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Einhorn J, Murphy AR, Rogal SS, Suffoletto B, Irizarry T, Rollman BL, Forman DE, Muldoon MF. Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews. JMIR Cardio 2023; 7:e51316. [PMID: 38048147 PMCID: PMC10728784 DOI: 10.2196/51316] [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: 08/03/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. OBJECTIVE We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. METHODS Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. RESULTS Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient's home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. CONCLUSIONS In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. TRIAL REGISTRATION ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4.
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Affiliation(s)
| | - Andrew R Murphy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Shari S Rogal
- Dissemination and Implementation Science Collaboration, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Taya Irizarry
- Department of Advanced Analytics and Population Health, Highmark Health Enterprise, Pittsburgh, PA, United States
| | - Bruce L Rollman
- Center for Behavioral Health, Media and Techology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Daniel E Forman
- Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Geriatrics, Reseach, Education and Clinical Care (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Matthew F Muldoon
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- UPMC Hypertension Center, Heart and Vascular Institute, UPMC Healthcare System, Pittsburgh, PA, United States
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Deneka IE, Rodionov AV, Fomin VV. Optimization of blood pressure control in patients with resistant arterial hypertension and visceral obesity. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.10.201856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim. To evaluate the course of resistant arterial hypertension in patients with visceral obesity, to identify predictors of unsatisfactory shot-term and long-term treatment outcomes, to optimize therapy and improve adherence to treatment.
Materials and methods. A total number of 90 individuals with a history of refractory or resistant arterial hypertension and visceral obesity were a subject of intensive study. The prospective analysis group consisted of 30 patients with an individualized management plan each, whereas the retrospective group of real clinical practice included 60 participants. At baseline, all patients were taking antihypertensives like ACE inhibitors or angiotensin II receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors, calcium channel blockers (CCBs), and a diuretic. After the initial examination, therapy was individually optimized for each patient in accordance with current clinical guidelines. Most patients in the retrospective group received ARBs valsartan or losartan, CCBs amlodipine, the diuretics indapamide and torasemide, the -blockers bisoprolol and metoprolol, the 2-agonist moxonidine, and the mineralocorticoid receptor antagonist spironolactone. Patients in the prospective group were prescribed ARBs telmisartan and azilsartan, the CCB lercanidipine, thiazide and thiazide-like diuretics indapamide and chlorthalidone, the -blockers nebivolol and carvedilol, the 1-blocker doxazosin, and spironolactone. A re-examination was performed 2 months later. Subsequently, regular communication was maintained with participants of the prospective group during 8 months using a messenger. Communication with patients of the retrospective group was not maintained. All the patients were then asked to self-report their health status by conducting a telephone survey.
Results. After 2 months, according to the data of the follow-up, in the retrospective group the target values of mean daily SBP and DBP were observed in 35 and 36.7% of patients, though the statistics among the patients in the prospective group were 66.7 and 60%, respectively. After 10 months, according to the results of the interviews, the target values of SBP and DBP were observed in 10 and 18.3% of patients, though the statistics among the patients in the prospective group were 93.3 and 96.7%, respectively. In the retrospective group, 78.3% of patients changed the previously selected therapy, in the prospective group this figure was only 20%. In the retrospective group, anthropometric data did not change, while in the prospective group, weight and waist circumference significantly decreased (p0.05).
Conclusion. Maintaining regular contact with patients and a well-rounded treatment strategy with individualized choice and dosage of medications with an emphasis on modern metabolically neutral drugs with a prolonged duration of action led to better BP control, increased adherence to therapy and indicated significant weight loss among the patients from the prospective group.
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Gordeev IA, Posnenkova OM, Kiselev AR, Gridnev VI, Bogdanova TM. Сontribution of the department of propaedeutics of internal diseases at Saratov State Medical University to practical healthcare: a historical perspective. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The objective of the study was to analyze the contribution of the Department of Propaedeutics of Internal Diseases at Saratov State Medical University to practical healthcare, depending on the historical context of its work. Articles contained in the eLibrary and CyberLeninka databases, as well as data from open Internet sources about the history of the department, were analyzed. The obtained data are compared with the historical events of the corresponding period. It was shown that mutually beneficial cooperation between the clinic, the department and the research institute seem to be a reliable and economical form of introducing new medical care technologies into practical healthcare.
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Affiliation(s)
| | | | - A. R. Kiselev
- Saratov State Medical University; National Medical Research Center for Therapy and Preventive Medicine
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Bavishi A, Patel RB. Addressing Comorbidities in Heart Failure: Hypertension, Atrial Fibrillation, and Diabetes. Heart Fail Clin 2020; 16:441-456. [PMID: 32888639 DOI: 10.1016/j.hfc.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Heart failure (HF) is a growing global epidemic and an increasingly cumbersome burden on health care systems worldwide. As such, optimal management of existing comorbidities in the setting of HF is particularly important to prevent disease progression, reduce HF hospitalizations, and improve quality of life. In this review, the authors address 3 key comorbidities commonly associated with HF: hypertension, atrial fibrillation, and diabetes mellitus. They comprehensively describe the epidemiology, management, and emerging therapies in these 3 disease states as they relate to the overall HF syndrome.
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Affiliation(s)
- Aakash Bavishi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ravi B Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 600, Chicago, IL 60611, USA.
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Indraratna P, Tardo D, Yu J, Delbaere K, Brodie M, Lovell N, Ooi SY. Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e16695. [PMID: 32628615 PMCID: PMC7381017 DOI: 10.2196/16695] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/30/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022] Open
Abstract
Background Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. Objective A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. Methods Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. Results A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8% vs 287/803, 35.7%; n=1595; OR 0.77, 95% CI 0.62 to 0.97; P=.03; I2=0%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95% CI −7.8 to −0.78 mm Hg; n=2023; P=.02). Conclusions The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD.
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Affiliation(s)
- Praveen Indraratna
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Daniel Tardo
- Department of Medicine, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, The University of Notre Dame, Sydney, Australia
| | - Jennifer Yu
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Matthew Brodie
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.,Graduate School of Biomedical Engineering, The University of New South Wales, Sydney, Australia
| | - Nigel Lovell
- Graduate School of Biomedical Engineering, The University of New South Wales, Sydney, Australia
| | - Sze-Yuan Ooi
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
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Meurer WJ, Dinh M, Kidwell KM, Flood A, Champoux E, Whitfield C, Trimble D, Cowdery J, Borgialli D, Montas S, Cunningham R, Buis LR, Brown D, Skolarus L. Reach out behavioral intervention for hypertension initiated in the emergency department connecting multiple health systems: study protocol for a randomized control trial. Trials 2020; 21:456. [PMID: 32493502 PMCID: PMC7268693 DOI: 10.1186/s13063-020-04340-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Hypertension is the most important modifiable risk factor for cardiovascular disease, the leading cause of mortality in the United States. The Emergency Department represents an underutilized opportunity to impact difficult-to-reach populations. There are 136 million visits to the Emergency Department each year and nearly all have at least one blood pressure measured and recorded. Additionally, an increasing number of African Americans and socioeconomically disadvantaged patients are overrepresented in the Emergency Department patient population. In the age of electronic health records and mobile health, the Emergency Department has the potential to become an integral partner in chronic disease management. The electronic health records in conjunction with mobile health behavior interventions can be leveraged to identify hypertensive patients to impact otherwise unreached populations. Methods Reach Out is a factorial trial studying multicomponent, behavioral interventions to reduce blood pressure in the Emergency Department patient population. Potential participants are identified by automated alerts from the electronic health record and, following consent, receive a blood pressure cuff to take home. During the initial screening phase, they are prompted to submit weekly blood pressure readings. Responders with persistent hypertension are then randomized into one of three component arms, consisting of varying intensity levels: (1) healthy behavior text messaging (daily vs. none), (2) blood pressure self-monitoring (daily vs. weekly), and (3) facilitated primary care provider appointment scheduling and transportation (yes vs. no). If participants are randomized to receive facilitated primary care provider appointment scheduling and are not established with a primary care provider, care will be established at a local Federally Qualified Health Center. Participants are followed for 12 months. Discussion The Reach Out study is designed to determine which behavioral intervention components or ‘dose’ of components contributes to a reduction in systolic blood pressure after 1 year (Aim 1). The study will also assess the effect of primary care provider appointment assistance on total primary care follow-up visits of hypertensive patients treated in an urban, safety net Emergency Department (Aim 2). Ideally, the Reach Out system will contribute to hypertension management, serving as a model for safety net hospitals and Federally Qualified Health Centers to improve chronic disease management in underserved communities. Trial registration This study was registered at clinicaltrials.gov, identifier NCT03422718. The record was first available to the public on January 30, 2018 prior to the enrollment of patients on March 25, 2019.
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Affiliation(s)
- William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA. .,Department of Neurology, University of Michigan, Ann Arbor, MI, USA. .,Stroke Program, University of Michigan, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. .,Michigan Institute for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, MI, USA.
| | - Mackenzie Dinh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Adam Flood
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily Champoux
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Candace Whitfield
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Deborah Trimble
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joan Cowdery
- School of Health Promotion and Human Performance, Eastern Michigan University, Ypsilanti, MI, USA
| | - Dominic Borgialli
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, Hurley Medical Center, Flint, MI, USA
| | - Sacha Montas
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lorraine R Buis
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Devin Brown
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Stroke Program, University of Michigan, Ann Arbor, MI, USA
| | - Lesli Skolarus
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Stroke Program, University of Michigan, Ann Arbor, MI, USA
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7
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Tahkola A, Korhonen P, Kautiainen H, Niiranen T, Mäntyselkä P. Personalized text message and checklist support for initiation of antihypertensive medication: the cluster randomized, controlled check and support trial. Scand J Prim Health Care 2020; 38:201-209. [PMID: 32362175 PMCID: PMC8570747 DOI: 10.1080/02813432.2020.1753380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To assess whether the use of a checklist combined with text message support improves systolic blood pressure (SBP) control.Design and setting: A cluster randomized controlled trial in Finnish primary care.Interventions: Personalized text message support and a checklist for initiation of antihypertensive medication.Patients: 111 newly diagnosed hypertensive patients aged 30-75 years.Main outcome measures: The proportion of patients achieving 1) the office SBP target <140 mmHg or 2) the home SBP target <135 mmHg at 12 months.Results: 28% (n = 16) and 31% (n = 17) of patients in the intervention and control groups met the office SBP target, respectively (p = 0.51). The corresponding proportions were 36% (n = 18) and 42% (n = 21) for the home SBP target (p = 0.21). Office SBP decreased 23 mmHg (95% CI: 29-17) in the intervention group and 21 mmHg (95% CI: 27-15) in the control group (p = 0.61). Medication changes, number of antihypertensives at 12 months and health care utilization were similar in both study groups. Patients considered checklist and text message support useful and important.Conclusion: Only a small proportion of patients in the intervention and control groups reached their treatment target despite multiple health care contacts and medication changes. The study interventions did not improve SBP control. However, this study demonstrates new information about hypertension control, antihypertensive medication and health service utilization during the first treatment year.
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Affiliation(s)
- Aapo Tahkola
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland;
- Health Centre of Jyväskylä Cooperation Area, Jyväskylä, Finland;
- CONTACT Aapo Tahkola Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | | | - Teemu Niiranen
- National Institute for Health and Welfare, Helsinki, Finland;
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland;
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
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van Olmen J, Erwin E, García-Ulloa AC, Meessen B, Miranda JJ, Bobrow K, Iwelunmore J, Nwaozuru U, Obiezu Umeh C, Smith C, Harding C, Kumar P, Gonzales C, Hernández-Jiménez S, Yeates K. Implementation barriers for mHealth for non-communicable diseases management in low and middle income countries: a scoping review and field-based views from implementers. Wellcome Open Res 2020; 5:7. [PMID: 32399497 PMCID: PMC7194478 DOI: 10.12688/wellcomeopenres.15581.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Mobile health (mHealth) has been hailed as a potential gamechanger for non-communicable disease (NCD) management, especially in low- and middle-income countries (LMIC). Individual studies illustrate barriers to implementation and scale-up, but an overview of implementation issues for NCD mHealth interventions in LMIC is lacking. This paper explores implementation issues from two perspectives: information in published papers and field-based knowledge by people working in this field. Methods: Through a scoping review publications on mHealth interventions for NCDs in LMIC were identified and assessed with the WHO mHealth Evidence Reporting and Assessment (mERA) tool. A two-stage web-based survey on implementation barriers was performed within a NCD research network and through two online platforms on mHealth targeting researchers and implementors. Results: 16 studies were included in the scoping review. Short Message Service (SMS) messaging was the main implementation tool. Most studies focused on patient-centered outcomes. Most studies did not report on process measures and on contextual conditions influencing implementation decisions. Few publications reported on implementation barriers. The websurvey included twelve projects and the responses revealed additional information, especially on practical barriers related to the patients' characteristics, low demand, technical requirements, integration with health services and with the wider context. Many interventions used low-cost software and devices with limited capacity that not allowed linkage with routine data or patient records, which incurred fragmented delivery and increased workload. Conclusion: Text messaging is a dominant mHealth tool for patient-directed of quality improvement interventions in LMIC. Publications report little on implementation barriers, while a questionnaire among implementors reveals significant barriers and strategies to address them. This information is relevant for decisions on scale-up of mHealth in the domain of NCD. Further knowledge should be gathered on implementation issues, and the conditions that allow universal coverage.
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Affiliation(s)
- Josefien van Olmen
- Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, 1000, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, 1000, Belgium
| | - Erica Erwin
- Global Health Research Office, Queen’s University, Ontario, Canada
- Pamoja Tunaweza Research Center, Moshi, Tanzania
| | | | | | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kirsty Bobrow
- University of CapeTown, Capetown, South Africa
- Oxford University, Oxford, UK
| | - Juliet Iwelunmore
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | | | - Carter Smith
- Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | - Pratap Kumar
- Strathmore Business School, Institute of Healthcare Management, Nairobi, Kenya
| | - Clicerio Gonzales
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Karen Yeates
- College of Global Public Health, New York University, New York, USA
- Medicine, Queen's University, Ontario, Canada
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Ionov MV, Zhukova OV, Zvartau NE, Kurapeev DI, Yudina YS, Konradi AO. Assessment of the clinical efficacy of telemonitoring and distant counseling in patients with uncontrolled hypertension. TERAPEVT ARKH 2020; 92:49-55. [DOI: 10.26442/00403660.2020.01.000481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The aim of the study was to investigate the mathematical correlation of the clinical efficacy of blood pressure telemonitoring and distant counseling (BPTM) in patients in uncontrolled hypertension (HTN). Telehealth tools are widely used in HTN management. However clinical efficacy of such interventions assessed mainly in groups investigated without its populational and attributable impact. Materials and methods. The total of 240 patients were included, then randomized in 2:1 manner to BPTM group (n=160, median age 47 y.o.) and control group (n=80, median age 49 y.o). The user - friendly and secure telehealth software was provided with mobile application (patients) and desktop (doctors) platforms which allowed storage and analysis of self-BP monitoring data and remote consultations. A three - month surveillance was designed with mandatory baseline and final face - to - face visits with the assessment of office systolic BP (oSBP). Mathematical evaluation was based on target SBP rates achieved in comparator groups and included the absolute efficacies (AE), the attributable efficacy (AtE), the relative efficacy (RE) and the population attributable efficacy (PAtE). Results. BPTM group characterized by larger decrease in SBP level compared with controls (-16.8±2.9 mm Hg versus -7.9±3.9 mm Hg; p
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10
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Ionov МV, Zvartau NЕ, Emelyanov IV, Konradi AО. Telemonitoring and remote counseling in hypertensive patients. Looking for new ways to do old jobs. ACTA ACUST UNITED AC 2019. [DOI: 10.18705/1607-419x-2019-25-4-337-356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
XXI century emphasized humanity to embrace the digital era after a reality of Third and Fourth Industrial Revolutions, nowadays dictating new terms of social networking. It is expected that information and communication technologies integrated with value-based medicine will significantly impact healthcare delivery to tremendous number of patients with socially important noncommunicable diseases. Cardiovascular illnesses comprise the greatest part of such pathologies. Hypertension (HTN) being the most prevalent cardiovascular disease is also the key modifiable cardiovascular risk factor yet seems to be an attractive target for both value-based concept and telehealth interventions. Present review addresses up-to-date science on telehealth, sets out the main well-known, but yet unsolved challenges in management of HTN along with the new approaches involving telemedicine programs, digital health outlooks. The main barriers of telehealth implementation are also considered along with the possible solutions.
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Affiliation(s)
- М. V. Ionov
- Almazov National Medical Research Centre;
ITMO University
| | - N. Е. Zvartau
- Almazov National Medical Research Centre;
ITMO University
| | | | - A. О. Konradi
- Almazov National Medical Research Centre;
ITMO University
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11
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Allen ME, Irizarry T, Einhorn J, Kamarck TW, Suffoletto BP, Burke LE, Rollman BL, Muldoon MF. SMS-facilitated home blood pressure monitoring: A qualitative analysis of resultant health behavior change. PATIENT EDUCATION AND COUNSELING 2019; 102:2246-2253. [PMID: 31262674 PMCID: PMC6851464 DOI: 10.1016/j.pec.2019.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Hypertension is largely asymptomatic and, as a result, patients often fail to sufficiently engage in medication adherence and other health behaviors to control their blood pressure (BP). This study explores the mechanisms by which MyBP, an automated SMS-facilitated home blood pressure monitoring (HBPM) program, helps facilitate healthy behavior changes. METHODS A thematic analysis of transcribed audio-recordings from semi-structured post-intervention interviews (n = 40) was conducted. RESULTS Three primary themes were identified as contributing most to patients' decision to initiate a behavior change: 1) increased hypertension literacy attributed to educational videos presented at enrollment, 2) increased day-to-day salience of blood pressure levels as a result of consistent HBPM, and 3) use of BP readings as feedback, with high readings triggering motivations to make behavior changes. These themes and most accompanying sub-themes correspond to constructs in the Health Belief Model and Social Cognitive Theory. CONCLUSION Patient-centered HBPM interventions such asMyBP appear to promote improvements in hypertension self-management via several mechanisms consistent with recognized models of behavior change. PRACTICE IMPLICATIONS SMS-supported HBPM, paired with video-based education, may provide a simple and scalable way of encouraging health behavior adherence in hypertensive patients.
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Affiliation(s)
- Matthew E Allen
- University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Taya Irizarry
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
| | - Julian Einhorn
- Department of Psychology, University of Pittsburgh School of Arts and Sciences, Pittsburgh, PA, USA.
| | - Thomas W Kamarck
- Department of Psychology, University of Pittsburgh School of Arts and Sciences, Pittsburgh, PA, USA.
| | - Brian P Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Lora E Burke
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Bruce L Rollman
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Matthew F Muldoon
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Heart and Vascular Institute Hypertension Center, UPMC Health System, Pittsburgh, PA, USA.
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12
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Movahedi M, Khadivi R, Rouzbahani R, Tavakoli-Fard N. Effect of Training through Short Message Service on Compliance and Mean Blood Pressure of Hypertensive Patients. Int J Prev Med 2019; 10:200. [PMID: 31879549 PMCID: PMC6921284 DOI: 10.4103/ijpvm.ijpvm_507_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/25/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Hypertension has been one of the early mortality and morbidity in human societies. Training and consequently compliance increase will lead to improve treatment progress and disease control. The study aimed at the effect of training through short message service (SMS) on blood pressure mean and compliance scale in hypertensive patients. Hypertension control is essential to prevent early mortality. Methods: This study is a randomized controlled clinical, uni-center, single-blinded. The study was managed in a health-care center subordinated to Medical University of Isfahan, Iran, in 2017. Sampling was a convenient method therefore the researchers implemented it for 188 hypertensive patients who were allocated randomly into two groups: SMS group and control group. First, all patients filled the compliance questionnaire, and their blood pressure was measured. Afterward, the intervention group would be texting daily for 1 month containing a training text. During 1 and 2 months after intervention, all patients’ blood pressure will be measured, and then the questionnaire had been filled 2 months after intervention, again. Results: Systolic blood pressure mean decreased from 136.23 ± 15.91 to 121.70 ± 14.43 and diastolic blood pressure mean decreased from 91.95 ± 8.24 to 86.64 ± 7.86 in the intervention group according to analysis of variance through repeated measurement and is significantly different in comparison with control group (P < 0.001). Compliance scale increased from 72.95 ± 7.65 to 85.40 ± 5.62 based on dependent t-test which was significantly different with the control group (P < 0.001). Conclusions: SMS training would be an effective method to control hypertension.
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Affiliation(s)
- Marjan Movahedi
- Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Khadivi
- Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rouzbahani
- Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negah Tavakoli-Fard
- Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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The Efficacy of a Comprehensive Reminder System to Improve Health Behaviors and Blood Pressure Control in Hypertensive Ischemic Stroke Patients: A Randomized Controlled Trial. J Cardiovasc Nurs 2019; 33:509-517. [PMID: 29901484 DOI: 10.1097/jcn.0000000000000496] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The health behaviors of hypertensive stroke patients in China are not satisfactory. In this study, we tested the effect of a Health Belief Model Comprehensive Reminder System on health behaviors and blood pressure control in hypertensive ischemic stroke patients after occurrence and hospital discharge. METHODS A randomized, parallel-group, assessor-blinded experimental design yielded participation of 174 hospitalized hypertensive ischemic stroke patients. The intervention consisted of face-to-face and telephone health belief education, a patient calendar handbook, and weekly automated short-message services. Data were collected at baseline and 3 months after discharge. RESULTS Three months after discharge, the intervention group showed statistically, significantly better health behaviors for physical activity, nutrition, low-salt diet, and medication adherence. The intervention group also had statistically, significantly decreased systolic blood pressure and increased blood pressure control rate. Smoking and alcohol use behaviors were not affected. CONCLUSION At 3 months, use of the Comprehensive Reminder System based on the Health Belief Model, yielded improvement in most health behaviors and blood pressure control in hypertensive ischemic stroke patients. Continued implementation of this intervention protocol is warranted to determine the long-term effect. Smoking and alcohol use behaviors need to be targeted with a different intervention.
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Shariful Islam SM, Farmer AJ, Bobrow K, Maddison R, Whittaker R, Pfaeffli Dale LA, Lechner A, Lear S, Eapen Z, Niessen LW, Santo K, Stepien S, Redfern J, Rodgers A, Chow CK. Mobile phone text-messaging interventions aimed to prevent cardiovascular diseases (Text2PreventCVD): systematic review and individual patient data meta-analysis. Open Heart 2019; 6:e001017. [PMID: 31673381 PMCID: PMC6802999 DOI: 10.1136/openhrt-2019-001017] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/18/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
Background A variety of small mobile phone text-messaging interventions have indicated improvement in risk factors for cardiovascular disease (CVD). Yet the extent of this improvement and whether it impacts multiple risk factors together is uncertain. We aimed to conduct a systematic review and individual patient data (IPD) meta-analysis to investigate the effects of text-messaging interventions for CVD prevention. Methods Electronic databases were searched to identify trials investigating a text-messaging intervention focusing on CVD prevention with the potential to modify at least two CVD risk factors in adults. The main outcome was blood pressure (BP). We conducted standard and IPD meta-analysis on pooled data. We accounted for clustering of patients within studies and the primary analysis used random-effects models. Sensitivity and subgroup analyses were performed. Results Nine trials were included in the systematic review involving 3779 participants and 5 (n=2612) contributed data to the IPD meta-analysis. Standard meta-analysis showed that the weighted mean differences are as follows: systolic blood pressure (SBP), -4.13 mm Hg (95% CI -11.07 to 2.81, p<0.0001); diastolic blood pressure (DBP), -1.11 mm Hg (-1.91 to -0.31, p=0.002); and body mass index (BMI), -0.32 (-0.49 to -0.16, p=0.000). In the IPD meta-analysis, the mean difference are as follows: SBP, -1.3 mm Hg (-5.4 to 2.7, p=0.5236); DBP, -0.8 mm Hg (-2.5 to 1.0, p=0.3912); and BMI, -0.2 (-0.8 to 0.4, p=0.5200) in the random-effects model. The impact on other risk factors is described, but there were insufficient data to conduct meta-analyses. Conclusion Mobile phone text-messaging interventions have modest impacts on BP and BMI. Simultaneous but small impacts on multiple risk factors are likely to be clinically relevant and improve outcome, but there are currently insufficient data in pooled analyses to examine the extent to which simultaneous reduction in multiple risk factors occurs. PROSPERO registration number CRD42016033236.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
| | - Kirsten Bobrow
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Robyn Whittaker
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | | | - Andreas Lechner
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximillian Universität, Munich, Germany
| | - Scott Lear
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Zubin Eapen
- Department of Medicine, Duke University, Durham, North California, United States
| | - Louis Wilhelmus Niessen
- Faculty of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Karla Santo
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandrine Stepien
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Julie Redfern
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Rodgers
- Professorial Unit, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Clara K Chow
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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15
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Zahr RS, Anthony CA, Polgreen PM, Simmering JE, Goerdt CJ, Hoth AB, Miller ML, Suneja M, Segre AM, Carter BL, Cavanaugh JE, Polgreen LA. A texting-based blood pressure surveillance intervention. J Clin Hypertens (Greenwich) 2019; 21:1463-1470. [PMID: 31503408 DOI: 10.1111/jch.13674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/29/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023]
Abstract
The authors examined whether using home BP measurements collected via a custom-built bi-directional-texting platform incorporated into patients' electronic medical records would lead to treatment calibration and improved BP management. Patients were randomized to either the intervention group and collected home measurements based on reminders and reported via bi-directional texting, or to the control group, with home BP measurement reporting via standard practice (eg, phone, electronic medical record portal) and instructed to return 7 morning and 7 evening BP measurements. Outcomes included number of BP measurements submitted, the number of medication changes, reduction in BP, and BP control. 72% of the intervention group submitted at least 14 readings, compared with 45% of the control group. BP control improved in both groups. However, the authors found no statistically significant difference in BP or the number of BP-medication changes at 1, 3, or 6 months compared with the control group.
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Affiliation(s)
- Roula S Zahr
- Department of Internal Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Chris A Anthony
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Jacob E Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Angela B Hoth
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Michelle L Miller
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Manish Suneja
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Alberto M Segre
- Department of Computer Science, University of Iowa, Iowa City, IA, USA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA.,Department of Family Practice, University of Iowa, Iowa City, IA, USA
| | | | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA
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16
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Dounavi K, Tsoumani O. Mobile Health Applications in Weight Management: A Systematic Literature Review. Am J Prev Med 2019; 56:894-903. [PMID: 31003801 DOI: 10.1016/j.amepre.2018.12.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 12/23/2022]
Abstract
CONTEXT Weight management is an effective strategy for controlling chronic disease and maintaining physical health, and research on this topic has risen dramatically over the past four decades. The present systematic literature review aimed to identify existing evidence on the efficacy of mobile health technology in facilitating weight management behaviors, such as healthy food consumption and physical activity. EVIDENCE ACQUISITION A systematic search was conducted in Ovid MEDLINE and Ovid PsycINFO databases with the aim to identify studies published in peer-reviewed journal articles between 2012 and 2017. EVIDENCE SYNTHESIS A total of 39 studies were analyzed in spring 2018 and are presented here in terms of participant characteristics, effective technology components, additional treatments, impact on health-related behaviors, and treatment efficacy. Indicators of study quality and social validity are also provided. CONCLUSIONS Mobile health apps are widely considered as satisfactory, easy to use, and helpful in the pursuit of weight loss goals by patients. The potential of mobile health apps in facilitating weight loss lies in their ability to increase treatment adherence through strategies such as self-monitoring. These findings indicate that satisfactory treatment adherence and consequent weight loss and maintenance are achieved in the presence of high levels of engagement with a mobile health app. The research quality assessment of RCTs reveals a great need for following international standards both when conducting and reporting research.
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Affiliation(s)
- Katerina Dounavi
- School of Social Sciences, Education and Social Work, Queen's University of Belfast, Belfast, Northern Ireland.
| | - Olga Tsoumani
- Imec-SMIT, Vrije Universiteit Brussel, Brussels, Belgium
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17
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Ricci-Cabello I, Bobrow K, Islam SMS, Chow CK, Maddison R, Whittaker R, Farmer AJ. Examining Development Processes for Text Messaging Interventions to Prevent Cardiovascular Disease: Systematic Literature Review. JMIR Mhealth Uhealth 2019; 7:e12191. [PMID: 30924790 PMCID: PMC6460311 DOI: 10.2196/12191] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/27/2018] [Accepted: 01/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background Interventions delivered by mobile phones have the potential to prevent cardiovascular disease (CVD) by supporting behavior change toward healthier lifestyles and treatment adherence. To allow replication and adaptation of these interventions across settings, it is important to fully understand how they have been developed. However, the development processes of these interventions have not previously been systematically examined. Objective This study aimed to systematically describe and compare the development process of text messaging interventions identified in the Text2PreventCVD systematic review. Methods We extracted data about the development process of the 9 interventions identified in the Text2PreventCVD systematic review. Data extraction, which was guided by frameworks for the development of complex interventions, considered the following development stages: intervention planning, design, development, and pretesting. Following data extraction, we invited the developers of the interventions to contribute to our study by reviewing the accuracy of the extracted data and providing additional data not reported in the available publications. Results A comprehensive description of the development process was available for 5 interventions. Multiple methodologies were used for the development of each intervention. Intervention planning involved gathering information from stakeholder consultations, literature reviews, examination of relevant theory, and preliminary qualitative research. Intervention design involved the use of behavior change theories and behavior change techniques. Intervention development involved (1) generating message content based on clinical guidelines and expert opinions; (2) conducting literature reviews and primary qualitative research to inform decisions about message frequency, timing, and level of tailoring; and (3) gathering end-user feedback concerning message readability, intervention acceptability, and perceived utility. Intervention pretesting involved pilot studies with samples of 10 to 30 participants receiving messages for a period ranging from 1 to 4 weeks. Conclusions The development process of the text messaging interventions examined was complex and comprehensive, involving multiple studies to guide decisions about the scope, content, and structure of the interventions. Additional research is needed to establish whether effective messaging systems can be adapted from work already done or whether this level of development is needed for application in other conditions and settings.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Balearic Islands Health Research Institute, Palma de Mallorca, Spain.,Atención Primaria Mallorca, IB-Salut, Palma de Mallorca, Spain.,Ciber de Epidemiologia y Salud Publica, Madrid, Spain
| | - Kirsten Bobrow
- Chronic Disease Initiative for Africa, Cape Town, South Africa.,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Radcliffe Observatory Quarter, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Andrew J Farmer
- Radcliffe Observatory Quarter, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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18
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Skrabal Ross X, Gunn KM, Patterson P, Olver I. Mobile-Based Oral Chemotherapy Adherence-Enhancing Interventions: Scoping Review. JMIR Mhealth Uhealth 2018; 6:e11724. [PMID: 30578182 PMCID: PMC6320412 DOI: 10.2196/11724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background Adherence to oral chemotherapy is crucial to maximize treatment outcomes and avoid health complications in cancer patients. Mobile phones are widely available worldwide, and evidence that this technology can be successfully employed to increase medication adherence for the treatment of other chronic diseases (eg, diabetes) is well established. However, the extent to which there is evidence that mobile phone–based interventions improve adherence to oral chemotherapy is unknown. Objective This scoping review aims to explore what is known about mobile phone–delivered interventions designed to enhance adherence to oral chemotherapy, to examine the reported findings on the utility of these interventions in increasing oral chemotherapy adherence, and to identify opportunities for development of future interventions. Methods This study followed Arksey and O’Malley’s scoping review methodological framework. Results The review search yielded 5 studies reporting on 4 interventions with adults (aged >18 years) diagnosed with diverse cancer types. All interventions were considered acceptable, useful, and feasible. The following themes were evident: text messages and mobile apps were the main methods of delivering these interventions, the 2 most commonly employed oral chemotherapy adherence–enhancing strategies were management and reporting of drug-related symptoms and reminders to take medication, the importance of stakeholders’ engagement in intervention design, and the overall positive perceptions of delivery features. Areas for future research identified by this review include the need for further studies to evaluate the impact of mobile phone–delivered interventions on adherence to oral chemotherapy as well as the relevance for future studies to incorporate design frameworks and economic evaluations and to explore the moderator effect of high anxiety, poor baseline adherence, and longer time taking prescribed drug on adherence to oral chemotherapy. Conclusions Despite the increasing body of evidence on the use of mobile phones to deliver medication adherence–enhancing interventions in chronic diseases, literature on the oral chemotherapy context is lacking. This review showed that existing interventions are highly acceptable and useful to cancer patients. The engagement of stakeholders as well as the use of a design framework are important elements in the development of mobile phone–delivered interventions that can be translated into oncology settings.
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Affiliation(s)
- Xiomara Skrabal Ross
- Cancer Research Institute, University of South Australia, Adelaide, Australia.,School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate M Gunn
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Pandora Patterson
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia.,Research, Evaluation, and Social Policy Team, CanTeen Australia, Sydney, Australia
| | - Ian Olver
- Cancer Research Institute, University of South Australia, Adelaide, Australia
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Saleh S, Farah A, Dimassi H, El Arnaout N, Constantin J, Osman M, El Morr C, Alameddine M. Using Mobile Health to Enhance Outcomes of Noncommunicable Diseases Care in Rural Settings and Refugee Camps: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e137. [PMID: 30006326 PMCID: PMC6064041 DOI: 10.2196/mhealth.8146] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/23/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Rural areas and refugee camps are characterized by poor access of patients to needed noncommunicable disease (NCD)-related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions, such as mobile health (mHealth), may help improve NCDs prevention and control among disadvantaged populations. OBJECTIVE The aim of this study was to assess the effect of employing low-cost mHealth tools on the accessibility to health services and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon. METHODS This is a randomized controlled trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators examined in both control and intervention groups. Sixteen primary health care centers (eight controls, eight interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients-1433 in the intervention group and 926 in the control group-was extracted from patient files in the pre and postintervention periods. The intervention entailed weekly short message service messages, including medical information, importance of compliance, and reminders of appointments or regular physician follow-up. Internationally established care indicators were utilized in this study. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic and linear regression were conducted using SPSS (IBM Corp). RESULTS Bivariate analysis of quality indicators indicated that the intervention group had a significant increase in blood pressure control (P=.03), as well as a significant decrease in the mean systolic blood pressure (P=.02), mean glycated hemoglobin (HbA1c; P<.01), and in the proportion of HbA1c poor control (P=.02). Separate regression models controlling for age, gender, and setting showed a 28% increase in the odds of blood pressure control (P=.05) and a 38% decrease in the odds of HbA1c poor control (P=.04) among the intervention group in the posttest period. Females were at lower odds of HbA1c poor control (P=.01), and age was statistically associated with annual HbA1c testing (P<.01). Regression models for mean systolic blood pressure, mean diastolic blood pressure, and mean HbA1c showed that a mean decrease in HbA1c of 0.87% (P<.01) pretest to posttest period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA1c score as compared with those in refugee camps (P<.01). CONCLUSIONS This study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (ie, rural and refugee camps settings) are coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care that can be reflected by improved NCD-related health indicators among the population. TRIAL REGISTRATION ClinicalTrials.gov NCT03580330; https://clinicaltrials.gov/ct2/show/NCT03580330 (Archived by WebCite at http://www.webcitation.org/70mhVEUwQ).
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Affiliation(s)
- Shadi Saleh
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Angie Farah
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Joanne Constantin
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mona Osman
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Christo El Morr
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Mohamad Alameddine
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Health Management and Policy, College of Medicine, Mohammed bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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20
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Lakshminarayan K, Westberg S, Northuis C, Fuller CC, Ikramuddin F, Ezzeddine M, Scherber J, Speedie S. A mHealth-based care model for improving hypertension control in stroke survivors: Pilot RCT. Contemp Clin Trials 2018; 70:24-34. [PMID: 29763657 PMCID: PMC6317360 DOI: 10.1016/j.cct.2018.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Hypertension (HTN) is significantly under-treated in stroke survivors. We examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control (Funding: AHRQ R21HS021794). METHODS We used a RCT design. Planned study duration was 90 days. Intervention arm (IA) participants measured their BP daily using a smart phone and wireless BP monitor. This was transmitted automatically to the study database. Investigators (Physician + PharmD) made bi-weekly medication adjustments to achieve the BP goal. Control arm (CA) participants received a digital BP monitor and usual care. We examined Usability (measured with Marshfield System Usability Survey) and HTN control efficacy using an ITT (intent-to-treat) and as-treated (AT) analyses. RESULTS Fifty participants (IA = 28; CA = 22) completed the study. The Marshfield survey question, "I thought the system was easy to use" mean score was 4.6, (5 = strongly agree). Mean SBP declined significantly between enrollment and study completion in the IA. In ITT, IA SBP declined 9.88 mm, p = 0.005. In AT, IA SBP declined 10.81 mm, p = 0.0036. CA SBP decline was 5-6 mm Hg (not significant). In the ITT, baseline HTN control (SBP < 140 mm Hg) was 50% in IA and CA. At study completion, HTN was controlled in 82% (23/28) of IA and 64% (14/22) of CA (p = 0.14). In the AT, HTN was controlled in 89% (23/26) of IA and 58% (14/24) of CA, (p = 0.015). CONCLUSION A mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors. CLINICAL TRIAL gov: NCT01875094.
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Affiliation(s)
- Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, University of Minnesota, School of Public Health, United States.
| | - Sarah Westberg
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, College of Pharmacy, United States
| | - Carin Northuis
- Division of Epidemiology & Community Health, University of Minnesota, School of Public Health, United States
| | - Candace C Fuller
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, United States
| | - Farah Ikramuddin
- Department of Rehabilitation Medicine, University of Minnesota, United States
| | | | - Julie Scherber
- Department of Medicine, University of Minnesota, United States
| | - Stuart Speedie
- Institute for Health Informatics, University of Minnesota, United States
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21
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Mobile phone text messaging for improving secondary prevention in cardiovascular diseases: A systematic review. Heart Lung 2018; 47:351-359. [PMID: 29803297 DOI: 10.1016/j.hrtlng.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 05/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to identify, retrieve, critically appraise and synthesize information regarding existing mobile phone text messaging interventions that have been done for secondary prevention of cardiovascular disease (CVD). METHODS A systematic review was conducted. The searching was conducted by using the MEDLINE, EMBASE, PsychINFO, CINAHL, PubMed and ScienceDirect databases. Nine randomized controlled trials (RCTs) were eligible and included. RESULTS The preventive factors measured among studies varied. While the majority of studies examined medication adherence as a main outcome (4), the other 3 studies focused on CVD risk factors combining blood pressure (BP), smoking, body mass index (BMI), physical activity and dietary habits, only 2 studies examined both medication adherence and risk factor modification of CVD. CONCLUSION Even though mobile phone text messaging may be beneficial for the secondary prevention of CVD, reliable conclusions on the effects of text messaging cannot be drawn.
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22
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Vargas G, Cajita MI, Whitehouse E, Han HR. Use of Short Messaging Service for Hypertension Management: A Systematic Review. J Cardiovasc Nurs 2018; 32:260-270. [PMID: 27111819 PMCID: PMC5085898 DOI: 10.1097/jcn.0000000000000336] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mobile phone Short Message Service (SMS) is a tool now used by the health research community, providing the capability for instant communication between patients and health professionals. Greater understanding of how to best use SMS as a means to improve healthcare delivery and outcomes will foster innovation in research and provide an opportunity to progress as a public health community. PURPOSE The purposes of this systematic review are 2-fold: (1) to provide insight on the most used mobile phone SMS practices and characteristics in hypertension (HTN) outcome-focused publications and (2) to critically evaluate empirical evidence associated with SMS utilization and BP outcomes. METHODS Two independent systematic literature searches were completed. The final selected studies each then underwent data extraction and quality-rating assessment, followed by an evaluation for a meta-analysis to measure mean difference of the change in BP. RESULTS A total of 6 studies meeting the inclusion criteria were included in the review. Feasibility assessment for a meta-analysis was found unfavorable because of the variation among studies. Short Message Service interventions focused on BP management were most effective in studies featuring 2-way communication and individual patient-tailored content, and guided by evidence-based HTN management practices. IMPLICATIONS Short Message Service interventions for HTN management were supported through evidence provided by the studies reviewed. Short Message Service holds strong potential to bring greater innovation to HTN management and care, especially in racial/ethnic minority populations that face psychosocial and structural barriers in healthcare access and utilization.
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Affiliation(s)
- Grecia Vargas
- The Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 N. Wolfe St., Baltimore, MD
| | - Maan Isabella Cajita
- The Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 N. Wolfe St., Baltimore, MD
| | - Erin Whitehouse
- The Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 N. Wolfe St., Baltimore, MD
| | - Hae-Ra Han
- The Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 N. Wolfe St., Baltimore, MD
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Abstract
PURPOSE OF REVIEW Many cases of CVD may be avoidable through lowering behavioural risk factors such as smoking and physical inactivity. Mobile health (mHealth) provides a novel opportunity to deliver cardiovascular prevention programs in a format that is potentially scalable. Here, we provide an overview of text messaging-based mHealth interventions in cardiovascular prevention. RECENT FINDINGS Text messaging-based interventions appear effective on a range of behavioural risk factors and can effect change on multiple risk factors-e.g. smoking, weight, blood pressure-simultaneously. For many texting studies, there are challenges in interpretation as many texting interventions are part of larger complex interventions making it difficult to determine the benefits of the separate components. Whilst there is evidence for text messaging improving cardiovascular risk factor levels in the short-term, future studies are needed to examine the durability of these effects and whether they can be translated to improvements in clinical care and outcomes.
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Affiliation(s)
- Harry Klimis
- University of Sydney, Sydney, NSW, Australia. .,Department of Cardiology, Westmead Hospital, PO Box 533, Wentworthville, NSW, Australia, 2145. .,The George Institute for Global Health, Sydney, NSW, Australia.
| | - Mohammad Ehsan Khan
- University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, PO Box 533, Wentworthville, NSW, Australia, 2145
| | - Cindy Kok
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Clara K Chow
- University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, PO Box 533, Wentworthville, NSW, Australia, 2145.,The George Institute for Global Health, Sydney, NSW, Australia
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Abaza H, Marschollek M. mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries. Methods Inf Med 2017; 56:e105-e122. [PMID: 28925418 PMCID: PMC6291822 DOI: 10.3414/me17-05-0003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/25/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the continuous and enormous spread of mobile technologies, mHealth has evolved as a new subfield of eHealth. While eHealth is broadly focused on information and communication technologies, mHealth seeks to explore more into mobile devices and wireless communication. Since mobile phone penetration has exceeded other infrastructure in low and middle-income countries (LMICs), mHealth is seen as a promising component to provide pervasive and patient-centered care. OBJECTIVES The aim of our research work for this paper is to examine the mHealth literature to identify application areas, target diseases, and mHealth service and technology types that are most appropriate for LMICs. METHODS Based on the 2011 WHO mHealth report, a combination of search terms, all including the word "mHealth", was identified. A literature review was conducted by searching the PubMed and IEEE Xplore databases. Articles were included if they were published in English, covered an mHealth solution/ intervention, involved the use of a mobile communication device, and included a pilot evaluation study. Articles were excluded if they did not provide sufficient detail on the solution covered or did not focus on clinical efficacy/effectiveness. Cross-referencing was also performed on included articles. RESULTS 842 articles were retrieved and analyzed, 255 of which met the inclusion criteria. North America had the highest number of applications (n=74) followed by Europe (n=50), Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America (n=3) had the least number of studies. The majority of solutions addressed diabetes (n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors (n=16), and maternal and child's health (MCH) (n=11). Fewer solutions addressed asthma (n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2). Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu, ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each). The remainder of solutions (n=14) did not focus on a certain disease. Most applications fell in the areas of health monitoring and surveillance (n=93) and health promotion and raising awareness (n=88). Fewer solutions addressed the areas of communication and reporting (n=11), data collection (n=6), telemedicine (n=5), emergency medical care (n=3), point of care support (n=2), and decision support (n=2). The majority of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video (n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering from small sample sizes and short study durations. Problems addressed by solutions included travel distance for reporting, self-management and disease monitoring, and treatment/medication adherence. CONCLUSIONS SMS and app solutions are the most common forms of mHealth applications. SMS solutions are prevalent in both high and LMICs while app solutions are mostly used in high income countries. Common application areas include health promotion and raising awareness using SMS and health monitoring and surveillance using mobile apps. Remaining application areas are rarely addressed. Diabetes is the most commonly targeted medical condition, yet remains deficient in LMICs.
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Affiliation(s)
- Haitham Abaza
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
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Mobile Health (mHealth) Technology for the Management of Hypertension and Hyperlipidemia: Slow Start but Loads of Potential. Curr Atheroscler Rep 2017; 19:12. [PMID: 28210974 DOI: 10.1007/s11883-017-0649-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Hypertension and hyperlipidemia represent two major risk factors for atherosclerotic cardiovascular disease. Mobile health or mHealth is defined as the use of mobile phone and wireless technologies to support the achievement of health objectives. Management of hypertension, and to some extent hyperlipidemia, has often employed mHealth interventions given lower cost and greater patient engagement compared to traditional methods. These interventions include the use of text messaging, wireless devices, and mobile phone applications. This review considers recent studies evaluating the effectiveness of mHealth interventions in the management of hypertension and hyperlipidemia. RECENT FINDINGS Numerous studies have evaluated the role of mHealth interventions in the management of hypertension, while very few have evaluated their role in hyperlipidemia. Text messaging has been used most frequently. However, the trend is shifting towards the use of mobile phone applications and wireless devices. Interventions in developing countries have been modified for greater applicability to local settings. mHealth interventions were found to be frequently effective. However, studies comparing the relative efficacy of various mHealth strategies are scarce. Long-term cardiovascular outcomes data and analyses relating to cost effectiveness are also lacking. mHealth interventions may be effective in improving hypertension management. More studies are needed to evaluate the role of mHealth strategies in hyperlipidemia management, particularly in identifying high-risk individuals and improving medication adherence. Studies assessing the long-term impact of these interventions, comparing different interventions and analyzing their relative cost effectiveness, are also needed. Following recently published guidelines on reporting results of mHealth interventions will provide a more meaningful context for interpreting these promising early studies.
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Gutiérrez Dubois J, León Rosique MJ, Duro V. m-Health en pacientes atendidos por Medicina Interna. Med Clin (Barc) 2017; 149:128-129. [DOI: 10.1016/j.medcli.2017.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
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Skolarus LE, Cowdery J, Dome M, Bailey S, Baek J, Byrd JB, Hartley SE, Valley SC, Saberi S, Wheeler NC, McDermott M, Hughes R, Shanmugasundaram K, Morgenstern LB, Brown DL. Reach Out Churches: A Community-Based Participatory Research Pilot Trial to Assess the Feasibility of a Mobile Health Technology Intervention to Reduce Blood Pressure Among African Americans. Health Promot Pract 2017; 19:495-505. [PMID: 28583024 DOI: 10.1177/1524839917710893] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Innovative strategies are needed to reduce the hypertension epidemic among African Americans. Reach Out was a faith-collaborative, mobile health, randomized, pilot intervention trial of four mobile health components to reduce high blood pressure (BP) compared to usual care. It was designed and tested within a community-based participatory research framework among African Americans recruited and randomized from churches in Flint, Michigan. The purpose of this pilot study was to assess the feasibility of the Reach Out processes. Feasibility was assessed by willingness to consent (acceptance of randomization), proportion of weeks participants texted their BP readings (intervention use), number lost to follow-up (retention), and responses to postintervention surveys and focus groups (acceptance of intervention). Of the 425 church members who underwent BP screening, 94 enrolled in the study and 73 (78%) completed the 6-month outcome assessment. Median age was 58 years, and 79% were women. Participants responded with their BPs on an average of 13.7 (SD = 10.7) weeks out of 26 weeks that the BP prompts were sent. All participants reported satisfaction with the intervention. Reach Out, a faith-collaborative, mobile health intervention was feasible. Further study of the efficacy of the intervention and additional mobile health strategies should be considered.
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Affiliation(s)
| | - Joan Cowdery
- 2 Eastern Michigan University, Ypsilanti, MI, USA
| | - Mackenzie Dome
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Jonggyu Baek
- 4 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Sarah E Hartley
- 1 University of Michigan Medical School, Ann Arbor, MI, USA.,5 Veterans' Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Staci C Valley
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sima Saberi
- 6 Ann Arbor Endocrinology & Diabetes Associates, Ypsilanti MI, USA
| | | | | | - Rebecca Hughes
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Devin L Brown
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
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28
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King E, Kinvig K, Steif J, Qiu AQ, Maan EJ, Albert AY, Pick N, Alimenti A, Kestler MH, Money DM, Lester RT, Murray MCM. Mobile Text Messaging to Improve Medication Adherence and Viral Load in a Vulnerable Canadian Population Living With Human Immunodeficiency Virus: A Repeated Measures Study. J Med Internet Res 2017; 19:e190. [PMID: 28572079 PMCID: PMC5472843 DOI: 10.2196/jmir.6631] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/02/2017] [Accepted: 04/11/2017] [Indexed: 02/05/2023] Open
Abstract
Background Combination antiretroviral therapy (cART) as treatment for human immunodeficiency virus (HIV) infection is effective and available, but poor medication adherence limits benefits, particularly in vulnerable populations. In a Kenyan randomized controlled trial, a weekly text-messaging intervention (WelTel) improved cART adherence and HIV viral load (VL). Despite growing evidence for short message service (SMS) text-message interventions in HIV care, there is a paucity of data utilizing these interventions in marginalized or female cohorts. Objective This study was undertaken to assess whether the standardized WelTel SMS text-message intervention applied to a vulnerable, predominantly female, population improved cART adherence and VL. Methods We conducted a repeated measures study of the WelTel intervention in high-risk HIV-positive persons by measuring change in VL, CD4 count, and self-reported adherence 12 months before and 12 months after the WelTel intervention was introduced. Inclusion criteria included VL ≥200 copies/mL, indication for treatment, and meeting vulnerability criteria. Participants were given a mobile phone with unlimited texting (where required), and weekly check-in text messages were sent for one year from the WelTel computer platform. Clinical data were collected for control and intervention years. Participants were followed by a multidisciplinary team in a clinical setting. Outcomes were assessed using Wilcoxon signed ranks tests for change in CD4 and VL from control year to study end and mixed-effects logistic regressions for change in cART adherence and appointment attendance. A secondary analysis was conducted to assess the effect of response rate on the outcome by modeling final log10 VL by number of responses while controlling for mean log10 VL in the control year. Results Eighty-five participants enrolled in the study, but 5 withdrew (final N=80). Participants were predominantly female (90%, 72/80) with a variety of vulnerabilities. Mean VL decreased from 1098 copies/mL in the control year to 439 copies/mL at study end (P=.004). Adherence to cART significantly improved (OR 1.14, IQR 1.10-1.18; P<.001), whereas appointment attendance decreased slightly with the intervention (OR 0.81, IQR 0.67-0.99; P=.03). A response was received for 46.57% (1753/3764) of messages sent and 9.62% (362/3764) of text messages sent were replied to with a problem. An outcome analysis examining relationship between reply rate and VL did not meet statistical significance (P=.07), but may be worthy of investigating further in a larger study. Conclusions WelTel may be an effective tool for improving cART adherence and reducing VLs among high-risk, vulnerable HIV-positive persons. Trial Registration Clinicaltrials.gov NCT02603536; https://clinicaltrials.gov/ct2/show/NCT02603536 (Archived by WebCite at http://www.webcitation.org/6qK57zCwv)
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Affiliation(s)
- Elizabeth King
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karen Kinvig
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Jonathan Steif
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada
| | - Annie Q Qiu
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Evelyn J Maan
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Arianne Yk Albert
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ariane Alimenti
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Mary H Kestler
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deborah M Money
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Richard T Lester
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Caroline Margaret Murray
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Kim BY, Lee J. Smart Devices for Older Adults Managing Chronic Disease: A Scoping Review. JMIR Mhealth Uhealth 2017; 5:e69. [PMID: 28536089 PMCID: PMC5461419 DOI: 10.2196/mhealth.7141] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/30/2017] [Accepted: 04/18/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The emergence of smartphones and tablets featuring vastly advancing functionalities (eg, sensors, computing power, interactivity) has transformed the way mHealth interventions support chronic disease management for older adults. Baby boomers have begun to widely adopt smart devices and have expressed their desire to incorporate technologies into their chronic care. Although smart devices are actively used in research, little is known about the extent, characteristics, and range of smart device-based interventions. OBJECTIVE We conducted a scoping review to (1) understand the nature, extent, and range of smart device-based research activities, (2) identify the limitations of the current research and knowledge gap, and (3) recommend future research directions. METHODS We used the Arksey and O'Malley framework to conduct a scoping review. We identified relevant studies from MEDLINE, Embase, CINAHL, and Web of Science databases using search terms related to mobile health, chronic disease, and older adults. Selected studies used smart devices, sampled older adults, and were published in 2010 or after. The exclusion criteria were sole reliance on text messaging (short message service, SMS) or interactive voice response, validation of an electronic version of a questionnaire, postoperative monitoring, and evaluation of usability. We reviewed references. We charted quantitative data and analyzed qualitative studies using thematic synthesis. To collate and summarize the data, we used the chronic care model. RESULTS A total of 51 articles met the eligibility criteria. Research activity increased steeply in 2014 (17/51, 33%) and preexperimental design predominated (16/50, 32%). Diabetes (16/46, 35%) and heart failure management (9/46, 20%) were most frequently studied. We identified diversity and heterogeneity in the collection of biometrics and patient-reported outcome measures within and between chronic diseases. Across studies, we found 8 self-management supporting strategies and 4 distinct communication channels for supporting the decision-making process. In particular, self-monitoring (38/40, 95%), automated feedback (15/40, 38%), and patient education (13/40, 38%) were commonly used as self-management support strategies. Of the 23 studies that implemented decision support strategies, clinical decision making was delegated to patients in 10 studies (43%). The impact on patient outcomes was consistent with studies that used cellular phones. Patients with heart failure and asthma reported improved quality of life. Qualitative analysis yielded 2 themes of facilitating technology adoption for older adults and 3 themes of barriers. CONCLUSIONS Limitations of current research included a lack of gerontological focus, dominance of preexperimental design, narrow research scope, inadequate support for participants, and insufficient evidence for clinical outcome. Recommendations for future research include generating evidence for smart device-based programs, using patient-generated data for advanced data mining techniques, validating patient decision support systems, and expanding mHealth practice through innovative technologies.
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Affiliation(s)
- Ben Yb Kim
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Joon Lee
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Zhang H, Jiang Y, Nguyen HD, Poo DCC, Wang W. The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial. Health Qual Life Outcomes 2017; 15:49. [PMID: 28288636 PMCID: PMC5348869 DOI: 10.1186/s12955-017-0623-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background Coronary heart disease (CHD) is the most prevalent type of cardiac disease among adults worldwide, including those in Singapore. Most of its risk factors, such as smoking, physical inactivity and high blood pressure, are preventable. mHealth has improved in the last decade, showing promising results in chronic disease prevention and health promotion worldwide. Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention (SBCHDP) programme in improving awareness and knowledge of CHD, perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore. Methods The smartphone app “Care4Heart” was developed as the main component of the programme. App content was reviewed and validated by a panel of experts, including two cardiologists and two experienced cardiology-trained nurses. A pilot randomised controlled trial was conducted. Eighty working people were recruited and randomised to either the intervention group (n = 40) or the control group (n = 40). The intervention group underwent a 4-week SBCHDP programme, whereas the control group were offered health promotion websites only. The participants’ CHD knowledge, perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Questionnaire-2, Perceived Stress Scale, and Behavioural Risk Factor Surveillance System. Results After the SBCHDP programme, participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore (X2
= 6.486, p = 0.039), a better overall CHD knowledge level (t = 3.171, p = 0.002), and better behaviour concerning blood cholesterol control (X2 = 4.54, p = 0.033) than participants in the control group. Conclusion This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population. Due to the small sample size and short follow-up period, this study was underpowered to detect significant differences between groups. A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0623-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD 11, Level 2, 10 Medical Drive, Singapore, 117597, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD 11, Level 2, 10 Medical Drive, Singapore, 117597, Singapore
| | - Hoang D Nguyen
- Department of Information Systems, Computing School, National University of Singapore, Singapore, Singapore
| | - Danny Chiang Choon Poo
- Department of Information Systems, Computing School, National University of Singapore, Singapore, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD 11, Level 2, 10 Medical Drive, Singapore, 117597, Singapore.
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Abstract
BACKGROUND The popularity of mobile phones and similar mobile devices makes it an ideal medium for delivering interventions. This is especially true with heart failure (HF) interventions, in which mHealth-based HF interventions are rapidly replacing their telephone-based predecessors. PURPOSE This systematic review examined the impact of mHealth-based HF management interventions on HF outcomes. The specific aims of the systematic review are to (1) describe current mHealth-based HF interventions and (2) discuss the impact of these interventions on HF outcomes. METHODS PubMed, CINAHL Plus, EMBASE, PsycINFO, and Scopus were systematically searched for randomized controlled trials or quasi-experimental studies that tested mHealth interventions in people with HF using the terms Heart Failure, Mobile Health, mHealth, Telemedicine, Text Messaging, Texting, Short Message Service, Mobile Applications, and Mobile Apps. CONCLUSIONS Ten articles, representing 9 studies, were included in this review. The majority of the studies utilized mobile health technology as part of an HF monitoring system, which typically included a blood pressure-measuring device, weighing scale, and an electrocardiogram recorder. The impact of the mHealth interventions on all-cause mortality, cardiovascular mortality, HF-related hospitalizations, length of stay, New York Heart Association functional class, left ventricular ejection fraction, quality of life, and self-care were inconsistent at best. IMPLICATIONS Further research is needed to conclusively determine the impact of mHealth interventions on HF outcomes. The limitations of the current studies (eg, inadequate sample size, quasi-experimental design, use of older mobile phone models, etc) should be taken into account when designing future studies.
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Sun N, Rau PLP, Li Y, Owen T, Thimbleby H. Design and evaluation of a mobile phone-based health intervention for patients with hypertensive condition. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Masterson Creber RM, Hickey KT, Maurer MS. Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management? CURRENT CARDIOVASCULAR RISK REPORTS 2016; 10. [PMID: 28713481 DOI: 10.1007/s12170-016-0511-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Older adults with heart failure have multiple chronic conditions and a large number and range of symptoms. A fundamental component of heart failure self-care management is regular symptom monitoring. Symptom monitoring can be facilitated by cost-effective, easily accessible technologies that are integrated into patients' lives. Technologies that are tailored to older adults by incorporating gerontological design principles are called gerontechnologies. Gerontechnology is an interdisciplinary academic and professional field that combines gerontology and technology with the goals of improving prevention, care, and enhancing the quality of life for older adults. The purpose of this article is to discuss the role of gerontechnologies, specifically the use of mobile applications available on smartphones and tablets as well as remote monitoring systems, for outpatient disease management among older adults with heart failure. While largely unproven, these rapidly developing technologies have great potential to improve outcomes among older persons.
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Affiliation(s)
| | - Kathleen T Hickey
- Columbia University, School of Nursing, New York, NY, USA.,Division of Cardiology, NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Mathew S Maurer
- Division of Cardiology, NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.,College of Physicians & Surgeons, Columbia University, New York, NY, USA
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Park LG, Beatty A, Stafford Z, Whooley MA. Mobile Phone Interventions for the Secondary Prevention of Cardiovascular Disease. Prog Cardiovasc Dis 2016; 58:639-50. [PMID: 27001245 PMCID: PMC4904827 DOI: 10.1016/j.pcad.2016.03.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 01/04/2023]
Abstract
Mobile health in the form of text messaging and mobile applications provides an innovative and effective approach to promote prevention and management of cardiovascular disease (CVD); however, the magnitude of these effects is unclear. Through a comprehensive search of databases from 2002-2016, we conducted a quantitative systematic review. The selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. A large majority of studies (22 of 28, 79%) demonstrated text messaging, mobile applications, and telemonitoring via mobile phones were effective in improving outcomes. Some key factors associated with successful interventions included personalized messages with tailored advice, greater engagement (2-way text messaging, higher frequency of messages), and use of multiple modalities. Overall, text messaging appears more effective than smartphone-based interventions. Incorporating principles of behavioral activation will help promote and sustain healthy lifestyle behaviors in patients with CVD that result in improved clinical outcomes.
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Affiliation(s)
- Linda G Park
- Department of Community Health Systems, University of California, San Francisco.
| | - Alexis Beatty
- Veterans Affairs Puget Sound Medical Center, Cardiology Section, Seattle, WA; University of Washington, Department of Medicine.
| | - Zoey Stafford
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA.
| | - Mary A Whooley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, Department of Medicine.
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Ershad Sarabi R, Sadoughi F, Jamshidi Orak R, Bahaadinbeigy K. The Effectiveness of Mobile Phone Text Messaging in Improving Medication Adherence for Patients with Chronic Diseases: A Systematic Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25183. [PMID: 27437126 PMCID: PMC4939231 DOI: 10.5812/ircmj.25183] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 12/08/2014] [Accepted: 12/15/2014] [Indexed: 12/15/2022]
Abstract
Context Medication non-adherence is a commonly observed problem in the self-administration of treatment, regardless of the disease type. Text messaging reminders, as electronic reminders, provide an opportunity to improve medication adherence. In this study, we aimed to provide evidence addressing the question of whether text message reminders were effective in improving patients’ adherence to medication. Evidence Acquisition We carried out a systematic literature search, using the five electronic bibliographic databases: PubMed, Embase, PsycINFO, CINAHL, and the Cochrane central register of controlled trials. Studies were included on the basis of whether they examined the benefits and effects of short-message service (SMS) interventions on medication adherence. Results The results of this systematic review indicated that text messaging interventions have improved patients’ medication adherence rate (85%, 29.34). Included in the review, those who had problems with adherence, or those whom text messaging was most helpful had HIV, asthma, diabetes, schizophrenia and heart disease (73.5%). The period of intervention varied from 1 week to 14 months. The most common study design was randomized controlled trials (RCTs) (66%) carried out in the developed countries. Conclusions This study demonstrated the potential of mobile phone text messaging for medication non-adherence problem solving.
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Affiliation(s)
- Roghayeh Ershad Sarabi
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Farahnaz Sadoughi
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Farahnaz Sadoughi, Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188794302, Fax: +98-2188883334, E-mail:
| | - Roohangiz Jamshidi Orak
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
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Sawesi S, Rashrash M, Phalakornkule K, Carpenter JS, Jones JF. The Impact of Information Technology on Patient Engagement and Health Behavior Change: A Systematic Review of the Literature. JMIR Med Inform 2016; 4:e1. [PMID: 26795082 PMCID: PMC4742621 DOI: 10.2196/medinform.4514] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/07/2015] [Accepted: 10/09/2015] [Indexed: 01/31/2023] Open
Abstract
Background Advancements in information technology (IT) and its increasingly ubiquitous nature expand the ability to engage patients in the health care process and motivate health behavior change. Objective Our aim was to systematically review the (1) impact of IT platforms used to promote patients’ engagement and to effect change in health behaviors and health outcomes, (2) behavior theories or models applied as bases for developing these interventions and their impact on health outcomes, (3) different ways of measuring health outcomes, (4) usability, feasibility, and acceptability of these technologies among patients, and (5) challenges and research directions for implementing IT platforms to meaningfully impact patient engagement and health outcomes. Methods PubMed, Web of Science, PsycINFO, and Google Scholar were searched for studies published from 2000 to December 2014. Two reviewers assessed the quality of the included papers, and potentially relevant studies were retrieved and assessed for eligibility based on predetermined inclusion criteria. Results A total of 170 articles met the inclusion criteria and were reviewed in detail. Overall, 88.8% (151/170) of studies showed positive impact on patient behavior and 82.9% (141/170) reported high levels of improvement in patient engagement. Only 47.1% (80/170) referenced specific behavior theories and only 33.5% (57/170) assessed the usability of IT platforms. The majority of studies used indirect ways to measure health outcomes (65.9%, 112/170). Conclusions In general, the review has shown that IT platforms can enhance patient engagement and improve health outcomes. Few studies addressed usability of these interventions, and the reason for not using specific behavior theories remains unclear. Further research is needed to clarify these important questions. In addition, an assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements; these measurements should include those related to motivation for health behavior change, long-standing adherence, expenditure, satisfaction, and health outcomes.
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Affiliation(s)
- Suhila Sawesi
- School of Informatics and Computing - Indianapolis, Department of BioHealth Informatics, IUPUI, Indianapolis, IN, United States.
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Burke LE, Ma J, Azar KMJ, Bennett GG, Peterson ED, Zheng Y, Riley W, Stephens J, Shah SH, Suffoletto B, Turan TN, Spring B, Steinberger J, Quinn CC. Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association. Circulation 2015; 132:1157-213. [PMID: 26271892 PMCID: PMC7313380 DOI: 10.1161/cir.0000000000000232] [Citation(s) in RCA: 370] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Posnenkova OM, Kiselev AR. Could the data of home blood pressure monitoring be used to evaluate the risk of subclinical target organ damage in hypertensive patients? Anatol J Cardiol 2015; 15:594-5. [PMID: 26139176 PMCID: PMC5337048 DOI: 10.5152/akd.2015.6275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Olga M Posnenkova
- Centre of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University; Saratov-Russia.
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Banchs JE, Scher DL. Emerging role of digital technology and remote monitoring in the care of cardiac patients. Med Clin North Am 2015; 99:877-96. [PMID: 26042888 DOI: 10.1016/j.mcna.2015.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Current available mobile health technologies make possible earlier diagnosis and long-term monitoring of patients with cardiovascular diseases. Remote monitoring of patients with implantable devices and chronic diseases has resulted in better outcomes reducing health care costs and hospital admissions. New care models, which shift point of care to the outpatient setting and the patient's home, necessitate innovations in technology.
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Affiliation(s)
- Javier E Banchs
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology and Pacing, 2401 South 31st Street, Temple, TX 76508, USA.
| | - David Lee Scher
- Department of Medicine, Division of Cardiology, Penn State Hershey Heart & Vascular Institute, 500 University Drive, H047, Hershey, PA 17033, USA
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Widmer RJ, Collins NM, Collins CS, West CP, Lerman LO, Lerman A. Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis. Mayo Clin Proc 2015; 90:469-80. [PMID: 25841251 PMCID: PMC4551455 DOI: 10.1016/j.mayocp.2014.12.026] [Citation(s) in RCA: 218] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the potential benefit of digital health interventions (DHIs) on cardiovascular disease (CVD) outcomes (CVD events, all-cause mortality, hospitalizations) and risk factors compared with non-DHIs. PATIENTS AND METHODS We conducted a systematic search of PubMed, MEDLINE, EMBASE, Web of Science, Ovid, CINHAL, ERIC, PsychINFO, Cochrane, and Cochrane Central Register of Controlled Trials for articles published from January 1, 1990, through January 21, 2014. Included studies examined any element of DHI (telemedicine, Web-based strategies, e-mail, mobile phones, mobile applications, text messaging, and monitoring sensors) and CVD outcomes or risk factors. Two reviewers independently evaluated study quality utilizing a modified version of the Cochrane Collaboration risk assessment tool. Authors extracted CVD outcomes and risk factors for CVD such as weight, body mass index, blood pressure, and lipid levels from 51 full-text articles that met validity and inclusion criteria. RESULTS Digital health interventions significantly reduced CVD outcomes (relative risk, 0.61; 95% CI, 0.46-0.80; P<.001; I(2)=22%). Concomitant reductions in weight (-2.77 lb [95% CI, -4.49 to -1.05 lb]; P<.002; I(2)=97%) and body mass index (-0.17 kg/m(2) [95% CI, -0.32 kg/m(2) to -0.01 kg/m(2)]; P=.03; I(2)=97%) but not blood pressure (-1.18 mm Hg [95% CI, -2.93 mm Hg to 0.57 mm Hg]; P=.19; I(2)=100%) were found in these DHI trials compared with usual care. In the 6 studies reporting Framingham risk score, 10-year risk percentages were also significantly improved (-1.24%; 95% CI, -1.73% to -0.76%; P<.001; I(2)=94%). Results were limited by heterogeneity not fully explained by study population (primary or secondary prevention) or DHI modality. CONCLUSION Overall, these aggregations of data provide evidence that DHIs can reduce CVD outcomes and have a positive impact on risk factors for CVD.
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Affiliation(s)
- R Jay Widmer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - C Scott Collins
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res 2015; 17:e52. [PMID: 25803266 PMCID: PMC4376208 DOI: 10.2196/jmir.3951] [Citation(s) in RCA: 638] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management. OBJECTIVE We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management ("mAdherence"), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers. METHODS We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users. RESULTS In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39%). CONCLUSIONS There is potential for mHealth tools to better facilitate adherence to chronic disease management, but the evidence supporting its current effectiveness is mixed. Further research should focus on understanding and improving how mHealth tools can overcome specific barriers to adherence.
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Affiliation(s)
- Saee Hamine
- University of Washington, Seattle, WA, United States
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Hallberg I, Taft C, Ranerup A, Bengtsson U, Hoffmann M, Höfer S, Kasperowski D, Mäkitalo A, Lundin M, Ring L, Rosenqvist U, Kjellgren K. Phases in development of an interactive mobile phone-based system to support self-management of hypertension. Integr Blood Press Control 2014; 7:19-28. [PMID: 24910510 PMCID: PMC4046514 DOI: 10.2147/ibpc.s59030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hypertension is a significant risk factor for heart disease and stroke worldwide. Effective treatment regimens exist; however, treatment adherence rates are poor (30%-50%). Improving self-management may be a way to increase adherence to treatment. The purpose of this paper is to describe the phases in the development and preliminary evaluation of an interactive mobile phone-based system aimed at supporting patients in self-managing their hypertension. A person-centered and participatory framework emphasizing patient involvement was used. An interdisciplinary group of researchers, patients with hypertension, and health care professionals who were specialized in hypertension care designed and developed a set of questions and motivational messages for use in an interactive mobile phone-based system. Guided by the US Food and Drug Administration framework for the development of patient-reported outcome measures, the development and evaluation process comprised three major development phases (1, defining; 2, adjusting; 3, confirming the conceptual framework and delivery system) and two evaluation and refinement phases (4, collecting, analyzing, interpreting data; 5, evaluating the self-management system in clinical practice). Evaluation of new mobile health systems in a structured manner is important to understand how various factors affect the development process from both a technical and human perspective. Forthcoming analyses will evaluate the effectiveness and utility of the mobile phone-based system in supporting the self-management of hypertension.
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Affiliation(s)
- Inger Hallberg
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Linköping, Sweden ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charles Taft
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Linköping, Sweden ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Ranerup
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Linköping, Sweden ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Bengtsson
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Linköping, Sweden ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Hoffmann
- The NEPI Foundation, Linköping, Sweden ; Department of Medical and Health Sciences, Linköping University, Linköping
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Asa Mäkitalo
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg
| | - Mona Lundin
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg
| | - Lena Ring
- Centre for Research Ethics and Bioethics, Uppsala University ; Department of Use of Medical Products, Medical Products Agency, Uppsala
| | - Ulf Rosenqvist
- Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala
| | - Karin Kjellgren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Linköping, Sweden ; Department of Medical and Health Sciences, Linköping University, Linköping ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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