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Terkes N, Bektas H, Balci MK. Effect of web-based education intervention on blood glucose control, self-care and quality of life in patients with type 2 diabetes: A single-blinded randomized controlled trial. Int J Nurs Pract 2024:e13298. [PMID: 39155430 DOI: 10.1111/ijn.13298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/12/2023] [Accepted: 08/04/2024] [Indexed: 08/20/2024]
Abstract
AIM This study aimed to assess the effects of web-based education on blood glucose control, self-care and quality of life in patients with type 2 diabetes. METHODS A single-blinded randomized controlled trial was conducted in accordance with the Consolidated Standards of Reporting Trials (CONSORT) checklist at a university hospital in Turkey. The study included 89 patients with type 2 diabetes who were randomly divided into an intervention group (44) and a control group (45). Participants in the intervention group participated in a 3-month web-based education programme. RESULTS The findings indicated that there were no significant differences in sociodemographic characteristics and illness features between the intervention and control groups, and both were homogeneous. A statistically significant decrease of 0.71 was observed in the HbA1c (%) level of the intervention group following web-based education. Following web-based education, there was a significant difference in body mass index (kg/m2) and waist circumferences (cm) between the intervention and control groups. The intervention group displayed significantly improved self-care and quality of life over the 3-month period (p < 0.05). CONCLUSION This study suggests that web-based education can enhance the self-care and quality of life of patients with type 2 diabetes.
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Affiliation(s)
- Nurten Terkes
- Bucak Health School, Department of Internal Medicine Nursing, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Hicran Bektas
- Faculty of Nursing, Department of Internal Medicine Nursing, Akdeniz University, Antalya, Turkey
| | - Mustafa Kemal Balci
- Department of Endocrinology and Metabolism Disease, Akdeniz University Hospital, Antalya, Turkey
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Scheckel B, Schmidt K, Stock S, Redaèlli M. Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability. J Med Internet Res 2023; 25:e38447. [PMID: 37624629 PMCID: PMC10492174 DOI: 10.2196/38447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features. OBJECTIVE This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability. METHODS We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design. RESULTS After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support. CONCLUSIONS The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.
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Affiliation(s)
- Benjamin Scheckel
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katharina Schmidt
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Development and evaluation of web-based Self-care Management Health Education e-Learning Program for type 2 diabetes patients: A pilot study. ENFERMERIA CLINICA 2023. [DOI: 10.1016/j.enfcli.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Ramírez-Durán MDV, Basilio-Fernández B, Gómez-Luque A, Alfageme-García P, Clavijo-Chamorro MZ, Jiménez-Cano VM, Fabregat-Fernández J, Robles-Alonso V, Hidalgo-Ruiz S. Efficacy of an Online Educational Intervention in Reducing Body Weight in the Pre-Diabetic Population of 18-45 Years Old, a Randomized Trial Protocol. J Pers Med 2022; 12:1669. [PMID: 36294808 PMCID: PMC9604779 DOI: 10.3390/jpm12101669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/20/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Aim: to analyze the efficacy of an educational online intervention focused on lifestyle changes in reducing body weight from baseline to 6 months in the pre-diabetic population of 18−45 years old in Extremadura (Spain). Methods: a single-blind, multicenter randomized parallel-comparison trial with two intervention groups in a 1:1 ratio will be carried out. Participants will be randomly assigned to intervention A or B with 37 cases in each group according to inclusion criteria of being enrolled or working at Extremadura University, scoring >7 points on the Findrisc test and not having diagnosed diabetes mellitus or physical disabilities. Intervention-A group will have access to online information about healthy diet and exercise. Intervention-B group will have access to a six-session educational program regarding behavioral changes in diet and exercise habits. They will complete follow-up activities and have a personal trainer and motivation. The primary outcome will be identifying changes in body weight from baseline to 1 and 6 months and between groups. The secondary outcomes will be accomplishing regular physical activity (>30 min/day or >4 h/week), decreasing sugary food intake or avoiding it altogether, increasing vegetable/fruit intake and lowering HbA1c levels to non-diabetic status when necessary.
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Affiliation(s)
| | - Belinda Basilio-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Adela Gómez-Luque
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Pilar Alfageme-García
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | | | - Víctor Manuel Jiménez-Cano
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Juan Fabregat-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Vicente Robles-Alonso
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Sonia Hidalgo-Ruiz
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
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Mikhael EM, Hassali MA, Hussain SA. Validation of newly developed culturally specific diabetes self-management education and support program for Iraqi type 2 diabetes mellitus patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:357. [PMID: 34761043 PMCID: PMC8552248 DOI: 10.4103/jehp.jehp_311_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Diabetes self-management (DSM) is the cornerstone in diabetes mellitus (DM) management. Unfortunately, the practice of DSM by Iraqi type 2 DM (T2DM) patients is poor that mainly resulted from their poor knowledge about the required DSM behaviors. This lack of knowledge may be attributed to the lack of DSM education and support (DSMES) program in Iraq. Thus, this study was conducted with aim of developing and validating a culturally specific DSMES program for Iraqi T2DM patients. MATERIALS AND METHODS The development and validation of the DSMES program was done according to the Hilda Taba model. Content validity of the program was done by a panel of 6 health-care experts in management of Iraqi DM patients. Face validity was confirmed by conducting a pilot study for six adults with uncontrolled T2DM at the National Diabetes Center, Baghdad, Iraq. Both the experts and patients were asked to evaluate the developed program in regard to its contents, design, and supporting material (booklet). The evaluation was done by filling in a questionnaire that based on a 5-point scale. Items with a score ≥4 by <70% of the experts and patients were subjected to revision and further assessment. RESULTS No total disagreement for any item was expressed by all participants (experts and patients). Content and face validity was ensured through obtaining a positive feedback from all participants at which all items about the program had scores of ≥4 by at least 75% of participants. CONCLUSION The developed culturally based DSMES program is highly suitable for educating Iraqi T2DM patients.
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Affiliation(s)
- Ehab Mudher Mikhael
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Mohamed Azmi Hassali
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Saad Abdulrahman Hussain
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq
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Shariati E, Dadgari A, Talebi SS, Mahmoodi Shan GR, Ebrahimi H. The Effect of the Web-Based Communication between a Nurse and a Family Member on the Perceived Stress of the Family Member of Patients with Suspected or Confirmed COVID-19: A Parallel Randomized Clinical Trial. Clin Nurs Res 2021; 30:1098-1106. [PMID: 34044625 DOI: 10.1177/10547738211017688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to identify the effect of web-based communication between a nurse and a family member of a patient with COVID-19 on his/her perceived stress. In this multicenter parallel randomized controlled trial, 67 family members of COVID-19 patients admitted to the Intensive Care Unit (ICU) were investigated. In the intervention group, web-based communication was performed for four consecutive days for 10 to 15 minutes. The Perceived Stress Scale (PSS-14) were completed in both groups before and after the intervention. Mean and standard deviation of perceived stress scores in the two groups were not significantly different (p = 0.26) before the intervention; however, after the intervention, the mean PSS-14 in the intervention group was significantly lower than that of the control group (p < 0.001). Due to the need to follow the physical and social distancing to protect against Coronavirus disease, the use of web-based communication recommended in future studies.
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Affiliation(s)
- Esmail Shariati
- The Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ali Dadgari
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Seyedeh Solmaz Talebi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Hossein Ebrahimi
- Center for Health-Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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Yang Q, Millette D, Zhou C, Beatty M, Carcioppolo N, Wilson G. The Effectiveness of Interactivity in Improving Mediating Variables, Behaviors and Outcomes of Web-Based Health Interventions: A Meta-Analytic Review. HEALTH COMMUNICATION 2020; 35:1334-1348. [PMID: 31240958 DOI: 10.1080/10410236.2019.1631992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite the increasing amount of research investigating health interventions that applies to interactive computer technology, the effect sizes in Cohen's d obtained across these studies range from -0.32 to 1.74. The lack of systematic review of interactive health interventions leaves their overall effectiveness unknown. To address this, a meta-analysis of 67 studies examining the effects of web-based interactive health interventions was conducted. Results indicated that web-based interactive health interventions were effective in general, but the effects were moderated by health topic, theoretical framework, and design of treatment and control groups. The unique advantage of interactivity was small but significant when comparing to health interventions with comparable information in non-interactive version. Theoretical and practical implications of findings were discussed.
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Affiliation(s)
- Qinghua Yang
- Department of Communication Studies, Texas Christian University
| | - Diane Millette
- Department of Communication Studies, University of Miami
| | - Chun Zhou
- Department of Communication, Florida International University
| | - Michael Beatty
- Department of Communication Studies, University of Miami
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Reséndiz Lara T, Muñoz Torres AV, Mendoza Salmerón G, Zendejas Vela DD, Medina Bravo P, Roy García I, Velázquez López L. La educación con una plataforma multimedia en web mejora los conocimientos y la HbA1c de pacientes mexicanos con diabetes tipo 2. Ensayo clínico abierto. ENDOCRINOL DIAB NUTR 2020; 67:530-539. [DOI: 10.1016/j.endinu.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 10/25/2022]
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Tang SK, Tse MMY, Leung SF, Fotis T. Acute and chronic musculoskeletal pain situations among the working population and their pain education needs: an exploratory study. Fam Pract 2020; 37:445-452. [PMID: 32107538 DOI: 10.1093/fampra/cmaa013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pain affects a person's physical and psychological well-being, work performance and productivity. Working population bear their pain and continue to work which may contribute to the worsening of their pain condition. However, their pain situation was not well-examined. OBJECTIVE The aim of the study was to explore the prevalence of acute and chronic pain in the working population in Hong Kong, understand their pain management strategies and determine their preferences with regard to the use of electronic pain management materials. METHODS This was an exploratory online survey. The participants' pain history, their preferences in methods of pain management, the source of the pain management education that they had received, sources and preferences in relation to the use of the Internet for pain education, and the participants' demographic characteristics were collected. RESULTS A total of 210 participants joined the study, 67% of whom were experiencing pain. Of the group in pain, 71.6% were in chronic pain that has persisted for 3 months or more. Pain intensities ranged from 2.82 to 3.82 on a 10-point numeric scale. Of the participants, 85.7% reported not receiving adequate pain management education, and 91.4% of those agreed pain services were inadequate. Websites and health care professionals were the sources from which they obtained their pain management education. CONCLUSIONS The high prevalence of pain in the working population requires special attention. Health care professionals should be proactive and an online pain management programme can be a solution to address the critical problem of pain in the working population.
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Affiliation(s)
- Shuk Kwan Tang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Mimi Mun Yee Tse
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Theofanis Fotis
- School of Health Sciences, University of Brighton, Westlain House, Village Way, Brighton, UK
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Allida S, Du H, Xu X, Prichard R, Chang S, Hickman LD, Davidson PM, Inglis SC. mHealth education interventions in heart failure. Cochrane Database Syst Rev 2020; 7:CD011845. [PMID: 32613635 PMCID: PMC7390434 DOI: 10.1002/14651858.cd011845.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a chronic disease with significant impact on quality of life and presents many challenges to those diagnosed with the condition, due to a seemingly complex daily regimen of self-care which includes medications, monitoring of weight and symptoms, identification of signs of deterioration and follow-up and interaction with multiple healthcare services. Education is vital for understanding the importance of this regimen, and adhering to it. Traditionally, education has been provided to people with heart failure in a face-to-face manner, either in a community or a hospital setting, using paper-based materials or video/DVD presentations. In an age of rapidly-evolving technology and uptake of smartphones and tablet devices, mHealth-based technology (defined by the World Health Organization as mobile and wireless technologies to achieve health objectives) is an innovative way to provide health education which has the benefit of being able to reach people who are unable or unwilling to access traditional heart failure education programmes and services. OBJECTIVES To systematically review and quantify the potential benefits and harms of mHealth-delivered education for people with heart failure. SEARCH METHODS We performed an extensive search of bibliographic databases and registries (CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) Search Portal), using terms to identify HF, education and mHealth. We searched all databases from their inception to October 2019 and imposed no restriction on language of publication. SELECTION CRITERIA We included studies if they were conducted as a randomised controlled trial (RCT), involving adults (≥ 18 years) with a diagnosis of HF. We included trials comparing mHealth-delivered education such as internet and web-based education programmes for use on smartphones and tablets (including apps) and other mobile devices, SMS messages and social media-delivered education programmes, versus usual HF care. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risks of bias, and extracted data from all included studies. We calculated the mean difference (MD) or standardised mean difference (SMD) for continuous data and the odds ratio (OR) for dichotomous data with a 95% confidence interval (CI). We assessed heterogeneity using the I2 statistic and assessed the quality of evidence using GRADE criteria. MAIN RESULTS We include five RCTs (971 participants) of mHealth-delivered education interventions for people with HF in this review. The number of trial participants ranged from 28 to 512 participants. Mean age of participants ranged from 60 years to 75 years, and 63% of participants across the studies were men. Studies originated from Australia, China, Iran, Sweden, and The Netherlands. Most studies included participants with symptomatic HF, NYHA Class II - III. Three studies addressed HF knowledge, revealing that the use of mHealth-delivered education programmes showed no evidence of a difference in HF knowledge compared to usual care (MD 0.10, 95% CI -0.2 to 0.40, P = 0.51, I2 = 0%; 3 studies, 411 participants; low-quality evidence). One study assessing self-efficacy reported that both study groups had high levels of self-efficacy at baseline and uncertainty in the evidence for the intervention (MD 0.60, 95% CI -0.57 to 1.77; P = 0.31; 1 study, 29 participants; very low-quality evidence).Three studies evaluated HF self-care using different scales. We did not pool the studies due to the heterogenous nature of the outcome measures, and the evidence is uncertain. None of the studies reported adverse events. Four studies examined health-related quality of life (HRQoL). There was uncertainty in the evidence for the use of mHealth-delivered education on HRQoL (MD -0.10, 95% CI -2.35 to 2.15; P = 0.93, I2 = 61%; 4 studies, 942 participants; very low-quality evidence). Three studies reported on HF-related hospitalisation. The use of mHealth-delivered education may result in little to no difference in HF-related hospitalisation (OR 0.74, 95% CI 0.52 to 1.06; P = 0.10, I2 = 0%; 3 studies, 894 participants; low-quality evidence). We downgraded the quality of the studies due to limitations in study design and execution, heterogeneity, wide confidence intervals and fewer than 500 participants in the analysis. AUTHORS' CONCLUSIONS We found that the use of mHealth-delivered educational interventions for people with HF shows no evidence of a difference in HF knowledge; uncertainty in the evidence for self-efficacy, self-care and health-related quality of life; and may result in little to no difference in HF-related hospitalisations. The identification of studies currently underway and those awaiting classification indicate that this is an area of research from which further evidence will emerge in the short and longer term.
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Affiliation(s)
- Sabine Allida
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Huiyun Du
- School of Nursing and Midwifery, Flinders University, Bedford Park, Australia
| | - Xiaoyue Xu
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Roslyn Prichard
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sungwon Chang
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Louise D Hickman
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
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GÜLCÜ S, ARSLAN S, ARSLANOĞLU İ. Tip 1 Diyabetli Adolesanlarda Web Tabanlı Egzersiz Eğitiminin Etkinliği. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.589195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Turnbull S, Cabral C, Hay A, Lucas PJ. Health Equity in the Effectiveness of Web-Based Health Interventions for the Self-Care of People With Chronic Health Conditions: Systematic Review. J Med Internet Res 2020; 22:e17849. [PMID: 32459632 PMCID: PMC7305554 DOI: 10.2196/17849] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background Web-based self-care interventions have the potential to reduce health inequalities by removing barriers to access to health care. However, there is a lack of evidence about the equalizing effects of these interventions on chronic conditions. Objective This study investigated the differences in the effectiveness of web-based behavioral change interventions for the self-care of high burden chronic health conditions (eg, asthma, chronic obstructive pulmonary disease [COPD], diabetes, and osteoarthritis) across socioeconomic and cultural groups. Methods A systematic review was conducted, following Cochrane review guidelines. We conducted searches in Ovid Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature databases. Studies with any quantitative design were included (published between January 1, 2006, and February 20, 2019) if they investigated web-based self-care interventions targeting asthma, COPD, diabetes, and osteoarthritis; were conducted in any high-income country; and reported variations in health, behavior, or psychosocial outcomes across social groups. Study outcomes were investigated for heterogeneity, and the possibility of a meta-analysis was explored. A narrative synthesis was provided together with a novel figure that was developed for this review, displaying heterogeneous outcomes. Results Overall, 7346 records were screened and 18 studies were included, most of which had a high or critical risk of bias. Important study features and essential data were often not reported. The meta-analysis was not possible due to the heterogeneity of outcomes. There was evidence that intervention effectiveness was modified by participants’ social characteristics. Minority ethnic groups were found to benefit more from interventions than majority ethnic groups. Single studies with variable quality showed that those with higher education, who were employed, and adolescents with divorced parents benefited more from interventions. The evidence for differences by age, gender, and health literacy was conflicting (eg, in some instances, older people benefited more, and in others, younger people benefited more). There was no evidence of differences in income, numeracy, or household size. Conclusions There was evidence that web-based self-care interventions for chronic conditions can be advantageous for some social groups (ie, minority ethnic groups, adolescents with divorced parents) and disadvantageous for other (ie, low education, unemployed) social groups who have historically experienced health inequity. However, these findings should be treated with caution as most of the evidence came from a small number of low-quality studies. The findings for gender and health literacy were mixed across studies on diabetes, and the findings for age were mixed across studies on asthma, COPD, and diabetes. There was no evidence that income, numeracy, or the number of people living in the household modified intervention effectiveness. We conclude that there appear to be interaction effects, which warrant exploration in future research, and recommend a priori consideration of the predicted interaction effects. Trial Registration PROSPERO CRD42017056163; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=56163
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Affiliation(s)
- Sophie Turnbull
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Christie Cabral
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alastair Hay
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Patricia J Lucas
- School for Policy Studies, University of Bristol, Bristol, United Kingdom
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Tang SK, Tse MMY, Leung SF, Fotis T. The effectiveness of an electronic pain management programme for the working population with chronic pain: study protocol for a randomized controlled trial. Trials 2020; 21:421. [PMID: 32448387 PMCID: PMC7245757 DOI: 10.1186/s13063-020-04348-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022] Open
Abstract
Background Chronic pain is highly prevalent in the working population. People tend to attempt self-initiated treatments to manage their pain. The self-efficacy of behavioural change is a suitable model for guiding the development of an electronic pain management programme (ePain). The aim in this study is to develop ePain and to evaluate its effectiveness at improving pain self-efficacy, reducing pain intensity and negative emotions, and increasing quality of life. Methods This study will be a randomized controlled trial. ePain will take the form of a 6-week online pain management programme. Participants will be aged 15 years or above, have chronic pain, and be employed. They must complete the baseline questionnaire and will be randomized into intervention and control groups. They will receive notifications to encourage their participation in ePain and complete the evaluation questionnaires. They will complete the process evaluation at week 3, the post assessment at week 6, and the follow-up assessment at week 12. The study will focus on pain self-efficacy; pain situations; negative emotions including levels of depression, anxiety, and stress; and quality of life. The participants’ opinions of ePain will be collected as feedback. Data will be analysed on an intention-to-treat basis and generalized estimating equations will be used to investigate the time-averaged difference and differences at each follow-up time. Discussion The study will provide information about the pain situations of online users in the working population. The participants will benefit from improvements in pain self-efficacy, pain situations, emotional status, and quality of life. The study will illustrate whether online learning is an effective intervention for improving the pain self-efficacy of the working population. Trial registration ClinicalTrials.gov, NCT03718702. Registered on 23 October 2018.
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Affiliation(s)
- Shuk Kwan Tang
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Mimi Mun Yee Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Theofanis Fotis
- School of Health Sciences, University of Brighton, Westlain House, Village Way, Brighton, BN1 9PH, UK
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Adu MD, Malabu UH, Malau-Aduli AEO, Drovandi A, Malau-Aduli BS. Efficacy and Acceptability of My Care Hub Mobile App to Support Self-Management in Australians with Type 1 or Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2573. [PMID: 32283659 PMCID: PMC7177976 DOI: 10.3390/ijerph17072573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/04/2020] [Accepted: 04/05/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the preliminary efficacy and user acceptance of My Care Hub (MCH) mobile app-developed to provide evidenced-based support and education on diabetes self-management (DSM). Using a mixed-methods design, the efficacy and acceptability of MCH were measured among people with type 1 or type 2 diabetes after three weeks of intervention. The primary outcome measure was level of involvement with DSM, while the mediating factors were skills and self-efficacy for DSM. Telephone interviews were conducted to elucidate information on perceptions of the app's impact on participants' DSM and interest in future use. Statistically significant improvements were observed between pre- and post-intervention measures: DSM activities (4.55 ± 1.14 vs. 5.35 ± 0.84; p = 0.001); skills (7.10 ± 1.99 vs. 7.90 ± 1.67; p = 0.04); and self-efficacy (7.33 ±1.83 vs. 8.07 ± 1.54; p = 0.03). Multivariate analysis showed that self-efficacy had the strongest, though not significant influence on DSM. Interview findings revealed that the app reinforced knowledge and provided motivation to participate in DSM activities. The study suggested a positive impact of MCH on DSM and acceptability by patients. To confirm these promising results, further large scale and long-term studies are required.
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Affiliation(s)
- Mary D. Adu
- College of Medicine and Dentistry, James Cook University, Townsville QLD 4811, Australia; (M.D.A.); (U.H.M.); (A.D.); (B.S.M.-A.)
| | - Usman H. Malabu
- College of Medicine and Dentistry, James Cook University, Townsville QLD 4811, Australia; (M.D.A.); (U.H.M.); (A.D.); (B.S.M.-A.)
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia
| | - Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville QLD 4811, Australia; (M.D.A.); (U.H.M.); (A.D.); (B.S.M.-A.)
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville QLD 4811, Australia; (M.D.A.); (U.H.M.); (A.D.); (B.S.M.-A.)
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Zhang Z, Monro J, Venn BJ. Development and Evaluation of an Internet-Based Diabetes Nutrition Education Resource. Nutrients 2019; 11:E1217. [PMID: 31142056 PMCID: PMC6627433 DOI: 10.3390/nu11061217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/19/2023] Open
Abstract
Nutritional education for pre- and type 2 diabetes empowers individuals to make positive dietary and lifestyle choices. As the world migrates to digital devices, opportunities arise for education resources to reach a broad spectrum of society. This study aimed to develop and test the effectiveness of an electronic nutritional education resource for people with pre- and type 2 diabetes within the multi-ethnic New Zealand population. A needs assessment was conducted via ethnic-specific discussion groups (n = 29), followed by a population-based online survey (n = 448). An educational resource, including an educational video and pre- and post-questionnaires, was developed and tested online among 156 participants (17 with pre- and type 2 diabetes, 118 interested lay public and 21 health professionals). There was a strong desire to learn nutrition through simple, visual, practical, and culturally appropriate online educational resources. After interacting with the educational resource, the accuracy of identifying foods that increase blood glucose concentration improved by 17.4% (p = 0.013) in people with pre- and type 2 diabetes, 12.8% (p = 0.003) in health professionals, and 16.3% (p < 0.001) in interested lay public. There was an improvement among ethnic minority participants of 14.1% (p = 0.003). Most participants expressed intentions to make positive dietary and lifestyle choices. The electronic nutrition education resource was found to be an effective means for delivering education. It has potential to bridge the gap between the limited supply of healthcare resources and the increasing demand for diabetes nutrition education.
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Affiliation(s)
- Zhuoshi Zhang
- Department of Human Nutrition, University of Otago, PO Box 56, 9054 Dunedin, New Zealand.
| | - John Monro
- New Zealand Institute for Plant & Food Research Ltd, 11600 Private Bag, Palmerston North, New Zealand.
| | - Bernard J Venn
- Department of Human Nutrition, University of Otago, PO Box 56, 9054 Dunedin, New Zealand.
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Scalia P, Durand MA, Faber M, Kremer JA, Song J, Elwyn G. User-testing an interactive option grid decision aid for prostate cancer screening: lessons to improve usability. BMJ Open 2019; 9:e026748. [PMID: 31133587 PMCID: PMC6538002 DOI: 10.1136/bmjopen-2018-026748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To user-test a web-based, interactive Option Grid decision aid 'prostate-specific antigen (PSA) test: yes or no?' to determine its usability, acceptability and feasibility with men of high and low health literacy. DESIGN A semi-structured interview study. SETTING Interviews were conducted at a senior centre, academic hospital or college library in New Hampshire and Vermont. PARTICIPANTS Individuals over 45 years of age with no history of prostate cancer who voluntarily contacted study authors after viewing local invitations were eligible for inclusion. Twenty interviews were conducted: 10 participants had not completed a college degree, of which eight had low health literacy, and 10 participants had high health literacy. INTERVENTION An interactive, web-based Option Grid patient decision aid for considering whether or not to have a PSA test. RESULTS Users with lower health literacy levels were able to understand the content in the tool but were not able to navigate the Option Grid independent of assistance. The tool was used independently by men with high health literacy. In terms of acceptability, the flow of questions and answers embedded in the tool did not seem intuitive to some users who preferred seeing more risk information related to age and family history. Users envisioned that the tool could be feasibly implemented in clinical workflows. CONCLUSION Men in our sample with limited health literacy had difficulty navigating the Option Grid, thus suggesting that the tool was not appropriately designed to be usable by all audiences. The information provided in the tool is acceptable, but users preferred to view personalised risk information. Some participants could envision using this tool prior to an encounter in order to facilitate a better dialogue with their clinician. ETHICS APPROVAL The study received ethical approval from the Dartmouth College Committee for the Protection of Human Subjects (STUDY00030116).
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Marjan Faber
- Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - J A Kremer
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Julia Song
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
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Carpenter R, DiChiacchio T, Barker K. Interventions for self-management of type 2 diabetes: An integrative review. Int J Nurs Sci 2019; 6:70-91. [PMID: 31406872 PMCID: PMC6608673 DOI: 10.1016/j.ijnss.2018.12.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/17/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? PURPOSE/OBJECTIVES The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. DESIGN An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. PROCEDURES A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). RESULTS Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. CONCLUSIONS Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.
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Affiliation(s)
- Roger Carpenter
- West Virginia University School of Nursing, Morgantown, WV, 26506, USA
| | - Toni DiChiacchio
- Faculty Practice & Community Engagement, West Virginia University, Morgantown, WV, 26506, USA
| | - Kendra Barker
- West Virginia University School of Nursing, Morgantown, WV, 26506, USA
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Karahan Okuroğlu G, Ecevit Alpar Ş. Effect of Web-based diabetes training program on diabetes-related knowledge, attitudes, and skills of health professionals: A randomized controlled trial. Jpn J Nurs Sci 2018; 16:184-193. [PMID: 30073784 DOI: 10.1111/jjns.12228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/24/2018] [Accepted: 05/29/2018] [Indexed: 12/01/2022]
Abstract
AIM To determine the effect of a Web-Based Diabetes Training Program (WB-DTP) on the diabetes-related knowledge, attitudes, and skills of health professionals. METHODS This was an experimental pretest-post-test with a 1 month follow-up study design that included a control group. The results of the power analysis suggested that 50 individuals with diabetes should be in both the intervention and the control groups. The WB-DTP was developed in accordance with the Effective Teaching Instruction Model.. Measures included the information form, Achievement Test (AT), Diabetes Attitudes Scale (DAS), and skill observation forms. The Wilcoxon's Signed Rank test, Mann-Whitney U-test, and Friedman test were used to analyze group differences on these measures. RESULTS There was a significant difference between the AT post-test and the follow-up test scores of the intervention and control groups. No significant difference was present for the DAS post-test and follow-up scores between the intervention and control groups. A significant difference emerged on the Insulin Injection Skill Observation Form score between the intervention and control groups. In addition, there was a significant difference in the measurement level of blood glucose by the Glucometer Skill Observation Form between the intervention and control groups. CONCLUSIONS As a result, it was determined that the WB-DTP is effective in increasing the diabetes-related knowledge and skills of healthcare professionals. However, the program was not adequate at increasing the diabetes-related attitudes of health professionals.
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Affiliation(s)
- Gülten Karahan Okuroğlu
- Marmara University, Faculty of Health Sciences, Division of Nursing, Department of Nursing Fundamentals, Başıbüyük Campus, İstanbul, Turkey
| | - Şule Ecevit Alpar
- Marmara University, Faculty of Health Sciences, Division of Nursing, Department of Nursing Fundamentals, Başıbüyük Campus, İstanbul, Turkey
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Rush KL, Hatt L, Janke R, Burton L, Ferrier M, Tetrault M. The efficacy of telehealth delivered educational approaches for patients with chronic diseases: A systematic review. PATIENT EDUCATION AND COUNSELING 2018; 101:1310-1321. [PMID: 29486994 DOI: 10.1016/j.pec.2018.02.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The virtual delivery of patient education and other forms of telehealth have been proposed as alternatives to providing needed care for patients with chronic diseases. The purpose of this systematic review was to compare the efficacy of virtual education delivery on patient outcomes compared with usual care. METHODS The review examined citations from 3 databases, MEDLINE, CINAHL, and EMBASE using the search words telehealth, chronic disease, patient education, and related concepts. From 2447 records published between 2006 and 2017, 16 high to moderate quality studies were selected for review. Eligible papers compared virtual education to usual care using designs allowing for assessment of causality. RESULTS Telehealth modalities included the web, telephone, videoconference, and television delivered to patients with diabetes, chronic obstructive pulmonary disease, irritable bowel syndrome and heart failure. In 11 of 16 studies, virtually delivered interventions significantly improved outcomes compared to control conditions. In the remaining 5 studies, virtual education showed comparable outcomes to the control conditions. CONCLUSIONS Findings demonstrated that virtual education delivered to patients with chronic diseases was comparable, or more effective, than usual care. RESEARCH IMPLICATIONS Despite its benefits, there is potential for further research into the individual components which improve effectiveness of virtually delivered interventions.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada.
| | - Linda Hatt
- Irving K. Barber School of Arts and Sciences, University of British Columbia, Okanagan, Kelowna, Canada
| | - Robert Janke
- Library, University of British Columbia, Okanagan, Kelowna, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada
| | - Matthew Ferrier
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada
| | - Meghan Tetrault
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada
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Reagan L, Pereira K, Jefferson V, Evans Kreider K, Totten S, D’Eramo Melkus G, Johnson C, Vorderstrasse A. Diabetes Self-management Training in a Virtual Environment. DIABETES EDUCATOR 2017. [DOI: 10.1177/0145721717715632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetes self-management training (DSMT) improves diabetes health outcomes. However, low numbers of patients receive DSMT. Using virtual environments (VEs) for DSMT is an innovative approach to removing barriers for patients. The purpose of this paper is to describe the experience of health professionals and diabetes educators establishing and teaching DSMT in a VE, Diabetes LIVE© (Learning in Virtual Environments), and the implications for future use of VEs in DSMT. It was found that providing DSMT in a VE preserves real-time interaction between patients and educators. To facilitate ongoing patient learning and engagement, the DSMT curriculum was expanded beyond the core content as “Above and Beyond” topics. Using a VE for DSMT presents challenges and opportunities. Challenges include overcoming technological barriers and improving comfort levels to orient educators and patients to the functionality of the VE. Opportunities include overcoming barriers to reaching patients, particularly given the diabetes epidemic and relatively small number of diabetes educators. Using a VE also affords a simulated community for experiential learning. VEs may become powerful tools for diabetes and other health educators to reach patients. Ongoing education and support are vital to successful self-management of chronic disease.
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Affiliation(s)
- Louise Reagan
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Katherine Pereira
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Vanessa Jefferson
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Kathryn Evans Kreider
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Susan Totten
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Gail D’Eramo Melkus
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Constance Johnson
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Allison Vorderstrasse
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
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Huang MC, Hung CH, Yu CY, Berry DC, Shin SJ, Hsu YY. The effectiveness of multimedia education for patients with type 2 diabetes mellitus. J Adv Nurs 2016; 73:943-954. [PMID: 27779772 DOI: 10.1111/jan.13194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 12/29/2022]
Abstract
AIMS The aim of this study was to explore the effectiveness of two types of health education on improving knowledge concerning diabetes and insulin injection, insulin injection skills and self-efficacy, satisfaction with health education and glycated haemoglobin (HbA1c) and creatinine levels among patients with type 2 diabetes who began insulin therapy using a pen injector. BACKGROUND Insulin therapy is recommended to facilitate the regulation of plasma glucose; however, patient's acceptance of insulin therapy is generally low. Healthcare providers should help them improve their knowledge of diabetes and insulin injection, as well as their insulin injection skills. DESIGN A randomized repeated measures experimental study design. METHODS The experimental (n = 21) and control (n = 21) groups received multimedia and regular health education programmes, respectively from October 2013-August 2014. Four structured questionnaires were used and videotapes were applied to demonstrate injection skills. RESULTS Generalized estimating equations showed that the experimental group's scores were significantly higher than those of the control group for diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. On the other hand, an analysis of covariance revealed glycated hemoglobin (HbA1c) and creatinine levels did not differ significantly between the two groups. CONCLUSIONS Implementation of a multimedia diabetes education programme could improve patients' diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. Healthcare providers should improve quality of patient care by providing multimedia diabetes health education.
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Affiliation(s)
- Mei-Chuan Huang
- School of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Chich-Hsiu Hung
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Yun Yu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Diane C Berry
- School of Nursing, Beerstecher-Blackwell Distinguished Term Scholar, Chapel Hill, North Carolina, U.S.A
| | - Shyi-Jang Shin
- School of Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Sayakhot P, Carolan-Olah M, Steele C. Use of a web-based educational intervention to improve knowledge of healthy diet and lifestyle in women with Gestational Diabetes Mellitus compared to standard clinic-based education. BMC Pregnancy Childbirth 2016; 16:208. [PMID: 27495978 PMCID: PMC4974775 DOI: 10.1186/s12884-016-0996-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 07/29/2016] [Indexed: 12/01/2022] Open
Abstract
Background This study introduced a web-based educational intervention for Australian women with gestational diabetes mellitus (GDM). The aim was to improve knowledge on healthy diet and lifestyle in GDM. Evaluation of the intervention explored women’s knowledge and understanding of GDM, healthy diet, healthy food, and healthy lifestyle, after using the web-based program compared to women receiving standard clinic-based GDM education. Methods A total of 116 women, aged 18–45 years old, newly diagnosed with GDM, participated (Intervention (n) = 56 and control (n) = 60). Women were randomly allocated to the intervention or control groups and both groups attended a standard GDM education class. Group 1(Intervention) additionally used an online touch screen/computer program. All women completed a questionnaire following the computer program and/or the education class. All questions evaluating levels of knowledge had more than one correct answer and scores were graded from 0 to 1, with each correct component receiving a score, eg. 0.25 per each correct answer in a 4 answer question. Chi-square test was performed to compare the two groups regarding knowledge of GDM. Results Findings indicated that the majority of women in the intervention group reported correct answers for “types of carbohydrate foods” for pregnant women with GDM, compared to the control group (62.5 % vs 58.3 %, respectively). Most women in both groups had an excellent understanding of “fruits and vegetables” (98.2 % vs 98.3 %), and the majority of women in the intervention group understood that they should exercise daily for 30 min, compared to the control group (92.9 % vs 91.7 %). Both groups had a good understanding across all categories, however, the majority of women in the intervention group scored all correct answers (score = 1) in term of foetal effects (17.9 % vs 13.3 %, respectively), maternal predictors (5.4 % vs 5 %), care requirements (39.3 % vs 23.3 %), GDM perceptions (48.2 % vs 46.7 %) and GDM treatment (67.9 % vs 61.7 %), compared to women in the control group. Conclusion The study suggested that both approaches, standard education and standard education plus web-based program, resulted in excellent knowledge scores, but not statistically significant difference between groups. Multiple and immediate access to the web-based education program at home may prove useful as a source of reference for women with GDM. Future study comparing results pre and post intervention is needed. Trial registration ACTRN12615000697583; Date registered: 03/07/2015; Retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0996-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Padaphet Sayakhot
- Victoria University, St Albans Campus, College of Health and Biomedicine, Building 4C, McKechnie Street, St Albans, Victoria, 3021, Australia.
| | - Mary Carolan-Olah
- Victoria University, St Albans Campus, College of Health and Biomedicine, Building 4C, McKechnie Street, St Albans, Victoria, 3021, Australia
| | - Cheryl Steele
- Diabetes Education Service, Endocrinology and Diabetes Centre, Western Health Sunshine Hospital, 176 Furlong Road, Sunshine, Victoria, 3021, Australia
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Nelson LA, Coston TD, Cherrington AL, Osborn CY. Patterns of User Engagement with Mobile- and Web-Delivered Self-Care Interventions for Adults with T2DM: A Review of the Literature. Curr Diab Rep 2016; 16:66. [PMID: 27255269 PMCID: PMC5268129 DOI: 10.1007/s11892-016-0755-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Technology-delivered interventions can improve the health behaviors and clinical outcomes of persons with diabetes, but only if end users engage with these interventions. To summarize the current knowledge on engagement with technology-based interventions, we conducted a review of recent mobile- and web-delivered intervention studies for adults with type 2 diabetes published from 2011 to 2015. Among 163 identified studies, 24 studies satisfied our inclusion criteria. There was substantial variation in how intervention engagement was reported across studies. Engagement rates were lower among interventions with a longer duration, and engagement decreased over time. In several studies, older age and lower health literacy were associated with less engagement, and more engagement was associated with intervention improvement in at least one outcome, including glycemic control. Future technology-based intervention studies should report on engagement, examine and report on associations between user characteristics and engagement, and aim to standardize how this is reported, particularly in longer trials.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Taylor D Coston
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrea L Cherrington
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chandra Y Osborn
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Diabetes Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
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Jha S, Dogra S, Yadav A, Siddiqui S, Panda M, Srivastava K, Raghuvanshi L, Kaur S, Bhargava A, Mathur R, Gupta SK, Waghdhare S. A prospective observational study to assess the effectiveness of an electronic health (E-health) and mobile health (M-health) platform versus conventional care for the management of diabetes mellitus. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0501-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Farmahini Farahani M, Purfarzad Z, Ghorbani M, Ghamari Zare Z, Ghorbani F. The impact of Multimedia Software Support on the Knowledge and Self-Care Behaviors of Patients with Type 2 Diabetes: a Randomized Clinical Trial. J Caring Sci 2016; 5:111-20. [PMID: 27354975 PMCID: PMC4923835 DOI: 10.15171/jcs.2016.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/30/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction: Education is the most effective and economical
part of diabetes treatment. The purpose of this study was to investigate the effect of a
training program with multimedia software on the knowledge and self-care behaviors of
patients with type 2 diabetes. Methods: This study was a randomized controlled clinical
trial in which 60 patients referred to diabetes clinic at Arak city were divided randomly
into experimental (n=30) and control (n=30) groups. The instruments for collecting data
were "Summary of Diabetes self-care activities questionnaire" and "knowledge of self-care
in patients with diabetes". Data were collected before and 2 months after the intervention
in the both groups. Educational program with equal content was applied for both
experimental group (self-care program with multimedia software support) & control
group (lecture and presentation with PowerPoint). Data analysis was done using SPSS
Ver.13. Results: Implementation of the self-care program with
multimedia software support resulted in improvements in patients’ self-care behaviors in
the experimental group, whereas these behaviors had not significant changes in the control
group after eight weeks. There was a significant difference in the mean score of knowledge
in both the experiment and control groups before and after the intervention. Conclusion: Considering beneficial effects of training
program with multimedia software support on the knowledge and self-care behaviors and the
importance of this issue, suggested that the patients preferably provide terms of use of
educational software for themselves.
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Affiliation(s)
- Moloud Farmahini Farahani
- Department of Nursing, Nursing and Midwifery Faculty, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Purfarzad
- Department of Nursing, Nursing and Midwifery Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Ghorbani
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Fateme Ghorbani
- Department of Exercise Physiology, Faculty of Physical Education & Sport Sciences, Isfahan University, Isfahan, Iran
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Nelson LA, Bethune MC, Lagotte AE, Osborn CY. The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence. JMIR Hum Factors 2016; 3:e13. [PMID: 27174496 PMCID: PMC4909385 DOI: 10.2196/humanfactors.5177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/30/2015] [Accepted: 01/27/2016] [Indexed: 01/31/2023] Open
Abstract
Background Web-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website’s benefits can identify barriers to user engagement and maximize future use. Objective We developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial. Methods We recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants’ favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP. Results Enrolled participants (N=32) were an average of 51.7 ± 11.8 years old, 66% (21/32) female, 60% (19/32) non-Hispanic White, 88% (28/32) had more than 12 years of education, half had household incomes over $50,000, and 78% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 ± 6.3 years, average A1c was 7.4 ± 2.0, and 38% (12/32) were prescribed insulin. Of enrolled participants, 91% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an unspecified format). Participants also reported difficulty accessing the site and, once accessed, using all of its features. Participants recommended improving the site’s user interface to facilitate quick, efficient access to all features and content. Conclusions Adults with T2DM rated the Diabetes MAP website favorably on surveys, but focus groups gave more in-depth feedback on the user experience (eg, difficulty accessing the site, maximizing all of the site’s features and content, and recovering from errors). Appropriate usability testing methods ensure Web-delivered interventions work as intended and any benefits are not diminished by usability challenges.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Win KT, Hassan NM, Oinas-Kukkonen H, Probst Y. Online Patient Education for Chronic Disease Management: Consumer Perspectives. J Med Syst 2016; 40:88. [PMID: 26846749 DOI: 10.1007/s10916-016-0438-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/07/2016] [Indexed: 01/27/2023]
Abstract
Patient education plays an important role in chronic disease management. The aim of this study is to identify patients' preferences in regard to the design features of effective online patient education (OPE) and the benefits. A review of the existing literature was conducted in order to identify the benefits of OPE and its essential design features. These design features were empirically tested by conducting survey with patients and caregivers. Reliability analysis, construct validity and regression analysis were performed for data analysis. The results identified patient-tailored information, interactivity, content credibility, clear presentation of content, use of multimedia and interpretability as the essential design features of online patient education websites for chronic disease management.
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Affiliation(s)
- Khin Than Win
- Faculty of Engineering and Information Science, University of Wollongong, Wollongong, Australia.
| | - Naffisah Mohd Hassan
- Faculty of Engineering and Information Science, University of Wollongong, Wollongong, Australia.
| | - Harri Oinas-Kukkonen
- Department of Information Processing Science, University of Oulu, Oulu, Finland.
| | - Yasmine Probst
- Faculty of Engineering and Information Science, University of Wollongong, Wollongong, Australia.
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28
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Inglis SC, Du H, Dennison Himmelfarb C, Davidson PM. mHealth education interventions in heart failure. Hippokratia 2015. [DOI: 10.1002/14651858.cd011845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sally C Inglis
- Faculty of Health, University of Technology Sydney; Centre for Cardiovascular and Chronic Care; Sydney Australia
| | - Huiyun Du
- Flinders University; School of Nursing and Midwifery; Sturt Road Bedford Park SA Australia 5041
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Kinney RL, Lemon SC, Person SD, Pagoto SL, Saczynski JS. The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:545-52. [PMID: 25744281 DOI: 10.1016/j.pec.2015.02.005] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/26/2015] [Accepted: 02/07/2015] [Indexed: 05/20/2023]
Abstract
OBJECTIVE A systematic review of the published literature on the association between the PAM (Patient Activation Measure) and hospitalization, emergency room use, and medication adherence among chronically ill patient populations. METHODS A literature search of several electronic databases was performed. Studies published between January 1, 2004 and June 30, 2014 that used the PAM measure and examined at least one of the outcomes of interest among a chronically ill study population were identified and systematically assessed. RESULTS Ten studies met the eligibility criteria. Patients who scored in the lower PAM stages (Stages 1 and 2) were more likely to have been hospitalized. Patients who scored in the lowest stage were also more likely to utilize the emergency room. The relationship between PAM stage and medication adherence was inconclusive in this review. CONCLUSION Chronically ill patients reporting low stages of patient activation are at an increased risk for hospitalization and ER utilization. PRACTICAL IMPLICATIONS Future research is needed to further understand the relationship between patient activation and medication adherence, hospitalization and/or ER utilization in specific chronically ill (e.g. diabetic, asthmatic) populations. Research should also consider the role of patient activation in the development of effective interventions which seek to address the outcomes of interest.
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Affiliation(s)
- Rebecca L Kinney
- Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA.
| | - Stephenie C Lemon
- Department of Medicine, University of Massachusetts, Medical School, Worcester, USA
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA
| | - Sherry L Pagoto
- Department of Medicine, University of Massachusetts, Medical School, Worcester, USA
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA; Department of Medicine, University of Massachusetts, Medical School, Worcester, USA
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Pereira K, Phillips B, Johnson C, Vorderstrasse A. Internet delivered diabetes self-management education: a review. Diabetes Technol Ther 2015; 17:55-63. [PMID: 25238257 DOI: 10.1089/dia.2014.0155] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Diabetes self-management education is a cornerstone of successful diabetes management. Various methods have been used to reach the increasing numbers of patients with diabetes, including Internet-based education. The purpose of this article is to review various delivery methods of Internet diabetes education that have been evaluated, as well as their effectiveness in improving diabetes-related outcomes. MATERIALS AND METHODS Literature was identified in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Medline, EBSCO, the Cochrane Library, and the Web of Science databases through searches using the following terms: "type 2 diabetes AND internet/web based AND education" and "type 2 diabetes AND diabetes self-management education (DSME) AND web-based/internet OR technology assisted education." The search was limited to English language articles published in the last 10 years. The search yielded 111 articles; of these, 14 met criteria for inclusion in this review. Nine studies were randomized controlled trials, and study lengths varied from 2 weeks to 24 months, for a total of 2,802 participants. RESULTS DSME delivered via the Internet is effective at improving measures of glycemic control and diabetes knowledge compared with usual care. In addition, results demonstrate that improved eating habits and increased attendance at clinic appointments occur after the online DSME, although engagement and usage of Internet materials waned over time. Interventions that included an element of interaction with healthcare providers were seen as attractive to participants. CONCLUSIONS Internet-delivered diabetes education has the added benefit of easier access for many individuals, and patients can self-pace themselves through materials. More research on the cost-benefits of Internet diabetes education and best methods to maintain patient engagement are needed, along with more studies assessing the long-term impact of Internet-delivered DSME.
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Kousoulis AA, Patelarou E, Shea S, Foss C, Ruud Knutsen IA, Todorova E, Roukova P, Portillo MC, Pumar-Méndez MJ, Mujika A, Rogers A, Vassilev I, Serrano-Gil M, Lionis C. Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries. BMC Health Serv Res 2014; 14:453. [PMID: 25278037 PMCID: PMC4283086 DOI: 10.1186/1472-6963-14-453] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 09/11/2014] [Indexed: 01/01/2023] Open
Abstract
Background Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. Methods The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. Results Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. Conclusions This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-453) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Voutes, P,O, Box 2208, Heraklion 71003, Greece.
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Internet self-management uniform reporting framework: the need for uniform reporting criteria when reporting internet interventions. Comput Inform Nurs 2014; 31:554-65. [PMID: 24077451 DOI: 10.1097/01.ncn.0000432129.84397.a8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A review of the literature was conducted to identify the "active ingredients" needed to produce successful Internet interventions that support older adults in self-management of chronic disease. The term "Internet intervention" was used as an umbrella term to include all online self-management programs. Thirteen articles were found to meet the inclusion criteria from the initial 204 articles identified. Ritterband's Model of Internet Interventions was used as a framework to classify the intervention components reported. It was found that online self-management interventions can improve outcomes for some older adults. However, the wide diversity of interventions and the measures reported, coupled with the complex nature of the studies, made it difficult to identify the "active ingredients." To overcome this problem, the authors propose a minimum reporting set, the Internet Self-Management Uniform Reporting Framework, which can be used in the reporting of all interventions. Internet Self-Management Uniform Reporting Framework proposes the collection of specific data from six domains: Web site design, support, study design, Web site use, user characteristics and reporting outcomes. The adoption of Internet Self-Management Uniform Reporting Framework would enable easy comparison of online interventions targeting chronic diseases.
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33
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Kyle S, Shaw D. Doctor–patient communication, patient knowledge and health literacy: how difficult can it all be? ACTA ACUST UNITED AC 2014. [DOI: 10.1308/rcsbull.2014.96.6.e9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients who understand their injuries, the aims and potential of their treatment are likely to experience superior outcomes. We review the literature on positive, encouraging doctor–patient communication, and the impact of health literacy and education on patient knowledge in medicine and surgery, with a particular emphasis on orthopaedic surgery. We also highlight methods of improving doctor–patient communication and patient knowledge.
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Affiliation(s)
| | - D Shaw
- Bradford Teaching Hospitals NHS Foundation Trust
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34
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Or CKL, Tao D. Does the use of consumer health information technology improve outcomes in the patient self-management of diabetes? A meta-analysis and narrative review of randomized controlled trials. Int J Med Inform 2014; 83:320-9. [PMID: 24534118 DOI: 10.1016/j.ijmedinf.2014.01.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/15/2014] [Accepted: 01/16/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To assess whether the use of consumer health information technologies (CHITs) improves outcomes in the patient self-management of diabetes. METHOD The evidence from randomized controlled trials (RCTs) on the effects of CHITs on patient outcomes was analyzed using either meta-analysis or a narrative synthesis approach. A systematic search of seven electronic databases was conducted to identify relevant reports of RCTs for the analysis. In the meta-analyses, standardized mean differences in patient outcomes were calculated and random-effects models were applied in cases where the heterogeneity of the results was moderate or high, otherwise fixed-effects models were used. RESULTS Sixty-two studies, representing 67 RCTs, met the inclusion criteria. The results of the meta-analyses showed that the use of CHITs was associated with significant reductions in HbA1c, blood pressure, total cholesterol, and triglycerides levels when compared with the usual care. The findings from the narrative synthesis indicated that only a small proportion of the trials reported positive effects of CHITs on patient outcomes. CONCLUSIONS The use of CHITs in supporting diabetes self-management appears to have potential benefits for patients' self-management of diabetes. However, the effectiveness of the technologies in improving patient outcomes still awaits confirmation in future studies.
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Affiliation(s)
- Calvin K L Or
- Department of Industrial and Manufacturing Systems Engineering, Faculty of Engineering, The University of Hong Kong, Hong Kong.
| | - Da Tao
- Department of Industrial and Manufacturing Systems Engineering, Faculty of Engineering, The University of Hong Kong, Hong Kong
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Eikelenboom N, van Lieshout J, Wensing M, Smeele I, Jacobs AE. Implementation of personalized self-management support using the self-management screening questionnaire SeMaS; a study protocol for a cluster randomized trial. Trials 2013; 14:336. [PMID: 24134956 PMCID: PMC3874773 DOI: 10.1186/1745-6215-14-336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/02/2013] [Indexed: 11/21/2022] Open
Abstract
Background The number of patients with one or more chronic diseases is rising. In several standards of care there is a focus on enhancing self-management. We applied the concept of personalization on self-management support and developed a self-management screening questionnaire (SeMaS). The main research objective is to assess the effectiveness of the SeMaS questionnaire and subsequent personalized self-management on patients’ self-management behaviors. Methods/Design A cluster randomized controlled trial will be set up in 15 general practices in the Netherlands. The practices are all group practices, and member of one care group. The practices will be assigned to the control or intervention arms by stratified randomization. The strata are determined by the participation of the practice nurses in a course for behavioral change, and the nurse’s workload. Patients can be included if they are over 18 years of age, have at least one chronic condition and have a checkup appointment with the practice nurse in the inclusion period. The intervention consists of screening patients with the SeMaS questionnaire, producing a graphic profile with the abilities or barriers for self-management. Patients will receive tailored feedback. Practice nurses are trained in using the profile to enhance self-management of the patient and provide personalized self-management support. The use of individual care plans and self-management interventions is stimulated. In the control arm patients will receive care as usual. Patients of both trial arms will be asked to fill in the SeMaS questionnaire and additional questionnaires at inclusion and after 6 months. The primary outcome is the difference in the level of patient activation (PAM-13) between baseline and 6 months. Secondary outcomes include patient measures for lifestyle factors (exercise, diet, smoking), and process measures from medical record data analysis. Discussion This manuscript presents the protocol for a cluster randomized clinical trial of personalized self-management support using the SeMaS questionnaire in chronically ill patients in primary care. By carrying out this study, scientific evidence is built for the effectiveness of personalized self-management support. Trial registration The Netherlands National Trial Register: NTR3960.
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Affiliation(s)
- Nathalie Eikelenboom
- Radboud University Medical Centre, IQ healthcare, P,O, Box 9101, 114 6500 Nijmegen, HB, The Netherlands.
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Blanson Henkemans OA, Dusseldorp EML, Keijsers JFEM, Kessens JM, Neerincx MA, Otten W. Validity and Reliability of the eHealth Analysis and Steering Instrument. MEDICINE 2.0 2013; 2:e8. [PMID: 25075243 PMCID: PMC4085077 DOI: 10.2196/med20.2571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 07/25/2013] [Accepted: 08/12/2013] [Indexed: 12/05/2022]
Abstract
BACKGROUND eHealth services can contribute to individuals' self-management, that is, performing lifestyle-related activities and decision making, to maintain a good health, or to mitigate the effect of an (chronic) illness on their health. But how effective are these services? Conducting a randomized controlled trial (RCT) is the golden standard to answer such a question, but takes extensive time and effort. The eHealth Analysis and Steering Instrument (eASI) offers a quick, but not dirty alternative. The eASI surveys how eHealth services score on 3 dimensions (ie, utility, usability, and content) and 12 underlying categories (ie, insight in health condition, self-management decision making, performance of self-management, involving the social environment, interaction, personalization, persuasion, description of health issue, factors of influence, goal of eHealth service, implementation, and evidence). However, there are no data on its validity and reliability. OBJECTIVE The objective of our study was to assess the construct and predictive validity and interrater reliability of the eASI. METHODS We found 16 eHealth services supporting self-management published in the literature, whose effectiveness was evaluated in an RCT and the service itself was available for rating. Participants (N=16) rated these services with the eASI. We analyzed the correlation of eASI items with the underlying three dimensions (construct validity), the correlation between the eASI score and the eHealth services' effect size observed in the RCT (predictive validity), and the interrater agreement. RESULTS Three items did not fit with the other items and dimensions and were removed from the eASI; 4 items were replaced from the utility to the content dimension. The interrater reliabilities of the dimensions and the total score were moderate (total, κ=.53, and content, κ=.55) and substantial (utility, κ=.69, and usability, κ=.63). The adjusted eASI explained variance in the eHealth services' effect sizes (R(2) =.31, P<.001), as did the dimensions utility (R(2) =.49, P<.001) and usability (R(2) =.18, P=.021). Usability explained variance in the effect size on health outcomes (R(2) =.13, P=.028). CONCLUSIONS After removing 3 items and replacing 4 items to another dimension, the eASI (3 dimensions, 11 categories, and 32 items) has a good construct validity and predictive validity. The eASI scales are moderately to highly reliable. Accordingly, the eASI can predict how effective an eHealth service is in regard to supporting self-management. Due to a small pool of available eHealth services, it is advised to reevaluate the eASI in the future with more services.
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Affiliation(s)
- Olivier A Blanson Henkemans
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Department Lifestyle Leiden Netherlands
| | - Elise M L Dusseldorp
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Department Lifestyle Leiden Netherlands
| | - Jolanda F E M Keijsers
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Department Lifestyle Leiden Netherlands
| | - Judith M Kessens
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Department Lifestyle Leiden Netherlands
| | - Mark A Neerincx
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Department Lifestyle Leiden Netherlands
| | - Wilma Otten
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Department Lifestyle Leiden Netherlands
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Zhang YL, Gao WG, Pang ZC, Sun JP, Wang SJ, Ning F, Song X, Kapur A, Qiao Q. Diabetes self-risk assessment questionnaires coupled with a multimedia health promotion campaign are cheap and effective tools to increase public awareness of diabetes in a large Chinese population. Diabet Med 2012; 29:e425-9. [PMID: 22853711 DOI: 10.1111/j.1464-5491.2012.03760.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate costs and effectiveness of implementing a diabetes self-risk assessment (Diabetes Risk Score) questionnaire coupled with a multimedia health promotion campaign on changes in diabetes awareness in a large diabetes prevention programme. METHODS Between 2007 and 2010, a multimedia health promotion campaign was conducted targeting the 1.94 million population of Qingdao, China, using newspapers, radio programmes, distribution of free booklets and Diabetes Risk Score flyers. Diabetes awareness questionnaires filled out by people first interviewed in 2006 (survey A), before the initiation of the campaign, were compared with those first interviewed between 2007 and 2010 during the campaign period (survey B). The rates of diabetes awareness in both surveys were studied amongst adults aged 35-74 years without a prior history of diabetes, but with a Diabetes Risk Score of ≥ 14. RESULTS In survey B, 85, 82 and 76% of the urban participants correctly recognized obesity, family history of diabetes and physical inactivity, respectively, as important risk factors for diabetes; while the awareness rates were 43, 46 and 25%, respectively, in survey A (P < 0.001). The corresponding figures among rural participants were 65, 63 and 53% in survey B and 29, 22 and 11% in survey A (P < 0.001). To cover 1000 individuals, the programme spent €5.4 on the use of the Diabetes Risk Score flyer, €31.3 on the education booklet, €7.7 on the newspaper campaign and €37.5 on radio programmes. CONCLUSIONS The combination of a Diabetes Risk Score questionnaire with a multimedia health promotion campaign is a cheap and effective health promotion tool to raise public awareness of diabetes.
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Affiliation(s)
- Y L Zhang
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland.
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Shepherd JD, Badger-Brown KM, Legassic MS, Walia S, Wolfe DL. SCI-U: e-learning for patient education in spinal cord injury rehabilitation. J Spinal Cord Med 2012; 35:319-29. [PMID: 23031169 PMCID: PMC3459561 DOI: 10.1179/2045772312y.0000000044] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND/OBJECTIVES To develop an online patient education resource for use in spinal cord injury rehabilitation. PARTICIPANTS The development process involved more than 100 subject-matter experts (SMEs) (rehabilitation professionals and consumers) from across Canada. Preliminary evaluation was conducted with 25 end-users. METHODS An iterative development process was coordinated by a project team; SMEs (including patients) developed the content in working groups using wiki-based tools. Multiple rounds of feedback based on early prototypes helped improve the courses during development. RESULTS Five courses were created, each featuring more than 45 minutes of video content and hundreds of media assets. Preliminary evaluation results indicate that users were satisfied by the courses and perceived them to be effective. CONCLUSIONS This is an effective process for developing multimedia patient education resources; the involvement of patients in all parts of the process was particularly helpful. Future work will focus on implementation, integration into clinical practice and other delivery formats (smart phones, tablets).
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Affiliation(s)
- John D. Shepherd
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada,Correspondence to: John D. Shepherd, Toronto Rehabilitation Institute/University Health Network, Lyndhurst Centre, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada.
| | | | | | - Saagar Walia
- Lawson Health Research Institute, London, Ontario, Canada
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