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Locher C, Gaab J, Blease C. When a Placebo Is Not a Placebo: Problems and Solutions to the Gold Standard in Psychotherapy Research. Front Psychol 2018; 9:2317. [PMID: 30542310 PMCID: PMC6277873 DOI: 10.3389/fpsyg.2018.02317] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Charlotte Blease
- Program in Placebo Studies, General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard, MA, United States.,School of Psychology, University College Dublin, Dublin, Ireland
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Gorini A, Mazzocco K, Triberti S, Sebri V, Savioni L, Pravettoni G. A P5 Approach to m-Health: Design Suggestions for Advanced Mobile Health Technology. Front Psychol 2018; 9:2066. [PMID: 30429810 PMCID: PMC6220651 DOI: 10.3389/fpsyg.2018.02066] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
In recent years, technology has been developed as an important resource for health care management, especially in regard to chronic conditions. In the broad field of eHealth, mobile technology (mHealth) is increasingly used to empower patients not only in disease management but also in the achievement of positive experiences and experiential growth. mHealth tools are considered powerful because, unlike more traditional Internet-based tools, they allow patients to be continuously monitored and followed by their own mobile devices and to have continual access to resources (e.g., mobile apps or functions) supporting health care management activities. However, the literature has shown that, in many cases, such technology not accepted and/or adopted in the long term by its users. To address this issue, this article reviews the main factors influencing mHealth technology acceptance/adoption in health care. Finally, based on the main aspects emerging from the review, we propose an innovative approach to mHealth design and implementation, namely P5 mHealth. Relying on the P5 approach to medicine and health care, this approach provides design suggestions to address mHealth adoption issues already at the initial stages of development of the technologies.
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Affiliation(s)
- Alessandra Gorini
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Stefano Triberti
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Valeria Sebri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Lucrezia Savioni
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
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153
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Poureslami I, Shum J, Lester RT, Tavakoli H, Dorscheid DR, FitzGerald JM. A pilot randomized controlled trial on the impact of text messaging check-ins and a web-based asthma action plan versus a written action plan on asthma exacerbations. J Asthma 2018; 56:1-13. [PMID: 30003851 DOI: 10.1080/02770903.2018.1500583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/16/2018] [Accepted: 07/09/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We compared electronic asthma action plans (eAAP) supported by automated text messaging service (SMS) with written asthma action plans (AAP) on assessing acceptability and asthma control improvement. We hypothesized that the patients in eAAP group would have more improvements in their quality of life, asthma control and decreased asthma exacerbations. METHODS Patients with physician-diagnosed asthma having at least one asthma exacerbation in the previous 12 months were recruited. Participants received individualized action plans and were randomly assigned into either the intervention (eAAP) or control (AAP) group. Intervention participants received weekly SMS, triggering assessment of asthma control and viewing their eAAP. We assessed applicability of Telehealth platform on asthma exacerbations, asthma control, and quality of life over a 12-month period. RESULTS 106 patients were enrolled (eAAP = 52, AAP = 54). The cumulative response rate to all weekly SMS check-ins was 68.4%. Overall, 28% of patients checked into their eAAP during the intervention period. There were fewer exacerbations in the eAAP group (18%) compared to the AAP group (RR = 0.82 [95%CI 0.49, 1.36]), (P = 0.44). The mean scores for asthma control and quality of life were higher in the eAAP group compared to the AAP group by 4% (RR = 1.04 [95%CI 0.83, 1.30]), (P = 0.73) and 5.5% (RR = 1.06 [95%CI 0.87, 1.28]), (P = 0.59), respectively, but were not statistically significant. CONCLUSIONS We demonstrated that the eAAP presented improved asthma control outcomes, but as expected the sample size was inadequate to show a significant difference, but based on this pilot study we plan a larger appropriately powered randomized controlled trial (RCT).
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Affiliation(s)
- Iraj Poureslami
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
| | - Jessica Shum
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
| | - Richard T Lester
- c Division of Infectious Diseases, Department of Medicine , The University of British Columbia , Vancouver , Canada
| | - Hamid Tavakoli
- d Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences , The University of British Columbia , Vancouver , Canada
| | - Delbert R Dorscheid
- e Centre for Heart Lung Innovation, St. Paul's Hospital , The University of British Columbia , Vancouver , Canada
| | - J Mark FitzGerald
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
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154
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Razmak J, Bélanger CH, Farhan W. Development of a techno-humanist model for e-health adoption of innovative technology. Int J Med Inform 2018; 120:62-76. [PMID: 30409347 DOI: 10.1016/j.ijmedinf.2018.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/04/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE After investing billions of dollars in an integrated Electronic Medical Records (physicians) and Personal Health Records (patients) system to allow both parties to manage and communicate through e-health innovative technologies, Canada is still making slow adoption progress. In an attempt to bridge the human and technological perspectives by developing and testing a holistic model, this study purports to predict patients' behavioral intentions to use e-health applications. METHODS An interdisciplinary approach labelled as a techno-humanism model (THM) is testing twelve constructs identified from the technological, sociological, psychological, and organizational research literature and deemed to have a significant effect upon and positive relationship with patients' e-health applications adoption. Subjects were Canadians recruited in a mall-intercept mode from a region representing a demographically diverse population, including rural and urban residents. The SmartPLS measurement tool was used to evaluate the reliability and validity of study constructs. The twelve constructs were separately tested with quantitative data such as factor analysis, single, multiple, and hierarchical multiple regression. RESULTS The hierarchical multiple regression analysis process led us to formulate four models, each hinged on a combination of interdisciplinary variables. Model 1 consisted of the technological predictors and explained 62.3% (p < .001) of variance in the behavioral intention to use e-health. Model 2 added the sociological predictors to the equation and explained 72.3% (p < .001) of variance. Model 3 added the psychological predictors to Model 2 and explained 72.8% (p < .001). Finally, Model 4 included all twelve predictors and explained 73% (p < .001) of variance in the behavioral intention to use e-health applications. CONCLUSIONS One of the greatest barriers to applying e-health records in Canada resides in the lack of coordination among stakeholders. The present study implies that healthcare policy makers must consider the twelve variables with their findings and implications as a whole. The techno-humanist model (THM) we are proposing is a more holistic and continuous approach. It pushes back to a breakdown of the various technological, sociological, psychological, and managerial factors and stakeholders that are at the root cause of behavioral intentions to use e-health, as opposed to merely observing behavioral outcomes at the end of the "assembly line". Active participation and coordination of all stakeholders is a key feature.
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Affiliation(s)
- Jamil Razmak
- College of Business, Al Ain University of Science and Technology, United Arab Emirates.
| | | | - Wejdan Farhan
- College of Business, Al Ain University of Science and Technology, United Arab Emirates.
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155
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Paige SR, Stellefson M, Krieger JL, Anderson-Lewis C, Cheong J, Stopka C. Proposing a Transactional Model of eHealth Literacy: Concept Analysis. J Med Internet Res 2018; 20:e10175. [PMID: 30279155 PMCID: PMC6231800 DOI: 10.2196/10175] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/18/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts. Objective The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods Walker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC. Results Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of “communication” in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions. Conclusions The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of “noise” (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply).
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States.,Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | | | - JeeWon Cheong
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
| | - Christine Stopka
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
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156
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Ellen ME, Shach R, Balicer RD. Helping patients help themselves: Supporting the healthcare journey. PATIENT EDUCATION AND COUNSELING 2018; 101:1708-1711. [PMID: 29691111 DOI: 10.1016/j.pec.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/25/2018] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Abstract
Patients often feel lost when navigating the health care system, and poor care coordination leads to negative patient outcomes, consumes resources and makes diseases more difficult to treat. Patients and citizens have become eager to take health care decision making into their own hands. To this end, solutions have been proposed which assist patients by providing them with more information and enabling them to take a more active role in their care. These include enlisting a patient navigator, consumer engagement, process mapping, decision aids, and clinical pathways. However, as the global penetration of mobile devices approaches 100%, it is timely to update and optimize health system support technologies and information dissemination pathways. There is much room for improvement and health systems are beginning to echo other industries in asking "what do consumers want?" in their applications. We believe that now is the time to address emergent gaps and supplement the irreplaceable human elements of patient navigation with a mobile or computer application. It would be able to automate parts of the process, and consolidate important information, to serve as a broad-reaching, real-time companion for healthcare consumers and their families to accompany them on their journey from diagnosis to follow up.
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Affiliation(s)
- Moriah E Ellen
- Senior Lecturer, Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel; McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - Ruth Shach
- Senior Lecturer, Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel; Brown School, Washington University in St Louis, 1 Brookings Dr, St. Louis, MO, 63130, United States
| | - Ran D Balicer
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada; Clalit Research Institute at Clalit Health Services, 101 Arlozorov Street, Tel Aviv, 6209804, Israel
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157
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Sheon AR, Van Winkle B, Solad Y, Atreja A. An Algorithm for Digital Medicine Testing: A NODE.Health Perspective Intended to Help Emerging Technology Companies and Healthcare Systems Navigate the Trial and Testing Period prior to Full-Scale Adoption. Digit Biomark 2018; 2:139-154. [PMID: 31032473 PMCID: PMC6481949 DOI: 10.1159/000494365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/04/2018] [Indexed: 01/17/2023] Open
Abstract
Over the last several years, there has been rapid growth of digital technologies attempting to transform healthcare. Unique features of digital medicine technology lead to both challenges and opportunities for testing and validation. Yet little guidance exists to help a health system decide whether to undertake a pilot test of new technology, move right to full-scale adoption or start somewhere in between. To navigate this complexity, this paper proposes an algorithm to help choose the best path toward validation and adoption. Special attention is paid to considering whether the needs of patients with limited digital skills, equipment (e.g., smart-phones) and connectivity (e.g., data plans) have been considered in technology development and deployment. The algorithm reflects the collective experience of 20+ health systems and academic institutions that have established the Network of Digital Evidence for Health, NODE. Health, plus insights from existing clinical research taxonomies, syntheses or frameworks for assessing technology or for reporting clinical trials.
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Affiliation(s)
- Amy R. Sheon
- Case Western Reserve University School of Medicine, Rocky River, Ohio, USA
| | - Brian Van Winkle
- Sibley Memorial at Johns Hopkins Medicine, Washington, District of Columbia, USA
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158
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Portable System for Real-Time Detection of Stress Level. SENSORS 2018; 18:s18082504. [PMID: 30071643 PMCID: PMC6111320 DOI: 10.3390/s18082504] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/25/2018] [Accepted: 07/28/2018] [Indexed: 01/25/2023]
Abstract
Currently, mental stress is a major problem in our society. It is related to a wide variety of diseases and is mainly caused by daily-life factors. The use of mobile technology for healthcare purposes has dramatically increased during the last few years. In particular, for out-of-lab stress detection, a considerable number of biosignal-based methods and systems have been proposed. However, these approaches have not matured yet into applications that are reliable and useful enough to significantly improve people’s quality of life. Further research is needed. In this paper, we propose a portable system for real-time detection of stress based on multiple biosignals such as electroencephalography, electrocardiography, electromyography, and galvanic skin response. In order to validate our system, we conducted a study using a previously published and well-established methodology. In our study, ten subjects were stressed and then relaxed while their biosignals were simultaneously recorded with the portable system. The results show that our system can classify three levels of stress (stress, relax, and neutral) with a resolution of a few seconds and 86% accuracy. This suggests that the proposed system could have a relevant impact on people’s lives. It can be used to prevent stress episodes in many situations of everyday life such as work, school, and home.
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159
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Bosak K, Park SH. Characteristics of Adults' Use of Facebook and the Potential Impact on Health Behavior: Secondary Data Analysis. Interact J Med Res 2018; 7:e11. [PMID: 29903698 PMCID: PMC6024100 DOI: 10.2196/ijmr.9554] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/01/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022] Open
Abstract
Background Social influences are a primary factor in the adoption of health behaviors. Social media platforms, such as Facebook, disseminate information, raise awareness, and provide motivation and support for positive health behaviors. Facebook has evolved rapidly and is now a part of many individuals' daily routine. The high degree of individual engagement and low attrition rate of this platform necessitate consideration for a potentially positive impact on health behavior. Objective The aim of this paper is to investigate the use of Facebook by adults. Knowledge is limited to the unique characteristics of Facebook users, including time spent on Facebook by adults of various age groups. Characteristics of Facebook users are important to understand to direct efforts to engage adults in future health behavior interventions. Methods Institutional Review Board approval was obtained for this secondary analysis of existing de-identified survey data collected for the Pew Research Center. The sample included adults age 18-65 years and above. Binomial logistic regression was performed for the model of age group and Facebook use, controlling for other demographics. A multinomial logistic regression model was used for the variable of time spent on Facebook. Based on the regression models, we computed and reported the marginal effects on Facebook use and time spent of adults age groups, including age groups 18-29, 30-49, 50-64, and 65 and over. We discuss these findings in the context of the implications for promoting positive health behaviors. Results The demographics of the final sample (N=730) included adults age 18-65 years and above (mean 48.2 yrs, SD 18.3 yrs). The majority of the participants were female (372/730, 50.9%), white (591/730, 80.9%) and non-Hispanic (671/730, 91.9%). Bivariate analysis indicated that Facebook users and nonusers differed significantly by age group (χ2=76.71, P<.001) and sex (χ2=9.04, P=.003). Among subjects aged 50 and above, the predicted probability was 66% for spending the same amount of time, 10% with increased time, and 24% with decreased time. Conclusions The key findings of this study were Facebook use among midlife and older adults was more likely to stay the same over time, compared to the other age groups. Interestingly, the young adult age group 18-29 years was more likely to decrease their time on Facebook over time. Specifically, younger females were most likely to decrease time spent on Facebook. In general, male participants were most likely to spend the same amount of time on Facebook. These findings have implications for future health intervention research, and ultimately, for translation to the clinic setting to improve health outcomes.
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Affiliation(s)
- Kelly Bosak
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shin Hye Park
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, United States
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160
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van den Heuvel JF, Groenhof TK, Veerbeek JH, van Solinge WW, Lely AT, Franx A, Bekker MN. eHealth as the Next-Generation Perinatal Care: An Overview of the Literature. J Med Internet Res 2018; 20:e202. [PMID: 29871855 PMCID: PMC6008510 DOI: 10.2196/jmir.9262] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/19/2018] [Accepted: 03/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. Objective This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. Methods We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. Results The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care. Conclusions This review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care.
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Affiliation(s)
| | - T Katrien Groenhof
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jan Hw Veerbeek
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - A Titia Lely
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Arie Franx
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mireille N Bekker
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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161
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Featherall J, Lapin B, Chaitoff A, Havele SA, Thompson N, Katzan I. Characterization of Patient Interest in Provider-Based Consumer Health Information Technology: Survey Study. J Med Internet Res 2018; 20:e128. [PMID: 29674312 PMCID: PMC6004033 DOI: 10.2196/jmir.7766] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/03/2017] [Accepted: 11/02/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Consumer health information technology can improve patient engagement in their health care and assist in navigating the complexities of health care delivery. However, the consumer health information technology offerings of health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer health information technology resource allocation. OBJECTIVE The aims of this paper were to measure patient interest in different health system consumer health information technology apps and determine the influence of patient characteristics on consumer health information technology interest. METHODS Patients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer health information technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer health information technology in the categories of self-management, education, and communication. RESULTS The majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24%) and to schedule appointments (3211/3839, 83.64%). Patient interest in consumer health information technology was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smartphone ownership (P<.001 for all listed). CONCLUSIONS Patients should be viewed as active stakeholders in consumer health information technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer health information technologies that assist patients in scheduling appointments and asking questions of providers. Patients with depression should also be considered for targeted consumer health information technology implementation. Health self-efficacy is a valid predictor of consumer health information technology interest and may play a role in the utilization of consumer health information technologies. Health systems, broadly, should put forth greater effort to understand the needs and interests of patients in the consumer health information technology development process. Consumer health information technology design and implementation may be improved by understanding which technologies patients want.
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Affiliation(s)
- Joseph Featherall
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Brittany Lapin
- Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, United States.,Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Alexander Chaitoff
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Sonia A Havele
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Nicolas Thompson
- Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, United States.,Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Irene Katzan
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, United States
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162
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Poureslami I, Pakhale S, Lavoie KL, Gupta S, Bacon S, Aaron SD, To T, Boulet LP, FitzGerald JM. Patients as research partners in chronic obstructive pulmonary disease and asthma research: Priorities, challenges and recommendations from asthma and COPD patients. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2018.1443294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Iraj Poureslami
- Respiratory Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Smita Pakhale
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kim L. Lavoie
- Faculty of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Samir Gupta
- The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Simon Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Shawn D. Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, University of Toronto, and Senior Scientist, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Louis-Philippe Boulet
- Pneumology, Institut universitaire de cardiologie et de pneumologie de Québec, Department of Medicine at Laval University, Quebec, Quebec, Canada
| | - J. Mark FitzGerald
- UBC Division of Respiratory Medicine, and Vancouver Coastal Health Research Institute, Institute for Heart and Lung Health, The Lung Centre, Vancouver, British Columbia, Canada
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163
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Benjamin K, Potts HW. Digital transformation in government: Lessons for digital health? Digit Health 2018; 4:2055207618759168. [PMID: 29942624 PMCID: PMC6005404 DOI: 10.1177/2055207618759168] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Henry Ww Potts
- UCL Institute of Health Informatics, University College London, UK
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164
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Walker DM, Sieck CJ, Menser T, Huerta TR, Scheck McAlearney A. Information technology to support patient engagement: where do we stand and where can we go? J Am Med Inform Assoc 2018; 24:1088-1094. [PMID: 28460042 DOI: 10.1093/jamia/ocx043] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/31/2017] [Indexed: 01/13/2023] Open
Abstract
Objective Given the strong push to empower patients and make them partners in their health care, we evaluated the current capability of hospitals to offer health information technology that facilitates patient engagement (PE). Materials and Methods Using an ontology mapping approach, items from the American Hospital Association Information Technology Supplement were mapped to defined levels and categories within the PE Framework. Points were assigned for each health information technology function based upon the level of engagement it encompassed to create a PE-information technology (PE-IT) score. Scores were divided into tertiles, and hospital characteristics were compared across tertiles. An ordered logit model was used to estimate the effect of characteristics on the adjusted odds of being in the highest tertile of PE-IT scores. Results Thirty-six functions were mapped to specific levels and categories of the PE Framework, and adoption of each item ranged from 23.5 to 96.7%. Hospital characteristics associated with being in the highest tertile of PE-IT scores included medium and large bed size (relative to small), nonprofit (relative to government nonfederal), teaching hospital, system member, Midwest and South regions, and urban location. Discussion Hospital adoption of PE-oriented technology remains varied, suggesting that hospitals are considering how technology can create partnerships with patients. However, PE functionalities that facilitate higher levels of engagement are lacking, suggesting room for improvement. Conclusion While hospitals have reached modest levels of adoption of PE technologies, consistent monitoring of this capacity can identify opportunities to use technology to facilitate engagement.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Terri Menser
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.,Department of Bioinformatics, College of Medicine, Ohio State University
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
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165
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Kropp C, Ellis J, Nekkanti R, Sears S. Monitoring Patients With Implantable Cardioverter Defibrillators Using Mobile Phone Electrocardiogram: Case Study. JMIR Cardio 2018; 2:e5. [PMID: 31758776 PMCID: PMC6857957 DOI: 10.2196/cardio.8710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Preventable poor health outcomes associated with atrial fibrillation continue to make early detection a priority. A one-lead mobile electrocardiogram (mECG) device given to patients with an implantable cardioverter defibrillator (ICD) allowed users to receive real-time ECG readings in 30 seconds. Objective Three cases were selected from an institutional review board-approved clinical trial aimed at assessing mECG device usage and satisfaction, patient engagement, quality of life (QoL), and cardiac anxiety. These three specific cases were selected to examine a variety of possible patient presentations and user experiences. Methods Three ICD patients with mobile phones who were being seen in an adult device clinic were asked to participate. The participants chosen represented individuals with varying degrees of reported education and patient engagement. Participants were instructed to use the mECG device at least once per day for 30 days. Positive ECGs for atrial fibrillation were evaluated in clinic. At follow-up, information was collected regarding their frequency of use of the mECG device and three psychological outcomes in the domains of patient engagement, QoL, and cardiac anxiety. Results Each patient used the technology approximately daily or every other day as prescribed. At the 30-day follow-up, usage reports indicated an average of 32 readings per month per participant. At 90-day follow-up, usage reports indicated an average of 34 readings per month per participant. Two of the three participants self-reported a significant improvement in their physical QoL from baseline to completion, while simultaneously self-reporting a significant decrease in their mental QoL. All three participants reported high levels of device acceptance and technology satisfaction. Conclusions This case study demonstrates that ICD patients with varying degrees of education and patient engagement were relatively active in their use of mECGs. All three participants using the mECG technology reported high technology satisfaction and device acceptance. High sensitivity, specificity, and accuracy of mECG technology may allow routine atrial fibrillation screening at lower costs, in addition to improving patient outcomes.
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Affiliation(s)
- Caley Kropp
- Department of Psychology, East Carolina University, Greenville, NC, United States
| | - Jordan Ellis
- Department of Psychology, East Carolina University, Greenville, NC, United States
| | - Rajasekhar Nekkanti
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
| | - Samuel Sears
- Department of Psychology, East Carolina University, Greenville, NC, United States.,Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
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166
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Grünloh C, Myreteg G, Cajander Å, Rexhepi H. "Why Do They Need to Check Me?" Patient Participation Through eHealth and the Doctor-Patient Relationship: Qualitative Study. J Med Internet Res 2018; 20:e11. [PMID: 29335237 PMCID: PMC5789160 DOI: 10.2196/jmir.8444] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Roles in the doctor-patient relationship are changing and patient participation in health care is increasingly emphasized. Electronic health (eHealth) services such as patient accessible electronic health records (PAEHRs) have been implemented to support patient participation. Little is known about practical use of PAEHR and its effect on roles of doctors and patients. OBJECTIVE This qualitative study aimed to investigate how physicians view the idea of patient participation, in particular in relation to the PAEHR system. Hereby, the paper aims to contribute to a deeper understanding of physicians' constructions of PAEHR, roles in the doctor-patient relationship, and levels and limits of involvement. METHODS A total of 12 semistructured interviews were conducted with physicians in different fields. Interviews were transcribed, translated, and a theoretically informed thematic analysis was performed. RESULTS Two important aspects were identified that are related to the doctor-patient relationship: roles and involvement. The physicians viewed their role as being the ones to take on the responsibility, determining treatment options, and to be someone who should be trusted. In relation to the patient's role, lack of skills (technical or regarding medical jargon), motives to read, and patients' characteristics were aspects identified in the interviews. Patients were often referred to as static entities disregarding their potential to develop skills and knowledge over time. Involvement captures aspects that support or hinder patients to take an active role in their care. CONCLUSIONS Literature of at least two decades suggests an overall agreement that the paternalistic approach in health care is inappropriate, and a collaborative process with patients should be adopted. Although the physicians in this study stated that they, in principle, were in favor of patient participation, the analysis found little support in their descriptions of their daily practice that participation is actualized. As seen from the results, paternalistic practices are still present, even if professionals might not be aware of this. This can create a conflict between patients who strive to become more informed and their questions being interpreted as signs of critique and mistrust toward the physician. We thus believe that the full potential of PAEHRs is not reached yet and argue that the concept of patient empowerment is problematic as it triggers an interpretation of "power" in health care as a zero-sum, which is not helpful for the maintenance of the relationship between the actors. Patient involvement is often discussed merely in relation to decision making; however, this study emphasizes the need to include also sensemaking and learning activities. This would provide an alternative understanding of patients asking questions, not in terms of "monitoring the doctor" but to make sense of the situation.
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Affiliation(s)
- Christiane Grünloh
- School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden.,Institute of Informatics, Technische Hochschule Köln, University of Applied Sciences, Gummersbach, Germany
| | - Gunilla Myreteg
- Department of Business Studies, Uppsala University, Uppsala, Sweden
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Hanife Rexhepi
- School of Informatics, University of Skövde, Skövde, Sweden
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167
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Digital Health Research Methods and Tools: Suggestions and Selected Resources for Researchers. ADVANCES IN BIOMEDICAL INFORMATICS 2018. [DOI: 10.1007/978-3-319-67513-8_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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168
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Kip H, Bouman YHA, Kelders SM, van Gemert-Pijnen LJEWC. eHealth in Treatment of Offenders in Forensic Mental Health: A Review of the Current State. Front Psychiatry 2018; 9:42. [PMID: 29515468 PMCID: PMC5826338 DOI: 10.3389/fpsyt.2018.00042] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant one-size-fits-all approach by being tailored to individual patients. OBJECTIVE To examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness. METHODS A systematic search in Scopus, PsycINFO, and Web of Science was performed up until December 2017. Studies were included if they focused on technological interventions to improve the treatment of forensic psychiatric patients. RESULTS The search resulted in 50 studies in which eHealth was used for treatment purposes. Multiple types of studies and technologies were identified, such as virtual reality, web-based interventions, and videoconferencing. The results confirmed the benefits of technology, for example, the acquisition of unique information about offenders, effectiveness, and tailoring to specific characteristics, but indicated that these are not fully taken advantage of. DISCUSSION To overcome the barriers and obtain the benefits, eHealth has to have a good fit with patients and the forensic psychiatric context. It has to be seamlessly integrated in existing care and should not be added as an isolated element. To bridge the gap between the current situation and eHealth's potential, further research on development, implementation, and evaluation should be conducted.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | | | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Lisette J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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169
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Bosak K, Park SH. Characteristics of Adults Seeking Health Care Provider Support Facilitated by Mobile Technology: Secondary Data Analysis. JMIR Hum Factors 2017; 4:e33. [PMID: 29269337 PMCID: PMC5754563 DOI: 10.2196/humanfactors.8246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/17/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022] Open
Abstract
Background Mobile health technology is rapidly evolving with the potential to transform health care. Self-management of health facilitated by mobile technology can maximize long-term health trajectories of adults. Little is known about the characteristics of adults seeking Web-based support from health care providers facilitated by mobile technology. Objective This study aimed to examine the following: (1) the characteristics of adults who seek human support from health care providers for health concerns using mobile technology rather than from family members and friends or others with similar health conditions and (2) the use of mobile health technology among adults with chronic health conditions. Findings of this study were interpreted in the context of the Efficiency Model of Support. Methods We first described characteristics of adults seeking Web-based support from health care providers. Using chi-square tests for categorical variables and t test for the continuous variable of age, we compared adults seeking Web-based and conventional support by demographics. The primary aim was analyzed using multivariate logistic regression to examine whether chronic health conditions and demographic factors (eg, sex, income, employment status, race, ethnicity, education, and age) were associated with seeking Web-based support from health care providers. Results The sample included adults (N=1453), the majority of whom were female 57.60% (837/1453), white 75.02% (1090/1453), and non-Hispanic 89.13% (1295/1453). The age of the participants ranged from 18 to 92 years (mean 48.6, standard deviation [SD] 16.8). The majority 76.05% (1105/1453) of participants reported college or higher level of education. A disparity was found in access to health care providers via mobile technology based on socioeconomic status. Adults with annual income of US $30,000 to US $100,000 were 1.72 times more likely to use Web-based methods to contact a health care provider, and adults with an annual income above US $100,000 were 2.41 to 2.46 times more likely to access health care provider support on the Web, compared with those with an annual income below US $30,000. After adjusting for other demographic covariates and chronic conditions, age was not a significant factor in Web-based support seeking. Conclusions In this study, the likelihood of seeking Web-based support increased when adults had any or multiple chronic health conditions. A higher level of income and education than the general population was found to be related to the use of mobile health technology among adults in this survey. Future study is needed to better understand the disparity in Web-based support seeking for health issues and the clinicians’ role in promoting access to and use of mobile health technology.
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Affiliation(s)
- Kelly Bosak
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shin Hye Park
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, United States
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170
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Göransson C, Eriksson I, Ziegert K, Wengström Y, Langius-Eklöf A, Brovall M, Kihlgren A, Blomberg K. Testing an app for reporting health concerns-Experiences from older people and home care nurses. Int J Older People Nurs 2017; 13:e12181. [PMID: 29210218 DOI: 10.1111/opn.12181] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of using an app among older people with home-based health care and their nurses. BACKGROUND Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. DESIGN Explorative qualitative design. METHODS For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. RESULTS The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. CONCLUSIONS The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. IMPLICATIONS FOR PRACTICE The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.
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Affiliation(s)
- Carina Göransson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Yvonne Wengström
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Brovall
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Annica Kihlgren
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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171
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Ringwald J, Marwedel L, Junne F, Ziser K, Schäffeler N, Gerstner L, Wallwiener M, Brucker SY, Hautzinger M, Zipfel S, Teufel M. Demands and Needs for Psycho-Oncological eHealth Interventions in Women With Cancer: Cross-Sectional Study. JMIR Cancer 2017; 3:e19. [PMID: 29175813 PMCID: PMC5722981 DOI: 10.2196/cancer.7973] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/28/2017] [Accepted: 09/22/2017] [Indexed: 01/22/2023] Open
Abstract
Background Over the last decade, a growing body of studies regarding the application of eHealth and various digital interventions has been published and are widely used in the psycho-oncological care. However, the effectiveness of eHealth applications in psycho-oncological care is still questioned due to missing considerations regarding evidence-based studies on the demands and needs in cancer-affected patients. Objective This cross-sectional study aimed to explore the cancer-affected women’s needs and wishes for psycho-oncological content topics in eHealth applications and whether women with cancer differ in their content topics and eHealth preferences regarding their experienced psychological burden. Methods Patients were recruited via an electronic online survey through social media, special patient Internet platforms, and patient networks (both inpatients and outpatients, University Hospital Tuebingen, Germany). Participant demographics, preferences for eHealth and psycho-oncological content topics, and their experienced psychological burden of distress, quality of life, and need for psychosocial support were evaluated. Results Of the 1172 patients who responded, 716 were included in the study. The highest preference for psycho-oncological content topics reached anxiety, ability to cope, quality of life, depressive feelings, and adjustment toward a new life situation. eHealth applications such as Web-based applications, websites, blogs, info email, and consultation hotline were considered to be suitable to convey these content topics. Psychological burden did not influence the preference rates according to psycho-oncological content and eHealth applications. Conclusions Psycho-oncological eHealth applications may be very beneficial for women with cancer, especially when they address psycho-oncological content topics like anxiety, ability to cope, depressive feelings, self-esteem, or adjustment to a new life situation. The findings of this study indicate that psycho-oncological eHealth applications are a promising medium to improve the psychosocial care and enhance individual disease management and engagement among women with cancer.
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Affiliation(s)
- Johanna Ringwald
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital Tuebingen, Tuebingen, Germany
| | - Lennart Marwedel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Lena Gerstner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sara Yvonne Brucker
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR-Clinic Essen, University of Duisburg-Essen, Essen, Germany
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172
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Daher J, Vijh R, Linthwaite B, Dave S, Kim J, Dheda K, Peter T, Pai NP. Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017). BMJ Open 2017; 7:e017604. [PMID: 29101138 PMCID: PMC5695353 DOI: 10.1136/bmjopen-2017-017604] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Digital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs. DESIGN Systematic review. SETTING/PARTICIPANTS All settings/all participants. INTERVENTION We classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth). PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility, acceptability, impact. METHODS We searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis. RESULTS We reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99).All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials. CONCLUSION Digital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space.
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Affiliation(s)
- Jana Daher
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Rohit Vijh
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Blake Linthwaite
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sailly Dave
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - John Kim
- National HIV/AIDS Labs, National Labs, Winnipeg, Manitoba, Canada
| | - Keertan Dheda
- Department of Pulmonology, UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Trevor Peter
- Clinton Health Access Initiative (CHAI), Boston, USA
| | - Nitika Pant Pai
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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173
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Glaser E, Richard C, Lussier MT. The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:2062-2070. [PMID: 28535926 DOI: 10.1016/j.pec.2017.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 05/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Examine the impact of a PACE (Prepare, Ask, Check, Express) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals for patients suffering from chronic diseases (CDs), compared to usual care. METHODS Three arm single-blind RCT in community primary care (PC) practices. PC practitioners (n=18) had a CD patient caseload, and practicing >5 years. Patients >40 years old, English speaking, computer literate, not reaching treatment goals for hypertension, type II diabetes, and/or dyslipidemia. INTERVENTIONS (1) web-intervention and (2) web intervention and nurse facilitated workshop and (3) usual care. OUTCOME Proportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for. RESULTS Patients (n=322) were randomized, and of these 221 returned for follow up. Patients in the web group were 1.42 times more likely to meet targets compared to usual care [95% CI: 1.00-2.00], a statistical difference not seen in the combined group. Sensitivity analyses were performed to mitigate bias due to loss to follow up. CONCLUSIONS Training patients in communication skills using a website positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients. PRACTICE IMPLICATIONS Web communication interventions are an effective tool that can be used in primary care.
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Affiliation(s)
- Emma Glaser
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada; Faculty of Medicine, Université de Montréal, Canada.
| | - Claude Richard
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada
| | - Marie-Thérèse Lussier
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada; Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université de Montréal, Canada
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174
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Perceived value of eHealth among people living with multimorbidity: a qualitative study. JOURNAL OF COMORBIDITY 2017; 7:96-111. [PMID: 29359124 PMCID: PMC5777537 DOI: 10.15256/joc.2017.7.98] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 07/12/2017] [Indexed: 12/02/2022]
Abstract
Background The prevalence of multimorbidity is increasing, creating challenges for patients, healthcare professionals, and healthcare systems. Given that chronic disease management increasingly involves eHealth, it is useful to assess its perceived value among people with multimorbidity. Objective To explore challenges related to multimorbidity and patients’ perspectives on eHealth. Design Ten semi-structured interviews with adults, living with multimorbidity in Copenhagen, Denmark. Interviews focused on patient-experienced challenges, from challenges related to self-management to challenges experienced in the healthcare sector, as well as perceptions of eHealth. During interviews, participants were presented with pictures of different eHealth technologies. Data analysis followed the systematic text condensation approach. Results Participants experienced challenges in their daily lives, e.g. when practicing self-management activities, when navigating the healthcare sector, and when interacting with healthcare professionals. Patient-perceived value of eHealth varied, depending on their burden of illness and treatment: those with a greater burden had more positive perceptions of eHealth, and expressed more intention to use it. Participants with less complex disease patterns and less burdensome treatment regimens were more likely to perceive eHealth as something worthless and undesirable. Participants stressed that eHealth should only be introduced as an optional supplement. Conclusions eHealth can potentially address some patient-experienced challenges related to multimorbidity by promoting self-management, patient-centeredness, and access. However, patients’ needs and preferences vary and eHealth cannot substitute the personal interaction between patient and healthcare professionals. Our findings point to the importance of patient assessment and stratification to ensure appropriate use of eHealth.
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175
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Graffigna G, Barello S, Bonanomi A. The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model. PLoS One 2017; 12:e0179865. [PMID: 28654686 PMCID: PMC5487073 DOI: 10.1371/journal.pone.0179865] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 06/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed. OBJECTIVE To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway. MATERIAL AND METHODS This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 -short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients' emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed. RESULTS According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis. CONCLUSIONS Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing the quality of care. The Patient Health Engagement Model might acts as a mechanism to increase patient activation and adherence.
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Affiliation(s)
| | - Serena Barello
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Andrea Bonanomi
- Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
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Coorey GM, Neubeck L, Usherwood T, Peiris D, Parker S, Lau AYS, Chow C, Panaretto K, Harris M, Zwar N, Redfern J. Implementation of a consumer-focused eHealth intervention for people with moderate-to-high cardiovascular disease risk: protocol for a mixed-methods process evaluation. BMJ Open 2017; 7:e014353. [PMID: 28077414 PMCID: PMC5253559 DOI: 10.1136/bmjopen-2016-014353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Technology-mediated strategies have potential to engage patients in modifying unhealthy behaviour and improving medication adherence to reduce morbidity and mortality from cardiovascular disease (CVD). Furthermore, electronic tools offer a medium by which consumers can more actively navigate personal healthcare information. Understanding how, why and among whom such strategies have an effect can help determine the requirements for implementing them at a scale. This paper aims to detail a process evaluation that will (1) assess implementation fidelity of a multicomponent eHealth intervention; (2) determine its effective features; (3) explore contextual factors influencing and maintaining user engagement; and (4) describe barriers, facilitators, preferences and acceptability of such interventions. METHODS AND ANALYSIS Mixed-methods sequential design to derive, examine, triangulate and report data from multiple sources. Quantitative data from 3 sources will help to inform both sampling and content framework for the qualitative data collection: (1) surveys of patients and general practitioners (GPs); (2) software analytics; (3) programme delivery records. Qualitative data from interviews with patients and GPs, focus groups with patients and field notes taken by intervention delivery staff will be thematically analysed. Concurrent interview data collection and analysis will enable a thematic framework to evolve inductively and inform theory building, consistent with a realistic evaluation perspective. Eligible patients are those at moderate-to-high CVD risk who were randomised to the intervention arm of a randomised controlled trial of an eHealth intervention and are contactable at completion of the follow-up period; eligible GPs are the primary healthcare providers of these patients. ETHICS AND DISSEMINATION Ethics approval has been received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council (AH&MRC) of New South Wales. Results will be disseminated via scientific forums including peer-reviewed publications and national and international conferences. TRIAL REGISTRATION NUMBER ANZCTR 12613000715774.
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Affiliation(s)
- Genevieve M Coorey
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Sydney Nursing School, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Timothy Usherwood
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Clara Chow
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Kathryn Panaretto
- Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Julie Redfern
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
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Krist AH, Tong ST, Aycock RA, Longo DR. Engaging Patients in Decision-Making and Behavior Change to Promote Prevention. Stud Health Technol Inform 2017; 240:284-302. [PMID: 28972524 PMCID: PMC6996004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Effectively engaging patients in their care is essential to improve health outcomes, improve satisfaction with the care experience, reduce costs, and even benefit the clinician experience. This chapter will address the topic of patient engagement directly and review the relationships between health literacy and patient engagement. While there are many ways to define patient and family engagement, this chapter will consider engagement as "patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system - direct care, organizational design and governance, and policy making - to improve health and health care [1]." We will specifically focus on the patient engagement and health literacy needs for three scenarios (1) decision-making, (2) health behavior change, and (3) chronic disease management; we will include the theoretical underpinnings of engagement, the systems required to better support patient engagement, how social determinants of health influence patient engagement, and practical examples to demonstrate approaches to better engage patients in their health and wellbeing. We will close by describing the future of patient engagement, which extends beyond the traditional domains of decision-making and self-care to describe how patient engagement can influence the design of the healthcare delivery system; local, state, and national health policies; and future research relevant to the needs and experiences of patients.
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Affiliation(s)
- Alex H. Krist
- Corresponding author: Alex H. Krist, One Capital Square Room 631, 830 East Main Street, Richmond VA 23219.
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178
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van der Meij E, Huirne JA, Bouwsma EV, van Dongen JM, Terwee CB, van de Ven PM, den Bakker CM, van der Meij S, van Baal WM, Leclercq WK, Geomini PM, Consten EC, Schraffordt Koops SE, van Kesteren PJ, Stockmann HB, Ten Cate AD, Davids PH, Scholten PC, van den Heuvel B, Schaafsma FG, Meijerink WJ, Bonjer HJ, Anema JR. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e245. [PMID: 28003177 PMCID: PMC5215129 DOI: 10.2196/resprot.6580] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 01/28/2023] Open
Abstract
Background Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. Objective With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. Methods This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social participation, self-rated health, duration of return to work, physical activity, length of recovery, pain intensity, and patient satisfaction. In addition, an economic evaluation alongside this randomized controlled trial will be performed from the societal and health care perspective. All statistical analyses will be conducted according to the intention-to-treat principle. Results The enrollment of patients started in September 2015. The follow-up period will be completed in February 2017. Data cleaning and analyses have not begun as of the time this article was submitted. Conclusions We hypothesize that patients receiving the intervention program will resume their normal activities sooner than patients in the control group and costs will be lower. ClinicalTrial Netherlands Trial Registry NTC4699; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4699 (Archived by WebCite at http://www.webcitation.org/6mcCBZmwy)
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Affiliation(s)
- Eva van der Meij
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, Netherlands
| | - Judith Af Huirne
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, Netherlands
| | - Esther Va Bouwsma
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Lokatie Oost, Amsterdam, Netherlands
| | - Johanna M van Dongen
- EMGO+ Institute for Health and Care Research, Department of Health Sciences, Vrije Universiteit, Faculty of Earth and Life Sciences, Amsterdam, Netherlands
| | - Caroline B Terwee
- EMGO+ Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Peter M van de Ven
- EMGO+ Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Chantal M den Bakker
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands.,Department of Surgery, VU University Medical Center, Amsterdam, Netherlands
| | | | - W Marchien van Baal
- Department of Obstetrics and Gynaecology, Flevo Ziekenhuis, Almere, Netherlands
| | | | - Peggy Maj Geomini
- Department of Obstetrics and Gynaecology, Maxima Medisch Centrum, Veldhoven, Netherlands
| | - Esther Cj Consten
- Department of Surgery, Meander Medisch Centrum, Amersfoort, Netherlands
| | | | - Paul Jm van Kesteren
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Lokatie Oost, Amsterdam, Netherlands
| | | | - A Dorien Ten Cate
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, Netherlands
| | - Paul Hp Davids
- Department of Surgery, Diakonessenhuis, Utrecht, Netherlands
| | - Petrus C Scholten
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, Netherlands
| | | | - Frederieke G Schaafsma
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands
| | | | - H Jaap Bonjer
- Department of Surgery, VU University Medical Center, Amsterdam, Netherlands
| | - Johannes R Anema
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands
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Bureš V, Čech P, Mikulecká J, Ponce D, Kuca K. The effect of cognitive training on the subjective perception of well-being in older adults. PeerJ 2016; 4:e2785. [PMID: 28028465 PMCID: PMC5180580 DOI: 10.7717/peerj.2785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 11/11/2016] [Indexed: 02/03/2023] Open
Abstract
Background There is a growing number of studies indicating the major consequences of the subjective perception of well-being on mental health and healthcare use. However, most of the cognitive training research focuses more on the preservation of cognitive function than on the implications of the state of well-being. This secondary analysis of data from a randomised controlled trial investigated the effects of individualised television-based cognitive training on self-rated well-being using the WHO-5 index while considering gender and education as influencing factors. The effects of cognitive training were compared with leisure activities that the elderly could be engaged in to pass time. Methods Cognitively healthy participants aged 60 years or above screened using the Mini-Mental State Examination (MMSE) and Major Depression Inventory (MDI) were randomly allocated to a cognitive training group or to an active control group in a single-blind controlled two-group design and underwent 24 training sessions. Data acquired from the WHO-5 questionnaire administered before and after intervention were statistically analysed using a mixed design model for repeated measures. The effect of individualised cognitive training was compared with leisure activities while the impact of gender and education was explored using estimated marginal means. Results A total of 81 participants aged 67.9 ± 5.59 [60–84] without cognitive impairments and absent of depression symptoms underwent the study. Participants with leisure time activities declared significantly higher scores compared to participants with cognitive training M = 73.48 ± 2.88, 95% CI [67.74–79.22] vs M = 64.13 ± 3.034, 95% CI [58.09–70.17] WHO-5 score. Gender and education were found to moderate the effect of cognitive training on well-being when compared to leisure activities. Females engaged in leisure activities in the control group reported higher by M = 9.77 ± 5.4, 95% CI [−0.99–20.54] WHO-5 scores than females with the cognitive training regimen. Participants with high school education declared leisure activities to increase WHO-5 scores by M = 14.59 ± 5.39, 95% CI [3.85–25.34] compared to individualised cognitive training. Discussion The findings revealed that individualised cognitive training was not directly associated with improvements in well-being. Changes in the control group indicated that involvement in leisure time activities, in which participants were partly free to choose from, represented more favourable stimulation to a self-perceived sense of well-being than individualised cognitive training. Results also supported the fact that gender and education moderated the effect of cognitive training on well-being. Females and participants with high school education were found to be negatively impacted in well-being when performance connected with cognitive training was expected.
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Affiliation(s)
- Vladimír Bureš
- Faculty of Informatics and Management, University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Pavel Čech
- Faculty of Informatics and Management, University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Jaroslava Mikulecká
- Faculty of Informatics and Management, University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Daniela Ponce
- Faculty of Informatics and Management, University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Kamil Kuca
- Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic; Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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180
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Villani D, Cognetta C, Toniolo D, Scanzi F, Riva G. Engaging Elderly Breast Cancer Patients: The Potential of eHealth Interventions. Front Psychol 2016; 7:1825. [PMID: 27899909 PMCID: PMC5110527 DOI: 10.3389/fpsyg.2016.01825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Daniela Villani
- Department of Psychology, Università Cattolica del Sacro Cuore Milan, Italy
| | - Chiara Cognetta
- Department of Medical Oncology, "G.Salvini" ASST Rhodense Milan, Italy
| | - Davide Toniolo
- Department of Medical Oncology, "G.Salvini" ASST Rhodense Milan, Italy
| | - Francesco Scanzi
- U.O. Oncologia Medica, Ospedale S. Giuseppe-Multimedica Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro CuoreMilan, Italy; Applied Technology for Neuro-Psychology Lab, Istituto Auxologico ItalianoMilan, Italy
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181
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Menichetti J, Graffigna G. "PHE in Action": Development and Modeling of an Intervention to Improve Patient Engagement among Older Adults. Front Psychol 2016; 7:1405. [PMID: 27695435 PMCID: PMC5025533 DOI: 10.3389/fpsyg.2016.01405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/02/2016] [Indexed: 01/16/2023] Open
Abstract
The increasing prevalence of chronic conditions among older adults constitutes a major public health problem. Thus, changes in lifestyles are required to prevent secondary conditions and sustain good care practices. While patient engagement received great attention in the last years as key strategy to solve this issue, to date no interventions exist to sustain the engagement of older chronic patients toward their health management. This study describes the design, development, and optimization of PHEinAction, a theoretically-driven intervention program to increase patient engagement in older chronic populations and consequently to foster healthy changes that can help reduce risks of health problems. The development process followed the UK Medical Research Council's (MRC) guidelines and involved selecting the theoretical base for the intervention, identifying the relevant evidence-based literature, and conducting exploratory research to qualitatively evaluate program's feasibility, acceptability, and comprehension. The result was a user-endorsed intervention designed to improve older patients' engagement in health management based on the theoretical framework of the Patient Health Engagement (PHE) model. The intervention program, which emerged from this process, consisted of 2 monthly face-to-face 1-h sessions delivered by a trained facilitator and one brief telephonic consultation, and aimed to facilitate a range of changes for patient engagement (e.g., motivation to change, health information seeking and use, emotional adjustment, health behaviors planning). PHEinAction is the first example of a theoretically-based patient engagement intervention designed for older chronic targets. The intervention program is based on psychological theory and evidence; it facilitates emotional, psychological, and behavioral processes to support patient engagement and lifestyle change and maintenance. It provides estimates of the extent to which it could help high-risk groups engage in effective health management and informs future trials.
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Huddy JR, Weldon SM, Ralhan S, Painter T, Hanna GB, Kneebone R, Bello F. Sequential simulation (SqS) of clinical pathways: a tool for public and patient engagement in point-of-care diagnostics. BMJ Open 2016; 6:e011043. [PMID: 27625053 PMCID: PMC5030544 DOI: 10.1136/bmjopen-2016-011043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Public and patient engagement (PPE) is fundamental to healthcare research. To facilitate effective engagement in novel point-of-care tests (POCTs), the test and downstream consequences of the result need to be considered. Sequential simulation (SqS) is a tool to represent patient journeys and the effects of intervention at each and subsequent stages. This case study presents a process evaluation of SqS as a tool for PPE in the development of a volatile organic compound-based breath test POCT for the diagnosis of oesophagogastric (OG) cancer. SETTING Three 3-hour workshops in central London. PARTICIPANTS 38 members of public attended a workshop, 26 (68%) had no prior experience of the OG cancer diagnostic pathway. INTERVENTIONS Clinical pathway SqS was developed from a storyboard of a patient, played by an actor, noticing symptoms of oesophageal cancer and following a typical diagnostic pathway. The proposed breath testing strategy was then introduced and incorporated into a second SqS to demonstrate pathway impact. Facilitated group discussions followed each SqS. PRIMARY AND SECONDARY OUTCOME MEASURES Evaluation was conducted through pre-event and postevent questionnaires, field notes and analysis of audiovisual recordings. RESULTS 38 participants attended a workshop. All participants agreed they were able to contribute to discussions and like the idea of an OG cancer breath test. Five themes emerged related to the proposed new breath test including awareness of OG cancer, barriers to testing and diagnosis, design of new test device, new clinical pathway and placement of test device. 3 themes emerged related to the use of SqS: participatory engagement, simulation and empathetic engagement, and why participants attended. CONCLUSIONS SqS facilitated a shared immersive experience for participants and researchers that led to the coconstruction of knowledge that will guide future research activities and be of value to stakeholders concerned with the invention and adoption of POCT.
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Affiliation(s)
- Jeremy R Huddy
- Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Shvaita Ralhan
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Tim Painter
- Patient Representative, London Cancer Alliance, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Roger Kneebone
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Fernando Bello
- Department of Surgery and Cancer, Imperial College, London, UK
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Chaet AV, Morshedi B, Wells KJ, Barnes LE, Valdez R. Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review. J Med Internet Res 2016; 18:e214. [PMID: 27511437 PMCID: PMC4997005 DOI: 10.2196/jmir.5794] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/22/2016] [Accepted: 07/08/2016] [Indexed: 11/15/2022] Open
Abstract
Background As consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions. Objective Our aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics. Methods A narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author’s last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics. Results We included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention. Conclusions This study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes.
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Affiliation(s)
- Alexis V Chaet
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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Triberti S, Barello S. The quest for engaging AmI: Patient engagement and experience design tools to promote effective assisted living. J Biomed Inform 2016; 63:150-156. [PMID: 27515924 DOI: 10.1016/j.jbi.2016.08.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/21/2016] [Accepted: 08/06/2016] [Indexed: 12/25/2022]
Abstract
Recent research highlights that patient engagement, conceived as a patient's behavioral, cognitive and emotional commitment to his own care management, is a key issue while implementing new technologies in the healthcare process. Indeed, eHealth interventions may systematically fail when the patient's subjective experience has not been taken into consideration since the first steps of the technology design. In the present contribution, we argue that such an issue is more and more crucial as regarded to the field of Ambient Intelligence (AmI). Specifically, the exact concept of technologies embedded in the patients' surrounding environment implies a strong impact on their everyday life, which can be perceived as a limitation to autonomy and privacy, and therefore refused or even openly opposed by the final users. The present contribution tackles this issue directly, highlighting: (1) a theoretical framework to include patient engagement in the design of AmI technologies; (2) assessment measures for patient engagement while developing and testing the effectiveness of AmI prototypes for healthcare. Finally (3) this contribution provides an overview of the main issues emerging while implementing AmI technologies and suggests specific design solutions to address them.
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Affiliation(s)
- Stefano Triberti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy.
| | - Serena Barello
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy
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185
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van der Meij E, Anema JR, Otten RHJ, Huirne JAF, Schaafsma FG. The Effect of Perioperative E-Health Interventions on the Postoperative Course: A Systematic Review of Randomised and Non-Randomised Controlled Trials. PLoS One 2016; 11:e0158612. [PMID: 27383239 PMCID: PMC4934874 DOI: 10.1371/journal.pone.0158612] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/17/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND E-health interventions have become increasingly popular, including in perioperative care. The objective of this study was to evaluate the effect of perioperative e-health interventions on the postoperative course. METHODS We conducted a systematic review and searched for relevant articles in the PUBMED, EMBASE, CINAHL and COCHRANE databases. Controlled trials written in English, with participants of 18 years and older who underwent any type of surgery and which evaluated any type of e-health intervention by reporting patient-related outcome measures focusing on the period after surgery, were included. Data of all included studies were extracted and study quality was assessed by using the Downs and Black scoring system. FINDINGS A total of 33 articles were included, reporting on 27 unique studies. Most studies were judged as having a medium risk of bias (n = 13), 11 as a low risk of bias, and three as high risk of bias studies. Most studies included patients undergoing cardiac (n = 9) or orthopedic surgery (n = 7). All studies focused on replacing (n = 11) or complementing (n = 15) perioperative usual care with some form of care via ICT; one study evaluated both type of interventions. Interventions consisted of an educational or supportive website, telemonitoring, telerehabilitation or teleconsultation. All studies measured patient-related outcomes focusing on the physical, the mental or the general component of recovery. 11 studies (40.7%) reported outcome measures related to the effectiveness of the intervention in terms of health care usage and costs. 25 studies (92.6%) reported at least an equal (n = 8) or positive (n = 17) effect of the e-health intervention compared to usual care. In two studies (7.4%) a positive effect on any outcome was found in favour of the control group. CONCLUSION Based on this systematic review we conclude that in the majority of the studies e-health leads to similar or improved clinical patient-related outcomes compared to only face to face perioperative care for patients who have undergone various forms of surgery. However, due to the low or moderate quality of many studies, the results should be interpreted with caution.
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Affiliation(s)
- Eva van der Meij
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Johannes R. Anema
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Judith A. F. Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederieke G. Schaafsma
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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186
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Miller JW, Klass DW, Mokri B, Okazaki H. Triphasic waves in cerebral carcinomatosis. Another nonmetabolic cause. J Particip Med 1986; 43:1191-3. [PMID: 3778253 PMCID: PMC10580142 DOI: 10.1001/archneur.1986.00520110077022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 01/07/2023] Open
Abstract
A 59-year-old woman with a metastatic adenocarcinoma of unknown origin and no metabolic abnormalities developed a diffuse encephalopathy, with generalized triphasic waves seen on the electroencephalogram. Postmortem examination revealed widespread, multifocal perivascular carcinomatosis of the cerebral cortices. Triphasic waves have been described with dementing processes, subdural hematomas, and cerebrovascular disease, but they are more commonly seen with metabolic encephalopathies. This case demonstrates an additional nonmetabolic cause of triphasic waves.
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