1
|
Bender BF, Berry JA. Trends in Passive IoT Biomarker Monitoring and Machine Learning for Cardiovascular Disease Management in the U.S. Elderly Population. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2023; 5:e230002. [PMID: 37274061 PMCID: PMC10237513 DOI: 10.20900/agmr20230002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It is predicted that the growth in the U.S. elderly population alongside continued growth in chronic disease prevalence will further strain an already overburdened healthcare system and could compromise the delivery of equitable care. Current trends in technology are demonstrating successful application of artificial intelligence (AI) and machine learning (ML) to biomarkers of cardiovascular disease (CVD) using longitudinal data collected passively from internet-of-things (IoT) platforms deployed among the elderly population. These systems are growing in sophistication and deployed across evermore use-cases, presenting new opportunities and challenges for innovators and caregivers alike. IoT sensor development that incorporates greater levels of passivity will increase the likelihood of continued growth in device adoption among the geriatric population for longitudinal health data collection which will benefit a variety of CVD applications. This growth in IoT sensor development and longitudinal data acquisition is paralleled by the growth in ML approaches that continue to provide promising avenues for better geriatric care through higher personalization, more real-time feedback, and prognostic insights that may help prevent downstream complications and relieve strain on the healthcare system overall. However, findings that identify differences in longitudinal biomarker interpretations between elderly populations and relatively younger populations highlights the necessity that ML approaches that use data from newly developed passive IoT systems should collect more data on this target population and more clinical trials will help elucidate the extent of benefits and risks from these data driven approaches to remote care.
Collapse
Affiliation(s)
| | - Jasmine A. Berry
- Robotics Institute, University of Michigan, College of Engineering, Ann Arbor, MI 48109, USA
| |
Collapse
|
2
|
Strauss BH, Sud M, Arbel Y, Elbaz-Greener G. Using a Novel Smart-Device Application for Follow-up After Percutaneous Coronary Intervention. Can J Cardiol 2020; 36:1322-1325. [PMID: 32333851 DOI: 10.1016/j.cjca.2019.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 11/24/2022] Open
Abstract
Smart-device applications offer a potential novel and accessible opportunity to follow-up patients undergoing percutaneous coronary intervention (PCI) and identify opportunities to improve care. To date, no studies have described patient follow-up through surveys administered with the use of smart-device applications. Through a large online personal health management record solution system (MyChart) and a complementary smart-device application, an electronic 26-item survey was administered to patients on their mobile device at 4 days, 1 month, 3 months, and 6 months after PCI at a single tertiary-care hospital from July 2017 to March 2018. Among the 112 participants, response rates at 4 days and 3-6 months after PCI were both 53%. Seventy-two percent of patients responded to at least 1 follow-up survey, and 25% patients responded at all 4 follow-up times. In responders, 68% had follow-up with cardiology/internal medicine at 30 days. At 3-6 months, 30% of patients reported persistent or recurrent symptoms, 19% had had a readmission for any cause, 54% were enrolled in cardiac rehabilitation, 25% were not on statin therapy, and 90% of patients who were working before PCI had returned to work. Post-PCI follow-up with the use of patient questionnaires through a smart-device application is feasible and a novel tool for improving quality of care.
Collapse
Affiliation(s)
- Bradley H Strauss
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Maneesh Sud
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yaron Arbel
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabby Elbaz-Greener
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel
| |
Collapse
|
3
|
The Delivery of Cardiac Rehabilitation Using Communications Technologies: The “Virtual” Cardiac Rehabilitation Program. Can J Cardiol 2018; 34:S278-S283. [DOI: 10.1016/j.cjca.2018.07.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022] Open
|
4
|
Kandola DK, Banner D, Araki Y, Bates J, Hadi H, Lear SA. The Participant Recruitment Outcomes (PRO) study: Exploring contemporary perspectives of telehealth trial non-participation through insights from patients, clinicians, study investigators, and study staff. Contemp Clin Trials Commun 2018; 11:75-82. [PMID: 29998203 PMCID: PMC6008707 DOI: 10.1016/j.conctc.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/13/2018] [Accepted: 05/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background Telehealth has been proposed as an alternative means to providing traditional modes of care while alleviating the need for participant travel and reducing overall healthcare costs. The purpose of this study was to explore contemporary perspectives of patients and stakeholders regarding non-participation in telehealth trials. Methods We undertook a two-phase exploratory qualitative study to understand the reasons behind patient non-participation in telehealth. Data were collected through semi-structured interviews with non-participating patient participants (n = 8) and stakeholders (n = 27) including clinicians, study investigators, and study staff. An analysis of interview data were undertaken and guided by a qualitative descriptive approach. Findings Patients and stakeholders reported many barriers to telehealth participation including technological barriers, limited understanding of disease, and an understated need for services. Both groups had some overlap in their concerns but also provided unique insights. Conclusion The analysis of study findings revealed perspectives of patients and stakeholders including barriers to participation as well as suggestions for future telehealth initiatives. Further research is needed to explore non-participation including patient readiness to assist in the development of future telehealth programs.
Collapse
Affiliation(s)
- Damanpreet K Kandola
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, V2N 4Z9, Canada.,School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, V2N 4Z9, Canada
| | - Davina Banner
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, V2N 4Z9, Canada
| | - Yuriko Araki
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, V5A 1S6, Canada
| | - Joanna Bates
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Haidar Hadi
- Northern Medical Program, Department of Medicine, University of Northern British Columbia, V2N 4Z9, Canada.,Northern Health Authority, Prince George, British Columbia, V2L 5B8, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, V5A 1S6, Canada.,Division of Cardiology, Providence Healthcare, Vancouver, British Columbia, V6Z 1Y6, Canada
| |
Collapse
|
5
|
Boudreau F, Moreau M, Côté J. Effectiveness of Computer Tailoring Versus Peer Support Web-Based Interventions in Promoting Physical Activity Among Insufficiently Active Canadian Adults With Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e20. [PMID: 26869015 PMCID: PMC4768043 DOI: 10.2196/resprot.5019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/10/2015] [Accepted: 11/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that less than half of people with type 2 diabetes in Canada are sufficiently active to meet the Canadian Diabetes Association's guidelines, effective programs targeting the adoption of regular physical activity are in demand for this population. Many researchers have argued that Web-based interventions targeting physical activity are a promising avenue for insufficiently active populations; however, it remains unclear if this type of intervention is effective among people with type 2 diabetes. OBJECTIVE This research project aims to evaluate the effectiveness of two Web-based interventions targeting the adoption of regular aerobic physical activity among insufficiently active adult Canadian Francophones with type 2 diabetes. METHODS A 3-arm, parallel randomized controlled trial with 2 experimental groups and 1 control group was conducted in the province of Quebec, Canada. A total of 234 participants were randomized at a 1:1:1 ratio to receive an 8-week, fully automated, computer-tailored, Web-based intervention (experimental group 1); an 8-week peer support (ie, Facebook group) Web-based intervention (experimental group 2); or no intervention (control group) during the study period. RESULTS The primary outcome of this study is self-reported physical activity level (total min/week of moderate-intensity aerobic physical activity). Secondary outcomes are attitude, social influence, self-efficacy, type of motivation, and intention. All outcomes are assessed at baseline and 3 and 9 months after baseline with a self-reported questionnaire filled directly on the study websites. CONCLUSIONS By evaluating and comparing the effectiveness of 2 Web-based interventions characterized by different behavior change perspectives, findings of this study will contribute to advances in the field of physical activity promotion in adult populations with type 2 diabetes. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN15747108; http://www.isrctn.com/ISRCTN15747108 (Archived by WebCite at http://www.webcitation.org/6eJTi0m3r).
Collapse
Affiliation(s)
- François Boudreau
- Interdisciplinary Group of Health Applied Research, Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
| | | | | |
Collapse
|
6
|
Moreau M, Gagnon MP, Boudreau F. Development of a fully automated, web-based, tailored intervention promoting regular physical activity among insufficiently active adults with type 2 diabetes: integrating the I-change model, self-determination theory, and motivational interviewing components. JMIR Res Protoc 2015; 4:e25. [PMID: 25691346 PMCID: PMC4376153 DOI: 10.2196/resprot.4099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 12/24/2022] Open
Abstract
Background Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that fewer than half of people with type 2 diabetes in Canada are sufficiently active to meet the recommendations, effective programs targeting the adoption of regular physical activity (PA) are in demand for this population. Many researchers argue that Web-based, tailored interventions targeting PA are a promising and effective avenue for sedentary populations like Canadians with type 2 diabetes, but few have described the detailed development of this kind of intervention. Objective This paper aims to describe the systematic development of the Web-based, tailored intervention, Diabète en Forme, promoting regular aerobic PA among adult Canadian francophones with type 2 diabetes. This paper can be used as a reference for health professionals interested in developing similar interventions. We also explored the integration of theoretical components derived from the I-Change Model, Self-Determination Theory, and Motivational Interviewing, which is a potential path for enhancing the effectiveness of tailored interventions on PA adoption and maintenance. Methods The intervention development was based on the program-planning model for tailored interventions of Kreuter et al. An additional step was added to the model to evaluate the intervention’s usability prior to the implementation phase. An 8-week intervention was developed. The key components of the intervention include a self-monitoring tool for PA behavior, a weekly action planning tool, and eight tailored motivational sessions based on attitude, self-efficacy, intention, type of motivation, PA behavior, and other constructs and techniques. Usability evaluation, a step added to the program-planning model, helped to make several improvements to the intervention prior to the implementation phase. Results The intervention development cost was about CDN $59,700 and took approximately 54 full-time weeks. The intervention officially started on September 29, 2014. Out of 2300 potential participants targeted for the tailored intervention, approximately 530 people visited the website, 170 people completed the registration process, and 83 corresponded to the selection criteria and were enrolled in the intervention. Conclusions Usability evaluation is an essential step in the development of a Web-based tailored intervention in order to make pre-implementation improvements. The effectiveness and relevance of the theoretical framework used for the intervention will be analyzed following the process and impact evaluation. Implications for future research are discussed.
Collapse
Affiliation(s)
- Michel Moreau
- Interdisciplinary Group of Health Applied Research, Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | |
Collapse
|
7
|
Lear SA, Singer J, Banner-Lukaris D, Horvat D, Park JE, Bates J, Ignaszewski A. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the Internet. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:952-9. [PMID: 25271050 DOI: 10.1161/circoutcomes.114.001230] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Scott A Lear
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.).
| | - Joel Singer
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Davina Banner-Lukaris
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Dan Horvat
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Julie E Park
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Joanna Bates
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Andrew Ignaszewski
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| |
Collapse
|
8
|
O'Brien KK, Solomon P, Worthington C, Ibáñez-Carrasco F, Baxter L, Nixon SA, Baltzer-Turje R, Robinson G, Zack E. Considerations for conducting Web-based survey research with people living with human immunodeficiency virus using a community-based participatory approach. J Med Internet Res 2014; 16:e81. [PMID: 24642066 PMCID: PMC3971118 DOI: 10.2196/jmir.3064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/27/2014] [Accepted: 02/11/2014] [Indexed: 12/03/2022] Open
Abstract
Background Web or Internet-based surveys are increasingly popular in health survey research. However, the strengths and challenges of Web-based surveys with people living with human immunodeficiency virus (HIV) are unclear. Objective The aim of this article is to describe our experience piloting a cross-sectional, Web-based, self-administered survey with adults living with HIV using a community-based participatory research approach. Methods We piloted a Web-based survey that investigated disability and rehabilitation services use with a sample of adults living with HIV in Canada. Community organizations in five provinces emailed invitations to clients, followed by a thank you/reminder one week later. We obtained survey feedback in a structured phone interview with respondents. Participant responses were transcribed verbatim and analyzed using directed content analysis. Results Of 30 people living with HIV who accessed the survey link, 24/30 (80%) initiated and 16/30 (53%) completed the survey instrument. A total of 17 respondents participated in post-survey interviews. Participants described the survey instrument as comprehensive, suggesting content validity. The majority (13/17, 76%) felt instruction and item wording were clear and easy to understand, and found the software easy to navigate. Participants felt having a pop-up reminder directing them to missed items would be useful. Conclusions Strengths of implementing the Web-based survey included: our community-based participatory approach, ease of software use, ability for respondents to complete the questionnaire on one’s own time at one’s own pace, opportunity to obtain geographic variation, and potential for respondent anonymity. Considerations for future survey implementation included: respondent burden and fatigue, the potentially sensitive nature of HIV Web-based research, data management and storage, challenges verifying informed consent, varying computer skills among respondents, and the burden on community organizations. Overall, results provide considerations for researchers conducting community-based participatory Web-based survey research with people living with HIV.
Collapse
|
9
|
Jones J, Cassie S, Thompson M, Atherton I, Leslie SJ. Delivering Healthcare Information via the Internet: Cardiac Patients' Access, Usage, Perceptions of Usefulness, and Web Site Content Preferences. Telemed J E Health 2014; 20:223-7; quiz 228. [DOI: 10.1089/tmj.2013.0182] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jenny Jones
- University of Stirling, Highland Campus, Inverness, United Kingdom
| | | | | | - Iain Atherton
- University of Stirling, Highland Campus, Inverness, United Kingdom
| | | |
Collapse
|
10
|
Nolan RP, Payne AY, Ross H, White M, D'Antono B, Chan S, Barr SI, Gwadry-Sridhar F, Nigam A, Perreault S, Farkouh M, McDonald M, Goodman J, Thomas S, Zieroth S, Isaac D, Oh P, Rajda M, Chen M, Eysenbach G, Liu S, Zbib A. An Internet-Based Counseling Intervention With Email Reminders that Promotes Self-Care in Adults With Chronic Heart Failure: Randomized Controlled Trial Protocol. JMIR Res Protoc 2014; 3:e5. [PMID: 24480783 PMCID: PMC3936276 DOI: 10.2196/resprot.2957] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 01/03/2023] Open
Abstract
Background Chronic heart failure (CHF) is a public health priority. Its age-standardized prevalence has increased over the past decade. A major challenge for the management of CHF is to promote long-term adherence to self-care behaviors without overtaxing available health care resources. Counseling by multidisciplinary health care teams helps to improve adherence to self-care behaviors and to reduce the rate of death and hospitalization. In the absence of intervention, adherence to self-care is below recommended standards. Objective This trial aims to establish and evaluate a Canadian e-platform that will provide a core, standardized protocol of behavioral counseling and education to facilitate long-term adherence to self-care among patients with CHF. Methods Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT) is a multi-site, double blind, randomized controlled trial with a 2 parallel-group (e-Counseling + Usual Care vs e-Info Control + Usual Care) by 3 assessments (baseline, 4-, and 12-month) design. We will identify subjects with New York Heart Association Class II or III systolic heart failure from collaborating CHF clinics and then recruit them (n=278) by phone. Subjects will be randomized in blocks within each site (Toronto, Montreal, and Vancouver). The primary outcome will be improved quality of life, defined as an increased number of subjects with an improvement of ≥5 points on the summary score of the Kansas City Cardiomyopathy Questionnaire. We will also assess the following secondary outcomes: (1) diet habits, depression, anxiety, smoking history, stress level, and readiness for change using self-report questionnaires, (2) physical activity level, current smoking status, and vagal-heart rate modulation by physiological tests, and (3) exercise capacity, prognostic indicators of cardiovascular functioning, and medication adherence through medical chart review. The primary outcome will be analyzed using generalized estimation equations with repeated measures on an intention-to-treat basis. Secondary outcomes will be analyzed using repeated-measures linear mixed models with a random effects intercept. All significant main effects or interactions in the statistical models will be followed up with post hoc contrasts using a Bonferroni correction with a 2-sided statistical significance criterion of P<.05. Results This 3.5-year, proof-of-principle trial will establish the e-infrastructure for a pan-Canadian e-platform for CHF that is comprised of a standardized, evidence-based protocol of e-Counseling. Conclusions CHF-CePPORT is designed to improve long-term adherence to self-care behaviors and quality of life among patients with CHF. It will demonstrate a distinct Canadian initiative to build capacity for preventive eHealth services for patients with CHF. Trial Registration ClinicalTrials.gov NCT01864369; http://clinicaltrials.gov/ct2/show/NCT01864369 (Archived by WebCite at http://www.webcitation.org/6Iiv6so7E).
Collapse
Affiliation(s)
- Robert P Nolan
- Behavioral Cardiology Research Unit, University Health Network, Toronto, ON, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Hage E, Roo JP, van Offenbeek MAG, Boonstra A. Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review. BMC Health Serv Res 2013; 13:19. [PMID: 23311452 PMCID: PMC3575225 DOI: 10.1186/1472-6963-13-19] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 12/28/2012] [Indexed: 11/22/2022] Open
Abstract
Background An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? Methods We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. Results Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption. Conclusions Rural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).
Collapse
Affiliation(s)
- Eveline Hage
- Department of Innovation Management & Strategy, University of Groningen, PO box 800, 9700 AV, Groningen, Netherlands.
| | | | | | | |
Collapse
|
12
|
Abstract
Few studies have examined patients' preferences for and predictors of completing health surveys by paper versus Internet. The purpose of this study was to examine if participants of registry research preferred to complete health surveys by the Internet or paper, and if demographics and previous computer experiences were associated with health survey completion method preference. Using a descriptive design and convenience sample, participants of colorectal surgery registries completed an 18-item survey about Internet use and personal characteristics. Multiple linear regressions were used to determine predictors of total Internet use and access and survey preference. In 526 participants, preference for Internet-based health survey completion was associated with younger age, higher education, computer ownership, and using e-health medical records (all P ≤ .01). Those who previously completed Internet-based health surveys were more often married or divorced and computer owners and had electronic access to health records (all P ≤ .001). After multivariable regression, the Internet use/access sum score was associated with computer ownership, using a secure Web-based system and preference for completing electronic health surveys (all P < .001). In conclusion, after controlling for demographics, computer ownership, comfort in using Web-based systems including surveys, and access to computerized health records predicted preference for completing research-based health surveys by the Internet.
Collapse
|