[Use of smartphone apps in secondary stroke prevention]

Information needs of people who have suffered a stroke or TIA and their preferred approaches of receiving health information: A scoping review

PURPOSE

We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention.

METHODS

In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O'Malley's methodological framework for scoping reviews.

FINDINGS

We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early.

CONCLUSION

PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS's information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.

Akzeptanz und Nutzungsbedingungen digitaler Interventionen zur Distressprävention bei Studierenden

Hintergrund

Das ausbildungsbezogene Stressempfinden auf Ebene von Distress von Studierenden stellt ein hohes Risiko für die Entstehung von psychischen Erkrankungen dar. Die konsequente Nutzung digitaler Anti-Stress-Apps kann dazu beitragen, Versorgungsdefizite in der Vermeidung von stressinduzierten Erkrankungen wirksam auszugleichen, wenn existierende Hilfsangebote nicht genutzt werden, oder helfen, Barrieren zur Nutzung bestehender Interventionsmaßnahmen mindern. In diesem Kontext untersucht der vorliegende Beitrag die Einstellungsakzeptanz und die verbundenen Nutzungsbedingungen Studierender der Universität Bielefeld gegenüber digitalen Anti-Stress-Apps. Basierend auf der Akzeptanz und den Nutzungsbedingungen sollen Anforderungen für die bessere Implementierung digitaler Interventionen geleitet werden.

Methodik

Die Erhebung wurde mittels qualitativer leitfadengestützter Interviews und quantitativer Umfragen an denselben 15 Studierenden (n = 14 Frauen und einem Mann im Alter von 22 bis 31 Jahren) der Universität Bielefeld durchgeführt. Für die Auswertung der Interviews wurde die strukturierte Inhaltsanalyse nach Mayring herangezogen, bei der mit Hilfe von deduktiven und induktiven Kategorien die Transkripte analysiert wurden. Zur Strukturierung und Analyse der Ergebnisse wurde die „unified theory of acceptance and use of technology 2“ (UTAUT 2) eingesetzt.

Ergebnisse

Anhand der UTAUT 2 konnten bedürfnisorientierte Bedingungen zur Nutzung und Einstellung hinsichtlich der Akzeptanz identifiziert werden. Die Einstellungsakzeptanz von Studierenden zu Anti-Stress-Apps ist weitestgehend positiv, geht jedoch nicht einher mit dem Nutzungsverhalten. Die Ergebnisse weisen eine starke Abhängigkeit von individuellen Bedürfnissen auf, was zudem von verschiedenen Alltagssituationen ausgeht, in denen Stress individuell empfunden wird.

Schlussfolgerungen

Bedingungen an die vorhandenen Elemente und Interventionen in einer App zur Stressreduktion müssen in der Softwareentwicklung berücksichtigt werden, damit die Anwendung subjektiv als wirksam wahrgenommen wird. Der Ausbau und die Einführung bedürfnisorientierter Angebote in die Lebenswelt der Nutzer*innen und Nutzergruppen sowie begleitende Maßnahmen zur zielgruppenspezifischen Sensibilisierung, können die Akzeptanz weiter steigern, das Nutzungsverhalten positiv beeinflussen und gegen Stressbelastungen wirken.

Mobile Health Application to Support Family Caregivers in Recurrent Stroke Prevention: Scoping Review

BACKGROUND OF THE STUDY: Caregivers play a vital role in continuum care for stroke patients. Involvement of caregivers in stroke care was important. With the advancement of information technology and the rapid growth worldwide in cell-phone use and internet connectivity, additional evidence may be needed in the use of mobile applications to support caregivers in stroke care. AIM OF THE STUDY: The aims of this review was to identify existing mobile application designed to support family caregivers of people with stroke disease. METHODOLOGY: A scoping review study framework was carried out in this study, using the EBSCO, Cochrane, PubMed, ProQuest, and Science Direct databases using search keywords: ‘family caregiver’, ‘mobile health application’,  and ‘recurrent stroke or secondary stroke prevention’. This review examined studies published between January 2011 and December 2020. Of a total of 728 papers found, 9 journals were selected. RESULTS: The results founded three categories and their attendant sub-categories. The categories was caregivers support, involvement caregivers in stroke care, and barriers. The majority of mobile application was used to provide video education for caregivers. Caregivers involved in stroke care including emotional care, nutrition, exercise, and recurrent stroke prevention. Poor connection was the most barrier in using mobile application. CONCLUSION: Mobile application can support caregivers in stroke care. Healthcare providers are expected to utilize mobile applications in helping caregivers in post-stroke care.

Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study

Background: Efficient treatment of modifiable vascular risk factors decreases reoccurrence of ischemic stroke, which is of uttermost importance in younger patients. In this longitudinal pilot study, we thus assessed the effect of a newly developed smartphone app for risk factor management in such a cohort. Methods: The app conveys key facts about stroke, provides motivational support for a healthy lifestyle, and a reminder function for medication intake and blood pressure measurement. Between January 2019 and February 2020, we consecutively invited patients with ischemic stroke aged between 18 and 55 years to participate. Patients in the intervention group used the app between hospital discharge and 3-month follow-up. The control group received standard clinical care. Modifiable risk factors (physical activity, nutrition, alcohol consumption, smoking behavior, obesity, and hypertension) were assessed during the initial hospital stay and at a dedicated stroke outpatient department three months post-stroke. Results: The study cohort comprised 21 patients in the app intervention group (62% male; age = 41 ± 11 years; education = 12 ± 3 years) and 21 sex-, age- and education-matched control patients with a comparable stroke risk factor profile. Baseline stroke severity was comparable between groups (intervention: median NIHSS = 3; control: median NIHSS = 4; p = 0.604). Three months post-stroke, patients in the intervention group reported to be physically almost twice as active (13 ± 9 h/week) compared to controls (7 ± 5 h/week; p = 0.022). More intense app usage was strongly associated with higher physical activity (r = 0.60, p = 0.005) and lower consumption of unhealthy food (r = -0.51, p = 0.023). Smoking behavior (p = 0.001) and hypertension (p = 0.003) improved in all patients. Patients in the intervention group described better self-reported health-related quality of life three months post-stroke (p = 0.003). Conclusions: Specifically designed app interventions can be an easily to implement and cost-efficient approach to promote a healthier lifestyle in younger patients with a stroke.

mHealth impact on secondary stroke prevention: a scoping review of randomized controlled trials among stroke survivors between 2010-2020

BACKGROUND

A fundamental gap between clinical prevention and self-management awareness heightens the risk for stroke recurrence in approximately one-fourth of the highest risk stroke survivors annually. Secondary stroke prevention has the potential to be promoted by mobile health (mHealth) applications for effective real-world adoption of vascular risk factor mitigation. This scoping review aims to evaluate the impact of mHealth interventions and their effectiveness to reduce recurrent stroke rates among stroke survivors in randomized controlled trials (RCTs).

METHODS

Scoping review in Ovid Medline, Cochrane Library, CINAHL, and Scopus for RCT literature employing mHealth among stroke populations published in English from 2010 to November 19, 2020. Small or pilot studies that included randomized design were included.

RESULTS

A total of 352 abstracts met inclusion criteria; 31 full-text articles were assessed and 18 unique RCTs involving 1,453 patients ultimately fulfilled criteria. Twelve of 18 met the pre-defined primary outcome measure, including 2 studies evaluating feasibility. Eight of 18 only addressed recovery from index stroke deficits. Most outcomes focused on self-reported functional status, mood, quality of life or compliance with intervention; primary outcome was an objective metric in 4/18 (blood pressure readings, step number, obstructive sleep apnea support compliance). Intervention duration 2-12 months, with a median 9 weeks.

CONCLUSIONS

No high-quality evidence supporting mHealth applications to reduce recurrent stroke was found in this scoping review. Overall, most studies were relatively small, heterogenous, and employed subjective primary outcome measures. mHealth's potential as an effective tool for stroke stakeholders to reduce recurrent stroke rates has not been sufficiently demonstrated in this review. Future randomized studies are needed that explicitly evaluate stroke recurrence rate.

Effective German and English Language mHealth Apps for Self-management of Bronchial Asthma in Children and Adolescents: Comparison Study

Background

Mobile health (mHealth) apps hold great potential for asthma self-management. Data on the suitability of asthma apps intended for children are insufficient, and the availability of German language apps is still inadequate compared with English language apps.

Objective

This study aims to identify functional asthma apps for children in German and to compare them with English language apps. In line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the Google Play Store and Apple App Store are systematically searched to preselect the most efficient apps, which are then compared according to a self-compiled criteria catalog.

Methods

Both app stores were screened for the term asthma. Following a PRISMA preselection process, the apps that met the inclusion criteria (ie, available free of charge, German or English language, and suitable for children) were rated by 3 independent persons following a criteria catalog consisting of 9 categories, some conceived for this purpose (availability, child-friendly, learning factor, and range of functions) and some adopted from existing validated catalogs (functionality and design, ease of use, potential for improving asthma self-management, fun factor and incentives, and information management and medical accuracy). The highest rated apps in German and English were compared.

Results

A total of 403 apps were identified on the Google Play Store and the Apple App Store. Finally, 24 apps that met the inclusion criteria were analyzed. In the first step of the quality assessment, only 4 available German language asthma apps were compared with 20 English language asthma apps. The 4 German language apps were then compared with the 4 highest rated English language apps. All selected apps, independent of the language, were comparable in the following categories: availability, functionality and design, ease of use, and information management and medical accuracy. The English language apps scored significantly higher in the following categories: potential for improving self-management, child-friendly, fun factor, learning factor, and range of function. English language apps (mean total points 34.164, SD 1.09) performed significantly better than German language asthma apps (mean total points 22.91, SD 2.898; P=.003). The best rated English language app was Kiss my asthma (36/42 points), whereas the best rated German language app Kata achieved only 27.33 points.

Conclusions

The recommended English language apps are Kiss my asthma, AsthmaXcel, AsthmaAustralia, and Ask Me, AsthMe!, whereas the only recommended German language app is Kata. The use of apps plays an increasingly important role in patients’ lives and in the medical field, making mHealth a staple in the future of asthma treatment plans. Although validated recommendations on rating mHealth apps have been published, it remains a challenging task for physicians and patients to choose a suitable app for each case, especially in non–English-speaking countries.

[Personal health data in times of a pandemic-legal and ethical aspects]

Im Zusammenhang mit der COVID-19-Pandemie ist immer wieder das Argument zu hören gewesen, Gesundheitsschutz müsse dem Datenschutz jedenfalls vorgehen. In dieser Pauschalität ist diese Aussage zwar plakativ, aber weder aus ethischer noch aus rechtlicher Sicht zutreffend. Eine Pandemie kann zwar durchaus einen Grund dafür liefern, vorübergehend auf Gesundheitsdaten zuzugreifen. Dabei ist aber zum einen darauf zu achten, dass dies nur in unbedingt notwendigem Ausmaß erfolgt und zum anderen, in welchem größeren Kontext diese Daten verwendet werden. Dieser Beitrag skizziert an drei Beispielen – Risikoatteste, Tracking Apps und Immunitätszertifikate – einige der dabei zu berücksichtigenden ethischen und rechtlichen Überlegungen. Damit soll verdeutlicht werden, dass auch in der Pandemie die Abwägung von Argumenten und die Verhältnismäßigkeit der ergriffenen Maßnahmen nicht aus den Augen verloren werden dürfen.