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Su JJ, Liu JYW, Cheung DSK, Wang S, Christensen M, Kor PPK, Tyrovolas S, Leung AYM. Long-term effects of e-Health secondary prevention on cardiovascular health: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2023; 22:562-574. [PMID: 36695341 DOI: 10.1093/eurjcn/zvac116] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/06/2022] [Accepted: 12/08/2023] [Indexed: 01/26/2023]
Abstract
AIMS Despite the well-documented short-to-medium-term effectiveness of e-Health (electronic health) secondary prevention interventions on patients with cardiovascular disease (CVD), there is limited empirical evidence regarding long-term effectiveness. This review aims to evaluate the long-term effects of e-Health secondary prevention interventions on the health outcomes of patients with CVD. METHODS AND RESULTS This systematic review and meta-analysis followed Cochrane Handbook for Systematic Reviews of Interventions. EMBASE, Medline, Web of Science, and Scopus were searched from 1990 to May 2022. Randomized controlled trials investigating the effects of e-Health secondary prevention on health outcomes of CVD patients that collected endpoint data at ≥ 12 months were included. RevMan 5.3 was used for risk of bias assessment and meta-analysis. Ten trials with 1559 participants were included. Data pooling suggested that e-Health programmes have significantly reduced LDL cholesterol [n = 6; SMD = -0.26, 95% confidence interval (CI): (-0.38, -0.14), I2 = 17%, P < 0.001]; systolic blood pressure [n = 5; SMD = -0.46, 95% CI: (-0.84, -0.08), I2 = 90%, P = 0.02]; and re-hospitalization, reoccurrence, and mortality [risk ratio = 0.36, 95% CI: (0.17, 0.77), I2 = 0%, P = 0.009]. Effects on behavioural modification, physiological outcomes of body weight and blood glucose, and quality of life were inconclusive. CONCLUSION e-Health secondary prevention is effective in improving long-term management of risk factors and reducing the reoccurrence of cardiac events in patients with CVD. Results are inconclusive for behaviour modification and quality of life. Exploring, implementing, and strengthening strategies in e-Health secondary prevention programmes that focus on maintaining behaviour changes and enhancing psychosocial elements should be undertaken. REGISTRATION PROSPERO CRD42022300551.
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Affiliation(s)
- Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon 999077, Hong Kong
- World Health Organization for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR, China
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
| | - Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon 999077, Hong Kong
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR 999077, China
| | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon 999077, Hong Kong
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR 999077, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon 999077, Hong Kong
- World Health Organization for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR, China
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
| | - Martin Christensen
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon 999077, Hong Kong
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
| | - Patrick Pui Kin Kor
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon 999077, Hong Kong
- World Health Organization for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR, China
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
| | - Stefanos Tyrovolas
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon 999077, Hong Kong
- World Health Organization for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR, China
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain
| | - Angela Yee Man Leung
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon 999077, Hong Kong
- World Health Organization for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR, China
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR 999077, China
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Britton LE, Arcia A, Kaur G, Sontan O, Marshall CJ, George M. "A patient should not have to ask": Women's experiences of patient education about preconception care for type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2023; 112:107739. [PMID: 37094436 PMCID: PMC10399209 DOI: 10.1016/j.pec.2023.107739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To characterize perspectives and experiences regarding preconception care (PCC) patient education among women with type 2 diabetes. METHOD Descriptive, qualitative research design. Thirty-two English-speaking women with type 2 diabetes identifying as Black and/or Latina, ages 18-40 years old, participated. We conducted semi-structured interviews about PCC perspectives and experiences which we analyzed with conventional content analysis. To enhance rigor, we collected freelisting data from which we calculated salience scores. We triangulated our qualitative findings with salience scores. RESULTS We identified three themes. Our first theme concerned mismatch between women's desires for PCC counseling to be frequent in contrast with their experiences of its infrequency. Our second theme captured how women felt responsible for initiating care in the clinical encounter but uncertain about what they "should" be asking for. Our third theme characterized women's perspectives on receiving information about PCC and pregnancy planning. CONCLUSIONS Young adult women with type 2 diabetes who are Black and/or Latina welcome more education about how PCC can prevent obstetrical complications associated with diabetes, which disproportionately affect their communities. PRACTICE IMPLICATIONS Our findings provide actionable suggestions for improving acceptability and accessibility of PCC patient education in the United States where PCC awareness and uptake are low.
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Affiliation(s)
| | - Adriana Arcia
- University of San Diego, Hahn School of Nursing and Health Science, USA
| | - Guneet Kaur
- University of California Los Angeles David Geffen School of Medicine, David Geffen School of Medicine, USA
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Zou W, Zhang X, He J. Making Sense of Jiese: An Interview Study of Members from a Porn-Free Self-Help Forum in China. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:385-397. [PMID: 36318357 PMCID: PMC9628386 DOI: 10.1007/s10508-022-02456-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
About 6 million men in China engage in jiese (abstaining from masturbation and porn) and call themselves jieyou (porn-free self-help community members). In this article, we sought to unpack how the idea of jiese took root in Chinese historical, social, and cultural contexts by interviewing 32 jieyou. Guided by the sensemaking theory, we conducted a critical discourse analysis of participants' responses and ended up identifying four major themes: embodied experiences, jiese as rational and noble, reconstructing the subjectivity of jieyou, and nationalistic sentiments. We found out that jieyou tended to justify their abstinence by seeking sources of legitimacy in traditional Chinese culture, the ideology of healthism, science, and patriotic discourses. We argue that jiese reflects young men's contradictory cultural practices of conservatism, self-medicalization, and neoliberal governmentality.
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Affiliation(s)
- Wenxue Zou
- Department of Communication and Journalism, Texas A&M University, College Station, TX, USA
| | - Xinyu Zhang
- School of Communication Studies, Kent State University, 157 Taylor Hall, 625 Loop Road, Kent, OH, 44242, USA.
| | - Jingqi He
- School of Ethnology and Sociology, Minzu University of China, Beijing, China
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Bosch-Frigola I, Coca-Villalba F, Pérez-Lacasta MJ, Carles-Lavila M. European national health plans and the monitoring of online searches for information on diabetes mellitus in different European healthcare systems. Front Public Health 2022; 10:1023404. [PMID: 36504997 PMCID: PMC9729732 DOI: 10.3389/fpubh.2022.1023404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
Diabetes mellitus (DM) is a serious non-communicable disease (NCD) and relies on the patient being aware of their condition, proactive, and having adequate medical care. European countries healthcare models are aware of the impact of these variables. This study evaluates the impact of online health information seeking behavior (OHISB) during World Diabetes Mellitus Day (WDMD) in European countries from 2014 to 2019 by grouping countries according to the changes in citizens' search behavior, diabetes mellitus prevalence, the existence of National Health Plans (NHP), and their respective healthcare systems. We extracted data from Global Burden of Disease, Google Trends (GT), Public Health European Commission, European Coalition for Diabetes, and the Spanish Ministry of Health. First, we used the broken-line models to analyze significant changes in search trends (GT) in European Union member countries in the 30-day intervals before and after the WDMD (November 14) from 2014 to 2019. Then the results obtained were used in the second phase to group these countries by factor analysis of mixed data (FAMD) using the prevalence of DM, the existence of NHP, and health models in each country. The calculations were processed using R software (gtrendsR, segmented, Factoextra, and FactoMineR). We established changes in search trends before and after WDMD, highlighting unevenness among European countries. However, significant changes were mostly observed among countries with NHP. These changes in search trends, in addition to being significant, were reiterated over time and occurred especially in countries belonging to the Beveridge Model (Portugal, Spain, and Sweden) and with NHPs in place. Greater awareness of diabetes mellitus among the population and continuous improvements in NHP can improve the patients' quality of life, thus impacting in disease management and healthcare expenditure.
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Affiliation(s)
- Irene Bosch-Frigola
- Department of Economics, Rovira i Virgili University, Reus, Spain
- Facultad de Comunicación y Ciencias Sociales, Universidad San Jorge, Zaragoza, Spain
| | | | - María José Pérez-Lacasta
- Department of Economics, Rovira i Virgili University, Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
- Research Center on Economics and Sustainability (ECO-SOS), Reus, Spain
| | - Misericòrdia Carles-Lavila
- Department of Economics, Rovira i Virgili University, Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
- Research Center on Economics and Sustainability (ECO-SOS), Reus, Spain
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Bass SB, Swavely D, Allen S, Kelly PJ, Hoadley A, Zisman-Ilani Y, Durrani M, Brajuha J, Iwamaye A, Rubin DJ. Understanding Type 2 Diabetes Self-Management in Racial/Ethnic Minorities: Application of the Extended Parallel Processing Model and Sensemaking Theory in a Qualitative Study. DIABETES EDUCATOR 2022; 48:372-386. [PMID: 35950550 DOI: 10.1177/26350106221116904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of the study was to understand the role of perceived disease threat and self-efficacy in type 2 diabetes (T2DM) patients' self-management by using the extended parallel processing model (EPPM) and sensemaking theory. METHODS Semistructured interviews (n = 25) were conducted with T2DM patients from an urban safety-net hospital. Participants were 50% male/female median age was 55 years and 76% were Black. Participants were categorized by EPPM group based on validated questionnaires (high/low disease threat [HT/LT]; high/low self-efficacy [HE/LE]). Nine were HT/HE, 7 HT/LE, 6 LT/HE, and 3 LT/LE. Interviews were transcribed and analyzed using inductive and deductive coding. Sensemaking theory was applied to contextualize and analyze data. RESULTS Those with HT indicated threat fluctuated throughout diagnosis but that certain triggers (eg, diabetic complications) drove changes in disease view. Those in the HT/HE group more frequently expressed disease acceptance, whereas the HT/LE group more often expressed anger or denial. HT/HE participants expressed having adequate social support and higher trust in health care providers. HT/LE participants reported limited problem-solving skills. In those with LT, the HE group took more ownership of self-management behaviors. The LT/LE group had heightened positive and negative emotional responses that appeared to limit their ability to perform self-care. They also less frequently described problem-solving skills, instead expressing reliance on medical guidance from their providers. CONCLUSIONS EPPM and sensemaking theory are effective frameworks for understanding how perceived health threat and self-efficacy may impede T2DM self-care. A greater focus on these constructs is needed to improve care among low-income minority patients, especially those with low threat and self-efficacy.
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Affiliation(s)
- Sarah Bauerle Bass
- Department Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania
| | - Deborah Swavely
- Nursing Clinical Inquiry and Research, Tower Health, West Reading, Pennsylvania
| | - Shaneisha Allen
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Patrick J Kelly
- Risk Communication Laboratory, Temple University, Philadelphia, Pennsylvania
| | - Ariel Hoadley
- Department Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania
| | - Yaara Zisman-Ilani
- Department Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania
| | - Maryyam Durrani
- Risk Communication Laboratory, Temple University, Philadelphia, Pennsylvania
| | - Jesse Brajuha
- Risk Communication Laboratory, Temple University, Philadelphia, Pennsylvania
| | - Amy Iwamaye
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Daniel J Rubin
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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Cerón-Guzmán JA, Tetteroo D, Hu J, Markopoulos P. “Not Sure Sharing Does Anything Extra for Me”: Understanding How People with Cardiovascular Disease Conceptualize Sharing Personal Health Data with Peers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159508. [PMID: 35954863 PMCID: PMC9368547 DOI: 10.3390/ijerph19159508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022]
Abstract
As people deal with cardiovascular disease (CVD), they are to self-monitor routinely and be aware of complications and the corresponding course of action. Engaging in these self-care behaviors is conducive to gaining knowledge of health status. Even so, knowledge of the self may be insufficient in making sense of chronic conditions. In constructing a new normal after health-related life disruptions, people often turn to peers (others facing similar health issues) and share personal health information with each other. Although health information-sharing behavior is well-documented, it remains underexplored what attitudes individuals with chronic conditions, such as CVD, have toward disclosing personal health data to peers and exploring those of others with similar conditions. We surveyed 39 people who reported being diagnosed with CVD to understand how they conceptualize sharing personal health data with their peers. By analyzing qualitative survey data thematically, we found that respondents expressed themselves as uncertain about the benefits of interacting with peers in such a manner. At the same time, they recognized an opportunity to learn new ideas to enhance CVD self-care in mutual data sharing. We also report participants’ analytical orientation toward this sort of data sharing herein and elaborate on what sharing a range of personal health data could mean. In light of the existing literature, this study unpacks the notion of sharing in a different population/pathology and with more nuance, particularly by distinguishing between disclosing one’s data and exploring others’.
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Turesson C, Liedberg G, Vixner L, Lofgren M, Björk M. Evidence-based digital support during 1 year after an Interdisciplinary Pain Rehabilitation Programme for persons with chronic musculoskeletal pain to facilitate a sustainable return to work: a study protocol for a registry-based multicentre randomised controlled trial. BMJ Open 2022; 12:e060452. [PMID: 35470201 PMCID: PMC9039404 DOI: 10.1136/bmjopen-2021-060452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain (CMSP) severely affects the individual's quality of life, functioning and ability to work, and comes with significant societal costs for sick leave and productivity loss. After rehabilitation, patients with CMSP often experience lack of support when responsibility for the return-to-work process is taken over by the employer. Therefore, we aim to evaluate the effectiveness of a digital support (Sustainable WorkEr digital support for Persons with chronic Pain and their Employers (SWEPPE)) for promoting a sustainable return-to-work for persons with CMSP and to facilitate the employers' supportive role and responsibilities in the process. METHODS AND ANALYSIS In this registry-based multicentre randomised controlled trial, 360 patients with CMSP will be randomised to either receive the smartphone application SWEPPE (n=180) or to a control group (n=180). The intervention group will use SWEPPE for 1 year and the control group will not receive any intervention for return to work (RTW). Participants will be recruited from approximately 10 specialist and primary care level units connected to the Swedish National Quality Registry for Pain Rehabilitation providing Interdisciplinary Pain Rehabilitation Programmes (IPRP) for CMSP. Eligibility criteria are age 18-65 years and a need for support in RTW or continued support at work for creating a sustainable work situation. Baseline data will be collected when the participants have completed the IPRP. Final assessment will be performed after 12 months. The primary outcome will be a number of days with sickness cash benefit. Secondary outcomes and explanatory variables including important domains affected by CMSP such as health-related quality of life, functioning and work ability will be collected. ETHICS AND DISSEMINATION The Swedish Ethics Review Board approved the study (Dnr 2020-01593, Dnr 2021-01854). The study findings will be disseminated through publication, national and international conferences, and meetings to be available for patients, healthcare providers or stakeholders. TRIAL REGISTRATION NUMBER NCT05058547.
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Affiliation(s)
- Christina Turesson
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Gunilla Liedberg
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Monika Lofgren
- Department of Clinical Sciences and Department of Rehabilitation Medicine Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mathilda Björk
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
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Turesson C, Liedberg G, Björk M. Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach. JMIR Hum Factors 2022; 9:e33571. [PMID: 35285814 PMCID: PMC8961348 DOI: 10.2196/33571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Persons with chronic pain experience a lack of support after completing rehabilitation and the responsibility for the return-to-work (RTW) process is taken over by the employer. In addition, employers describe not knowing how to support their employees. Smartphone apps have been increasingly used for self-management, but there is a lack of available eHealth apps with evidence-based content providing digital support for persons with chronic pain and their employers when they return to work. OBJECTIVE This study aims to describe the development of a digital support application with evidence-based content that includes a biopsychosocial perspective on chronic pain for sustainable RTW for persons with chronic pain and their employers (SWEPPE [Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers]). METHODS A user-centered agile design approach was applied. The multidisciplinary project team consisted of health care researchers, a user representative, and a software team. A total of 2 reference groups of 7 persons with chronic pain and 4 employers participated in the development process and usability testing. Mixed methods were used for data collection. The design was revised using feedback from the reference groups. The content of SWEPPE was developed based on existing evidence and input from the reference groups. RESULTS The reference groups identified the following as important characteristics to include in SWEPPE: keeping users motivated, tracking health status and work situation, and following progress. SWEPPE was developed as a smartphone app for the persons with chronic pain and as a web application for their employers. SWEPPE consists of six modules: the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. The employers found the following functions in SWEPPE to be the most useful: employees' goals related to RTW, barriers to RTW, support wanted from the employer, and the ability to follow employees' progress. The persons with chronic pain found the following functions in SWEPPE to be the most useful: setting a goal related to RTW, identifying barriers and strategies, and self-monitoring. Usability testing revealed that SWEPPE was safe, useful (ie, provided relevant information), logical, and easy to use with an appealing interface. CONCLUSIONS This study reports the development of a digital support application for persons with chronic pain and their employers. SWEPPE fulfilled the need of support after an interdisciplinary pain rehabilitation program with useful functions such as setting a goal related to RTW, identification of barriers and strategies for RTW, self-monitoring, and sharing information between the employee and the employer. The user-centered agile design approach contributed to creating SWEPPE as a relevant and easy-to-use eHealth intervention. Further studies are needed to examine the effectiveness of SWEPPE in a clinical setting.
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Affiliation(s)
- Christina Turesson
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Gunilla Liedberg
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lu Y, Barrett LA, Lin RZ, Amith M, Tao C, He Z. Understanding Information Needs and Barriers to Accessing Health Information Across All Stages of Pregnancy: Systematic Review. JMIR Pediatr Parent 2022; 5:e32235. [PMID: 35188477 PMCID: PMC8902674 DOI: 10.2196/32235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding consumers' health information needs across all stages of the pregnancy trajectory is crucial to the development of mechanisms that allow them to retrieve high-quality, customized, and layperson-friendly health information. OBJECTIVE The objective of this study was to identify research gaps in pregnancy-related consumer information needs and available information from different sources. METHODS We conducted a systematic review of CINAHL, Cochrane, PubMed, and Web of Science for relevant articles that were published from 2009 to 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Program. A descriptive data analysis was performed on these articles. Based on the review result, we developed the Pregnancy Information Needs Ontology (PINO) and made it publicly available in GitHub and BioPortal. RESULTS A total of 33 articles from 9 countries met the inclusion criteria for this review, of which the majority were published no earlier than 2016. Most studies were either descriptive (9/33, 27%), interviews (7/33, 21%), or surveys/questionnaires (7/33, 21%); 20 articles mentioned consumers' pregnancy-related information needs. Half (9/18, 50%) of the human-subject studies were conducted in the United States. More than a third (13/33, 39%) of all studies focused on during-pregnancy stage; only one study (1/33, 3%) was about all stages of pregnancy. The most frequent consumer information needs were related to labor delivery (9/20, 45%), medication in pregnancy (6/20, 30%), newborn care (5/20, 25%), and lab tests (6/20, 30%). The most frequently available source of information was the internet (15/24, 63%). PINO consists of 267 classes, 555 axioms, and 271 subclass relationships. CONCLUSIONS Only a few articles assessed the barriers to access to pregnancy-related information and the quality of each source of information; further work is needed. Future work is also needed to address the gaps between the information needed and the information available.
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Affiliation(s)
- Yu Lu
- School of Information, Florida State University, Tallahassee, FL, United States
| | - Laura A Barrett
- School of Information, Florida State University, Tallahassee, FL, United States
| | - Rebecca Z Lin
- Washington University School of Medicine at St. Louis, St. Louis, MO, United States
| | - Muhammad Amith
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cui Tao
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Zhe He
- School of Information, Florida State University, Tallahassee, FL, United States
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Cruz-Martínez RR, Wentzel J, Bente BE, Sanderman R, van Gemert-Pijnen JE. Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis. JMIR Cardio 2021; 5:e31985. [PMID: 34855608 PMCID: PMC8686487 DOI: 10.2196/31985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. OBJECTIVE This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. METHODS Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. RESULTS In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. CONCLUSIONS Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions.
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Britt Elise Bente
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,General Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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11
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Greshake Tzovaras B, Senabre Hidalgo E, Alexiou K, Baldy L, Morane B, Bussod I, Fribourg M, Wac K, Wolf G, Ball M. Using an Individual-Centered Approach to Gain Insights From Wearable Data in the Quantified Flu Platform: Netnography Study. J Med Internet Res 2021; 23:e28116. [PMID: 34505836 PMCID: PMC8463949 DOI: 10.2196/28116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Wearables have been used widely for monitoring health in general, and recent research results show that they can be used to predict infections based on physiological symptoms. To date, evidence has been generated in large, population-based settings. In contrast, the Quantified Self and Personal Science communities are composed of people who are interested in learning about themselves individually by using their own data, which are often gathered via wearable devices. OBJECTIVE This study aims to explore how a cocreation process involving a heterogeneous community of personal science practitioners can develop a collective self-tracking system for monitoring symptoms of infection alongside wearable sensor data. METHODS We engaged in a cocreation and design process with an existing community of personal science practitioners to jointly develop a working prototype of a web-based tool for symptom tracking. In addition to the iterative creation of the prototype (started on March 16, 2020), we performed a netnographic analysis to investigate the process of how this prototype was created in a decentralized and iterative fashion. RESULTS The Quantified Flu prototype allowed users to perform daily symptom reporting and was capable of presenting symptom reports on a timeline together with resting heart rates, body temperature data, and respiratory rates measured by wearable devices. We observed a high level of engagement; over half of the users (52/92, 56%) who engaged in symptom tracking became regular users and reported over 3 months of data each. Furthermore, our netnographic analysis highlighted how the current Quantified Flu prototype was a result of an iterative and continuous cocreation process in which new prototype releases sparked further discussions of features and vice versa. CONCLUSIONS As shown by the high level of user engagement and iterative development process, an open cocreation process can be successfully used to develop a tool that is tailored to individual needs, thereby decreasing dropout rates.
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Affiliation(s)
- Bastian Greshake Tzovaras
- Center for Research & Interdisciplinarity, INSERM U1284, Université de Paris, Paris, France
- Open Humans Foundation, Sanford, NC, United States
| | - Enric Senabre Hidalgo
- Center for Research & Interdisciplinarity, INSERM U1284, Université de Paris, Paris, France
| | | | | | | | - Ilona Bussod
- Center for Research & Interdisciplinarity, Paris, France
| | | | - Katarzyna Wac
- Quality of Life Technologies, GSEM/CUI, University of Geneva, Geneva, Switzerland
| | - Gary Wolf
- Article 27 Foundation, Berkeley, CA, United States
| | - Mad Ball
- Open Humans Foundation, Sanford, NC, United States
- Center for Research & Interdisciplinarity, Paris, France
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12
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Pollack AH, Snyder J. Reflecting on patient-generated photographs of the pediatric renal transplant experience. Pediatr Transplant 2021; 25:e13896. [PMID: 33111458 PMCID: PMC8108545 DOI: 10.1111/petr.13896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Poor self-management contributes to reduced renal allograft survival during adolescence and young adulthood. Providing patients with self-reflection tools to help explore the question "Is my experience normal?" may help mitigate these challenges. We explore Photograph-elicitation, a qualitative method where images are used to prompt individuals to talk about their personal experiences and values, engages pediatric transplant recipients and their families to generate insight into their experiences and the challenges they face after transplant. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Pediatric renal transplant recipients and one family member from Seattle Children's Hospital submitted 5 photographs showcasing their transplant story, which were used as prompts during semi-structured interviews. Interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Twenty-four individuals (13 patients: ages 7-21, and 11 parents) completed the study. Conversations generated by the photographs covered topics in more depth than a routine clinical encounter leading to more opportunities for reflection by patients and their family. The photographs generated conversations on four emergent themes: (a) sensemaking; (b) transitions and agency; (c) social interactions and community engagement; and (d) barriers and obstacles. CONCLUSIONS Photograph elicitation generated a rich dataset describing a range of pediatric renal transplant experiences helping physicians gain a rich and nuanced understanding of the daily lives and experiences of their patients outside the clinical setting. Photograph elicitation, as a clinical intervention, may provide new opportunities to address previously unrecognized modifiable risk factors, improving graft survival and health-related quality of life.
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Affiliation(s)
- Ari H. Pollack
- Seattle Children’s Hospital, Seattle, WA, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Jaime Snyder
- Information School, University of Washington, Seattle, WA, USA
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13
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Ayre J, Bonner C, Muscat DM, Bramwell S, McClelland S, Jayaballa R, Maberly G, McCaffery K. Type 2 diabetes self-management schemas across diverse health literacy levels: a qualitative investigation. Psychol Health 2021; 37:867-889. [PMID: 33931003 DOI: 10.1080/08870446.2021.1909023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to explore how people with diabetes and diverse health literacy levels conceptualise their experience and efforts to engage in self-management behaviours (their self-management 'schemas'). DESIGN A qualitative design was applied. METHODS Twenty-six people in Sydney, Australia, took part in semi-structured interviews, which were audio-recorded and coded using Framework analysis. RESULTS Half the participants (54%) had limited health literacy, whereas 38% adequate health literacy (using Newest Vital Sign). Regardless of health literacy, people described how monitoring increased self-management awareness and signalled periods of low self-management ('lulls'). Accounts of monitoring to sustain motivation were more apparent for participants with adequate health literacy. Most participants described simple and flexible rules (e.g. use artificial sweeteners; eat in moderation). Two schemas related to 'lulls': a 'problem-solving orientation' depicted lulls as inevitable and was associated with varied coping strategies; a 'willpower orientation' attributed lulls to lack of 'willpower,' and described willpower as a main coping strategy. CONCLUSION There is considerable variation in how people think about their diabetes self-management and the strategies they use. Health literacy may contribute to some of this variation. Self-management interventions could benefit from depicting motivation as fluctuating and challenging ideas about willpower and self-blame.
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Affiliation(s)
- Julie Ayre
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sian Bramwell
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia
| | - Sharon McClelland
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia
| | - Rajini Jayaballa
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia.,School of Medicine, Western Sydney University, Blacktown, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Künzler-Heule P, Fierz K, Schmidt AJ, Rasi M, Bogdanovic J, Kocher A, Engberg S, Battegay M, Nöstlinger C, Lehner A, Kouyos R, Schmid P, Braun DL, Fehr J, Nicca D. Response to a sexual risk reduction intervention provided in combination with hepatitis C treatment by HIV/HCV co-infected men who have sex with men: a reflexive thematic analysis. BMC Infect Dis 2021; 21:319. [PMID: 33823783 PMCID: PMC8022541 DOI: 10.1186/s12879-021-06003-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hepatitis C virus reinfections in HIV-positive men-who-have-sex-with-men (MSM) challenge the effectiveness of antiviral treatment. To fight this problem, an adapted sexual risk reduction intervention was implemented within a hepatitis C treatment trial. Following this, the current study had two aims and describes 1) how the program was received by participants; and 2) their responses to the program regarding sexual risk taking. Based on the participants' input, we hoped to judge the intervention's potential for scale-up. METHODS Seventeen participants who received the sexual risk reduction intervention in addition to hepatitis C treatment were recruited for semi-structured interviews six to 12 months post-intervention. We evaluated the responses via reflexive thematic analysis and applied the concept of sense-making. RESULTS Giving hepatitis C a place and living without it again illustrates how participants received the program and how their experiences were altered by the impact of sense-making. Based on their responses, we allocated participants to three groups: 1. Avoid risks: get rid of hepatitis C for life. For these men, hepatitis C remained a life-threatening disease: they actively modified their risk behavior and felt supported by the intervention in maintaining their behavioral changes. 2. Minimize risks: live as long as possible without hepatitis C. In contrast to group 1, these men saw hepatitis C as a manageable disease. The intervention facilitated reflection on risks and how to develop behavioral changes that suited them individually. 3. Accept risks; live with the risk of hepatitis C. These men perceived behavioral changes as much more difficult than "easy" medical treatment. They expected to either undergo repeated rounds of treatment or stay HCV re-infected. CONCLUSION These results illustrate the diversity of men's responses and their decisions regarding sexual risk behavior after participating in a combination of antiviral treatment and a sexual risk reduction intervention. Two major aspects were identified: 1) Teachable moments, particularly at the time of diagnosis/treatment, could offer an opportunity to develop openness for behavioral change; 2) adapting sexual risk reduction interventions to sense-making patterns could help to improve its effectiveness. Support for reducing infection risk and raising awareness of preventative measures are additional benefits. TRIAL REGISTRATION Clinical Trial Number: NCT02785666 , 30.05.2016.
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Affiliation(s)
- Patrizia Künzler-Heule
- Nursing Science, Department Public Health, Medical Faculty, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Katharina Fierz
- Zurich University of Applied Sciences (ZUAS), Winterthur, Switzerland
| | - Axel Jeremias Schmidt
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Manuela Rasi
- Department of Public & Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jasmina Bogdanovic
- Nursing Science, Department Public Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Agnes Kocher
- Nursing Science, Department Public Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Sandra Engberg
- Nursing Science, Department Public Health, Medical Faculty, University of Basel, Basel, Switzerland.,School of Nursing, University of Pittsburgh, Pittsburgh, USA
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | | | | | - Roger Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Dominique Laurent Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Department of Public & Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Dunja Nicca
- Nursing Science, Department Public Health, Medical Faculty, University of Basel, Basel, Switzerland. .,Department of Public & Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
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15
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Jorge H, Duarte IC, Correia BR, Barros L, Relvas AP, Castelo-Branco M. Successful metabolic control in diabetes type 1 depends on individual neuroeconomic and health risk-taking decision endophenotypes: a new target in personalized care. Psychol Med 2021; 52:1-9. [PMID: 33731230 PMCID: PMC9772909 DOI: 10.1017/s0033291721000386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neurobehavioral decision profiles have often been neglected in chronic diseases despite their direct impact on major public health issues such as treatment adherence. This remains a major concern in diabetes, despite intensive efforts and public awareness initiatives regarding its complications. We hypothesized that high rates of low adherence are related to risk-taking profiles associated with decision-making phenotypes. If this hypothesis is correct, it should be possible to define these endophenotypes independently based both on dynamic measures of metabolic control (HbA1C) and multidimensional behavioral profiles. METHODS In this study, 91 participants with early-stage type 1 diabetes fulfilled a battery of self-reported real-world risk behaviors and they performed an experimental task, the Balloon Analogue Risk Task (BART). RESULTS K-means and two-step cluster analysis suggest a two-cluster solution providing information of distinct decision profiles (concerning multiple domains of risk-taking behavior) which almost perfectly match the biological partition, based on the division between stable or improving metabolic control (MC, N = 49) v. unstably high or deteriorating states (NoMC, N = 42). This surprising dichotomy of behavioral phenotypes predicted by the dynamics of HbA1C was further corroborated by standard statistical testing. Finally, the BART game enabled to identify groups differences in feedback learning and consequent behavioral choices under ambiguity, showing distinct group choice behavioral patterns. CONCLUSIONS These findings suggest that distinct biobehavioral endophenotypes can be related to the success of metabolic control. These findings also have strong implications for programs to improve patient adherence, directly addressing risk-taking profiles.
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Affiliation(s)
- Helena Jorge
- PIDFIF* and Coimbra Institute for Biomedical Imaging and Translational Research, CIBIT/ICNAS, University of Coimbra, Coimbra-Lisboa, Portugal
| | - Isabel C. Duarte
- Coimbra Institute for Biomedical Imaging and Translational Research, CIBIT/ICNAS, University of Coimbra, Portugal
| | - Bárbara R. Correia
- Faculty of Medicine, Laboratory of Biostatistics and Medical Informatics, University of Coimbra, Portugal
| | - Luísa Barros
- Endocrinology, Diabetes and Metabolism Department (SEMD), University and Hospital Center of Coimbra, Portugal
| | - Ana Paula Relvas
- Faculty of Psychology and Educational Sciences & Center for Social Studies, University of Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research, CIBIT/ICNAS, University of Coimbra, Portugal
- Faculty of Medicine, Laboratory of Biostatistics and Medical Informatics, University of Coimbra, Portugal
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16
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Whelan ME, Denton F, Bourne CLA, Kingsnorth AP, Sherar LB, Orme MW, Esliger DW. A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes: a qualitative study exploring intuitive engagement with real-time glucose and physical activity feedback. BMC Public Health 2021; 21:130. [PMID: 33435946 PMCID: PMC7805160 DOI: 10.1186/s12889-020-09740-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/21/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mobile health technologies have advanced to now allow monitoring of the acute physiological responses to lifestyle behaviours. Our aim was to explore how people engaged with real-time feedback on their physical activity and glucose levels over several weeks. METHODS Semi-structured interviews with 26 participants (61.5% female, 56.6 years) at moderate-to-high risk of developing type 2 diabetes were conducted. Interviews were completed after participants took part in an intervention comprising a flash glucose monitor (Freestyle Libre) and a physical activity monitor (Fitbit Charge 2). Purposive sampling ensured representation of ages, genders and group allocations. RESULTS Inductive thematic analysis revealed how individuals intuitively used, interpreted and acted on feedback from wearable technologies. Six key themes emerged: triggers of engagement with the technologies, links between behaviour and health, lack of confidence, changes to movement behaviours, changes to diet and barriers to lifestyle behaviour change. CONCLUSIONS Our findings demonstrate that accessing behavioural and physiological feedback can increase self-awareness of how lifestyle impacts short-term health. Some participants noticed a link between the feedback presented by the two devices and changed their behaviour but many did not. Training and educational support, as well as efforts to optimize how feedback is presented to users, are needed to sustain engagement and behaviour change. Extensions of this work to involve people with diabetes are also warranted to explore whether behavioural and physiological feedback in parallel can encourage better diabetes self-management. TRIAL REGISTRATION ISRCTN Registry, ISRCTN17545949 , 12/05/2017, prospectively registered.
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Affiliation(s)
- Maxine E Whelan
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK.
| | - Francesca Denton
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Claire L A Bourne
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Andrew P Kingsnorth
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Lauren B Sherar
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- NIHR Leicester Biomedical Research Centre-Lifestyle, Leicestershire, UK
| | - Mark W Orme
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Dale W Esliger
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- NIHR Leicester Biomedical Research Centre-Lifestyle, Leicestershire, UK
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17
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Pichon A, Schiffer K, Horan E, Massey B, Bakken S, Mamykina L, Elhadad N. Divided We Stand: The Collaborative Work of Patients and Providers in an Enigmatic Chronic Disease. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2021; 4:261. [PMID: 33981961 PMCID: PMC8112593 DOI: 10.1145/3434170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In chronic conditions, patients and providers need support in understanding and managing illness over time. Focusing on endometriosis, an enigmatic chronic condition, we conducted interviews with specialists and focus groups with patients to elicit their work in care specifically pertaining to dealing with an enigmatic disease, both independently and in partnership, and how technology could support these efforts. We found that the work to care for the illness, including reflecting on the illness experience and planning for care, is significantly compounded by the complex nature of the disease: enigmatic condition means uncertainty and frustration in care and management; the multi-factorial and systemic features of endometriosis without any guidance to interpret them overwhelm patients and providers; the different temporal resolutions of this chronic condition confuse both patients and provides; and patients and providers negotiate medical knowledge and expertise in an attempt to align their perspectives. We note how this added complexity demands that patients and providers work together to find common ground and align perspectives, and propose three design opportunities (considerations to construct a holistic picture of the patient, design features to reflect and make sense of the illness, and opportunities and mechanisms to correct misalignments and plan for care) and implications to support patients and providers in their care work. Specifically, the enigmatic nature of endometriosis necessitates complementary approaches from human-centered computing and artificial intelligence, and thus opens a number of future research avenues.
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Affiliation(s)
| | | | - Emma Horan
- Columbia University, Department of Biomedical Informatics
| | - Bria Massey
- Columbia University, Department of Biomedical Informatics
| | - Suzanne Bakken
- Columbia University, Department of Biomedical Informatics and School of Nursing
| | - Lena Mamykina
- Columbia University, Department of Biomedical Informatics
| | - Noémie Elhadad
- Columbia University, Department of Biomedical Informatics
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18
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Johari MZ, Abdullah Z, Mohd Hanafiah AN, Mohammed Nadzri NI, Razli SA, Kong YL. Can patients make heads or tails of enhanced primary health care (EnPHC)? Experience through their own journey. BMC FAMILY PRACTICE 2020; 21:182. [PMID: 32887562 PMCID: PMC7487683 DOI: 10.1186/s12875-020-01254-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
Background Implementation of the new Enhanced Primary Health Care (EnPHC) intervention aims to improve service quality and experience at primary healthcare clinics; especially to newly diagnosed patients. This was achieved by restructuring and improving existing services to better manage non-communicable diseases amongst patients. Objectives of this study are to explore patients’ experiences of the EnPHC intervention, to document their feedback and to determine effects of EnPHC intervention on patients. Methods This phenomenological qualitative study focussed on patients’ experiences in relation to EnPHC interventions. Participants were purposely selected from a group of patients who attended the eight intervention primary healthcare clinics in Johor and Selangor regularly for treatment. Data collection was conducted between April to July 2018. Semi-structured interviews were conducted at average an hour per interview for four to five patients per clinic. Interviews were audio recorded, transcribed verbatim, coded and analysed using a thematic analysis approach. Results A total of 35 patients participated. Analysis revealed five main themes about patient experiences receiving the EnPHC intervention. These are: (1) health assessment in disease progress monitoring, (2) patient-doctor relationship and continuity of care, (3) professionalism in service delivery, (4) ensuring compliance in achieving health targets and (5) communication skills. Each theme represents an important aspect of the service, how it should be delivered within the patient expectations and how it can improve patient’s health through their lens. Conclusion Even though patients were not able to exactly identify the EnPHC intervention components implemented, they are able to describe the process changes that occurred; enabling them to improve their healthcare status. Engagement is necessary to better inform patients of the EnPHC intervention, its purpose, mechanisms, changes and importance for healthcare. It would reduce resistance and increase awareness amongst patients at the clinic.
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Affiliation(s)
- Mohammad Zabri Johari
- Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, No: 1, Block B3, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia.
| | - Zalilah Abdullah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, No: 1, Block B2, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Ainul Nadziha Mohd Hanafiah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, No: 1, Block B2, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Nur Izzati Mohammed Nadzri
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, No: 1, Block B2, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Siti Aisyah Razli
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, No: 1, Block B2, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Yuke Lin Kong
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, No: 1, Block B2, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
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19
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Holden RJ, Daley CN, Mickelson RS, Bolchini D, Toscos T, Cornet VP, Miller A, Mirro MJ. Patient decision-making personas: An application of a patient-centered cognitive task analysis (P-CTA). APPLIED ERGONOMICS 2020; 87:103107. [PMID: 32310109 DOI: 10.1016/j.apergo.2020.103107] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 12/21/2019] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
Personas can be used to understand patterns of variation in patients' performance of cognitive work, particularly self-care decision making. In this study, we used a patient-centered cognitive task analysis (P-CTA) to develop self-care decision-making personas. We collected data from 24 older adults with chronic heart failure and 14 support persons, using critical incident and fictitious scenario interviews. Qualitative analyses produced three personas but revealed that individuals exemplify different personas across situations. The Rule-Following persona seeks clear rules, exercises caution under uncertainty, and grounds actions in confidence in clinician experts. The Researching persona seeks information to gain better understanding, invents strategies, and conducts experiments independently or with clinicians. The Disengaging persona does not actively seek rules or information and does not attempt to reduce uncertainty or conduct experiments. We discuss the situational nature of personas, their use in design, and the benefits of P-CTA for studying patient decision making.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., USA.
| | - Carly N Daley
- Department of BioHealth Informatics, IUPUI School of Informatics and Computing, USA; Parkview Mirro Center for Research and Innovation, Parkview Health, USA
| | | | - Davide Bolchini
- Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA
| | - Victor P Cornet
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA; Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Amy Miller
- Department of Radiology Oncology, Indiana University School of Medicine, USA
| | - Michael J Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA
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Du Y, Dennis B, Rhodes SL, Sia M, Ko J, Jiwani R, Wang J. Technology-Assisted Self-Monitoring of Lifestyle Behaviors and Health Indicators in Diabetes: Qualitative Study. JMIR Diabetes 2020; 5:e21183. [PMID: 32857056 PMCID: PMC7486673 DOI: 10.2196/21183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Self-monitoring is key to successful behavior change in diabetes and obesity, and the use of traditional paper-based methods of self-monitoring may be time-consuming and burdensome. OBJECTIVE This study aimed to explore participant experiences while using technology-assisted self-monitoring of lifestyle behaviors and health indicators among overweight or obese adults with type 2 diabetes. METHODS Qualitative data collected from the intervention group of a 6-month, three-arm (control, paper diary, and technology-assisted self-monitoring groups) randomized clinical trial were analyzed. Study participants in the intervention group monitored their diet, exercise, and weight using the LoseIt! app, and their blood glucose levels using a glucometer and the Diabetes Connect app. Semistructured group discussions were conducted at 6 weeks (n=10) from the initiation of the behavioral lifestyle intervention and again at 6 months (n=9). All group interviews were audiotaped and transcribed verbatim. Using a combination of thematic and comparative analysis approaches, two trained professionals coded the transcriptions independently and then discussed and concluded common themes for the 6-week and 6-month discussions separately. RESULTS The sample (n=10), which primarily involved African American participants (n=7) and female participants (n=8), had a mean age of 59.4 years. The following eight themes emerged: (1) perceived benefits of technology-assisted self-monitoring; (2) perceived ease of use (eg, barriers: technical difficulties and lack of self-discipline; facilitators: help from family, friends, and the program); (3) use of technology-assisted self-monitoring; (4) facilitators of engaging in healthy lifestyle behaviors (eg, visualization and awareness of calorie input/expenditure); (5) positive lifestyle change; (6) barriers of engaging in healthy lifestyle behaviors (eg, event influence); (7) learning curve; and (8) monitored data sharing. The first six of these themes were shared between the 6-week and 6-month timepoints, but the codes within these themes were not all the same and differed slightly between the two timepoints. These differences provide insights into the evolution of participant thoughts and perceptions on using technology for self-monitoring and subsequent behavioral lifestyle changes while participating in lifestyle interventions. The findings from the 6-week and 6-month data helped to paint a picture of participant comfort and the integration of technology and knowledge overtime, and clarified participant attitudes, difficulties, behavioral processes, and modifications, as well as health indicators that were experienced throughout the study. CONCLUSIONS Although there were some barriers, participants were able to identify various individual and external facilitators to adjust to and engage in technology-assisted self-monitoring, and it was concluded that the technology-assisted self-monitoring approach was beneficial, safe, and feasible to use for positive lifestyle change. These patient perspectives need to be considered in future research studies when investigating the effectiveness of using technology-assisted self-monitoring, as well as in clinical practice when recommending technology-assisted self-monitoring of lifestyle behaviors and health indicators to improve health outcomes.
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Affiliation(s)
- Yan Du
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Brittany Dennis
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Shanae Lakel Rhodes
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Michelle Sia
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jisook Ko
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Yin K, Jung J, Coiera E, Laranjo L, Blandford A, Khoja A, Tai WT, Phillips DP, Lau AYS. Patient Work and Their Contexts: Scoping Review. J Med Internet Res 2020; 22:e16656. [PMID: 32484449 PMCID: PMC7298639 DOI: 10.2196/16656] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life. Objective This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors. Methods A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health–related tasks, (2) cognitive health–related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools). Results In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support. Conclusions This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one’s internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.
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Affiliation(s)
- Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Joshua Jung
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Ann Blandford
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Adeel Khoja
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Wan-Tien Tai
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Daniel Psillakis Phillips
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia.,UCL Interaction Centre, University College London, London, United Kingdom
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Despins LA, Wakefield BJ. Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: A qualitative study. J Clin Nurs 2020; 29:2572-2588. [PMID: 32279366 DOI: 10.1111/jocn.15280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/25/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES To describe individuals' with type 2 diabetes mellitus sense-making of blood glucose data and other influences impacting self-management behaviour. BACKGROUND Type 2 diabetes mellitus prevalence is increasing globally. Adherence to effective diabetes self-management regimens is an ongoing healthcare challenge. Examining individuals' sense-making processes can advance staff knowledge of and improve diabetes self-management behaviour. DESIGN A qualitative exploratory design examining how individuals make sense of blood glucose data and symptoms, and the influence on self-management decisions. METHODS Sixteen one-on-one interviews with adults diagnosed with type 2 diabetes mellitus using a semi-structured interview guide were conducted from March-May 2018. An inductive-deductive thematic analysis of data using the Sensemaking Framework for Chronic Disease Self-Management was used. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in completing this paper. RESULTS Three main themes described participants' type 2 diabetes mellitus sense-making and influences on self-management decisions: classifying blood glucose data, building mental models and making self-management decisions. Participants classified glucose levels based on prior personal experiences. Participants learned about diabetes from classes, personal experience, health information technology and their social network. Seven participants expressed a need for periodic refreshing of diabetes knowledge. CONCLUSION Individuals use self-monitored glucose values and/or HbA1C values to evaluate glucose control. When using glucose values, they analyse the context in which the value was obtained through the lens of personal parameters and expectations. Understanding how individuals make sense of glycaemic data and influences on diabetes self-management behaviour with periodic reassessment of this understanding can guide the healthcare team in optimising collaborative individualised care plans. RELEVANCE TO CLINICAL PRACTICE Nurses must assess sense-making processes in self-management decisions. Periodic "refresher" diabetes education may be needed for individuals with type 2 diabetes mellitus.
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Affiliation(s)
- Laurel A Despins
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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23
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Rosenthal S, Das S, Hsueh PYS, Barker K, Chen CH. Efficient goal attainment and engagement in a care manager system using unstructured notes. JAMIA Open 2020; 3:ooaa001. [PMID: 32142137 PMCID: PMC7309242 DOI: 10.1093/jamiaopen/ooaa001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/22/2019] [Accepted: 01/28/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To improve efficient goal attainment of patients by analyzing the unstructured text in care manager (CM) notes (CMNs). Our task is to determine whether the goal assigned by the CM can be achieved in a timely manner. MATERIALS AND METHODS Our data consists of CM structured and unstructured records from a private firm in Orlando, FL. The CM data is based on phone interactions between the CM and the patient. A portion of the data has been manually annotated to indicate engagement. We present 2 machine learning classifiers: an engagement model and a goal attainment model. RESULTS We can successfully distinguish automatically between engagement and lack of engagement. Subsequently, incorporating engagement and features from textual information from the unstructured notes significantly improves goal attainment classification. DISCUSSION Two key challenges in this task were the time-consuming annotation effort for engagement classification and the limited amount of data for the more difficult goal attainment class (specifically, for people who take a long time to achieve their goals). We successfully explore domain adaptation and transfer learning techniques to improve performance on the under-represented classes. We also explore the value of using features from unstructured notes to improve the model and interpretability. CONCLUSIONS Unstructured CMNs can be used to improve accuracy of our classification models for predicting patient self-management goal attainment. This work can be used to help identify patients who may require special attention from CMs to improve engagement in self-management.
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Affiliation(s)
| | - Subhro Das
- MIT-IBM Watson AI Lab, IBM Research, Cambridge, Massachusetts, USA
| | | | - Ken Barker
- IBM Research, Yorktown Heights, New York, USA
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Beentjes TAA, van Gaal BGI, van Achterberg T, Goossens PJJ. Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research. J Am Psychiatr Nurses Assoc 2020; 26:464-482. [PMID: 31578904 DOI: 10.1177/1078390319877953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: The development of de-hospitalization policies in mental health has resulted in a growing emphasis on self-management. In the chronic care model, self-management support is an essential element. Because of the episodic nature of severe mental illness (SMI) and its high relapse rates, we assume that the extent of self-management support needs of individuals with an SMI is considerable. However, a clear overview of the nature of the self-management support needs of persons with SMI is missing. AIMS: This study aimed to identify self-management support needs from the perspective of individuals with SMI. METHOD: A systematic review was conducted using the method of thematic synthesis of qualitative studies. After searching the databases MEDLINE, PsycINFO, CINAHL, and EMBASE, we screened the papers for the eligibility criteria: individuals with an SMI, adequately representing the voice of persons with SMI and describing their self-management support needs. Thirty-one papers were included. RESULTS: The main findings showed that participants in the studies described the need for informational support, emotional support, acknowledgment, encouragement, and guidance to make sense of their illness experiences, ease suffering, obtain validation and recognition, execute self-management tasks, and be led through unfamiliar territory. CONCLUSION: The perspectives of persons with SMI can provide a road map for constructing a self-management support intervention for persons with SMI. Important others have an essential role in fulfilling support needs. Independently managing an SMI is difficult. Therefore, it is preferable to let important others participate in self-management interventions and to introduce peer support.
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Affiliation(s)
- Titus A A Beentjes
- Titus A. A. Beentjes, MScN, APRN, RN, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; Dimence Group Mental Health Care Centre, Deventer, the Netherlands; Centre for Nursing Research, Saxion University of Applied Science, Deventer, the Netherlands
| | - Betsie G I van Gaal
- Betsie G. I. van Gaal, PhD, FEANS, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Theo van Achterberg
- Theo van Achterberg, PhD, FEANS, KU Leuven, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Peter J J Goossens
- Peter J. J. Goossens, PhD, APRN, RN, FEANS, Dimence Group Mental Health Care Centre, Deventer, the Netherlands; University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Hatcher D, Chang E, Schmied V, Garrido S. Holding momentum: a grounded theory study of strategies for sustaining living at home in older persons. Int J Qual Stud Health Well-being 2019; 14:1658333. [PMID: 31451098 PMCID: PMC6720313 DOI: 10.1080/17482631.2019.1658333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2019] [Indexed: 11/05/2022] Open
Abstract
Purpose: Government strategies are putting increasing emphasis on sustaining the capacity of older persons to continue living independently in their own homes to ease strain on aged care services. The aim of this study was to understand the experiences and strategies that older people utilize to remain living at home from their own perspective. Methods: A grounded theory methodology was used to explore the actions and strategies used by persons over the age of 65 to enable them to remain living in their own homes. Data were collected from 21 women and men in three focus group discussions and 10 in-depth semi-structured interviews. Results: The data revealed that the central process participants used to hold momentum and sustain living at home involves a circular process in which older people acknowledge change and make ongoing evaluations and decisions about ageing at home. Conclusion: These findings have implications for informing policy and service provision by identifying appropriate resources and services to promote successful ageing at home.
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Affiliation(s)
- Deborah Hatcher
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
| | - Sandra Garrido
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Richmond, Australia
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Abstract
PurposeUsing a sense making approach, the purpose of this paper is to examine the role that virtual health communities play as a source of informational and social support for pregnant diabetic women. The paper helps to understand how women suffering from a critical medical condition (i.e. diabetes during pregnancy and birth) manage a complex health situation.Design/methodology/approachThe data sample consisted of 507 posts collected from a virtual health community for diabetic pregnant women. Data were analysed deductively looking for different expressions of normality and different types of health information about diabetes.FindingsContent analysis revealed four themes that reflect the process that diabetic women go through from their attempts to conceive through pregnancy and birth. The findings show that for women dealing with a chronic illness such as diabetes, the breakdown of normal was the beginning of the pregnancy that prompted a new range of informational and emotional needs. The members of the community negotiated a socially constructed sense of normality and tried to empower other members with a new sense of normal by sharing information about their births. The findings also showed that members of the community disclosed personal health information to elicit medical information, advice and social support from other members.Originality/valueThe study highlighted the significance of sense-making processes in managing complex health situations and the value of virtual communities as sources of information and social support as to resolve discontinuities in the management of their illnesses.
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Masterson Y, Brady E, Miller A. Informational Practices of Postacute Brain Injury Patients During Personal Recovery: Qualitative Study. J Particip Med 2019; 11:e15174. [PMID: 33055067 PMCID: PMC7434071 DOI: 10.2196/15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The effects of brain injury, structural damage, or the physiological disruption of brain function last far beyond initial clinical treatment. Self-tracking and management technologies have the potential to help individuals experiencing brain injury in their personal recovery-helping them to function at their best despite ongoing symptoms of illness. However, current self-tracking technologies may be unsuited for measuring the interconnected, nonlinear ways in which brain injury manifests. OBJECTIVE This study aimed to investigate (1) the current informational practices and sensemaking processes used by postacute brain injury patients during personal recovery and (2) the potential role of quality-of-life instruments in improving patient awareness of brain injury recovery, advocacy, and involvement in care used outside the clinical context. Our objective was to explore the means of improving awareness through reflection that leads to compensatory strategies by anticipating or recognizing the occurrence of a problem caused by impairment. METHODS We conducted a qualitative study and used essentialist or realist thematic analysis to analyze the data collected through semistructured interviews and questionnaires, 2 weeks of structured data collection using brain injury-specific health-related quality of life instrument, quality of life after brain injury (QoLIBRI), and final interviews. RESULTS Informational practices of people with brain injury involve data collection, data synthesis, and obtaining and applying the insights to their lifestyles. Participants collected data through structured tools such as spreadsheets and wearable devices but switched to unstructured tools such as journals and blogs as changes in overall progress became more qualitative in nature. Although data collection helped participants summarize their progress better, the lack of conceptual understanding made it challenging to know what to monitor or communicate with clinicians. QoLIBRI served as an education tool in this scenario but was inadequate in facilitating reflection and sensemaking. CONCLUSIONS Individuals with postacute brain injury found the lack of conceptual understanding of recovery and tools for making sense of their health data as major impediments for tracking and being aware of their personal recovery. There is an urgent need for a better framework for recovery and a process model for choosing patient-generated health data tools that focus on the holistic nature of recovery and improve the understanding of brain injury for all stakeholders involved throughout recovery.
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Affiliation(s)
- Yamini Masterson
- Department of Human-Centered Computing, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Erin Brady
- Department of Human-Centered Computing, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Andrew Miller
- Department of Human-Centered Computing, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
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Abstract
BACKGROUND Engaging patients as partners in their care is clinically appealing, yet challenging to implement, and we lack a measurement framework that is applicable to vulnerable populations. To address this gap, we conducted a qualitative study to refine a conceptual framework that reflects an individual's propensity to engage with care. OBJECTIVES Our objectives were to refine the framework's domains of engagement behavior; identify key behaviors within each domain that describe engagement with providers, health systems or settings; and illustrate examples for each behavior where higher self-efficacy describes an opportunity to enhance engagement, and lower self-efficacy describes difficulties with engagement that risk burden. RESEARCH DESIGN AND SAMPLE We elicited patient perspectives by conducting individual semistructured interviews with veterans receiving care for mental health and/or chronic conditions from the Veterans Health Administration. Data were analyzed using the framework method. RESULTS The resulting engagement framework encompassed 4 interrelated domains: Self-Management, Health Information Use, Collaborative Communication, and Healthcare Navigation. The propensity to engage with care was conceptualized as the cumulative self-efficacy to engage in behaviors across these domains. Results emphasize the collaborative nature of engagement behaviors and the impact of veteran cultural influences via perceptions of collective efficacy. CONCLUSIONS This framework can be applied to judgments regarding a patient's propensity to engage in care. Because self-efficacy is an individual's context-specific judgment of their capabilities, this framework may inform health care and social service interventions that aim to engage patients. This maybe especially useful for public sector settings and populations with social risks.
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Turchioe MR, Heitkemper EM, Lor M, Burgermaster M, Mamykina L. Designing for engagement with self-monitoring: A user-centered approach with low-income, Latino adults with Type 2 Diabetes. Int J Med Inform 2019; 130:103941. [PMID: 31437618 PMCID: PMC6746233 DOI: 10.1016/j.ijmedinf.2019.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/12/2019] [Accepted: 08/01/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND SIGNIFICANCE Data-driven interventions for health can help to personalize self-management of Type 2 Diabetes (T2D), but lack of sustained engagement with self-monitoring among disadvantaged populations may widen existing health disparities. Prior work developing approaches to increase motivation and engagement with self-monitoring holds promise, but little is known about applicability of these approaches to underserved populations. OBJECTIVE To explore how low-income, Latino adults with T2D respond to different design concepts for data-driven solutions in health that require self-monitoring, and what features resonate with them the most. MATERIAL AND METHODS We developed a set of mockups that incorporated different design features for promoting engagement with self-monitoring in T2D. We conducted focus groups to examine individuals' perceptions and attitudes towards mockups. Multiple interdisciplinary researchers analyzed data using directed content analysis. RESULTS We conducted 14 focus groups with 25 English- and Spanish-speaking adults with T2D. All participants reacted positively to external incentives. Social connectedness and healthcare expert feedback were also well liked because they enhanced current social practices and presented opportunities for learning. However, attitudes were more mixed towards goal setting, and very few participants responded positively to self-discovery and personalized decision support features. Instead, participants wished for personalized recommendations for meals and other health behaviors based on their personal health data. CONCLUSION This study suggests connections between individuals' degree of internal motivation and motivation for self-monitoring in health and their attitude towards designs of self-monitoring apps. We relate our findings to the self-determination continuum in self-determination theory (SDT) and propose it as a blueprint for aligning incentives for self-monitoring to different levels of motivation.
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Affiliation(s)
- Meghan Reading Turchioe
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States.
| | | | - Maichou Lor
- School of Nursing, Columbia University, New York, NY, United States
| | - Marissa Burgermaster
- Department of Nutritional Sciences, College of Natural Sciences & Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
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Tan E, Khoo J, Gani LU, Malakar RD, Tay TL, Tirukonda PS, Kam JW, Tin AS, Tang TY. Effect of multidisciplinary intensive targeted care in improving diabetes mellitus outcomes: a randomized controlled pilot study - the Integrated Diabetes Education, Awareness and Lifestyle modification in Singapore (IDEALS) Program. Trials 2019; 20:549. [PMID: 31477163 PMCID: PMC6720083 DOI: 10.1186/s13063-019-3601-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/19/2019] [Indexed: 11/11/2022] Open
Abstract
Background There is a global pandemic of type 2 diabetes mellitus (T2DM), especially in Asia. Singapore has a prevalence of T2DM at 10.5%, which is higher than the world average of 8.8%. Multiple studies have shown that multidisciplinary, team-based, coordinated care has been associated with improved measures of quality care and reduced healthcare utilization. Patients with poor glycemic control and nephropathy are at the highest risk of developing cardiovascular complications and renal failure. In this study, we aimed to investigate the impact of intensive multidisciplinary diabetes mellitus care with patient empowerment versus routine clinical care on the rate of progression of micro and macrovascular complications and peripheral atherosclerotic burden, as measured by changes in femoral intima-media thickness (IMT) in patients with persistently elevated HbA1c and nephropathy. Methods The study is a single-center randomized controlled trial (RCT) with two study arms - intensive diabetes mellitus care versus routine clinical care. Patients in the intensive arm will receive care from a multidisciplinary team consisting of an endocrinologist, diabetes nurse educator, dietitian, renal pharmacist and medical social worker for counselling. In addition, patients will be provided with tools for self-care empowerment such as glucometers, blood pressure monitors and android tablets to facilitate care, monitoring and education. Patients in the routine clinical care arm will receive standard clinical care. Follow up (FU) will be for 3 years. Primary outcomes include cardiovascular events, rate of progression of nephropathy and development of end-stage renal disease. Secondary endpoints include the proportions of patients with documented improved control of cardiovascular risk factors (HbA1c, blood pressure, low density lipoprotein-C (LDL-C), reduction in body weight), frequency of hypoglycemia, hospitalization days and changes in femoral IMT. We will also examine the prevalence of peripheral atherosclerosis and the predictive value and usability of lower extremity arterial ultrasound to predict cardio-cerebrovascular events, amputation and peripheral intervention. Discussion Diabetes mellitus carries significant healthcare costs. Patients with poor glycemic control and nephropathy are at highest risk of developing cardiovascular complications and renal failure. Intensive diabetes mellitus care with patient empowerment may lead to sustained glycemic control, reduction of clinical complications and progression of nephropathy, and incidence of cardiovascular complications. Trial registration ClinicalTrials.gov, NCT03413215. Registered on 29 January 2019. Electronic supplementary material The online version of this article (10.1186/s13063-019-3601-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eberta Tan
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore.
| | - Joan Khoo
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Linsey Utami Gani
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | | | - Tunn Lin Tay
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | | | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore
| | - Aung Soe Tin
- Health Services Research Department, Changi General Hospital, Singapore, Singapore
| | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
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Schroeder J, Karkar R, Fogarty J, Kientz JA, Munson SA, Kay M. A Patient-Centered Proposal for Bayesian Analysis of Self-Experiments for Health. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2019; 3:124-155. [PMID: 30847434 DOI: 10.1007/s41666-018-0033-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The rise of affordable sensors and apps has enabled people to monitor various health indicators via self-tracking. This trend encourages self-experimentation, a subset of self-tracking in which a person systematically explores potential causal relationships to try to answer questions about their health. Although recent research has investigated how to support the data collection necessary for self-experiments, less research has considered the best way to analyze data resulting from these self-experiments. Most tools default to using traditional frequentist methods. However, the US Agency for Healthcare Research and Quality recommends using Bayesian analysis for n-of-1 studies, arguing from a statistical perspective. To develop a complementary patient-centered perspective on the potential benefits of Bayesian analysis, this paper describes types of questions people want to answer via self-experimentation, as informed by 1) our experiences engaging with irritable bowel syndrome patients and their healthcare providers and 2) a survey investigating what questions individuals want to answer about their health and wellness. We provide examples of how those questions might be answered using 1) frequentist null hypothesis significance testing, 2) frequentist estimation, and 3) Bayesian estimation and prediction. We then provide design recommendations for analyses and visualizations that could help people answer and interpret such questions. We find the majority of the questions people want to answer with self-tracking data are better answered with Bayesian methods than with frequentist methods. Our results therefore provide patient-centered support for the use of Bayesian analysis for n-of-1 studies.
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Chung CF, Wang Q, Schroeder J, Cole A, Zia J, Fogarty J, Munson SA. Identifying and Planning for Individualized Change: Patient-Provider Collaboration Using Lightweight Food Diaries in Healthy Eating and Irritable Bowel Syndrome. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2019; 3:7. [PMID: 31080941 PMCID: PMC6504841 DOI: 10.1145/3314394] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/01/2019] [Indexed: 12/20/2022]
Abstract
Identifying and planning strategies that support a healthy lifestyle or manage a chronic disease often require patient-provider collaboration. For example, people with healthy eating goals often share everyday food, exercise, or sleep data with health coaches or nutritionists to find opportunities for change, and patients with irritable bowel syndrome (IBS) often gather food and symptom data as part of working with providers to diagnose and manage symptoms. However, a lack of effective support often prevents health experts from reviewing large amounts of data in time-constrained visits, prevents focusing on individual goals, and prevents generating correct, individualized, and actionable recommendations. To examine how to design photo-based diaries to help people and health experts exchange knowledge and focus on collaboration goals when reviewing the data together, we designed and developed Foodprint, a photo-based food diary. Foodprint includes three components: (1) A mobile app supporting lightweight data collection, (2) a web app with photo-based visualization and quantitative visualizations supporting collaborative reflection, and (3) a pre-visit note communicating an individual's expectations and questions to experts. We deployed Foodprint in two studies: (1) with 17 people with healthy eating goals and 7 health experts, and (2) with 16 IBS patients and 8 health experts. Building upon the lens of boundary negotiating artifacts and findings from two field studies, our research contributes design principles to (1) prepare individuals to collect data relevant to their health goals and for collaboration, (2) help health experts focus on an individual's eating context, experiences, and goals in collaborative review, and (3) support individuals and experts to develop individualized, actionable plans and strategies.
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Affiliation(s)
- Chia-Fang Chung
- Informatics, Indiana University Bloomington, Bloomington, IN, 47405, USA
| | - Qiaosi Wang
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jessica Schroeder
- Paul G. Allen School of Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
| | - Allison Cole
- Family Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jasmine Zia
- Division of Gastroenterology, University of Washington, Seattle, WA, 98195, USA
| | - James Fogarty
- Paul G. Allen School of Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
| | - Sean A Munson
- Human Centered Design & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
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Taylor JO, Hartzler AL, Osterhage KP, Demiris G, Turner AM. Monitoring for change: the role of family and friends in helping older adults manage personal health information. J Am Med Inform Assoc 2018; 25:989-999. [PMID: 29726993 PMCID: PMC7646862 DOI: 10.1093/jamia/ocy037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Although family and friends (FF) often play a significant support role in the health of older adults (OA), we know little about their role in personal health information management (PHIM). To address this gap and inform the design of PHIM tools, we describe the work, needs, and barriers of FF in the context of PHIM for OAs. Methods We conducted semi-structured telephone interviews with 52 FF identified by OA as being important in their health and PHIM. We analyzed interview transcripts for themes about FF information work, barriers, and support needs. Results FF play a supportive role in OA health maintenance, medical encounters, decision making, and daily activities. Monitoring, the ongoing process of seeking information related to the OA status, emerged as a key activity comprised of 3 phases: detection, interpretation, and action. Barriers to monitoring included OA choices and constraints, FF constraints, and difficulty with technological tools, resources, health information exchange between providers, social network dynamics, and physical distance. Conclusions FF frequently monitor for change in OA well-being, seeking up-to-date information to facilitate support of OA PHIM. Health information technology tools designed for FF can support all phases of monitoring by providing: (1) timely and granular levels of access to OA health information as the OA ages; (2) tailored health education for FF that is based on OA clinical data; and (3) networking platforms that integrate delegation, volunteering, and relevant resources, along with tools to facilitate support of OA appointment calendars and medication management. Such tools could reduce the burden of PHIM for OA and their loved ones.
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Affiliation(s)
- Jean O Taylor
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Katie P Osterhage
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne M Turner
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
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Hu X, Hsueh PYS, Chen CH, Diaz KM, Cheung YKK, Qian M. A First Step Towards Behavioral Coaching for Managing Stress: A Case Study on Optimal Policy Estimation with Multi-stage Threshold Q-learning. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:930-939. [PMID: 29854160 PMCID: PMC5977571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Psychological stress is a major contributor to the adoption of unhealthy behaviors, which in turn accounts for 41% of global cardiovascular disease burden. While the proliferation of mobile health apps has offered promise to stress management, these apps do not provide micro-level feedback with regard to how to adjust one's behaviors to achieve a desired health outcome. In this paper, we formulate the task of multi-stage stress management as a sequential decision-making problem and explore the application of reinforcement learning to provide micro-level feedback for stress reduction. Specifically, we incorporate a multi-stage threshold selection into Q-learning to derive an interpretable form of a recommendation policy for behavioral coaching. We apply this method on an observational dataset that contains Fitbit ActiGraph measurements and self-reported stress levels. The estimated policy is then used to understand how exercise patterns may affect users' psychological stress levels and to perform coaching more effectively.
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Affiliation(s)
- Xinyu Hu
- Department of Biostatistics, Columbia University, New York, NY, USA
| | | | - Ching-Hua Chen
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Columbia University, New York, NY, USA
| | | | - Min Qian
- Department of Biostatistics, Columbia University, New York, NY, USA
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Cheung YK, Hsueh PYS, Qian M, Yoon S, Meli L, Diaz KM, Schwartz JE, Kronish IM, Davidson KW. Are Nomothetic or Ideographic Approaches Superior in Predicting Daily Exercise Behaviors? Methods Inf Med 2018; 56:452-460. [PMID: 29582914 PMCID: PMC5897129 DOI: 10.3414/me16-02-0051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The understanding of how stress influences health behavior can provide insights into developing healthy lifestyle interventions. This understanding is traditionally attained through observational studies that examine associations at a population level. This nomothetic approach, however, is fundamentally limited by the fact that the environment- person milieu that constitutes stress exposure and experience can vary substantially between individuals, and the modifiable elements of these exposures and experiences are individual-specific. With recent advances in smartphone and sensing technologies, it is now possible to conduct idiographic assessment in users' own environment, leveraging the full-range observations of actions and experiences that result in differential response to naturally occurring events. The aim of this paper is to explore the hypothesis that an ideographic N-of-1 model can better capture an individual's stress- behavior pathway (or the lack thereof) and provide useful person-specific predictors of exercise behavior. METHODS This paper used the data collected in an observational study in 79 participants who were followed for up to a 1-year period, wherein their physical activity was continuously and objectively monitored by actigraphy and their stress experience was recorded via ecological momentary assessment on a mobile app. In addition, our analyses considered exogenous and environmental variables retrieved from public archive such as day in a week, daylight time, temperature and precipitation. Leveraging the multiple data sources, we developed prediction algorithms for exercise behavior using random forest and classification tree techniques using a nomothetic approach and an N-of-1 approach. The two approaches were compared based on classification errors in predicting personalized exercise behavior. RESULTS Eight factors were selected by random forest for the nomothetic decision model, which was used to predict whether a participant would exercise on a particular day. The predictors included previous exercise behavior, emotional factors (e.g., midday stress), external factors such as weather (e.g., temperature), and self-determination factors (e.g., expectation of exercise). The nomothetic model yielded an average classification error of 36%. The ideographic N-of-1 models used on average about two predictors for each individual, and had an average classification error of 25%, which represented an improvement of 11 percentage points. CONCLUSIONS Compared to the traditional one-size-fits-all, nomothetic model that generalizes population-evidence for individuals, the proposed N-of-1 model can better capture the individual difference in their stressbehavior pathways. In this paper, we demonstrate it is feasible to perform personalized exercise behavior prediction, mainly made possible by mobile health technology and machine learning analytics.
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Mamykina L, Heitkemper EM, Smaldone AM, Kukafka R, Cole-Lewis HJ, Davidson PG, Mynatt ED, Cassells A, Tobin JN, Hripcsak G. Personal discovery in diabetes self-management: Discovering cause and effect using self-monitoring data. J Biomed Inform 2017; 76:1-8. [PMID: 28974460 PMCID: PMC5967393 DOI: 10.1016/j.jbi.2017.09.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To outline new design directions for informatics solutions that facilitate personal discovery with self-monitoring data. We investigate this question in the context of chronic disease self-management with the focus on type 2 diabetes. MATERIALS AND METHODS We conducted an observational qualitative study of discovery with personal data among adults attending a diabetes self-management education (DSME) program that utilized a discovery-based curriculum. The study included observations of class sessions, and interviews and focus groups with the educator and attendees of the program (n = 14). RESULTS The main discovery in diabetes self-management evolved around discovering patterns of association between characteristics of individuals' activities and changes in their blood glucose levels that the participants referred to as "cause and effect". This discovery empowered individuals to actively engage in self-management and provided a desired flexibility in selection of personalized self-management strategies. We show that discovery of cause and effect involves four essential phases: (1) feature selection, (2) hypothesis generation, (3) feature evaluation, and (4) goal specification. Further, we identify opportunities to support discovery at each stage with informatics and data visualization solutions by providing assistance with: (1) active manipulation of collected data (e.g., grouping, filtering and side-by-side inspection), (2) hypotheses formulation (e.g., using natural language statements or constructing visual queries), (3) inference evaluation (e.g., through aggregation and visual comparison, and statistical analysis of associations), and (4) translation of discoveries into actionable goals (e.g., tailored selection from computable knowledge sources of effective diabetes self-management behaviors). DISCUSSION The study suggests that discovery of cause and effect in diabetes can be a powerful approach to helping individuals to improve their self-management strategies, and that self-monitoring data can serve as a driving engine for personal discovery that may lead to sustainable behavior changes. CONCLUSIONS Enabling personal discovery is a promising new approach to enhancing chronic disease self-management with informatics interventions.
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Affiliation(s)
- Lena Mamykina
- Department of Biomedical Informatics, Columbia University, United States.
| | | | | | - Rita Kukafka
- Department of Biomedical Informatics, Columbia University, United States
| | | | | | | | | | | | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, United States
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[Adaptation and validation of the SMP-T2D questionnaire in Spanish for evaluating self-management of high blood pressure and type 2 diabetes: PAG-DT2+HTA]. HIPERTENSION Y RIESGO VASCULAR 2017; 34:165-175. [PMID: 28811094 DOI: 10.1016/j.hipert.2017.06.003] [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: 02/27/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND High blood pressure is one of the most common chronic conditions worldwide. It affects one in every 3 adults over 40, while one in 10 suffers from diabetes. For both diseases, adherence to pharmacological treatment is over 30%, and self-management, which takes into account diet and physical activity, is still unknown, as there is no tool available to measure self-management. Therefore, the object of this study was to adapt and validate the Spanish version of the self-management profile for type 2 diabetes (SMP-T2D) questionnaire in patients with type 2 diabetes and high blood pressure among users of first level care in the social security institution of Mexico. METHODS The SMP-T2D was adapted to Spanish by translation into Spanish, and being used only in patients with high blood pressure and type 2 diabetes-hypertension. A convergent and discriminatory validation was performed. Patients over 50 years old with high blood pressure were include. Those that did not complete the questionnaire or give informed consent were rejected. RESULTS The Spanish version of the SMP-T2D was called PAG-DT2+HTA, and was applied to 145 people with hypertension: 54.4% with hypertension only, and 43.6% with hypertension and type 2 diabetes. Mean age was 66.14 years (SD=10.78), with 34.7% women and 65.3% men. Internal consistency by α-Cronbach for the questionnaire was 0.561 (P=.000). The correlation between the PAG-DT2+HTA and Morisky-Green was significant. The ability to discriminate between people with and without education and with and without economic means was obtained. CONCLUSION The Spanish version of SMP-T2D (PAG-DT2+HTA) that measures self-management in type 2 diabetes, can be used to measure self-management in people with type 2 diabetes-hypertension.
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Lai AM, Hsueh PYS, Choi YK, Austin RR. Present and Future Trends in Consumer Health Informatics and Patient-Generated Health Data. Yearb Med Inform 2017; 26:152-159. [PMID: 29063559 PMCID: PMC6239232 DOI: 10.15265/iy-2017-016] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives: Consumer Health Informatics (CHI) and the use of Patient-Generated Health Data (PGHD) are rapidly growing focus areas in healthcare. The objective of this paper is to briefly review the literature that has been published over the past few years and to provide a sense of where the field is going. Methods: We searched PubMed and the ACM Digital Library for articles published between 2014 and 2016 on the topics of CHI and PGHD. The results of the search were screened for relevance and categorized into a set of common themes. We discuss the major topics covered in these articles. Results: We retrieved 65 articles from our PubMed query and 32 articles from our ACM Digital Library query. After a review of titles, we were left with 47 articles to conduct our full article survey of the activities in CHI and PGHD. We have summarized these articles and placed them into major categories of activity. Within the domain of consumer health informatics, articles focused on mobile health and patient-generated health data comprise the majority of the articles published in recent years. Conclusions: Current evidence indicates that technological advancements and the widespread availability of affordable consumer-grade devices are fueling research into using PGHD for better care. As we observe a growing number of (pilot) developments using various mobile health technologies to collect PGHD, major gaps still exist in how to use the data by both patients and providers. Further research is needed to understand the impact of PGHD on clinical outcomes.
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Affiliation(s)
- A. M. Lai
- Institute for Informatics, Washington University in St. Louis, USA
| | - P.-Y. S. Hsueh
- Computational Health Behavior and Decision Science, Center for Computational Health, IBM T.J. Watson Research Center, USA
| | - Y. K. Choi
- Department of Biomedical Informatics and Medical Education, University of Washington, USA
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Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, Yardley L. Using digital interventions for self-management of chronic physical health conditions: A meta-ethnography review of published studies. PATIENT EDUCATION AND COUNSELING 2017; 100:616-635. [PMID: 28029572 PMCID: PMC5380218 DOI: 10.1016/j.pec.2016.10.019] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/16/2016] [Accepted: 10/19/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To understand the experiences of patients and healthcare professionals (HCPs) using self-management digital interventions (DIs) for chronic physical health conditions. METHODS A systematic search was conducted in 6 electronic databases. Qualitative studies describing users' experiences of self-management DIs were included, and authors' interpretations were synthesised using meta-ethnography. RESULTS 30 papers met the inclusion criteria, covering a range of DIs and chronic conditions, including hypertension, asthma and heart disease. The review found that patients monitoring their health felt reassured by the insight this provided, and perceived they had more meaningful consultations with the HCP. These benefits were elicited by simple tele-monitoring systems as well as multifaceted DIs. Patients appeared to feel more reliant on HCPs if they received regular feedback from the HCP. HCPs focused mainly on their improved clinical control, and some also appreciated patients' increased understanding of their condition. CONCLUSIONS Patients using self-management DIs tend to feel well cared for and perceive that they adopt a more active role in consultations, whilst HCPs focus on the clinical benefits provided by DIs. PRACTICE IMPLICATIONS DIs can simultaneously support patient condition management, and HCPs' control of patient health. Tele-monitoring physiological data can promote complex behaviour change amongst patients.
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Affiliation(s)
- Katherine Morton
- Academic unit of Psychology, University of Southampton, Southampton, UK.
| | - Laura Dennison
- Academic unit of Psychology, University of Southampton, Southampton, UK.
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK.
| | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK.
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Lucy Yardley
- Academic unit of Psychology, University of Southampton, Southampton, UK.
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Blondon KS, Maître F, Muller-Juge V, Bochatay N, Cullati S, Hudelson P, Vu NV, Savoldelli GL, Nendaz MR. Interprofessional collaborative reasoning by residents and nurses in internal medicine: Evidence from a simulation study. MEDICAL TEACHER 2017; 39:360-367. [PMID: 28379080 DOI: 10.1080/0142159x.2017.1286309] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clinical reasoning has been studied in residents or nurses, using interviews or patient-provider encounters. Despite a growing interest in interprofessional collaboration, the notion of collaborative reasoning has not been well studied in clinical settings. Our study aims at exploring resident-nurse collaborative reasoning in a simulation setting. We enrolled 14 resident-nurse teams from a general internal medicine division in a mixed methods study. Teams each managed one of four acute case scenarios, followed by a stimulated-recall session. A qualitative, inductive analysis of the transcripts identified five dimensions of collaborative reasoning: diagnostic reasoning, patient management, patient monitoring, communication with the patient, and team communication. Three investigators (two senior physicians, one nurse) assessed individual and team performances using a five-point Likert scale, and further extracted elements supporting the collaborative reasoning process. Global assessment of the resident-nurse team was not simply an average of individual performances. Qualitative results underlined the need to improve situational awareness, particularly for task overload. Team communication helped team members stay abreast of each other's thoughts and improve their efficiency. Residents and nurses differed in their reasoning processes, and awareness of this difference may contribute to improving interprofessional collaboration. Understanding collaborative reasoning can provide an additional dimension to interprofessional education.
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Affiliation(s)
- K S Blondon
- a Division of General Internal Medicine , University Hospitals of Geneva , Geneva , Switzerland
| | - F Maître
- a Division of General Internal Medicine , University Hospitals of Geneva , Geneva , Switzerland
| | - V Muller-Juge
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - N Bochatay
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - S Cullati
- c Quality of Care Service , University Hospitals of Geneva , Geneva , Switzerland
- d Institute of Sociological Research, University of Geneva , Geneva , Switzerland
| | - P Hudelson
- e Department of Community Medicine, Primary Care and Emergency Medicine , University Hospitals of Geneva , Geneva , Switzerland
| | - N V Vu
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - G L Savoldelli
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
- f Division of Anaesthesiology , University Hospitals of Geneva , Geneva , Switzerland
| | - M R Nendaz
- a Division of General Internal Medicine , University Hospitals of Geneva , Geneva , Switzerland
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
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Huygens MWJ, Swinkels ICS, de Jong JD, Heijmans MJWM, Friele RD, van Schayck OCP, de Witte LP. Self-monitoring of health data by patients with a chronic disease: does disease controllability matter? BMC FAMILY PRACTICE 2017; 18:40. [PMID: 28320330 PMCID: PMC5360032 DOI: 10.1186/s12875-017-0615-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is a growing emphasis on self-monitoring applications that allow patients to measure their own physical health parameters. A prerequisite for achieving positive effects is patients' willingness to self-monitor. The controllability of disease types, patients' perceived self-efficacy and health problems could play an essential role in this. The purpose of this study is to investigate the relationship between patients' willingness to self-monitor and a range of disease and patient specific variables including controllability of disease type, patients' perceived self-efficacy and health problems. METHODS Data regarding 627 participants with 17 chronic somatic disease types from a Dutch panel of people with chronic diseases have been used for this cross-sectional study. Perceived self-efficacy was assessed using the general self-efficacy scale, perceived health problems using the Physical Health Composite Score (PCS). Participants indicated their willingness to self-monitor. An expert panel assessed for 17 chronic disease types the extent to which patients can independently keep their disease in control. Logistic regression analyses were conducted. RESULTS Patients' willingness to self-monitor differs greatly among disease types: patients with diabetes (71.0%), asthma (59.6%) and hypertension (59.1%) were most willing to self-monitor. In contrast, patients with rheumatism (40.0%), migraine (41.2%) and other neurological disorders (42.9%) were less willing to self-monitor. It seems that there might be a relationship between disease controllability scores and patients' willingness to self-monitor. No evidence is found of a relationship between general self-efficacy and PCS scores, and patients' willingness to self-monitor. CONCLUSIONS This study provides the first evidence that patients' willingness to self-monitor might be associated with disease controllability. Further research should investigate this association more deeply and should focus on how disease controllability influences willingness to self-monitor. In addition, since willingness to self-monitor differed greatly among patient groups, it should be taken into account that not all patient groups are willing to self-monitor.
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Affiliation(s)
- Martine W J Huygens
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Centre for Care Technology Research, Maastricht, The Netherlands.
| | - Ilse C S Swinkels
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Centre for Care Technology Research, Maastricht, The Netherlands
| | - Judith D de Jong
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Monique J W M Heijmans
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Roland D Friele
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Tilburg School of Social and Behavioral Sciences, Tilburg University, Tranzo, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands.,Centre for Care Technology Research, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Centre for Care Technology Research, Maastricht, The Netherlands
| | - Luc P de Witte
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Research Center Technology in Care, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN, Heerlen, The Netherlands.,Centre for Assistive Technology and Connected Healthcare (CATCH), University of Sheffield, 217 Portobello, Sheffield, S1 4DP, UK.,Centre for Care Technology Research, Maastricht, The Netherlands
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The interaction of fatigue, physical activity, and health-related quality of life in adults with multiple sclerosis (MS) and cardiovascular disease (CVD). Appl Nurs Res 2017; 33:49-53. [DOI: 10.1016/j.apnr.2016.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 01/06/2023]
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Aselmaa A, van Herk M, Laprie A, Nestle U, Götz I, Wiedenmann N, Schimek-Jasch T, Picaud F, Syrykh C, Cagetti LV, Jolnerovski M, Song Y, Goossens RH. Using a contextualized sensemaking model for interaction design: A case study of tumor contouring. J Biomed Inform 2017; 65:145-158. [DOI: 10.1016/j.jbi.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/02/2016] [Accepted: 12/04/2016] [Indexed: 12/28/2022]
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Mickelson RS, Unertl KM, Holden RJ. Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure. JMIR Hum Factors 2016; 3:e27. [PMID: 27733331 PMCID: PMC5081481 DOI: 10.2196/humanfactors.6338] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 01/04/2023] Open
Abstract
Background Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts. Objective The objective of this research was to describe and analyze the work of medication management by older adults with heart failure, using a macrocognitive workflow framework. Methods We interviewed and observed 61 older patients along with 30 informal caregivers about self-care practices including medication management. Descriptive qualitative content analysis methods were used to develop categories, subcategories, and themes about macrocognitive processes used in medication management workflow. Results We identified 5 high-level macrocognitive processes affecting medication management—sensemaking, planning, coordination, monitoring, and decision making—and 15 subprocesses. Data revealed workflow as occurring in a highly collaborative, fragile system of interacting people, artifacts, time, and space. Process breakdowns were common and patients had little support for macrocognitive workflow from current tools. Conclusions Macrocognitive processes affected medication management performance. Describing and analyzing this performance produced recommendations for technology supporting collaboration and sensemaking, decision making and problem detection, and planning and implementation.
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Affiliation(s)
- Robin S Mickelson
- Vanderbilt School of Nursing, Vanderbilt University, The Center for Research and Innovation in Systems Safety (CRISS), Vanderbilt University Medical Center, Nashville, TN, United States
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Pollack AH, Backonja U, Miller AD, Mishra SR, Khelifi M, Kendall L, Pratt W. Closing the Gap: Supporting Patients' Transition to Self-Management after Hospitalization. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2016; 2016:5324-5336. [PMID: 27500285 DOI: 10.1145/2858036.2858240] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs.
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Affiliation(s)
- Ari H Pollack
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Uba Backonja
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Andrew D Miller
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Sonali R Mishra
- The Information School, University of Washington, Seattle, WA, USA
| | - Maher Khelifi
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Logan Kendall
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, USA
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Chung CF, Dew K, Cole A, Zia J, Fogarty J, Kientz JA, Munson SA. Boundary Negotiating Artifacts in Personal Informatics: Patient-Provider Collaboration with Patient-Generated Data. CSCW : PROCEEDINGS OF THE CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK. CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK 2016; 2016:770-786. [PMID: 28516171 DOI: 10.1145/2818048.2819926] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patient-generated data is increasingly common in chronic disease care management. Smartphone applications and wearable sensors help patients more easily collect health information. However, current commercial tools often do not effectively support patients and providers in collaboration surrounding these data. This paper examines patient expectations and current collaboration practices around patient-generated data. We survey 211 patients, interview 18 patients, and re-analyze a dataset of 21 provider interviews. We find that collaboration occurs in every stage of self-tracking and that patients and providers create boundary negotiating artifacts to support the collaboration. Building upon current practices with patient-generated data, we use these theories of patient and provider collaboration to analyze misunderstandings and privacy concerns as well as identify opportunities to better support these collaborations. We reflect on the social nature of patient-provider collaboration to suggest future development of the stage-based model of personal informatics and the theory of boundary negotiating artifacts.
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Affiliation(s)
- Chia-Fang Chung
- Human Centered Design & Engineering, DUB Group, University of Washington
| | - Kristin Dew
- Human Centered Design & Engineering, DUB Group, University of Washington
| | - Allison Cole
- Family Medicine, DUB Group, University of Washington
| | - Jasmine Zia
- Division of Gastroenterology, DUB Group, University of Washington
| | - James Fogarty
- Computer Science & Engineering, DUB Group, University of Washington
| | - Julie A Kientz
- Human Centered Design & Engineering, DUB Group, University of Washington.,Computer Science & Engineering, DUB Group, University of Washington
| | - Sean A Munson
- Human Centered Design & Engineering, DUB Group, University of Washington.,Computer Science & Engineering, DUB Group, University of Washington
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Miyamoto SW, Henderson S, Young HM, Pande A, Han JJ. Tracking Health Data Is Not Enough: A Qualitative Exploration of the Role of Healthcare Partnerships and mHealth Technology to Promote Physical Activity and to Sustain Behavior Change. JMIR Mhealth Uhealth 2016; 4:e5. [PMID: 26792225 PMCID: PMC4758807 DOI: 10.2196/mhealth.4814] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/31/2015] [Accepted: 10/18/2015] [Indexed: 11/13/2022] Open
Abstract
Background Despite the recent explosion of the mobile health (mHealth) industry and consumer acquisition of mHealth tools such as wearable sensors and applications (apps), limited information is known about how this technology can sustain health behavior change and be integrated into health care. Objective The objective of the study was to understand potential users’ views of mHealth technology, the role this technology may have in promoting individual activity goals aimed at improving health, and the value of integrating mHealth technology with traditional health care. Methods Four focus groups were conducted with adults interested in sharing their views on how mHealth technology could support wellness programs and improve health. Participants (n=30) were enrolled from an employee population at an academic health institution. Qualitative thematic analysis was used to code transcripts and identify overarching themes. Results Our findings suggest that tracking health data alone may result in heightened awareness of daily activity, yet may not be sufficient to sustain use of mHealth technology and apps, which often have low reuse rates. Participants suggested that context, meaning, and health care partnerships need to be incorporated to engage and retain users. In addition to these findings, drivers for mHealth technology previously identified in the literature, including integration and control of health data were confirmed in this study. Conclusions This study explores ways that mHealth technologies may be used to not only track data, but to encourage sustained engagement to achieve individual health goals. Implications of these findings include recommendations for mHealth technology design and health care partnership models to sustain motivation and engagement, allowing individuals to achieve meaningful behavior change.
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Affiliation(s)
- Sheridan W Miyamoto
- College of Nursing, The Pennsylvania State University, University Park, CA, United States.
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Mamykina L, Heitkemper EM, Smaldone AM, Kukafka R, Cole-Lewis H, Davidson PG, Mynatt ED, Tobin JN, Cassells A, Goodman C, Hripcsak G. Structured scaffolding for reflection and problem solving in diabetes self-management: qualitative study of mobile diabetes detective. J Am Med Inform Assoc 2016; 23:129-36. [PMID: 26769910 DOI: 10.1093/jamia/ocv169] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 10/13/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate subjective experiences and patterns of engagement with a novel electronic tool for facilitating reflection and problem solving for individuals with type 2 diabetes, Mobile Diabetes Detective (MoDD). METHODS In this qualitative study, researchers conducted semi-structured interviews with individuals from economically disadvantaged communities and ethnic minorities who are participating in a randomized controlled trial of MoDD. The transcripts of the interviews were analyzed using inductive thematic analysis; usage logs were analyzed to determine how actively the study participants used MoDD. RESULTS Fifteen participants in the MoDD randomized controlled trial were recruited for the qualitative interviews. Usage log analysis showed that, on average, during the 4 weeks of the study, the study participants logged into MoDD twice per week, reported 120 blood glucose readings, and set two behavioral goals. The qualitative interviews suggested that individuals used MoDD to follow the steps of the problem-solving process, from identifying problematic blood glucose patterns, to exploring behavioral triggers contributing to these patterns, to selecting alternative behaviors, to implementing these behaviors while monitoring for improvements in glycemic control. DISCUSSION This qualitative study suggested that informatics interventions for reflection and problem solving can provide structured scaffolding for facilitating these processes by guiding users through the different steps of the problem-solving process and by providing them with context-sensitive evidence and practice-based knowledge related to diabetes self-management on each of those steps. CONCLUSION This qualitative study suggested that MoDD was perceived as a useful tool in engaging individuals in self-monitoring, reflection, and problem solving.
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Affiliation(s)
- Lena Mamykina
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | | | - Rita Kukafka
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Heather Cole-Lewis
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | | | - Jonathan N Tobin
- The Rockefeller University Center for Clinical and Translational Science, New York, NY USA Department of Epidemiology and Public Health, Albert Einstein College of Medicine of Yeshiva University/Montefiore Medical Center, New York, NY USA
| | | | | | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
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