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Haverinen J, Harju T, Mikkonen H, Liljamo P, Turpeinen M, Reponen J. Digital Care Pathway for Patients With Sleep Apnea in Specialized Care: Mixed Methods Study. JMIR Hum Factors 2024; 11:e47809. [PMID: 38386368 PMCID: PMC10921334 DOI: 10.2196/47809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/31/2023] [Accepted: 01/20/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Sleep apnea is a significant public health disorder in Finland, with a prevalence of 3.7%. Continuous positive airway pressure (CPAP) therapy is the first-line treatment for moderate or severe sleep apnea. From November 18, 2019, all patients who started their CPAP therapy at Oulu University Hospital were attached to a sleep apnea digital care pathway (SA-DCP) and were instructed on its use. Some patients still did not use the SA-DCP although they had started their CPAP therapy. OBJECTIVE We aimed to study health care professionals' (HCPs') perspectives on the SA-DCP and its usefulness for their work; whether the main targets of SA-DCP can be reached: shortening the initial guiding sessions of CPAP therapy, reducing patient calls and contact with HCPs, and improving patients' adherence to CPAP therapy; and patients' perspectives on the SA-DCP and its usefulness to them. METHODS Overall, 6 HCPs were interviewed in May and June 2021. The survey for SA-DCP users (58/91, 64%) and SA-DCP nonusers (33/91, 36%) was conducted in 2 phases: from May to August 2021 and January to June 2022. CPAP device remote monitoring data were collected from SA-DCP users (80/170, 47.1%) and SA-DCP nonusers (90/170, 52.9%) in May 2021. The registered phone call data were collected during 2019, 2020, and 2021. Feedback on the SA-DCP was collected from 446 patients between February and March 2022. RESULTS According to HCPs, introducing the SA-DCP had not yet significantly improved their workload and work practices, but it had brought more flexibility in some communication situations. A larger proportion of SA-DCP users familiarized themselves with prior information about CPAP therapy before the initial guiding session than nonusers (43/58, 74% vs 16/33, 49%; P=.02). Some patients still had not received prior information about CPAP therapy; therefore, most of the sessions were carried out according to their needs. According to the patient survey and remote monitoring data of CPAP devices, adherence to CPAP therapy was high for both SA-DCP users and nonusers. The number of patients' phone calls to HCPs did not decrease during the study. SA-DCP users perceived their abilities to use information and communications technology to be better than nonusers (mean 4.2, SD 0.8 vs mean 3.2, SD 1.2; P<.001). CONCLUSIONS According to this study, not all the goals set for the introduction of the SA-DCP have been achieved. Despite using the SA-DCP, some patients still wanted to communicate with HCPs by phone. The most significant factors explaining the nonuse of the SA-DCP were lower digital literacy and older age of the patients. In the future, more attention should be paid to these user groups when designing and introducing upcoming digital care pathways.
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Affiliation(s)
- Jari Haverinen
- Finnish Coordinating Center for Health Technology Assessment, Oulu University Hospital, Oulu, Finland
- FinnTelemedicum, Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Terttu Harju
- Medical Research Center Oulu, Oulu Pulmonary Department, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Hanna Mikkonen
- The Wellbeing Services County of North Ostrobothnia, Oulu, Finland
| | - Pia Liljamo
- Finnish Institute for Health and Welfare, Department of Knowledge Brokers, Data and Analytics Unit, Helsinki, Finland
| | - Miia Turpeinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jarmo Reponen
- FinnTelemedicum, Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Personalized Mobile Health for Elderly Home Care: A Systematic Review of Benefits and Challenges. Int J Telemed Appl 2023; 2023:5390712. [PMID: 36704749 PMCID: PMC9871396 DOI: 10.1155/2023/5390712] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023] Open
Abstract
Mobile health as one of the new technologies can be a proper solution to support care provision for the elderly and provide personalized care for them. This study is aimed at reviewing the benefits and challenges of personalized mobile health (PMH) for elderly home care. With a systematic review methodology, 1895 records were retrieved by searching four databases. After removing duplicates, 1703 articles remained. Following full-text examination, 21 articles that met the inclusion criteria were studied in detail, and the output was presented in different tables. The results indicated that 25% of the challenges were related to privacy, cybersecurity, and data ownership (10%), technology (7.5%), and implementation (7.5%). The most frequent benefits were related to cost-saving (17.5%), nurse engagement improvement (10%), and caregiver stress reduction (7.5%). In general, the number of benefits in this study was slightly higher than the challenges, but in order to use PMH technologies, the challenges presented in this study must be carefully considered and a suitable solution must be adopted. Benefits can also be helpful in persuading individuals and health-care providers. This study shed light on those points that need to be highlighted for further work in order to convert the challenges toward benefits.
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Factors influencing the elderly’s adoption of mHealth: an empirical study using extended UTAUT2 model. BMC Med Inform Decis Mak 2022; 22:191. [PMID: 35871682 PMCID: PMC9308955 DOI: 10.1186/s12911-022-01917-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the high usage of mobile phones in daily life in developing countries like Bangladesh, the adoption and usage of mHealth services have been significantly low among the elderly population. When searching previous studies, the researchers have found that no studies have empirically investigated whether the quality of life and service quality are significant for mHealth adoption by elderlies in Bangladesh. Hence, this study aimed to extend the Unified Theory of Acceptance and Use of Technology by adding service quality and the quality of life to empirically find the key factors that influence elderlies’ intention to adopt and use mHealth services in Bangladesh.
Methods A face-to-face structured questionnaire survey method was used to collect data from 493 elderlies (aged 60 years and above) in Bangladesh. The data were analyzed with the Structural Equations Modelling (SEM) and Fuzzy Set Qualitative Comparative Analysis (fsQCA). Results SEM results suggested that Social Influence, Hedonic Motivation, Price Value, Habit, and Service Quality had significant impact (p < 0.05) on the elderlies’ behavioral intention to adopt mHealth services. Service Quality, Quality of Life, and elderlies’ Habit were found significant in explaining the Use Behavior of mHealth services. Quality of Life did not show significant (p > 0.05) effect on Behavioral Intention, which is inconsistent with existing literature. In addition, fsQCA findings suggest how the intensity of the influencers may contribute to high versus low m-health behavioral outcomes. Conclusions The findings have significant implications for theory, practice and future research as explained in the paper. The originality of this study is the integration of quality of life and service quality into UTUAT2 to explain the users’ behavioural intention and use behaviour. Overall, the findings may contribute to shaping appropriate policies for designing and implementing mHealth services effectively for elderlies in developing countries.
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Zaman SB, Khan RK, Evans RG, Thrift AG, Maddison R, Islam SMS. Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review. JMIR Aging 2022; 5:e25251. [PMID: 34994695 PMCID: PMC8783284 DOI: 10.2196/25251] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/10/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ≥55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health record (2/31, 6%), and mixed ICT interventions (14/31, 45%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29%), diabetes (7/31, 23%), chronic respiratory disease (6/31, 19%), and mental health disorders (8/31, 26%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider–related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions.
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Affiliation(s)
- Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Raihan Kabir Khan
- Department of Health Sciences, James Madison University, Harrisonburg, VA, United States
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Melbourne, Australia.,Department of Physiology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise & Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise & Nutrition Sciences, Deakin University, Geelong, Australia
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Portenhauser AA, Terhorst Y, Schultchen D, Sander LB, Denkinger MD, Stach M, Waldherr N, Dallmeier D, Baumeister H, Messner EM. Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores. JMIR Aging 2021; 4:e23313. [PMID: 33605884 PMCID: PMC8081158 DOI: 10.2196/23313] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background Through the increasingly aging population, the health care system is confronted with various challenges such as expanding health care costs. To manage these challenges, mobile apps may represent a cost-effective and low-threshold approach to support older adults. Objective This systematic review aimed to evaluate the quality, characteristics, as well as privacy and security measures of mobile apps for older adults in the European commercial app stores. Methods In the European Google Play and App Store, a web crawler systematically searched for mobile apps for older adults. The identified mobile apps were evaluated by two independent reviewers using the German version of the Mobile Application Rating Scale. A correlation between the user star rating and overall rating was calculated. An exploratory regression analysis was conducted to determine whether the obligation to pay fees predicted overall quality. Results In total, 83 of 1217 identified mobile apps were included in the analysis. Generally, the mobile apps for older adults were of moderate quality (mean 3.22 [SD 0.68]). Four mobile apps (5%) were evidence-based; 49% (41/83) had no security measures. The user star rating correlated significantly positively with the overall rating (r=.30, P=.01). Obligation to pay fees could not predict overall quality. Conclusions There is an extensive quality range within mobile apps for older adults, indicating deficits in terms of information quality, data protection, and security precautions, as well as a lack of evidence-based approaches. Central databases are needed to identify high-quality mobile apps.
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Affiliation(s)
- Alexandra A Portenhauser
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany.,Department of Psychological Research Methods, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, University of Ulm, Ulm, Germany
| | - Natalie Waldherr
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
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Coombs C, Hislop D, Taneva SK, Barnard S. The strategic impacts of Intelligent Automation for knowledge and service work: An interdisciplinary review. JOURNAL OF STRATEGIC INFORMATION SYSTEMS 2020. [DOI: 10.1016/j.jsis.2020.101600] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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7
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Krishnaswami A, Beavers C, Dorsch MP, Dodson JA, Masterson Creber R, Kitsiou S, Goyal P, Maurer MS, Wenger NK, Croy DS, Alexander KP, Batsis JA, Turakhia MP, Forman DE, Bernacki GM, Kirkpatrick JN, Orr NM, Peterson ED, Rich MW, Freeman AM, Bhavnani SP. Gerotechnology for Older Adults With Cardiovascular Diseases: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:2650-2670. [PMID: 33243384 PMCID: PMC10436190 DOI: 10.1016/j.jacc.2020.09.606] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
The growing population of older adults (age ≥65 years) is expected to lead to higher rates of cardiovascular disease. The expansion of digital health (encompassing telehealth, telemedicine, mobile health, and remote patient monitoring), Internet access, and cellular technologies provides an opportunity to enhance patient care and improve health outcomes-opportunities that are particularly relevant during the current coronavirus disease-2019 pandemic. Insufficient dexterity, visual impairment, and cognitive dysfunction, found commonly in older adults should be taken into consideration in the development and utilization of existing technologies. If not implemented strategically and appropriately, these can lead to inequities propagating digital divides among older adults, across disease severities and socioeconomic distributions. A systematic approach, therefore, is needed to study and implement digital health strategies in older adults. This review will focus on current knowledge of the benefits, barriers, and use of digital health in older adults for cardiovascular disease management.
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Affiliation(s)
- Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente Medical Center, San Jose, California.
| | - Craig Beavers
- Division of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - John A Dodson
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Ruth Masterson Creber
- Weill Cornell Medicine, Department of Population Health Sciences, Division of Health Informatics, New York, New York
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - John A Batsis
- Department of Medicine, Geisel School of Medicine and The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College and Dartmouth-Hitchcock, Lebanon, New Hampshire; Division of Geriatric Medicine, School of Medicine, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Chapel Hill, North Carolina
| | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, California; Palo Alto Veterans Administration Health Care System, Palo Alto, California
| | - Daniel E Forman
- Division of Geriatric Cardiology, University of Pittsburgh, Geriatric Research, Education and Clinical Center; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gwen M Bernacki
- Cardiovascular Division, Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - James N Kirkpatrick
- Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Nicole M Orr
- Post-Acute Cardiology Care, LCC, Darien, Connecticut; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Eric D Peterson
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Michael W Rich
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Sanjeev P Bhavnani
- Prebys Cardiovascular Institute, Scripps Clinic & Research Foundation, San Diego, California
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Compernolle S, Cardon G, van der Ploeg HP, Van Nassau F, De Bourdeaudhuij I, Jelsma JJ, Brondeel R, Van Dyck D. Engagement, Acceptability, Usability, and Preliminary Efficacy of a Self-Monitoring Mobile Health Intervention to Reduce Sedentary Behavior in Belgian Older Adults: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e18653. [PMID: 33118951 PMCID: PMC7661260 DOI: 10.2196/18653] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/07/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Although healthy aging can be stimulated by the reduction of sedentary behavior, few interventions are available for older adults. Previous studies suggest that self-monitoring might be a promising behavior change technique to reduce older adults’ sedentary behavior. However, little is known about older adults’ experiences with a self-monitoring–based intervention aimed at the reduction of sedentary behavior. Objective The aim of this study is to evaluate engagement, acceptability, usability, and preliminary efficacy of a self-monitoring–based mHealth intervention developed to reduce older adults’ sedentary behavior. Methods A mixed methods study was performed among 28 community-dwelling older adults living in Flanders, Belgium. The 3-week intervention consisted of general sedentary behavior information as well as visual and tactile feedback on participants’ sedentary behavior. Semistructured interviews were conducted to explore engagement with, and acceptability and usability of, the intervention. Sitting time was measured using the thigh-worn activPAL (PAL Technologies) accelerometer before and after the intervention. System usage data of the app were recorded. Quantitative data were analyzed using descriptive statistics and paired-samples t tests; qualitative data were thematically analyzed and presented using pen profiles. Results Participants mainly reported positive feelings regarding the intervention, referring to it as motivating, surprising, and interesting. They commonly reported that the intervention changed their thinking (ie, they became more aware of their sedentary behavior) but not their actual behavior. There were mixed opinions on the kind of feedback (ie, tactile vs visual) that they preferred. The intervention was considered easy to use, and the design was described as clear. Some problems were noticed regarding attaching and wearing the self-monitoring device. System usage data showed that the median frequency of consulting the app widely differed among participants, ranging from 0 to 20 times a day. No significant reductions were found in objectively measured sitting time. Conclusions Although the intervention was well perceived by the majority of older adults, no reductions in sitting time were found. Possible explanations for the lack of reductions might be the short intervention duration or the fact that only bringing the habitual sedentary behavior into conscious awareness might not be sufficient to achieve behavior change. Trial Registration ClinicalTrials.gov NCT04003324; https://tinyurl.com/y2p4g8hx
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Affiliation(s)
- Sofie Compernolle
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | | | - Femke Van Nassau
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Judith J Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ruben Brondeel
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
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Félix IB, Guerreiro MP, Cavaco A, Cláudio AP, Mendes A, Balsa J, Carmo MB, Pimenta N, Henriques A. Development of a Complex Intervention to Improve Adherence to Antidiabetic Medication in Older People Using an Anthropomorphic Virtual Assistant Software. Front Pharmacol 2019; 10:680. [PMID: 31281256 PMCID: PMC6597679 DOI: 10.3389/fphar.2019.00680] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction: Improving adherence to antidiabetic medication is crucial, resulting in improved health outcomes, cost reduction, and minimization of waste. A lack of underlying theory in existing interventions may explain the limited success in sustaining behavior change. This paper describes the development of a theory and evidence-based complex intervention to improve adherence to oral antidiabetics in older people via a software prototype with an anthropomorphic virtual assistant. Methods: The Behavior Change Wheel (BCW) was used to develop a theoretical understanding of the change process, corresponding to the first phase of the Medical Research Council Framework for developing and evaluating complex interventions. At the BCW core is a model of human behavior (COM-B), which posits that human behavior (B) results from the interaction between capabilities (C), opportunities (O), and motivation (M). Literature-derived medication adherence determinants were mapped onto COM-B components. Then, intervention functions (IFs) were selected employing the APEASE criteria. Finally, standardized behavior change techniques (BCTs) were chosen based on their suitability and their effectiveness on medication adherence trials. The prototype was developed for android devices; its core was implemented in Unity3D, using a female 3D virtual assistant, named Vitória. Results: Two COM-B components were identified as main targets for behavior change—psychological capability and reflective motivation; these were linked with four IFs—education, persuasion, enablement, and environmental restructuring. Eleven BCTs were, in turn, linked with the IFs. An example of a BCT is “problem solving”; it requires users to pinpoint factors influencing non-adherence and subsequently offers strategies to achieve the desired behavior. BCTs were operationalized into the dialogues with Vitória and into supplementary software features. Vitória communicates with users verbally and non-verbally, expressing emotions. Input options consist of buttons or recording values, such as medication taken. Conclusion: The present approach enabled us to derive the most appropriate BCTs for our intervention. The use of an explicit bundle of BCTs, often overlooked in interventions promoting medication adherence, is expected to maximize effectiveness and facilitates replication. The first prototype is being refined with users and health professionals’ contributions. Future work includes subjecting the prototype to usability tests and a feasibility trial.
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Affiliation(s)
- Isa Brito Félix
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
| | - Mara Pereira Guerreiro
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| | - Afonso Cavaco
- iMed.ULisboa, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Ana Paula Cláudio
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Anabela Mendes
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
| | - João Balsa
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Maria Beatriz Carmo
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Nuno Pimenta
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Santarém, Portugal
| | - Adriana Henriques
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
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Mobile Health Technologies for Older Adults with Cardiovascular Disease: Current Evidence and Future Directions. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0270-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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11
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Hernandez Silva E, Lawler S, Langbecker D. The effectiveness of mHealth for self-management in improving pain, psychological distress, fatigue, and sleep in cancer survivors: a systematic review. J Cancer Surviv 2019; 13:97-107. [PMID: 30635865 DOI: 10.1007/s11764-018-0730-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 12/24/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Integrating mHealth into the cancer care continuum may be an effective strategy to improve cancer survivorship care by supporting self-management. We aim to assess the effectiveness of mHealth applications (apps) for self-management in improving pain, psychological distress, fatigue, or sleep outcomes in adult cancer survivors. METHODS Experimental quantitative studies evaluating apps aiming to support self-management for adult cancer survivors and reporting pain, psychological distress, fatigue, or sleep outcomes were included. PubMed, Web of Science, Embase, CINAHL, PsycINFO, Scopus, and CENTRAL databases were searched from inception through December 2017. Risk of bias was assessed using the Cochrane risk of bias tool (PROSPERO registration number CRD42017081182). RESULTS Seven studies of six mHealth interventions (n = 949 participants) were included. Two randomized controlled trials (RCTs), one quasi-RCT, one non-RCT, and three single-arm studies involved survivors with a mix of cancer types. The most common app features were symptom questionnaires (n = 5) and progress tracking (n = 5). Four studies reported outcomes for pain, with three showing improvements. Two studies reported psychological distress outcomes, showing mixed results. Four studies reported improvements in fatigue post-intervention or in the intervention compared with control group, but the changes were not all statistically significant. Two studies reported improvements in sleep outcomes. CONCLUSIONS There is emerging evidence that mHealth interventions that support self-management can improve pain and fatigue outcomes in cancer survivors, and some promise for psychological distress and sleep outcomes. Further development and investigation of mHealth is needed, incorporating targeted, evidence-based models of care into app design. IMPLICATIONS FOR CANCER SURVIVORS mHealth interventions can improve outcomes for cancer survivors and have significant potential to benefit this growing population due to their reach.
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Affiliation(s)
- Elizabeth Hernandez Silva
- Centre for Online Health/Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia.
| | - Sheleigh Lawler
- Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Danette Langbecker
- Centre for Online Health/Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
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Aging barriers influencing mobile health usability for older adults: A literature based framework (MOLD-US). Int J Med Inform 2018; 114:66-75. [PMID: 29673606 DOI: 10.1016/j.ijmedinf.2018.03.012] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/13/2017] [Accepted: 03/23/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND With the growing population of older adults as a potential user group of mHealth, the need increases for mHealth interventions to address specific aging characteristics of older adults. The existence of aging barriers to computer use is widely acknowledged. Yet, usability studies show that mHealth still fails to be appropriately designed for older adults and their expectations. To enhance designs of mHealth aimed at older adult populations, it is essential to gain insight into aging barriers that impact the usability of mHealth as experienced by these adults. OBJECTIVES This study aims to synthesize literature on aging barriers to digital (health) computer use, and explain, map and visualize these barriers in relation to the usability of mHealth by means of a framework. METHODS We performed a scoping review to synthesize and summarize reported physical and functional age barriers in relation to digital (mobile) health applications use. Aging barriers reported in the literature were mapped onto usability aspects categorized by Nielsen to explain their influence on user experience of mHealth. A framework (MOLD-US) was developed summarizing the evidence on the influence of aging barriers on mHealth use experienced by older adults. RESULTS Four key categories of aging barriers influencing usability of mHealth were identified: cognition, motivation, physical ability and perception. Effective and satisfactory use of mHealth by older adults is complicated by cognition and motivation barriers. Physical ability and perceptual barriers further increase the risk of user errors and fail to notice important interaction tasks. Complexities of medical conditions, such as diminished eye sight related to diabetes or deteriorated motor skills as a result of rheumatism, can cause errors in user interaction. CONCLUSIONS This research provides a novel framework for the exploration of aging barriers and their causes influencing mHealth usability in older adults. This framework allows for further systematic empirical testing and analysis of mHealth usability issues, as it enables results to be classified and interpreted based on impediments intrinsic to usability issues experienced by older adults. Importantly, the paper identifies a key need for future research on motivational barriers impeding mhealth use of older adults. More insights are needed in particular to disaggregating normal age related functional changes from specific medical conditions that influence experienced usefulness of mHealth by these adults.
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Factors Influencing Acceptance and Continued Use of mHealth Apps. HCI IN BUSINESS, GOVERNMENT AND ORGANIZATIONS. INTERACTING WITH INFORMATION SYSTEMS 2017. [DOI: 10.1007/978-3-319-58481-2_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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