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Tong A, Morton R, Howard K, Craig JC. Adolescent experiences following organ transplantation: a systematic review of qualitative studies. J Pediatr 2009; 155:542-9. [PMID: 19555971 DOI: 10.1016/j.jpeds.2009.04.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 03/02/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the experiences of adolescents who underwent organ transplantation. STUDY DESIGN We conducted a systematic review of qualitative studies that explored the experiences of adolescents who underwent organ transplantation. We searched 5 electronic databases (to week 3 of July 2008) and reference lists of relevant articles. RESULTS Eighteen articles reporting the experiences of 313 adolescent organ transplant recipients were included. Five major themes were identified: (1) redefining identity (seeking normality, anxiety and disappointment, adopting a positive attitude, desiring independence); (2) family functioning (parental overprotection, sibling support); (3) social adjustment (support networks, peer rejection, maintaining schoolwork, participation in physical activities); (4) managing medical demands (assuming responsibility, dependence on caregivers, disruption to lifestyle, vigilant adherence, pain and discomfort); and (5) attitude toward the donor (obligation of gratitude, strengthened relationship, concerns about risks to donor). CONCLUSIONS Although transplantation offers adolescents a better chance of survival and increased freedom and energy, it poses many challenges. A multifaceted response is needed to equip adolescent transplant recipients with skills and capacities to help them achieve a sense of normality, cope with fear of death and organ rejection, gain acceptance among their peers, build confidence in learning, and resolve relationship tensions with the living donor.
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Affiliation(s)
- Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia.
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302
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Dumrongpakapakorn P, Hopkins K, Sherwood P, Zorn K, Donovan H. Computer-mediated patient education: opportunities and challenges for supporting women with ovarian cancer. Nurs Clin North Am 2009; 44:339-54. [PMID: 19683095 DOI: 10.1016/j.cnur.2009.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A majority of women with ovarian cancer will face recurrent disease despite receiving aggressive chemotherapy at the time of diagnosis. Given the complex medical and psychosocial needs of women with ovarian cancer and the time constraints within busy clinical settings, providing women with the necessary education related to their disease and treatments can be challenging. The advent of computers and web-based technologies has created new opportunities for educating cancer patients and supporting them to better cope with their disease. This article reviews prior studies of computer-based patient education interventions to identify key intervention components and other factors associated with improved patient outcomes. Opportunities for using computer-based technologies to support women with ovarian cancer are discussed and WRITE Symptoms (a Written Representational Intervention To Ease Symptoms), a web-based, symptom management intervention for women with recurrent ovarian cancer, is introduced.
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Affiliation(s)
- Phensiri Dumrongpakapakorn
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA
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303
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Ritterband LM, Thorndike FP, Cox DJ, Kovatchev BP, Gonder-Frederick LA. A behavior change model for internet interventions. Ann Behav Med 2009; 38:18-27. [PMID: 19802647 PMCID: PMC2878721 DOI: 10.1007/s12160-009-9133-4] [Citation(s) in RCA: 367] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The Internet has become a major component to health care and has important implications for the future of the health care system. One of the most notable aspects of the Web is its ability to provide efficient, interactive, and tailored content to the user. Given the wide reach and extensive capabilities of the Internet, researchers in behavioral medicine have been using it to develop and deliver interactive and comprehensive treatment programs with the ultimate goal of impacting patient behavior and reducing unwanted symptoms. To date, however, many of these interventions have not been grounded in theory or developed from behavior change models, and no overarching model to explain behavior change in Internet interventions has yet been published. PURPOSE The purpose of this article is to propose a model to help guide future Internet intervention development and predict and explain behavior changes and symptom improvement produced by Internet interventions. RESULTS The model purports that effective Internet interventions produce (and maintain) behavior change and symptom improvement via nine nonlinear steps: the user, influenced by environmental factors, affects website use and adherence, which is influenced by support and website characteristics. Website use leads to behavior change and symptom improvement through various mechanisms of change. The improvements are sustained via treatment maintenance. CONCLUSION By grounding Internet intervention research within a scientific framework, developers can plan feasible, informed, and testable Internet interventions, and this form of treatment will become more firmly established.
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Affiliation(s)
- Lee M Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, Behavioral Health and Technology, University of Virginia Health System, PO Box 801075, Charlottesville, VA 22908, USA.
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Ritterband LM, Thorndike FP, Gonder-Frederick LA, Magee JC, Bailey ET, Saylor DK, Morin CM. Efficacy of an Internet-based behavioral intervention for adults with insomnia. ACTA ACUST UNITED AC 2009; 66:692-8. [PMID: 19581560 DOI: 10.1001/archgenpsychiatry.2009.66] [Citation(s) in RCA: 321] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Insomnia is a major health problem with significant psychological, health, and economic consequences. However, availability of one of the most effective insomnia treatments, cognitive behavioral therapy, is significantly limited. The Internet may be a key conduit for delivering this intervention. OBJECTIVE To evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia. DESIGN, SETTING, AND PARTICIPANTS Forty-five adults were randomly assigned to an Internet intervention (n = 22) or wait-list control group (n = 23). Forty-four eligible participants (mean [SD] age, 44.86 [11.03] years; 34 women) who had a history of sleep difficulties longer than 10 years on average (mean [SD], 10.59 [8.89] years) were included in the analyses. INTERVENTION The Internet intervention is based on well-established face-to-face cognitive behavioral therapy incorporating the primary components of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention. MAIN OUTCOME MEASURES The Insomnia Severity Index and daily sleep diary data were used to determine changes in insomnia severity and the main sleep variables, including wake after sleep onset and sleep efficiency. RESULTS Intention-to-treat analyses showed that scores on the Insomnia Severity Index significantly improved from 15.73 (95% confidence interval [CI], 14.07 to 17.39) to 6.59 (95% CI, 4.73 to 8.45) for the Internet group but did not change for the control group (16.27 [95% CI, 14.61 to 17.94] to 15.50 [95% CI, 13.64 to 17.36]) (F(1,42) = 29.64; P < .001). The Internet group maintained their gains at the 6-month follow-up. Internet participants also achieved significant decreases in wake after sleep onset (55% [95% CI, 34% to 76%]) and increases in sleep efficiency (16% [95% CI, 9% to 22%]) compared with the nonsignificant control group changes of wake after sleep onset (8% [95% CI, -17% to 33%) and sleep efficiency (3%; 95% CI, -4% to 9%). CONCLUSIONS Participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the control group did not have a significant change. The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00328250.
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Affiliation(s)
- Lee M Ritterband
- Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, VA 22908, USA.
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305
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Roek MGA, Welschen LMC, Kostense PJ, Dekker JM, Snoek FJ, Nijpels G. Web-based guided insulin self-titration in patients with type 2 diabetes: the Di@log study. Design of a cluster randomised controlled trial [TC1316]. BMC FAMILY PRACTICE 2009; 10:40. [PMID: 19508712 PMCID: PMC2703619 DOI: 10.1186/1471-2296-10-40] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 06/09/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many patients with type 2 diabetes (T2DM) are not able to reach the glycaemic target level of HbA1c < 7.0%, and therefore are at increased risk of developing severe complications. Transition to insulin therapy is one of the obstacles in diabetes management, because of barriers of both patient and health care providers. Patient empowerment, a patient-centred approach, is vital for improving diabetes management. We developed a web-based self-management programme for insulin titration in T2DM patients. The aim of our study is to investigate if this internet programme helps to improve glycaemic control more effectively than usual care. METHODS/DESIGN T2DM patients (n = 248), aged 35-75 years, with an HbA1c > or = 7.0%, eligible for treatment with insulin and able to use the internet will be selected from general practices in two different regions in the Netherlands. Cluster randomisation will be performed at the level of general practices. Patients in the intervention group will use a self-developed internet programme to assist them in self-titrating insulin. The control group will receive usual care.Primary outcome is the difference in change in HbA1c between intervention and control group. Secondary outcome measures are quality of life, treatment satisfaction, diabetes self-efficacy and frequency of hypoglycaemic episodes. Results will be analysed according to the intention-to-treat principle. DISCUSSION An internet intervention supporting self-titration of insulin therapy in T2DM patients is an innovative patient-centred intervention. The programme provides guided self-monitoring and evaluation of health and self-care behaviours through tailored feedback on input of glucose values. This is expected to result in a better performance of self-titration of insulin and consequently in the improvement of glycaemic control. The patient will be enabled to 'discover and use his or her own ability to gain mastery over his/her diabetes' and therefore patient empowerment will increase. Based on the self-regulation theory of Leventhal, we hypothesize that additional benefits will be achieved in terms of increases in treatment satisfaction, quality of life and self-efficacy. TRIAL REGISTRATION Dutch Trial Register TC1316.
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Affiliation(s)
- Mariëlle G A Roek
- The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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306
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Murray E, Khadjesari Z, White IR, Kalaitzaki E, Godfrey C, McCambridge J, Thompson SG, Wallace P. Methodological challenges in online trials. J Med Internet Res 2009; 11:e9. [PMID: 19403465 PMCID: PMC2762798 DOI: 10.2196/jmir.1052] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 12/12/2008] [Accepted: 02/03/2009] [Indexed: 01/24/2023] Open
Abstract
Health care and health care services are increasingly being delivered over the Internet. There is a strong argument that interventions delivered online should also be evaluated online to maximize the trial's external validity. Conducting a trial online can help reduce research costs and improve some aspects of internal validity. To date, there are relatively few trials of health interventions that have been conducted entirely online. In this paper we describe the major methodological issues that arise in trials (recruitment, randomization, fidelity of the intervention, retention, and data quality), consider how the online context affects these issues, and use our experience of one online trial evaluating an intervention to help hazardous drinkers drink less (DownYourDrink) to illustrate potential solutions. Further work is needed to develop online trial methodology.
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Affiliation(s)
- Elizabeth Murray
- University College London, Director, E-health Unit, Archway Campus, Highgate Hill, London N19 5LW, UK.
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307
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Bennett GG, Glasgow RE. The Delivery of Public Health Interventions via the Internet: Actualizing Their Potential. Annu Rev Public Health 2009; 30:273-92. [PMID: 19296777 DOI: 10.1146/annurev.publhealth.031308.100235] [Citation(s) in RCA: 515] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gary G. Bennett
- Center for Community Based Research, Dana Farber Cancer Institute, Boston, Massachusetts, 02115
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, 02115
| | - Russell E. Glasgow
- Clinical Research Unit, Kaiser Permanente-Colorado, Denver, Colorado, 80237;
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308
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Berzins K, Reilly S, Abell J, Hughes J, Challis D. UK self-care support initiatives for older patients with long-term conditions: a review. Chronic Illn 2009; 5:56-72. [PMID: 19276226 DOI: 10.1177/1742395309102886] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Supporting self-care for people with long-term conditions is an aim of UK health policy. As many with long-term conditions are older it is of interest to explore which self-care support interventions have positive impacts for this group. This review explores what types of intervention have been reported in the UK and their impact upon older people. METHODS Studies were identified using existing reviews, electronic databases and through hand searching journals. After inclusion and exclusion criteria were applied data were extracted from 18 studies. These were summarized in a narrative synthesis supported by summary tables. RESULTS All studies described interventions to support self-care, many targeted at people with arthritis. All used patient education, usually delivered to groups by a range of professionals. The majority of studies reported some significant positive outcomes, most frequently changes in physical functioning, illness knowledge and increased self-efficacy. The average age of participants was 60. DISCUSSION This review shows that self-care interventions have had positive effects for older participants but it remains unknown how best to support self-care in participants over 75, a group of people with long-term conditions who may have different needs.
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Affiliation(s)
- K Berzins
- Personal Social Services Research Unit, Faculty of Medical and Human Sciences, University of Manchester, Dover Street Building, Oxford Road, Manchester, M13 9PL, UK.
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309
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McDaniel AM, Schutte DL, Keller LO. Consumer health informatics: from genomics to population health. Nurs Outlook 2009; 56:216-223.e3. [PMID: 18922271 DOI: 10.1016/j.outlook.2008.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Indexed: 11/19/2022]
Abstract
Innovations in health information technology have ushered in a new era of health care. The use of emerging information and communication technology to improve or enable health and health care is the central focus of consumer health informatics (CHI). Traditionally, CHI interventions to promote health and well-being have targeted the individual or family. Advances in genomic health and the emergence of public health informatics call for broadening the scope of CHI. The authors discuss CHI from the point-of-view of the consumer (e.g., from individuals to policy makers) and the level of health data from the subcellular (e.g., genetic or protein structures) to population (e.g., geographically-referenced information).
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Affiliation(s)
- Anna M McDaniel
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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310
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Gagnon MP, Légaré F, Labrecque M, Frémont P, Pluye P, Gagnon J, Car J, Pagliari C, Desmartis M, Turcot L, Gravel K. Interventions for promoting information and communication technologies adoption in healthcare professionals. Cochrane Database Syst Rev 2009:CD006093. [PMID: 19160265 PMCID: PMC3973635 DOI: 10.1002/14651858.cd006093.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Information and communication technologies (ICT) are defined as digital and analogue technologies that facilitate the capturing, processing, storage and exchange of information via electronic communication. ICTs have the potential to improve information management, access to health services, quality of care, continuity of services, and cost containment. Knowledge is lacking on conditions for successful ICT integration into practice. OBJECTIVES To carry out a systematic review of the effectiveness of interventions to promote the adoption of ICT by healthcare professionals. SEARCH STRATEGY Specific strategies, defined with the help of an information specialist, were used to search the Cochrane Effective Practice and Organisation of Care Group (EPOC) register and additional relevant databases. We considered studies published from January 1990 until October 2007. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before/after studies (CBAs), and interrupted time series (ITS) that reported objectively measured outcomes concerning the effect of interventions to promote adoption of ICT in healthcare professionals' practices. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed each potentially relevant study for inclusion. We resolved discrepancies by discussion or a third reviewer. Two teams of two reviewers independently extracted data and assessed the quality of included studies. A meta-analysis of study outcomes was not possible, given the small number of included studies and the heterogeneity of intervention and outcomes measures. We conducted qualitative analyses, and have presented the results in a narrative format. MAIN RESULTS Ten studies met the inclusion criteria. Nine of them were RCTs. All studies involved physicians as participants (including postgraduate trainees), and one study also included other participants. Only two studies measured patient outcomes. Searching skills and/or frequency of use of electronic databases, mainly MEDLINE, were targeted in eight studies. Use of Internet for audit and feedback, and email for provider-patient communication, were targeted in two studies. Four studies showed small to moderate positive effects of the intervention on ICT adoption. Four studies were unable to demonstrate significant positive effects, and the two others showed mixed effects. No studies looked at the long-term effect or sustainability of the intervention. AUTHORS' CONCLUSIONS There is very limited evidence on effective interventions promoting the adoption of ICTs by healthcare professionals. Small effects have been reported for interventions targeting the use of electronic databases and digital libraries. The effectiveness of interventions to promote ICT adoption in healthcare settings remains uncertain, and more well designed trials are needed.
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Affiliation(s)
- Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval - Centre hospitalier universitaire de Québec, 10, rue de l'Espinay, D6-726, Québec, Québec, Canada, G1L 3L5.
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311
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Coster S, Norman I. Cochrane reviews of educational and self-management interventions to guide nursing practice: a review. Int J Nurs Stud 2008; 46:508-28. [PMID: 19012889 DOI: 10.1016/j.ijnurstu.2008.09.009] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 09/09/2008] [Accepted: 09/11/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND The burden of chronic disease on healthcare services worldwide is growing and the increased development of educational interventions which help patients to better manage their own conditions is evident internationally. OBJECTIVES This paper reports on findings of a review of Cochrane systematic reviews of interventions designed to improve patients' knowledge and skills to manage chronic disease, with particular reference to nursing contribution and practice. METHODS Thirty Cochrane systematic reviews were identified as meeting the inclusion criteria. Data were extracted and summarised. FINDINGS The majority of reviews included in this paper were judged by Cochrane reviewers to provide inadequate evidence (n=18, 60%) of the effectiveness of the interventions reviewed. Information on the professional delivering the interventions was often not available, although 77% (23) of reviews mentioned that nurses were involved in a proportion of studies. CONCLUSION Educational programmes have definite benefits for patients suffering from asthma and are promising for interventions in areas such as diabetes mellitus, epilepsy and mental health. However, it still is not clear what the active ingredients of many successful interventions are.
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Affiliation(s)
- Samantha Coster
- Florence Nightingale School of Nursing and Midwifery, Division of Health and Social Care, King's College, London, UK.
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Baker TB, McFall RM, Shoham V. Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care. Psychol Sci Public Interest 2008; 9:67-103. [PMID: 20865146 PMCID: PMC2943397 DOI: 10.1111/j.1539-6053.2009.01036.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The escalating costs of health care and other recent trends have made health care decisions of great societal import, with decision-making responsibility often being transferred from practitioners to health economists, health plans, and insurers. Health care decision making increasingly is guided by evidence that a treatment is efficacious, effective-disseminable, cost-effective, and scientifically plausible. Under these conditions of heightened cost concerns and institutional-economic decision making, psychologists are losing the opportunity to play a leadership role in mental and behavioral health care: Other types of practitioners are providing an increasing proportion of delivered treatment, and the use of psychiatric medication has increased dramatically relative to the provision of psychological interventions. Research has shown that numerous psychological interventions are efficacious, effective, and cost-effective. However, these interventions are used infrequently with patients who would benefit from them, in part because clinical psychologists have not made a convincing case for the use of these interventions (e.g., by supplying the data that decision makers need to support implementation of such interventions) and because clinical psychologists do not themselves use these interventions even when given the opportunity to do so. Clinical psychologists' failure to achieve a more significant impact on clinical and public health may be traced to their deep ambivalence about the role of science and their lack of adequate science training, which leads them to value personal clinical experience over research evidence, use assessment practices that have dubious psychometric support, and not use the interventions for which there is the strongest evidence of efficacy. Clinical psychology resembles medicine at a point in its history when practitioners were operating in a largely prescientific manner. Prior to the scientific reform of medicine in the early 1900s, physicians typically shared the attitudes of many of today's clinical psychologists, such as valuing personal experience over scientific research. Medicine was reformed, in large part, by a principled effort by the American Medical Association to increase the science base of medical school education. Substantial evidence shows that many clinical psychology doctoral training programs, especially PsyD and for-profit programs, do not uphold high standards for graduate admission, have high student-faculty ratios, deemphasize science in their training, and produce students who fail to apply or generate scientific knowledge. A promising strategy for improving the quality and clinical and public health impact of clinical psychology is through a new accreditation system that demands high-quality science training as a central feature of doctoral training in clinical psychology. Just as strengthening training standards in medicine markedly enhanced the quality of health care, improved training standards in clinical psychology will enhance health and mental health care. Such a system will (a) allow the public and employers to identify scientifically trained psychologists; (b) stigmatize ascientific training programs and practitioners; (c) produce aspirational effects, thereby enhancing training quality generally; and (d) help accredited programs improve their training in the application and generation of science. These effects should enhance the generation, application, and dissemination of experimentally supported interventions, thereby improving clinical and public health. Experimentally based treatments not only are highly effective but also are cost-effective relative to other interventions; therefore, they could help control spiraling health care costs. The new Psychological Clinical Science Accreditation System (PCSAS) is intended to accredit clinical psychology training programs that offer high-quality science-centered education and training, producing graduates who are successful in generating and applying scientific knowledge. Psychologists, universities, and other stakeholders should vigorously support this new accreditation system as the surest route to a scientifically principled clinical psychology that can powerfully benefit clinical and public health.
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Kerr C, Murray E, Burns J, Turner I, Westwood MA, Macadam C, Nazareth I, Patterson D. Applying user-generated quality criteria to develop an Internet intervention for patients with heart disease. J Telemed Telecare 2008; 14:124-7. [PMID: 18430276 DOI: 10.1258/jtt.2008.003006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Internet interventions can help people to self-manage chronic disease. However, they are only likely to be used if they meet patients' perceived needs. We have developed an Internet intervention in two stages to meet the needs of patients with coronary heart disease (CHD). First, user-generated criteria were applied to an existing US-based intervention called 'CHESS Living with Heart Disease' which provides information, emotional and social support, self-assessment and monitoring tools, and behavioural change support. This identified the development work required. Then we conducted a user evaluation with a panel of five patients with CHD. Overall, users generally made positive comments about the information content. However they were critical of presentation, ease of navigation through the content, understanding what was offered in the different services and finding the information they were after. Applying user-generated quality criteria proved useful in developing an intervention to meet the needs of UK patients with CHD.
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Affiliation(s)
- Cicely Kerr
- Department of Primary Care and Population Sciences, University College London, UK.
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314
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Clark M. Diabetes self-management education: a review of published studies. Prim Care Diabetes 2008; 2:113-120. [PMID: 18779034 DOI: 10.1016/j.pcd.2008.04.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 03/18/2008] [Accepted: 04/28/2008] [Indexed: 11/19/2022]
Abstract
Diabetes self-management is seen as the cornerstone of care for all individuals with diabetes who want to achieve successful health-related outcomes and is considered most effective when delivered by a multidisciplinary team with a comprehensive plan of care. There is a growing body of literature on both educational and psychosocial interventions, aimed at helping individuals to better manage their diabetes. However, the progress of this research and its implications for clinical practice remain unclear and sometimes controversial. This paper therefore aims to further clarify this literature by considering published evidence for the effectiveness of self-management education, including community-based peer support groups and ongoing home telephone support.
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Affiliation(s)
- Marie Clark
- Centre for Behavioural & Social Sciences in Medicine, Division of Medicine, UCL, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK.
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Williams A, Manias E, Walker R. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs 2008; 63:132-43. [DOI: 10.1111/j.1365-2648.2008.04656.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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316
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Ritterband LM, Ardalan K, Thorndike FP, Magee JC, Saylor DK, Cox DJ, Sutphen JL, Borowitz SM. Real world use of an Internet intervention for pediatric encopresis. J Med Internet Res 2008; 10:e16. [PMID: 18653440 PMCID: PMC2483922 DOI: 10.2196/jmir.1081] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 04/14/2000] [Accepted: 06/03/2008] [Indexed: 11/19/2022] Open
Abstract
Background The Internet is a significant source of medical information and is now being shown to be an important conduit for delivering various health-related interventions. Objective This paper aimed to examine the utility and impact of an Internet intervention for childhood encopresis as part of standard medical care in a “real world” setting. Methods Patients diagnosed with encopresis were given a Web-based information prescription to use an Internet intervention for pediatric encopresis. A total of 22 families utilized the intervention between July 2004 and June 2006. A chart review and phone interview were undertaken to collect user characteristics; defecation-related information, including frequency of soiling, bowel movements (BMs) in the toilet, and amount of pain associated with defecation; and information on computer/Internet usage. Three questionnaires were used to examine the utility of, impact of, and adherence to the Internet intervention. Program utilization was obtained from a data tracking system that monitored usage in real time. Results Overall, parents rated the Internet intervention as enjoyable, understandable, and easy to use. They indicated that the Internet intervention positively affected their children, decreasing overall accidents and increasing child comfort on the toilet at home. Of the 20 children who initially reported fecal accidents, 19 (95%) experienced at least a 50% improvement, with a reduction of accident frequency from one fecal accident per day to one accident per week. Although it is not clear whether this improvement is directly related to the use of the Internet intervention, patient feedback suggests that the program was an important element, further establishing Internet interventions as a viable and desirable addition to standard medical care for pediatric encopresis. Conclusions To our knowledge, this is the first time a pediatric Internet intervention has been examined as part of a “real world” setting. This is an important step toward establishing Internet interventions as an adjunctive component to treatment of pediatric patients in a clinical setting, particularly given the positive user feedback, possible cost savings, and significant potential for large-scale dissemination.
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Affiliation(s)
- Lee M Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Behavioral Health and Technology, PO Box 801075, Charlottesville, VA 22908-1075, USA.
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Ilic D, Egberts K, McKenzie JE, Risbridger G, Green S. Informing men about prostate cancer screening: a randomized controlled trial of patient education materials. J Gen Intern Med 2008; 23:466-71. [PMID: 18373146 PMCID: PMC2359522 DOI: 10.1007/s11606-007-0466-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient education materials can assist patient decision making on prostate cancer screening. OBJECTIVE To explore the effectiveness of presenting health information on prostate cancer screening using video, internet, and written interventions on patient decision making, attitudes, knowledge, and screening interest. DESIGN Randomized controlled trial. PARTICIPANTS A total of 161 men aged over 45, who had never been screened for prostate cancer, were randomized to receive information on prostate cancer screening. MEASUREMENTS Participants were assessed at baseline and 1-week postintervention for decisional conflict, screening interest, knowledge, anxiety, and decision-making preference. RESULTS A total of 156 men were followed-up at 1-week postintervention. There was no statistical, or clinical, difference in mean change in decisional conflict scores between the 3 intervention groups (video vs internet -0.06 [95% CI -0.24 to 0.12]; video vs pamphlet 0.04 [95%CI -0.15 to 0.22]; internet vs pamphlet 0.10 [95%CI -0.09 to 0.28]). There was also no statistically significant difference in mean knowledge, anxiety, decision-making preference, and screening interest between the 3 intervention groups. CONCLUSION Results from this study indicate that there are no clinically significant differences in decisional conflict when men are presented health information on prostate cancer screening via video, written materials, or the internet. Given the equivalence of the 3 methods, other factors need to be considered in deciding which method to use. Health professionals should provide patient health education materials via a method that is most convenient to the patient and their preferred learning style.
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Affiliation(s)
- Dragan Ilic
- Monash Institute of Health Services Research, Monash University, Clayton, Australia.
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318
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Sevick MA, Trauth JM, Ling BS, Anderson RT, Piatt GA, Kilbourne AM, Goodman RM. Patients with Complex Chronic Diseases: perspectives on supporting self-management. J Gen Intern Med 2007; 22 Suppl 3:438-44. [PMID: 18026814 PMCID: PMC2150604 DOI: 10.1007/s11606-007-0316-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking. With this paper, the authors present the case of an individual with diabetes and end-stage renal disease who is having difficulty with self-management. The case is discussed in terms of intervention effectiveness in the areas of prevention, addiction, and self-management of single diseases. Implications for research are discussed.
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Affiliation(s)
- Mary Ann Sevick
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (151-C), Pittsburgh, Pennsylvania, USA.
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319
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Stenhammar C, Sarkadi A, Edlund B. The role of parents' educational background in healthy lifestyle practices and attitudes of their 6-year-old children. Public Health Nutr 2007; 10:1305-13. [PMID: 17381933 DOI: 10.1017/s1368980007696396] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe aim of the present study was to examine parents' reported and desired frequencies (practices vs. attitudes) of their 6-year-old children's meals, nutritional intake and lifestyle components, as well as possible obstacles and desired support with respect to higher or lower educational backgrounds.DesignCross-sectional questionnaire study.SettingFive elementary schools in Uppsala, Sweden.SubjectsParents of 176 6-year-old pupils attending the first grade. The total response rate was 89.7%.ResultsParents with a college degree reported that their 6-year-olds had a higher frequency of milk, fruit and vegetable intake, more physical activity and fewer hours watching television compared with parents with a secondary school degree. Congruent to these differences in reported practices, more parents with a college degree desired a higher frequency of milk, fruit and vegetable intake, more physical exercise and less television viewing for their children. Regarding parents' desired meal frequencies during the week, no differences between the groups with higher and lower levels of education were found. Despite similar attitudes, however, parents with a college degree reported that their children ate mostly all meals significantly more often during the week. Both parent groups stated lack of time as the most common obstacle in providing their children with desired lifestyle practices, although parents with a secondary school education added lack of money as a contributing factor.ConclusionsAs attitudes are not always reflected in reported practices, it seems a fruitful approach to assess both, as well as obstacles perceived by parents, before planning interventions to enhance healthy lifestyle habits in children.
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Affiliation(s)
- Christina Stenhammar
- Uppsala University, Department of Public Health and Caring Sciences, Döbelnsgatan 2, SE- 752 37 Uppsala, Sweden
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320
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Murray E, McCambridge J, Khadjesari Z, White IR, Thompson SG, Godfrey C, Linke S, Wallace P. The DYD-RCT protocol: an on-line randomised controlled trial of an interactive computer-based intervention compared with a standard information website to reduce alcohol consumption among hazardous drinkers. BMC Public Health 2007; 7:306. [PMID: 17963483 PMCID: PMC2238765 DOI: 10.1186/1471-2458-7-306] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 10/26/2007] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Excessive alcohol consumption is a significant public health problem throughout the world. Although there are a range of effective interventions to help heavy drinkers reduce their alcohol consumption, these have little proven population-level impact. Researchers internationally are looking at the potential of Internet interventions in this area. METHODS/DESIGN In a two-arm randomised controlled trial, an on-line psychologically enhanced interactive computer-based intervention is compared with a flat, text-based information web-site. Recruitment, consent, randomisation and data collection are all on-line. The primary outcome is total past-week alcohol consumption; secondary outcomes include hazardous or harmful drinking, dependence, harm caused by alcohol, and mental health. A health economic analysis is included. DISCUSSION This trial will provide information on the effectiveness and cost-effectiveness of an on-line intervention to help heavy drinkers drink less. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register ISRCTN31070347.
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Affiliation(s)
- Elizabeth Murray
- E-health Unit, Department of Primary Care and Population Sciences, University College London, Highgate Hill, London N19 5LW, UK
| | - Jim McCambridge
- Centre for Research on Drugs & Health Behaviour, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Zarnie Khadjesari
- E-health Unit, Department of Primary Care and Population Sciences, University College London, Highgate Hill, London N19 5LW, UK
| | - Ian R White
- MRC Biostatistics Unit, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Simon G Thompson
- MRC Biostatistics Unit, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Christine Godfrey
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Stuart Linke
- E-health Unit, Department of Primary Care and Population Sciences, University College London, Highgate Hill, London N19 5LW, UK
| | - Paul Wallace
- E-health Unit, Department of Primary Care and Population Sciences, University College London, Highgate Hill, London N19 5LW, UK
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321
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Piette JD. Interactive behavior change technology to support diabetes self-management: where do we stand? Diabetes Care 2007; 30:2425-32. [PMID: 17586735 DOI: 10.2337/dc07-1046] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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322
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McLean R, Richards BH, Wardman JI. The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution? Med J Aust 2007; 187:174-7. [PMID: 17680746 DOI: 10.5694/j.1326-5377.2007.tb01180.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 05/29/2007] [Indexed: 11/17/2022]
Abstract
Web 2.0 is a term describing new collaborative Internet applications. The primary difference from the original World Wide Web is greater user participation in developing and managing content, which changes the nature and value of the information. Key elements of Web 2.0 include: Really Simple Syndication (RSS) to rapidly disseminate awareness of new information; blogs to describe new trends; wikis to share knowledge; and podcasts to make information available "on the move". The medical community needs to be aware of these technologies and their increasing role in providing health information "any time, any place".
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Affiliation(s)
- Rick McLean
- Australian Government Department of Health and Ageing, Canberra, ACT, Australia.
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323
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Affiliation(s)
- Angela Coulter
- Picker Institute Europe, King's Mead House, Oxford OX1 1RX.
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324
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Wise M, Gustafson DH, Sorkness CA, Molfenter T, Staresinic A, Meis T, Hawkins RP, Shanovich KK, Walker NP. Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a Web-based asthma education program. Health Promot Pract 2007; 8:282-91. [PMID: 16928987 PMCID: PMC2366971 DOI: 10.1177/1524839906289983] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised.
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Affiliation(s)
- Meg Wise
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison in Madison, Wisconsin, USA
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325
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Munro S, Lewin S, Swart T, Volmink J. A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health 2007; 7:104. [PMID: 17561997 PMCID: PMC1925084 DOI: 10.1186/1471-2458-7-104] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 06/11/2007] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Suboptimal treatment adherence remains a barrier to the control of many infectious diseases, including tuberculosis and HIV/AIDS, which contribute significantly to the global disease burden. However, few of the many interventions developed to address this issue explicitly draw on theories of health behaviour. Such theories could contribute to the design of more effective interventions to promote treatment adherence and to improving assessments of the transferability of these interventions across different health issues and settings. METHODS This paper reviews behaviour change theories applicable to long-term treatment adherence; assesses the evidence for their effectiveness in predicting behaviour change; and examines the implications of these findings for developing strategies to improve TB and HIV/AIDS medication adherence. We searched a number of electronic databases for theories of behaviour change. Eleven theories were examined. RESULTS Little empirical evidence was located on the effectiveness of these theories in promoting adherence. However, several models have the potential to both improve understanding of adherence behaviours and contribute to the design of more effective interventions to promote adherence to TB and HIV/AIDS medication. CONCLUSION Further research and analysis is needed urgently to determine which models might best improve adherence to long-term treatment regimens.
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Affiliation(s)
- Salla Munro
- South African Cochrane Centre, Medical Research Council of South Africa, P.O. Box 19070, Tygerberg 7505, Cape Town, South Africa
| | - Simon Lewin
- Health Systems Research Unit, Medical Research Council of South Africa and Department of Public Health and Policy London School of Hygiene and Tropical Medicine, Keppel Street London WC1E7 HT, UK
| | - Tanya Swart
- Department of Psychology School of Human & Community Development, University of the Witwatersrand Private Bag X3, Wits, 2050, South Africa
| | - Jimmy Volmink
- South African Cochrane Centre, Medical Research Council of South Africa and Deputy Dean: Research Faculty of Health Sciences, Stellenbosch University PO Box 19063, Tygerberg 7505, Cape Town, South Africa
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326
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Akl EA, Grant BJB, Guyatt GH, Montori VM, Schünemann HJ. A decision aid for COPD patients considering inhaled steroid therapy: development and before and after pilot testing. BMC Med Inform Decis Mak 2007; 7:12. [PMID: 17504536 PMCID: PMC1877801 DOI: 10.1186/1472-6947-7-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 05/15/2007] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Decision aids (DA) are tools designed to help patients make specific and deliberative choices among disease management options. DAs can improve the quality of decision-making and reduce decisional conflict. An area not covered by a DA is the decision of a patient with chronic obstructive pulmonary disease (COPD) to use inhaled steroids which requires balancing the benefits and downsides of therapy. METHODS We developed a DA for COPD patients considering inhaled steroid therapy using the Ottawa Decision Support Framework, the best available evidence for using inhaled steroid in COPD and the expected utility model. The development process involved patients, pulmonologists, DA developers and decision making experts. We pilot tested the DA with 8 COPD patients who completed an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale. RESULTS The DA is a computer-based interactive tool incorporating four different decision making models. In the first part, the DA provides information about COPD as a disease, the different treatment options, and the benefits and downsides of using inhaled steroids. In the second part, it coaches the patient in the decision making process through clarifying values and preferences. Patients evaluated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008). CONCLUSION We have developed a computer-based interactive DA for COPD patients considering inhaled steroids serving as a model for other DAs in COPD, in particular related to inhaled therapies. Future research should assess the DA effectiveness.
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Affiliation(s)
- Elie A Akl
- Department of Medicine, University at Buffalo, Buffalo, NY, USA
- Department of Social & Preventive Medicine, University at Buffalo, Buffalo, NY, USA
| | - Brydon JB Grant
- Department of Medicine, University at Buffalo, Buffalo, NY, USA
- Department of Social & Preventive Medicine, University at Buffalo, Buffalo, NY, USA
- Department of Medicine, VAMC, Buffalo, NY, USA
- Department of Biostatistics, University at Buffalo, Buffalo, NY, USA
- Department of Physiology and Biophysics, University at Buffalo, Buffalo, NY, USA
| | - Gordon H Guyatt
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Victor M Montori
- Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Holger J Schünemann
- INFORMA, Dept. of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy
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327
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Linke S, Murray E, Butler C, Wallace P. Internet-based interactive health intervention for the promotion of sensible drinking: patterns of use and potential impact on members of the general public. J Med Internet Res 2007; 9:e10. [PMID: 17513281 PMCID: PMC1874715 DOI: 10.2196/jmir.9.2.e10] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 02/21/2007] [Accepted: 03/30/2007] [Indexed: 11/17/2022] Open
Abstract
Background Heavy drinking is responsible for major health and social problems. Brief interventions have been shown to be effective, but there have been difficulties in reaching those who might benefit from them. Pilot studies have indicated that a Web-based intervention is likely to be acceptable to heavy drinkers and may produce some health benefits. However, there are few data on how many people might use such a program, the patterns of use, and potential benefits. Objectives The aim was to examine the demographic characteristics of users of a free, Web-based, 6-week intervention for heavy drinkers and to describe the methods by which users identified the site, the pattern of site use and attrition, the characteristics associated with completing the program, and the self-reported impact on alcohol-related outcomes. Methods Cohort study. Visitors to the Web site were offered screening with the Fast Alcohol Screening Test, and those scoring above the cutoff for risky drinking were invited to register with the program. Demographic information was collected routinely at registration, and questionnaires were completed at the end of weeks 1 and 6. The outcome measures assessed dependency (Short Alcohol Dependency Data Questionnaire), harms (modified Alcohol Problems Questionnaire), and mental health (Clinical Outcomes in Routine Evaluation–Outcome Measure). Results The records of 10000 users were analyzed. The mean age was 37.4 years, 51.1% were female, 37.5% were single, and 42.4% lived with children. The majority were White British, lived in the United Kingdom, and reported occupations from the higher socioeconomic strata. Over 70% connected to the Down Your Drink (Down Your Drink) site from another Internet-based resource, whereas only 5.8% heard about the site from a health or other professional. Much of the Web site use (40%) was outside normal working hours. Attrition from the program was high, with only 16.5% of registrants completing the whole 6 weeks. For those who completed the program, and the final outcome measures, measures of dependency, alcohol-related problems, and mental health symptoms were all reduced at week 6. Conclusions The Web-based intervention was highly used, and those who stayed with the program showed significant reductions in self-reported indicators of dependency, alcohol-related problems, and mental health symptoms; however, this association cannot be assumed to be causal. Programs of this type may have the potential to reach large numbers of heavy drinkers who might not otherwise seek help. There are significant methodological challenges and further research is needed to fully evaluate such interventions.
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Affiliation(s)
- Stuart Linke
- Islington Mental Health Psychology Services, Camden and Islington Mental Health and Social Care Trust, London, UK.
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328
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Clark RA, Inglis SC, McAlister FA, Cleland JGF, Stewart S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ 2007; 334:942. [PMID: 17426062 PMCID: PMC1865411 DOI: 10.1136/bmj.39156.536968.55] [Citation(s) in RCA: 461] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether remote monitoring (structured telephone support or telemonitoring) without regular clinic or home visits improves outcomes for patients with chronic heart failure. DATA SOURCES 15 electronic databases, hand searches of previous studies, and contact with authors and experts. DATA EXTRACTION Two investigators independently screened the results. REVIEW METHODS Published randomised controlled trials comparing remote monitoring programmes with usual care in patients with chronic heart failure managed within the community. RESULTS 14 randomised controlled trials (4264 patients) of remote monitoring met the inclusion criteria: four evaluated telemonitoring, nine evaluated structured telephone support, and one evaluated both. Remote monitoring programmes reduced the rates of admission to hospital for chronic heart failure by 21% (95% confidence interval 11% to 31%) and all cause mortality by 20% (8% to 31%); of the six trials evaluating health related quality of life three reported significant benefits with remote monitoring, and of the four studies examining healthcare costs with structured telephone support three reported reduced cost and one no effect. CONCLUSION Programmes for chronic heart failure that include remote monitoring have a positive effect on clinical outcomes in community dwelling patients with chronic heart failure.
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Affiliation(s)
- Robyn A Clark
- Division of Health Sciences, University of South Australia, Adelaide, Australia
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329
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Wathen CN, Harris RM. "I try to take care of it myself." how rural women search for health information. QUALITATIVE HEALTH RESEARCH 2007; 17:639-51. [PMID: 17478646 DOI: 10.1177/1049732307301236] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Rural living poses special challenges (and opportunities) for the significant health information intermediary role that women enact. The authors describe interviews with 40 women living in a rural, medically underserved county in south-western Ontario, Canada, who discussed their information-seeking experiences and the strategies used to find information about a chronic health concern or an acute medical problem. The women's stories reveal that they define health very broadly and that their information seeking is influenced by contextual factors, such as rural living and gender roles, that interplay with their self-reliance, health literacy, and the availability and willingness of others in professional and non-professional roles to give support within relationships of care. The authors discuss themes emerging from the interviews in connection with the apparent mismatch between women's lived realities and the policy assumptions supporting the development of e-health strategies for providing health information to people living in rural and remote communities.
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330
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Ahern DK. Challenges and opportunities of eHealth research. Am J Prev Med 2007; 32:S75-82. [PMID: 17466822 DOI: 10.1016/j.amepre.2007.01.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 01/26/2007] [Accepted: 01/29/2007] [Indexed: 12/01/2022]
Abstract
The Internet and related digital technologies have spawned the burgeoning growth of an information revolution in health care. Emerging evidence provides support for the beneficial effects of online interactive eHealth programs, although many challenges remain with respect to research approaches to methodology, implementation, and evaluation. This paper addresses and highlights some of the unique challenges and opportunities that researchers in eHealth face with a particular emphasis on methodologic issues. A brief historical perspective provides context for the subsequent appraisal of the current state of eHealth research. Next, emerging evidence pointing to the growing interest and investment in eHealth research is presented.
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Affiliation(s)
- David K Ahern
- Health e-Technologies Initiative, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA.
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331
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Edwards A, Thomas R, Williams R, Ellner AL, Brown P, Elwyn G. Presenting risk information to people with diabetes: evaluating effects and preferences for different formats by a web-based randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2006; 63:336-49. [PMID: 16860964 DOI: 10.1016/j.pec.2005.12.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 12/06/2005] [Accepted: 12/15/2005] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Web-based patient information is widespread and information on the benefits and risks of treatments is often difficult to understand. We therefore evaluated different risk presentation formats - numerical, graphical and others - addressing the pros and cons of tight control versus usual treatment approaches for diabetes. METHOD DESIGN Randomised controlled trial. SETTING Online. Publicity disseminated via Diabetes UK. PARTICIPANTS People with diabetes or their carers. INTERVENTIONS Control group information based on British Medical Journal 'Best Treatments'. Four intervention groups received enhanced information resources: (1) detailed numerical information (absolute/relative risk, numbers-needed-to-treat); (2) 'anchoring' to familiar risks or descriptions; (3) graphical (bar charts, thermometer scales, crowd figure formats); (4) combination of 1-3. OUTCOMES Decision conflict scale (DCS, a measure of uncertainty); satisfaction with information; further free text responses for qualitative content analysis. RESULTS Seven hundred and ten people visited the website and were randomised. Five hundred and eight completed the questionnaire for quantitative data. Mean DCS scores ranged from 2.12 to 2.24 for the five randomisation groups, indicating neither clear delay or vacillation about decisions (usually DCS>2.5) nor tending to make decisions (usually DCS<2.0). There were no statistically significant effects of the interventions on DCS, or satisfaction with information. Two hundred and fifty-six participants provided responses for qualitative analysis: most found graphical representations helpful, specifically bar chart formats; many found other graphic formats (thermometer style, crowd figures/smiley faces) and 'anchoring' information unhelpful, and indicated information overload. Many negative experiences with healthcare indicate a challenging context for effective information provision and decision support. CONCLUSION Online evaluation of different risk representation formats was feasible. There was a lack of intervention effects on quantitative outcomes, perhaps reflecting already well-informed participants from the Diabetes UK patient organisation. The large qualitative dataset included many comments about what participants found helpful as formats for communicating risk information. PRACTICE IMPLICATIONS These findings assist the design of online decision aids and the representation of risk information. The challenge is to provide more information, in appropriate and clear formats, but without risking information overload. Interactive web designs hold much promise to achieve this.
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Affiliation(s)
- Adrian Edwards
- Centre for Health Sciences Research, Cardiff University, Wales, UK.
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332
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Ritterband LM, Thorndike F. Internet interventions or patient education web sites? J Med Internet Res 2006; 8:e18; author reply e19. [PMID: 17032634 PMCID: PMC2018829 DOI: 10.2196/jmir.8.3.e18] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 09/28/2006] [Accepted: 08/31/2006] [Indexed: 11/15/2022] Open
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Ritterband LM, Andersson G, Christensen HM, Carlbring P, Cuijpers P. Directions for the International Society for Research on Internet Interventions (ISRII). J Med Internet Res 2006; 8:e23. [PMID: 17032639 PMCID: PMC2018834 DOI: 10.2196/jmir.8.3.e23] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 08/31/2006] [Indexed: 11/13/2022] Open
Abstract
In 2004, the International Society for Research on Internet Interventions (ISRII) was formed to encourage eHealth researchers to collaborate in their efforts to further the science behind developing, testing, and disseminating Web-based treatment programs. The group held its second meeting (April 2006) to clarify the Society's direction and identify key issues that need addressing in the field. These issues are identified and examined in the current paper. Given the success of using the Internet to treat a range of medical and mental health problems, and the growing need for better dissemination of health care, Internet interventions will almost certainly play a prominent role in global health. ISRII plans to provide the necessary venue to ensure the science driving this field is strong, enabling researchers to conduct the highest quality research and permitting meaningful conclusions from completed studies.
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Affiliation(s)
- Lee M Ritterband
- Department of Psychiatric Medicine, Center for Behavioral Medicine Research, University of Virginia Health System, PO Box 800223, Charlottesville, VA 22908, USA.
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Kerr C, Murray E, Stevenson F, Gore C, Nazareth I. Internet interventions for long-term conditions: patient and caregiver quality criteria. J Med Internet Res 2006; 8:e13. [PMID: 16954123 PMCID: PMC1550703 DOI: 10.2196/jmir.8.3.e13] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 03/27/2006] [Accepted: 04/05/2006] [Indexed: 12/03/2022] Open
Abstract
Background Interactive health communication applications (IHCAs) that combine high-quality health information with interactive components, such as self-assessment tools, behavior change support, peer support, or decision support, are likely to benefit people with long-term conditions. IHCAs are now largely Web-based and are becoming known as "Internet interventions." Although there are numerous professionally generated criteria to assess health-related websites, to date there has been scant exploration of patient-generated assessment criteria even though patients and professionals use different criteria for assessing the quality of traditional sources of health information. Objective We aimed to determine patients' and caregivers' requirements of IHCAs for long-term conditions as well as their criteria for assessing the quality of different programs. Methods This was a qualitative study with focus groups. Patients and caregivers managing long-term conditions used three (predominantly Web-based) IHCAs relevant to their condition and subsequently discussed the strengths and weaknesses of the different IHCAs in focus groups. Participants in any one focus group all shared the same long-term condition and viewed the same three IHCAs. Patient and caregiver criteria for IHCAs emerged from the data. Results There were 40 patients and caregivers who participated in 10 focus groups. Participants welcomed the potential of Internet interventions but felt that many were not achieving their full potential. Participants generated detailed and specific quality criteria relating to information content, presentation, interactivity, and trustworthiness, which can be used by developers and purchasers of Internet interventions. Conclusions The user-generated quality criteria reported in this paper should help developers and purchasers provide Internet interventions that better meet user needs.
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Affiliation(s)
- Cicely Kerr
- Department of Primary Care and Population SciencesLondonUnited Kingdom
| | - Elizabeth Murray
- Department of Primary Care and Population SciencesLondonUnited Kingdom
| | - Fiona Stevenson
- Department of Primary Care and Population SciencesLondonUnited Kingdom
| | | | - Irwin Nazareth
- Department of Primary Care and Population SciencesLondonUnited Kingdom
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Gammon D, Arsand E, Walseth OA, Andersson N, Jenssen M, Taylor T. Parent-child interaction using a mobile and wireless system for blood glucose monitoring. J Med Internet Res 2005; 7:e57. [PMID: 16403721 PMCID: PMC1550683 DOI: 10.2196/jmir.7.5.e57] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 11/09/2005] [Accepted: 10/31/2005] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children with type 1 diabetes and their parents face rigorous procedures for blood glucose monitoring and regulation. Mobile telecommunication systems show potential as an aid for families' self-management of diabetes. OBJECTIVE A prototype designed to automatically transfer readings from a child's blood glucose monitor to their parent's mobile phone was tested. In this formative stage of development, we sought insights into the appropriateness of the concept, feasibility of use, and ideas for further development and research. METHODS During four months, a self-selected sample of 15 children (aged 9 to 15 years) with type 1 diabetes and their parents (n = 30) used the prototype approximately three times daily. Parent and child experiences were collected through questionnaires and through interviews with 9 of the parents. RESULTS System use was easily integrated into everyday life, and parents valued the sense of reassurance offered by the system. Parents' ongoing struggle to balance control of their children with allowing independence was evident. For children who measured regularly, use appeared to reduce parental intrusions. For those who measured irregularly, however, parental reminders (eg, "nagging") appeared to increase. Although increased reminders could be considered a positive outcome, they can potentially increase parent-child conflict and thus also undermine proper metabolic control. Parents felt that system appropriateness tapered off with the onset of adolescence, partly due to a potential sense of surveillance from the child's perspective that could fuel oppositional behavior. Parental suggestions for further developments included similar alerts of irregular insulin dosages and automatically generated dietary and insulin dosage advice. CONCLUSIONS User enthusiasm suggests that such systems might find a consumer market regardless of whether or not they ultimately improve health outcomes. Thus, more rigorous studies are warranted to inform guidelines for appropriate use. Potentially fruitful approaches include integrating such systems with theory-based parenting interventions and approaches that can aid in interpreting and responding to experiences of surveillance, virtual presence, and balances of power in e-mediated relationships.
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Affiliation(s)
- Deede Gammon
- Norwegian Centre for Telemedicine, Tromsø, Norway.
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