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Hersi M, Beck A, Hamel C, Esmaeilisaraji L, Pussegoda K, Austin B, Ahmadzai N, Pratt M, Thuku M, Yazdi F, Bennett A, Shaver N, Vyas N, Skidmore B, Hutton B, Manuel D, Morrow M, Pakhale S, Presseau J, Shea BJ, Little J, Moher D, Stevens A. Effectiveness of smoking cessation interventions among adults: an overview of systematic reviews. Syst Rev 2024; 13:179. [PMID: 38997788 PMCID: PMC11242003 DOI: 10.1186/s13643-024-02570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/23/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND This overview of reviews aims to identify evidence on the benefits (i.e. tobacco use abstinence and reduction in smoking frequency) and harms (i.e. possible adverse events/outcomes) of smoking cessation interventions among adults aged 18 years and older. METHODS We searched Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the CADTH Health Technology Assessment Database and several other websites for grey literature. Searches were conducted on November 12, 2018, updated on September 24, 2020, with publication years 2008 to 2020. Two reviewers independently performed title-abstract and full-text screening considering pre-determined inclusion criteria. Data extraction and quality assessments were initially completed by two reviewers independently (i.e. 73% of included studies (n = 22)) using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR 2), and the remainder done by one reviewer and verified by another due to resources and feasibility. The application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed by one independent reviewer and verified by another. RESULTS A total of 22 Cochrane systematic reviews evaluating the impact of smoking cessation interventions on outcomes such as tobacco use abstinence, reduction in smoking frequency, quality of life and possible adverse events were included. Pharmaceutical (i.e. varenicline, cytisine, nicotine replacement therapy (NRT), bupropion) and behavioural interventions (i.e. physician advice, non-tailored print-based self-help materials, stage-based individual counselling, etc.) showed to have increased smoking cessation; whereas, data for mobile phone-based interventions including text messaging, hypnotherapy, acupuncture, continuous auricular stimulation, laser therapy, electrostimulation, acupressure, St John's wort, S-adenosyl-L-methionine (SAMe), interactive voice response systems and other combination treatments were unclear. Considering harms related to smoking cessation interventions, small/mild harms (i.e. increased palpitations, chest pain, nausea, insomnia, headache) were observed following NRT, varenicline and cytisine use. There were no data on harms related to behavioural therapies (i.e. individual or group counselling self-help materials, internet interventions), combination therapies or other therapies (i.e. laser therapy, electrostimulation, acupressure, St John's wort, SAMe). CONCLUSION Results suggest that pharmacological and behavioural interventions may help the general smoking population quit smoking with observed small/mild harms following NRT or varenicline. Consequently, evidence regarding ideal intervention strategies and the long-term impact of these interventions for preventing smoking was unclear. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018099691.
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Affiliation(s)
- Mona Hersi
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Andrew Beck
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Leila Esmaeilisaraji
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Kusala Pussegoda
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Bradley Austin
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nadera Ahmadzai
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Misty Pratt
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Micere Thuku
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fatemeh Yazdi
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Alexandria Bennett
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Nicole Shaver
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Niyati Vyas
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Otolaryngology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Matt Morrow
- Patient Representative, British Columbia, Vancouver, Canada
| | - Smita Pakhale
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley J Shea
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - David Moher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Adrienne Stevens
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
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Del Fiol G, Orleans B, Kuzmenko TV, Chipman J, Greene T, Martinez A, Wirth J, Meads R, Kaphingst KK, Gibson B, Kawamoto K, King AJ, Siaperas T, Hughes S, Pruhs A, Pariera Dinkins C, Lam CY, Pierce JH, Benson R, Borsato EP, Cornia R, Stevens L, Bradshaw RL, Schlechter CR, Wetter DW. SCALE-UP II: protocol for a pragmatic randomised trial examining population health management interventions to increase the uptake of at-home COVID-19 testing in community health centres. BMJ Open 2024; 14:e081455. [PMID: 38508633 PMCID: PMC10961568 DOI: 10.1136/bmjopen-2023-081455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION SCALE-UP II aims to investigate the effectiveness of population health management interventions using text messaging (TM), chatbots and patient navigation (PN) in increasing the uptake of at-home COVID-19 testing among patients in historically marginalised communities, specifically, those receiving care at community health centres (CHCs). METHODS AND ANALYSIS The trial is a multisite, randomised pragmatic clinical trial. Eligible patients are >18 years old with a primary care visit in the last 3 years at one of the participating CHCs. Demographic data will be obtained from CHC electronic health records. Patients will be randomised to one of two factorial designs based on smartphone ownership. Patients who self-report replying to a text message that they have a smartphone will be randomised in a 2×2×2 factorial fashion to receive (1) chatbot or TM; (2) PN (yes or no); and (3) repeated offers to interact with the interventions every 10 or 30 days. Participants who do not self-report as having a smartphone will be randomised in a 2×2 factorial fashion to receive (1) TM with or without PN; and (2) repeated offers every 10 or 30 days. The interventions will be sent in English or Spanish, with an option to request at-home COVID-19 test kits. The primary outcome is the proportion of participants using at-home COVID-19 tests during a 90-day follow-up. The study will evaluate the main effects and interactions among interventions, implementation outcomes and predictors and moderators of study outcomes. Statistical analyses will include logistic regression, stratified subgroup analyses and adjustment for stratification factors. ETHICS AND DISSEMINATION The protocol was approved by the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with National Institutes of Health data sharing policies. Results will be disseminated through study partners and peer-reviewed publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT05533918 and NCT05533359.
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Affiliation(s)
- Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Brian Orleans
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Tatyana V Kuzmenko
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan Chipman
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Anna Martinez
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jennifer Wirth
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Ray Meads
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | | | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Andy J King
- Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Tracey Siaperas
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Shlisa Hughes
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Alan Pruhs
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | | | - Cho Y Lam
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Joni H Pierce
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ryzen Benson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Emerson P Borsato
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Leticia Stevens
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Porri D, Morabito LA, Cavallaro P, La Rosa E, Li Pomi A, Pepe G, Wasniewska M. Time to act on childhood obesity: the use of technology. Front Pediatr 2024; 12:1359484. [PMID: 38434727 PMCID: PMC10904600 DOI: 10.3389/fped.2024.1359484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Childhood obesity is rapidly increasing worldwide and there is an urgent need to implement treatment and prevention programs. Over the last decade, in addition to increasing rates of childhood obesity, we have also observed rapid technological and digital development. The Covid-19 pandemic has largely contributed to both expansions but has also allowed an opening towards a broader vision of medicine, through new therapeutic opportunities such as mobile healthcare. The digital and technological delivery of obesity prevention and treatment programs can represent an innovative tool to support children and families to overcome some limitations and barriers such as the accessibility of programs that prevent them from adopting healthy lifestyle changes. This review aimed to summarize the impact of different digital interventions for children and adolescent affected by obesity.
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Affiliation(s)
| | | | - Paola Cavallaro
- Unit of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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Kalenderian E, Tungare S, Mehta U, Hamid S, Mungia R, Yansane AI, Holmes D, Funkhouser K, Ibarra-Noriega AM, Urata J, Rindal DB, Spallek H, White J, Walji MF. Patient and dentist perspectives on collecting patient reported outcomes after painful dental procedures in the National Dental PBRN. BMC Oral Health 2024; 24:201. [PMID: 38326805 PMCID: PMC10848340 DOI: 10.1186/s12903-024-03931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Dental Patient Reported Outcomes (PROs) relate to a dental patient's subjective experience of their oral health. How practitioners and patients value PROs influences their successful use in practice. METHODS Semi-structured interviews were conducted with 22 practitioners and 32 patients who provided feedback on using a mobile health (mHealth) platform to collect the pain experience after dental procedures. A themes analysis was conducted to identify implementation barriers and facilitators. RESULTS Five themes were uncovered: (1) Sense of Better Care. (2) Tailored Follow-up based on the dental procedure and patient's pain experience. (3) Effective Messaging and Alerts. (4) Usable Digital Platform. (5) Routine mHealth Integration. CONCLUSION Frequent automated and preferably tailored follow-up messages using an mHealth platform provided a positive care experience for patients, while providers felt it saved them time and effort. Patients thought that the mHealth questionnaires were well-developed and of appropriate length. The mHealth platform itself was perceived as user-friendly by users, and most would like to continue using it. PRACTICAL IMPLICATIONS Patients are prepared to use mobile phones to report their pain experience after dental procedures. Practitioners will be able to close the post-operative communication gap with their patients, with little interruption of their workflow.
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Affiliation(s)
- Elsbeth Kalenderian
- Marquette University, School of Dentistry, Milwaukee, WI, USA
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
- University of Pretoria, School of Dentistry, Pretoria, South Africa
| | - Sayali Tungare
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Urvi Mehta
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Sharmeen Hamid
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Rahma Mungia
- UTHealth School of Dentistry, San Antonio, TX, USA
| | - Alfa-Ibrahim Yansane
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | | | - Kim Funkhouser
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA
| | - Ana M Ibarra-Noriega
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Janelle Urata
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | | | - Heiko Spallek
- University of Sydney, School of Dentistry, Sydney, Australia
| | - Joel White
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | - Muhammad F Walji
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA.
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Palacios-Delgado J, Garduño FAG. A mobile phone intervention to reduce heavy drinking: a preliminary analysis of anchoring heuristics. BMC Psychol 2023; 11:427. [PMID: 38057842 DOI: 10.1186/s40359-023-01465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Preliminary evidence has been presented for interventions focused on preventing alcohol consumption or reducing the occurrence of episodes of excessive drinking. The anchoring text message intervention is a newly proposed theory-based approach to reducing heavy drinking among youth. The current study tests the preliminary efficacy of this intervention for reducing heavy drinking among Mexican youth. METHODS Focusing on a sample of sixteen Mexican youths-nine not-heavy drinkers and seven heavy drinkers-the participants completed a survey on alcohol consumption and anchoring heuristics. Pretest and post-test questionnaire data were collected to evaluate the effectiveness of the intervention. The anchoring text messages consisted of strategies to limit alcohol use and feedback reminder messages. Assessments were conducted at baseline, four weeks of intervention, and post-intervention. RESULTS Logistic regression analyses indicated a significant effect on heavy drinking episodes post-intervention. The post-intervention anchoring effects among the heavy drinker participants were different from those among the non-heavy drinkers in terms of reporting heavy drinking and future drinking. The anchoring heuristic-based intervention reduced the quantity of drinking and the future estimation of drinking and improved the ability to reject alcohol in the heavy drinker group. CONCLUSIONS These findings provide preliminary support for the effectiveness of the anchoring heuristic-based intervention, conducted through text messages sent by mobile phone to reduce alcohol consumption. The intervention promoted a reduction in alcohol consumption. Future research should be directed toward investigating the anchoring effects among heavy drinkers.
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Affiliation(s)
- Jorge Palacios-Delgado
- Universidad del Valle de México, Querétaro, México.
- Unidad de Investigación en Neurociencias Aplicadas, Querétaro, México.
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Moreno-Peral P, Rodríguez-Morejón A, Bellón J, García-Huércano C, Martínez-Vispo C, Campos-Paino H, Galán S, Reyes-Martín S, Sánchez Aguadero N, Rangel-Henriques M, Motrico E, Conejo-Cerón S. Effectiveness of a universal personalized intervention for the prevention of anxiety disorders: Protocol of a randomized controlled trial (the prevANS project). Internet Interv 2023; 34:100640. [PMID: 38023964 PMCID: PMC10630113 DOI: 10.1016/j.invent.2023.100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background To date, all preventive anxiety disorders interventions are one-fit-all and none of them are based on individual level and risk profile. The aim of this project is to design, develop and evaluate an online personalized intervention based on a risk algorithm for the universal prevention of anxiety disorders in the general population. Methods A randomized controlled trial (RCT) with two parallel arms (prevANS vs usual care) and 1-year follow-up including 2000 participants without anxiety disorders from Spain and Portugal will be conducted.The prevANS intervention will be self-guided and can be implemented from the prevANS web or from the participants' Smartphone (through an App). The prevANS intervention will have different intensities depending on the risk level of the population, evaluated from the risk algorithm for anxiety: predictA. Both low and moderate-high risk participants will receive information on their level and profile (risk factors) of anxiety disorders, will have access to stress management tools and psychoeducational information periodically. In addition, participants with a moderate-high risk of anxiety disorders will also have access to cognitive-behavioral training (problem-solving, decision-making, communication skills, and working with thoughts). The control group will not receive any intervention, but they will fill out the same questionnaires as the intervention group.Assessments will be completed at baseline, 6 and 12-month follow-up. The primary outcome is the cumulative incidence of anxiety disorders. Secondary outcomes include depressive and anxiety symptoms, risk probability of anxiety disorders (predictA algorithm) and depression (predictD algorithm), improvement in physical and mental quality of life, and acceptability and satisfaction with the intervention. In addition, cost-effectiveness and cost-utility analyses will also be carried out from two perspectives, societal and health system, and analyses of mediators and moderators will also be performed. Discussion To the best of our knowledge, prevANS study will be the first to evaluate the effectiveness and cost-effectiveness of a personalized online intervention based on a risk predictive algorithm for the universal prevention of anxiety disorders. Trial registration ClinicalTrials.gov: NCT05682365.
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Affiliation(s)
- P. Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA Plataforma BIONAND), C. Severo Ochoa, 35, 29590 Málaga, Spain
- Chronicity, Primary Care and Health Promotion Research Network (RICAPSS), ISCIII, Gran Via de les Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), C/ Dr. Ortiz Ramos, 12; 29010 Málaga, Spain
| | - A. Rodríguez-Morejón
- Biomedical Research Institute of Malaga (IBIMA Plataforma BIONAND), C. Severo Ochoa, 35, 29590 Málaga, Spain
- Chronicity, Primary Care and Health Promotion Research Network (RICAPSS), ISCIII, Gran Via de les Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), C/ Dr. Ortiz Ramos, 12; 29010 Málaga, Spain
| | - J.A. Bellón
- Biomedical Research Institute of Malaga (IBIMA Plataforma BIONAND), C. Severo Ochoa, 35, 29590 Málaga, Spain
- Chronicity, Primary Care and Health Promotion Research Network (RICAPSS), ISCIII, Gran Via de les Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
- ‘El Palo’ Health Centre, Servicio Andaluz de Salud (SAS), Av. Salvador Allende, 159, 29018 Málaga, Spain
- Department of Public Health and Psychiatry, Faculty of Medicine, University of Málaga (UMA), Campus de Teatinos, Blvrd. Louis Pasteur, 32, 29010 Málaga, Spain
| | - C. García-Huércano
- Biomedical Research Institute of Malaga (IBIMA Plataforma BIONAND), C. Severo Ochoa, 35, 29590 Málaga, Spain
| | - C. Martínez-Vispo
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela (USC), Campus Vida, Calle Xosé María Suárez Núñez, s/n, 15782 Santiago de Compostela, Spain
| | - H. Campos-Paino
- Biomedical Research Institute of Malaga (IBIMA Plataforma BIONAND), C. Severo Ochoa, 35, 29590 Málaga, Spain
- Chronicity, Primary Care and Health Promotion Research Network (RICAPSS), ISCIII, Gran Via de les Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
| | - S. Galán
- Biomedical Research Institute of Malaga (IBIMA Plataforma BIONAND), C. Severo Ochoa, 35, 29590 Málaga, Spain
- Chronicity, Primary Care and Health Promotion Research Network (RICAPSS), ISCIII, Gran Via de les Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
| | - S. Reyes-Martín
- Biomedical Research Institute of Malaga (IBIMA Plataforma BIONAND), C. Severo Ochoa, 35, 29590 Málaga, Spain
| | - N. Sánchez Aguadero
- Department of Nursing and Physiotherapy, University of Salamanca (USAL), Campus Miguel de Unamuno, C. Donantes de Sangre, s/n, 37007 Salamanca, Spain
| | - M. Rangel-Henriques
- Faculty of Psychology and Education Science, University of Porto, R. Alfredo Allen, 4200-135 Porto, Portugal
| | - E. Motrico
- Department of Psychology, University Loyola Andalucía, Av. de las Universidades, s/n, 41704 Dos Hermanas, Sevilla, Spain
| | - S. Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA Plataforma BIONAND), C. Severo Ochoa, 35, 29590 Málaga, Spain
- Chronicity, Primary Care and Health Promotion Research Network (RICAPSS), ISCIII, Gran Via de les Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
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Schlechter CR, Del Fiol G, Jones DR, Orleans B, Gibson B, Nahum-Shani I, Maxfield E, Locke A, Cornia R, Bradshaw R, Wirth J, Jaggers SJ, Lam CY, Wetter DW. Increasing the reach of evidence-based interventions for weight management and diabetes prevention among Medicaid patients: study protocol for a pilot Sequential Multiple Assignment Randomised Trial. BMJ Open 2023; 13:e075157. [PMID: 38011967 PMCID: PMC10685946 DOI: 10.1136/bmjopen-2023-075157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/16/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Over 40% of US adults meet criteria for obesity, a major risk factor for chronic disease. Obesity disproportionately impacts populations that have been historically marginalised (eg, low socioeconomic status, rural, some racial/ethnic minority groups). Evidence-based interventions (EBIs) for weight management exist but reach less than 3% of eligible individuals. The aims of this pilot randomised controlled trial are to evaluate feasibility and acceptability of dissemination strategies designed to increase reach of EBIs for weight management. METHODS AND ANALYSIS This study is a two-phase, Sequential Multiple Assignment Randomized Trial, conducted with 200 Medicaid patients. In phase 1, patients will be individually randomised to single text message (TM1) or multiple text messages (TM+). Phase 2 is based on treatment response. Patients who enrol in the EBI within 12 weeks of exposure to phase 1 (ie, responders) receive no further interventions. Patients in TM1 who do not enrol in the EBI within 12 weeks of exposure (ie, TM1 non-responders) will be randomised to either TM1-Continued (ie, no further TM) or TM1 & MAPS (ie, no further TM, up to 2 Motivation And Problem Solving (MAPS) navigation calls) over the next 12 weeks. Patients in TM+ who do not enrol in the EBI (ie, TM+ non-responders) will be randomised to either TM+Continued (ie, monthly text messages) or TM+ & MAPS (ie, monthly text messages, plus up to 2 MAPS calls) over the next 12 weeks. Descriptive statistics will be used to characterise feasibility (eg, proportion of patients eligible, contacted and enrolled in the trial) and acceptability (eg, participant opt-out, participant engagement with dissemination strategies, EBI reach (ie, the proportion of participants who enrol in EBI), adherence, effectiveness). ETHICS AND DISSEMINATION Study protocol was approved by the University of Utah Institutional Review Board (#00139694). Results will be disseminated through study partners and peer-reviewed publications. TRIAL REGISTRATION NUMBER clinicaltrials.gov; NCT05666323.
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Affiliation(s)
- Chelsey R Schlechter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Dusti R Jones
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Brian Orleans
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen Maxfield
- Osher Center for Integrative Health, University of Utah, Salt Lake City, Utah, USA
- Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amy Locke
- Osher Center for Integrative Health, University of Utah, Salt Lake City, Utah, USA
- Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Richard Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Wirth
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Shanna J Jaggers
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Cho Y Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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Rangraz Jeddi F, Nabovati E, Mobayen M, Akbari H, Feizkhah A, Osuji J, Bagheri Toolaroud P. Health care needs, eHealth literacy, use of mobile phone functionalities, and intention to use it for self-management purposes by informal caregivers of children with burns: a survey study. BMC Med Inform Decis Mak 2023; 23:236. [PMID: 37872538 PMCID: PMC10591411 DOI: 10.1186/s12911-023-02334-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This study aimed to assess health care needs, electronic health literacy, mobile phone usage, and intention to use it for self-management purposes by informal caregivers of children with burn injuries. METHODS This cross-sectional research was carried out in 2021 with 112 informal caregivers of children with burns in a burn center in the north of Iran. The data collection tools were questionnaires that included the participants' demographics, their E-Health Literacy, their current mobile phone usage, and their desires for mobile phone use for burn care services. RESULTS Most informal caregivers had smartphones (83.0%) and Internet access (81.3%). Most participants occasionally used phone calls (63.4%), the Internet (45.5%), and social media (42.9) to receive information about psychosocial disorders, infection control, wound care, pain, itch, physical exercise, and feeding. Most participants have never used some of the mobile phone functionalities to receive burn-related information, such as applications/Software (99.1%) and e-mail (99.1%). Nevertheless, most informal caregivers desire to use mobile applications for self-management purposes in the future (88.4%). The mean eHealth literacy score was 25.01 (SD = 9.61). Informal caregivers who had higher education levels, access to the Internet, and lived in urban areas had higher eHealth literacy (P < 001). CONCLUSION The current research delivers beneficial information about the healthcare needs of informal caregivers and their preference to use mobile functionality to receive burns-related healthcare and rehabilitation information post-discharge. This information can help design and implement mobile health (mHealth) interventions to enhance the self-care skills of informal caregivers.
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Affiliation(s)
- Fatemeh Rangraz Jeddi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hossein Akbari
- Social Determinants of Health (SDH) Research Center, Department of Biostatistics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Feizkhah
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Department of Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Joseph Osuji
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Ab, Canada
| | - Parissa Bagheri Toolaroud
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran.
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran.
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Chun-Hung L, Guan-Hsiung L, Wu-Chuan Y, Yu-Hsin L. Chatbot-assisted therapy for patients with methamphetamine use disorder: a preliminary randomized controlled trial. Front Psychiatry 2023; 14:1159399. [PMID: 37484677 PMCID: PMC10359989 DOI: 10.3389/fpsyt.2023.1159399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Background Methamphetamine (MA) use disorder is associated with a large public health burden. Despite the therapeutic effects of psychosocial interventions based on current evidence, finding an approach to retain patients in treatment remains a real-world challenge. The rapid development of mobile health (mHealth) systems suggests the potential to provide real-time personalized care at any time and from any location, minimize barriers to treatment, maximize use, and promote the dissemination of accessible therapeutic tools in at-risk populations. Our study aimed to investigate the feasibility and effectiveness of chatbots for the treatment of MA use disorder. Method The inclusion criteria were (a) a diagnosis of MA use disorder as defined by the DSM-5, (b) age between 18 and 65 years, (c) no acute exacerbation of severe mental illness during the initial assessment, such as schizophrenia or bipolar I disorder, (d) willingness to participate in standard outpatient treatment for ≥ 6 months, and (e) an Android phone. Participants were randomly allocated to either a chatbot-assisted therapy via smartphone (CAT) group or a control group following simple randomization procedures (computerized random numbers) without blinding. All participants were followed up for 6 months. Treatment retention and monthly urine test results were analyzed as outcome measures. Participants' satisfaction with CAT was also assessed. Results In total, 50 and 49 participants were allocated to the CAT and control groups, respectively. There were no significant differences in retention time between the two treatment groups (df = 1, p = 0.099). The CAT group had fewer MA-positive urine samples than the control group (19.5% vs. 29.6%, F = 9.116, p = 0.003). The proportion of MA-positive urine samples was positively correlated with the frequency of MA use (r = 0.323, p = 0.001), severity of MA use disorder (r = 0.364, p < 0.001), and polysubstance use (r = 0.212, p = 0.035), and negatively correlated with readiness to change (r = -0.330, p = 0.001). Totally 55 participants completed the study at the 6-month follow-up and 60% reported relative satisfaction. Conclusion Participants in this study had favorable acceptance and generally positive outcomes, which indicates that chatbot is feasible for treating people who use MA.
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Affiliation(s)
- Lee Chun-Hung
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
- Jianan Psychiatric Center, Ministry of Health and Welfare (MOHW), Tainan, Taiwan
| | - Liaw Guan-Hsiung
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Yang Wu-Chuan
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Liu Yu-Hsin
- King's College London, Florence Nightingale School of Nursing & Midwifery, London, United Kingdom
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Stump TK, Wetter DW, Kuzmenko T, Orleans B, Kolp L, Wirth J, Del Fiol G, Chipman J, Haaland B, Kaphingst KA, Hersh AL, Wu YP. Preliminary Reach of an Information Technology Approach to Support COVID-19 Testing in Schools. Pediatrics 2023; 152:e2022060352E. [PMID: 37394508 PMCID: PMC10312282 DOI: 10.1542/peds.2022-060352e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES SCALE-UP Counts tests population health management interventions to promote coronavirus disease 2019 (COVID-19) testing in kindergarten through 12th-grade schools that serve populations that have been historically marginalized. METHODS Within 6 participating schools, we identified 3506 unique parents/guardians who served as the primary contact for at least 1 student. Participants were randomized to text messaging (TM), text messaging + health navigation (HN) (TM + HN), or usual care. Bidirectional texts provided COVID-19 symptom screening, along with guidance on obtaining and using tests as appropriate. If parents/guardians in the TM + HN group were advised to test their child but either did not test or did not respond to texts, they were called by a trained health navigator to address barriers. RESULTS Participating schools served a student population that was 32.9% non-white and 15.4% Hispanic, with 49.6% of students eligible to receive free lunches. Overall, 98.8% of parents/guardians had a valid cell phone, of which 3.8% opted out. Among the 2323 parents/guardians included in the intervention, 79.6% (n = 1849) were randomized to receive TM, and 19.1% (n = 354) engaged with TM (ie, responded to at least 1 message). Within the TM + HN group (40.1%, n = 932), 1.3% (n = 12) qualified for HN at least once, of which 41.7% (n = 5) talked to a health navigator. CONCLUSIONS TM and HN are feasible ways to reach parents/guardians of kindergarten through 12th-grade students to provide COVID-19 screening messages. Strategies to improve engagement may strengthen the impact of the intervention.
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Affiliation(s)
- Tammy K. Stump
- Departments of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - David W. Wetter
- Population Health Sciences
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Brian Orleans
- Population Health Sciences
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Leighann Kolp
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jennifer Wirth
- Population Health Sciences
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Jonathan Chipman
- Population Health Sciences
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | | | - Yelena P. Wu
- Departments of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Gatwood J, Brookhart A, Kinney O, Hagemann T, Chiu CY, Ramachandran S, Gravlee E, Hohmeier K. Impact of patient and provider nudges on addressing herpes zoster vaccine series completion. Vaccine 2023; 41:778-786. [PMID: 36526504 DOI: 10.1016/j.vaccine.2022.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine the combined impact of provider-facing and text message-based, patient nudges on herpes zoster vaccine series completion. METHODS Following a period during which Kroger Health implemented provider facing nudges, select US patients that initiated herpes zoster vaccination were randomized to receive timed text messages when the second dose was due and available as part of a quality improvement exercise. Main comparisons were between patients intervened by provider nudge only and those intervened by both provider and patient nudges. Data were assessed by GEE-basedlogistic and linear regression, controlling for available patient- and store-level characteristics, and geospatial analyses. RESULTS During the baseline period, 100,627 adults received at least one HZ vaccine dose and 83.9% completed the series within 6 months over 88.6 days (SD: 26.53) on average. In the intervention period, 120,339 adults were vaccinated at least once and series completion was 88.3% (both provider nudges and text messaging) and 85.3% (not texted) during this observation window (both p < 0.0001). Time between doses was shorter for those who received text messages compared to both the baseline period and those in the intervention period that were not texted (both p < 0.001). Controlling for multiple characteristics, the odds of completion improved in the intervention period compared to baseline (OR: 1.07; 95% CI: 1.033-1.111), but a noticeably higher completion odds was observed amongst patients who received a text message in the intervention period (OR: 1.35; 95% CI: 1.286-1.414). Adjusting for patient and pharmacy factors, those who were texted received their second herpes zoster vaccine dose 8.6 days sooner (95% CI: -9.08 - -8.17, p < 0.0001) compared to those intervened by the provider nudge only. CONCLUSION The combined use of clinical and patient-focused nudges is a simple mechanism by which pharmacies and other health care access points can address the multi-dose vaccine needs of diverse patient populations.
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Affiliation(s)
- Justin Gatwood
- University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Nashville, TN 37211, USA.
| | | | - Olivia Kinney
- Kroger Health, 555 Race Street, Cincinnati, OH 45202, USA
| | - Tracy Hagemann
- University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Nashville, TN 37211, USA
| | - Chi-Yang Chiu
- University of Tennessee Health Science Center, College of Medicine, Doctor's Office Building, Memphis, TN 38163, USA
| | - Sujith Ramachandran
- University of Mississippi, School of Pharmacy, P.O. Box 1848, Oxford, MS 38677, USA
| | - Emily Gravlee
- University of Mississippi, School of Pharmacy, P.O. Box 1848, Oxford, MS 38677, USA
| | - Kenneth Hohmeier
- University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Nashville, TN 37211, USA
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Murillo R, Ordóñez-Reyes C, Caicedo-Martínez M, Vargas SP, Ariza E, Schüz J, Espina C. Coverage and Acceptability of Mobile Phone Messages for Cancer Prevention: a Population-Based Study in a Latin American Country. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1000-1008. [PMID: 33185816 PMCID: PMC9399024 DOI: 10.1007/s13187-020-01912-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
Mobile health (m-health) has shown positive effects on disease prevention; however, several factors might influence its effectiveness, particularly in low- and middle-income countries. Randomized trials provide data with high internal validity but no major information on population impact. We conducted a pilot population-based study to assess the feasibility of cancer prevention through m-health in a Latin American population. A sample of affiliates to a health insurance company in Colombia was randomly selected and assigned to receive a short message service (SMS) or voice messages (VMS) during 4 weeks; weekly frequencies 2 and 7. Baseline and post-intervention surveys were conducted. Overall, 797 affiliates were contacted (SMS 393, VMS 404) but only 15.3% and 24.8% enrolled, respectively. Over 80% acceptability was observed among participants for all items evaluated (usefulness, understandability, timing, and frequency); however, 2-VMS per week was the only frequency consistent with the declared number of messages received and listened. Other frequencies resulted in high reception recall but low willingness to read/listen the messages. The willingness to be part of future programs was 20.0%. The gap between declared acceptability and practice, low participation rates, and low willingness to read/listen messages indicate m-health should be part of multicomponent interventions and should not be conceived as the sole intervention.
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Affiliation(s)
- Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
- Bogotá, Colombia
| | - Camila Ordóñez-Reyes
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Sandra Paola Vargas
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Elsa Ariza
- Gerencia de Prestación de Servicios - Nueva EPS, Bogotá, Colombia
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Carolina Espina
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
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Sampathkumar S, Sankar M, Ramasamy S, Sriram N, Saravanan P, Ram U. Uptake, Engagement and Acceptance, Barriers and Facilitators of a Text Messaging Intervention for Postnatal Care of Mother and Child in India-A Mixed Methods Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158914. [PMID: 35897288 PMCID: PMC9329952 DOI: 10.3390/ijerph19158914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 12/07/2022]
Abstract
This study aimed to test the feasibility and to identify barriers and facilitators towards adherence of a text messaging intervention for postnatal care in India. Mixed methods research involving both quantitative and qualitative methods were used. A survey questionnaire for feasibility and focus group interviews to identify the barriers and facilitators to the intervention were conducted. The top three reasons for activation of service were: helped the new mother to understand the changes (95%); provided continuation of care (90%) and clarified conflicting information (89%). Over 90% read the messages daily. 80% were happy with the message frequency. About 75% shared the content with others. The main reasons for non-activation were: 30% had technical issues, 15% did not think it would be useful, 17% did not have time to activate and for 5%, husbands made the decision. These findings were triangulated through the qualitative focus groups. The main themes identified via the focus groups were: (1) reliable, current information; (2) issues and themes well aligned with new mothers' needs and priorities; (3) expanded the repertoire of information sources available; and (4) high-quality accessible information. The satisfaction and trust rates were high. This technology may be useful for health information intervention in specific postnatal areas.
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Affiliation(s)
- Swetha Sampathkumar
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry CV4 7AL, UK;
| | | | | | - Nivedita Sriram
- UT South Western Medical School, Dallas, TX 75390, USA;
- Brown University, Providence, RI 02912, USA
| | - Ponnusamy Saravanan
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry CV4 7AL, UK;
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton CV10 7DJ, UK
- Correspondence: (P.S.); (U.R.); Tel.: +44-2476863512 (P.S.); +91-44-49496666 (U.R.)
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai 600014, India
- Correspondence: (P.S.); (U.R.); Tel.: +44-2476863512 (P.S.); +91-44-49496666 (U.R.)
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Information and Communication Technologies in Lung Transplantation: Perception of Patients and Medical Teams. PHARMACY 2022; 10:pharmacy10040075. [PMID: 35893713 PMCID: PMC9326681 DOI: 10.3390/pharmacy10040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Optimal therapeutic management is a major determinant of patient prognosis and healthcare costs. Information and communication technologies (ICTs) represent an opportunity to enhance therapeutic management in complex chronic diseases, such as lung transplantation (LT). The objective of this study was to assess the preferences of LT patients and healthcare professionals regarding ICTs in LT therapeutic management. A cross-sectional opinion survey was conducted among lung transplant patients and healthcare professionals from the French lung transplantation centers. Five ICTs were defined (SMS, email, phone, internet, and smartphone application) in addition to face-to-face communication. An unsupervised approach by Principal Component Analysis (PCA) identified lung transplant patient profiles according to their preferences for ICTs. Fifty-three lung transplant patients and 15 healthcare professionals of the French LT centers were included. Both expected ICTs for treatment management and communication. Phone call, face-to-face, and emails were the most preferred communication tools for treatment changes and initiation. PCA identified four ICTs-related profiles (“no ICT”, “email”, “SMS”, and “oral communication”). “Email” and “oral communication” profiles are mainly concerned with treatment changes and transmission of new prescriptions. The “SMS” profile expected reminders for healthcare appointments and optimizing therapeutic management. This study provides practical guidance to enhance LT therapeutic management by ICT intervention. The type of ICT used should take into account patient profiles to improve adherence and thereby the prognosis. A combination of strategies including information, education by a multidisciplinary team, and reminders is a promising approach to ensure an optimal management of our patients.
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Wrobel J, Silvasstar J, Peterson R, Sumbundu K, Kelley A, Stephens D, Craig Rushing S, Bull S. Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns. JMIR Form Res 2022; 6:e32138. [PMID: 35212633 PMCID: PMC8917435 DOI: 10.2196/32138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Many American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness, and help-seeking skills may be an effective strategy for promoting health and wellbeing among AI/AN youth. The Northwest Portland Area Indian Health Board designed the BRAVE intervention for AI/AN youth. BRAVE is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective The aim of this study is to explore system data from the BRAVE intervention to determine patterns of user engagement and differences in psychosocial outcomes based on the number of clicks on BRAVE content. Methods The BRAVE study included 1030 AI/AN teens and young adults nationwide (15 to 24 years old). The message series in the BRAVE and STEM study arms included 3 to 5 SMS text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons (Upland Software Inc), a mobile messaging provider that supports text, picture, and video SMS. Results Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least 1 trackable click on a study SMS text message. Of the 270, 184 (68.1%) were female, 50 (18.5%) were male, and 36 (13.3%) selected another gender category. The average participant was 20.6 years old, with a minimum and maximum age of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2; mean 3.4), although others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing 1 of 7 role model videos), with 64.8% (175/270) of total clicks coming from the role model videos, and earlier episodes receiving the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P<.001), with a rate ratio of 0.82 (0.73, 0.92), indicating that each 1-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study content clicks. Conclusions This is the first study to set initial standards for assessing user engagement in an mHealth intervention. Our work underscores the feasibility of exploring the impact of engagement on intended outcomes, allowing for more precise exploration of the dose-response relationship that may be realized through these low-touch interventions that offer promising potential for reaching high numbers of program participants. Trial Registration ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481
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Affiliation(s)
- Julia Wrobel
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Joshva Silvasstar
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Roger Peterson
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Kanku Sumbundu
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Allyson Kelley
- Allyson Kelley and Associates PLLC, Sisters, OR, United States
| | - David Stephens
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | | | - Sheana Bull
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
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Selvaraju S, Malaisamy M, Dolla CK, Murali L, Karikalan N, Saravanan B, Tholkappian AS, Tripathy SP. Application of mobile phone technology as intervention for the management of tuberculosis patients diagnosed through community survey. Indian J Med Res 2022; 155:301-305. [PMID: 35946208 PMCID: PMC9629519 DOI: 10.4103/ijmr.ijmr_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background & objectives The delay in communicating the results to tuberculosis (TB) patients leads to increased rates of initial loss to follow up of treatment. The gap in communication among healthcare providers requires application of new tools that will address the challenges. Mobile phone technologies could be a useful tool in this context for the delivery of information. The objective was thus to evaluate communication by mobile applications such as the WhatsApp Messenger to decrease initial loss to follow up after initial treatment for TB. Methods Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India undertook a community prevalence survey to find the burden of TB. During this survey, mobile phone-based technology (WhatsApp messenger) was employed as an intervention among the healthcare providers and researchers involved for communicating. This was further evaluated for its usefulness by examining the initial loss to follow up and patients initiated on treatment. Results The study covered four blocks of Thiruvallur district of Tamil Nadu, South India, namely Kadambathur, Poondi, Thiruvalangadu and Periyapalayam. The survey population was around 20,000 from each block, and the average patients diagnosed by community TB prevalence survey were 30 patients from each block. Among the patients diagnosed through this survey, in the first block, only 55 per cent were initiated on treatment; subsequently, with the intervention, the initial loss to follow up was significantly reduced from 45 to zero per cent. Interpretation & conclusions After integrating of WhatsApp messenger application for communication among healthcare providers and researchers, the initial loss to follow up among patients being treated for TB was significantly decreased.
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Affiliation(s)
- Sriram Selvaraju
- Department of Epidemiology, ICMR-NIRT, Chetput, Chennai, Tamil Nadu, India
| | - Muniyandi Malaisamy
- Department of Health Economics, ICMR-NIRT, Chetput, Chennai, Tamil Nadu, India
| | | | - Lakshmi Murali
- District TB Center, Poonamallee, Thiruvallur, Tamil Nadu, India
| | - Nagarajan Karikalan
- Department of Health Economics, ICMR-NIRT, Chetput, Chennai, Tamil Nadu, India
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Khunti K, Griffin S, Brennan A, Dallosso H, Davies M, Eborall H, Edwardson C, Gray L, Hardeman W, Heathcote L, Henson J, Morton K, Pollard D, Sharp S, Sutton S, Troughton J, Yates T. Behavioural interventions to promote physical activity in a multiethnic population at high risk of diabetes: PROPELS three-arm RCT. Health Technol Assess 2022; 25:1-190. [PMID: 34995176 DOI: 10.3310/hta25770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a leading cause of mortality globally and accounts for significant health resource expenditure. Increased physical activity can reduce the risk of diabetes. However, the longer-term clinical effectiveness and cost-effectiveness of physical activity interventions in those at high risk of type 2 diabetes is unknown. OBJECTIVES To investigate whether or not Walking Away from Diabetes (Walking Away) - a low-resource, 3-hour group-based behavioural intervention designed to promote physical activity through pedometer use in those with prediabetes - leads to sustained increases in physical activity when delivered with and without an integrated mobile health intervention compared with control. DESIGN Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with follow-up conducted at 12 and 48 months. SETTING Primary care and the community. PARTICIPANTS Adults whose primary care record included a prediabetic blood glucose measurement recorded within the past 5 years [HbA1c ≥ 42 mmol/mol (6.0%), < 48 mmol/mol (6.5%) mmol/mol; fasting glucose ≥ 5.5 mmol/l, < 7.0 mmol/l; or 2-hour post-challenge glucose ≥ 7.8 mmol/l, < 11.1 mmol/l] were recruited between December 2013 and February 2015. Data collection was completed in July 2019. INTERVENTIONS Participants were randomised (1 : 1 : 1) using a web-based tool to (1) control (information leaflet), (2) Walking Away with annual group-based support or (3) Walking Away Plus (comprising Walking Away, annual group-based support and a mobile health intervention that provided automated, individually tailored text messages to prompt pedometer use and goal-setting and provide feedback, in addition to biannual telephone calls). Participants and data collectors were not blinded; however, the staff who processed the accelerometer data were blinded to allocation. MAIN OUTCOME MEASURES The primary outcome was accelerometer-measured ambulatory activity (steps per day) at 48 months. Other objective and self-reported measures of physical activity were also assessed. RESULTS A total of 1366 individuals were randomised (median age 61 years, median body mass index 28.4 kg/m2, median ambulatory activity 6638 steps per day, women 49%, black and minority ethnicity 28%). Accelerometer data were available for 1017 (74%) and 993 (73%) individuals at 12 and 48 months, respectively. The primary outcome assessment at 48 months found no differences in ambulatory activity compared with control in either group (Walking Away Plus: 121 steps per day, 97.5% confidence interval -290 to 532 steps per day; Walking Away: 91 steps per day, 97.5% confidence interval -282 to 463). This was consistent across ethnic groups. At the intermediate 12-month assessment, the Walking Away Plus group had increased their ambulatory activity by 547 (97.5% confidence interval 211 to 882) steps per day compared with control and were 1.61 (97.5% confidence interval 1.05 to 2.45) times more likely to achieve 150 minutes per week of objectively assessed unbouted moderate to vigorous physical activity. In the Walking Away group, there were no differences compared with control at 12 months. Secondary anthropometric, biomechanical and mental health outcomes were unaltered in either intervention study arm compared with control at 12 or 48 months, with the exception of small, but sustained, reductions in body weight in the Walking Away study arm (≈ 1 kg) at the 12- and 48-month follow-ups. Lifetime cost-effectiveness modelling suggested that usual care had the highest probability of being cost-effective at a threshold of £20,000 per quality-adjusted life-year. Of 50 serious adverse events, only one (myocardial infarction) was deemed possibly related to the intervention and led to the withdrawal of the participant from the study. LIMITATIONS Loss to follow-up, although the results were unaltered when missing data were replaced using multiple imputation. CONCLUSIONS Combining a physical activity intervention with text messaging and telephone support resulted in modest, but clinically meaningful, changes in physical activity at 12 months, but the changes were not sustained at 48 months. FUTURE WORK Future research is needed to investigate which intervention types, components and features can help to maintain physical activity behaviour change over the longer term. TRIAL REGISTRATION Current Controlled Trials ISRCTN83465245. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 77. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Applied Research Collaboration, East Midlands, UK
| | - Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration, East Midlands, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Helen Eborall
- Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Charlotte Edwardson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Laura Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laura Heathcote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Joseph Henson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katie Morton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Innovia Technology Limited, Cambridge, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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18
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Risling T, Carlberg C, Kassam I, Moss T, Janssen P, Iduye S, Strudwick G. Supporting population mental health and wellness during the COVID-19 pandemic in Canada: protocol for a sequential mixed-method study. BMJ Open 2021; 11:e052259. [PMID: 34794993 PMCID: PMC8602926 DOI: 10.1136/bmjopen-2021-052259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The global COVID-19 pandemic has reported to have a negative impact on the mental health and well-being of individuals around the world. Mental health system infrastructure, primarily developed to support individuals through in-person care, struggled to meet rising demand for services even prior to COVID-19. With public health guidelines requiring the use of physical distancing during the pandemic, digital mental health supports may be one way to address the needs of the population. Despite this, barriers exist in promoting and supporting access to existing and emerging digital resources. Text messaging may address some of these barriers, extending the potential reach of these digital interventions across divides that may separate some vulnerable or disadvantaged groups from essential mental health supports. Building on an existing knowledge synthesis project identifying key digital resources for improved mental health, this research will establish low-tech connections to assess need and better match access to services for those who need it most. The aim of this study is to codesign a customised two-way texting service to explore need and better align access to mental health supports for Canadians located in Saskatchewan during the COVID-19 pandemic. METHODS AND ANALYSIS This study will be completed in Saskatchewan, Canada. For this project, the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will be used to support three phases of a sequential mixed-method study. An advisory committee of Saskatchewan residents will guide this work with the study team. A 10-week service will be launched to connect individuals with appropriately suited digital mental health interventions through the use of text messaging. In phase 1, implementation and prototyping will be conducted with collaborative codesign for key elements related to features of an enrolment survey and initial messaging content. Phase 2 will focus on advancing the effectiveness of the service using quantitative user data. In phase 3, an embedding approach will be used to integrate both qualitative and quantitative data collected to understand the overall acceptability, satisfaction and perceived benefit of the text messaging service. Thematic analysis and descriptive statistics will be used as analytic methods. ETHICS AND DISSEMINATION This study has received approval from the Research Ethics Board at the University of Saskatchewan. A knowledge dissemination plan has been developed that includes traditional academic approaches such as conference presentations, and academic publications, as well as mainstream approaches such as social media, radio and dissemination through the advisory committee.
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Affiliation(s)
- Tracie Risling
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Courtney Carlberg
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Iman Kassam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tyler Moss
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Patricia Janssen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Iduye
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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19
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Yakovchenko V, McInnes DK, Petrakis BA, Gillespie C, Lipschitz JM, McCullough MB, Richardson L, Vetter B, Hogan TP. Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework. JMIR Mhealth Uhealth 2021; 9:e31037. [PMID: 34779779 PMCID: PMC8663696 DOI: 10.2196/31037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Jessica M Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Megan B McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Public Health, University of Massachusetts, Lowell, MA, United States
| | - Lorilei Richardson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Brian Vetter
- Office of Connected Care, Veterans Health Administration, Washington, DC, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
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20
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Bae JW, Woo SI, Lee J, Park SD, Kwon SW, Choi SH, Yoon GS, Kim MS, Hwang SS, Lee WK. mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e29928. [PMID: 34559058 PMCID: PMC8501404 DOI: 10.2196/29928] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/07/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile. Objective This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI). Methods A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and adherence to the recommended health behaviors. Results Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62% (relative risk 1.62, 95% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes. Conclusions Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease. Trial Registration Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282
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Affiliation(s)
- Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seoung-Il Woo
- Department of Cardiology, School of Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea
| | - Joongyub Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Don Park
- Department of Cardiology, School of Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea
| | - Sung Woo Kwon
- Department of Cardiology, School of Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea
| | - Seong Huan Choi
- Department of Cardiology, School of Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea
| | - Gwang-Seok Yoon
- Department of Cardiology, School of Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea
| | - Mi-Sook Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Sik Hwang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Won Kyung Lee
- Department of Prevention and Management, School of Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea
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21
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Craig Rushing S, Kelley A, Bull S, Stephens D, Wrobel J, Silvasstar J, Peterson R, Begay C, Ghost Dog T, McCray C, Love Brown D, Thomas M, Caughlan C, Singer M, Smith P, Sumbundu K. Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial. JMIR Ment Health 2021; 8:e26158. [PMID: 34524092 PMCID: PMC8482172 DOI: 10.2196/26158] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. OBJECTIVE We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. METHODS From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. RESULTS A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618) at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. CONCLUSIONS This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. TRIAL REGISTRATION ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481.
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Affiliation(s)
| | - Allyson Kelley
- Allyson Kelley & Associates PLLC, Sisters, OR, United States
| | - Sheana Bull
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, aurora, CO, United States
| | - David Stephens
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Julia Wrobel
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, aurora, CO, United States
| | - Joshva Silvasstar
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, aurora, CO, United States
| | - Roger Peterson
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Corey Begay
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Thomas Ghost Dog
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Celena McCray
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Danica Love Brown
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Morgan Thomas
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Colbie Caughlan
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Paige Smith
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Kanku Sumbundu
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, aurora, CO, United States
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22
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Lim SY, Lee KW, Seow WL, Mohamed NA, Devaraj NK, Amin-Nordin S. Effectiveness of Integrated Technology Apps for Supporting Healthy Food Purchasing and Consumption: A Systematic Review. Foods 2021; 10:1861. [PMID: 34441638 PMCID: PMC8392602 DOI: 10.3390/foods10081861] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
A healthy diet is essential for good health and nutrition, though literature showed that there are various factors affecting the intention to purchase and consume healthy food. Technology integration is known to be useful in various aspects, but findings from studies on the efficacy of technology integration to improve healthy food consumption and purchase have largely been inconsistent. Therefore, we aimed to examine the efficacy of interventions that use technology apps to improve healthy food purchasing and consumption in adults. Relevant studies were identified through PubMed, Scopus, CINAHL, SportDiscuss and ACM Digital Library. Twenty studies were included in the systematic review. The majority of studies (n = 18) used a smartphone in the intervention, and only two studies used a personal digital assistant. The results showed that technology integration-based intervention favoured healthy changes in household food purchases, and increased consumption of healthy food and healthy eating outcomes - albeit to different extents. Overall, technology apps are convenient and user-friendly tools to encourage a change in healthy food purchase and consumption among people.
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Affiliation(s)
- Sook Yee Lim
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.Y.L.); (W.-L.S.)
- Faculty of Applied Sciences, UCSI University, Cheras 56000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang 43000, Selangor, Malaysia;
| | - Wen-Li Seow
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.Y.L.); (W.-L.S.)
| | - Nurul Azmawati Mohamed
- Department of Basic Medical Sciences 2, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Bandar Baru Nilai, Nilai 71800, Negeri Sembilan, Malaysia;
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Syafinaz Amin-Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.Y.L.); (W.-L.S.)
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23
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Glasgow RE, Knoepke CE, Magid D, Grunwald GK, Glorioso TJ, Waughtal J, Marrs JC, Bull S, Ho PM. The NUDGE trial pragmatic trial to enhance cardiovascular medication adherence: study protocol for a randomized controlled trial. Trials 2021; 22:528. [PMID: 34380527 PMCID: PMC8356469 DOI: 10.1186/s13063-021-05453-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Nearly half of patients do not take their cardiovascular medications as prescribed, resulting in increased morbidity, mortality, and healthcare costs. Mobile and digital technologies for health promotion and disease self-management offer an opportunity to adapt behavioral “nudges” using ubiquitous mobile phone technology to facilitate medication adherence. The Nudge pragmatic clinical trial uses population-level pharmacy data to deliver nudges via mobile phone text messaging and an artificial intelligent interactive chat bot with the goal of improving medication adherence and patient outcomes in three integrated healthcare delivery systems. Methods The Theory of mHealth, the Expanded RE-AIM/PRISM, and the PRECIS-2 frameworks were used for program planning, implementation, and evaluation, along with a focus on dissemination and cost considerations. During the planning phase, the Nudge study team developed and piloted a technology-based nudge message and chat bot of optimized interactive content libraries for a range of diverse patients. Inclusion criteria are very broad and include patients in one of three diverse health systems who take medications to treat hypertension, atrial fibrillation, coronary artery disease, diabetes, or hyperlipidemia. A target of approximately 10,000 participants will be randomized to one of 4 study arms: usual care (no intervention), generic nudge (text reminder), optimized nudge, and optimized nudge plus interactive AI chat bot. The PRECIS-2 tool indicated that the study protocol is very pragmatic, although there is variability across PRECIS-2 dimensions. Discussion The primary effectiveness outcome is medication adherence defined by the proportion of days covered (PDC) using pharmacy refill data. Implementation outcomes are assessed using the RE-AIM framework, with a particular focus on reach, consistency of implementation, adaptations, cost, and maintenance/sustainability. The project has limitations including limited power to detect some subgroup effects, medication complications (bleeding), and longer-term outcomes (myocardial infarction). Strengths of the study include the diverse healthcare systems, a feasible and generalizable intervention, transparent reporting using established pragmatic research and implementation science frameworks, strong stakeholder engagement, and planning for dissemination and sustainment. Trial registration ClinicalTrials.govNCT03973931. Registered on 4 June 2019. The study was funded by the NIH; grant number is 4UH3HL144163-02 issued 4/5/19. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05453-9.
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Affiliation(s)
- Russell E Glasgow
- Department of Family Medicine, University of Colorado Denver - Anschutz Medical Campus, Denver, USA. .,Dissemination and Implementation Science Program of ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), Aurora, USA.
| | - Christopher E Knoepke
- Department of Medicine, Division of Cardiology, University of Colorado Denver - Anschutz Medical Campus, Denver, USA.,ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), Aurora, USA
| | - David Magid
- University of Colorado Denver - Anschutz, Denver, USA
| | - Gary K Grunwald
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Denver, USA.,U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Joy Waughtal
- mHealth Impact Laboratory Colorado School of Public Health, Aurora, USA
| | - Joel C Marrs
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Sheana Bull
- mHealth Impact Laboratory Colorado School of Public Health, Aurora, USA.,Department of Community and Behavioral Health, Aurora, USA.,Digital Education, Denver, USA
| | - P Michael Ho
- Department of Medicine, University of Colorado School of Medicine, Aurora, USA.,VA Eastern Colorado Health Care System, Aurora, USA
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Scott K, Ummer O, Shinde A, Sharma M, Yadav S, Jairath A, Purty N, Shah N, Mohan D, Chamberlain S, LeFevre AE. Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India. BMJ Glob Health 2021; 6:bmjgh-2021-005868. [PMID: 34312156 PMCID: PMC8327813 DOI: 10.1136/bmjgh-2021-005868] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/11/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction Kilkari is one of the world’s largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged. Methods We used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari’s calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices. Results While women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari’s recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding. Conclusion To deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.
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Affiliation(s)
- Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Osama Ummer
- Oxford Policy Management, New Delhi, India.,BBC Media Action, New Delhi, India
| | - Aashaka Shinde
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | - Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Amnesty Elizabeth LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Sarfo FS, Akpalu A, Bockarie A, Appiah L, Nguah SB, Ayisi-Boateng NK, Adamu S, Neizer C, Arthur A, Nyamekye R, Agyenim-Boateng K, Tagge R, Adusei-Mensah N, Ampofo M, Laryea R, Singh A, Amuasi JH, Ovbiagele B. Phone-Based Intervention under Nurse Guidance after Stroke (PINGS II) Study: Protocol for a Phase III Randomized Clinical Trial. J Stroke Cerebrovasc Dis 2021; 30:105888. [PMID: 34102553 PMCID: PMC8282744 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105888] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/24/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The Sub-Saharan African (SSA) region now has the highest estimated effect size of hypertension for stroke causation worldwide. An urgent priority for countries in SSA is to develop and test self-management interventions to control hypertension among those at highest risk of adverse outcomes. Thus the overall objective of the Phone-based Intervention under Nurse Guidance after Stroke II study (PINGS-2) is to deploy a hybrid study design to assess the efficacy of a theoretical-model-based, mHealth technology-centered, nurse-led, multi-level integrated approach to improve longer term blood pressure (BP) control among stroke survivors. MATERIALS AND METHODS A phase III randomized controlled trial involving 500 recent stroke survivors to be enrolled across 10 Ghanaian hospitals. Using a computer-generated sequence, patients will be randomly assigned 1:1 into the intervention or usual care arms. The intervention comprises of (i) home BP monitoring at least once weekly with nurse navigation for high domiciliary BP readings; (2) medication reminders using mobile phone alerts and (3) education on hypertension and stroke delivered once weekly via audio messages in preferred local dialects. The intervention will last for 12 months. The control group will receive usual care as determined by local guidelines. The primary outcome is the proportion of patients with systolic BP <140 mm Hg at 12 months. Secondary outcomes will include medication adherence, self-management of hypertension, major adverse cardiovascular events, health related quality of life and implementation outcomes. CONCLUSION An effective PINGS intervention can potentially be scaled up and disseminated across healthcare systems in low-and-middle income countries challenged with resource constraints to reduce poor outcomes among stroke survivors.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | - Lambert Appiah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Samuel Blay Nguah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | - Agnes Arthur
- Ankaase Methodist Faith Hospital, Ankaase, Ghana
| | | | | | - Raelle Tagge
- Northern California Institute of Research and Education, USA
| | | | | | | | - Arti Singh
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kuriyama A, Fujii H, Hotta A, Asanuma R, Irie H. Prevalence of bacterial contamination of touchscreens and posterior surfaces of smartphones owned by healthcare workers: a cross-sectional study. BMC Infect Dis 2021; 21:681. [PMID: 34256724 PMCID: PMC8276544 DOI: 10.1186/s12879-021-06379-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/30/2021] [Indexed: 02/01/2023] Open
Abstract
Background Mobile phones used by healthcare workers (HCWs) are contaminated with bacteria, but the posterior surface of smartphones has rarely been studied. The aim of this study was to compare the prevalence of microbial contamination of touchscreens and posterior surfaces of smartphones owned by HCWs. Methods A cross-sectional study of smartphones used by HCWs employed at two intensive care units at a Japanese tertiary care hospital was performed. Bacteria on each surface of the smartphones were isolated separately. The primary outcomes were the prevalence of microbial contamination on each surface of smartphones and associated bacterial species. Fisher’s exact test was used to compare dichotomous outcomes. Results Eighty-four HCWs participated in this study. The touchscreen and posterior surface were contaminated in 27 (32.1%) and 39 (46.4%) smartphones, respectively, indicating that the posterior surface was more frequently contaminated (p = 0.041). Bacillus species and coagulase-negative staphylococci were isolated from each surface of the smartphones. Conclusions The posterior surface of a smartphone was more significantly contaminated with bacteria than the touchscreen, regardless of having a cover. Therefore, routine cleaning of the posterior surface of a smartphone is recommended.
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Affiliation(s)
- Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.
| | - Hiroyuki Fujii
- Department of Clinical Laboratory, Kurashiki Central Hospital, Okayama, Japan
| | - Aki Hotta
- Intensive Care Unit, Kurashiki Central Hospital, Okayama, Japan
| | - Rina Asanuma
- Emergency Intensive Care Unit, Kurashiki Central Hospital, Okayama, Japan
| | - Hiromasa Irie
- Department of Anesthesiology, Kurashiki Central Hospital, Okayama, Japan
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Levine G, Salifu A, Mohammed I, Fink G. Mobile nudges and financial incentives to improve coverage of timely neonatal vaccination in rural areas (GEVaP trial): A 3-armed cluster randomized controlled trial in Northern Ghana. PLoS One 2021; 16:e0247485. [PMID: 34010312 PMCID: PMC8133473 DOI: 10.1371/journal.pone.0247485] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/07/2021] [Indexed: 12/22/2022] Open
Abstract
Background Despite progress in vaccination coverage, timeliness of childhood vaccination remains a challenge in many settings. We aimed to assess if mobile phone-based reminders and incentives to health workers and caregivers could increase timely neonatal vaccination in a rural, low-resource setting. Methods We conducted an open-label cluster randomized controlled 1:1:1 trial with three arms in 15 communities in Northern Ghana. Communities were randomized to 1) a voice call reminder intervention; 2) a community health volunteer (CHV) intervention with incentivized rewards; 3) control. In the voice call reminder arm, a study staff member made voice calls to mothers shortly after birth to encourage vaccination and provide personalized information about available vaccination services. In the incentive arm, CHVs promoted infant vaccination and informed women with recent births about available vaccination opportunities. Both CHVs and women were provided small monetary incentives for on-time early infant vaccination in this arm, delivered using mobile phone-based banking applications. No study activities were conducted in control communities. A population-based survey compared vaccination coverage across arms in the pre-intervention and intervention periods. The primary endpoint was completion of at least one dose of Polio vaccine within 14 days of life and BCG vaccination within 28 days of life. Results Six-hundred ninety births were identified; 106, 88, and 88 from pre-intervention and 150, 135, and 123 in the intervention period, in the control, voice call reminder and CHV incentive arms, respectively. In adjusted intent-to-treat analysis, voice call reminders were associated with 10.5 percentage point (95% CI: 4.0, 17.1) higher coverage of on-time vaccination, while mobile phone-based incentives were associated with 49.5 percentage point (95% CI: 26.4, 72.5) higher coverage. Conclusion Community-based interventions using mobile phone technologies can improve timely early vaccination coverage. A CHV approach with incentives to community workers and caregivers was a more effective strategy than voice call reminders. The impact of vaccination “nudges” via voice calls may be constrained in settings where network coverage and phone ownership are limited. Trial registration This trial was registered at ClinicalTrials.gov; NCT03797950.
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Affiliation(s)
- Gillian Levine
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | | | | | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Luong P, Glorioso TJ, Grunwald GK, Peterson P, Allen LA, Khanna A, Waughtal J, Sandy L, Ho PM, Bull S. Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study. Circ Cardiovasc Qual Outcomes 2021; 14:e007015. [PMID: 33993727 PMCID: PMC8153195 DOI: 10.1161/circoutcomes.120.007015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication refill behavior in patients with cardiovascular diseases is suboptimal. Brief behavioral interventions called Nudges may impact medication refill behavior and can be delivered at scale to patients using text messaging. METHODS Patients who were prescribed and filled at least one medication for hypertension, hyperlipidemia, diabetes, atrial fibrillation, and coronary artery disease were identified for the pilot study. Patients eligible for the pilot (N=400) were enrolled with an opportunity to opt out. In phase I of the pilot, we tested text message delivery to 60 patients. In phase II, we tested intervention feasibility by identifying those with refill gap of ≥7 days and randomized them to intervention or control arms. Patients were texted Nudges and assessed whether they refilled their medications. RESULTS Of 400 patients sent study invitations, 56 (14%) opted out. In phase I, we successfully delivered text messages to 58 of 60 patients and captured patient responses via text. In phase II, 207 of 286 (72.4%) patients had a medication gap ≥7 days for one or more cardiovascular medications and were randomized to intervention or control. Enrolled patients averaged 61.7 years old, were primarily male (69.1%) and White (72.5%) with hypertension being the most prevalent qualifying condition (78.7%). There was a trend towards intervention patients being more likely to refill at least 1 gapping medication (30.6% versus 18.0%; P=0.12) and all gapping medications (17.8% versus 10.0%; P=0.27). CONCLUSIONS It is possible to set up automated processes within health care delivery systems to identify patients with gaps in medication adherence and send Nudges to facilitate medication refills. Text message Nudges could potentially be a feasible and effective method to facilitate medication refills. A large multi-site randomized trial to determine the impact of text-based Nudges on overall CVD morbidity and mortality is now underway to explore this further. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03973931.
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Affiliation(s)
- Phat Luong
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
| | - Thomas J Glorioso
- Veteran Affairs Eastern Colorado Health Care System, Aurora, CO (T.J.G., G.K.G., P.M.H.)
| | - Gary K Grunwald
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
- Veteran Affairs Eastern Colorado Health Care System, Aurora, CO (T.J.G., G.K.G., P.M.H.)
| | - Pamela Peterson
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
- Denver Health and Hospital System, Denver, CO (P.P.)
| | - Larry A Allen
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
| | - Amber Khanna
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
| | - Joy Waughtal
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
| | - Lisa Sandy
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
| | - P Michael Ho
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
- Veteran Affairs Eastern Colorado Health Care System, Aurora, CO (T.J.G., G.K.G., P.M.H.)
| | - Sheana Bull
- University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.)
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Bogale B, Mørkrid K, Abbas E, Abu Ward I, Anaya F, Ghanem B, Hijaz T, Isbeih M, Issawi S, A. S. Nazzal Z, E. Qaddomi S, Frøen JF. The effect of a digital targeted client communication intervention on pregnant women's worries and satisfaction with antenatal care in Palestine-A cluster randomized controlled trial. PLoS One 2021; 16:e0249713. [PMID: 33891597 PMCID: PMC8064599 DOI: 10.1371/journal.pone.0249713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background The eRegCom cluster randomized controlled trial assesses the effectiveness of targeted client communication (TCC) via short message service (SMS) to pregnant women, from a digital maternal and child health registry (eRegistry) in Palestine, on improving attendance and quality of care. In this paper, we assess whether this TCC intervention could also have unintended consequences on pregnant women’s worries, and their satisfaction with antenatal care (ANC). Methods We interviewed a sub-sample of Arabic-speaking women attending ANC at public primary healthcare clinics, randomized to either the TCC intervention or no TCC (control) in the eRegCom trial, who were in 38 weeks of gestation and had a phone number registered in the eRegistry. Trained female data collectors interviewed women by phone from 67 intervention and 64 control clusters, after securing informed oral consent. The Arabic interview guide, pilot-tested prior to the data collection, included close-ended questions to capture the woman’s socio-demographic status, agreement questions about their satisfaction with ANC services, and the 13-item Cambridge Worry Scale (CWS). We employed a non-inferiority study design and an intention-to-treat analysis approach. Results A total of 454 women, 239 from the TCC intervention and 215 from the control arm participated in this sub-study. The mean and standard deviation of the CWS were 1.8 (1.9) for the intervention and 2.0 (1.9) for the control arm. The difference in mean between the intervention and control arms was -0.16 (95% CI: -0.31 to -0.01) after adjusting for clustering, which was below the predefined non-inferiority margin of 0.3. Women in both groups were equally satisfied with the ANC services they received. Conclusion The TCC intervention via SMS did not increase pregnancy-related worries among recipients. There was no difference in women’s satisfaction with the ANC services between intervention and control arms.
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Affiliation(s)
- Binyam Bogale
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - Eatimad Abbas
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Itimad Abu Ward
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Firas Anaya
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Buthaina Ghanem
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | | | - Mervett Isbeih
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Sally Issawi
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Zaher A. S. Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sharif E. Qaddomi
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - J. Frederik Frøen
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
- * E-mail:
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Mano R. Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis. JMIR Hum Factors 2021; 8:e21251. [PMID: 33885372 PMCID: PMC8103300 DOI: 10.2196/21251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/06/2020] [Accepted: 12/23/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Rising criticism about the risks associated with the use of mobile health apps necessitates a critical perspective to assess the use of these apps. A cost-benefit approach involving several moderating factors can be used to detect technology effects and individual-level push and pull factors related to health attitudes, lifestyle, and health management behaviors. OBJECTIVE We introduce a cost-benefit perspective to examine how health attitudes related to mobile health apps and health situational factors (health crises, health changes, and hospitalization) affect the likelihood of adopting lifestyle and health management behaviors among app users. METHODS The analysis is based on individuals' reported use of mobile health apps. The sample included 1495 US adults aged over 18 years who were contacted by landline or cellphone. A total of 50.96% (762/1495) of the participants were women. A set of logistic regression models was used to predict lifestyle and health management behaviors among users considering variations in the extent of use, health attitudes, health situation, and socioeconomic characteristics. RESULTS The findings indicate that the proposed models were reasonably adequate. In all, 88.76% (1327/1495) of the cases were correctly classified regarding lifestyle behaviors, but only 71.97% (1076/1495) of the cases were correctly classified regarding health management behaviors. Although a large percentage of individuals changed their attitudes following the use of mobile health apps, only a small proportion adopted health management behaviors. The use of mobile health apps affected up to 67.95% (1016/1495) of the users for consultation and 71.97% (1076/1495) of the users for decision making. The model was effective for 88.76% (1327/1495) of the cases regarding lifestyle behaviors but only 71.97% (1076/1495) regarding health management behaviors. The moderating effect of regular use of mobile health apps significantly affects lifestyle (Wald=61.795; B=2.099; P<.005) but not health management behaviors (Wald=12.532; B=0.513; P=.01). These results collectively indicate that the use of mobile health apps for health management is partially effective. CONCLUSIONS The use of mobile health apps is a main route to instigate the process of health empowerment and shape health attitudes. However, an accurate assessment of the effectiveness of mobile health apps necessitates distinguishing between lifestyle and health management behaviors and adopting a cost-benefit approach because individuals facing health concerns, such as a chronic disease, health emergency, health crisis, or health change, consider their affordances and situational effects. These moderators generate a push and pull framework in the decision-making process that balances the costs and benefits of use.
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Affiliation(s)
- Rita Mano
- Department of Human Services, University of Haifa, Haifa, Israel
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Vives N, Farre A, Ibáñez-Sanz G, Vidal C, Binefa G, Milà N, Pérez-Lacasta MJ, Travier N, Benito L, Espinàs JA, Bagaria G, Garcia M. Text messaging as a tool to improve cancer screening programs (M-TICS Study): A randomized controlled trial protocol. PLoS One 2021; 16:e0245806. [PMID: 33481914 PMCID: PMC7822525 DOI: 10.1371/journal.pone.0245806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Short message service (SMS) based interventions are widely used in healthcare and have shown promising results to improve cancer screening programs. However, more research is still needed to implement SMS in the screening process. We present a study protocol to assess the impact on health and economics of three targeted SMS-based interventions in population-based cancer screening programs. METHODS/DESIGN The M-TICs study is a randomized controlled trial with a formal process evaluation. Participants aged 50-69 years identified as eligible from the colorectal cancer (CRC) and breast cancer (BC) screening program of the Catalan Institute of Oncology (Catalonia, Spain) will be randomly assigned to receive standard invitation procedure (control group) or SMS-based intervention to promote participation. Two interventions will be conducted in the CRC screening program: 1) Screening invitation reminder: Those who do not participate in the CRC screening within 6 weeks of invite will receive a reminder (SMS or letter); 2) Reminder to complete and return fecal immunochemical test (FIT) kit: SMS reminder versus no intervention to individuals who have picked up a FIT kit at the pharmacy and they have not returned it after 14 days. The third intervention will be performed in the BC screening program. Women who had been screened previously will receive an SMS invitation or a letter invitation to participate in the screening. As a primary objective we will assess the impact on participation for each intervention. The secondary objectives will be to analyze the cost-effectiveness of the interventions and to assess participants' perceptions. EXPECTED RESULTS The results from this randomized controlled trial will provide important empirical evidence for the use of mobile phone technology as a tool for improving population-based cancer screening programs. These results may influence the cancer screening invitation procedure in future routine practice. TRIAL REGISTRATION Registry: NCT04343950 (04/09/2020); clinicaltrials.gov.
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Affiliation(s)
- Nuria Vives
- Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Madrid, Spain
| | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Gemma Ibáñez-Sanz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Madrid, Spain
- Oncology Data Analytics Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Gastroenterology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Vidal
- Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Madrid, Spain
| | - Gemma Binefa
- Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Madrid, Spain
| | - Núria Milà
- Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Madrid, Spain
| | - Maria Jose Pérez-Lacasta
- Department of Economics, University Rovira i Virgili, Reus, Spain
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
| | - Noemie Travier
- Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Llucia Benito
- Fundamental Care and Medical Surgical Nursing Department, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Alfons Espinàs
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Barcelona, Spain
| | | | - Montse Garcia
- Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Madrid, Spain
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Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2021; 1:CD013229. [PMID: 33411338 PMCID: PMC11354481 DOI: 10.1002/14651858.cd013229.pub2] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Smoking is a leading cause of disease and death worldwide. In people who smoke, quitting smoking can reverse much of the damage. Many people use behavioural interventions to help them quit smoking; these interventions can vary substantially in their content and effectiveness. OBJECTIVES To summarise the evidence from Cochrane Reviews that assessed the effect of behavioural interventions designed to support smoking cessation attempts and to conduct a network meta-analysis to determine how modes of delivery; person delivering the intervention; and the nature, focus, and intensity of behavioural interventions for smoking cessation influence the likelihood of achieving abstinence six months after attempting to stop smoking; and whether the effects of behavioural interventions depend upon other characteristics, including population, setting, and the provision of pharmacotherapy. To summarise the availability and principal findings of economic evaluations of behavioural interventions for smoking cessation, in terms of comparative costs and cost-effectiveness, in the form of a brief economic commentary. METHODS This work comprises two main elements. 1. We conducted a Cochrane Overview of reviews following standard Cochrane methods. We identified Cochrane Reviews of behavioural interventions (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials) for smoking cessation by searching the Cochrane Library in July 2020. We evaluated the methodological quality of reviews using AMSTAR 2 and synthesised data from the reviews narratively. 2. We used the included reviews to identify randomised controlled trials of behavioural interventions for smoking cessation compared with other behavioural interventions or no intervention for smoking cessation. To be included, studies had to include adult smokers and measure smoking abstinence at six months or longer. Screening, data extraction, and risk of bias assessment followed standard Cochrane methods. We synthesised data using Bayesian component network meta-analysis (CNMA), examining the effects of 38 different components compared to minimal intervention. Components included behavioural and motivational elements, intervention providers, delivery modes, nature, focus, and intensity of the behavioural intervention. We used component network meta-regression (CNMR) to evaluate the influence of population characteristics, provision of pharmacotherapy, and intervention intensity on the component effects. We evaluated certainty of the evidence using GRADE domains. We assumed an additive effect for individual components. MAIN RESULTS We included 33 Cochrane Reviews, from which 312 randomised controlled trials, representing 250,563 participants and 845 distinct study arms, met the criteria for inclusion in our component network meta-analysis. This represented 437 different combinations of components. Of the 33 reviews, confidence in review findings was high in four reviews and moderate in nine reviews, as measured by the AMSTAR 2 critical appraisal tool. The remaining 20 reviews were low or critically low due to one or more critical weaknesses, most commonly inadequate investigation or discussion (or both) of the impact of publication bias. Of note, the critical weaknesses identified did not affect the searching, screening, or data extraction elements of the review process, which have direct bearing on our CNMA. Of the included studies, 125/312 were at low risk of bias overall, 50 were at high risk of bias, and the remainder were at unclear risk. Analyses from the contributing reviews and from our CNMA showed behavioural interventions for smoking cessation can increase quit rates, but effectiveness varies on characteristics of the support provided. There was high-certainty evidence of benefit for the provision of counselling (odds ratio (OR) 1.44, 95% credibility interval (CrI) 1.22 to 1.70, 194 studies, n = 72,273) and guaranteed financial incentives (OR 1.46, 95% CrI 1.15 to 1.85, 19 studies, n = 8877). Evidence of benefit remained when removing studies at high risk of bias. These findings were consistent with pair-wise meta-analyses from contributing reviews. There was moderate-certainty evidence of benefit for interventions delivered via text message (downgraded due to unexplained statistical heterogeneity in pair-wise comparison), and for the following components where point estimates suggested benefit but CrIs incorporated no clinically significant difference: individual tailoring; intervention content including motivational components; intervention content focused on how to quit. The remaining intervention components had low-to very low-certainty evidence, with the main issues being imprecision and risk of bias. There was no evidence to suggest an increase in harms in groups receiving behavioural support for smoking cessation. Intervention effects were not changed by adjusting for population characteristics, but data were limited. Increasing intensity of behavioural support, as measured through the number of contacts, duration of each contact, and programme length, had point estimates associated with modestly increased chances of quitting, but CrIs included no difference. The effect of behavioural support for smoking cessation appeared slightly less pronounced when people were already receiving smoking cessation pharmacotherapies. AUTHORS' CONCLUSIONS Behavioural support for smoking cessation can increase quit rates at six months or longer, with no evidence that support increases harms. This is the case whether or not smoking cessation pharmacotherapy is also provided, but the effect is slightly more pronounced in the absence of pharmacotherapy. Evidence of benefit is strongest for the provision of any form of counselling, and guaranteed financial incentives. Evidence suggested possible benefit but the need of further studies to evaluate: individual tailoring; delivery via text message, email, and audio recording; delivery by lay health advisor; and intervention content with motivational components and a focus on how to quit. We identified 23 economic evaluations; evidence did not consistently suggest one type of behavioural intervention for smoking cessation was more cost-effective than another. Future reviews should fully consider publication bias. Tools to investigate publication bias and to evaluate certainty in CNMA are needed.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Alqabandi N, Al-Ozairi E, Ahmed A, Ross EL, Jamison RN. Secondary Impact of Social Media via Text Message Screening for Type 2 Diabetes Risk in Kuwait: Survey Study. JMIR Diabetes 2020; 5:e20532. [PMID: 33180021 PMCID: PMC7691091 DOI: 10.2196/20532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/14/2020] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is an international problem of alarming epidemic proportions. T2DM can develop due to multiple factors, and it usually begins with prediabetes. Fortunately, this disease can be prevented by following a healthy lifestyle. However, many health care systems fail to properly educate the public on disease prevention and to offer support in embracing behavioral interventions to prevent diabetes. SMS messaging has been combined with cost-effective ways to reach out to the population at risk for medical comorbidities. To our knowledge, the use of nationwide SMS messaging in the Middle East as a screening tool to identify individuals who might be at risk of developing T2DM has not been reported in the literature. OBJECTIVE The primary aim of this study was to assess the feasibility of conducting a series of SMS messaging campaigns directed at random smartphone users in Kuwait for the detection and prevention of T2DM. It was predicted that 1% of those receiving the text message would find it relevant and participate in the study. The secondary aim of this study was to assess the incidence of participation of those who were forwarded the initial text message by family members and friends. METHODS In this study, 5 separate text message screening campaigns were launched inviting recipients to answer 6 questions to determine the risk of developing T2DM. If subjects agreed to participate, a link to the prediabetes screening test devised by the Centers for Disease Control and Prevention was automatically transmitted to their mobile devices. Those identified as high risk were invited to participate in a diabetes prevention program. RESULTS A total of 180,000 SMSs were sent to approximately 6% of the adult population in Kuwait. Of these, 0.14% (260/180,000) of the individuals who received the SMS agreed to participate, of whom 58.8% (153/260) completed the screening. Surprisingly, additional surveys were completed by 367 individuals who were invited via circulated SMS messages forwarded by family members and friends. Altogether, 23.3% (121/520) qualified and agreed to participate in a diabetes prevention program. The majority of those who chose to participate in the prevention program were overweight, aged 45-65 years, and reported being less physically active than those who chose not to participate (χ22=42.1, P<.001). CONCLUSIONS Although health care screening via text messaging was found to have limited effectiveness by itself, it exhibited increased reach through shared second-party social media messaging. Despite the fact a subpopulation at possible risk of developing T2DM could be reached via text messaging, most responders were informed about the screening campaign by family and friends. Future research should be designed to tap into the benefits of social media use in health risk campaigns.
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Affiliation(s)
| | | | - Adel Ahmed
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Edgar L Ross
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, United States
| | - Robert N Jamison
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, United States
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Nabovati E, Farzandipour M, Heidarzadeh Arani M, Akbari H, Sharif R, Anvari S. The use of mobile phone functionalities by patients with asthma and their desire to use for self-care purposes. BMC Med Inform Decis Mak 2020; 20:281. [PMID: 33126888 PMCID: PMC7602318 DOI: 10.1186/s12911-020-01301-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/22/2020] [Indexed: 01/05/2023] Open
Abstract
Background Mobile health (mHealth) has good potential for promoting self-care in patients suffering from chronic diseases. The patients' positive attitude toward this technology is a key factor for the successful implementation. The present study was conducted to investigate the asthma patients' use of mobile phone functionalities and their desire to receive self-care services through this technology. Methods This survey study was conducted in Iran in 2018. The study population consisted of 146 patients suffering from asthma. The data collection tool was a questionnaire containing items on the demographic characteristics of patients, current use of mobile phone functionalities, and desire to use them for receiving self-care services. Data were analyzed using descriptive and analytical statistics.
Results Out of the 160 questionnaires distributed, 146 (91.25%) were completed. The majority of the participants had smartphones (84.9%). Less than half of the participants occasionally used mobile phone functionalities including mobile phone calls (42.5%) and mobile Internet (40.4%) to receive asthma-related information. A significant number of the participants had never used smartphone applications (72.6%) and E-mail (66.4%) to receive asthma-related information. The participants had their greatest use of Internet search, followed by social media, to receive information about asthma symptoms, allergenic and irritating substances, medicinal therapy, and how to use therapy aids. The participants were most willing to use social media for receiving asthma information, communicating with other patients, receiving reminders about doctor's appointment, and receiving warnings about the lack of asthma control. Conclusion In Iran as a developing country, asthma patients use Internet search mostly to receive instructional information and are willing to use social media rather than other mobile phone functionalities to receive self-care services. These patients believe that mobile phones are appropriate for receiving instructional information and reminders.
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Affiliation(s)
- Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Pezeshk Blvd, 5th of Qotbe Ravandi Blvd - Pardis Daneshgah, Kashan, Iran
| | - Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Pezeshk Blvd, 5th of Qotbe Ravandi Blvd - Pardis Daneshgah, Kashan, Iran
| | - Marzieh Heidarzadeh Arani
- Pediatric Department, School of Medicine, Kashan University of Medical Sciences, Pezeshk Blvd, 5th of Qotbe Ravandi Blvd - Pardis Daneshgah, Kashan, Iran
| | - Hossein Akbari
- Department of Biostatistics and Epidemiology, School of Health, Kashan University of Medical Sciences, Pezeshk Blvd, 5th of Qotbe Ravandi Blvd - Pardis Daneshgah, Kashan, Iran
| | - Reihane Sharif
- Health Information Management Research Center, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Pezeshk Blvd, 5th of Qotbe Ravandi Blvd - Pardis Daneshgah, Kashan, Iran.
| | - Shima Anvari
- Health Information Management Research Center, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Pezeshk Blvd, 5th of Qotbe Ravandi Blvd - Pardis Daneshgah, Kashan, Iran
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Islam MM, Poly TN, Walther BA, Jack Li YC. Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis. JMIR Mhealth Uhealth 2020. [PMID: 32706724 DOI: 10.2196/1703941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. OBJECTIVE The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. METHODS PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. RESULTS A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (-1.07 kg, 95% CI -1.92 to -0.21, P=.01) and body mass index (-0.45 kg/m2, 95% CI -0.78 to -0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI -2.21 to 2.55, P=.88). CONCLUSIONS The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples.
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Affiliation(s)
- Md Mohaimenul Islam
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tahmina Nasrin Poly
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Bruno Andres Walther
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Islam MM, Poly TN, Walther BA, Jack Li YC. Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e17039. [PMID: 32706724 PMCID: PMC7407260 DOI: 10.2196/17039] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/16/2020] [Accepted: 04/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. Objective The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. Methods PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. Results A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (−1.07 kg, 95% CI −1.92 to −0.21, P=.01) and body mass index (−0.45 kg/m2, 95% CI −0.78 to −0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI −2.21 to 2.55, P=.88). Conclusions The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples.
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Affiliation(s)
- Md Mohaimenul Islam
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tahmina Nasrin Poly
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Bruno Andres Walther
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Palmer MJ, Henschke N, Bergman H, Villanueva G, Maayan N, Tamrat T, Mehl GL, Glenton C, Lewin S, Fønhus MS, Free C. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database Syst Rev 2020; 8:CD013679. [PMID: 32813276 PMCID: PMC8477611 DOI: 10.1002/14651858.cd013679] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication (TCC) via mobile devices (MD) (TCCMD) may be a useful strategy to improve MNCH. OBJECTIVES To assess the effects of TCC via MD on health behaviour, service use, health, and well-being for MNCH. SEARCH METHODS In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA We included randomised controlled trials that assessed TCC via MD to improve MNCH behaviour, service use, health, and well-being. Eligible comparators were usual care/no intervention, non-digital TCC, and digital non-targeted client communication. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. MAIN RESULTS We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low-, middle- or high-income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle-income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls. Pregnant and postpartum women TCCMD versus standard care For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low-certainty evidence), but have little or no effect in settings where almost all women breastfeed (low-certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low-certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low-certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low. TCCMD versus non-digital TCC (e.g. pamphlets) TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low-certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low-certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies. TCCMD versus digital non-targeted communication No studies reported behavioural, health, or well-being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low-certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low-certainty evidence). Pregnant and postpartum women living with HIV TCCMD versus standard care For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low-certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI -0.36 to 3.36; low-certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low-certainty evidence. For health and well-being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low-certainty evidence. No studies reported on maternal mortality or morbidity. TCCMD versus non-digital TCC The effect is unknown due to lack of studies reporting this comparison. TCCMD versus digital non-targeted communication TCCMD may increase infant ARV/prevention of mother-to-child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low-certainty evidence). The effect on other outcomes is unknown due to lack of studies. Parents of children aged less than five years No studies reported on correct treatment, nutritional, or health outcomes. TCCMD versus standard care Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low-certainty evidence); however, the effect estimates varied widely between studies. TCCMD versus non-digital TCC TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low-certainty evidence), and may make little or no difference to oral hygiene practices (low-certainty evidence). TCCMD versus digital non-targeted communication TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low-certainty evidence). No trials in any population reported data on unintended consequences. AUTHORS' CONCLUSIONS The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High-quality, adequately powered trials and cost-effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality.
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Affiliation(s)
- Melissa J Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Palmer MJ, Henschke N, Villanueva G, Maayan N, Bergman H, Glenton C, Lewin S, Fønhus MS, Tamrat T, Mehl GL, Free C. Targeted client communication via mobile devices for improving sexual and reproductive health. Cochrane Database Syst Rev 2020; 8:CD013680. [PMID: 32779730 PMCID: PMC8409381 DOI: 10.1002/14651858.cd013680] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The burden of poor sexual and reproductive health (SRH) worldwide is substantial, disproportionately affecting those living in low- and middle-income countries. Targeted client communication (TCC) delivered via mobile devices (MD) (TCCMD) may improve the health behaviours and service use important for sexual and reproductive health. OBJECTIVES To assess the effects of TCC via MD on adolescents' knowledge, and on adolescents' and adults' sexual and reproductive health behaviour, health service use, and health and well-being. SEARCH METHODS In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA We included randomised controlled trials of TCC via MD to improve sexual and reproductive health behaviour, health service use, and health and well-being. Eligible comparators were standard care or no intervention, non-digital TCC, and digital non-targeted communication. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. We have presented results separately for adult and adolescent populations, and for each comparison. MAIN RESULTS We included 40 trials (27 among adult populations and 13 among adolescent populations) with a total of 26,854 participants. All but one of the trials among adolescent populations were conducted in high-income countries. Trials among adult populations were conducted in a range of high- to low-income countries. Among adolescents, nine interventions were delivered solely through text messages; four interventions tested text messages in combination with another communication channel, such as emails, multimedia messaging, or voice calls; and one intervention used voice calls alone. Among adults, 20 interventions were delivered through text messages; two through a combination of text messages and voice calls; and the rest were delivered through other channels such as voice calls, multimedia messaging, interactive voice response, and instant messaging services. Adolescent populations TCCMD versus standard care TCCMD may increase sexual health knowledge (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.23 to 1.71; low-certainty evidence). TCCMD may modestly increase contraception use (RR 1.19, 95% CI 1.05 to 1.35; low-certainty evidence). The effects on condom use, antiretroviral therapy (ART) adherence, and health service use are uncertain due to very low-certainty evidence. The effects on abortion and STI rates are unknown due to lack of studies. TCCMD versus non-digital TCC (e.g. pamphlets) The effects of TCCMD on behaviour (contraception use, condom use, ART adherence), service use, health and wellbeing (abortion and STI rates) are unknown due to lack of studies for this comparison. TCCMD versus digital non-targeted communication The effects on sexual health knowledge, condom and contraceptive use are uncertain due to very low-certainty evidence. Interventions may increase health service use (attendance for STI/HIV testing, RR 1.61, 95% CI 1.08 to 2.40; low-certainty evidence). The intervention may be beneficial for reducing STI rates (RR 0.61, 95% CI 0.28 to 1.33; low-certainty evidence), but the confidence interval encompasses both benefit and harm. The effects on abortion rates and on ART adherence are unknown due to lack of studies. We are uncertain whether TCCMD results in unintended consequences due to lack of evidence. Adult populations TCCMD versus standard care For health behaviours, TCCMD may modestly increase contraception use at 12 months (RR 1.17, 95% CI 0.92 to 1.48) and may reduce repeat abortion (RR 0.68 95% CI 0.28 to 1.66), though the confidence interval encompasses benefit and harm (low-certainty evidence). The effect on condom use is uncertain. No study measured the impact of this intervention on STI rates. TCCMD may modestly increase ART adherence (RR 1.13, 95% CI 0.97 to 1.32, low-certainty evidence, and standardised mean difference 0.44, 95% CI -0.14 to 1.02, low-certainty evidence). TCCMD may modestly increase health service utilisation (RR 1.17, 95% CI 1.04 to 1.31; low-certainty evidence), but there was substantial heterogeneity (I2 = 85%), with mixed results according to type of service utilisation (i.e. attendance for STI testing; HIV treatment; voluntary male medical circumcision (VMMC); VMMC post-operative visit; post-abortion care). For health and well-being outcomes, there may be little or no effect on CD4 count (mean difference 13.99, 95% CI -8.65 to 36.63; low-certainty evidence) and a slight reduction in virological failure (RR 0.86, 95% CI 0.73 to 1.01; low-certainty evidence). TCCMD versus non-digital TCC No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may modestly increase in service attendance overall (RR: 1.12, 95% CI 0.92-1.35, low certainty evidence), however the confidence interval encompasses benefit and harm. TCCMD versus digital non-targeted communication No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may increase service utilisation overall (RR: 1.71, 95% CI 0.67-4.38, low certainty evidence), however the confidence interval encompasses benefit and harm and there was considerable heterogeneity (I2 = 72%), with mixed results according to type of service utilisation (STI/HIV testing, and VMMC). Few studies reported on unintended consequences. One study reported that a participant withdrew from the intervention as they felt it compromised their undisclosed HIV status. AUTHORS' CONCLUSIONS TCCMD may improve some outcomes but the evidence is of low certainty. The effect on most outcomes is uncertain/unknown due to very low certainty evidence or lack of evidence. High quality, adequately powered trials and cost effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCC delivered by mobile devices. Given the sensitivity and stigma associated with sexual and reproductive health future studies should measure unintended consequences, such as partner violence or breaches of confidentiality.
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Affiliation(s)
- Melissa J Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Stevens T, McGinnis RS, Hewgill B, Choquette RH, Tourville TW, Harvey J, Lachapelle R, Beynnon BD, Toth MJ, Skalka C. A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile-Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation. JMIR Hum Factors 2020; 7:e16605. [PMID: 32384052 PMCID: PMC7248795 DOI: 10.2196/16605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/13/2020] [Accepted: 02/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. OBJECTIVE This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. METHODS The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System-based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. RESULTS Compared with the NMES device software-tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. CONCLUSIONS RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing.
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Affiliation(s)
- Timothy Stevens
- Department of Computer Science, University of Vermont, Burlington, VT, United States
| | - Ryan S McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States
| | - Blake Hewgill
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States
| | - Rebecca H Choquette
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, United States
| | - Timothy W Tourville
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, United States.,Department of Rehabilitation and Movement Sciences, University of Vermont, Burlington, VT, United States
| | - Jean Harvey
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, United States
| | - Richard Lachapelle
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, United States
| | - Bruce D Beynnon
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, United States
| | - Michael J Toth
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, United States.,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, United States.,Department of Medicine, University of Vermont, Burlington, VT, United States
| | - Christian Skalka
- Department of Computer Science, University of Vermont, Burlington, VT, United States
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Chapman E, Haby MM, Toma TS, de Bortoli MC, Illanes E, Oliveros MJ, Barreto JOM. Knowledge translation strategies for dissemination with a focus on healthcare recipients: an overview of systematic reviews. Implement Sci 2020; 15:14. [PMID: 32131861 PMCID: PMC7057470 DOI: 10.1186/s13012-020-0974-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While there is an ample literature on the evaluation of knowledge translation interventions aimed at healthcare providers, managers, and policy-makers, there has been less focus on patients and their informal caregivers. Further, no overview of the literature on dissemination strategies aimed at healthcare users and their caregivers has been conducted. The overview has two specific research questions: (1) to determine the most effective strategies that have been used to disseminate knowledge to healthcare recipients, and (2) to determine the barriers (and facilitators) to dissemination of knowledge to this group. METHODS This overview used systematic review methods and was conducted according to a pre-defined protocol. A comprehensive search of ten databases and five websites was conducted. Both published and unpublished reviews in English, Spanish, or Portuguese were included. A methodological quality assessment was conducted; low-quality reviews were excluded. A narrative synthesis was undertaken, informed by a matrix of strategy by outcome measure. The Health System Evidence taxonomy for "consumer targeted strategies" was used to separate strategies into one of six categories. RESULTS We identified 44 systematic reviews that describe the effective strategies to disseminate health knowledge to the public, patients, and caregivers. Some of these reviews also describe the most important barriers to the uptake of these effective strategies. When analyzing those strategies with the greatest potential to achieve behavioral changes, the majority of strategies with sufficient evidence of effectiveness were combined, frequent, and/or intense over time. Further, strategies focused on the patient, with tailored interventions, and those that seek to acquire skills and competencies were more effective in achieving these changes. In relation to barriers and facilitators, while the lack of health literacy or e-literacy could increase inequities, the benefits of social media were also emphasized, for example by widening access to health information for ethnic minorities and lower socioeconomic groups. CONCLUSIONS Those interventions that have been shown to be effective in improving knowledge uptake or health behaviors should be implemented in practice, programs, and policies-if not already implemented. When implementing strategies, decision-makers should consider the barriers and facilitators identified by this overview to ensure maximum effectiveness. PROTOCOL REGISTRATION PROSPERO: CRD42018093245.
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Affiliation(s)
| | - Michelle M. Haby
- Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, Sonora Mexico
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Tereza Setsuko Toma
- Instituto de Saúde, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | | | | | - Maria Jose Oliveros
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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Chen T. Assessing factors critical to smart technology applications to mobile health care - the fgm-fahp approach. HEALTH POLICY AND TECHNOLOGY 2020; 9:194-203. [PMID: 32346502 PMCID: PMC7185808 DOI: 10.1016/j.hlpt.2020.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current practices of smart technology applications to mobile health care are reviewed. The fuzzy geometric mean and fuzzy analytic hierarchy process approach is proposed to assess the relative importance of critical factors. The most important critical factors were the relaxation of laws, unobtrusiveness, and the correct identification of the need.
Smart technologies present numerous opportunities for enhancing mobile health care. However, some concerns regarding the viability of smart technology applications must be addressed. This study investigated these concerns by reviewing the current practices of smart technology applications to mobile health care. As a result, five factors critical to the applicability of a smart technology to mobile health care are identified, and the fuzzy geometric mean-fuzzy analytic hierarchy process (FGM-FAHP) approach is proposed to assess the relative importance levels of the identified factors. The experimental results showed that the three most critical factors identified include: (a) the relaxation of the related medical laws; (b) unobtrusiveness; and (c) the precise need and situation of a user. Accordingly, approximately 44%, 26%, and 15% of the budget should be allocated to the realization of the three critical factors, respectively. In addition, the challenges involved and opportunities for enhancing the effectiveness of existing applications are discussed.
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Affiliation(s)
- Toly Chen
- Department of Industrial Engineering and Management, National Chiao Tung University, 1001, University Rd., Hsinchu City, Taiwan
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Johansson M, Athilingam P. Structured Telephone Support Intervention: Improved Heart Failure Outcomes. JMIR Aging 2020; 3:e13513. [PMID: 32039813 PMCID: PMC7055840 DOI: 10.2196/13513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/26/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background Presently, 6.5 million Americans are living with heart failure (HF). These patients are expected to follow a complex self-management regimen at home. Several demographic and psychosocial factors limit patients with HF in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital readmissions. Under the Affordable Care Act, there are financial implications related to hospital readmissions for hospitals and programs such as the Program of All-Inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and SMS text messaging. Objective This study aimed to evaluate the effects of STS and SMS on self-care, knowledge, medication adherence, and QoL of patients with HF. Methods A prospective quality improvement project using a pre-post design was implemented. Data were collected at baseline, 30 days, and 3 months from 51 patients with HF who were enrolled in PACE in Pinellas County, Florida. All participants received STS and SMS for 30 days. The feasibility and sustained benefit of using STS and SMS was assessed at a 3-month follow-up. Results A paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t49=0.66; P=.01), HF knowledge (t49=0.71; P=.01), medication adherence (t49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t49=0.81; P=.01). The results also demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P<.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (aged less than 65 years) performed extremely well compared with older adults. Conclusions STS and SMS were feasible to use among PACE participants with sustained benefits at 3 months. Implementing STS and SMS may serve as viable options to improve HF outcomes. Improving outcomes with HF affects hospital systems and the agencies that monitor and provide care for outpatients and those in independent or assisted-living facilities. Investigating viable options and support for implementation will improve outcomes.
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Affiliation(s)
- Marcia Johansson
- College of Nursing, University of South Florida, Tampa, FL, United States
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Assessing the suitability of smart technology applications for e-health using a judgment-decomposition analytic hierarchy process approach. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00408-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fernandez ME, Schlechter CR, Del Fiol G, Gibson B, Kawamoto K, Siaperas T, Pruhs A, Greene T, Nahum-Shani I, Schulthies S, Nelson M, Bohner C, Kramer H, Borbolla D, Austin S, Weir C, Walker TW, Lam CY, Wetter DW. QuitSMART Utah: an implementation study protocol for a cluster-randomized, multi-level Sequential Multiple Assignment Randomized Trial to increase Reach and Impact of tobacco cessation treatment in Community Health Centers. Implement Sci 2020; 15:9. [PMID: 32000812 PMCID: PMC6993416 DOI: 10.1186/s13012-020-0967-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tobacco use remains the leading cause of death and disability in the USA and is disproportionately concentrated among low socioeconomic status (SES) populations. Community Health Centers (CHCs) are a key venue for reaching low SES populations with evidence-based tobacco cessation treatment such as Quitlines. Electronic health record (EHR)-based interventions at the point-of-care, text messaging (TM), and phone counseling have the potential to increase Quitline reach and are feasible to implement within CHCs. However, there is a lack of data to inform how, when, and in what combination these strategies should be implemented. The aims of this cluster-randomized trial are to evaluate multi-level implementation strategies to increase the Reach (i.e., proportion of tobacco-using patients who enroll in the Quitline) and Impact (i.e., Reach × Efficacy [efficacy is defined as the proportion of tobacco-using patients who enroll in Quitline treatment that successfully quit]) and to evaluate characteristics of healthcare system, providers, and patients that may influence tobacco-use outcomes. METHODS This study is a multilevel, three-phase, Sequential Multiple Assignment Randomized Trial (SMART), conducted in CHCs (N = 33 clinics; N = 6000 patients). In the first phase, clinics will be randomized to two different EHR conditions. The second and third phases are patient-level randomizations based on prior treatment response. Patients who enroll in the Quitline receive no further interventions. In phase two, patients who are non-responders (i.e., patients who do not enroll in Quitline) will be randomized to receive either TM or continued-EHR. In phase three, patients in the TM condition who are non-responders will be randomized to receive either continued-TM or TM + phone coaching. DISCUSSION This project will evaluate scalable, multi-level interventions to directly address strategic national priorities for reducing tobacco use and related disparities by increasing the Reach and Impact of evidence-based tobacco cessation interventions in low SES populations. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov (NCT03900767) on April 4th, 2019.
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Affiliation(s)
- Maria E Fernandez
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Tracey Siaperas
- Association for Utah Community Health, 860 E 4500 S, Murray, UT, 84107, USA
| | - Alan Pruhs
- Association for Utah Community Health, 860 E 4500 S, Murray, UT, 84107, USA
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI, 48104, USA
| | - Sandra Schulthies
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Marci Nelson
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Claudia Bohner
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Sharon Austin
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Timothy W Walker
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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Arapovic-Johansson B, Wåhlin C, Hagberg J, Kwak L, Axén I, Björklund C, Jensen I. Experience of Stress Assessed by Text Messages and Its Association with Objective Workload-A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E680. [PMID: 31973041 PMCID: PMC7037329 DOI: 10.3390/ijerph17030680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 12/23/2022]
Abstract
Exploring stress trajectories in detail and over a long time may give valuable information in terms of both understanding and practice. We followed a group of primary health care employees in a randomized controlled trial. The objective was to describe their experience of stress, explore the intra-individual variability and examine the association between the experience of stress and the objective workload. Weekly text messages with a single item stress question were distributed in two time series: 12 weeks at the beginning of the trial and 26 weeks after the 6-month follow up. Aggregated objective data about workload were collected from their administration office and related to stress levels. There was a seasonal variation, with higher stress during the fall than in spring and summer. The analysis comparing high and low stress subgroups showed that the stress trajectory of a high-stress subgroup was different from that of a low-stress subgroup. Individuals with high exhaustion scores had higher odds of belonging to a subgroup of individuals with high intra-individual variability in stress experience. The objective workload was measured in two ways and was strongly associated with the stress experience. We found that the lower the productivity, the higher the feeling of stress.
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Affiliation(s)
- Bozana Arapovic-Johansson
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute, 171 77 Solna, Sweden; (C.W.); (J.H.); (L.K.); (I.A.); (C.B.); (I.J.)
| | - Charlotte Wåhlin
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute, 171 77 Solna, Sweden; (C.W.); (J.H.); (L.K.); (I.A.); (C.B.); (I.J.)
- Occupational and Environmental Medicine Center, and Department of Health, Medicine and Caring sciences, Unit of Clinical Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Jan Hagberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute, 171 77 Solna, Sweden; (C.W.); (J.H.); (L.K.); (I.A.); (C.B.); (I.J.)
| | - Lydia Kwak
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute, 171 77 Solna, Sweden; (C.W.); (J.H.); (L.K.); (I.A.); (C.B.); (I.J.)
| | - Iben Axén
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute, 171 77 Solna, Sweden; (C.W.); (J.H.); (L.K.); (I.A.); (C.B.); (I.J.)
| | - Christina Björklund
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute, 171 77 Solna, Sweden; (C.W.); (J.H.); (L.K.); (I.A.); (C.B.); (I.J.)
| | - Irene Jensen
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute, 171 77 Solna, Sweden; (C.W.); (J.H.); (L.K.); (I.A.); (C.B.); (I.J.)
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Ionov МV, Zvartau NЕ, Emelyanov IV, Konradi AО. Telemonitoring and remote counseling in hypertensive patients. Looking for new ways to do old jobs. ACTA ACUST UNITED AC 2019. [DOI: 10.18705/1607-419x-2019-25-4-337-356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
XXI century emphasized humanity to embrace the digital era after a reality of Third and Fourth Industrial Revolutions, nowadays dictating new terms of social networking. It is expected that information and communication technologies integrated with value-based medicine will significantly impact healthcare delivery to tremendous number of patients with socially important noncommunicable diseases. Cardiovascular illnesses comprise the greatest part of such pathologies. Hypertension (HTN) being the most prevalent cardiovascular disease is also the key modifiable cardiovascular risk factor yet seems to be an attractive target for both value-based concept and telehealth interventions. Present review addresses up-to-date science on telehealth, sets out the main well-known, but yet unsolved challenges in management of HTN along with the new approaches involving telemedicine programs, digital health outlooks. The main barriers of telehealth implementation are also considered along with the possible solutions.
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Affiliation(s)
- М. V. Ionov
- Almazov National Medical Research Centre;
ITMO University
| | - N. Е. Zvartau
- Almazov National Medical Research Centre;
ITMO University
| | | | - A. О. Konradi
- Almazov National Medical Research Centre;
ITMO University
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A Fuzzy Collaborative Approach for Evaluating the Suitability of a Smart Health Practice. MATHEMATICS 2019. [DOI: 10.3390/math7121180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A fuzzy collaborative approach is proposed in this study to assess the suitability of a smart health practice, which is a challenging task, as the participating decision makers may not reach a consensus. In the fuzzy collaborative approach, each decision maker first applies the alpha-cut operations method to derive the fuzzy weights of the criteria. Then, fuzzy intersection is applied to aggregate the fuzzy weights derived by all decision makers to measure the prior consensus among them. The fuzzy intersection results are then presented to the decision makers so that they can subjectively modify the pairwise comparison results to bring them closer to the fuzzy intersection results. Thereafter, the consensus among decision makers is again measured. The collaboration process will stop when no more modifications are made by any decision maker. Finally, the fuzzy weighted mean-centroid defuzzification method is applied to assess the suitability of a smart health practice. The fuzzy collaborative approach and some existing methods have been applied to assess the suitabilities of eleven smart health practices for a comparison. Among the compared practices, only the fuzzy collaborative approach could guarantee the existence of a full consensus among decision makers after the collaboration process, i.e., that the assessment results were acceptable to all decision makers.
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Avila-Garcia P, Hernandez-Ramos R, Nouri SS, Cemballi A, Sarkar U, Lyles CR, Aguilera A. Engaging users in the design of an mHealth, text message-based intervention to increase physical activity at a safety-net health care system. JAMIA Open 2019; 2:489-497. [PMID: 32025646 PMCID: PMC6994014 DOI: 10.1093/jamiaopen/ooz049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Text-messaging interventions are a promising approach to increasing physical activity in vulnerable populations. To better inform the development of a text-messaging intervention, we sought to identify barriers and facilitators to using text messaging and engaging in physical activity among patients with diabetes and comorbid depression. MATERIALS AND METHODS We conducted interviews with primary care patients at a safety-net health care system (N = 26). Data were collected at 3 stages, including a focus group (stage 1), and individual interviews (stage 2 and 3). Patients in stage 1 and 2 previously participated in a text-messaging intervention as part of depression treatment. Discussions focused on participant experience of previously using a text-messaging intervention, influences and perceptions of physical activity, and mobile phone use. We analyzed all transcripts for emerging themes. RESULTS Participants were 56.2 years (±9.7); 69.2% were female, 65.4% identified as Hispanic/Latino(a), and 46.2% reported having less than a high school education. All had depression and 61.5% had diabetes. Specific barriers that emerged included low literacy and only basic use of mobile phones in everyday life, in combination with a high prevalence of comorbid health conditions and limited mobility. These were each addressed with a specific content or intervention delivery change in the overall intervention design. CONCLUSIONS Conducting a focus group and individual interviews with end users of an mHealth intervention under development has implications for tailoring and modifying components of the content and format to ensure that the final intervention will engage end users most effectively.
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Affiliation(s)
- Patricia Avila-Garcia
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Rosa Hernandez-Ramos
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anupama Cemballi
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
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Johnson AC, Lipkus I, Tercyak KP, Luta G, Rehberg K, Phan L, Abroms LC, Mays D. Development and Pretesting of Risk-Based Mobile Multimedia Message Content for Young Adult Hookah Use. HEALTH EDUCATION & BEHAVIOR 2019; 46:97-105. [PMID: 31742460 PMCID: PMC6886357 DOI: 10.1177/1090198119874841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background. Hookah is one of the most commonly used tobacco products among U.S. young adults due in part to widespread misperceptions that it is not harmful or addictive. There is growing evidence that hookah tobacco is associated with health harms and can lead to addiction. Research on interventions to address these misperceptions by communicating the harms and addictiveness of hookah use is needed. Aims. This study developed and pretested mobile multimedia message service (MMS) message content communicating the risks of hookah tobacco use to young adult hookah smokers. Method. Message content, delivery, and pretesting were tailored to participants' risk beliefs, hookah use frequency, and responses to simulated text message prompts. Participants viewed 4 of 12 core MMS messages randomized within-subjects and completed postexposure measures of message receptivity and emotional response (e.g., worry). Results. The sample included 156 young adult (age 18-30 years) hookah smokers; 31% smoked hookah monthly and 69% weekly/daily. Prior to viewing messages, a majority endorsed beliefs reflecting misperceptions about the risks of hookah tobacco. Postexposure measures showed participants were receptive to the messages and the messages evoked emotional response. As anticipated, messages produced similar receptivity and there were few differences in emotional response between the messages tested. Discussion. Young adult hookah tobacco smokers were receptive to tailored mobile MMS messages and messages evoked emotional response, two critical precursors to behavior change. Conclusion. Findings indicate that research testing the efficacy of tailored MMS messaging as a strategy for reducing hookah tobacco use in young adults is warranted.
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Affiliation(s)
- Andrea C Johnson
- Georgetown University Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, NC, USA
| | | | - George Luta
- Georgetown University Medical Center, Washington, DC, USA
| | | | - Lilianna Phan
- Georgetown University Medical Center, Washington, DC, USA
- University of Maryland, College Park, MD, USA
| | | | - Darren Mays
- Georgetown University Medical Center, Washington, DC, USA
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50
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Nelligan RK, Hinman RS, Atkins L, Bennell KL. A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel. JMIR Mhealth Uhealth 2019; 7:e14619. [PMID: 31628786 PMCID: PMC7012505 DOI: 10.2196/14619] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 01/12/2023] Open
Abstract
Background Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design. Objective The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework. Methods The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program. Results The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence. Conclusions This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise.
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Affiliation(s)
- Rachel K Nelligan
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Rana S Hinman
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Kim L Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
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