Effects of self-guided e-counseling on health behaviors and blood pressure: Results of a randomized trial

The mediating and moderating effect of health-promoting lifestyle on frailty and depressive symptoms for Chinese community-dwelling older adults: A cross-sectional study

BACKGROUND

This study aims to explore the mediating and moderating effect of health-promoting lifestyles on the relationship between frailty and depressive symptoms to provide a practical reference for effectively promoting the mental health of older adults.

METHODS

A cross-sectional survey of community-dwelling older adults (n = 3107) was conducted in three cities of Ningxia Province, China. Depressive symptoms, frailty, and health-promoting lifestyles were assessed through the 30-item Geriatric Depression Scale, frailty scale, and health-promoting Lifestyle profile-II, respectively. The Bootstrap methods PROCESS program is employed to test the mediation and moderation model.

RESULTS

The findings indicated that health-promoting lifestyles are negatively related to depressive symptoms and frailty, while frailty is positively associated with depressive symptoms. Health-promoting lifestyles have mediated the relationship between frailty and depressive symptoms. Besides, the health-promoting lifestyles weakened the positive relationship between frailty and depression symptoms; there existed a moderating effect of health-promoting lifestyles on the relationship between frailty and depression symptoms among older adults.

LIMITATIONS

Given the cross-sectional study, it is impossible to make causal inferences.

CONCLUSIONS

A health-promoting lifestyle might be a protective factor for older adults' health in China. The mediating and moderating effect of a health-promoting lifestyle on the relationship between frailty and depression symptoms among older adults should be integrated to achieve maximum utility. Healthcare practitioners and medical service personnel are recommended to advance health education and publicity, encouraging healthy lifestyles among community-dwelling older adults with frailty to prevent depressive symptoms and promote healthy aging.

Effectiveness of digital health interventions for telemedicine/telehealth for managing blood pressure in adults: a systematic review and meta-analysis

This systematic review and meta-analysis included randomized controlled trials or observational studies that compare digital health interventions (DHIs) for telemedicine/telehealth versus usual care for managing blood pressure (BP) in adults. We searched PubMed, Cochrane CENTRAL, and IchuShi-Web, and used a random-effects meta-analysis of the weighted mean difference (MD) between the comparison groups to pool data from the included studies. The outcome included the pooled MD of office BP from baseline to each follow-up period. This meta-analysis considered 117 studies with 68677 participants as eligible. The 3-month intervention period reduced office systolic BP (SBP) compared with usual care in 38 studies (MD: -3.21 mmHg [95% confidence interval: -4.51 to -1.90]), with evidence of heterogeneity. Office SBP across intervention periods demonstrated comparable effects (3-, 6- [54 studies], 12- [43 studies], and >12-month periods [9 studies]). The benefits for office diastolic BP were similar to those for office SBP. Additionally, the interventions significantly reduced the office SBP compared with the control, regardless of the mode of intervention delivery (smartphone apps [38 studies], text messages [35 studies], and websites [34 studies]) or type of facility (medical [74 studies] vs. non-medical [33 studies]). The interventions were more effective in 41 hypertension cohorts compared with 66 non-hypertension cohorts (-4.81 mmHg [-6.33, -3.29] vs. -2.17 mmHg [-3.15, -1.19], P = 0.006 for heterogeneity). In conclusion, DHIs for telemedicine/telehealth improved BP management compared with usual care. The effectiveness with heterogeneity should be considered, as prudent for implementing evidence-based medicine. This meta-analysis considered 117 studies with 68677 participants eligible. The DHIs for telemedicine/telehealth reduced office BP compared with usual care, regardless of intervention duration, intervention delivery mode, facility type, and cohort type. Additionally, the DHIs reduced the risk of uncontrolled BP compared with usual care, regardless of intervention duration, intervention delivery mode, and facility type. BP blood pressure, DHI digital health intervention, MD mean difference, RR risk ratio, SBP systolic blood pressure.

Effects of Health-Promoting Lifestyle on Late-Onset Depression in Older Adults: Mediating Effect of Meaning in Life and Interleukin-6 (IL-6)

Purpose

Late-onset depression (LOD) with poor treatment response has high incidence and mortality in the China's aged people, this study aims to explore the correlation between health-promoting lifestyle, meaning in life, interleukin-6 (IL-6) and LOD for providing scientific basis of LOD prevention and rehabilitation.

Patients and Methods

A total of 496 LOD patients (study group) and healthy older adults (control group) were enrolled and investigated by using the Health-promoting lifestyle Profile-II, revised (HPLP-IIR), Meaning in Life Questionnaire-Chinese Version (MLQ-C), and Hamilton Depression Scale (HAMD). The interleukin-6 (IL-6) in the circulating blood was detected by utilizing ELISA kit.

Results

The results showed that the scores of all factors in HPLP-IIR and MLQ were significantly lower and IL-6 level was higher in the study group than the control group. Scores of most factors in HPLP-IIR and MLQ negatively and IL-6 positively correlated with scores of subscales and total HAMD score. Meaning in life and IL-6 partially mediated the relationship between health-promoting lifestyles and depression severity in the study group, with the mediating effect explains 15.76% and 22.64% of the total effect, respectively.

Conclusion

Health-promoting lifestyles, meaning in life, and IL-6 are predictors of LOD, and an unhealthy lifestyle could induce LOD through the mediating effect of meaning in life and IL-6 in older adults.

Automated Digital Counseling Program (ODYSSEE-Kidney Health): A Pilot Study on Health-Related Quality of Life

Key Points

Feasibility of implementing an automated, scalable, digital self-care program for patients with CKD was established. The primary outcome of improvement in health-related quality of life improved with the ODYSSEE-Kidney Health program. A dose relationship was shown between program engagement tertile and improvement in 4-month outcomes.

Background

In-person counseling programs promote self-care behavior and health-related quality of life (HRQoL). ODYSSEE-Kidney Health (prO moting health with D igitallY based counS eling for S elf-care bE havior and quality of lifE ; ODYSSEE-KH) is an automated, scalable, digital counseling program for patients with CKD. This open-label, single-arm pilot study tested the efficacy potential of the ODYSSEE-KH program to improve HRQoL in patients with CKD.

Methods

Adults with categories G3b to 5d CKD were recruited from nephrology clinics in Toronto, Canada. Patients (N =29) received access to the ODYSSEE-KH program in conjunction with usual care. Generalized linear models and pairwise comparisons of mean change scores were conducted to assess the primary outcome: Mental Component Score (MCS) of the Kidney Disease Quality of Life–Short Form instrument. Secondary outcomes included the MCS Mental Health Scale, 36-Item Kidney Disease Quality of Life–Short Form, Generalized Anxiety Disorder Scale, Patient Health Questionnaire for depression, Enhancing Recovery in Coronary Heart Disease Social Support Instrument, and 3-Item Revised University of California, Los Angeles (UCLA) Loneliness Scale.

Results

The mean age of the patients was 53.5 years (SD=18.3); 35% were women; 56% were White; 93% had completed ≥postsecondary education; patients came from the Multi-Care Kidney Clinic (n =9), Home Peritoneal Dialysis Unit (n =12), and Home Hemodialysis Unit (n =8); and 24 participants completed the 4-month end-of-study questionnaires. Outcomes were assessed according to tertiles of program log-on minutes: median (range)=67 (62–108), 212 (119–355), and 500 (359–1573) minutes, respectively. Patients in the highest tertile of engagement showed significant improvements on the MCS versus the moderate tertile group (P = 0.01). Significant dose-response associations were observed for the MCS Mental Health Scale (P < 0.05), KDQoL Burden on Kidney Disease (P < 0.01), KDQoL Effect of Kidney Disease on Everyday Life (P < 0.01), aggregated KDQoL Summary Scale (P < 0.05), Generalized Anxiety Disorder Scale (P < 0.01), Patient Health Questionnaire for Depression (P < 0.05), Enhancing Recovery in Coronary Heart Disease Social Support Instrument (P < 0.01), and 3-Item Revised UCLA Loneliness Scale (P < 0.01).

Conclusion

The ODYSSEE-KH program demonstrated feasibility as an automated, scalable, digital self-care program for patients with CKD. There is evidence of its efficacy potential to improve HRQoL. Further evaluation with a larger sample is warranted.

Impact of mHealth Interventions on Supporting Dietary Adherence in Cardiovascular Disease: A Systematic Review

INTRODUCTION

A systematic review was conducted to determine if mobile health (mHealth) interventions, and which intervention characteristics, effectively support dietary adherence and reduce risk factors in patients with cardiovascular disease (CVD).

METHOD

Using 7 databases, studies involving adult participants with specific CVD diagnoses, mHealth intervention testing, and dietary adherence assessment were identified. Systematic reviews, qualitative studies, or studies testing interventions involving open dialogue between participants and health care providers or researchers were excluded. Two independent reviewers conducted screening and assessed the risk of bias.

RESULTS

Thirteen studies involved participants with prehypertension (n = 1), hypertension (n = 9), coronary artery disease (n = 2), and heart failure (n = 1). mHealth interventions in 8 studies improved dietary adherence, 4 showed mixed results, and 1 showed no improvements. Eight studies found interactive text and/or application-based mHealth intervention features effectively improved dietary adherence. One study had a low risk of bias, 2 had some concerns/moderate risk, and 10 had a high/critical or serious risk.

DISCUSSION

In most included studies, mHealth interventions positively impacted dietary adherence for patients with CVD.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Clinicians may recommend mHealth interventions to support nutrition education and self-management for their patients with CVD.

Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial

BACKGROUND

Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults do not meet the PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mobile health technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework; thus, pay-per-minute (PPM) and self-funded investment incentive (SFII) frameworks were explored.

OBJECTIVE

The aims were to (1) determine the feasibility (recruitment, engagement, and acceptability) of an 8-week mobile-based PPM and SFII hypertension prevention PA program and (2) explore the effects of PPM and SFII interventions relative to a control on the PA levels, BP, and PA motivation.

METHODS

In total, 55 adults aged 40-65 years not meeting the Canadian PA guidelines were recruited from Facebook and randomized into the following groups: financial incentive groups, PPM or SFII, receiving up to CAD $20 each (at the time of writing: CAD $1=US $0.74), or a control group without financial incentive. PPM participants received CAD $0.02 for each minute of moderate-to-vigorous PA (MVPA) per week up to the PA guidelines and the SFII received CAD $2.50 for each week they met the PA guidelines. Feasibility outcome measures (recruitment, engagement, and acceptability) were assessed. Secondary outcomes included changes in PA outcomes (MVPA and daily steps) relative to baseline were compared among PPM, SFII, and control groups at 4 and 8 weeks using linear regressions. Changes in BP and relative autonomy index relative to baseline were compared among the groups at follow-up.

RESULTS

Participants were randomized to the PPM (n=19), SFII (n=18), or control (n=18) groups. The recruitment, retention rate, and engagement were 77%, 75%, and 65%, respectively. The intervention received overall positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to the control at 4 weeks, the PPM and SFII arms increased their MVPA with medium effect (PPM vs control: η²_p=0.06, mean 117.8, SD 514 minutes; SFII vs control: η²_p=0.08, mean 145.3, SD 616 minutes). At 8 weeks, PPM maintained a small effect in MVPA relative to the control (η²_p=0.01, mean 22.8, SD 249 minutes) and SFII displayed a medium effect size (η²_p=0.07, mean 113.8, SD 256 minutes). Small effects were observed for PPM and SFII relative to the control for systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PPM: η²_p=0.12, Δmean SBP 7.1, SD 23.61 mm Hg; η²_p=0.04, Δmean DBP 3.5, SD 6.2 mm Hg; SFII: η²_p=0.01, Δmean SBP -0.4, SD 1.4 mm Hg; η²_p=0.02, Δmean DBP -2.3, SD 7.7 mm Hg) and relative autonomy index (PPM: η²_p=0.01; SFII: η²_p=0.03).

CONCLUSIONS

The feasibility metrics and preliminary findings suggest that a future full-scale randomized controlled trial examining the efficacy of PPM and SFII relative to a control is feasible, and studies with longer duration are warranted.

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility.

METHODS

In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845.

FINDINGS

Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a -3·62 mm Hg (95% CI -5·22 to -2·02) greater reduction in systolic blood pressure, and a -2·45 mm Hg (-3·83 to -1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (-2·45 mm Hg [-4·15 to -0·74]); however, there were no statistically significant reductions for SMS interventions (-1·80 mm Hg [-4·60 to 1·00]) or website interventions (-3·43 mm Hg [-7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant.

INTERPRETATION

SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility.

FUNDING

European Union's Horizon 2020 Research and Innovation Programme.

Effectiveness of Telemedicine for Reducing Cardiovascular Risk: A Systematic Review and Meta-Analysis

BACKGROUND

Cardiovascular diseases are the leading cause of death globally. There are six cardiovascular risk factors: diabetes, hypertension, hypercholesterolemia, overweight, sedentary lifestyle and smoking. Due to the low attendance of healthy people in the health system, the use of telemedicine can influence the acquisition of a heart-healthy lifestyle.

OBJECTIVE

this systematic review and meta-analysis aimed to determine the effectiveness of telemedicine and e-health in reducing cardiovascular risk.

METHODS

A systematic review and meta-analysis were carried out using the PubMed, Scopus, Cinhal and WOS databases. Randomized controlled studies between 2017 and 2022 in which telemedicine was used to reduce any of the risk factors were included. The methodological quality was assessed using the "PEDro" scale.

RESULTS

In total, 763 studies were obtained; after the review, 28 target articles were selected and finally grouped as follows: 13 studies on diabetes, six on hypertension, seven on obesity and two on physical activity. For all of the risk factors, a small effect of the intervention was seen.

CONCLUSIONS

although the current evidence is heterogeneous regarding the statistically significant effects of telemedicine on various cardiovascular risk factors, its clinical relevance is undeniable; therefore, its use is recommended as long as the necessary infrastructure exists.

Patient perspectives on the use of mobile apps to support heart failure management: A qualitative descriptive study

BACKGROUND

Adherence to diet and medical therapies are key to improving heart failure (HF) outcomes; however, nonadherence is common. While mobile apps may be a promising way to support patients with adherence via education and monitoring, HF patient perspectives regarding the use of apps for HF management in unknown. This data is critical for these tools to be successfully developed, implemented, and adopted to optimize adherence and improve HF outcomes.

OBJECTIVE

To determine patients' needs, motivations, and challenges on the use of mobile apps to support HF management.

METHODS

A qualitative descriptive study using focus groups (n = 4,60 minutes) was conducted among HF patients from outpatient HF clinics in Toronto, Canada. The Diffusion of Innovation theory informed a ten-question interview guide. Interview transcripts were independently coded by two researchers and analyzed using content analysis.

RESULTS

Nineteen HF patients (65 ± 10 yrs, 12 men) identified a total of four key themes related to the use of mobile apps. The theme 'Factors impacting technology use by patients' identified motivations and challenges to app use, including access to credible information, easy and accessible user-interface. Three themes described patients' needs on the use of mobile apps to support HF management: 1) 'Providing patient support through access to information and self-monitoring', apps could provide education on HF-related content (e.g., diet, medication, symptoms); 2) 'Facilitating connection and communication', through information sharing with healthcare providers and connecting with other patients; 3) 'Patient preferences', app features such as reminders for medication, and visuals to show changes in HF symptoms were favoured.

CONCLUSIONS

HF patients perceive several benefits and challenges to app use for HF self-management. Capitalizing on the benefits and addressing the challenges during the app development process may maximize adoption of such tools in this patient population.

Evaluating the Effectiveness of a Family-Based Virtual Childhood Obesity Management Program Delivered During the COVID-19 Pandemic in Canada: Prospective Study

BACKGROUND

Generation Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear.

OBJECTIVE

We aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support-related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction.

METHODS

This study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI ≥85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children's physical activity, dietary and sedentary behaviors, and screen time, and the parent's support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses.

RESULTS

Both the virtual and blended GH programs improved children's moderate-to-vigorous physical activity (F_1,380=18.37; P<.001; ηp²=0.07) and reduced screen time (F_1,380=9.17; P=.003; ηp²=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F_1,380=15.19; P<.001; ηp²=0.004). Parents in both groups showed significant improvements in support behaviors for children's physical activity (F_1,380=5.55; P=.02; ηp²=0.002) and healthy eating (F_1,380=3.91; P<.001; ηp²=0.01), as well as self-regulation of parental support for children's physical activity (F_1,380=49.20; P<.001; ηp²=0.16) and healthy eating (F_1,380=91.13; P<.001; ηp²=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001).

CONCLUSIONS

The study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support-related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions.

The effectiveness of psycho-educational counseling in pregnant women with preeclampsia: A systematic review

Pre-eclampsia is one of the main causes of maternal mortality, premature birth and low birth weight in developing countries. In addition, this condition can lead to chronic diseases (including cardiovascular and renal diseases) in postpartum mothers. The purpose of this study was to review the effectiveness of psycho-educational counseling in pregnant women with preeclampsia. The methods of this study were using PRISMA guidelines, databases from Scopus, PubMed and ScienceDirect, were published 2016 until 2020, yielded 65 articles. The keywords were retrieved from Medical Subject Heading (Mesh). The results showed interventions were given during the treatment period ranges from cognitive-behavioral counseling group that received four 1.5-h counseling sessions and the solution-focused counseling that received three 1.5-h counseling sessions, which were held weekly. This systematic review concludes that improving prenatal empowerment and self-care enable mothers to experience fewer complications in this period of their life. Thus, psycho-educational provides an excellent opportunity for educating and counseling pregnant women to promote maternal and neonatal health and psychological well-being.

Effect of Telehealth Interventions on Blood Pressure Control: A Meta-analysis

The aim of this study was to find out the effects of telehealth interventions on blood pressure control by conducting a meta-analysis. Six databases were used. The literature review covered the period between December 1, 2020, and January 26, 2021. The meta-analysis was conducted by comprehensive Meta-Analysis Software version 2.2. Categorical variables were analyzed by odds ratios at a confidence interval of 95%. In data formatting and analysis, independent groups (sample size, P value); independent groups (mean, SD); Cohen's d, SE; and paired groups (N, P value) were used. The bias risk was assessed based on the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. Total sample size including 22 studies was 11 120. It was determined that interventions performed through telehealth applications had a significant effect on blood pressure control (odds ratio = -0.14; 95% confidence interval = -0.20 to -0.08; P < .001). In telehealth applications, blood pressure values decreased more when the application was performed through a Web site (-0.31; 95% confidence interval = -0.49 to -0.13), duration of the intervention was 12 months or shorter (-0.18; 95% confidence interval = -0.28 to -0.010), stroke developed in case of hypertension (-0.31, 95% confidence interval = -0.76 to 0.12), and the study was conducted in the Far East countries (-0.24; 95% confidence interval = 0.40 to -0.07). Interventions with telehealth applications are effective in blood pressure management. PROSPERO ID: CRD42021228536.

Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review

Background

Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions.

Objective

This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill.

Methods

Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results.

Results

Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment.

Conclusions

This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling.

Evaluation of a Video-Assisted Patient Education Program to Reduce Blood Pressure Delivered Through the Electronic Medical Record: Results of a Quality Improvement Project

BACKGROUND

Low-cost, automated interventions that increase knowledge and skills around diet and lifestyle modifications are recommended for cardiovascular disease risk reduction.

METHODS

We initiated a quality improvement program to assess the impact of a web-based diet and lifestyle intervention utilizing short animated videos in adults with high blood pressure (BP) at a primary care clinic in Saudi Arabia. We enrolled adults with elevated BP, not on BP medications, who were identified using the electronic medical record. We delivered a web-linked diet and lifestyle intervention using animated videos covering diet and lifestyle topics. Videos and reminders were sent weekly for 5 weeks. Outcomes were proportion who engaged in the program, returned for a repeat BP within 3 months, and change in BP.

RESULTS

We enrolled 269 adult participants, with a mean (SD) age of 41.6 (12.4) years; 77% were male. At the conclusion of the pilot, we demonstrated a high level of engagement: overall, 69% of materials were viewed and 67% of patients returned for BP. Patients who returned had a mean (SD) baseline systolic BP of 138.0 (7.2) mm Hg and a large mean reduction in systolic BP from baseline, -10.5 mm Hg (12.4; P < 0.001).

CONCLUSIONS

Overall, the feasibility of a video-assisted, web-based, diet and lifestyle intervention as a support tool for hypertension management demonstrated a high participation rate and a high return rate for reassessment of BP. These findings suggest that this low-cost, automated intervention may have a great potential as a scalable tool for blood pressure management. However, randomized trials to understanding the effectiveness of the support tools are needed.

Hypertension telemonitoring and home-based physical training programs

PURPOSE

Hypertensive patients with access to telemedicine can receive telemonitoring of blood pressure and cardiovascular risk factors such as sedentary lifestyle, diet, and remote supervision of treatment compliance. Faced with this challenge, electronic devices for telemonitoring of BP have gained space. They have shown to be effective in the follow-up of hypertensive patients and assist in the adherence and control of associated risk factors such as physical inactivity and obesity.

MATERIALS AND METHODS

Narrative Review.

RESULTS

The use of advanced smartwatches, smartphone apps, and online software for monitoring physical activity is increasingly common. Electronic equipment is briefly presented here as a support for better addressing some cardiovascular variables. Using various automated feedback services with a follow-up multidisciplinary clinical team is the ideal strategy.

CONCLUSION

Mobile health can improve risk factors and health status, particularly for hypertensive patients, improving access to cardiac rehabilitation and reducing the cost.

Comparative effect of eHealth interventions on hypertension management-related outcomes: A network meta-analysis

BACKGROUND

Increasingly, health professionals and patients have begun to be involved in eHealth interventions to assist in the self-management of hypertension. Therefore, this study was aimed at comparing the effect of different types of eHealth interventions (phone calls, blood pressure telemonitoring, emails, web-site, smartphone-app, short message service (SMS) and more than two eHealth interventions) on reducing systolic and diastolic blood pressure, increasing adherence to medication treatment, improving physical activity compliance, controlling blood pressure, and improving quality of life (QoL).

METHODS

A systematic search in MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted to identify experimental studies addressing the effect of eHealth interventions on the self-management of hypertension. Comparative evaluation of the eHealth interventions effect were performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between eHealth interventions and control/non-intervention.

RESULTS

Fifty-one studies were included in the analysis showing a moderate effect size for more than two types of eHealth interventions (-0.46; 95%CI: -0.64, -0.27, p < 0.001 and -0.29; 95%CI: -0.46, -0.13, p < 0.001), phone calls (-0.37; 95%CI: -0.57, -0.17, p < 0.001 and -0.29; 95%CI: -0.52, -0.07, p = 0.011) and smartphone-app (-0.26; 95%CI: -0.50, -0.01, p = 0.040 and -0.40; 95%CI: -0.70, -0.10, p = 0.010) on reducing both systolic and diastolic blood pressure, respectively. Additionally, i) smartphone-app improved medication adherence by 45%; ii) more than two types of eHealth interventions and emails improved physical activity compliance by 18% and 57% respectively; ii) more than two types of eHealth interventions, phone calls, blood pressure telemonitoring, website and SMS improved blood pressure control between 16% and 30%; and iv) blood pressure telemonitoring showed a week effect on QoL CONCLUSIONS: Our study reported eHealth to be a suitable intervention for the self-management of hypertension. Considering our results and the population's accessibility to eHealth devices, eHealth could be a useful and largely scalable tool for the self-management of hypertension.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020187468.

Web-Based Dietary and Physical Activity Intervention Programs for Patients With Hypertension: Scoping Review

BACKGROUND

Hypertension is the root cause of many chronic diseases. Lifestyle changes (ie, dietary alterations and physical activity) are seen to be an important step in the prevention and treatment of hypertension. Educating people through web-based interventional programs could offer an effective solution and help these patients with hypertension in the existing health care scenario.

OBJECTIVE

In this study, the researchers conducted a scoping literature review of the web-based dietary changes and physical activity-related intervention programs designed for the patients with hypertension and identified the methodologies, effectiveness, protocols, and theories, which could affect and improve existing clinical activities.

METHODS

This review followed the scoping review methodology to identify and process the peer-reviewed studies published between 2010 and 2020. The literature searches were conducted on the following electronic databases: PubMed, Web of Science, MEDLINE (Medical Literature Analysis and Retrieval System Online), ScienceDirect, Scopus, and Google Scholar. By using relevant search terms, studies were included if they offered information related to the web-based intervention tools, specifically dietary and physical activity intervention for patients with hypertension. Studies written or translated in English language and published within the date range (January 2010 to March 2020) were included.

RESULTS

Overall, 1441 articles were initially identified. The reviewers included 35 articles after removing duplicates and screening titles. Only 21 articles were assessed for full review, and 15 were kept for analysis. The researchers selected 15 web-based intervention articles published on the topic of hypertension from 7 countries. A few of these 15 web-based tools (4, 27%) included more than 3 functions and provided a lot of important information (such as appointments, health records, or viewable care). Several tools were standalone tools (11, 73%), while most of the tools supported communication intervention-related lifestyle or behavioral changes (13, 87%) and medication adherence (6, 40%). It was found that physicians (9, 60%), allied health professionals (5, 33%), and nurses (5, 33%) were the health care providers who generally used these tools for communicating with their patients. More than half of the above tools (10, 67%) were assessed by different researchers in randomized controlled trials, while 5 tools (33%) were investigated in nonrandomized studies.

CONCLUSIONS

We identified many web-based intervention programs for patients with hypertension from the literature databases. The findings indicate that numerous benefits can be derived after using a web-based dietary and physical activity intervention program for hypertension focusing on lifestyle changes. However, developers need to consider the preferences of the patients with regard to the information or the design features while developing or modifying web-based educational websites. These tools could be used for designing a patient-tailored website intervention program that is based on diet and physical activities for patients with hypertension.

A systematic review of the dose-response relationship between usage and outcomes of online physical activity weight-loss interventions

BACKGROUND

Online physical activity interventions can be an effective strategy for weight loss. However, there is a lack of systematic reviews examining the relationship between intervention usage (dose) and participants' response to online physical activity interventions for weight loss. It remains unclear whether certain usage metrics (e.g. login frequency, percent of content accessed) would be associated with improvements in behavioral outcomes. Understanding the dose-response relationship for online physical activity interventions for weight loss would be important for designing and evaluating future interventions.

OBJECTIVE

1) Review the methods used to assess intervention usage and 2) to explore the association between intervention usage metrics and outcomes for online physical activity interventions for weight-loss.

METHODS

We conducted a systematic review following the PRISMA guidelines to examine the dose-response relationship of online-based interventions targeting physical activity. We used the following keywords: web OR internet OR online OR eHealth AND physical activity OR exercise, AND engagement OR dose OR dose-response OR usage AND obesity OR weight*. Peer-reviewed articles published between 2006 and 2019 were included.

RESULTS

A total of five articles met the inclusion criteria. The mean intervention length was 10 ± 6 months (range 2-30 months). The usage metrics were total number of logins, login frequency, and usage of online tools. All usage metrics reported were found to be related to outcomes in physical activity interventions for weight-loss.

CONCLUSION

Our findings suggest that usage metrics for online physical activity interventions for weight-loss included login frequency, login duration, and use of online tools. Increased intervention usage appeared to be associated with an improvement in participant's weight, physical activity behaviors, and intervention retention. Future research should examine innovative ways to maintain intervention usage throughout the intervention.

An application of the theory of planned behavior to self-care in patients with hypertension

Background

Self-care behaviors and positive changes in lifestyle are essential for successful hypertension control. We used a behavioral model based on the theory of planned behavior to assess which factors influence self-care behaviors for controlling hypertension.

Methods

In this cross-sectional study, five hundred patients with at leastaone-year history of diagnosed hypertension participated in this study. The data collection tool was designed based on the theory of planned behavior. Structural equation modeling was used to estimate the main parameters.

Results

For self-care behaviors, ninety-six (19.2%) and forty-five (9.1%) participants had good knowledge and acceptable behavior(≥8 out of 10 points). Having perceived behavioral control regarding quitting smoking and alcohol intake was associated with the patient’s intention and behavior [b:1.283 ± .095 and b:1.59 ± .014 (p < .001)]. Having perceived behavioral control over the other self-care behaviors had a positive effect on the intention in female patients [b: .885 ± .442 (p = .045)]. Subjective norms had a positive effect on behavioral intention in younger patients [b:4.52 ± 2.24 (P = .04)].

Conclusions

Group-specific behavioral barriers are important when improving self-care behaviors in patients with hypertension. Perceived control over self-care behaviors is more important in vulnerable patients, such as the elderly and women.

Consensus statement on the problem of terminology in psychological interventions using the internet or digital components

Since the emergence of psychological interventions delivered via the Internet they have differed in numerous ways. The wealth of formats, methods, and technological solutions has led to increased availability and cost-effectiveness of clinical care, however, it has simultaneously generated a multitude of terms. With this paper, we first aim to establish whether a terminology issue exists in the field of Internet-delivered psychological interventions. If so, we aim to determine its implications for research, education, and practice. Furthermore, we intend to discuss solutions to mitigate the problem; in particular, we propose the concept of a common glossary. We invited 23 experts in the field of Internet-delivered interventions to respond to four questions, and employed the Delphi method to facilitate a discussion. We found that experts overwhelmingly agreed that there were terminological challenges, and that it had significant consequences for conducting research, treating patients, educating students, and informing the general public about Internet-delivered interventions. A cautious agreement has been reached that formulating a common glossary would be beneficial for the field to address the terminology issue. We end with recommendations for the possible formats of the glossary and means to disseminate it in a way that maximizes the probability of broad acceptance for a variety of stakeholders.