The effectiveness of user-focused mobile health applications in paediatric chronic disease management: A systematic review

An umbrella review of effectiveness and efficacy trials for app-based health interventions

Health interventions based on mobile phone or tablet applications (apps) are promising tools to help patients manage their conditions more effectively. Evidence from randomized controlled trials (RCTs) on efficacy and effectiveness of such interventions is increasingly available. This umbrella review aimed at mapping and narratively summarizing published systematic reviews on efficacy and effectiveness of mobile app-based health interventions within patient populations. We followed a pre-specified publicly available protocol. Systematic reviews were searched in two databases from inception until August 28, 2023. Reviews that included RCTs evaluating integrated or stand-alone health app interventions in patient populations with regard to efficacy/effectiveness were considered eligible. Information on indications, outcomes, app characteristics, efficacy/effectiveness results and authors' conclusions was extracted. Methodological quality was assessed using the AMSTAR2 tool. We identified 48 systematic reviews published between 2013 and 2023 (35 with meta-analyses) that met our inclusion criteria. Eleven reviews included a broad spectrum of conditions, thirteen focused on diabetes, five on anxiety and/or depression, and others on various other indications. Reported outcomes ranged from medication adherence to laboratory, anthropometric and functional parameters, symptom scores and quality of life. Fourty-one reviews concluded that health apps may be effective in improving health outcomes. We rated one review as moderate quality. Here we report that the synthesized evidence on health app effectiveness varies largely between indications. Future RCTs should consider reporting behavioral (process) outcomes and measures of healthcare resource utilization to provide deeper insights on mechanisms that make health apps effective, and further elucidate their impact on healthcare systems.

Telehealth for children and adolescents with chronic pulmonary disease: systematic review

OBJECTIVE

To revise the impact of telehealth on the quality of life, reduction in pulmonary exacerbations, number of days using antibiotics, adherence to treatment, pulmonary function, emergency visits, hospitalizations, and the nutritional status of individuals with asthma and cystic fibrosis.

DATA SOURCE

Four databases were used, MEDLINE, LILACS, Web of Science and Cochrane, as well as manual searches in English, Portuguese and Spanish. Randomized clinical trials, published between January 2010 and December 2020, with participants aged 0 to 20 years, were included.

DATA SYNTHESIS

Seventy-one records were identified after the removal of duplicates; however, twelve trials were eligible for synthesis. Included trials utilized: mobile phone applications (n=5), web platforms (n= 4), mobile telemedicine unit (n=1), software with an electronic record (n=1), remote spirometer (n=1), and active video games platform (n=1). Three trials used two tools, including telephone calls. Among the different types of interventions, improvement in adherence, quality of life, and physiologic variables were observed for mobile application interventions and game platforms compared to usual care. Visits to the emergency department, unscheduled medical appointments, and hospitalizations were not reduced. There was considerable heterogeneity among studies.

CONCLUSIONS

The findings suggest that better control of symptoms, quality of life, and adherence to treatment can be attributed to the technological interventions used. Nevertheless, further research is needed to compare telehealth with face-to-face care and to indicate the most effective tools in the routine care of children with chronic lung diseases.

Schulische Reintegration von Kindern und Jugendlichen mit einem ZNS-Tumor

Zusammenfassung: Unterstützung bei der schulischen Reintegration wird als standard of care in der pädiatrischen Onkologie definiert. Ziel ist die Bereitstellung von Informationen und die Koordination der Kommunikation zwischen Patient_in/Familie, Schule und Krankenhaus. Dies ist von entscheidender Bedeutung für Schüler_innen mit Tumoren des Zentralnervensystems (ZNS), insbesondere in der Nachsorge, da sie eine Risikogruppe für Spätfolgen darstellen. Um die Kooperation zu verbessern, wurden mehrere praktische Unterstützungsmöglichkeiten eingeführt. Im Rahmen des vorgestellten Pilotprojekts wurde darüber hinaus ein Webinar konzipiert und evaluiert, das speziell auf die Fragen von externen Lehrer_innen eingeht. Die Ergebnisse zeigen, dass eine Online-Informationsveranstaltung das notwendige Wissen und die Zusammenarbeit verbessern kann, verdeutlichen gleichzeitig aber auch die Wichtigkeit der kontinuierlichen Unterstützung in Form von Expert_innen für schulische Reintegration, um Schüler_innen mit ZNS-Tumoren angemessen zu begleiten.

Home administration of needle injections for children with rheumatic diseases: A qualitative study on nurses' perception of their educational role

PURPOSE

To explore nurses' perceptions of their educational role, pedagogical competence, and practice in teaching children with rheumatic diseases and their parents to manage subcutaneous injections at home.

DESIGN AND METHODS

In this qualitative study, we used thematic analysis to analyze data from three focus groups with 14 nurses responsible for patient education at one pediatric ward and two outpatient clinics.

RESULTS

We identified three main themes capturing nurses' perceptions of their educational role: myriad expectations, awareness of own competence, and facilitation and prioritization of patient education. Nurses perceived patient education as an expected but challenging duty of their work. They described a lack of pedagogical competence, insecurity in managing parents' and children's fears and worries, and limited organizational structures guiding their educational role. Nurses who worked in outpatient clinics felt freer to individualize education compared to ward nurses.

CONCLUSIONS

Nurses perceive their educational role as significant in enabling children and parents to manage subcutaneous injections at home; however, they require pedagogical competence integrated with daily practice to provide high-quality care. Short-term admissions require a different organization of patient education than before.

PRACTICAL IMPLICATIONS

Nurses need increased training in communication and management of children's pain and fear during needle injections. Competence development should include opportunities for reflection and guidance in clinical practice. Pediatric specialist nurses at outpatient clinics seem to have better competence to provide individual patient education for these families. The potential advantage of web-based solutions for nurses' patient education is a promising avenue for future research.