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Freyer O, Wrona KJ, de Snoeck Q, Hofmann M, Melvin T, Stratton-Powell A, Wicks P, Parks AC, Gilbert S. The regulatory status of health apps that employ gamification. Sci Rep 2024; 14:21016. [PMID: 39251786 PMCID: PMC11383928 DOI: 10.1038/s41598-024-71808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/30/2024] [Indexed: 09/11/2024] Open
Abstract
Smartphone applications are one of the main delivery modalities in digital health. Many of these mHealth apps use gamification to engage users, improve user experience, and achieve better health outcomes. Yet, it remains unclear whether gamified approaches help to deliver effective, safe, and clinically beneficial products to users. This study examines the compliance of 69 gamified mHealth apps with the EU Medical Device Regulation and assesses the specific risks arising from the gamified nature of these apps. Of the identified apps, 32 (46.4%) were considered non-medical devices; seven (10.1%) were already cleared/approved by the regulatory authorities, and 31 (44.9%) apps were assessed as likely non-compliant or potentially non-compliant with regulatory requirements. These applications and one approved application were assessed as on the market without the required regulatory approvals. According to our analysis, a higher proportion of these apps would be classified as medical devices in the US. The level of risk posed by gamification remains ambiguous. While most apps showed only a weak link between the degree of gamification and potential risks, this link was stronger for those apps with a high degree of gamification or an immersive game experience.
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Affiliation(s)
- Oscar Freyer
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
- WhalesDontFly H&F GmbH, Berlin, Germany
| | - Kamil J Wrona
- Bielefeld University of Applied Sciences and Arts, Bielefeld, Germany
| | - Quentin de Snoeck
- Therapixel, Nice, France
- School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | | | - Tom Melvin
- School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Ashley Stratton-Powell
- School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
- RQM+, Altrincham, Cheshire, UK
| | - Paul Wicks
- Wicks Digital Health, Advantage House, Stowe Court, Lichfield, UK
| | | | - Stephen Gilbert
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany.
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Zhang Q, Zhang Y, Long T, Wu Y, Zhang Y, Li M. Effects of nudge strategy-based dietary education intervention in patients with type 2 diabetes mellitus: A cluster randomized controlled trial. DIABETES & METABOLISM 2024; 50:101563. [PMID: 38981568 DOI: 10.1016/j.diabet.2024.101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES We aimed to assess the clinical effects of dietary education intervention utilizing the nudge strategy in individuals with type 2 diabetes mellitus (T2DM). BACKGROUND The global prevalence of T2DM and its associated complications presents a significant health challenge. While the benefits of dietary education intervention for blood glucose management are widely acknowledged, patients often struggle to adhere to dietary recommendations. The implementation of the nudge strategy may offer a promising solution to change unhealthy dietary behavior and enhance diabetes control among individuals with T2DM. METHODS This is a sub-study within a broader cluster-randomized trial that evaluated the effects of nudge-based dietary education and traditional dietary education intervention. Measurements of HbA1c, fasting blood glucose (FBG), body mass index (BMI), blood lipid levels, blood pressure, dietary behavior, and diabetes distress were assessed at baseline and 3 months after the intervention in 147 individuals with T2DM from six primary care practices in Beijing, China. RESULTS All outcome measurements were complete at two time points for 134 participants. Results showed that compared to the control group, the intervention group achieved a significantly greater reduction in HbA1c, FBG, BMI, total cholesterol, low-density lipoprotein cholesterol, blood pressure, total energy intake, carbohydrate intake, fat intake, and protein intake and had lower diabetes distress. The intervention group also maintained HDL-C levels and had a significantly greater increase in vegetable intake, while changes in triglycerides were similar in the two groups. CONCLUSION The present study provides evidence that nudge strategy-based dietary education intervention is effective in improving blood glucose, BMI, blood lipid levels, and blood pressure and facilitating changes in patients' dietary behavior and diabetes distress. These findings suggest that implementing nudge strategies can contribute to the optimization of T2DM dietary management and overall patient well-being.
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Tianxue Long
- School of Nursing, Peking University, Beijing, China
| | - Yi Wu
- School of Nursing, Peking University, Beijing, China
| | - Yiyun Zhang
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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Cain J, Behal M, Richter LM. An Integrative Scoping Review of Behavioral Economics Applications in Higher Education: Opportunities for Academic Pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100732. [PMID: 38852679 DOI: 10.1016/j.ajpe.2024.100732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES This integrative scoping review explores the applications of behavioral economics within higher education, particularly, through the lens of nudging (a concept that leverages insights from economics and psychology to guide individuals' decisions subtly). The primary objective is to provide a broad overview of interventions that use behavioral economics principles and, secondarily, discuss their potential to improve pharmacy education and create a foundation for future research in this area. FINDINGS The review analyzed 89 studies that applied behavioral economics principles in higher education settings. Reminders and prompts were the most frequently used principles, with generally positive outcomes, especially in enrollment management. Framing, incentives, and salience also demonstrated effectiveness, depending on the context. Social norms and simplification showed mixed results, whereas priming, loss aversion, feedback, comparison, and commitment had varying degrees of success in influencing behavior. SUMMARY Behavioral economics principles offer valuable insights and tools for enhancing various aspects of education. The review highlights the potential for using these principles to improve student engagement, enrollment processes, and health and well-being initiatives. However, it emphasizes the importance of context-specific design and careful implementation when applying these interventions. Future research opportunities exist to further explore the applications of behavioral economics in pharmacy education and beyond.
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Affiliation(s)
- Jeff Cain
- University of Kentucky College of Pharmacy, Department of Pharmacy Practice & Science, Lexington, KY, USA.
| | - Michael Behal
- University of Tennessee Medical Center, Department of Pharmacy, Knoxville, TN, USA
| | - Lisa M Richter
- North Dakota State University College of Health and Human Sciences, Department of Pharmacy Practice, Fargo, ND, USA
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Tebianian MA, Jahromi SR. Advancing Diabetes Self-Management: A Novel Smartphone Application Featuring a Scoring Algorithm for Tailored User Engagement. Int J Prev Med 2024; 15:20. [PMID: 39170922 PMCID: PMC11338364 DOI: 10.4103/ijpvm.ijpvm_268_23] [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: 10/06/2023] [Accepted: 02/20/2024] [Indexed: 08/23/2024] Open
Abstract
Background We developed and evaluated an intelligent diabetes assistant application (Diabetter) for the self-management of diabetes. It suggested that increasing the patient's interest and participation in using smartphone apps is important for the effectiveness of diabetes management apps. Methods After evaluating all-encompassing features for diabetes management, we divided the selected factors into sub-factors for use in the application. Then, we created the first high-fidelity prototype using related programs and conducted early user testing to validate and improve Diabetter. To handle the user transaction time and keep them motivated, we designed and implemented a scoring system based on the nudge theory rules within the app. Results To evaluate Diabetter's impact on diabetes self-management, we measured HbA1c levels after a prolonged period. The Diabetter prototype was developed and modified in a revised version for better user interaction with the app. The scoring system increased the input of users' information, which resulted in more analysis and recommendations to users. Clinical studies showed that as a result of continuous input of information from users who had been using the application for a longer period of time, their HbA1c levels were within the healthy range. Conclusions The results demonstrate that the Diabetter application has been able to play an effective role in diabetes self-management by increasing users' app usage time. However, future study is needed to provide a better interpretation.
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Affiliation(s)
- Mohammad A. Tebianian
- Department of Computer Software Engineering, South Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Soodeh Razeghi Jahromi
- Department of Clinical Nutrition, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Iran
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Zhou Y, Meng J, Zhang X, Ma J, Fan S, Zuo H, Shi J, Wang W, Wang H. Nurse-led sequential multiple assignment randomized trial of nudging intervention for early antiretroviral therapy initiation among patients with HIV/AIDS: Implementation study protocol. J Adv Nurs 2024. [PMID: 38923586 DOI: 10.1111/jan.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/18/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
AIMS In China, more than 30% of patients have not initiated treatment within 30 days of HIV diagnosis. Delayed initiation has a detrimental influence on disease outcomes and increases HIV transmission. The study aims to evaluate the effectiveness of a nurse-led antiretroviral therapy initiation nudging intervention for people newly diagnosed with HIV in China to find the optimal intervention implementation strategy. METHODS A Hybrid Type II sequential multiple assignment randomized trial will be conducted at four Centers for Disease Control and Prevention in Hunan, China. This study will recruit 447 people newly diagnosed with HIV aged ≥18 years and randomly assign them into two intervention groups and one control group. On top of the regular counselling services and referrals, intervention groups will receive a 4-week, 2-phase intervention based on the dual-system theory and the nudge theory. The control group will follow the currently recommended referral procedures. The primary outcomes are whether treatment is initiated, as well as the length of time it takes. The study outcomes will be measured at the baseline, day 15, day 30, week 12, week 24 and week 48. Generalized estimating equations and survival analysis will be used to compare effectiveness and explore factors associated with antiretroviral therapy initiation. Both qualitative and quantitative information will be collected to assess implementation outcomes. DISCUSSION Existing strategies mostly target institutional-level factors, with little consideration given to patients' decision-making. To close this gap, we aim to develop an effective theory-driven nudging strategy to improve early ART initiation. IMPACT This nurse-led study will help to prevent delayed initiation by employing implementation science strategies for people newly diagnosed with HIV. This study contributes to the United Nations' objective of ending the AIDS pandemic by 2030. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300070140. The trial was prospectively registered before the first participant was recruited. PATIENT AND PUBLIC INVOLVEMENT The nudging intervention was finalized through the Nominal Group Technique where we invited five experts in the related field and five people living with HIV to participate.
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Affiliation(s)
- Yaqin Zhou
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jingjing Meng
- School of Nursing, Anhui Medical University, Hefei, China
| | - Xiangjun Zhang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jun Ma
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Sisi Fan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hong Zuo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jingzheng Shi
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, China
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Cheng SH, Chung KP, Wang YC, Tsai HY. The Nudging Effect of a Reminder Letter to Reduce Duplicated Medications: A Randomized Controlled Trial. Med Care 2024; 62:326-332. [PMID: 38498873 DOI: 10.1097/mlr.0000000000001989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The increasing trend of multiple chronic conditions across the world has worsened the problem of medication duplication in health care systems without gatekeeping or referral requirement. Thus, to overcome this problem, a reminder letter has been developed in Taiwan to nudge patients to engage in medication management. OBJECTIVE To evaluate the effect of reminder letter on reducing duplicated medications. RESEARCH DESIGN A 2-arm randomized controlled trial design. SUBJECTS Patients with duplicated medications in the first quarter of 2019. MEASURES The Taiwanese single-payer National Health Insurance Administration identified the eligible patients for this study. A postal reminder letter regarding medication duplication was mailed to the patients in the study group, and no information was provided to the comparison group. Generalized estimation equation models with a difference-in-differences analysis were used to estimate the effects of the reminder letters. RESULTS Each group included 11,000 patients. Those who had received the reminder letter were less likely to receive duplicated medications in the subsequent 2 quarters (postintervention 1: odds ratio [OR]=0.95, 95% CI=0.87-1.03; postintervention_2: OR=0.99, 95% CI=0.90-1.08) and had fewer days of duplicated medications (postintervention 1: β=-0.115, P =0.015; postintervention 2 (β=-0.091, P =0.089) than those who had not received the reminder letter, showing marginal but significant differences. CONCLUSIONS A one-off reminder letter nudge could mildly decrease the occurrence of duplicated medications. Multiple nudges or nudges incorporating behavioral science insights may be further considered to improve medication safety in health systems without gatekeeping.
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Affiliation(s)
- Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Ying-Chieh Wang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Hsin-Yun Tsai
- Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
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Kim HK. Attraction and achievement as 2 attributes of gamification in healthcare: an evolutionary concept analysis. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2024; 21:10. [PMID: 38600768 PMCID: PMC11130557 DOI: 10.3352/jeehp.2024.21.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
This study conducted a conceptual analysis of gamification in healthcare utilizing Rogers’ evolutionary concept analysis methodology to identify its attributes and provide a method for its applications in the healthcare field. Gamification has recently been used as a health intervention and education method, but the concept is used inconsistently and confusingly. A literature review was conducted to derive definitions, surrogate terms, antecedents, influencing factors, attributes (characteristics with dimensions and features), related concepts, consequences, implications, and hypotheses from various academic fields. A total of 56 journal articles in English and Korean, published between August 2 and August 7, 2023, were extracted from databases such as PubMed Central, the Institute of Electrical and Electronics Engineers, the Association for Computing Machinery Digital Library, the Research Information Sharing Service, and the Korean Studies Information Service System, using the keywords “gamification” and “healthcare.” These articles were then analyzed. Gamification in healthcare is defined as the application of game elements in health-related contexts to improve health outcomes. The attributes of this concept were categorized into 2 main areas: attraction and achievement. These categories encompass various strategies for synchronization, enjoyable engagement, visual rewards, and goal-reinforcing frames. Through a multidisciplinary analysis of the concept’s attributes and influencing factors, this paper provides practical strategies for implementing gamification in health interventions. When developing a gamification strategy, healthcare providers can reference this analysis to ensure the game elements are used both appropriately and effectively.
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Affiliation(s)
- Hyun Kyoung Kim
- /Department of Nursing, Kongju National University, Gongju, Korea
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Rizvi RF, Schoephoerster JA, Desphande SS, Usher M, Oien AE, Peters MM, Loth MS, Bahr MW, Ventz S, Koopmeiners JS, Melton GB. Decreasing Opioid Addiction and Diversion Using Behavioral Economics Applied Through a Digital Engagement Solution: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52882. [PMID: 38457203 PMCID: PMC10960208 DOI: 10.2196/52882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Despite strong and growing interest in ending the ongoing opioid health crisis, there has been limited success in reducing the prevalence of opioid addiction and the number of deaths associated with opioid overdoses. Further, 1 explanation for this is that existing interventions target those who are opiate-dependent but do not prevent opioid-naïve patients from becoming addicted. OBJECTIVE Leveraging behavioral economics at the patient level could help patients successfully use, discontinue, and dispose of their opioid medications in an acute pain setting. The primary goal of this project is to evaluate the effect of the 3 versions of the Opioid Management for You (OPY) tool on measures of opioid use relative to the standard of care by leveraging a pragmatic randomized controlled trial (RCT). METHODS A team of researchers from the Center for Learning Health System Sciences (CLHSS) at the University of Minnesota partnered with M Health Fairview to design, build, and test the 3 versions of the OPY tool: social influence, precommitment, and testimonial version. The tool is being built using the Epic Care Companion (Epic Inc) platform and interacts with the patient through their existing MyChart (Epic Systems Corporation) personal health record account, and Epic patient portal, accessed through a phone app or the MyChart website. We have demonstrated feasibility with pilot data of the social influence version of the OPY app by targeting our pilot to a specific cohort of patients undergoing upper-extremity procedures. This study will use a group sequential RCT design to test the impact of this important health system initiative. Patients who meet OPY inclusion criteria will be stratified into low, intermediate, and high risk of opiate use based on their type of surgery. RESULTS This study is being funded and supported by the CLHSS Rapid Prospective Evaluation and Digital Technology Innovation Programs, and M Health Fairview. Support and coordination provided by CLHSS include the structure of engagement, survey development, data collection, statistical analysis, and dissemination. The project was initially started in August 2022. The pilot was launched in February 2023 and is still running, with the data last counted in August 2023. The actual RCT is planned to start by early 2024. CONCLUSIONS Through this RCT, we will test our hypothesis that patient opioid use and diverted prescription opioid availability can both be improved by information delivery applied through a behavioral economics lens via sending nudges directly to the opioid users through their personal health record. TRIAL REGISTRATION ClinicalTrials.gov NCT06124079; https://clinicaltrials.gov/study/NCT06124079. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52882.
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Affiliation(s)
- Rubina Fatima Rizvi
- Division of Computational Health Sciences, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
- University of Minnesota Medical School, Minneapolis, MN, United States
| | | | - Sagar Satish Desphande
- University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Michael Usher
- University of Minnesota Medical School, Minneapolis, MN, United States
- M Health Fairview Systems, Minneapolis, MN, United States
| | - Andy Elaine Oien
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Maya Marie Peters
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Matthew Scott Loth
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
| | | | - Steffen Ventz
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Joseph Stephen Koopmeiners
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Genevieve B Melton
- Division of Computational Health Sciences, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
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Nagarajan K, Kumarswamy K, Begum R, Panibatla V, Singarajipura A, Adepu R, Munjattu JF, Sellapan S, Arangba S, Goswami A, Swamickan R, Basha J, Dsouza PM, Muniyandi M. Self-driven solutions and resilience adapted by people with drug-resistant tuberculosis and their caregivers in Bengaluru and Hyderabad, India: a qualitative study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 22:100372. [PMID: 38420270 PMCID: PMC10900834 DOI: 10.1016/j.lansea.2024.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/08/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Background One-fifth of people with drug-resistance tuberculosis (DR-TB) who were initiated on newer shorter treatment regimen (with injection) had unfavourable treatment outcomes in India as on 2020. Evidence on self-driven solutions and resilience adapted by people with DR-TB (PwDR-TB) towards their multi-dimensional disease and treatment challenges are scarce globally, which we aimed to understand. Methods In this qualitative study using positive deviance framework, we conducted semi-structured in-depth interviews among consenting adult PwDR-TB (7 women, 13 men) who completed shorter treatment regimen (including injections) with maximum treatment adherence. The study was conducted in the southern districts of Bengaluru and Hyderabad, India between June 2020 and December 2022. Caregivers (14 women, 6 men) and health providers (8 men, 2 women) of PwDR-TB were also interviewed. Interviews were conducted in local language (Kannada, Tamil, Telugu, Urdu and Hindi) and inquired about practices, behaviours, experiences, perceptions and attributes which enabled maximum adherence and resilience of PwDR-TB. Interviews were audio recorded, transcribed, and translated to English and coded for thematic analysis using inductive approach. Findings Distinctive themes explanatory of the self-driven solutions and resilience exhibited by PwDR-TB and their caregivers were identified: (i) Self-adaptation towards the biological consequences of drugs, by personalised nutritional and adjuvant practices, which helped to improve drug ingestion and therapeutic effects. Also home remedies and self-plans for ameliorating injection pain. (ii) Perceptual adaptation towards drugs aversion and fatigue, by their mind diversion practices, routinisation and normalisation of drug intake process. and constant reinforcement and re-interpretation of bodily signs of disease recovery (iii) Family caregivers intense and participatory care for PwDR-TB, by aiding their essential life activities and ensuring survival, learning and fulfilling special nutritional needs and goal oriented actions to aid drug intake (iv) Health care providers care, marked by swift and timely risk mitigation of side-effects and crisis response (v) Acquired self-efficacy of PwDR-TB, by their decisive family concerns resulting in attitudinal change. Also being sensitised on the detrimental consequences of disease and being motivated through positive examples. Interpretation Synthesised findings on self-driven solutions and resilience towards the multi-dimensional DR-TB challenges provides opportunity for developing and testing new interventions for its effectiveness in DR-TB care settings globally. Designing and testing personalised cognitive interventions for PwDR-TB: to inculcate attitudinal change and self-efficacy towards medication, developing cognitive reinforcements to address the perception burden of treatment, skill building and mainstreaming the role of family caregivers as therapeutic partners of PwDR-TB, curating self-adaptive behaviours and practices of PwDR-TB to normalise their drug consumptions experiences could be the way forward in building resilience towards DR-TB. Funding United States Agency for International Development (USAID) through Karnataka Health Promotion Trust (KHPT), Bengaluru, India.
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Affiliation(s)
- Karikalan Nagarajan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Karthikeyan Kumarswamy
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Rehana Begum
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Vikas Panibatla
- TB Alert India, Hyderabad, West Marredpally, Secunderabad, Telangana, 500026, India
| | - Anil Singarajipura
- State TB Office, 2nd Floor, Arogya Soudha, Magadi Road, Bengaluru, Karnataka, 560023, India
| | - Rajesham Adepu
- State TB Office, Directorate of Medical & Health Services, Hyderabad, Telangana, 500095, India
| | - Joseph Francis Munjattu
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Senthil Sellapan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Stephen Arangba
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | | | | | - Javeed Basha
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Pearl Maria Dsouza
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Malaisamy Muniyandi
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
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Thongseiratch T, Chalermphol K, Traipidok P, Charleowsak P. Promoting Medication Adherence in Children with Attention Deficit Hyperactivity Disorder: A Mixed-Methods Systematic Review with Meta-analysis and Qualitative Comparative Analysis. J Atten Disord 2024; 28:139-150. [PMID: 38006238 DOI: 10.1177/10870547231211021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
OBJECTIVE To evaluate the efficacy of ADHD medication adherence interventions and explore the pathways to effectiveness. METHODS A systematic review was conducted using multiple databases to identify relevant randomized controlled trials (RCTs). Pooled effect sizes were calculated for medication adherence and ADHD symptom outcomes. Qualitative Comparative Analysis (QCA) was used to identify pathways to effectiveness. RESULTS Six RCTs were included. The interventions significantly improved medication adherence (OR = 2.39, 95% CI [1.19, 4.79]) and ADHD symptoms (Hedges' g = -0.96, 95% CI [-1.38, -0.54]). Multi-regression analysis showed a positive relationship between medication adherence and ADHD symptom reduction. QCA revealed two paths for effectiveness: (1) Presence of ADHD drug education and absence of reminder and (2) Presence of tracking and absence of reminder. CONCLUSION ADHD medication adherence interventions have a positive impact on both medication adherence and ADHD symptoms. Interventions should consider including ADHD drug education or tracking to maximize effectiveness.
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Affiliation(s)
- Therdpong Thongseiratch
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Kanokphorn Chalermphol
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Pathrada Traipidok
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Pattra Charleowsak
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
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Sumner J, Bundele A, Lim HW, Phan P, Motani M, Mukhopadhyay A. Developing an Artificial Intelligence-Driven Nudge Intervention to Improve Medication Adherence: A Human-Centred Design Approach. J Med Syst 2023; 48:3. [PMID: 38063940 PMCID: PMC10709244 DOI: 10.1007/s10916-023-02024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
To improve medication adherence, we co-developed a digital, artificial intelligence (AI)-driven nudge intervention with stakeholders (patients, providers, and technologists). We used a human-centred design approach to incorporate user needs in creating an AI-driven nudge tool. We report the findings of the first stage of a multi-phase project: understanding user needs and ideating solutions. We interviewed healthcare providers (n = 10) and patients (n = 10). Providers also rated example nudge interventions in a survey. Stakeholders felt the intervention could address existing deficits in medication adherence tracking and were optimistic about the solution. Participants identified flexibility of the intervention, including mode of delivery, intervention intensity, and the ability to stratify to user ability and needs, as critical success factors. Reminder nudges and provision of healthcare worker contact were rated highly by all. Conversely, patients perceived incentive-based nudges poorly. Finally, participants suggested that user burden could be minimised by leveraging existing software (rather than creating a new App) and simplifying or automating the data entry requirements where feasible. Stakeholder interviews generated in-depth data on the perspectives and requirements for the proposed solution. The participatory approach will enable us to incorporate user needs into the design and improve the utility of the intervention. Our findings show that an AI-driven nudge tool is an acceptable and appropriate solution, assuming it is flexible to user requirements.
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Affiliation(s)
- Jennifer Sumner
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore.
| | - Anjali Bundele
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Hui Wen Lim
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Phillip Phan
- Johns Hopkins Carey Business School and the Department of Medicine, Baltimore, USA
| | - Mehul Motani
- Department of Electrical & Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Amartya Mukhopadhyay
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kazemian A, Hoseinzadeh M, Banihashem Rad SA, Jouya A, Tahani B. Nudging oral habits; application of behavioral economics in oral health promotion: a critical review. Front Public Health 2023; 11:1243246. [PMID: 38145077 PMCID: PMC10739307 DOI: 10.3389/fpubh.2023.1243246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Background Oral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people's decision-making and self-management capacities in a cost-efficient manner. As a result, these interventions could be valuable tools for fostering improved oral care habits. This critical review explores potential behavioral nudges applicable to promoting oral health. Methods A thorough electronic literature search was conducted on Scopus, Embase, and PubMed databases for papers published post-2008. The search focused on empirical evidence concerning the direct and indirect application of Nudge theory in oral health enhancement. In addition, the investigation included the nudge intervention's role in managing common non-communicable disease risk factors (tobacco, alcohol, and sugar) and their use in other health sectors. Results and conclusion There is a dearth of studies on behavioral economics, particularly those involving reward and reminder techniques. However, various successful nudge interventions have been identified in other sectors that aim to improve health decisions. These include strategies encouraging healthier nutritional choices, tobacco and alcohol cessation, medication compliance, routine physical activity, and regular health check-ups. Such interventions can also have direct or indirect positive impacts on oral health. Implementing these interventions within an oral care framework could promote oral health due to similar underlying cognitive mechanisms. However, different types of nudge interventions have varying degrees of effectiveness. Furthermore, factors such as the method of delivery and the characteristics of the targeted population significantly influence the outcome of the intervention. Hence, it is imperative to conduct extensive studies in diverse socioeconomic settings to fully understand the potentials, limitations, and impacts of nudge interventions in promoting oral health.
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Affiliation(s)
- Ali Kazemian
- Department of Community Oral Health, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Melika Hoseinzadeh
- Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ahmad Banihashem Rad
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Anahid Jouya
- Department of Community Oral Health, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahareh Tahani
- Department of Oral Public Health, Dental Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Signal N, Olsen S, Rashid U, McLaren R, Vandal A, King M, Taylor D. Haptic Nudging Using a Wearable Device to Promote Upper Limb Activity during Stroke Rehabilitation: Exploring Diurnal Variation, Repetition, and Duration of Effect. Behav Sci (Basel) 2023; 13:995. [PMID: 38131851 PMCID: PMC10740938 DOI: 10.3390/bs13120995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Haptic nudging via wearable devices promotes physical activity and may increase upper limb movement in stroke rehabilitation. This study investigated the optimal approach to haptic nudging by examining diurnal variation, duration of effect, and repeated nudging. The study analysed data from a multiple-period randomised crossover study. A 12 h inpatient rehabilitation day was divided into 72 intervals in which participants with stroke (n = 20) randomly received either a 'nudge' or 'no nudge'. Upper limb movement was observed, classified, and analysed using longitudinal mixed models. The odds of affected upper limb movement following a nudge compared with no nudge were significantly higher during active periods such as breakfast, lunch, and morning and afternoon activities (odds ratios (ORs) 2.01-4.63, 95% CIs [1.27-2.67, 3.17-8.01]), but not dinner (OR 1.36, 95% CI [0.86, 2.16]). The effect of nudging was no longer statistically significant at 50-60 s post-nudge. Consecutive delays in nudging significantly decreased the odds of moving when a nudge was eventually delivered. Contrary to expectations, people with stroke appear more responsive to haptic nudging during active periods rather than periods of inactivity. By understanding the optimal timing and frequency of haptic nudging, the design of wearable devices can be optimised to maximise their therapeutic benefits.
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Affiliation(s)
- Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
| | - Sharon Olsen
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Ruth McLaren
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
| | - Alain Vandal
- Department of Statistics, University of Auckland, 38 Princes Street, Auckland 1010, New Zealand;
| | - Marcus King
- Callaghan Innovation, 5 Sheffield Crescent, Burnside, Christchurch 8053, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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15
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Seng JJB, Gwee MFR, Yong MHA, Kwan YH, Thumboo J, Low LL. Role of Caregivers in Remote Management of Patients With Type 2 Diabetes Mellitus: Systematic Review of Literature. J Med Internet Res 2023; 25:e46988. [PMID: 37695663 PMCID: PMC10520771 DOI: 10.2196/46988] [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: 03/04/2023] [Revised: 04/24/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND With the growing use of remote monitoring technologies in the management of patients with type 2 diabetes mellitus (T2DM), caregivers are becoming important resources that can be tapped into to improve patient care. OBJECTIVE This review aims to summarize the role of caregivers in the remote monitoring of patients with T2DM. METHODS We performed a systematic review in MEDLINE, Embase, Scopus, PsycINFO, and Web of Science up to 2022. Studies that evaluated the role of caregivers in remote management of adult patients with T2DM were included. Outcomes such as diabetes control, adherence to medication, quality of life, frequency of home glucose monitoring, and health care use were evaluated. RESULTS Of the 1198 identified citations, 11 articles were included. The majority of studies were conducted in North America (7/11, 64%) and South America (2/11, 18%). The main types of caregivers studied were family or friends (10/11, 91%), while the most common remote monitoring modalities evaluated were interactive voice response (5/11, 45%) and phone consultations (4/11, 36%). With regard to diabetes control, 3 of 6 studies showed improvement in diabetes-related laboratory parameters. A total of 2 studies showed improvements in patients' medication adherence rates and frequency of home glucose monitoring. Studies that evaluated patients' quality of life showed mixed evidence. In 1 study, increased hospitalization rates were noted in the intervention group. CONCLUSIONS Caregivers may play a role in improving clinical outcomes among patients with T2DM under remote monitoring. Studies on mobile health technologies are lacking to understand their impact on Asian populations and long-term patient outcomes.
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Affiliation(s)
- Jun Jie Benjamin Seng
- MOH Holding Private Limited, Singapore, Singapore
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
| | | | | | - Yu Heng Kwan
- MOH Holding Private Limited, Singapore, Singapore
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Program in Health Services and Systems Research, Singapore, Singapore
| | - Julian Thumboo
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Program in Health Services and Systems Research, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
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Mehra R, Pulman A, Dogan H, Murphy J, Bitters F. A Tailored mHealth App for Improving Health and Well-Being Behavioral Transformation in UK Police Workers: Usability Testing via a Mixed Methods Study. JMIR Hum Factors 2023; 10:e42912. [PMID: 37540549 PMCID: PMC10439470 DOI: 10.2196/42912] [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: 10/04/2022] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND When considering the policing environment of 2022, many roles previously in the domain of warranted officers (police officer) are now performed by nonwarranted police staff equivalents. These police staff roles have expanded rapidly into other areas such as investigations, custody, and contact management, which were traditionally seen as police officer functions and put staff under some of the same stresses as police officers. A UK police force requested help in investigating technologies that could be used to improve health and well-being for both officers and staff. OBJECTIVE The aim of this study was to create a health and well-being app for police officers and staff, which considered the unique requirements of the users throughout the designing, building, prototyping, and testing stages. METHODS This study involved quantitative approaches (demographic web-based survey questions and the System Usability Scale) and qualitative approaches (open web-based survey questions and semistructured interviews). Unsupervised usability testing of a prototype app was undertaken by members (N=48) of the commissioning client using their smartphones. After completing a preregistration application for screening purposes, participants downloaded a trial version of the app. Then, they completed a web-based questionnaire after testing the app for 10 days. A subsample of participants (9/48, 19%) was interviewed. Deductive thematic analysis was undertaken to identify key themes and subthemes. RESULTS Data collected during usability testing concerned the 6 domains of the app-food and diet, activity, fluid intake, sleep, good mental health, and financial well-being-and informed the creation of improved design during prototyping. Some usability and design issues and suggestions for improvements were also addressed and implemented-including shift management and catch-up cards-during this cycle of development. CONCLUSIONS This study highlights the importance of coparticipation with officers and staff across the entire development cycle, to coproduce a human-centered design methodology to enable the development of a considered and user-centered solution. It demonstrates the need for producing a multifunctional tool rather than focusing purely on an individual element for this user group. It also highlights how linking and being able to track optional, personalized elements of health data against one another, cross-referenced to individual shift patterns, might help to inform and provide users with a chance for reflection and therefore influence behavior change.
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Affiliation(s)
- Richa Mehra
- Bournemouth University, Faculty of Science and Technology, Bournemouth, United Kingdom
| | - Andy Pulman
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, United Kingdom
| | - Huseyin Dogan
- Bournemouth University, Faculty of Science and Technology, Bournemouth, United Kingdom
| | - Jane Murphy
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, United Kingdom
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Chen KY, Lang Y, Zhou Y, Kosmari L, Daniel K, Gurses A, Xiao Y. Assessing Interventions on Crowdsourcing Platforms to Nudge Patients for Engagement Behaviors in Primary Care Settings: Randomized Controlled Trial. J Med Internet Res 2023; 25:e41431. [PMID: 37440308 PMCID: PMC10375278 DOI: 10.2196/41431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Engaging patients in health behaviors is critical for better outcomes, yet many patient partnership behaviors are not widely adopted. Behavioral economics-based interventions offer potential solutions, but it is challenging to assess the time and cost needed for different options. Crowdsourcing platforms can efficiently and rapidly assess the efficacy of such interventions, but it is unclear if web-based participants respond to simulated incentives in the same way as they would to actual incentives. OBJECTIVE The goals of this study were (1) to assess the feasibility of using crowdsourced surveys to evaluate behavioral economics interventions for patient partnerships by examining whether web-based participants responded to simulated incentives in the same way they would have responded to actual incentives, and (2) to assess the impact of 2 behavioral economics-based intervention designs, psychological rewards and loss of framing, on simulated medication reconciliation behaviors in a simulated primary care setting. METHODS We conducted a randomized controlled trial using a between-subject design on a crowdsourcing platform (Amazon Mechanical Turk) to evaluate the effectiveness of behavioral interventions designed to improve medication adherence in primary care visits. The study included a control group that represented the participants' baseline behavior and 3 simulated interventions, namely monetary compensation, a status effect as a psychological reward, and a loss frame as a modification of the status effect. Participants' willingness to bring medicines to a primary care visit was measured on a 5-point Likert scale. A reverse-coding question was included to ensure response intentionality. RESULTS A total of 569 study participants were recruited. There were 132 in the baseline group, 187 in the monetary compensation group, 149 in the psychological reward group, and 101 in the loss frame group. All 3 nudge interventions increased participants' willingness to bring medicines significantly when compared to the baseline scenario. The monetary compensation intervention caused an increase of 17.51% (P<.001), psychological rewards on status increased willingness by 11.85% (P<.001), and a loss frame on psychological rewards increased willingness by 24.35% (P<.001). Responses to the reverse-coding question were consistent with the willingness questions. CONCLUSIONS In primary care, bringing medications to office visits is a frequently advocated patient partnership behavior that is nonetheless not widely adopted. Crowdsourcing platforms such as Amazon Mechanical Turk support efforts to efficiently and rapidly reach large groups of individuals to assess the efficacy of behavioral interventions. We found that crowdsourced survey-based experiments with simulated incentives can produce valid simulated behavioral responses. The use of psychological status design, particularly with a loss framing approach, can effectively enhance patient engagement in primary care. These results support the use of crowdsourcing platforms to augment and complement traditional approaches to learning about behavioral economics for patient engagement.
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Affiliation(s)
- Kay-Yut Chen
- College of Business, University of Texas at Arlington, Arlington, TX, United States
| | - Yan Lang
- Department of Business, State University of New York at Oneonta, Oneonta, NY, United States
| | - Yuan Zhou
- Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at Arlington, Arlington, TX, United States
| | - Ludmila Kosmari
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Kathryn Daniel
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Ayse Gurses
- Armstrong Institute Center for Health Care Human Factors, Anesthesiology and Critical Care, Emergency Medicine, and Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Yan Xiao
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
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Zhao L, Bidargaddi N, Vakulin A, Li W, Luscombe-Marsh N, Benton F, Adams R, Kemps E, Vincent AD, Heilbronn LK, Wittert GA. A micro-randomized pilot study to examine the impact of just-in-time nudging on after-dinner snacking in adults with type 2 diabetes: A study protocol. Diabetes Obes Metab 2023. [PMID: 37385960 DOI: 10.1111/dom.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/20/2023] [Indexed: 07/01/2023]
Abstract
AIM To determine whether a digital nudge soon after dinner reduces after-dinner snacking events as measured objectively by continuous glucose monitoring (CGM) in patients with type 2 diabetes (T2D). METHODS This is a single-site micro-randomized trial (MRT). People with T2D, aged 18-75 years, managed with diet or a stable dose of oral antidiabetic medications for at least 3 months, and who habitual snack after dinner at least 3 nights per week, will be recruited. Picto-graphic nudges were designed by mixed research methods. After a 2-week lead-in phase to determine eligibility and snacking behaviours by a CGM detection algorithm developed by the investigators, participants will be micro-randomized daily (1:1) to a second 2-week period to either a picto-graphic nudge delivered-in-time (Intui Research) or no nudge. During lead-in and MRT phases, 24-hour glucose will be measured by CGM, sleep will be tracked by an under-mattress sleep sensor, and dinner timing will be captured daily by photographing the evening meal. RESULTS The primary outcome is the difference in the incremental area under the CGM curve between nudging and non-nudging days during the period from 90 minutes after dinner until 04:00 AM. Secondary outcomes include the effect of baseline characteristics on treatment, and comparisons of glucose peaks and time-in-range between nudging and non-nudging days. The feasibility of 'just-in-time' messaging and nudge acceptability will be evaluated, along with the analysis of sleep quality measures and their night-to-night variability. CONCLUSIONS This study will provide preliminary evidence of the impact of appropriately timed digital nudges on 24 -hour intertitial glucose levels resulting from altered after-dinner snacking in people with T2D. An exploratory sleep substudy will provide evidence of a bidirectional relationship between after-dinner snacking behaviour, glycaemia and sleep. Ultimately, this study will allow for the design of a future confirmatory study of the potential for digital nudging to improve health related behaviours and health outcomes.
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Affiliation(s)
- Lijun Zhao
- Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Niranjan Bidargaddi
- Digital Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Wenhao Li
- Digital Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Fiona Benton
- Diabetes Australia South Australia, Adelaide, South Australia, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Eva Kemps
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Andrew D Vincent
- Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Leonie K Heilbronn
- Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Tanaka R. Nudge for Environmental Restructuring in Diabetes Self-Management: Comment on Existing Systematic Reviews. Health Serv Insights 2023; 16:11786329231174337. [PMID: 37215647 PMCID: PMC10196547 DOI: 10.1177/11786329231174337] [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: 02/02/2023] [Accepted: 04/15/2023] [Indexed: 05/24/2023] Open
Abstract
Diabetes self-management education and support are necessary for all people living with diabetes, but its accessibility is limited worldwide. Nudge strategies have been proposed as an environmental outreach for diabetes management. This article provides further insights regarding environmental restructuring nudges into the cumulative evidence on diabetes self-management interventions from existing systematic reviews that classified primary trials using the behavior change technique taxonomy (BCTTv1). Among the 137 relevant articles searched through the bibliographic databases until 2022, three systematic reviews were scrutinized. Environmental restructuring nudges have been tested in interpersonal communications for diabetes self-management. Although nudge-based techniques were used with other types of behavior techniques in various trial contexts, the independent effects of social restructuring nudges were not denied in previous meta-analyses. Environmental restructuring nudges may be feasible in diabetes management, but they are still controversial with internal and external validation. Considering care accessibility for diabetes management, social restructuring nudges applied to healthcare providers are expected to complement healthcare systems. For future implementation, the rationale for the practice should be explicit in the conceptualization and evidence synthesis of diabetes-specific nudge interventions based on global sources.
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Affiliation(s)
- Rie Tanaka
- Institute of Medicine, University of Tsukuba, Tsukuba,
Ibaraki, Japan
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20
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Hirota N, Okada H, Okamura N. The effectiveness in preventing frailty of exercise intervention provided by community pharmacists to older persons with chronic conditions: A pragmatic randomized controlled trial. BMC Geriatr 2023; 23:225. [PMID: 37029343 PMCID: PMC10081300 DOI: 10.1186/s12877-023-03858-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Once older persons become frail, the risk of falls, bone fractures, and other problems increases. Exercise intervention is a form of prevention that has a high degree of evidence. OBJECTIVE We investigated the effectiveness of frailty prevention consisting of exercise intervention by community pharmacists at 11 pharmacies operated by Osaka Pharma Plan. METHODS In total, 103 older persons between 70 and 79 years of age (53 males and 50 females) who were suffering from chronic conditions and who visited one of 11 pharmacies between January and March 2021 were enrolled. They were then randomly assigned to either the Intervention group (IG: 6 pharmacies, 61 patients) who were subjected to intervention by a pharmacist, or the Usual Care group (UG: 5 pharmacies, 42 patients) who were not subjected to intervention. At the beginning of the trial and 6 month after, their muscle mass, etc. were measured using a body composition meter, and their Five-Times Sit-To-Stand Test results were also measured. Patients in the IG were provided with information by way of leaflets during the time they were guided regarding taking their medication for a period of one to six months that encouraged exercising at home. Those in the UG were given the standard guidance related to taking their medication. RESULTS The amount of change in muscle mass was 1.08 ± 7.83% (95%CI: -1.24-3.41) in IG and - 0.43 ± 2.73% (95%CI:-1.58-0.72) in UG, indicating that there was a trend toward an increase in IG. The percent change in the Five Times Sit-To-Stand Test times at + 6 M was - 0.002 ± 0.24% (95%CI: -0.09-0.05) in IG and - 0.04 ± 0.21% (95%CI:-0.13-0.07) in UG, but in cases in which the second measured time was faster than the first measured time, the results were 65.2% for IG and 29.2% for UG, indicating a significant difference (p = 0.00563). CONCLUSION Despite the fact that the amount of time community pharmacists can devote to providing guidance on taking medications is limited, it has been previously reported that providing information to patients causes a change in patient behavior. The results of the present study are highly significant as they suggest the possibility that this may hold true even when used to prevent frailty, based on the evidence obtained. TRIAL REGISTRATION This trial was registered at UMIN-CRT on 1st of January, 2021. The registration number is UMIN000042571.
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Affiliation(s)
- Noritake Hirota
- Department of Clinical Pharmacy, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan.
- Aozora Pharmacy, General Incorporated Association Osaka Pharma Plan, Osaka, Japan.
| | - Hiroshi Okada
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Noboru Okamura
- Department of Clinical Pharmacy, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
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Gao C, Shen Y, Xu W, Zhang Y, Tu Q, Zhu X, Lu Z, Yang Y. A fuzzy-set qualitative comparative analysis exploration of multiple paths to users' continuous use behavior of diabetes self-management apps. Int J Med Inform 2023; 172:105000. [PMID: 36806902 DOI: 10.1016/j.ijmedinf.2023.105000] [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: 09/06/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the obvious potential benefits of diabetes self-management apps, users' continuous use of diabetes self-management apps is still not widespread. Influential factors coexisted in information ecologies are likely to have a synthetic effect on users' continuous use behavior. However, it is less clear how factors in information ecologies combine to influence users' continuous use behavior. OBJECTIVE The objectives of this study are to explore combinations of factors (perceived severity, information quality, service quality, system quality, and social influence) in information ecologies that lead to users' continuous use behavior of diabetes self-management apps and which combination is the most important. METHODS Purpose sampling was used to recruit diabetes self-management app users from July 1, 2021 to January 31, 2022. Fuzzy-set qualitative comparative analysis (fsQCA) was then employed by conducting necessity and sufficiency analysis. RESULTS In total 280 diabetes self-management app users participated. The necessity analysis indicated that no single factor was necessary to cause users' continuous use behavior, and the sufficiency analysis identified five different combinations of factors that lead to users' continuous use behavior. Of these five, the combination of high information quality, high service quality, and high social influence was found to be the most important path. CONCLUSIONS Users' continuous use behavior of diabetes self-management apps results from the synergistic effects of factors in information ecologies. The five paths that directly contribute to users' continuous use, as well as the four user types preliminarily identified in this study may provide a reference for healthcare providers and app developers.
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Affiliation(s)
- Chenchen Gao
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yucong Shen
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenxian Xu
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yongjie Zhang
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiongyao Tu
- Department of Intensive Care Medicine, Huangyan Hospital,Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Xingjie Zhu
- Department of Theater, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhongqiu Lu
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Yeqin Yang
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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22
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Effects of the theory of planned behavior and nudge strategy-based intervention on the adherence to anticoagulation treatment in patients with non-valvular atrial fibrillation. Geriatr Nurs 2023; 51:17-24. [PMID: 36871327 DOI: 10.1016/j.gerinurse.2023.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Non-valvular atrial fibrillation is associated with the incidence of thromboembolism. Current guidelines recommend preferential use of novel oral anticoagulants(NOAC) in patients with nonvalvular atrial fibrillation. Oral anticoagulation medication adherence rate was relatively low among discharged patients with non-valvular atrial fibrillation. AIM To investigate the effects of the anticoagulation programs based on the theory of planned behavior and nudge strategy among patients with non-valvular atrial fibrillation. METHODS 130 patients with non-valvular atrial fibrillation were randomized to the intervention group or control group, 72 patients in the intervention group, and 58 patients in the control group with a 6-month follow-up. Medication adherence,intention,attitude, perceived behavioral control and subjective norm and quality of life were assessed. RESULTS There were significantly differences in the attitude and subjective norm between the two groups at one month,three months and six months follow-up(P <0.01).There were significantly differences in the perceived behavioral control between the two groups at six months follow-up(P <0.01).There were significantly differences in the intention scale between the two groups at three months follow-up(P <0.01). The medication adherence scale score was higher in the intervention group than in the control group at six months follow-up.However, there were no differences in quality of life between the two groups at six months follow-up. CONCLUSIONS The program based on the theory of planned behavior and nudge strategy can improve medication adherence in patients with non-valvular atrial fibrillation.
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Golob AL, Geyer J, O'Keeffe C, Nelson K, Song C, Vanderwarker C, Britton J, Reddy A, Wong E, Schuttner L. Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence. BMJ Open Qual 2023; 12:bmjoq-2022-001985. [PMID: 36746551 PMCID: PMC9906179 DOI: 10.1136/bmjoq-2022-001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Medication adherence impacts health outcomes. Healthcare organisations implementing system-level interventions have potential for greater spread and sustainability than individual-level interventions. Within the integrated US Veterans Health Administration, a multidisciplinary team developed and evaluated a pilot quality improvement programme to assess the feasibility of automatic mailed prescription refills for patients with diabetes and low medication adherence (assessed by medication possession ratio <80%). METHODS Patients were randomised to usual care with self-initiated refills versus automatic mailed refills for 6 months. Process outcomes included glycaemic control measures (HgbA1C), medication possession ratios for both automatic and self-initiated (reference) refills of medications, patient satisfaction and workforce effort (pharmacist time). RESULTS Overall, 199 patients were randomised to automatic refills (n=99; 40 of whom participated) versus usual care (n=100). In multivariable analysis adjusting for baseline differences, after 6 months there was no difference in the proportion of patients with follow-up HgbA1C <8% (60.8% automatic refills vs 60.5% usual care, p=0.96). In the automatic refill group, the medication possession ratio for reference medicines was significantly higher than usual care (63.9% vs 54.5%, 95% CI (for difference) 3.1% to 15.9%, p<0.01). CONCLUSIONS Implications and lessons from this pilot programme include potential beneficial indirect effects from automatic medication refills on patient self-initiated refills of other medications; the importance of tailoring solutions to patient subgroups and specific adherence barriers; and recognition that the rapid deployment, iteration and evaluation of the project was facilitated by a multidisciplinary team embedded within an organisational learning health system.
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Affiliation(s)
- Anna L Golob
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA .,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - John Geyer
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Chatty O'Keeffe
- Patient Care Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Kaylen Nelson
- Pharmacy Clinical Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Cassandra Song
- Pharmacy Clinical Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Christopher Vanderwarker
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jacqueline Britton
- Rehabilitation Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Ashok Reddy
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA,Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Edwin Wong
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Linnaea Schuttner
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA,Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
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Fox MG, Cass LM, Sykes KJ, Cummings EL, Fassas SN, Nallani R, Smith JB, Chiu AG, Villwock JA. Factors affecting adherence to intranasal treatment for allergic rhinitis: A qualitative study. Laryngoscope Investig Otolaryngol 2023; 8:40-45. [PMID: 36846400 PMCID: PMC9948570 DOI: 10.1002/lio2.986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the facilitators of and barriers to adherence to use of intranasal pharmacotherapy (daily intranasal corticosteroids and/or antihistamine, and nasal saline irrigation [NSI]), for allergic rhinitis (AR). Methods Patients were recruited from an academic tertiary care rhinology and allergy clinic. Semi-structured interviews were conducted after the initial visit and/or 4-6 weeks following treatment. Transcribed interviews were analyzed using a grounded theory, inductive approach to elucidate themes regarding patient adherence to AR treatment. Results A total of 32 patients (12 male, 20 female; age 22-78) participated (seven at initial visit, seven at follow-up visit, and 18 at both). Memory triggers, such as linking nasal routine to existing daily activities or medications, were identified by patients as the most helpful strategy for adherence at initial and follow-up visits. Logistical obstacles related to NSI (messy, takes time, etc.) was the most common concept discussed at follow-up. Patients modified the regimen based on side effects experienced or perceived efficacy. Conclusions Memory triggers help patients adhere to nasal routines. Logistical obstacles related to NSI can deter from use. Health care providers should address both concepts during patient counseling. Nudge-based interventions that incorporate these concepts may help improve adherence to AR treatment. Level of Evidence 2.
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Affiliation(s)
- Meha G. Fox
- Department of Otolaryngology – Head & Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Lauren M. Cass
- Department of Head and Neck SurgeryKaiser PermanentePortlandOregonUSA
| | - Kevin J. Sykes
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Emily L. Cummings
- Department of Internal MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Scott N. Fassas
- Department of Internal MedicineGeorge Washington School of Medicine & Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Rohit Nallani
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Josh B. Smith
- Department of Otolaryngology – Head & Neck SurgerySt. Louis University School of MedicineSt. LouisMissouriUSA
| | - Alexander G. Chiu
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Jennifer A. Villwock
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
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Al Ayed MY, Ababneh A, Alwin Robert A, Ahmed R, Al Ghofaili I, Al Saeed A, Al Dawish MA. Factors Associated With Self-Efficacy of Foot Self-Care Among Patients With Diabetes Attending a Tertiary Care Center in Saudi Arabia. INT J LOW EXTR WOUND 2023:15347346221148820. [PMID: 36597574 DOI: 10.1177/15347346221148820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Several reports have shown self-efficacy to be a reliable way of predicting foot self-care behavior in patients with diabetes. However, at a global level in general, and in Saudi Arabia in particular, investigation of the factors related to self-efficacy in executing foot self-care continues to remain inadequate. This study endeavors to identify the factors associated with the self-efficacy of foot self-care among patients with diabetes in Saudi Arabia. From a tertiary diabetes care center in Saudi Arabia, 175 patients with diabetes were selected to participate in this cross-sectional study. Employing the Arabic version of the Foot Care Confidence Scale (FCCS), the principal end results and the sociodemographic, clinical, and psychosocial independent variables were collected and assessed. From the total reported FCCS score, the mean was found to be 28.1 ± 8.2. Multiple linear regression analysis indicated 2 independent factors were positively associated with a higher reported FCCS score; being middle-aged (< 60 years old) (β=0.31, P< .01) and having a higher score on the Foot Care Outcome Expectations Scale (FCOES) (β=0.36, P< .01). In conclusion, patients with diabetes in Saudi Arabia have a mild level of self-efficacy to perform the needed foot self-care. Therefore, this has turned the spotlight on the young or middle-aged < 60-year-old Saudi population with diabetes as the target group, making them the priority for future self-efficacy promotion programs to upgrade the level of foot self-care.
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Affiliation(s)
- Musab Yousef Al Ayed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Anas Ababneh
- Faculty of Nursing, 59177Applied Science Private University, Amman, Jordan
| | - Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rania Ahmed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Al Ghofaili
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulghani Al Saeed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Abdulaziz Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Kwan YH, Ong ZQ, Choo DYX, Phang JK, Yoon S, Low LL. A Mobile Application to Improve Diabetes Self-Management Using Rapid Prototyping: Iterative Co-Design Approach in Asian Settings. Patient Prefer Adherence 2023; 17:1-11. [PMID: 36636285 PMCID: PMC9830050 DOI: 10.2147/ppa.s386456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diabetes is a global public health issue, causing burden on healthcare system and increasing risk of mortality. Mobile applications (apps) can be a promising approach to facilitate diabetes self-management. An increasingly utilized approach to facilitate engagement with mobile health (mHealth) technology is to involve potential users in the creation of the technology. OBJECTIVE The aim of this study was to use co-design for type 2 diabetes mellitus (T2DM) self-management mHealth development. METHODS Three rounds of iterative rapid prototyping panel sessions were conducted with a total of 9 T2DM participants in an Asian setting between Oct 2020 and April 2021. The participants were recruited through convenience sampling. For each round, feedback was gathered through qualitative interviews, and the feedback was used as a reference by the development team to develop and test a more refined version of the app in the next round. Transcribed semi-structured interview data was analyzed thematically using an inductive approach. RESULTS Participants' ages ranged from 40 to 69 years. Data saturation was reached, with no new themes emerging from the data. During the sessions, the participants expressed a variety of concerns and feedback on T2DM self-management using EMPOWER app and raised suggestions on the features of ideal T2DM self-management app. Important features include 1) reminders and notifications for medications, 2) Bluetooth integration with glucometers and blood pressure machines to minimize manual entry, 3) enlarged local food database including information on sugar content and recommendations for healthier options, 4) one touch for logging of routine medications and favorite foods, 5) export function for data sharing with physicians. Overall inputs concerned aspects such as user-friendliness of the app, customization possibilities, and educational content for the features in the mobile app. CONCLUSION In this study, we explored users' opinions on a T2DM self-management mobile app using co-design approach. This study adds to the growing body of literature on co-designing behavioral mHealth interventions and can potentially guide researchers in mobile app design for other chronic conditions.
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Affiliation(s)
- Yu Heng Kwan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Internal Medicine Residency, SingHealth, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Zhi Quan Ong
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Dawn Yee Xi Choo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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27
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Worth C, Nutter PW, Salomon-Estebanez M, Auckburally S, Dunne MJ, Banerjee I, Harper S. The behaviour change behind a successful pilot of hypoglycaemia reduction with HYPO-CHEAT. Digit Health 2023; 9:20552076231192011. [PMID: 37545627 PMCID: PMC10403985 DOI: 10.1177/20552076231192011] [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: 11/21/2022] [Accepted: 07/18/2023] [Indexed: 08/08/2023] Open
Abstract
Background Children with hypoglycaemia disorders, such as congenital hyperinsulinism (CHI), are at constant risk of hypoglycaemia (low blood sugars) with the attendant risk of brain injury. Current approaches to hypoglycaemia detection and prevention vary from fingerprick glucose testing to the provision of continuous glucose monitoring (CGM) to machine learning (ML) driven glucose forecasting. Recent trends for ML have had limited success in preventing free-living hypoglycaemia, due to a focus on increasingly accurate glucose forecasts and a failure to acknowledge the human in the loop and the essential step of changing behaviour. The wealth of evidence from the fields of behaviour change and persuasive technology (PT) allows for the creation of a theory-informed and technologically considered approach. Objectives We aimed to create a PT that would overcome the identified barriers to hypoglycaemia prevention for those with CHI to focus on proactive prevention rather than commonly used reactive approaches. Methods We used the behaviour change technique taxonomy and persuasive systems design models to create HYPO-CHEAT (HYpoglycaemia-Prevention-thrOugh-Cgm-HEatmap-Assisted-Technology): a novel approach that presents aggregated CGM data in simple visualisations. The resultant ease of data interpretation is intended to facilitate behaviour change and subsequently reduce hypoglycaemia. Results HYPO-CHEAT was piloted in 10 patients with CHI over 12 weeks and successfully identified weekly patterns of hypoglycaemia. These patterns consistently correlated with identifiable behaviours and were translated into both a change in proximal fingerprick behaviour and ultimately, a significant reduction in aggregated hypoglycaemia from 7.1% to 5.4% with four out of five patients showing clinically meaningful reductions in hypoglycaemia. Conclusions We have provided pilot data of a new approach to hypoglycaemia prevention that focuses on proactive prevention and behaviour change. This approach is personalised for individual patients with CHI and is a first step in changing our approach to hypoglycaemia prevention in this group.
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Affiliation(s)
- Chris Worth
- Department of Computer Science, University of Manchester, Manchester, UK
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Paul W Nutter
- Department of Computer Science, University of Manchester, Manchester, UK
| | - Maria Salomon-Estebanez
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Sameera Auckburally
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Mark J Dunne
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Simon Harper
- Department of Computer Science, University of Manchester, Manchester, UK
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Shareinia H, Ghiyasvandian S, Rooddehghan Z, Esteghamati A. Types of health-related procrastination in patients with type-2 diabetes: a qualitative content analysis. J Diabetes Metab Disord 2022; 21:1509-1517. [PMID: 36158709 PMCID: PMC9483280 DOI: 10.1007/s40200-022-01092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/18/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
Background and objectives: Health-related procrastination refers to a delay in the performance of health-related activities, which is a rather neglected subject despite being critical. Due to the adverse effects of procrastination on the care and treatment of patients with type-2 diabetes, it is necessary to explore procrastination among this group of patients through in-depth studies. The present research was conducted to explain different types of health-related procrastination in patients with type-2 diabetes. Materials and methods This qualitative study applied content analysis with 13 patients with type-2 diabetes selected via purposive sampling. Data were collected through individual and semi-structured interviews. The data were then analyzed using Lundman and Graneheim content analysis method. Findings: Based on the analysis of the data, instances of health-related procrastination in patients with type-2 diabetes were classified into six main categories, including minimizing self-care, poor adherence to treatment, poor nutritional habits, poor adherence to drug regimen, disregard for disease monitoring, and a sedentary lifestyle. Conclusions The results of this study provide an in-depth understanding of the various forms of health-related procrastination in patients with type-2 diabetes. These findings can be employed in the design, implementation, and monitoring of treatment and care programs targeting these patients.
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He Z, Cao X, Zhao D, Tang Z, Zhao J, Beasley M, Renne A, Liu L, Zhu S, Gao Y, Yan LL. Promoting the adoption of local governmental policy on the reimbursement of chronic disease medicines (PAPMed): study protocol of a field-based cluster randomized trial in rural Nantong, China. Trials 2022; 23:785. [PMID: 36109757 PMCID: PMC9479297 DOI: 10.1186/s13063-022-06710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/02/2022] [Indexed: 11/14/2022] Open
Abstract
Background Among rural Chinese patients with non-communicable diseases (NCDs), low socioeconomic status increases the risk of developing NCDs and associated financial burdens in paying for medicines and treatments. Despite the chronic disease medicine reimbursement policy of the local government in Nantong City, China, various barriers prevent patients from registering for and benefitting from the policy. This study aims to develop a behavior science-based intervention program for promoting the adoption of the policy and to evaluate the effectiveness of the program compared with usual practices. Methods Barriers and opportunities affecting stakeholders in adopting the policy were identified through contextual research and summarized through behavior mapping. The intervention is designed to target these barriers and opportunities through behavior science theories and will be evaluated through a 6-month cluster randomized controlled trial in Tongzhou District, Nantong, China. A total of 30 villages from two townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual practices). Village doctors in the intervention arm (1) receive systematic training on policy details, registration procedures, and intervention protocol, (2) promote the policy and encourage registration, (3) follow up with patients in the first, third, and sixth months after the intervention, and (4) receive financial incentives based on performance. The primary outcome is policy registration rate and the secondary outcomes include the number of patients registering for the policy, medical costs saved, frequency of village doctor visits, and health measures such as blood pressure and glucose levels. Discussion This study is one of very few that aims to promote adoption of NCDs outpatient medication reimbursement policies, and the first study to evaluate the impact of these policies on patients’ financial and physical wellbeing in China. The simple, feasible, and scalable intervention is designed based on the theories of behavior science and is applicable to similar low-income regions nationwide where outpatient medical costs remain a financial burden for patients. Trial registration ClinicalTrials.govNCT04731194, registered on 29 January 2021; Chinese Clinical Trial Registry ChiCTR2100042152, registered on 14 January 14 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06710-1.
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Joachim S, Forkan ARM, Jayaraman PP, Morshed A, Wickramasinghe N. A Nudge-Inspired AI-Driven Health Platform for Self-Management of Diabetes. SENSORS 2022; 22:s22124620. [PMID: 35746402 PMCID: PMC9227220 DOI: 10.3390/s22124620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022]
Abstract
Diabetes mellitus is a serious chronic disease that affects the blood sugar levels in individuals, with current predictions estimating that nearly 578 million people will be affected by diabetes by 2030. Patients with type II diabetes usually follow a self-management regime as directed by a clinician to help regulate their blood glucose levels. Today, various technology solutions exist to support self-management; however, these solutions tend to be independently built, with little to no research or clinical grounding, which has resulted in poor uptake. In this paper, we propose, develop, and implement a nudge-inspired artificial intelligence (AI)-driven health platform for self-management of diabetes. The proposed platform has been co-designed with patients and clinicians, using the adapted 4-cycle design science research methodology (A4C-DSRM) model. The platform includes (a) a cross-platform mobile application for patients that incorporates a macronutrient detection algorithm for meal recognition and nudge-inspired meal logger, and (b) a web-based application for the clinician to support the self-management regime of patients. Further, the platform incorporates behavioral intervention techniques stemming from nudge theory that aim to support and encourage a sustained change in patient lifestyle. Application of the platform has been demonstrated through an illustrative case study via two exemplars. Further, a technical evaluation is conducted to understand the performance of the MDA to meet the personalization requirements of patients with type II diabetes.
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Affiliation(s)
- Shane Joachim
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
- Correspondence: ; Tel.: +61-392-148-150
| | - Abdur Rahim Mohammad Forkan
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
| | - Prem Prakash Jayaraman
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
| | - Ahsan Morshed
- College of Information and Communications Technology, School of Engineering and Technology, Central Queensland University, Melbourne 3000, Australia;
| | - Nilmini Wickramasinghe
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne 3122, Australia;
- Epworth Healthcare, Richmond 3121, Australia
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Okada A, Hashimoto Y, Goto T, Yamaguchi S, Ono S, Ikeda Kurakawa K, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T. A Machine Learning-Based Predictive Model to Identify Patients Who Failed to Attend a Follow-up Visit for Diabetes Care After Recommendations From a National Screening Program. Diabetes Care 2022; 45:1346-1354. [PMID: 35435949 DOI: 10.2337/dc21-1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Reportedly, two-thirds of the patients who were positive for diabetes during screening failed to attend a follow-up visit for diabetes care in Japan. We aimed to develop a machine-learning model for predicting people's failure to attend a follow-up visit. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of adults with newly screened diabetes at a national screening program using a large Japanese insurance claims database (JMDC, Tokyo, Japan). We defined failure to attend a follow-up visit for diabetes care as no physician consultation during the 6 months after the screening. The candidate predictors were patient demographics, comorbidities, and medication history. In the training set (randomly selected 80% of the sample), we developed two models (previously reported logistic regression model and Lasso regression model). In the test set (remaining 20%), prediction performance was examined. RESULTS We identified 10,645 patients, including 5,450 patients who failed to attend follow-up visits for diabetes care. The Lasso regression model using four predictors had a better discrimination ability than the previously reported logistic regression model using 13 predictors (C-statistic: 0.71 [95% CI 0.69-0.73] vs. 0.67 [0.65-0.69]; P < 0.001). The four selected predictors in the Lasso regression model were lower frequency of physician visits in the previous year, lower HbA1c levels, and negative history of antidyslipidemic or antihypertensive treatment. CONCLUSIONS The developed machine-learning model using four predictors had a good predictive ability to identify patients who failed to attend a follow-up visit for diabetes care after a screening program.
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan.,TXP Medical Co. Ltd, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Toranomon Hospital, Tokyo, Japan
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Wu A, Snell B, Younge J. Blood Pressure Reduction as a Result of the Boxville Vitals Partnership. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Wu
- University of Illinois Chicago College of Pharmacy Chicago Illinois
| | - Brittney Snell
- University of Illinois Chicago College of Pharmacy Chicago Illinois
| | - Jewel Younge
- University of Illinois Chicago College of Pharmacy Chicago Illinois
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Horne BD, Muhlestein JB, Lappé DL, May HT, Le VT, Bair TL, Babcock D, Bride D, Knowlton KU, Anderson JL. Behavioral Nudges as Patient Decision Support for Medication Adherence: The ENCOURAGE Randomized Controlled Trial. Am Heart J 2022; 244:125-134. [PMID: 34798073 DOI: 10.1016/j.ahj.2021.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Medication adherence is generally low and challenging to address because patient actions control healthcare delivery outside of medical environments. Behavioral nudging changes clinician behavior, but nudging patient decision-making requires further testing. This trial evaluated whether behavioral nudges can increase statin adherence, measured as the proportion of days covered (PDC). METHODS In a 12-month parallel-group, unblinded, randomized controlled trial, adult patients in Intermountain Healthcare cardiology clinics were enrolled. Inclusion required an indication for statins and membership in SelectHealth insurance. Subjects were randomized 1:1 to control or nudges. Nudge content, timing, frequency, and delivery route were personalized by CareCentra using machine learning of subject motivations and abilities from psychographic assessment, demographics, social determinants, and the Intermountain Mortality Risk Score. PDC calculation used SelectHealth claims data. RESULTS Among 182 subjects, age averaged 63.2±8.5 years, 25.8% were female, baseline LDL-C was 82.5±32.7 mg/dL, and 93.4% had coronary disease. Characteristics were balanced between nudge (n = 89) and control arms (n = 93). The statin PDC was greater at 12 months in the nudge group (PDC: 0.742±0.318) compared to controls (PDC: 0.639±0.358, P = 0.042). Adherent subjects (PDC ≥80%) were more concentrated in the nudge group (66.3% vs controls: 50.5%, P = 0.036) while a composite of death, myocardial infarction, stroke, and revascularization was non-significant (nudges: 6.7% vs control: 10.8%, P = 0.44). CONCLUSIONS Persuasive behavioral nudges driven by artificial intelligence resulted in a clinically important increase in statin adherence in general cardiology patients. This precision patient decision support utilized computerized nudge design and delivery with minimal on-going human input.
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Affiliation(s)
- Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
| | - Joseph B Muhlestein
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Donald L Lappé
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Heidi T May
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Viet T Le
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Tami L Bair
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Daniel Babcock
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Daniel Bride
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Kirk U Knowlton
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jeffrey L Anderson
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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Yoon S, Ng JH, Kwan YH, Low LL. Healthcare Professionals' Views of Factors Influencing Diabetes Self-Management and the Utility of a mHealth Application and Its Features to Support Self-Care. Front Endocrinol (Lausanne) 2022; 13:793473. [PMID: 35282452 PMCID: PMC8907617 DOI: 10.3389/fendo.2022.793473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The perspectives of healthcare professionals (HCPs) are pivotal to co-development of self-management strategies for patients with diabetes. However, literature has been largely limited to perspectives of patients within the context of a Western healthcare setting. This study aims to explore factors influencing diabetes self-management in adult patients with diabetes from the perspectives of HCPs and their views of the value of mHealth application for diabetes self-management. MATERIALS AND METHODS We conducted focus group discussions (FGD) with purposively selected HCPs in Singapore. All FGDs were audio-recorded and transcribed verbatim. Thematic analysis was conducted using NVivo 12. RESULTS A total of 56 HCPs participated in the study. Barriers to self-management included limited patient commitment to lifestyle changes, suboptimal adherence to medication and treatment, patient resistance to insulin initiation and insufficient rapport between patients and HCPs. Patients' perceived susceptibility to complications, social support from family and community, multidisciplinary team care and patient's understanding of the benefits of self-care were viewed as facilitating self-management. HCPs saw mHealth apps as a vital opportunity to engage patients in the self-management of conditions and empower them to foster behavior changes. Yet, there were concerns regarding patient's limited digital literacy, lack of integration into routine electronic system and reluctance. DISCUSSION We identified a set of factors influencing self-management in adult patients with diabetes and useful app features that can empower patients to manage their conditions. Findings will inform the development of a mHealth application, and its features designed to improve self-care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Jun Hao Ng
- Duke-NUS Medical School, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Internal Medicine Residency Programme, SingHealth Residency, Singapore, Singapore
| | - Lian Leng Low
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- *Correspondence: Lian Leng Low,
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Rogers A, Wilkinson S, Truby H, Downie O. Communication of Nutrition Information by Influencers on Social Media: A Scoping Review. Health Promot J Austr 2021; 33:657-676. [PMID: 34870880 DOI: 10.1002/hpja.563] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 01/18/2023] Open
Abstract
ISSUE ADDRESSED Although government promoted public health, social media and media campaigns have communicated nutrition information, the Australian population remain chronic under-consumers of fruit and vegetables and over-consumers of ultra-processed foods. This scoping review aimed to determine how social media influencers (SMI) communicate nutrition information and the factors that influence the popularity of messages. Identified factors could inform how governments may utilise social media to impact positively on food choices. METHODS Nine databases were searched in the past 5 years (2016-2021). After relevant sources were identified, entire texts of the grey literature and the 'Results' sections of the academic literature were coded. Using Microsoft Word, each key feature of the relevant text was highlighted, and the relevant code was recorded. Inductive coding was utilised where codes were created based on the text itself. These codes were then sorted iteratively into relevant themes and subthemes. RESULTS Eleven studies were included. From these sources, five themes were identified. These were, 1) Promoting Dietary Change, 2) Certain Modes/Styles of Content Delivery, 3) An Attractive Individual, 4) Language Features and 5) Appearing Connected to the Audience. CONCLUSION SMI are selective in their content and communication techniques to ensure their nutrition messages are popular with social media users. These methods exhibited by SMI could inform strategies to build trust in government messages about food and nutrition. SO WHAT?: SMI are able to nurture trust and exert influence on followers. It may be possible to leverage existing SMI to deliver specific nutrition messages to their audiences.
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Affiliation(s)
- Alice Rogers
- The University of Queensland, School of Human Movement and Nutrition Science, Australia
| | - Shelley Wilkinson
- The University of Queensland, School of Human Movement and Nutrition Science, Australia
| | - Helen Truby
- The University of Queensland, School of Human Movement and Nutrition Science, Australia
| | - Olivia Downie
- The University of Queensland, School of Human Movement and Nutrition Science, Australia
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Nakanishi S, Shimoda M, Tatsumi F, Kohara K, Obata A, Sanada J, Fushimi Y, Mune T, Kaku K, Kaneto H. Association between Grit Scales and adherence to regular hospital visits among Japanese patients with type 2 diabetes: Prospective observational study. J Diabetes Investig 2021; 12:2259-2262. [PMID: 34018334 PMCID: PMC8668056 DOI: 10.1111/jdi.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/01/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
This study examined the association between Grit Scales and adherence to a schedule of regular hospital visits among Japanese type 2 diabetes patients. Patients with type 2 diabetes who visited the outpatient clinic as new patients comprised the study's participants. Self-administered Short Grit Scale data were obtained from 122 patients at the first consultation and were then observed for 1 year. As the results, 21 participants failed to attend the hospital. In a logistic regression analysis, the Grit Scale as a continuous variable was positively associated with adherence to regular clinical visits. Its odds ratio and 95% confidential interval was 9.68 and 2.87-32.65 (P = 0.0003). In conclusion, it is likely that the Grit Scale is closely associated with adherence to regular hospital visits among Japanese type 2 diabetes patients.
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Affiliation(s)
- Shuhei Nakanishi
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Masashi Shimoda
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Fuminori Tatsumi
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Kenji Kohara
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Atsushi Obata
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Junpei Sanada
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Yoshiro Fushimi
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Tomoatsu Mune
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Kohei Kaku
- Department of MedicineKawasaki Medical SchoolKawasaki HospitalOkayamaJapan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
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Li R, Zhang Y, Cai X, Luo D, Zhou W, Long T, Zhang H, Jiang H, Li M. The nudge strategies for weight loss in adults with obesity and overweight: A systematic review and meta-analysis. Health Policy 2021; 125:1527-1535. [PMID: 34772518 DOI: 10.1016/j.healthpol.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022]
Abstract
Obesity and overweight conditions have become major health challenges worldwide. The exploration of effective weight loss strategies is essential. Nudges are currently advancing approaches that represent a new and better method for changing the behaviors of people. However, the effectiveness of nudge interventions on weight loss in overweight people who may be obese has not been synthesized in a systematic manner. In this study, a systematic literature search was performed. Only randomized controlled trials (RCTs) were considered. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated as summary statistics. In total, 25 RCTs involving a population of 5,929 individuals were included. Significant effects of the nudge strategy on weight loss (WMD: -0.96 kg, 95% CI: -1.49 to -0.43), body mass index (WMD: -0.3 kg/m2, 95% CI: -0.41 to -0.19) and waist circumference (WMD: -0.75 cm, 95% CI: -1.23 to -0.27) were observed. The subgroup analysis showed that the reduction in body weight associated with nudge interventions was significant in younger and more obese people. Moreover, the effect of nudge intervention on weight loss weakened over time. Overall, the nudge strategy can promote changes in weight loss, body mass index and waist circumference of adults, albeit at a mild magnitude and in particular types of individuals. Nudge strategies can be recommended to clinical practitioners and policy-makers to promote obesity management.
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Affiliation(s)
- Ruxue Li
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Xue Cai
- Zhongda Hospital Southeast University, Nanjing, China
| | - Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wuai Zhou
- Department of Automation, Tsinghua University, Beijing, China
| | - Tianxue Long
- School of Nursing, Peking University, Beijing, China
| | - Huijing Zhang
- School of Nursing, Peking University, Beijing, China
| | - Hua Jiang
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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Syrkiewicz-Świtała M, Detyna B, Sosada N, Detyna J, Świtała R, Bitkowska A, Szkutnik J. Mobile applications and eating habits among women and men – Polish experiences. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yoon S, Goh H, Nadarajan GD, Sung S, Teo I, Lee J, Ong MEH, Graves N, Teo TL. Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study. J Med Internet Res 2021; 23:e26282. [PMID: 33979296 PMCID: PMC8168635 DOI: 10.2196/26282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/13/2021] [Accepted: 04/19/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. OBJECTIVE This study aimed to explore frontline workers' experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. METHODS We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies-those commonly used for mHealth development-to assess participants' preferences for particular features and their reasoning. RESULTS A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. CONCLUSIONS Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Sharon Sung
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Irene Teo
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Jungup Lee
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Marcus E H Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Tess Lin Teo
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Studer M. Invited Clinical Commentary On: Are the Recommended Physical Activity Guidelines Practical and Realistic for Older People With Complex Medical Issues? J Geriatr Phys Ther 2021; 44:70-73. [PMID: 33770814 DOI: 10.1519/jpt.0000000000000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mike Studer
- Northwest Rehabilitation Associates, Salem, Oregon
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Klonoff DC, Zhang JY, Shang T, Mehta C, Kerr D. Pharmacoadherence: An Opportunity for Digital Health to Inform the Third Dimension of Pharmacotherapy for Diabetes. J Diabetes Sci Technol 2021; 15:177-183. [PMID: 33289578 PMCID: PMC7783015 DOI: 10.1177/1932296820973185] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The basis of pharmacotherapy requires knowledge of two properties of a drug: pharmacokinetics (PK) and pharmacodynamics (PD). In the era of precision medicine, there is growing interest in determining between-individual variations in PK and PD. While these two dimensions of pharmacotherapy are key foci of investigation, a third property is also emerging as a critical factor in understanding how a drug affects an individual. This third property of a drug is known as phamacoadherence (PA). There can be wide variation in PA among people with diabetes, whether they are using oral or injectable medications. The use of new digital health interventions and telehealth communication tools, such as smart insulin pens, is now creating opportunities for health care professionals to have a more complete understanding of the PA of drugs, which allows for more personalized prescribing practices.
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Affiliation(s)
| | | | - Trisha Shang
- Diabetes Technology Society, Burlingame, CA, USA
| | - Chhavi Mehta
- Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
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