; 8:e34073. [PMID: 35559986 PMCID: PMC9143777 DOI: 10.2196/34073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Immunotherapy and targeted therapy treatments are novel treatments available for patients with metastatic and adjuvant melanoma. As recently approved treatments, information surrounding the patients’ and caregivers’ experience with these therapies, perceptions of treatments, and the effect the treatments have on their day-to-day life are lacking. Such insights would be valuable for any future decision-making with regard to treatment options. Objective This study aims to use health-related social media data to understand the experience of patients with adjuvant and metastatic melanoma who are receiving either immunotherapy or targeted therapies. This study also included caregivers’ perspectives. Methods Publicly available social media forum posts by patients with self-reported adjuvant or metastatic melanoma (and their caregivers) between January 2014 to October 2019 were programmatically extracted, deidentified, cleaned, and analyzed using a combination of natural language processing and qualitative data analyses. This study identified spontaneously reported symptoms and their impacts, symptom duration, and the impact of treatment for both treatment groups. Results Overall, 1037 users (9023 posts) and 114 users (442 posts) were included in the metastatic group and adjuvant group, respectively. The most identified symptoms in both groups were fatigue, pain, or exanthema (identified in 5%-43% of patients dependent on the treatment group). Symptom impacts reported by both groups were physical impacts, impacts on family, and impacts on work. Positive treatment impacts were reported in both groups and covered the areas of work, social and family life, and general health and quality of life. Conclusions This study explored health-related social media to better understand the experience and perspectives of patients with melanoma receiving immunotherapy or targeted therapy treatments as well as the experience of their caregivers. This exploratory work uncovered the most discussed concerns among patients and caregivers on the forums including symptoms and their impacts, thus contributing to a deeper understanding of the patient/caregiver experience.
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Affiliation(s)
- Guy Faust
- University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
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Thiel B, Iao I, Smid J, de Wit E, Koopman S, Geerts B, Godfried M, Kalkman C. The adoption of a postoperative pain self-report tool, a qualitative study (Preprint). JMIR Hum Factors 2021; 9:e33706. [PMID: 35471472 PMCID: PMC9092239 DOI: 10.2196/33706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background With electronic technologies, patients are provided with tools to easily acquire information and to manage and record their own health status. eHealth interventions are already broadly applied to perioperative care. In a similar way, we aimed to utilize a smartphone application to enable postoperative patients to partially self-manage their postoperative pain. The results of a previously performed proof-of-concept study regarding the application were promising, and nurses as well as patients were optimistic regarding this innovative mobile application. Nevertheless, in reality, it appears that the usage and overall implementation of this application have stagnated since its introduction. Problems with innovation adoption are not novel; various studies have been conducted to explore the reasons for low implementation success of eHealth applications and indicated that adoption is influenced by multiple organizational factors. This study investigated the influence of these organizational factors on the adoption process, aiming to provide more insight in the dos and don’ts for implementing eHealth in the working processes of hospital care. Objective This study aimed to provide insight in how to successfully implement a technological eHealth innovation in a general nonacademic hospital. Methods A qualitative study was conducted to explore organizational factors affecting the innovation adoption process. Data were collected by conducting semistructured one-on-one interviews with 11 stakeholders. The data were analyzed using thematic analysis identifying overarching themes. Results Absorptive capacity, referred to as an organization’s dynamic capability pertaining to knowledge creation and utilization that enhances an organization’s ability to gain and sustain a competitive advantage, was regarded as the most influential factor on the application’s adoption. Accordingly, it appeared that innovation adoption is mainly determined by the capability and willingness to assimilate and transform new information into productive use and the ability to absorb a novel innovation. Absorptive capacity was found to be influenced by the innovation’s benefit and the sense of ownership and responsibility. Organizational readiness and management support were also regarded as essential since absorptive capacity seemed to be mediated by these factors. The size of the hospital influenced eHealth adoption by the amount of resources available and by its organizational structure. Conclusions In conclusion, absorptive capacity is essential for eHealth adoption, and it is mediated by management support and organizational readiness. It is recommended to increase the degree of willingness and ability to adopt an eHealth innovation by enhancing the relevance, engaging stakeholders, and assigning appropriate leaders to offer guidance.
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Affiliation(s)
- Bram Thiel
- Department of Anesthesiology, OLVG Hospital, Amsterdam, Netherlands
| | - Inez Iao
- Department of Services and Solutions Delivery, Philips Benelux, Amsterdam, Netherlands
| | - Joris Smid
- Department of Cardiology, OLVG Hospital, Amsterdam, Netherlands
| | - Emmy de Wit
- Faculty of Science, Athena Institute, Vu University, Amsterdam, Netherlands
| | - Seppe Koopman
- Department of Anesthesiology, Maasstad Hospital, Rotterdam, Netherlands
| | - Bart Geerts
- Department of Intensive Care, Spaarne Gasthuis Hospital, Haarlem, Netherlands
| | - Marc Godfried
- Department of Anesthesiology, OLVG Hospital, Amsterdam, Netherlands
| | - Cor Kalkman
- Department of Anesthesia and Intensive Care, University Medical Centre Utrecht, Utrecht, Netherlands
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121
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Blanchette JE, Tran MJ, Grigorian EG, Iacob E, Edelman LS, Oser TK, Litchman ML. GoFundMe isn't a Medical Plan: An Ecological Study of Crowdfunding Insulin Success (Preprint). JMIR Diabetes 2021; 7:e33205. [PMID: 35436214 PMCID: PMC9055489 DOI: 10.2196/33205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Individuals in need of medical care turn to crowdfunding websites to engage a “crowd” or group for financial support. In the last decade, access to insulin has decreased considerably for several reasons, including the rising cost of insulin, increasing popularity of high-deductible insurance plans, and increasing insurance premiums. Many people with diabetes are forced to ration or go without insulin, and they turn to crowdfunding websites to seek financial donations to purchase insulin needed to reduce health risks and mortality, and sustain quality of life. Objective This study aimed to explore crowdfunding campaign requests to purchase insulin in the United States. Methods In this retrospective, quantitative, and qualitative study, we coded the text of GoFundMe online crowdfunding campaigns and viral measures (shares, hearts, and comments) from February 25 to April 15, 2019. We described campaigns (N=205) and explored the factors associated with campaign success using correlations and qualitative thematic analysis. Results The majority of campaigns were initiated by middle-aged adults (age 26-64 years; 77/205, 37.6%), those with type 1 diabetes (94/205, 45.9%), and those needing funds owing to insurance coverage issues (125/205, 61.0%). The factors associated with campaign success included requests for ≤US $500 (P=.007) and higher viral measures (shares, P=.007; hearts, P<.001; comments, P=.002). The following 4 themes emerged from the campaign text: (1) desire for self-management and survival, (2) diabetes management untenable given insulin access, (3) aftermath of insulin unaffordability, and (4) privacy issues with crowdfunding. Campaign comments were both supportive (tangible, informational, and emotional) and unsupportive (questioned the need for the campaign and deemed crowdfunding inappropriate). Conclusions Despite crowdfunding websites being used to support the purchase of insulin, campaigns raised only a fraction of the money requested. Therefore, GoFundMe campaigns are not a reliable solution to obtain funds for insulin in the United States. Applying quantitative and qualitative methods is adequate to analyze online crowdfunding for costs of medications such as insulin. However, it is critical for people with diabetes to use resources other than online crowdfunding to access and obtain insulin owing to low success rates. Clinicians should routinely assess difficulty accessing or affording insulin, and federal health care policies should support lowering the cost of insulin.
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Affiliation(s)
- Julia E Blanchette
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - M J Tran
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Ernest G Grigorian
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Linda S Edelman
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Tiersen F, Batey P, Harrison MJC, Naar L, Serban AI, Daniels SJC, Calvo RA. Smart Home Sensing and Monitoring in Households With Dementia: User-Centered Design Approach. JMIR Aging 2021; 4:e27047. [PMID: 34383672 PMCID: PMC8387885 DOI: 10.2196/27047] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/01/2021] [Accepted: 05/16/2021] [Indexed: 02/03/2023] Open
Abstract
Background As life expectancy grows, so do the challenges of caring for an aging population. Older adults, including people with dementia, want to live independently and feel in control of their lives for as long as possible. Assistive technologies powered by artificial intelligence and internet of things devices are being proposed to provide living environments that support the users’ safety, psychological, and medical needs through remote monitoring and interventions. Objective This study investigates the functional, psychosocial, and environmental needs of people living with dementia, their caregivers, clinicians, and health and social care service providers toward the design and implementation of smart home systems. Methods We used an iterative user-centered design approach comprising 9 substudies. First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health and social care clinicians) were conducted to define the needs of people with dementia, home caregivers, and professional stakeholders in both daily activities and technology-specific interactions. Then, the spectrum of needs identified was represented via patient–caregiver personas and discussed with stakeholders in a workshop (14 occupational therapists; 4 National Health Service pathway directors; and 6 researchers in occupational therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care services (n=8), eliciting opportunities for innovative care technologies and public health strategies. Finally, these design opportunities were discussed in semistructured interviews with participants of a smart home trial involving environmental sensors, physiological measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors that motivate household members to use these technologies. Results Outcomes of these activities include a qualitative and quantitative analysis of patient, caregiver, and clinician needs and the identification of challenges and opportunities for the design and implementation of remote monitoring systems in public health pathways. Conclusions Participatory design methods supported the triangulation of stakeholder perspectives to aid the development of more patient-centered interventions and their translation to clinical practice and public health strategy. We discuss the implications and limitations of our findings, the value and the applicability of our methodology, and directions for future research.
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Affiliation(s)
- Federico Tiersen
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Philippa Batey
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College London, London, United Kingdom
| | - Matthew J C Harrison
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College London, London, United Kingdom
| | - Lenny Naar
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College London, London, United Kingdom.,Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Alina-Irina Serban
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College London, London, United Kingdom
| | - Sarah J C Daniels
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College London, London, United Kingdom.,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
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McCarron TL, Clement F, Rasiah J, Moran C, Moffat K, Gonzalez A, Wasylak T, Santana M. Patients as partners in health research: A scoping review. Health Expect 2021; 24:1378-1390. [PMID: 34153165 PMCID: PMC8369093 DOI: 10.1111/hex.13272] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/10/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The role of patient involvement in health research has evolved over the past decade. Despite efforts to engage patients as partners, the role is not well understood. We undertook this review to understand the engagement practices of patients who assume roles as partners in health research. METHODS Using a recognized methodological approach, two academic databases (MEDLINE and EMBASE) and grey literature sources were searched. Findings were organized into one of the three higher levels of engagement, described by the Patient and Researcher Engagement framework developed by Manafo. We examined and quantified the supportive strategies used during involvement, used thematic analysis as described by Braun and Clarke and themed the purpose of engagement, and categorized the reported outcomes according to the CIHR Engagement Framework. RESULTS Out of 6621 records, 119 sources were included in the review. Thematic analysis of the purpose of engagement revealed five themes: documenting and advancing PPI, relevance of research, co-building, capacity building and impact on research. Improved research design was the most common reported outcome and the most common role for patient partners was as members of the research team, and the most commonly used strategy to support involvement was by meetings. CONCLUSION The evidence collected during this review advanced our understanding of the engagement of patients as research partners. As patient involvement becomes more mainstream, this knowledge will aid researchers and policy-makers in the development of approaches and tools to support engagement. PATIENT/USER INVOLVEMENT Patients led and conducted the grey literature search, including the synthesis and interpretation of the findings.
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Affiliation(s)
- Tamara L. McCarron
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Fiona Clement
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Jananee Rasiah
- Faculty of Nursing3‐141 Edmonton Clinic Health Academy (ECHA)University of AlbertaEdmontonABCanada
| | - Chelsea Moran
- The Department PsychologyUniversity of CalgaryCalgaryABCanada
| | - Karen Moffat
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
- Patient PartnerCalgaryABCanada
| | - Andrea Gonzalez
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Tracy Wasylak
- Alberta Health ServicesCalgaryABCanada
- Faculty of NursingUniversity of CalgaryCalgaryABCanada
| | - Maria Santana
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
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Woodford J, Farrand P, Hagström J, Hedenmalm L, von Essen L. Internet-Administered Cognitive Behavioral Therapy for Common Mental Health Difficulties in Parents of Children Treated for Cancer: Intervention Development and Description Study. JMIR Form Res 2021; 5:e22709. [PMID: 34142662 PMCID: PMC8367173 DOI: 10.2196/22709] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/08/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Following the end of a child's treatment for cancer, parents may report psychological distress. However, there is a lack of evidence-based interventions that are tailored to the population, and psychological support needs are commonly unmet. An internet-administered low-intensity cognitive behavioral therapy (LICBT)-based intervention (EJDeR [internetbaserad självhjälp för föräldrar till barn som avslutat en behandling mot cancer]) may provide a solution. OBJECTIVE The first objective is to provide an overview of a multimethod approach that was used to inform the development of the EJDeR intervention. The second objective is to provide a detailed description of the EJDeR intervention in accordance with the Template for Intervention Description and Replication (TIDieR) checklist. METHODS EJDeR was developed through a multimethod approach, which included the use of existing evidence, the conceptualization of distress, participatory action research, a cross-sectional survey, and professional and public involvement. Depending on the main presenting difficulty identified during assessment, LICBT behavioral activation or worry management treatment protocols are adopted for the treatment of depression or generalized anxiety disorder when experienced individually or when comorbid. EJDeR is delivered via the Uppsala University Psychosocial Care Programme (U-CARE) portal, a web-based platform that is designed to deliver internet-administered LICBT interventions and includes secure videoconferencing. To guide parents in the use of EJDeR, weekly written messages via the portal are provided by e-therapists comprising final year psychology program students with training in cognitive behavioral therapy. RESULTS An overview of the development process and a description of EJDeR, which was informed by the TIDieR checklist, are presented. Adaptations that were made in response to public involvement are highlighted. CONCLUSIONS EJDeR represents a novel, guided, internet-administered LICBT intervention for supporting parents of children treated for cancer. Adopting the TIDieR checklist offers the potential to enhance fidelity to the intervention protocol and facilitate later implementation. The intervention is currently being tested in a feasibility study (the ENGAGE study). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-023708.
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Affiliation(s)
- Joanne Woodford
- Uppsala University, Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education, Development, and Research (CEDAR), Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Josefin Hagström
- Uppsala University, Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala, Sweden
| | - Li Hedenmalm
- Uppsala University, Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala, Sweden
| | - Louise von Essen
- Uppsala University, Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala, Sweden
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Nathan A, Fricker M, Patel S, Georgi M, Hang MK, Asif A, Sinha A, Mullins W, Shea J, Hanna N, Lamb B, Kelly J, Sridhar A, Collins J. Virtual Interactive Surgical Skills Classroom: Protocol for a Parallel-Group, Noninferiority, Adjudicator-Blinded, Randomized Controlled Trial (VIRTUAL). JMIR Res Protoc 2021; 10:e28671. [PMID: 34292162 PMCID: PMC8367109 DOI: 10.2196/28671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Traditional face-to-face training (FFT) for basic surgical skills is inaccessible and resource-intensive. Noninteractive computer-based learning is more economical but less educationally beneficial. Virtual classroom training (VCT) is a novel method that permits distanced interactive expert instruction. VCT may optimize resources and increase accessibility. Objective We aim to investigate whether VCT is superior to computer-based learning and noninferior to FFT in improving proficiency in basic surgical skills. Methods This is a protocol for a parallel-group, noninferiority, randomized controlled trial. A sample of 72 undergraduates will be recruited from 5 medical schools in London. Participants will be stratified by subjective and objective suturing experience level and allocated to 3 intervention groups at a 1:1:1 ratio. VCT will be delivered using the BARCO weConnect software, and FFT will be provided by expert instructors. Optimal student-to-teacher ratios of 12:1 for VCT and 4:1 for FFT will be maintained. The assessed task will be interrupted suturing with hand-tied knots. Results The primary outcome will be the postintervention Objective Structured Assessment of Technical Skills score, adjudicated by 2 experts blinded to the study and adjusted for baseline proficiency. The noninferiority margin (δ) will be defined using historical data. Conclusions This study will serve as a comprehensive appraisal of the suitability of virtual basic surgical skills classroom training as an alternative to FFT. Our findings will assist the development and implementation of further resource-efficient, accessible, virtual basic surgical skills training programs during the COVID-19 pandemic and in the future. Trial Registration International Standard Randomized Controlled Trial Number ISRCTN12448098; https://www.isrctn.com/ISRCTN12448098 International Registered Report Identifier (IRRID) PRR1-10.2196/28671
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Affiliation(s)
- Arjun Nathan
- University College London, London, United Kingdom
| | | | - Sonam Patel
- University College London, London, United Kingdom
| | - Maria Georgi
- University College London, London, United Kingdom
| | | | - Aqua Asif
- University College London, London, United Kingdom
| | - Amil Sinha
- University of Cambridge, Cambridge, United Kingdom
| | | | - Jessie Shea
- University of Cambridge, Cambridge, United Kingdom
| | - Nancy Hanna
- University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Lamb
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - John Kelly
- University College London, London, United Kingdom
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Green H, Fernandez R, MacPhail C. Social Media as a Platform for Recruitment to a National Survey During the COVID-19 Pandemic: Feasibility and Cost Analysis. JMIR Form Res 2021; 5:e28656. [PMID: 34133315 PMCID: PMC8274672 DOI: 10.2196/28656] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/17/2021] [Accepted: 05/19/2021] [Indexed: 01/22/2023] Open
Abstract
Background With improved accessibility to social media globally, health researchers are capitalizing on social media platforms to recruit participants for research studies. This has particularly been the case during the COVID-19 pandemic, when researchers were not able to use traditional methods of recruitment. Nevertheless, there is limited evidence on the feasibility of social media for recruiting a national sample. Objective This paper describes the use of social media as a tool for recruiting a national sample of adults to a web-based survey during the COVID-19 pandemic. Methods Between August and October 2020, participants were recruited through Facebook via two advertisement campaigns (paid option and no-cost option) into a web-based survey exploring the relationship between social determinants of health and well-being of adults during the COVID-19 pandemic. Data were analyzed using SPSS software and Facebook metrics that were autogenerated by Facebook Ads Manager. Poststratification weights were calculated to match the Australian population on the basis of gender, age, and state or territory based on the 2016 Australian census data. Results In total, 9594 people were reached nationally with the paid option and potentially 902,000 people were reached through the no-cost option, resulting in a total of 1211 survey responses. The total cost of the advertisement campaign was Aus $649.66 (US $489.23), resulting in an overall cost per click of Aus $0.25 (US $0.19). Conclusions Facebook is a feasible and cost-effective method of recruiting participants for a web-based survey, enabling recruitment of population groups that are considered hard to reach or marginalized. Recruitment through Facebook facilitated diversity, with participants varying in socioeconomic status, geographical location, educational attainment, and age.
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Affiliation(s)
- Heidi Green
- School of Nursing, University of Wollongong, Wollongong, Australia.,Centre for Research in Nursing and Health, St George Hospital, Kogarah, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, Wollongong, Australia.,Centre for Research in Nursing and Health, St George Hospital, Kogarah, Australia
| | - Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, Australia
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Hwang HS, Choi SY. Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study. JMIR Mhealth Uhealth 2021; 9:e25310. [PMID: 33934068 PMCID: PMC8277309 DOI: 10.2196/25310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/16/2021] [Accepted: 05/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. Objective This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test. Methods In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed. Results In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of –0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable. Conclusions In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver’s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers.
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Affiliation(s)
- Ho Sung Hwang
- Department of Occupational Therapy, Wonkwang University Gwangju Medical Center, Gwangju, Republic of Korea
| | - Seong-Youl Choi
- Department of Occupational Therapy, Gwangju Women's University, Gwangju, Republic of Korea
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Shen N, Kassam I, Zhao H, Chen S, Wang W, Wickham S, Strudwick G, Carter-Langford A. Foundations for Meaningful Consent in Canada’s Digital Health Ecosystem: Findings from a Pan-Canadian Survey (Preprint). JMIR Med Inform 2021; 10:e30986. [PMID: 35357318 PMCID: PMC9015739 DOI: 10.2196/30986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/17/2021] [Accepted: 01/31/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Nelson Shen
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Iman Kassam
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Haoyu Zhao
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sheng Chen
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- College of Public Health, University of South Florida, Tampa, FL, United States
| | | | - Gillian Strudwick
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Machen L, Handley MA, Powe N, Tuot D. Engagement With a Health Information Technology-Augmented Self-Management Support Program in a Population With Limited English Proficiency: Observational Study. JMIR Mhealth Uhealth 2021; 9:e24520. [PMID: 33973868 PMCID: PMC8205419 DOI: 10.2196/24520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/15/2021] [Accepted: 04/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Limited English proficiency (LEP) is an important driver of health disparities. Many successful patient-level interventions to prevent chronic disease progression and complications have used automated telephone self-management support, which relies on patient activation and communication to achieve improved health outcomes. It is not clear whether these interventions are similarly applicable to patients with LEP compared to patients with English proficiency. Objective The objectives of this study were as follows: (1) To examine the impact of LEP on patient engagement (primary outcome) with a 12-month language-concordant self-management program that included automated telephone self-management support, designed for patients with chronic kidney disease (CKD). (2) To assess the impact of LEP on change in systolic blood pressure (SBP) and albuminuria (secondary outcomes) resulting from the self-management program. Methods This was a secondary analysis of the Kidney Awareness Registry and Education (KARE) pilot trial (NCT01530958) which was funded by the National Institutes of Health in August 2011, approved by the University of California Institutional Review Board in October 2011 (No. 11-07399), and executed between 2013 and 2015. Multivariable logistic and linear models were used to examine various facets of patient engagement with the CKD self-management support program by LEP status. Patient engagement was defined by patient’s use of educational materials, completion of a health coaching action plan, and degree of participation with automated telephone self-management support. Changes in SBP and albuminuria at 12 months by LEP status were determined using multivariable linear mixed models. Results Of 137 study participants, 53 (38.7%) reported LEP, of which 45 (85%) were Spanish speaking and 8 (15%) Cantonese speaking. While patients with LEP and English proficiency similarly used the program’s educational materials (85% [17/20] vs 88% [30/34], P=.69) and completed an action plan (81% [22/27] vs 74% [35/47], P=.49), those with LEP engaged more with the automated telephone self-management support component. Average call completion was 66% among patients with LEP compared with 57% among those with English proficiency; patients with LEP requested more health coach telephone calls (P=.08) and had a significantly longer average automated call duration (3.3 [SD 1.4] min vs 2.2 [1.1 min], P<.001), indicating higher patient engagement. Patients with LEP randomized to self-management support had a larger, though nonstatistically significant (P=.74), change in SBP (–4.5 mmHg; 95% CI –9.4 to 0.3) and albuminuria (–72.4 mg/dL; 95% CI –208.9 to 64.1) compared with patients with English proficiency randomized to self-management support (–2.1 mmHg; 95% CI –8.6 to 4.3 and –11.1 mg/dL; 95% CI –166.9 to 144.7). Conclusions Patients with LEP with CKD were equally or more engaged with a language-concordant, culturally appropriate telehealth intervention compared with their English-speaking counterparts. Augmented telehealth may be useful in mitigating communication barriers among patients with LEP. Trial Registration ClinicalTrials.gov NCT01530958; https://clinicaltrials.gov/ct2/show/NCT01530958
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Affiliation(s)
- Leah Machen
- University of California, San Francisco, San Francisco, CA, United States
| | - Margaret A Handley
- University of California, San Francisco, San Francisco, CA, United States
| | - Neil Powe
- University of California, San Francisco, San Francisco, CA, United States
| | - Delphine Tuot
- University of California, San Francisco, San Francisco, CA, United States
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130
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Baalsrud Hauge J, Söbke H, Bröker T, Lim T, Luccini AM, Kornevs M, Meijer S. Current Competencies of Game Facilitators and Their Potential Optimization in Higher Education: Multimethod Study. JMIR Serious Games 2021; 9:e25481. [PMID: 33949956 PMCID: PMC8135020 DOI: 10.2196/25481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/28/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Serious games can be a powerful learning tool in higher education. However, the literature indicates that the learning outcome in a serious game depends on the facilitators’ competencies. Although professional facilitators in commercial game-based training have undergone specific instruction, facilitators in higher education cannot rely on such formal instruction, as game facilitation is only an occasional part of their teaching activities. Objective This study aimed to address the actual competencies of occasional game facilitators and their perceived competency deficits. Methods Having many years of experience as professional and occasional facilitators, we (n=7) defined requirements for the occasional game facilitator using individual reflection and focus discussion. Based on these results, guided interviews were conducted with additional occasional game facilitators (n=4) to check and extend the requirements. Finally, a group of occasional game facilitators (n=30) answered an online questionnaire based on the results of the requirement analysis and existing competency models. Results Our review produced the following questions: Which competencies are needed by facilitators and what are their training needs? What do current training courses for occasional game facilitators in higher education look like? How do the competencies of occasional game facilitators differ from other competencies required in higher education? The key findings of our analysis are that a mix of managerial and technical competencies is required for facilitating serious games in higher educational contexts. Further, there is a limited or no general competence model for game facilitators, and casual game facilitators rarely undergo any specific, formal training. Conclusions The results identified the competencies that game facilitators require and a demand for specific formal training. Thus, the study contributes to the further development of a competency model for game facilitators and enhances the efficiency of serious games.
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Affiliation(s)
- Jannicke Baalsrud Hauge
- KTH Royal Institute of Technology, Södertalje, Sweden.,BIBA - Bremer Institut für Produktion und Logistik GmbH, Bremen, Germany
| | | | - Thomas Bröker
- Nuremberg Institute of Technology, Nuremberg, Germany
| | - Theodore Lim
- Heriot Watt University, Edinburgh, United Kingdom
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131
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McCreesh-Toselli S, Torline J, Gouse H, Robbins RN, Mellins CA, Remien RH, Rowe J, Peton N, Rabie S, Joska JA. Staff Perceptions of Preimplementation Barriers and Facilitators to a Mobile Health Antiretroviral Therapy Adherence Counseling Intervention in South Africa: Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e23280. [PMID: 33821806 PMCID: PMC8058692 DOI: 10.2196/23280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/04/2021] [Accepted: 02/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background South Africa adopted a universal test and treatment program for HIV infection in 2015. The standard of care that people living with HIV receive consists of 3 sessions of readiness counseling delivered by lay counselors (LCs). In the largest antiretroviral therapy (ART) program worldwide, effective and early HIV and ART education and support are key for ensuring ART adoption, adherence, and retention in care. Having LCs to deliver readiness counseling allows for the wide task-sharing of this critical activity but carries the risks of loss of standardization, incomplete content delivery, and inadequate monitoring and supervision. Systems for ensuring that a minimum standard of readiness counseling is delivered to the growing number of people living with HIV are essential in the care cascade. In resource-constrained, high-burden settings, mobile health (mHealth) apps may potentially offer solutions to these treatment gaps by providing content structure and delivery records. Objective This study aims to explore, at a large Cape Town–based nonprofit HIV care organization, the staff’s perceived preimplementation barriers and facilitators of an mHealth intervention (Masivukeni) developed as a structured app for ART readiness counseling. Methods Masivukeni is a laptop-based app that incorporates written content, graphics, short video materials, and participant activities. In total, 20 participants were included in this study. To explore how an mHealth intervention might be adopted across different staff levels within the organization, we conducted 7 semistructured interviews (participants: 7/20, 35%) and 3 focus groups (participants in 2 focus groups: 4/20, 20%; participants in 1 focus group: 3/20, 15%) among LCs, supervisors, and their managers. In total, 20 participants were included in this study. Interviews lasted approximately 60 minutes, and focus groups ranged from 90 to 120 minutes. The Consolidated Framework for Implementation Research was used to explore the perceived implementation barriers and facilitators of the Masivukeni mHealth intervention. Results Several potential facilitators of Masivukeni were identified. Multimedia and visual elements were generally regarded as aids in content delivery. The interactive learning components were notably helpful, whereas facilitated updates to the adherence curriculum were important to facilitators and managers. The potential to capture administrative information regarding LC delivery and client logging was regarded as an attractive feature. Barriers to implementation included security risks and equipment costs, the high volume of clients to be counseled, and variable computer literacy among LCs. There was uncertainty about the app’s appeal to older clients. Conclusions mHealth apps, such as Masivukeni, were perceived as being well placed to address some of the needs of those who deliver ART adherence counseling in South Africa. However, the successful implementation of mHealth apps appeared to be dependent on overcoming certain barriers in this setting.
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Affiliation(s)
- Siobhan McCreesh-Toselli
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - John Torline
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Jessica Rowe
- The Columbia Center for New Media Teaching and Learning, Columbia University, New York, NY, United States
| | - Neshaan Peton
- City of Cape Town Metropolitan Municipality, Cape Town, South Africa
| | - Stephan Rabie
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
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132
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Marcotte-Beaumier G, Bouchard S, Gosselin P, Langlois F, Belleville G, Marchand A, Dugas MJ. The Role of Intolerance of Uncertainty and Working Alliance in the Outcome of Cognitive Behavioral Therapy for Generalized Anxiety Disorder Delivered by Videoconference: Mediation Analysis. JMIR Ment Health 2021; 8:e24541. [PMID: 33720024 PMCID: PMC8077936 DOI: 10.2196/24541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. OBJECTIVE As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. METHODS A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. RESULTS The results revealed that the therapeutic bond did not predict treatment outcome (r=-0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=-0.42; P=.004 and r=-0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=-0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. CONCLUSIONS These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.
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Affiliation(s)
- Gabrielle Marcotte-Beaumier
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Stéphane Bouchard
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre de recherche du Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Patrick Gosselin
- Département de psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédéric Langlois
- Département de psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - André Marchand
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Michel J Dugas
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre de recherche du Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada
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Tena A, Claria F, Solsona F, Meister E, Povedano M. Detection of Bulbar Involvement in Patients With Amyotrophic Lateral Sclerosis by Machine Learning Voice Analysis: Diagnostic Decision Support Development Study. JMIR Med Inform 2021; 9:e21331. [PMID: 33688838 PMCID: PMC7991994 DOI: 10.2196/21331] [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: 10/26/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Bulbar involvement is a term used in amyotrophic lateral sclerosis (ALS) that refers to motor neuron impairment in the corticobulbar area of the brainstem, which produces a dysfunction of speech and swallowing. One of the earliest symptoms of bulbar involvement is voice deterioration characterized by grossly defective articulation; extremely slow, laborious speech; marked hypernasality; and severe harshness. Bulbar involvement requires well-timed and carefully coordinated interventions. Therefore, early detection is crucial to improving the quality of life and lengthening the life expectancy of patients with ALS who present with this dysfunction. Recent research efforts have focused on voice analysis to capture bulbar involvement. Objective The main objective of this paper was (1) to design a methodology for diagnosing bulbar involvement efficiently through the acoustic parameters of uttered vowels in Spanish, and (2) to demonstrate that the performance of the automated diagnosis of bulbar involvement is superior to human diagnosis. Methods The study focused on the extraction of features from the phonatory subsystem—jitter, shimmer, harmonics-to-noise ratio, and pitch—from the utterance of the five Spanish vowels. Then, we used various supervised classification algorithms, preceded by principal component analysis of the features obtained. Results To date, support vector machines have performed better (accuracy 95.8%) than the models analyzed in the related work. We also show how the model can improve human diagnosis, which can often misdiagnose bulbar involvement. Conclusions The results obtained are very encouraging and demonstrate the efficiency and applicability of the automated model presented in this paper. It may be an appropriate tool to help in the diagnosis of ALS by multidisciplinary clinical teams, in particular to improve the diagnosis of bulbar involvement.
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Affiliation(s)
- Alberto Tena
- Information and Communication Technologies Group, International Centre for Numerical Methods in Engineering, Barcelona, Spain
| | - Francec Claria
- Department of Computer Science, Universitat de Lleida, Lleida, Spain
| | - Francesc Solsona
- Department of Computer Science, Universitat de Lleida, Lleida, Spain
| | - Einar Meister
- Institute of Cybernetics, Tallinn University of Technology, Tallinn, Estonia
| | - Monica Povedano
- Motoneuron Functional Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
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Patel S, Craigen G, Pinto da Costa M, Inkster B. Opportunities and Challenges for Digital Social Prescribing in Mental Health: Questionnaire Study. J Med Internet Res 2021; 23:e17438. [PMID: 33687338 PMCID: PMC7988390 DOI: 10.2196/17438] [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] [Received: 12/12/2019] [Revised: 07/27/2020] [Accepted: 01/30/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The concept of digital social prescription usually refers to social prescriptions that are facilitated by using technology. Tools that enable such digital social prescriptions may be beneficial in recommending nonmedical activities to people with mental illness. As these tools are still somewhat novel and emerging, little is known about their potential advantages and disadvantages. OBJECTIVE The objective of this study is to identify the potential opportunities and challenges that may arise from digital social prescriptions. METHODS We developed a qualitative questionnaire that was disseminated through social media (Facebook and Twitter). A purposive sample targeting digital mental health experts and nonexperts was approached. The questionnaire asked participants' views about digital social prescription; the core elements linked with a definition of digital social prescription; and the strengths, weaknesses, opportunities, and threats associated with digital social prescription. RESULTS Four core elements were recommended to define the concept of digital social prescription: digital, facilitate, user, and social. The main strength identified was the possibility to rapidly start using digital social prescription tools, which were perceived as cost-effective. The main weaknesses were their poor adherence and difficulties with using such tools. The main opportunities were an increased access to social prescription services and the prevention of serious mental illness. The main threats were certain groups being disadvantaged, patients being subject to unintended negative consequences, and issues relating to confidentiality and data protection. CONCLUSIONS Although digital social prescriptions may be able to effectively augment the social prescriptions, a careful consideration of practical challenges and data ethics is imperative in the design and implementation of such technologies.
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Affiliation(s)
- Shivani Patel
- South London and Maudsley NHS Trust, London, United Kingdom
| | - Gerry Craigen
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mariana Pinto da Costa
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Becky Inkster
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,Finance and Economics Programme, The Alan Turing Institute, London, United Kingdom
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135
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Ntalindwa T, Nduwingoma M, Uworwabayeho A, Nyirahabimana P, Karangwa E, Rashid Soron T, Westin T, Karunaratne T, Hansson H. Adopting the use of digital content to improve the learning of numeracy among children with autism spectrum disorders in Rwanda: A Thematic content analysis study (Preprint). JMIR Serious Games 2021; 10:e28276. [PMID: 35438638 PMCID: PMC9066332 DOI: 10.2196/28276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/09/2021] [Accepted: 01/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many teachers consider it challenging to teach children with autism spectrum disorder (ASD) in an inclusive classroom due to their unique needs and challenges. The integration of information communication technology (ICT) in the education system allows children with ASD to improve their learning. However, these ICT tools should meet their needs to lead a productive life. Objective This study aimed to examine the possibilities of re-creating and adapting digital content to improve the learning of numeracy among children with ASD in inclusive school settings. Methods We conducted 7 focus group discussions (FGDs) with 56 teachers from 7 schools and 14 parents from April to November 2019. Each of the FGDs took around 1 hour. Two clustered sets of questions were used: (1) general knowledge about teaching children with ASD and (2) analysis of selected online educational video content of early math (specifically, counting numbers). The researchers used video to understand current methodologies used in teaching children with ASD, possibilities of adaptation of the content in the current teaching environment, future challenges when the content is adapted, and possible solutions to overcome those challenges. All data, including audio recordings, field notes, and participants’ comments, were transcribed, recorded, and analyzed following the steps recommended in qualitative data analysis. Results The researchers identified ten themes from the analysis of the data: (1) awareness of the existence of ASD among children in schools and the community, (2) acceptance of children with ASD in an inclusive classroom and the community, (3) methods and models used when teaching children with ASD, (4)realia used to improve the learning of children with ASD, (5) the design of educational digital content, (6) the accessibility of online educational content, (7) quality of the content of the educational multimedia, (8) the opportunity of using the translated and re-created content inside and outside the classroom, (9) the relevance of the digital content in the Rwandan educational system, and (10) enhancement of the accessibility and quality of the digital content. We found that participants assumed that the content translation, gamification, and re-creation would help teach children with ASD. Moreover, they recommended contextualizing the content, increasing access to digital devices, and further research in the education of different subjects. Conclusions Although many studies have identified the possibilities of using ICT to support children with ASD, few studies have documented the possibilities of integrating the existing technologies tested in the international community. This study is charting new territory to investigate online content to suit the context of schools. This study recommends further exploration of possible methodologies, such as applied behavior analysis or verbal behavior therapy, and the development of contextualized technologies that respond to the educational needs of children with ASD.
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Affiliation(s)
| | | | | | | | - Evariste Karangwa
- School of Inclusive and Special Needs Education, University of Rwanda, Kigali, Rwanda
| | | | - Thomas Westin
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Thashmee Karunaratne
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Henrik Hansson
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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Cheng VWS, Piper SE, Ottavio A, Davenport TA, Hickie IB. Recommendations for Designing Health Information Technologies for Mental Health Drawn From Self-Determination Theory and Co-design With Culturally Diverse Populations: Template Analysis. J Med Internet Res 2021; 23:e23502. [PMID: 33565985 PMCID: PMC7904400 DOI: 10.2196/23502] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/14/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Culturally diverse populations (including Aboriginal and Torres Strait Islander people, people of diverse genders and sexualities, and culturally and linguistically diverse people) in nonurban areas face compounded barriers to accessing mental health care. Health information technologies (HITs) show promising potential to overcome these barriers. Objective This study aims to identify how best to improve a mental health and well-being HIT for culturally diverse Australians in nonurban areas. Methods We conducted 10 co-design workshops (N=105 participants) in primary youth mental health services across predominantly nonurban areas of Australia and conducted template analysis on the workshop outputs. Owing to local (including service) demographics, the workshop participants naturalistically reflected culturally diverse groups. Results We identified 4 main themes: control, usability, affirmation, and health service delivery factors. The first 3 themes overlap with the 3 basic needs postulated by self-determination theory (autonomy, competence, and relatedness) and describe participant recommendations on how to design an HIT. The final theme includes barriers to adopting HITs for mental health care and how HITs can be used to support care coordination and delivery. Hence, it describes participant recommendations on how to use an HIT. Conclusions Although culturally diverse groups have specific concerns, their expressed needs fall broadly within the relatively universal design principles identified in this study. The findings of this study provide further support for applying self-determination theory to the design of HITs and reflect the tension in designing technologies for complex problems that overlap multiple medical, regulatory, and social domains, such as mental health care. Finally, we synthesize the identified themes into general recommendations for designing HITs for mental health and provide concrete examples of design features recommended by participants.
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Affiliation(s)
| | - Sarah E Piper
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Antonia Ottavio
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Niu Z, Willoughby JF, Coups EJ, Stapleton JL. Effects of Website Interactivity on Skin Cancer-Related Intentions and User Experience: Factorial Randomized Experiment. J Med Internet Res 2021; 23:e18299. [PMID: 33439131 PMCID: PMC7840277 DOI: 10.2196/18299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/14/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital media technologies provide users with the ability to interact with content and to receive information based on their preferences and engagement. OBJECTIVE We used skin cancer and sun protection as a health topic to explore how modality interactivity, interface tools that afford users greater activity, resulting in greater depth and breadth of mentally representing and experiencing mediated content, and message interactivity, the extent to which the system allows users to exchange messages back and forth on health websites, influenced users' attitudes, knowledge, behavioral intentions, and experience. METHODS We employed a 2×2 (modality interactivity: high vs low; message interactivity: high vs low) between-subject online experiment for which 4 websites were created. Participants (n=293) were recruited using Amazon Mechanical Turk and randomly assigned into to 1 of 4 conditions. After browsing the website, participants completed an online survey regarding their experience and cognitive perceptions. General linear models and path analysis were used to analyze the data. RESULTS Both modality interactivity (P=.001) and message interactivity (P<.001) had an impact on intention to use sun protection. Attitudes toward health websites and perceived knowledge mediated the effects of modality interactivity and message interactivity on sun protection use intention, individually. Participants in the high modality interactivity and high message interactivity condition felt more satisfied (P=.02). Participants in the low message interactivity condition had more interest in the experience with health websites than participants in the high message interactivity condition (P=.044). CONCLUSIONS Findings suggested that modality interactivity influenced intention to use sun protection directly as well as via attitudes toward the websites. Message interactivity impacted intention to use sunscreen directly and also through perceived knowledge. Implications for designing health websites and health intervention content are discussed.
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Affiliation(s)
- Zhaomeng Niu
- Section of Behavioral Sciences, Division of Medical Oncology, Rutgers Institute of New Jersey, New Brunswick, NJ, United States
| | - Jessica Fitts Willoughby
- The Edward R Murrow College of Communication, Washington State University, Pullman, WA, United States
| | | | - Jerod L Stapleton
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
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van der Velde M, Valkenet K, Geleijn E, Kruisselbrink M, Marsman M, Janssen LM, Ruurda JP, van der Peet DL, Aarden JJ, Veenhof C, van der Leeden M. Usability and Preliminary Effectiveness of a Preoperative mHealth App for People Undergoing Major Surgery: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e23402. [PMID: 33410758 PMCID: PMC7819776 DOI: 10.2196/23402] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Major surgery is associated with negative postoperative outcomes such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mobile health (mHealth) could be an effective new approach. OBJECTIVE The objectives of this pilot study were to (1) evaluate the usability of the Be Prepared mHealth app prototype for people undergoing major surgery, (2) explore whether the app was capable of bringing about a change in risk behaviors, and (3) estimate a preliminary effect of the app on functional recovery after major surgery. METHODS A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total, 86 people undergoing major surgery participated. Participants in the intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires. Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about the usability of the app were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data. RESULTS Seventy-nine people-40 in the intervention group and 39 in the control group-were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that patients considered the Be Prepared app to have acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app. Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values (β=-2.4 [95% CI -5.9 to 1.1]). CONCLUSIONS The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified with which the app and future research can be optimized. TRIAL REGISTRATION Netherlands Trial Registry NL8623; https://www.trialregister.nl/trial/8623.
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Affiliation(s)
- Miriam van der Velde
- Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karin Valkenet
- Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjoke Kruisselbrink
- Clinical Health Sciences, Program Physiotherapy Sciences, Utrecht University, Utrecht, Netherlands
| | - Marije Marsman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Liedewij Mj Janssen
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Donald L van der Peet
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jesse J Aarden
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Cindy Veenhof
- Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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139
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Marton G, Monzani D, Vergani L, Pizzoli SFM, Pravettoni G. “Optimism Is a Strategy for Making a Better Future”. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Cancer is a deadly disease that can lead to psychological suffering and decreased quality of life (QoL). Personality has been proven to have an effect on QoL and, in particular, Dispositional Optimism (DO) has been studied in relation to overcoming health crisis. The aim of this systematic review is to deepen the state of art of the relationship between QoL and DO in cancer patients. PubMed and Embase databases were systematically searched. Fifteen studies were included with a total of 5,249 cancer patients. All of the studies consider the relationship between DO and QoL, some studies analyze the correlation between the two variables and found a positive association. The majority of the studies investigate the predictive power of DO over QoL and most of them found DO to be predictive of a higher QoL. Results confirmed the association between DO and QoL in a sample of cancer patients. These results could influence the clinical practice as DO has been proven to have a beneficial effect on mental and physical health.
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Affiliation(s)
- Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
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Patel D, Berger CA, Kityamuwesi A, Ggita J, Kunihira Tinka L, Turimumahoro P, Feler J, Chehab L, Chen AZ, Gupta N, Turyahabwe S, Katamba A, Cattamanchi A, Sammann A. Iterative Adaptation of a Tuberculosis Digital Medication Adherence Technology to Meet User Needs: Qualitative Study of Patients and Health Care Providers Using Human-Centered Design Methods. JMIR Form Res 2020; 4:e19270. [PMID: 33289494 PMCID: PMC7755538 DOI: 10.2196/19270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/29/2020] [Accepted: 09/24/2020] [Indexed: 12/25/2022] Open
Abstract
Background Digital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes. Objective This study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase. Methods 99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration. Results The 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable. Conclusions We demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes.
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Affiliation(s)
- Devika Patel
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher Allen Berger
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California, San Francisco, San Francisco, CA, United States
| | - Alex Kityamuwesi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Joseph Ggita
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | | | | | - Joshua Feler
- School of Medicine, Yale University, New Haven, CA, United States
| | - Lara Chehab
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Amy Z Chen
- Everwell Health Solutions, Bangalore, India
| | | | | | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California, San Francisco, San Francisco, CA, United States.,Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Amanda Sammann
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
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Lee J, Park YR, Beck SS. Deriving Key Architectural Features of FHIR-BlockChain Integration through the Qualitative Content Analysis (Preprint). JMIR Form Res 2020. [DOI: 10.2196/26026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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142
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Kong SS, Azarfar A, Ashour A, Atkins C, Bhanusali N. Awareness and Attitudes Towards Telemedicine Among Medical Students in the United States. Cureus 2020; 12:e11574. [PMID: 33364099 PMCID: PMC7749854 DOI: 10.7759/cureus.11574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Telemedicine (TM) or telehealth is defined as the delivery of healthcare services at a distance using electronic means. It is a rapidly growing field of medicine that uses telecommunication to provide healthcare services to patients such as the elderly and those in rural locations who may otherwise be unable to make it to the hospital or physician’s office. With the rise in the popularity of TM, educating future physicians on this technology will become vital. This study aimed to explore medical students’ experiences and opinions regarding TM. Methods: An online survey was sent to 287 medical students in 20 different allopathic medical schools in the United States. The survey consisted of 14 questions that included demographic information, information regarding TM exposure, interest in TM, and plans for future utilization. Results: The result of this study indicated that only 17.4% of medical students had prior exposure to TM. However, the increased exposure to TM helped not only to increase awareness of the technology but also helped students form opinions on TM. Lastly, students in all intended specialties had interests in utilizing TM in the future with specialties such as pathology, psychiatry, ophthalmology, and dermatology indicating the highest levels of interest. Conclusion: As medicine continues to incorporate technology into the care of patients, training institutions need to expose future physicians to the modalities of care they will be utilizing. The results of this survey suggest that the development of education and exposure to TM will become increasingly important as more medical students indicate interest in utilizing this technology.
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Affiliation(s)
- Steve S Kong
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Azin Azarfar
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Amnie Ashour
- Cardiac/Thoracic/Vascular Surgery, Renaissance School of Medicine at Stony Brook University, State University of New York, Stony Brook, USA
| | | | - Neha Bhanusali
- Rheumatology, University of Central Florida College of Medicine, Orlando, USA
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Ziesemer K, König LM, Boushey CJ, Villinger K, Wahl DR, Butscher S, Müller J, Reiterer H, Schupp HT, Renner B. Occurrence of and Reasons for "Missing Events" in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies. JMIR Mhealth Uhealth 2020; 8:e15430. [PMID: 33052123 PMCID: PMC7593856 DOI: 10.2196/15430] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/16/2020] [Accepted: 08/03/2020] [Indexed: 01/24/2023] Open
Abstract
Background Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). Objective Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. Methods Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). Results Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=−.11 to −.14, Ps<.001, pseudo-R²=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. Conclusions Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual’s actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence.
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Affiliation(s)
- Katrin Ziesemer
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Laura Maria König
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Carol Jo Boushey
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, United States
| | - Karoline Villinger
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Deborah Ronja Wahl
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Simon Butscher
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Jens Müller
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Reiterer
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Thomas Schupp
- General Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
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Wannheden C, Revenäs Å. How People with Parkinson's Disease and Health Care Professionals Wish to Partner in Care Using eHealth: Co-Design Study. J Med Internet Res 2020; 22:e19195. [PMID: 32955448 PMCID: PMC7536604 DOI: 10.2196/19195] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/04/2020] [Accepted: 07/26/2020] [Indexed: 01/26/2023] Open
Abstract
Background Worldwide, the number of people with Parkinson’s disease (PD) is predicted to double between the years 2005 and 2030. Chronic care management requires active collaboration and knowledge exchange between patients and health care professionals (HCPs) for best possible health outcomes, which we describe as co-care. eHealth services have the potential to support the realization of co-care between people with PD (PwP) and HCPs. Objective This study aimed to explore how co-care could be operationalized in PD care, supported by eHealth. More specifically, this study explores PwP's and HCPs' expectations and desired eHealth functionalities to achieve co-care. Methods Principles of participatory design were used to enable the identification of co-care needs and design ideas, in a series of 4 half-day co-design workshops. The sample included 7 (4 women) PwP and 9 (4 women) HCPs, including 4 neurologists, 3 nurses, and 2 physiotherapists. The co-design process resulted in a functional prototype that was evaluated by the co-design participants in the last workshop. Data were collected through note cards produced by the participants during the first 3 workshops and focus group discussions during the 3rd and 4th workshops. The data were analyzed using qualitative thematic analysis. After the workshop series, the prototype was demonstrated at a Mini Fair for ongoing PD research and evaluated using a self-developed questionnaire with 37 respondents: 31 PwP (14 women) and 6 informal caregivers (3 women). Descriptive statistics are reported. Results The qualitative analysis of data resulted in 2 main themes. The first theme, core eHealth functionalities and their expected values, describes 6 desired eHealth functionalities for supporting PD co-care between PwP and HCPs: (1) self-tracking, (2) previsit forms, (3) graphical visualization, (4) clinical decision support, (5) self-care recommendations, and (6) asynchronous communication. The second theme, individual and organizational constraints, describes constraints that need to be addressed to succeed with an eHealth service for co-care. Individual constraints include eHealth literacy and acceptance; organizational constraints include teamwork and administrative workload. The majority of the questionnaire respondents (31/37, 84%) perceived that they would benefit from an eHealth service similar to the demonstrated prototype. All prototype functionalities were rated as very important or important by the majority of respondents (ranging from 86% to 97% per functionality). Conclusions This study adds to our knowledge on how PD co-care could be operationalized. Co-care implies a shift from episodic routine-driven care to more flexible care management that is driven by the mutual needs of patients and HCPs and supported by active information exchange between them, as well as automated information processing to generate patient-specific advice. More research is needed to further explore the concept of co-care in chronic care management and what it means for self-care and health care. International Registered Report Identifier (IRRID) RR2-10.2196/11278
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Affiliation(s)
- Carolina Wannheden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Åsa Revenäs
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås, Sweden.,School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
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145
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Lawless MT, Archibald M, Pinero de Plaza MA, Drioli-Phillips P, Kitson A. Peer-to-Peer Health Communication in Older Adults' Online Communities: Protocol for a Qualitative Netnographic Study and Co-Design Approach. JMIR Res Protoc 2020; 9:e19834. [PMID: 32924960 PMCID: PMC7522734 DOI: 10.2196/19834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background Online communities provide an environment in which people with similar health concerns can interact and access content that can support the self-management of long-term conditions (LTCs). Recently, the importance of online social networks as sources of health information and social support has been brought into focus with the emergence and widespread societal impacts of COVID-19. Although online communities exist for older adults, little is known about the specific health and self-care topics that older people discuss in such environments and how these relate to users’ support needs and outcomes. A better understanding of users’ needs and peer-to-peer communication in these communities is necessary to inform the design of information and communication technology (ICT) interventions that are relevant to older people and their peer supporters. Objective This study aims to use a two-phase, web-based ethnographic (netnography) and co-design approach to explore specific health care and self-care topics that older adults discuss in a UK-based online community and how peer supporters respond to these queries with informational and/or social support and engage with stakeholders to define the needs and requirements for new ICT-based interventions capable of reducing social isolation and facilitating LTC self-management support. Methods The first phase of the research will involve a qualitative netnographic analysis of posts in discussion forums in a publicly accessible online community. The second phase will involve co-design workshops with health care consumers (ie, older adults and carers) and service providers to determine the needs and requirements for new ICT-based interventions and digital innovations. Constructivist grounded theory will be used in the first phase; in the second phase, the co-design workshops will be audiorecorded and analyzed thematically. Results This research project is in progress. Permission was obtained from the website administrator to use materials from the social media forum; data collection for the first phase began in April 2020. The second phase of the study is expected to begin in late 2020. This study is due to be completed by the end of 2021. Conclusions This study is the first, to the best of our knowledge, to combine qualitative netnography with an iterative co-design framework to specify the needs and requirements for new ICT-based interventions. The findings from this study will inform the next phase of the multiphase knowledge translation project and will provide insights into the potential of online peer health communities to reduce social isolation and facilitate chronic illness self-management support and self-care. International Registered Report Identifier (IRRID) PRR1-10.2196/19834
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Affiliation(s)
- Michael Thomas Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
| | - Mandy Archibald
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.,College of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
| | | | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
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146
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McMichael L, Farič N, Newby K, Potts HWW, Hon A, Smith L, Steptoe A, Fisher A. Parents of Adolescents Perspectives of Physical Activity, Gaming and Virtual Reality: Qualitative Study. JMIR Serious Games 2020; 8:e14920. [PMID: 32840487 PMCID: PMC7479580 DOI: 10.2196/14920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/19/2019] [Accepted: 06/25/2020] [Indexed: 12/14/2022] Open
Abstract
Background Virtual reality (VR) exergaming may be a promising avenue to engage adolescents with physical activity. Since parental support is a consistent determinant of physical activity in adolescents, it is crucial to gather the views of parents of adolescents about this type of intervention. Objective This study aimed to interview parents of younger adolescents (13-17 years old) about physical activity, gaming, and VR as part of the larger vEngage study. Methods Semistructured interviews were conducted with 18 parents of adolescents. Data were synthesized using framework analysis. Results Parents believed that encouraging physical activity in adolescents was important, particularly for mental health. Most parents felt that their children were not active enough. Parents reported their adolescents regularly gamed, with mostly negative perceptions of gaming due to violent content and becoming addicted. Parents discussed an inability to relate to gaming due to “generational differences,” but an exception was exergaming, which they had played with their children in the past (eg, Wii Fit). Specific recommendations for promoting a VR exergaming intervention were provided, but ultimately parents strongly supported harnessing gaming for any positive purpose. Conclusions The current study suggests promise for a VR exergaming intervention, but this must be framed in a way that addresses parental concerns, particularly around addiction, violence, and safety, without actively involving their participation. While parents would rather their children performed “real-world” physical activity, they believed the key to engagement was through technology. Overall, there was the perception that harnessing gaming and sedentary screen time for a positive purpose would be strongly supported.
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Affiliation(s)
- Lucy McMichael
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Nuša Farič
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Katie Newby
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | | | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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147
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Brar Prayaga R, Prayaga RS. Mobile Fotonovelas Within a Text Message Outreach: An Innovative Tool to Build Health Literacy and Influence Behaviors in Response to the COVID-19 Pandemic. JMIR Mhealth Uhealth 2020; 8:e19529. [PMID: 32716894 PMCID: PMC7419135 DOI: 10.2196/19529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/26/2020] [Accepted: 07/24/2020] [Indexed: 01/19/2023] Open
Abstract
With all 50 US states reporting cases of coronavirus disease (COVID-19), people around the country are adapting and stepping up to the challenges of the pandemic; however, they are also frightened, anxious, and confused about what they can do to avoid exposure to the disease. Usual habits have been interrupted as a result of the crisis, and consumers are open to suggestions and strategies to help them change long-standing attitudes and behaviors. In response, a novel and innovative mobile communication capability was developed to present health messages in English and Spanish with links to fotonovelas (visual stories) that are accessible, easy to understand across literacy levels, and compelling to a diverse audience. While SMS text message outreach has been used to build health literacy and provide social support, few studies have explored the benefits of SMS text messaging combined with visual stories to influence health behaviors and build knowledge and self-efficacy. In particular, this approach can be used to provide vital information, resources, empathy, and support to the most vulnerable populations. This also allows providers and health plans to quickly reach out to their patients and members without any additional resource demands at a time when the health care system is severely overburdened.
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Oedegaard CH, Davidson L, Stige B, Veseth M, Blindheim A, Garvik L, Sørensen JM, Søraa Ø, Engebretsen IMS. "It means so much for me to have a choice": a qualitative study providing first-person perspectives on medication-free treatment in mental health care. BMC Psychiatry 2020; 20:399. [PMID: 32770965 PMCID: PMC7414551 DOI: 10.1186/s12888-020-02770-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 06/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2016, the Western Norway Regional Health Authority started to integrate more evidence-based psychosocial interventions into the existing mental health care, emphasizing the right for persons with psychosis to choose medication-free treatment. This change emerged from the debate on the effectiveness and adverse effects of the use of antipsychotic medication. Aspects beyond symptom reduction, such as interpersonal relationships, increased understanding of one's own pattern of suffering, hope and motivation, are all considered important for the personal recovery process. METHODS This study explores whether these aspects were present in users' descriptions of their recovery processes within the medication-free treatment programme in Bergen, Western Norway. We interviewed ten patients diagnosed with psychosis who were eligible for medication-free services about their treatment experiences. Data were analysed using Attride-Stirling's thematic network approach. RESULTS The findings show a global theme relating to personal recovery processes facilitated by the provision of more psychosocial treatment options, with three organizing subthemes: interpersonal relationships between patients and therapists, the patient's understanding of personal patterns of suffering, and personal motivation for self-agency in the recovery process. Participants described an improved relationship with therapists compared to previous experiences. Integrating more evidence-based psychosocial interventions into existing mental health services facilitated learning experiences regarding the choice of treatment, particularly the discontinuation of medication, and appeared to support participants' increased self-agency and motivation in their personal recovery processes. CONCLUSION Health care in Norway is perhaps one step closer to optimizing care for people with psychosis, allowing for more patient choice and improving the dialogue and hence the interpersonal relationship between the patient and the therapist. Personal patterns of suffering can be explored within a system aiming to support and have a higher level of acceptance for the discontinuation of medication. Such a system requires personal agency in the treatment regimen, with more focus on personal coping strategies and more personal responsibility for the recovery process.
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Affiliation(s)
- Christine H. Oedegaard
- grid.412008.f0000 0000 9753 1393Haukeland University Hospital, Kronstad DPS, Pb 1400, 5021 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Pb. 7804, 5020 Bergen, Norway
| | - Larry Davidson
- grid.47100.320000000419368710Department of Psychiatry, Yale Medical School, New Haven, Connecticut USA
| | - Brynjulf Stige
- grid.7914.b0000 0004 1936 7443The Grieg Academy, University of Bergen, Pb. 7800, 5020 Bergen, Norway
| | - Marius Veseth
- grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Pb. 7807, 5020 Bergen, Norway
| | - Anne Blindheim
- grid.412008.f0000 0000 9753 1393Haukeland University Hospital, Kronstad DPS, Pb 1400, 5021 Bergen, Norway
| | - Linda Garvik
- Hvite Ørn User Organisation, Thomles gt. 4, 0270 Oslo, Norway
| | | | - Øystein Søraa
- Hvite Ørn User Organisation, Thomles gt. 4, 0270 Oslo, Norway
| | - Ingunn Marie Stadskleiv Engebretsen
- grid.7914.b0000 0004 1936 7443Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Pb. 7804, 5020 Bergen, Norway
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Piera-Jiménez J, Winters M, Broers E, Valero-Bover D, Habibovic M, Widdershoven JWMG, Folkvord F, Lupiáñez-Villanueva F. Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial. J Med Internet Res 2020; 22:e17351. [PMID: 32720908 PMCID: PMC7420510 DOI: 10.2196/17351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/20/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the last few decades, preventing the development of cardiovascular disease has become a mainstay for reducing cardiovascular morbidity and mortality. It has been suggested that interventions should focus more on committed approaches of self-care, such as electronic health techniques. OBJECTIVE This study aimed to provide evidence to understand the financial consequences of implementing the "Do Cardiac Health: Advanced New Generation Ecosystem" (Do CHANGE 2) intervention, which was evaluated in a multisite randomized controlled trial to change the health behavior of patients with cardiovascular disease. METHODS The cost-effectiveness analysis of the Do CHANGE 2 intervention was performed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing tool, based on a Markov model of five health states. The following two types of costs were considered for both study groups: (1) health care costs (ie, costs associated with the time spent by health care professionals on service provision, including consultations, and associated unplanned hospitalizations, etc) and (2) societal costs (ie, costs attributed to the time spent by patients and informal caregivers on care activities). RESULTS The Do CHANGE 2 intervention was less costly in Spain (incremental cost was -€2514.90) and more costly in the Netherlands and Taiwan (incremental costs were €1373.59 and €1062.54, respectively). Compared with treatment as usual, the effectiveness of the Do CHANGE 2 program in terms of an increase in quality-adjusted life-year gains was slightly higher in the Netherlands and lower in Spain and Taiwan. CONCLUSIONS In general, we found that the incremental cost-effectiveness ratio strongly varied depending on the country where the intervention was applied. The Do CHANGE 2 intervention showed a positive cost-effectiveness ratio only when implemented in Spain, indicating that it saved financial costs in relation to the effect of the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305.
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Affiliation(s)
- Jordi Piera-Jiménez
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of R&D, Badalona Serveis Assistencials, Badalona, Spain
| | | | - Eva Broers
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | | | - Mirela Habibovic
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Jos W M G Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Frans Folkvord
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Francisco Lupiáñez-Villanueva
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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150
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Lu H, Xie J, Gerido LH, Cheng Y, Chen Y, Sun L. Information Needs of Breast Cancer Patients: Theory-Generating Meta-Synthesis. J Med Internet Res 2020; 22:e17907. [PMID: 32720899 PMCID: PMC7420822 DOI: 10.2196/17907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/07/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Breast cancer has become one of the most frequently diagnosed carcinomas and the leading cause of cancer deaths. The substantial growth in the number of breast cancer patients has put great pressure on health services. Meanwhile, the information patients need has increased and become more complicated. Therefore, a comprehensive and in-depth understanding of their information needs is urgently needed to improve the quality of health care. However, previous studies related to the information needs of breast cancer patients have focused on different perspectives and have only contributed to individual results. A systematic review and synthesis of breast cancer patients' information needs is critical. OBJECTIVE This paper aims to systematically identify, evaluate, and synthesize existing primary qualitative research on the information needs of breast cancer patients. METHODS Web of Science, EBSCO, Scopus, ProQuest, PubMed, PsycINFO, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature were searched on February 12 and July 9, 2019, to collect relevant studies. A Google Scholar search, interpersonal network recommendations, and reference chaining were also conducted. Eligible studies included qualitative or mixed-methods studies focusing on the information needs (across the cancer continuum) of breast cancer patients or their social networks. Subsequently, a Critical Appraisals Skills Programme checklist was used to assess the quality of included research. The results, findings, and discussions were extracted. Data analysis was guided by the theory-generating meta-synthesis and grounded theory approach. RESULTS Three themes, 19 categories, and 55 concepts emerged: (1) incentives (physical abnormality, inquiry from others, subjective norm, and problems during appointments); (2) types of information needs (prevention, etiology, diagnosis, clinical manifestation, treatment, prognosis, impact and resumption of normal life, scientific research, and social assistance); (3) moderating variables (attitudes, health literacy, demographic characteristics, disease status, as well as political and cultural environment). The studies revealed that the information needs of breast cancer patients were triggered by different incentives. Subsequently, the patients sought a variety of information among different stages of the cancer journey. Five types of variables were also found to moderate the formation of information needs. CONCLUSIONS This study contributes to a thorough model of information needs among breast cancer patients and provides practical suggestions for health and information professionals.
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Affiliation(s)
- Hongru Lu
- School of Information Management, Nanjing University, Nanjing, China
| | - Juan Xie
- School of Information Management, Nanjing University, Nanjing, China
| | | | - Ying Cheng
- School of Information Management, Nanjing University, Nanjing, China
| | - Ya Chen
- School of Information Management, Nanjing University, Nanjing, China
| | - Lizhu Sun
- Department of Oncology, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, China
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