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Hazime D, Burner E. Social support via Internet communication technology for diabetes self-management: a scoping review. Mhealth 2024; 10:18. [PMID: 38689617 PMCID: PMC11058598 DOI: 10.21037/mhealth-23-34] [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: 06/27/2023] [Accepted: 01/06/2024] [Indexed: 05/02/2024] Open
Abstract
Background The global prevalence of diabetes has been increasing over the past 30 years, leading to a rise in complications; diabetes is the leading cause of amputations, blindness, and kidney failure in developed countries. Diabetes self-management is challenging due to the complex lifestyle changes required. Social support from family and friends plays a crucial role in overcoming barriers to healthy behavior choices. Integrating Internet and communication technologies with social support interventions has the potential to improve diabetes self-management. Methods A scoping review was conducted by searching PubMed, Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Association for Computing Machinery (ACM) Digital Library databases for studies combining diabetes, Internet and communication technologies, and social support interventions. Inclusion criteria focused on adult patients with diabetes and primarily Internet and communication technologies-based strategies to initiate and enhance social support. Data abstraction included study population, design, outcomes, social support domains emphasized, support relationship intervention strategy, and Internet and communication technologies modality. Results The review identified 39 articles and 33 unique studies representing 27 unique interventions utilizing peer web forums, interactive voice recordings, messaging-based interventions (including Short Message Service and instant messaging), and email as Internet and communication technologies modalities. Various outcomes were reported, including improvements in perception of social support, psychosocial well-being, behavior changes, and clinical outcomes. Existing support relationships may be more effective in promoting behavior change and clinical outcomes compared to developing new relationships. Studies that explicitly measured patients' perception of support consistently showed improvements in psycho-social, behavioral, and clinical outcomes. Conclusions This scoping review highlights the pivotal role of social support in diabetes self-management. By integrating Internet and communication technologies into interventions, diverse modalities such as web forums and text messaging have shown promise in enhancing patients' perception of support and improving psychosocial well-being, behavior changes, and clinical outcomes. The emphasis on leveraging existing support relationships, rather than establishing new ones, underscores the effectiveness of personalized, patient-centered approaches. These findings provide essential insights for healthcare strategies, emphasizing the need to harness technology and existing social networks to empower individuals in managing diabetes effectively.
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Affiliation(s)
- Danielle Hazime
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
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Abu Hussain SM, Miptah HN, Shibraumalisi NA, Mohamed-Yassin MS, Baharudin N, Badlishah-Sham SF, Nik Mohd Nasir NM, Kamaruddin KN, Kanoo LL, Abdul-Razak S, Abdul-Hamid H, Daud MH, Yusoff FH, Ramli AS. Factors associated with usability of the EMPOWER-SUSTAIN Self-management mobile app© among individuals with cardiovascular risk factors in primary care. Digit Health 2024; 10:20552076241242795. [PMID: 38571876 PMCID: PMC10989042 DOI: 10.1177/20552076241242795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Objective This study aimed to determine the usability of the EMPOWER-SUSTAIN Self-Management Mobile App© and evaluate the factors associated with its usability among patients with cardiovascular risk factors in primary care. Methodology This was a cross-sectional study, conducted among patients aged ≥ 18 years with cardiovascular risk factors attending a university primary care clinic. Patients were given the app to use for at least three months. Those who fulfilled the eligibility criteria were recruited. Data gathered were on sociodemographic, clinical characteristics, self-management support by doctors, utilisation of the app at home and social support in using the app. The previously translated and validated Malay version of the mHealth App Usability Questionnaire was used to measure usability. The mean usability score was calculated and linear regressions analysis was conducted to determine the factors associated with the usability of the app. Results A total of 247 patients with at least one cardiovascular risk factor(s) were recruited. The mean age was 60.2 (±8.2). The majority were Malays (86.2%) and half of them were males (52.2%). The total mean (±SD) usability score was 5.26 (±0.67) indicating a high usability of the app. Usability of the app declined with increasing age in the simple linear regressions analysis. The multiple linear regressions yielded that being Malay (b = 0.31, 95% CI 0.08,0.54), using the app at home to understand their medications (b = 0.33, 95% CI 0.12,0.53) and having social support from family members and friends (b = 0.28, 95% CI 0.07,0.49) were significantly associated with higher usability of the app. Conclusion The usability of the EMPOWER-SUSTAIN Self-Management Mobile App© was high among patients with cardiovascular risk factors in our primary care clinic. This finding supports the widespread use of this app among our patients. Involvement of family members and friends should be encouraged to improve the usability of the app.
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Affiliation(s)
- Siti M Abu Hussain
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Hayatul N Miptah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Nur A Shibraumalisi
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Noorhida Baharudin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Siti F Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Nik M Nik Mohd Nasir
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Khairatul N Kamaruddin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Lina L Kanoo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Suraya Abdul-Razak
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Cardio Vascular and Lungs Research Institute (CaVaLRI), Hospital Al-Sultan Abdullah (HASA), Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Hasidah Abdul-Hamid
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Maryam H Daud
- School of Occupational Safety and Health, Netherlands Maritime University College, Jalan Abdullah Ibrahim, Johor Bahru, Johor, Malaysia
| | | | - Anis S Ramli
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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Fowler M, Tobback H, Karuri A, Fernández-Ortega P. Nursing care and management of adverse events for patients with BRAF V600E-mutant metastatic colorectal cancer receiving encorafenib in combination with cetuximab: a review. Support Care Cancer 2023; 31:204. [PMID: 36881161 PMCID: PMC9989561 DOI: 10.1007/s00520-023-07579-9] [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: 07/08/2022] [Accepted: 01/05/2023] [Indexed: 03/08/2023]
Abstract
Encorafenib is a B-Raf proto-oncogene serine/threonine-protein kinase (BRAF) inhibitor, approved in the EU and USA, in combination with the epidermal growth factor receptor (EGFR) inhibitor cetuximab, for the treatment of patients with BRAFV600E-mutant metastatic colorectal cancer (mCRC). In the pivotal BEACON CRC trial, patients achieved longer survival with encorafenib in combination with cetuximab vs. conventional chemotherapy. This targeted therapy regimen is also generally better tolerated than cytotoxic treatments. However, patients may present with adverse events unique to the regimen and characteristic of BRAF and EGFR inhibitors, which produce their own set of challenges. Nurses play an essential role in navigating the care of patients with BRAFV600E-mutant mCRC and managing adverse events that patients may experience. This includes early and efficient identification of treatment-related adverse events, subsequent management of adverse events and education of patients and their caregivers around key adverse events. This manuscript aims to provide support to nurses managing patients with BRAFV600E-mutant mCRC receiving encorafenib in combination with cetuximab, by summarising potential adverse events and providing guidance on how to manage them. Special attention will be paid to the presentation of key adverse events, dose modifications that may be required, practical recommendations and supportive care measures.
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Affiliation(s)
- Matthew Fowler
- University Hospitals of Derby and Burton NHSFT, Uttoxeter Road, DE22 3NE, Derby, UK.
| | | | | | - Paz Fernández-Ortega
- Institut Català d'Oncologia, Granvia de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
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Mayberry LS, El-Rifai M, Nelson LA, Parks M, Greevy RA, LeStourgeon L, Molli S, Bergner E, Spieker A, Aikens JE, Wolever RQ. Rationale, design, and recruitment outcomes for the Family/Friend Activation to Motivate Self-care (FAMS) 2.0 randomized controlled trial among adults with type 2 diabetes and their support persons. Contemp Clin Trials 2022; 122:106956. [PMID: 36208719 PMCID: PMC10364455 DOI: 10.1016/j.cct.2022.106956] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/11/2022] [Accepted: 10/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Self-care behaviors help reduce hemoglobin A1c (HbA1c) and prevent or delay type 2 diabetes (T2D) complications. Individualized interventions that support goal setting and self-monitoring improve self-care and HbA1c in the short-term; engaging family and friends may enhance and/or sustain effects. Family/Friend Activation to Motivate Self-care (FAMS) is a mobile phone-delivered intervention (i.e., phone coaching and text message support) based on Family Systems Theory which was successfully piloted among diverse adults with T2D. METHODS We made improvements to FAMS and conducted iterative usability testing to finalize FAMS 2.0 before evaluation in a randomized controlled trial (RCT). Adult persons with diabetes (PWDs) who enrolled were asked to invite a support person (friend or family member) to participate alongside them. For the RCT, dyads were randomly assigned to FAMS 2.0 or enhanced treatment as usual (control) for the first 9 months of the 15-month trial. Outcomes include PWDs' HbA1c and psychosocial well-being (including diabetes distress) and support persons' own diabetes distress and support burden. RESULTS We recruited RCT participants from April 2020 through October 2021 (N = 338 PWDs with T2D; 89% [n = 300] with a support person). PWDs were 52% male, 62% non-Hispanic White, aged 56.9 ± 11.0 years with HbA1c 8.7% ± 1.7% at enrollment; 73% cohabitated with their enrolled support person. Data collection is ongoing through January 2023. CONCLUSION Findings will inform the utility of engaging family/friends in self-care behaviors for both PWD and support person outcomes. Using widely available mobile phone technology, FAMS 2.0, if successful, has potential for scalability. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04347291 posted April 15, 2020.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Makenzie Parks
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel Molli
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
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Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial. Trials 2022; 23:841. [PMID: 36192769 PMCID: PMC9527393 DOI: 10.1186/s13063-022-06764-1] [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: 08/26/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs' social networks. Fifty to 75% of AWDs have an unpaid family member or friend ("support person") who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs' diabetes management. METHODS This parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach. The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months. The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient's diabetes. We also will assess the effect of the COVID-19 pandemic on patient's ability to manage diabetes. DISCUSSION This study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described. TRIAL REGISTRATION ClinicalTrials.gov NCT03812614. Registered on 18 January 2019.
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Donovan G, Hall N, Ling J, Smith F, Wilkes S. Influencing medication taking behaviors using automated two-way digital communication: A narrative synthesis systematic review informed by the Behavior Change Wheel. Br J Health Psychol 2022; 27:861-890. [PMID: 35080811 PMCID: PMC9541766 DOI: 10.1111/bjhp.12580] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/28/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Around half of prescribed medications for long-term conditions are not taken as directed. Automated two-way digital communication, such as text messaging and interactive voice response technology, could deliver interventions to improve medication adherence, and subsequently health. However, exploration of how such interventions may improve medication adherence is limited. This review aimed to explore how automated two-way digital communication can improve medication taking with or without using non-digital intervention components, such as phone calls with healthcare professionals. METHODS A theory-informed narrative synthesis systematic review. Several databases were searched including CINAHL, Embase, Medline, and Web of Science using key words relating to 'medication adherence' and digital communication technologies. The Behavior Change Technique (BCT) coding using the BCT Taxonomy V1 and the Behavior Change Wheel were used to identify BCTs delivered within the included interventions. RESULTS A total of 3,018 records were screened with 43 study reports included in the review. Four medication-taking behaviors: taking medication, obtaining medication, self-testing, and asking for support were identified as targets for behavior change within the included interventions. Most BCTs within the digital communication component aimed to increase motivation for medication adherence, with non-digital intervention components included to address other medication taking barriers, such as physical and psychological capability. CONCLUSION Automated two-way digital communication can detect barriers to medication adherence by monitoring performance of the taking medication behavior. Monitoring outcomes from taking medication may increase reflective motivation to take medicines. Addressing physical opportunity to taking medication by facilitating the behavior obtaining medication may also increase adherence.
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Affiliation(s)
- Gemma Donovan
- Faculty of Health Sciences and WellbeingSchool of Pharmacy and Pharmaceutical SciencesUniversity of SunderlandUK
| | - Nicola Hall
- Faculty of Medical SciencesPopulation Health Sciences InstituteNewcastle UniversityUK
| | - Jonathan Ling
- Faculty of Health Sciences and WellbeingUniversity of SunderlandUK
| | | | - Scott Wilkes
- Faculty of Health Sciences and WellbeingSchool of MedicineUniversity of SunderlandUK
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Aikens JE, Valenstein M, Plegue MA, Sen A, Marinec N, Achtyes E, Piette JD. Technology-Facilitated Depression Self-Management Linked with Lay Supporters and Primary Care Clinics: Randomized Controlled Trial in a Low-Income Sample. Telemed J E Health 2022; 28:399-406. [PMID: 34086485 PMCID: PMC8968843 DOI: 10.1089/tmj.2021.0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To test whether technology-facilitated self-management support improves depression in primary care settings. Methods: We randomized 204 low-income primary care patients who had at least moderate depressive symptoms to intervention or control. Intervention participants received 12 months of weekly automated interactive voice response telephone calls that assessed their symptom severity and provided self-management strategies. Their patient-nominated supporter (CarePartner) received corresponding guidance on self-management support, and their primary care team received urgent notifications. Those randomized to enhanced usual care received printed generic self-management instructions. Results: One-year attrition rate was 14%. By month 6, symptom severity on the Patient Health Questionnaire-9 (PHQ-9) decreased 2.5 points more in the intervention arm than in the control arm (95% CI -4.2 to -0.8, p = 0.003). This benefit was similar at month 12 (p = 0.004). Intervention was also over twice as likely to lead to ≥50% reduction in symptom severity by month 6 (OR = 2.2 (1.1, 4.7)) and a decrease of ≥5 PHQ-9 points by month 12 (OR = 2.3 (1.2, 4.4)). Conclusions: Technology-facilitated self-management guidance with lay support and clinician notifications improves depression for primary care patients. Subsequent research should examine implementation and generalization to other chronic conditions. clinicaltrials.gov, identifier NCT01834534.
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Affiliation(s)
- James E. Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Address correspondence to: James Aikens, PhD, Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213, USA
| | - Marcia Valenstein
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.,VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Melissa A. Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolle Marinec
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Achtyes
- Cherry Health, Heart of the City Health Center, Grand Rapids, Michigan, USA.,Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Lansing, Michigan, USA
| | - John D. Piette
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Piette JD, Striplin D, Aikens JE, Lee A, Marinec N, Mansabdar M, Chen J, Gregory LA, Kim CS. Impacts of Post-Hospitalization Accessible Health Technology and Caregiver Support on 90-Day Acute Care Use and Self-Care Assistance: A Randomized Clinical Trial. Am J Med Qual 2021; 36:145-155. [PMID: 32723072 DOI: 10.1177/1062860620943673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospitalized patients often are readmitted soon after discharge, with many hospitalizations being potentially preventable. The authors evaluated a mobile health intervention designed to improve post-hospitalization support for older adults with common chronic conditions. All participants enrolled with an informal caregiver or "CarePartner" (CP). Intervention patients received automated assessment and behavior change calls. CPs received automated, structured feedback following each assessment. Clinicians received alerts about serious problems identified during patient calls. Controls had a 65% greater risk of hospitalization within 90 days post discharge than intervention patients (P = .041). For every 6.8 enrollees, the intervention prevented 1 rehospitalization or emergency department encounter. The intervention improved physical functioning at 90 days (P = .012). The intervention also improved medication adherence and indicators of the quality of communication with CPs (all P < .01). Automated telephone patient monitoring and self-care advice with feedback to primary care teams and CPs reduces readmission rates over 90 days.
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Affiliation(s)
- John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI University of Michigan, Ann Arbor, MI University of Mississippi, Oxford, MS MidMichigan Health Network, Midland, MI University of Washington, Seattle, WA
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9
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Lee AA, Heisler M, Trivedi R, Leukel P, Mor MK, Rosland AM. Autonomy support from informal health supporters: links with self-care activities, healthcare engagement, metabolic outcomes, and cardiac risk among Veterans with type 2 diabetes. J Behav Med 2021; 44:241-252. [PMID: 33247416 PMCID: PMC8744428 DOI: 10.1007/s10865-020-00196-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/11/2020] [Indexed: 12/01/2022]
Abstract
This study examined the role of autonomy support from adults' informal health supporters (family or friends) in diabetes-specific health behaviors and health outcomes. Using baseline data from 239 Veterans with type 2 diabetes at risk of complications enrolled in behavioral trial, we examined associations between autonomy support from a support person and that support person's co-residence with the participant's diabetes self-care activities, patient activation, cardiometabolic measures, and predicted risk of a cardiac event. Autonomy support from supporters was associated with significantly increased adherence to healthy lifestyle behaviors (diet, p < .001 and exercise, p = .003); higher patient activation (p < .001); greater patient efficacy in interacting with healthcare providers, and lower 5-year (p = .044) and 10-year (p = .027) predicted cardiac risk. Autonomy support was not significantly associated with diabetes-specific behaviors (checking blood glucose, foot care, or medication taking); or hemoglobin A1c, systolic blood pressure, or non-HDL cholesterol. There was a significant interaction of autonomy support and supporter residence in one model such that lack of autonomy support was associated with lower patient activation only among individuals with in-home supporters. No other interactions were significant. Findings suggest that autonomy support from family and friends may play a role in patient self-management, patient activation, and lower cardiac risk.
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Affiliation(s)
- Aaron A Lee
- Department of Psychology, University of Mississippi, 310C Peabody Hall, University, MS, 38677, USA.
| | - Michele Heisler
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ranak Trivedi
- VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Population Sciences and Public Mental Health, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Patric Leukel
- Department of Psychology, University of Mississippi, 310C Peabody Hall, University, MS, 38677, USA
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
- Department of Internal Medicine, University of Pittsburgh Medical School, Pittsburgh, PA, USA
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Zhang Y, Liu C, Luo S, Huang J, Yang Y, Ma X, Li X, Zhou Z. Effectiveness of the Family Portal Function on the Lilly Connected Care Program (LCCP) for Patients With Type 2 Diabetes: Retrospective Cohort Study With Propensity Score Matching. JMIR Mhealth Uhealth 2021; 9:e25122. [PMID: 33544081 PMCID: PMC7895638 DOI: 10.2196/25122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/03/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background Diabetes is a major health concern worldwide. Family member engagement in diabetes self-management education programs can improve patients’ diabetes management. However, there is limited evidence that the family portal on diabetes management apps is effective in the glycemic control of patients with diabetes. Objective We aimed to evaluate the effectiveness of family support through the family portal function on Lilly Connected Care Program (LCCP) platform. Methods This retrospective cohort study included patients with type 2 diabetes recruited to the LCCP platform from September 1, 2018, to August 31, 2019. Propensity score matching was used to match family (group A) and non–family (group B) portal use groups with similar baseline characteristics. The patients were followed up with for 12 weeks. The main objectives were differences in mean fasting blood glucose, proportion of patients achieving fasting blood glucose target <7mmol/L, mean postprandial blood glucose, proportion of patients achieving postprandial blood glucose target <10mmol/L, proportion of patients achieving both fasting blood glucose <7mmol/L and postprandial blood glucose <10mmol/L, self-monitoring of blood glucose frequency at week 12 and the number of diabetes education courses patients completed during the 12 weeks. Moreover, logistic regression analysis was used to explore the baseline factors which may be associated with the use of family portal, and odds ratios with 95% confidence intervals were calculated. Results A total of 6582 adult patients (aged ≥18 years) with type 2 diabetes who were receiving insulin therapy were enrolled in the study. Overall, 6.1% (402/6582) of the patients chose to engage their family members to use the family portal. Two groups of 394 patients were well-matched regarding baseline characteristics. After matching, mean fasting blood glucose and postprandial blood glucose at week 12 were significantly lower in group A than in group B (fasting blood glucose: 7.12 mmol/L, SD 1.70 vs 7.42 mmol/L, SD 1.88, respectively, P=.02; postprandial blood glucose: 8.56 mmol/L, SD 2.51 vs 9.10 mmol/L, SD 2.69, respectively, P=.002). When comparing group A to group B, the proportion of patients achieving both fasting blood glucose <7mmol and postprandial blood glucose <10mmol/L at week 12 (46.8% vs 39.4%, respectively, P=.04), self-monitoring of blood glucose frequency at week 12 (8.92 times per week, SD 6.77 vs 8.02 times per week, SD 5.97, respectively, P=.05) and number of diabetes education courses completed in 12 weeks (23.00, IQR9.00-38.00 vs 15.00, IQR 4.00-36.00, respectively, P<.001) was higher. Additionally, multivariate logistic regression analysis showed that higher age (OR=0.987, 95% CI 0.978-0.996, P=.006) and higher baseline fasting blood glucose (OR=0.914, 95% CI 0.859-0.972, P=.004) were correlated with less use of the family portal function, while increased baseline self-monitoring of blood glucose frequency (OR=1.022, 95% CI 1.012-1.032], P<.001) as well as increased education courses (OR=1.026, 95% CI 1.015-1.036, P<.001) were associated with more use of the family portal function. Conclusions Family support through the LCCP family portal is effective for glycemic control and self-management behavior improvement in type 2 diabetes patients.
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Affiliation(s)
- Yiyu Zhang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Endocrinology, Changsha Central Hospital, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuoming Luo
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jin Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuxin Yang
- Lilly Suzhou Pharmaceutical Company, Suzhou, China
| | - Xiao Ma
- Lilly Suzhou Pharmaceutical Company, Suzhou, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
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11
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Mayberry LS, Bergner EM, Harper KJ, Laing S, Berg CA. Text messaging to engage friends/family in diabetes self-management support: acceptability and potential to address disparities. J Am Med Inform Assoc 2021; 26:1099-1108. [PMID: 31403688 DOI: 10.1093/jamia/ocz091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/19/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Explore acceptability of engaging family/friends in patients' type 2 diabetes (T2D) self-management using text messaging. MATERIALS AND METHODS Participants (N = 123) recruited from primary care clinics for a larger trial evaluating mobile phone support for T2D completed self-report measures and a hemoglobin A1c test and then had the option to invite an adult support person to receive text messages. We examined characteristics and reasons of participants who did/did not invite a support person, responses to the invitation, and feedback from patients and support persons. RESULTS Participants were 55.9 ± 10.1 years old, 55% female, 53% minority, and 54% disadvantaged (low income, less than high school degree/GED, uninsured, and/or homeless). Participants who invited a support person (48%) were slightly younger, more likely to be partnered, and reported more depressive symptoms and more emergency department visits in the year prior to study enrollment as compared to participants who did not (all p <.05). Participants' reasons for inviting a support person included needing help and seeing benefits of engaging others, while reasons for not inviting a support person included concerns about being a "burden" and support person's ability or desire to text. Support persons reported the texts increased awareness, created dialogue, and improved their own health behaviors. DISCUSSION Patients inviting a support person had higher need and thus may stand to benefit most. Most support persons were open to engagement via text messages. CONCLUSION Across race and socioeconomic status, text messaging may engage support persons to increase health-related support-particularly for patients with higher levels of need. TRIAL REGISTRATION Clinicaltrials.gov NCT02409329.
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Affiliation(s)
- Lindsay S Mayberry
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erin M Bergner
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kryseana J Harper
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Simone Laing
- Meharry Medical College, Nashville, Tennessee, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
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12
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Shaffer KM, Tigershtrom A, Badr H, Benvengo S, Hernandez M, Ritterband LM. Dyadic Psychosocial eHealth Interventions: Systematic Scoping Review. J Med Internet Res 2020; 22:e15509. [PMID: 32130143 PMCID: PMC7081137 DOI: 10.2196/15509] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 01/03/2023] Open
Abstract
Background Dyadic psychosocial interventions have been found beneficial both for people coping with mental or physical health conditions as well as their family members and friends who provide them with support. Delivering these interventions via electronic health (eHealth) may help increase their scalability. Objective This scoping review aimed to provide the first comprehensive overview of dyadic eHealth interventions for individuals of all ages affected by mental or physical illness and their family members or friends who support them. The goal was to understand how dyadic eHealth interventions have been used and to highlight areas of research needed to advance dyadic eHealth intervention development and dissemination. Methods A comprehensive electronic literature search of PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO was conducted for articles published in the English language through March 2019. Eligible records described a psychosocial eHealth intervention that intervened with both care recipients and their support person. Results A total of 7113 records were reviewed of which 101 met eligibility criteria. There were 52 unique dyadic eHealth interventions identified, which were tested across 73 different trials. Of the unique interventions, 33 were conducted among dyads of children and their supporting parent, 1 was conducted with an adolescent-young adult care recipient population, and the remaining 18 were conducted among adult dyads. Interventions targeting pediatric dyads most commonly addressed a mental health condition (n=10); interventions targeting adult dyads most commonly addressed cancer (n=9). More than three-fourths of interventions (n=40) required some human support from research staff or clinicians. Most studies (n=64) specified one or more primary outcomes for care recipients, whereas less than one-fourth (n=22) specified primary outcomes for support persons. Where specified, primary outcomes were most commonly self-reported psychosocial or health factors for both care recipients (n=43) and support persons (n=18). Results of the dyadic eHealth intervention tended to be positive for care recipients, but evidence of effects for support persons was limited because of few studies specifying primary outcomes for supporters. Trials of dyadic eHealth interventions were most commonly randomized controlled trials (RCTs; n=44), and RCTs most commonly compared the dyadic eHealth intervention to usual care alone (n=22). Conclusions This first comprehensive review of dyadic eHealth interventions demonstrates that there is substantial, diverse, and growing literature supporting this interventional approach. However, several significant gaps were identified. Few studies were designed to evaluate the unique effects of dyadic interventions relative to individual interventions. There was also limited assessment and reporting of outcomes for support persons, and there were no interventions meeting our eligibility criteria specifically targeting the needs of older adult dyads. Findings highlight areas of research opportunities for developing dyadic eHealth interventions for novel populations and for increasing access to dyadic care.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, United States.,Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Hoda Badr
- Baylor College of Medicine, Houston, TX, United States
| | | | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, New York, NY, United States.,CUNY School of Medicine/City College of New York, New York, NY, United States
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
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13
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Irani E, Niyomyart A, Hickman RL. Systematic Review of Technology-Based Interventions Targeting Chronically Ill Adults and Their Caregivers. West J Nurs Res 2020; 42:974-992. [PMID: 31941418 DOI: 10.1177/0193945919897011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this systematic review is to synthesize the study design features as well as the attributes and outcomes of technology-based health interventions targeting chronically ill adults and their family caregivers. Twenty papers representing 19 studies met the inclusion criteria. Various theoretical foundations or approaches guided the interventions in 11 studies. Interventions either aimed to support patient self-management and improve patient outcomes or enhance shared illness management and improve patient and caregiver outcomes. The interventions included educational, behavioral, and support components and were delivered using various technologies ranging from text messaging to using the Internet. Overall, patients and caregivers expressed improvements in self-management outcomes (or support) and quality of life. Interventions with a dyadic focus reported on interpersonal outcomes, with improvements noted mostly in patients. This review captures an emerging area of science, and findings should be interpreted in light of the methodological limitations of the included studies.
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Affiliation(s)
- Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Atsadaporn Niyomyart
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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14
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Piette JD, Striplin D, Fisher L, Aikens JE, Lee A, Marinec N, Mansabdar M, Chen J, Gregory LA, Kim CS. Effects of Accessible Health Technology and Caregiver Support Posthospitalization on 30-Day Readmission Risk: A Randomized Trial. Jt Comm J Qual Patient Saf 2019; 46:109-117. [PMID: 31810829 DOI: 10.1016/j.jcjq.2019.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Patients with chronic illness often require ongoing support postdischarge. This study evaluated a simple-to-use, mobile health-based program designed to improve postdischarge follow-up via (1) tailored communication to patients using automated calls, (2) structured feedback to informal caregivers, and (3) automated alerts to clinicians about urgent problems. METHODS A total of 283 patients with common medical diagnoses, including chronic obstructive pulmonary disease, coronary artery disease, pneumonia, and diabetes, were recruited from a university hospital, a community hospital, and a US Department of Veterans Affairs hospital. All patients identified an informal caregiver or "care partner" (CP) to participate in their postdischarge support. Patient-CP dyads were randomized to the intervention or usual care. Intervention patients received weekly automated assessment and behavior change calls. CPs received structured e-mail feedback. Outpatient clinicians received fax alerts about serious problems. Primary outcomes were 30-day readmission rate and the combined outcome of readmission/emergency department (ED) use. Information about postdischarge outpatient visits, rehospitalizations, and ED encounters was obtained from medical records. RESULTS Overall, 11.4% of intervention patients and 17.9% of controls were rehospitalized within 30 days postdischarge (hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.31-1.11; p = 0.102). Compared to intervention patients with other illnesses, those with pulmonary diagnoses generated the most clinical alerts (p = 0.004). Pulmonary patients in the intervention group showed significantly reduced 30-day risk of rehospitalization relative to controls (HR: 0.31; 95% CI: 0.11-0.87; p = 0.026). CONCLUSION The CP intervention did not improve 30-day readmission rates overall, although post hoc analyses suggested that it may be promising among patients with pulmonary diagnoses.
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15
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Pichayapinyo P, Saslow LR, Aikens JE, Marinec N, Sillabutra J, Rattanapongsai P, Piette JD. Feasibility study of automated interactive voice response telephone calls with community health nurse follow-up to improve glycaemic control in patients with type 2 diabetes. Int J Nurs Pract 2019; 25:e12781. [PMID: 31531929 DOI: 10.1111/ijn.12781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thailand has a shortage of community health nurses for supporting the self-management of type 2 diabetes, which is prevalent and poorly controlled. AIM This study examined the feasibility and acceptability of a self-care assistance programme for poorly controlled type 2 diabetes mellitus. The SukapapNet programme consisted of automated interactive voice response calls to patients and automated follow-up email notifications to their nurses. DESIGN Single-arm pre-post trial. METHODS Six nurses and 35 type 2 diabetes patients were recruited from primary care settings in suburban provinces in Thailand. The study was conducted from June 2017 to November 2017. We assessed patients before and after 12 weeks of the SukapapNet intervention. RESULTS Mean glycated haemoglobin decreased by 0.9%. Patients reported reduced carbohydrate consumption, increased physical activity, increased medication adherence, improved sleep quality, and more frequent foot care. Patients and nurses both recommended using the intervention, although nurses expressed concerns regarding increased workload. CONCLUSIONS The study programme could improve outcomes in Thai type 2 diabetes patients. Further study of the impact of technology upon nurses' workload is warranted.
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Affiliation(s)
| | - Laura R Saslow
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nicolle Marinec
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan
| | | | - Piyamon Rattanapongsai
- Non-communicable disease clinic, Health Promoting Hospital, Pathumthani Province, Thailand
| | - John D Piette
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan.,School of Public Health and Center for Diabetes Translational Research, University of Michigan, Ann Arbor, Michigan
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16
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Affiliation(s)
- Alan L. Robin
- Department of Ophthalmology, Johns Hopkins School of Medicine and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Ophthalmology, The University of Michigan, Ann Arbor, MI, USA
| | - Kelly W. Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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17
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Burner E, Mercado J, Hernandez-Saenz A, Peters A, Mack W, Baezconde-Garbanati L, Arora S, Wu S. Design and patient characteristics of the randomized controlled trial TExT-MED + FANS A test of mHealth augmented social support added to a patient-focused text-messaging intervention for emergency department patients with poorly controlled diabetes. Contemp Clin Trials 2019; 80:1-8. [PMID: 30878623 PMCID: PMC6488230 DOI: 10.1016/j.cct.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 01/20/2023]
Abstract
Although diabetes is a nationwide epidemic, US Latinos are a particularly vulnerable population. Culturally appropriate interventions can combat this disparity, especially those that increase social support. However, these interventions face significant cost and time barriers, which mHealth (mobile health) may overcome. This trial examines the benefit of adding social support to an existing text-message based, patient-focused mHealth intervention for emergency department patients with poorly controlled diabetes. Family members and friends of patients were randomized to mHealth augmented social support training (daily text-messages that synchronize with the patient messages) or a pamphlet based training (the same content mailed to their house.) We hypothesize that patients who received mHealth augmented social support will have a larger improvement in diabetes management (glycosylated hemoglobin or A1C) than those receiving standard support at six-months, and that improvement will be sustained at twelve-months. Secondary patient outcomes are clinical (weight, blood pressure), behavioral (medication adherence, self-care activities) and psychosocial (general and diabetes-specific social support, self-efficacy, diabetes-related distress, depression, fatalism and quality of life). We screened 2004 patients and enrolled 166 patient/supporter dyads. 70% of patients are Spanish-speaking, 51% female, with a mean A1C of 10.8. We employed innovative measures to remotely enroll family members and support a bilingual population, which will assist other investigators in design of similar trials. The findings of our trial will have real-world applicability for clinicians, health system administrators, health educators and mHealth developers who aim to improve the health of this vulnerable population.
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Affiliation(s)
- Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, United States.
| | - Janisse Mercado
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, United States
| | | | - Anne Peters
- Division of Endocrinology, Keck School of Medicine of the University of Southern California, United States
| | - Wendy Mack
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, United States
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, United States
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, United States
| | - Shinyi Wu
- School of Social Work, University of Southern California, United States
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18
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Burner ERE, Menchine MD, Kubicek K, Robles M, Kagawa Singer M, Arora S. Perceptions of Family Among Low-Income Patients With Diabetes in a Text-Based Mobile Health Intervention. J Diabetes Sci Technol 2018; 12:1203-1210. [PMID: 29681170 PMCID: PMC6232730 DOI: 10.1177/1932296818770702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Diabetes disproportionately affects the US Latino population, due to socioeconomic pressures, genetics, reduced access to care and cultural practices. While efforts to improve self-care through interventions incorporating family are highly rated by Latinos, family can be both supportive and obstructive. To develop effective interventions, this role needs clarification. METHODS We conducted group interviews in Spanish and English with 24 participants with diabetes from a mobile health diabetes self-care intervention. We imported transcripts into Dedoose, a qualitative computer analysis program and analyzed them with a modified grounded theory technique. Utilizing an iterative process, we reexamined transcripts with new codes derived in each round of analysis until saturation was reached. We employed techniques to improve trustworthiness (co-coding, member checking). Broad categorical themes arose from the initial codes and were developed into a conceptual model of barriers to and strategies for diabetes management. RESULTS Family and family responsibilities emerged as both a supportive and obstructive force for diabetes self-care. While the desire to care for family motivated patients, food at family gatherings and pressure from managing multiple family responsibilities contributed to poor diet choices. Yet, some patients believed their diabetes caused their immediate family to make healthier choices. CONCLUSIONS Among these predominantly Latino patients, family and family responsibilities were key motivators as well as obstacles to self-care, particularly regarding nutrition. Finding the ideal design for social support mHealth-based interventions will require careful study and creation of culturally based programs to match the needs of specific populations, and may require educating family members to provide effective social support.
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Affiliation(s)
- Elizabeth R. E. Burner
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Michael D. Menchine
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Katrina Kubicek
- Community Engagement, SC Clinical &
Translational Science Institute
| | - Marisela Robles
- Community Engagement, SC Clinical &
Translational Science Institute
| | | | - Sanjay Arora
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
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19
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Bunn F, Goodman C, Jones PR, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. Managing diabetes in people with dementia: a realist review. Health Technol Assess 2018; 21:1-140. [PMID: 29235986 DOI: 10.3310/hta21750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes. OBJECTIVES To identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research. DESIGN Realist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders. PARTICIPANTS Twenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference. DATA SOURCES The following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing - UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA). RESULTS We included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context-mechanism-outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia. LIMITATIONS There is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven. CONCLUSIONS This review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020625. FUNDING The NIHR HTA programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
| | - Antony Bayer
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Chris Burton
- School of Healthcare Sciences, Bangor University, Bangor, UK
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20
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Post stroke depression: The sequelae of cerebral stroke. Neurosci Biobehav Rev 2018; 90:104-114. [DOI: 10.1016/j.neubiorev.2018.04.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/12/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
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21
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Ratanawongsa N, Quan J, Handley MA, Sarkar U, Schillinger D. Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims. BMC Health Serv Res 2018; 18:254. [PMID: 29625571 PMCID: PMC5889590 DOI: 10.1186/s12913-018-3071-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/28/2018] [Indexed: 12/15/2022] Open
Abstract
Background Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments. Methods As part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: “In the last 7 days, how many days did you MISS taking your …” diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview. Results Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01). Conclusions Language-concordant ATSM demonstrated modest potential for assessing adherence. Studies should evaluate HIT assessments of medication beliefs and concerns in diverse populations. Trial registration NCT00683020, registered May 21, 2008. Electronic supplementary material The online version of this article (10.1186/s12913-018-3071-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neda Ratanawongsa
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.
| | - Judy Quan
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Margaret A Handley
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.,Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Urmimala Sarkar
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Dean Schillinger
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
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Burner E, Lam CN, DeRoss R, Kagawa-Singer M, Menchine M, Arora S. Using Mobile Health to Improve Social Support for Low-Income Latino Patients with Diabetes: A Mixed-Methods Analysis of the Feasibility Trial of TExT-MED + FANS. Diabetes Technol Ther 2018; 20:39-48. [PMID: 29227155 PMCID: PMC5770080 DOI: 10.1089/dia.2017.0198] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Social support interventions can improve diabetes self-care, particularly for Latinos, but are time and resource intensive. Mobile health may overcome these barriers by engaging and training supporters remotely. METHODS We conducted a randomized controlled feasibility trial of emergency department patients with diabetes to determine the feasibility of enrolling patients and supporters, acceptability of the intervention, and preliminary efficacy results to power a larger trial. All patients received an existing mHealth curriculum (TExT-MED). After identifying a supporter, patients were randomized to intervention: supporters receiving FANS (family and friends network support), a text message support curriculum synchronized to patient messages, or control: supporters receiving a mailed pamphlet of the same information. Participants followed up at 3 months. FANS intervention participants came to postintervention interviews as part of a qualitative analysis. RESULTS We enrolled 44 patients (22 per arm) and followed up 36 at 3 months. Participants were positive about the program. FANS intervention improved HbA1c (intervention mean decreased from 10.4% to 9.0% vs. from 10.1% to 9.5%, delta -0.8%, confidence interval [CI] -0.4 to 2, P = 0.30), self-monitoring of glucose (intervention increased 1.6 days/week vs. control decreased 2 days/week, delta 2.3 days/week, CI 4-0.6, P = 0.02), and physical activity (mean Godin leisure time activity score improved 16.1 vs. decreased 9.6 for control, delta 25.7, CI 49.2-2.3, P = 0.10). In qualitative analysis, patients reported improved motivation, behaviors, and relationships. Supporters reported making healthier decisions for themselves. CONCLUSIONS mHealth is a feasible, acceptable, and promising avenue to improve social support and diabetes outcomes.
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Affiliation(s)
- Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rebecca DeRoss
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Bunn F, Goodman C, Reece Jones P, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Med 2017; 15:141. [PMID: 28750628 PMCID: PMC5532771 DOI: 10.1186/s12916-017-0909-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/04/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. METHODS This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders - user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers - took part in interviews, and 24 participated in a consensus conference. RESULTS We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. CONCLUSIONS Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. TRIAL REGISTRATION PROSPERO, CRD42015020625. Registered on 18 May 2015.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, LU1 3UA, UK
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Cardiff, Wales, CF10 3AT, LL57 2EF, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | | | - Christopher Burton
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
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Sentell T, Pitt R, Buchthal OV. Health Literacy in a Social Context: Review of Quantitative Evidence. Health Lit Res Pract 2017; 1:e41-e70. [PMID: 31294251 PMCID: PMC6607851 DOI: 10.3928/24748307-20170427-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background Conceptual literature has consistently noted that health literacy exists within a social context. This review examined how the intersection of social context and health literacy has been operationalized in quantitative, empirical research. Methods Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched seven databases, including PubMed and CINAHL (The Cumulative Index to Nursing and Allied Health Literature), using a range of potentially relevant keywords, and we hand-searched bibliographies. Inclusion criteria were quantitative studies of any design in which measurement of health literacy and measurement of social context intersected. We identified 1,052 unduplicated articles; 34 met inclusion criteria. Key Results We found three distinct perspectives on the intersection between health literacy and social context. Most common (n = 23) were studies measuring an association between individual health literacy and individual social capital, social support, or social engagement, particularly whether social support varied by health literacy and/or if this relationship mediated health outcomes. Another group of studies (n = 6) took the perspective that being health literate by definition included social context, including access to and/or use of social support as a domain in individual health literacy assessment. Five studies considered the social context of health literacy as an independent property measured beyond the individual level; two measured community-level health literacy and three measured health literacy capacity/concordance in caregiving dyads. The studies showed significant definitional and measurement complexity and overlap. In the most dramatic example, a similar question was used across various studies to measure (1) health literacy, (2) a social support domain in health literacy, (3) social support, and (4) a study outcome distinct from, but associated with, health literacy. Potential useful methods, such as social network analyses, were missing from the literature. Discussion Existing quantitative research on health literacy in a social context supports more attention to this topic. This review quantified evidence, revealed gaps, noted limitations, and identified important questions for future research. [Health Literacy Research and Practice . 2017;1(2):e41-e70.]. Plain Language Summary This study systemically compiles existing quantitative empirical research (34 articles) focusing on the intersection of health literacy in the social context. We find considerable measurement complexity in the current body of work on this topic and identify three distinct perspectives that researchers have taken while considering this topic. This information will be useful for future development of this important research area.
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Posadzki P, Mastellos N, Ryan R, Gunn LH, Felix LM, Pappas Y, Gagnon M, Julious SA, Xiang L, Oldenburg B, Car J. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 2016; 12:CD009921. [PMID: 27960229 PMCID: PMC6463821 DOI: 10.1002/14651858.cd009921.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. OBJECTIVES To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. SEARCH METHODS We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. SELECTION CRITERIA Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods to select and extract data and to appraise eligible studies. MAIN RESULTS We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear.For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data.The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use.Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.Only four trials (3%) reported adverse events, and it was unclear whether these were related to the interventions. AUTHORS' CONCLUSIONS ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost-effective.
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Affiliation(s)
- Pawel Posadzki
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
| | - Nikolaos Mastellos
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
| | - Rebecca Ryan
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Laura H Gunn
- Stetson UniversityPublic Health Program421 N Woodland BlvdDeLandFloridaUSA32723
| | - Lambert M Felix
- Edge Hill UniversityFaculty of Health and Social CareSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Yannis Pappas
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Marie‐Pierre Gagnon
- Traumatologie – Urgence – Soins IntensifsCentre de recherche du CHU de Québec, Axe Santé des populations ‐ Pratiques optimales en santé10 Rue de l'Espinay, D6‐727QuébecQCCanadaG1L 3L5
| | - Steven A Julious
- University of SheffieldMedical Statistics Group, School of Health and Related ResearchRegent Court, 30 Regent StreetSheffieldUKS1 4DA
| | - Liming Xiang
- Nanyang Technological UniversityDivision of Mathematical Sciences, School of Physical and Mathematical Sciences21 Nanyang LinkSingaporeSingapore
| | - Brian Oldenburg
- University of MelbourneMelbourne School of Population and Global HealthMelbourneVictoriaAustralia
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Janevic MR, Aruquipa Yujra AC, Marinec N, Aguilar J, Aikens JE, Tarrazona R, Piette JD. Feasibility of an interactive voice response system for monitoring depressive symptoms in a lower-middle income Latin American country. Int J Ment Health Syst 2016; 10:59. [PMID: 27688798 PMCID: PMC5034527 DOI: 10.1186/s13033-016-0093-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Innovative, scalable solutions are needed to address the vast unmet need for mental health care in low- and middle-income countries (LMICs). Methods We conducted a feasibility study of a 14-week automated telephonic interactive voice response (IVR) depression self-care service among Bolivian primary care patients with at least moderately severe depressive symptoms. We analyzed IVR call completion rates, the reliability and validity of IVR-collected data, and participant satisfaction. Results Of the 32 participants, the majority were women (78 % or 25/32) and non-indigenous (75 % or 24/32). Participants had moderate depressive symptoms at baseline (PHQ-8 score mean 13.3, SD = 3.5) and reported good or fair general health status (88 % or 28/32). Fifty-four percent of weekly IVR calls (approximately 7 out of 13 active call-weeks) were completed. Neither PHQ-8 scores nor IVR call completion differed significantly by ethnicity, education, self-reported depression diagnosis, self-reported overall health, number of chronic conditions, or health literacy. The reliability for IVR-collected PHQ-8 scores was good (Cronbach’s alpha = 0.83). Virtually every participant (97 %) was “mostly” or “very” satisfied with the program. Many described the program as beneficial for their mood and self-care, albeit limited by some technological difficulties and the lack of human interaction. Conclusion Findings suggest that IVR could feasibly be used to provide monitoring and self-care education to depressed patients in Bolivia. An expanded stepped-care service offering contact with lay health workers for more depressed individuals and expanded mHealth content may foster greater patient engagement and enhance its therapeutic value while remaining cost-effective. Trial registration ISRCTN ISRCTN 18403214. Registered 14 September 2016. Retrospectively registered
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Affiliation(s)
- Mary R Janevic
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | | | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
| | - Juvenal Aguilar
- Estado Plurinacional de Bolivia Ministerio de Salud, La Paz, Bolivia
| | - James E Aikens
- School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104 USA
| | - Rosa Tarrazona
- QUANTICA Organización Profesional para el Avance de la Salud Mental, La Paz, Bolivia
| | - John D Piette
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA
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Wakefield BJ, Vaughan-Sarrazin M. Home Telehealth and Caregiving Appraisal in Chronic Illness. Telemed J E Health 2016; 23:282-289. [PMID: 27631165 DOI: 10.1089/tmj.2016.0105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Remote health monitoring applications are being adopted to improve the health of chronically ill individuals. Little work has focused on the effects of these technologies on informal caregivers (CG) of patients with chronic illnesses. OBJECTIVES To examine differences in caregiving appraisal between CG of enrolled and nonenrolled Veterans in the home telehealth (HT) program. METHODS Cross-sectional survey methodology in 244 dyads (Veteran and CG) from 6 rural Midwestern Veterans Affairs Medical Centers. Survey variables were derived from the 2004 National Alliance for Caregiving survey, along with measures of caregiving strain, burden, and satisfaction. RESULTS We found no differences when comparing HT and non-HT CG. In multivariate analyses combining the two groups, CG characteristics associated with CG strain included younger age, providing help with activities of daily living and instrumental activities of daily living, use of coping skills, depressive symptoms, and less use of unpaid help (all p ≤ 0.001). Burden was associated with CG use of coping skills, caregiving confidence, and relationship quality with the Veteran (all p < 0.0001). CG satisfaction was associated with presence of social support (p < 0.0001). High CG strain was associated with Veteran hospitalization in the combined group (p = 0.03). Burden (p = 0.0002) was significantly associated with CG satisfaction. DISCUSSION Existing HT infrastructure provides an opportunity to incorporate training and support programs for CG of chronically ill patients. Such programs could improve CG confidence and use of positive coping skills, lower strain and burden, and potentially improve the health of both the care recipient and CG.
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Affiliation(s)
- Bonnie J Wakefield
- 1 Center for Comprehensive Access & Delivery Research and Evaluation , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,2 Rural Health Resource Center-Central Region , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,3 Sinclair School of Nursing, University of Missouri , Columbia, Missouri
| | - Mary Vaughan-Sarrazin
- 1 Center for Comprehensive Access & Delivery Research and Evaluation , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,2 Rural Health Resource Center-Central Region , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,4 Department of Internal Medicine, University of Iowa Roy and Lucille Carver College of Medicine , Iowa City, Iowa
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Trivedi R, Slightam C, Fan VS, Rosland AM, Nelson K, Timko C, Asch SM, Zeliadt SB, Heidenreich P, Hebert PL, Piette JD. A Couples' Based Self-Management Program for Heart Failure: Results of a Feasibility Study. Front Public Health 2016; 4:171. [PMID: 27626029 PMCID: PMC5004799 DOI: 10.3389/fpubh.2016.00171] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/03/2016] [Indexed: 11/15/2022] Open
Abstract
Background Heart failure (HF) is associated with frequent exacerbations and shortened lifespan. Informal caregivers such as significant others often support self-management in patients with HF. However, existing programs that aim to enhance self-management seldom engage informal caregivers or provide tools that can help alleviate caregiver burden or improve collaboration between patients and their informal caregivers. Objective To develop and pilot test a program targeting the needs of self-management support among HF patients as well as their significant others. Methods We developed the Dyadic Health Behavior Change model and conducted semi-structured interviews to determine barriers to self-management from various perspectives. Participants’ feedback was used to develop a family-centered self-management program called “SUCCEED: Self-management Using Couples’ Coping EnhancEment in Diseases.” The goals of this program are to improve HF self-management, quality of life, communication within couples, relationship quality, and stress and caregiver burden. We conducted a pilot study with 17 Veterans with HF and their significant others to determine acceptability of the program. We piloted psychosocial surveys at baseline and after participants’ program completion to evaluate change in depressive symptoms, caregiver burden, self-management of HF, communication, quality of relationship, relationship mutuality, and quality of life. Results Of the 17 couples, 14 completed at least 1 SUCCEED session. Results showed high acceptability for each of SUCCEED’s sessions. At baseline, patients reported poor quality of life, clinically significant depressive symptoms, and inadequate self-management of HF. After participating in SUCCEED, patients showed improvements in self-management of HF, communication, and relationship quality, while caregivers reported improvements in depressive symptoms and caregiver burden. Quality of life of both patients and significant others declined over time. Conclusion In this small pilot study, we showed positive trends with involving significant others in self-management. SUCCEED has the potential of addressing the growing public health problem of HF among patients who receive care from their significant other.
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Affiliation(s)
- Ranak Trivedi
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | | | - Vincent S Fan
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Ann-Marie Rosland
- University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Karin Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | | | - Steven M Asch
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Steven B Zeliadt
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Paul Heidenreich
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Paul L Hebert
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - John D Piette
- University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Health Care System, Ann Arbor, MI, USA
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Janevic MR, Piette JD, Ratz DP, Kim HM, Rosland AM. Correlates of family involvement before and during medical visits among older adults with high-risk diabetes. Diabet Med 2016; 33:1140-8. [PMID: 26642179 PMCID: PMC4896854 DOI: 10.1111/dme.13045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Abstract
AIMS To examine the characteristics of patients with diabetes who regularly receive help from a supporter in preparing for and attending medical visits, and the association between this help and clinical risk factors for diabetes complications. METHODS We linked survey data about family involvement for patients in the Veterans Health Administration system with poorly controlled Type 2 diabetes (n = 588; mean 67 years; 97% male) with health record data on blood pressure, glycaemic control and prescription-fill gaps. We used multivariable regression to assess whether supporter presence and, among patients with supporters, supporter role (visit preparation, accompaniment to medical visit or no involvement) were associated with concurrent trends in clinical risk factors over 2 years, adjusting for sociodemographic and health characteristics. RESULTS Most patients (78%) had a main health supporter; of these, more had regular support for preparing for appointments (69%) than were regularly accompanied to them (45%). Patients with preparation help only were younger and more educated than accompanied patients. Support presence and type was not significantly associated with clinical risk factors. CONCLUSIONS Family help preparing for appointments was common among these patients with high-risk diabetes. In its current form, family support for medical visits may not affect clinical factors in the short term. Supporters helping patients engage in medical visits may need training and assistance to have an impact on the clinical trajectory of patients with diabetes.
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Affiliation(s)
- M R Janevic
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - J D Piette
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - D P Ratz
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - H M Kim
- Center for Statistical Consultation and Research, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - A-M Rosland
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
- Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Interactive Voice Response-An Innovative Approach to Post-Stroke Depression Self-Management Support. Transl Stroke Res 2016; 8:77-82. [PMID: 27394917 DOI: 10.1007/s12975-016-0481-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
Automated interactive voice response (IVR) call systems can provide systematic monitoring and self-management support to depressed patients, but it is unknown if stroke patients are able and willing to engage in IVR interactions. We sought to assess the feasibility and acceptability of IVR as an adjunct to post-stroke depression follow-up care. The CarePartner program is a mobile health program designed to optimize depression self-management, facilitate social support from a caregiver, and strengthen connections between stroke survivors and primary care providers (PCPs). Ischemic stroke patients and an informal caregiver, if available, were recruited during the patient's acute stroke hospitalization or follow-up appointment. The CarePartner program was activated in patients with depressive symptoms during their stroke hospitalization or follow-up. The 3-month intervention consisted of weekly IVR calls monitoring both depressive symptoms and medication adherence along with tailored suggestions for depressive symptom self-management. After each completed IVR call, informal caregivers were automatically updated, and, if needed, the subject's PCP was notified. Of the 56 stroke patients who enrolled, depressive symptoms were identified in 13 (23 %) subjects. Subjects completed 74 % of the weekly IVR assessments. A total of six subjects did not complete the outcome assessment, including two non-study-related deaths. PCPs were notified five times, including two times for suicidal ideation and three times for medication non-adherence. Stroke patients with depressive symptoms were able to engage in an IVR call system. Future studies are needed to explore the efficacy of an IVR approach for post-stroke self-management and monitoring of stroke-related outcomes.
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Piette JD, Marinec N, Janda K, Morgan E, Schantz K, Yujra ACA, Pinto B, Soto JMH, Janevic M, Aikens JE. Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country. Telemed J E Health 2016; 22:261-8. [PMID: 26352854 PMCID: PMC4968278 DOI: 10.1089/tmj.2015.0099] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers ("CarePartners") increased engagement in m-health support among diabetes and hypertension patients in Bolivia. MATERIALS AND METHODS Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone ("standard m-health") or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call ("m-health+CP"). RESULTS The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had ≤6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR = 0.42; 95% CI, 0.19, 0.91). CONCLUSIONS In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathryn Janda
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emily Morgan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karolina Schantz
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Mary Janevic
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - James E. Aikens
- School of Medicine, University of Michigan, Ann Arbor, Michigan
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Can we engage caregiver spouses of patients with heart failure with a low-intensity, symptom-guided intervention? Heart Lung 2016; 45:114-20. [DOI: 10.1016/j.hrtlng.2015.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/04/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
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Nerini E, Bruno F, Citterio F, Schena FP. Nonadherence to immunosuppressive therapy in kidney transplant recipients: can technology help? J Nephrol 2016; 29:627-36. [DOI: 10.1007/s40620-016-0273-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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Piette JD, Striplin D, Marinec N, Chen J, Gregory LA, Sumerlin DL, DeSantis AM, Gibson C, Crause I, Rouse M, Aikens JE. Improving Post-Hospitalization Transition Outcomes through Accessible Health Information Technology and Caregiver Support: Protocol for a Randomized Controlled Trial. JOURNAL OF CLINICAL TRIALS 2016; 5. [PMID: 26779394 PMCID: PMC4711915 DOI: 10.4172/2167-0870.1000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective The goal of this trial is to evaluate a novel intervention designed to improve post-hospitalization support for older adults with chronic conditions via: (a) direct tailored communication to patients using regular automated calls post discharge, (b) support for informal caregivers outside of the patient’s household via structured automated feedback about the patient’s status plus advice about how caregivers can help, and (c) support for care management including a web-based disease management tool and alerts about potential problems. Methods 846 older adults with common chronic conditions are being identified upon hospital admission. Patients are asked to identify a “CarePartner” (CP) living outside their household, i.e., an adult child or other social network member willing to play an active role in their post-discharge transition support. Patient-CP pairs are randomized to the intervention or usual care. Intervention patients receive automated assessment and behavior change calls, and their CPs receives structured feedback and advice via email and automated calls following each assessment. Clinical teams have access to assessment results via the web and receive automated reports about urgent health problems. Patients complete surveys at baseline, 30 days, and 90 days post discharge; utilization data is obtained from hospital records. CPs, other caregivers, and clinicians are interviewed to evaluate intervention effects on processes of self-care support, caregiver stress and communication, and the intervention’s potential for broader implementation. The primary outcome is 30-day readmission rates; other outcomes measured at 30 days and 90 days include functional status, self-care behaviors, and mortality risk. Conclusion This trial uses accessible health technologies and coordinated communication among informal caregivers and clinicians to fill the growing gap between what discharged patients need and available resources. A unique feature of the intervention is the provision of transition support not only for patients but also for their informal caregivers.
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Affiliation(s)
- John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana Striplin
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenny Chen
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynn A Gregory
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Denise L Sumerlin
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela M DeSantis
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn Gibson
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ingrid Crause
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Marylena Rouse
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Snyder H, Engström J. The antecedents, forms and consequences of patient involvement: A narrative review of the literature. Int J Nurs Stud 2016; 53:351-78. [DOI: 10.1016/j.ijnurstu.2015.09.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/19/2022]
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Durcan L, Clarke WA, Magder LS, Petri M. Hydroxychloroquine Blood Levels in Systemic Lupus Erythematosus: Clarifying Dosing Controversies and Improving Adherence. J Rheumatol 2015; 42:2092-7. [PMID: 26428205 DOI: 10.3899/jrheum.150379] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Hydroxychloroquine (HCQ) is used for its effect on systemic lupus erythematosus (SLE) disease activity and longterm benefits. This can be limited by adherence. One way to assess adherence is to measure blood levels. Conflicting data exist regarding blood levels and disease activity. There is disagreement about dosing; rheumatologists recommend weight-based dosing while some other specialists advocate height-based "ideal body weight" dosing. METHODS Patients were prescribed HCQ not exceeding 6.5 mg/kg (max 400 mg/day). In hemodialysis, the dose was 200 mg after each session, and in renal insufficiency it was 200 mg/day. Levels were measured at each visit with a therapeutic range of 500-2000 ng/ml. Patients were divided according to baseline blood level. To assess the effect of measurement and counseling on adherence, we compared the proportion of patients with a level of 500 ng/ml or higher based on the number of prior assessments. RESULTS The proportion of patients with HCQ levels in the therapeutic range differed significantly by age, sex, and Vitamin D level. There was a trend toward lower levels with renal failure. Blood levels were similar regardless of height and ideal body weight. Comparing those with undetectable, subtherapeutic, and therapeutic levels, disease activity decreased (SLE Disease Activity Index 2.92, 2.36, and 2.20, p = 0.04 for trend). At first, 56% were therapeutic, and by the third measurement this increased to 80% (p ≤ 0.0001). CONCLUSION There was a trend toward higher disease activity with lower HCQ levels. Renal failure dosing led to suboptimum levels. We show that weight-based dosing (max 400 mg daily) is appropriate and that height does not appear to influence levels. Measurement, counseling, and repeated testing can increase adherence rates.
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Affiliation(s)
- Laura Durcan
- From the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine
| | - William A Clarke
- From the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine
| | - Laurence S Magder
- From the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine
| | - Michelle Petri
- From the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine
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Srinivasan M. When life span exceeds health span. J Gen Intern Med 2015; 30:267-8. [PMID: 25650258 PMCID: PMC4351270 DOI: 10.1007/s11606-014-3167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Malathi Srinivasan
- University of California Davis School of Medicine, 4150 V. Street, Suite 2400, Sacramento, CA, 95833, USA,
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Mohammad A. Capsule commentary on Aikens et al., integrating support persons into diabetes telemonitoring to improve self-management and medication adherence. J Gen Intern Med 2015; 30:346. [PMID: 25652538 PMCID: PMC4351265 DOI: 10.1007/s11606-014-3122-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Amir Mohammad
- VA Connecticut Healthcare System, Yale University School of Medicine, West Haven, CT, 06516, USA,
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Piette JD, Valenstein M, Eisenberg D, Fetters MD, Sen A, Saunders D, Watkins D, Aikens JE. Rationale and Methods of a Trial to Evaluate a Depression Telemonitoring Program that Includes a Patient-Selected Support Person. JOURNAL OF CLINICAL TRIALS 2014; 5:205. [PMID: 30815325 PMCID: PMC6388705 DOI: 10.4172/2167-0870.1000205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the effectiveness of an automated telemonitoring program for patients with depression that includes feedback to clinicians and support for a family member or friend serving as a non-professional caregiver. METHODS Prior to being randomized to receive one year of either the Care Partners for Depression (CP-D) intervention or usual care alone, depressed patients from primary care clinics serving primarily low-income populations in rural and urban Michigan select a supportive adult from outside their home (their "Care Partner;" CP) to assist them in their depression self-management. In the CP-D arm, patients receive weekly automated telephone calls that provide monitoring and self-management guidance, CPs receive emailed guidance on supporting the patient's self-management based on patient-reported information, and primary care providers receive notifications about any urgent issues. At Baseline, Month 6, and Month 12, we assess depressive symptom severity (primary outcome) and several secondary outcomes. CONCLUSION To date, this is the only mHealth intervention for any psychiatric condition that involves a patient-selected support person. If it proves effective and cost-efficient, a new sustainable intervention would be available to patients with significant depressive symptoms, providing new management alternatives for patients who are medically underserved or socially isolated.
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Affiliation(s)
- John D Piette
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Marcia Valenstein
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Eisenberg
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Saunders
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphne Watkins
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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